Q & A

Q & A

This page as an open thread for reader questions, especially questions about personal health concerns.

I am putting this page up as a way to share knowledge — my knowledge with questioners, but also so that others with similar concerns can read the conversation, and readers with relevant knowledge can chip in with their own thoughts.

Please keep in mind that I can’t research questions in any depth, so my answers should be considered tentative, incomplete, and subject to later correction. Also, I am not a doctor, and nothing I say should be construed as a substitute for medical diagnosis and treatment. I am only sharing opinions about disease origins and general therapeutic strategies which may or may not be applicable in any given case.

To get the page started, I’ll put up a few questions from recent emails. Here is an index by disease, with clickable links:

And here are my answers.

Chronic Lymphocytic Leukemia (CLL)


Been following your work on the PHD before the publication of the book and commented on my CLL and the usefulness of Vitamin D once on your blog and you responded to keep an eye on my Vitamin K intake, which I do now.. Am fortunate in a way to have my form of CLL as it indolent which gives me the opportunity to experiment without the pressure of undergoing conventional treatment. The PHD, I think, is helpful in this regard.

Wonder if you could point anything out to me that may be useful. Anything at all. And I will be happy to share with you my results.

Surely you know of the helpfulness of green tea with CLL. You may not be familiar with research that points out that those with low levels of Vitamin D need treatment for CLL far sooner than those with elevated levels.

Feel strongly that your version of a ketogenic diet would be helpful but also feel I need some direction in this area. Do you have any suggestions?

Warmest Regards,


Hi A,

I remember your comment, thanks for writing back. I’m glad you’re enjoying our diet and wish you the best.

Thanks for the tips about green tea and vitamin D. Neither one surprises me.

Most likely CLL is caused by a viral infection. So enhancing viral immunity is probably a good idea. Good strategies may include: (1) low-protein dieting, which inhibits viral reproduction and can promote autophagy; (2) maintaining high vitamin D levels; and (3) intermittent fasting, which promotes autophagy.

Some food compounds have been reported to have antiviral effects. An example is green tea catechins, eg http://pmid.us/16137775, http://pmid.us/18313149, and http://pmid.us/18363746, and this could be why green tea is helpful against cancers, http://pmid.us/21595018, which are usually viral in origin.

I might search Pubmed for herbs and spices with antiviral effects, and use them abundantly in cooking, along with antiviral foods. Turmeric / curcumin is a good choice, this needs to be taken with black pepper to enter the body. See http://pmid.us/21299124, http://pmid.us/20434445, http://pmid.us/20026048.

Coconut oil / lauric acid also has some antiviral properties, so inducing ketosis with coconut oil could benefit you even aside from the ketosis. You could also try monolaurin supplements which may enter the body better and which some people have reported to help viral infections.

You might also try HDL-raising tactics as discussed in this series: HDL and Immunity, April 12; HDL: Higher is Good, But is Highest Best?, April 14; How to Raise HDL, April 20.

Another possible tactic is high-dose riboflavin with UV exposure on the eyes. This requires going outdoors at midday and not wearing glasses or contact lenses. Riboflavin+UV is toxic to blood-borne viruses, and the retina is a location where UV can reach circulating blood cells. Sun exposure will also help you optimize vitamin D.

That’s a few ideas, at some point I’ll do some research to come up with more and do a blog post. Do keep me posted on your results!

Best, Paul

Bloating, acid reflux, anxiety, depression, hypoglycemia, hypothyroidism, fatigue

Just came upon your website and had a question for you. I have had some health concerns for the last four years, bloating, acid reflux, anxiety, depression, hypoglycemia symptoms, female complaints (I am in my forties), thyroid antibodies at 333, weight gain around my middle and too tired to work out like I once did. I used to be fikiiled with energy and great health no depression or anxiety. My doctor thinks these symtoms are all from peri-menopause and wants to treat me with Zoloft.

Needless to say I have tried to avoid the Zoloft. I have tired every avenue out there to cure myself. Most recently the Primal type diet. When I eat no grains or dairy I get horrible hypoglycemia symptoms and don’t feel great like everyone else on a low carb diet. I feel weak and more anxious. Do you think your diet would be easier for me with the addition of rice and potatoes?


Hi G,

Yes, I do think our diet will be better for you. You should eat enough starches to avoid hypoglycemia.

The key thing for you is treating the infections which are consuming so much glucose and making you glucose-deficient if you don’t eat enough carbs. Whatever pathogen(s) this is, it seems to have infected your gut and caused the various gut problems; circulating pathogen-derived toxins and immune cytokines are probably responsible for the anxiety and depression. Hashimoto’s hypothyroidism may be either due to circulating toxins or a thyroid infection.

I would suspect some kind of protozoal or parasitic infection due to the hypoglycemia, but what I really recommend is getting your doctor to have a stool sample analyzed for pathogens. Metametrix has a good test. Once you know what pathogen to treat, and get on a better diet like ours, you should improve quickly.


I am writing on behalf of my mother … We live in Dhaka Bangladesh …

Before her illness, my mom was 105 lbs, 5 feet tall and always 10ft tall in spirit…. When she was diagnosed with Lupus at the age of 30, we were all overwhelmed and out of our depths. My beautiful, athletic mother was in a wheelchair and given 6 months to live….

The doctors has advised her to eat literally nothing, minimum protein (1 small piece of chicken/fish, limited to 20g protein per day), only 2-3 types of vegetable and 2-3 fruits and of course lots of carbs to apparently compensate for her failing KIDNEY and LUPUS. She is on tons of medication, no food except the wrong foods (carbs) and in chronic pain. She currently weighs 139 lbs.

Please advise. — S

Hi S,

I believe lupus is a catch-all diagnosis for a variety of conditions which are probably caused by undiagnosed infections. In the US the infections are usually bacterial. I’ve known several people with diagnosed lupus who were cured by antibiotic treatments – in one case the problem was Lyme disease (Borrelia). I have no idea what the likely pathogens would be in Bangladesh. If she does better on low carb and coconut oil, that indicates bacteria; if she does better on high-carb, that indicates protozoa.

A healthy diet is very important. It is very bad advice to “eat literally nothing,” it is essential to be well nourished. Protein is necessary for healing and immune function, and 20 g/day is too little. Fasting is good, but it should be intermittent – not starvation! She needs healthy fats, more protein, and lots of micronutrients. Eggs, shellfish, seafood, bone broth soups, vegetable soups, and fermented vegetables may all be helpful. Coconut milk is probably good for her. You should basically follow the program in our book.

I would try to put her on a good diet, give her a little time for kidneys and other tissues to heal, and then try antimicrobial medicines. Usually, if they’re not working, then you don’t notice an effect. Any strong effect, good or bad, means they are working. Bad effects mean that pathogens are dying and releasing a lot of toxins as they disintegrate. If this occurs, detox aids (salt, water, and one of cholestyramine/charcoal/bentonite clay; also glutathione supports and vitamin C) will help.

Please stay in touch and let me know how things go.

Best, Paul


Jersie wrote:

I’ve suffered from depression for decades. A few months ago, I decided to try the Dr. Kruse protocol for jumpstarting leptin sensitivity and 2 interesting things happened.

When I went very low carb – below 50 gm -. I had half-day periods where the depression suddenly lifted (something that has rarely happened otherwise). However, I also suffered from darker than normal periods.

I stopped the Dr. Kruse protocol after 6 weeks, and went back to regular paleo (approx. 200 – 300 gm. Carb/day). I’m now generally more depressed than usual, without the good periods.

These changes seem to indicate that I can have an influence on my depression with diet, but not sure what diet to try. Thoughts?

Hi Jersie,

I think your experience on very low carb is diagnostically telling.

I would interpret it this way:

  1. Your depression is caused by an interferon-gamma mediated immune response in the brain, probably caused by a viral or bacterial infection. This leads to tryptophan being directed away from serotonin and toward the kynurenine pathway. So you have a serotonin deficiency and kynurenine excess.
  2. A ketogenic diet is both therapeutic (promotes immunity against bacterial and viral infections) and mood-improving (clears kynurenine).
  3. However, you are at risk for hypoglycemia in the brain (especially if the infection is bacterial) and hypoglycemia causes irritability/anxiety and can aggravate depression.

So the very low-carb diet had mixed effects (ketosis, hypoglycemia).

What I would do is follow our ketogenic diet advice. Eat at least 50 g/day carbs from starches to get sufficient glucose, plus sufficient protein to reach 600 calories/day protein+carb, but add in large amounts of MCT oil or coconut oil. Also, do intermittent fasting – eat all the carbs within an 8-hour window; eat at least half the MCT oil in the 16-hour fasting window.

Once on a good diet, I might experiment with antibiotics to see if they relieve symptoms.

Please let me know how things go.

Leave a comment ?


  1. Hey Paul, NAC is no longer going to be available as a supplement. What can it be replaced with? Maybe R-ALA?

    • You can still get bulk NAC on various sites. I just ordered a couple of pounds for future use. All major sites have already removed it, but do a general search for bulk nac and sites will pop up.

      • Thank you I have followed your advise. But still all expire in 2024. I wonder if Paul can suggest a replacement.
        The fascistas have attacked us from another angle.

  2. Hi Folks,

    I’m a thirty-six year old male in very good health–I’ve been proudly following the PHD for many years. I’ve read that Paul aims for a ferritin level of 50-150 (or 130?) ng/ml, and gives blood regulary every few months. So, is my case healthy? I had my ferrtin tested on 8/15/19 at 54 ng/ml and I retested yesterday, 5/26/21, at 53 ng/ml. I hadn’t given blood in the inteval.

    I’d appreciate anyone’s comments.


    • Hi Nate,

      That either means that you are in perfect health (no inflammation, which would raise ferritin) or that you have a combination of inflammation with an offsetting iron deficiency. As long as you feel healthy and have iron sources such as beef in your diet it is probably the former.

      Best, Paul

  3. Thanks Paul, I really appreciate the reply. I’m reading all your blog articles in chronological order–I’m currently halfway (of course, I’ve read the book.) It’s interesting to see the metamorphosis of the PHD. Let me know if I’m being orthorexic, or when the next Retreat comes up. Thanks, Nate

  4. Hi Paul,

    Would you like to play detective? A good friend has some symptoms and may end up on medication indefinitely.

    For the past 2 months:
    – he’s been having palpitations and arrhythmias,
    – His heart beats slower than normal
    – He has what he describes as “attacks in which I get dizzy, sweat, have a choking sensation and pressure in my chest, and it feels like my heart is going to stop at any moment”.

    About him:
    – 25 y.o. male,
    – Athletic and very muscular,
    – Exercises almost every day,
    – Follows a western standard diet, pretty bad, maybe not terrible.
    – Otherwise, I don’t think he has a too stressful life. No stress at work, no alcohol, no sleep deprivation.
    – His blood test was pretty standard. Just bilirubin a bit higher than normal, but hepatic damage was discarded via ultrasound examination.

    I did my homework :razz:, so following the philosophy of this blog:
    – I suspect my friend is overtraining with respect to his body’s ability to overcome the stress, or relative to his nutritional status.
    – First step would be to put him into the PHD, make sure he doesn’t overexercise, etc., but very unfortunately he won’t make any big change on diet or the like.

    I’ve searched possible nutritional causes of arrhythmias and palpitations, which apparently are:
    – magnesium deficiency,
    – calcium excess,
    – salt deficiency,
    – potassium deficiency or excess,
    – methylation imbalances,
    – or anemia.

    He doesn’t have other symptoms that would raise suspicion. We know he doesn’t have anemia. But we don’t know his electrolytes in blood.

    Any suspicion, advice, hint? I appreciate any help. It’s been only two months, and we may hopefully solve this before further damage is done!


    • Hi Hector,

      I would have him adopt PHD and also get tested or treated for possible parasitic infections, e.g. https://medcrine.com/5-parasites-affecting-the-heart-and-their-manifestations.

      Best, Paul

      • Thanks very much, Paul.

        I elaborated this plan:

        0. He will try to implement PHD as much as possible.

        Then he will soon have an appointment with his doctor. Apart from the specific tests that the doctor deems necessary, he will ask to:

        1. Be tested for parasitic infections,
        2. Be tested for C-reactive protein,
        3. Be tested for Total cholesterol, LDL, HDL, triglycerides,
        4. As per my prior comment, to be tested for electrolytes K, Ca, Na. I’d have included Mg here, but decided not to because (i) the doctor may be reluctant to test for it because it’s not such a mainstream test, (ii) serum Mg is not very sensible to deficiencies, and (iii) he will supplement a (low dosage of) Mg anyway.

        Do you agree with 2, 3, 4? I’d have though that 2 and 3 are very informative, yet he didn’t have those tested.

        Then, he will include some of your recommended supplements — not all due to budget:

        5. Magnesium 200 mg/d
        6. Ascorbic acid 1 g/d
        7. B-complex (I found pills without niacin but cannot avoid folic acid) 1 pill weekly

        Is there any other supplement you consider important for him, such as N-acetyl-cysteine, glycine (if he didn’t make collagen-rich soups), taurine?

        And finally:

        8. He will be wary of overtraining,
        9. He was doing intermittent fasting; I asked him to keep calories towards the morning and light hours, but not to prolong the fast if he feels hunger,
        10. Other general steps that are always health-promoting, such as circadian rhythm entraining, controlling stress, etc.

        I will update in the future to hopefully share good news. Thanks so much.

        Best, Héctor

        • (I recall some other nutrients you mention in your book relative to heart health, such as copper and zinc, but he will have those covered by eating whole food.)

        • For the sake of documenting my post, I mention that in the paleo community it seems like an emphasis of seafood, mainly because of its iodine and omega 3, is recommended for people suffering from palpitations and arrhythmias. He’ll try that too.

  5. What is the best time to practice intermittent fasting? Is it best to skip breakfast or dinner? I have read that eating breakfast can help entrain circadian rhythm, is this true? I prefer to skip breakfast but if there are advantages to skipping dinner I will switch.


    • Hi Shane,

      I know these answer from Paul very well because I have been working in implementing it:

      1. He believes that the best eating window is about 3 hours after dawn, and ends 1 hour before sunset. So e.g. if that was 6 am to 6 pm, that would be 9 am to 5 pm.

      2. He believes skipping breakfast will be harmful *only* if that leads you to eat late in the night. If not, it should be OK. On the other hand, I would say he prefers to move most of the calories towards the morning, and I know he emphasizes this e.g. in obesity (and maybe other conditions strongly affected by circadian-rhythm).

      3. I think he would agree. Again, I recall him saying that moving most calories towards the moon is preferable for circadian rhythms (although notice that technically *moving* calories can be done by *concentrating* calories during lunch and then eat less at dinner, even if you are skipping breakfast). And as I said I think he emphasizes it especially in unhealthy people who would be helped by circadian rhythm therapy. E.g., my mother is obese and once she was able to accomplish it he recommended doing two meals a day by skipping dinner (although I am missing if this is due to other reasons apart from circadian rhythms).

      Also, Seth Roberts discovered that he would tend to wake up about three hours before breakfast. He wrote “To ensure we’re active when food is available, [the food circadian oscillator] wakes us up about three hours earlier. If you usually eat at noon, for example, it will wake you up at 9 am”. Check: https://sethroberts.net/2013/12/11/sleep-summary-of-what-ive-learned/#more-12236

      I would say back in the day Paul was very interested by Seth discoveries (such as face-morning therapy to entrain circadian rhythms) and may have been influenced by some (when it already agreed with the evidence, as Seth Roberts was fascinating but had some weak ideas). The thing is that there is a discrepancy here, and I don’t know why.

      So, according to Seth’s theory we would wake up three hours before breakfast, but Paul recommends waking up about one hour before dawn, and start eating three hours after dawn, which would mean that we eat *four* hours after waking up, not *three*.

      Paul, if you are reading, can you clarify why? Do you think Seth was wrong on this one?


      Finally I’m pasting here two comments from Paul that may be helpful to you.

      [1] On 2016, he said:

      “We recommend having a personal 12 hour “day” that is shifted relative to the sun. This gives you time after work to cook dinner and eat well before the end of day.

      We personally use an 8 am to 8 pm day, 8 pm to 8 am night. On this schedule the best times to eat are between 11 am and 7 pm, the best times to sleep 11 pm to 7 am. Try to obtain most calories in the early afternoon. Try to exercise before eating.

      To implement this, set up bright 5500 K color temperature white lights throughout your home and office (or use a light box such as the one here, http://perfecthealthdiet.com/shop-circadian-rhythms/) and another set of orange-filtered bulbs for use in “night”. Switch to the orange bulbs about 3 hours before your bed time and after all eating and exercise is done.”

      [2] On 2013 (so old comment–he may have refined it), he said that the keys for circadian rhythm are:

      – Getting at least 2 hours per day of sunlight or very bright blue light distributed over a 10-12 hour period. Maintain lights as bright as possible over the rest of the period.
      – Getting 10-12 hours of essentially no blue light exposure; ie use amber light bulbs and f.lux on the computer, or wear blue-blocking amber goggles.
      – Eating meals within or close to the period of bright light exposure.
      – Sleeping at a consistent time and to a natural waking during the period of darkness.
      – Physical activity within the bright day period — preferably 30-40 minutes every day.
      – Social interaction and engagement during the day.


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