Supplements

Supplemental Foods

We recommend eating these “supplemental foods” on a regular schedule:

3 egg yolks daily, 5 yolks daily for women who are pregnant or planning to become pregnant (for choline, folate, vitamin A)
A bowl of soup made from bone, joint, tendon, foot, or hoof stock, 3 days per week (for calcium, phosphorus, and collagen)
Fermented vegetables such as kimchi, sauerkraut, or fermented mixed vegetables (for nucleotides, probiotic bacteria, and vitamins K2 and B12), and other vegetables such as tomato, avocado, potato, sweet potato, banana, green leafy vegetables, and seaweeds such as dulse, daily (for potassium)
¼ lb beef or lamb liver, weekly (copper, vitamin A, folate, choline). If you like, substitute ¼ lb chicken, duck, or goose liver weekly plus 30 g 85% dark chocolate daily
fish, shellfish, eggs, and kidneys, weekly (for selenium)

Daily Supplements

These are supplements we recommend be taken daily:

Sunshine and vitamin D3 as needed to achieve serum 25OHD of 40 ng/ml.
Vitamin K2 100 mcg or more
Magnesium 200 mg
Iodine 225 mcg
Vitamin C 1 g
Pantothenic acid (vitamin B-5) 500 mg

Vitamin D3 Seek total dose from sun, food, and supplements of 4,000 IU/day Adjust to 25OHD level of 40 ng/ml (whites/Asians), 30 ng/ml (blacks)	<br />	<br />	<br />
Vitamin K2 Recommended dose: 100 mcg MK-7 Pharmacological, possibly therapeutic doses: 1000 mcg to 5 mg MK-4	<br />	<br />	<br />
Magnesium Use chelate (e.g. glycinate) or citrate Daily dose 200 mg	<br />	<br />	<br />
Iodine Recommended dose 225 mcg/day (one tablet) Nori sheets have about 50 mcg each; 2-4 per day replaces supplements Supplementation is to prevent lengthy iodine droughts	<br />
Vitamin C Low dose: 500 mg – 1 g per day Under stress or viral infections, more may be needed Powder is least expensive way to get large doses	<br />	<br />	<br />
Vitamin B-5 (pantothenic acid or pantethine) 500 mg per day; we suggest daily due to its extreme safety Acne/skin blemishes or low energy/endurance are symptoms of deficiency	<br />	<br />	<br />

Weekly Supplements

These are supplements we recommend be taken once a week:

B vitamins:
- 50 to 100 mg each of B1, B2, and B6
- 5 mg biotin
- 500 mcg B12
Zinc 50 to 100 mg
Boron 3 mg

B1 (thiamin) 50-100 mg weekly	<br />	<br />	<br />
B2 (riboflavin) 100 mg per week	<br />	<br />	<br />
B6 For those who don’t take a B-50 complex We recommend 50 mg to 100 mg per week	<br />	<br />	<br />
Biotin We recommend 5 mg once per week	<br />	<br />	<br />
B12 We recommend 500 mcg to 1 mg once per week Sublingual methylcobalamin is preferred	<br />	<br />	<br />
Zinc We recommend about 50 mg per week Be sure to follow our copper recommendations as copper-zinc balance is crucial	<br />	<br />	<br />
Boron The 3 mg dose can be taken one to three times per week	<br />	<br />	<br />

Prenatal Supplements

The most important prenatal supplements are:

Extra duck, goose, or pastured chicken liver.
Extra egg yolks.

The following supplements may also be helpful during pregnancy or in the months leading up to conception. Note: We do not recommend prenatal multivitamins.

Choline

Not necessary if you eat enough egg yolks and liver
But extremely important during pregnancy, and safe

Inositol plus Choline

Not necessary if you eat enough egg yolks and liver
If supplementing choline, good to mix in some inositol

Iron (optional)

About 30% of pregnant women develop iron deficiency anemia
Don’t guess, test; blood tests will indicate if you need iron supplements

Optional Supplements

These supplements may be helpful for a significant fraction of the population. Experiment to see if they help you:

Probiotics
Chromium, 200-400 mcg per week (not necessary if you cook in stainless steel pots) and (optional) vanadium, 25 mcg per week
Lithium 5 to 10 mg per week
Silicon 5 mg to 25 mg daily
FOR PEOPLE WHO DO NOT EAT LIVER: Copper 2 mg per day
FOR PEOPLE WHO DO NOT EAT LIVER: Vitamin A from cod liver oil, 50,000 IU/week
FOR PEOPLE WHO DO NOT EAT MAKE BONE STOCK OR DRINK MINERAL WATER: Calcium up to 400 mg/day
B-50 complex (as a substitute for individual B supplements if you prefer fewer pills
Molybdenum 150 mcg per week
Taurine 500 mg to 5000 mg per week (higher doses may be therapeutic for small intestinal or systemic infections)
Selenium 0 or 200 mcg per week depending on selenium content of food (if food is produced in dry, flat areas = high selenium, no supplements; rainy, well-drained areas = 200 mcg/wk)

Probiotics Bifidobacterium spp can help with leanness and weight loss. Lactobacillus spp can help with acid reflux, bloating, SIBO, prediabetes, high triglycerides	<br />	<br />	<br />
More Probiotics Bifidobacterium spp can help with leanness and weight loss. Lactobacillus spp can help with small intestinal issues	<br />	<br />	<br />
More Probiotics VSL#3 is a good mix for inflammatory bowel diseases. Prescript Assist includes soil-based organisms that are a little riskier and should be taken only occasionally, not continuously, for therapeutic reasons.	<br />	<br />
Chromium If you don’t cook in stainless steel, we recommend 200 mcg chromium one to three times per week Stainless steel pots may release 88 mcg chromium per day of use Optional: vanadium 25 mcg one to two times per week	<br />	<br />	<br />
Lithium Best is to take 1 mg per day; 5 mg once or twice per week is next best Caution: too much lithium can exacerbate hypothyroidism and increase potassium excretion		<br />	<br />
Silicon Up to 25 mg per day Most people would benefit from more silicon Seaweed is a good food source	<br />	<br />	<br />
Copper (Only If Liver Is Not Eaten) Target of 2-3 mg/day can be met by eating 1/4 lb beef or lamb liver per week Do not supplement copper if you eat liver	<br />	<br />
Vitamin A (Only If Liver Is Not Eaten) Target of 50,000 IU/week with remaining A needs met from carotenoids (green leafy vegetables and orange plants like carrots) Do not supplement vitamin A if you eat liver, unless for therapeutic reasons	<br />	<br />
Calcium (If No Mineral Water or Bone Stock) PHD foods may fall short of calcium target by up to 400 mg/day Standard PHD prescription is to make up the difference with bone stock and/or mineral water These supplements also replace magnesium supplement; aim for 300-500 mg calcium and 150-250 mg magnesium per day	<br />	<br />
B-50 complex An alternative to the other B vitamins for those who prefer to take fewer pills Not recommended more than once per week due to folic acid and niacin content	<br />	<br />	<br />
Molybdenum We recommend 150 mcg to 1 mg per week	<br />	<br />	<br />
Taurine We recommend 500 to 1000 mg weekly for healthy persons Supports production of bile salts	<br />	<br />	<br />
Vitamin E Red palm oil is a good food source If supplementing, take mixed tocopherols and tocotrienols	<br />	<br />	<br />

Therapeutic Supplements

These supplements are unnecessary for healthy people but may be helpful in various disease conditions.

N-acetylcysteine Precursor to glutathione Recommended dose is 500 mg Can take more in cases of severe chronic infection	<br />	<br />	<br />
Glycine Supports collagen production, bile conjugation, and glutathione production Desirable if you don’t eat daily extracellular matrix (bones, joints, tendons, skin, hooves) Up to 2 teaspoons (10 g) per day	<br />	<br />	<br />
Creatine Supports muscle growth and preservation; especially valuable for the elderly Up to 1 teaspoon (5 g) per day	<br />	<br />	<br />
Melatonin An important sleep hormone, deficient in many brain diseases, has antimicrobial activity Take 1 mg sublingually just before bedtime For larger doses, combine 5 mg time-release with 1 mg sublingual	<br />	<br />	<br />
Detoxification Aids These can help bind toxins and excrete them in feces, preventing them from being re-absorbed in the colon Likely to be helpful for most people suffering from chronic infection or environmental mold.	<br />	<br />	<br />

Miscellaneous

These items may be helpful in implementing Perfect Health Diet and Lifestyle advice.

Pill boxes

Set out pills once per week, aids remembering to take them

Pill cutter

For cutting tablets to reduce the dose

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4,321 Comments.

Able January 12, 2019 at 9:13 pm

What’s the suggested amounts/frequency for fermented foods?

Reply
- Gena June 30, 2019 at 9:56 pm
  
  Dear Abi, if you do not have SIBO (Small intestinal Bacteria Growth) then you can eat fermented foods to appetite. Listen to your body and it will tell you when it is enough.
  
  Reply
Lori January 26, 2019 at 10:35 am

What are your suggestions, if any, for supplementation while following a ketogenic PHD? Your book mentions electrolytes, and BCAA but no specifics. Thanks for any help.

Reply
Gabby Falconer January 28, 2019 at 6:58 pm

I have a question about iodine supplements. I can’t take potassium iodine because of another medication I am on that I can’t take potassium with. So I’ve been taking organic kelp in pill form, 225mcg a day. But on a recent trip to Florida, I ate lots of shrimp, crab and other seafood (while still supplementing the kelp) and I ended up getting hives from overdosing on iodine (runs in my family). I was hoping supplementing iodine throughout the year would prevent this from happening to me. Do you recommend I continue to supplement or should I stop? Thanks!

Reply
- Gabby Falconer March 7, 2019 at 11:32 am
  
  Hi Paul,
  
  Still having this issue, would love your advice! Thank you 🙂
  
  Reply
- Gena June 30, 2019 at 5:58 pm
  
  Dear Gabby, on days you consume a lot of seafood you should skip on kelp. if you like seaweed you should eat only small amounts of it. Otherwise, you may be hurting your thyroid. Hope it helps.
  
  Reply
Chris January 31, 2019 at 4:15 am

Hi Paul,
I have been doing PHD for about 2 1/2 years. I was a early 50s guy becoming limited physically due to inflammation. Now my health is better in so many ways, and I feel more like I did in my 20 and 30s.
My blood test results recently had mostly good numbers but blood platelets were 143 the suggested good range was 150 to 450. I do bruise easily sometimes.
Do you have any suggestions for upping platelets?
Also is it OK to take a large dose of vitamin D once a week or better to spread it out over the week? Thanks.

Reply
- Paul Jaminet January 31, 2019 at 5:28 am
  
  Hi Chris,
  
  Great to hear you’ve done well. For platelets you could try supplementing vitamin B12 and folate. https://medlineplus.gov/ency/article/000586.htm.
  
  Best, Paul
  
  Reply
  - Chris February 1, 2019 at 12:55 am
    
    Hi Paul,
    Thank you I will have a look at those supplements and the info at medlineplus. Very helpful, I’ll try to get better platelet numbers for the next test.
    Thanks again, Chris.
    
    Reply
    - Chris February 1, 2019 at 4:31 am
      
      Oh I have only been taking 50 mcg B-12 from a weekly B-50. I’ll get some 1mg B12 and this simple change might help me into the suggested platelet range. Nice 🙂
      
      Reply
OMAR ALEJANDRO February 26, 2019 at 9:36 pm

PAUL >>>
Is there a specific supplement company that you recommend?

Reply
- OMAR ALEJANDRO February 27, 2019 at 11:01 am
  
  Never mind Paul >>> I had my Adblocker on and it did not load the recommendations you had there. 😳 Sorry 😳 😀 😛
  
  Reply
Daniel March 31, 2019 at 9:31 pm

Paul,

Do you have any thoughts on substances like NMN, resveratrol, metformin, and rapamycin that are said to effect certain longevity pathways?

Reply
- Gena June 30, 2019 at 6:16 pm
  
  Metformin is proven to prolong lifespan for people with T2D, pre-diabetic and wit metabolic disease. If you do not have any of these, do not take it. Everything should be taken for a reason. Resveratrol has a very low bioavailability of about 1%. You better off drinking red wine in moderation (1-2 glasses of wine 3-4 times a week). I would recommend reading this brief article.
  
  https://cen.acs.org/articles/95/i10/hit-snooze-button-aging.html
  
  Reply
Mary April 1, 2019 at 5:33 am

Paul,
Do you have particular recommendations for supplements to take and ones to avoid for someone who is on chemotherapy for breast cancer? My best friend just started chemo. Both she and I follow PHD but we were wondering if the supplements you recommend should be taken while she is on a six-month course of chemotherapy. Thank you.
Mary

Reply
Bertalan April 7, 2019 at 9:13 am

Hi Paul,
I have seen a study which correlates choline supplementation to higher levels of TMAO and blood clotting. They suggest that choline-rich foods, like eggs would have the same effect. What is your opinion?
https://www.webmd.com/dvt/news/20170424/common-food-nutrient-tied-to-risky-blood-clotting#1
Thanks!

Reply
- Paul Jaminet April 7, 2019 at 10:26 am
  
  Hi Bertalan,
  
  Choline is an extremely beneficial nutrient, and its conversion to TMAO is microbiome-dependent (e.g. https://www.ncbi.nlm.nih.gov/pubmed/30784906, https://www.ncbi.nlm.nih.gov/pubmed/30951169). A good diet will generate a good microbiome and give you the benefits of choline without potential downsides. In general these studies speak to the inter-connectedness of the various factors in diet and lifestyle, more than the perils of any one food or nutrient.
  
  Best, Paul
  
  Reply
Eric April 9, 2019 at 9:10 pm

Hi Paul,

I am a bit confused about the logic behind the suggested dose for supplemental B12.

Since PHD suggests animal foods with every meal, I assume that healthy individuals would have no trouble obtaining sufficient B12 from food on PHD. (Certainly, blood tests indicate that I have no trouble obtaining sufficient B12 from food.) Most of the benefit of supplemention would thus be seen in the nontrivial fraction of people (several percent) with B12 malabsorption.

So how much B12 is needed in cases of malabsorption? The following is taken mostly from [1]:

One common cause of B12 malabsorption is pernicious anemia, in which active transport (about 50% efficiency) is impaired, and B12 can only be absorbed via passive diffusion. From experiments with radiolabeled B12, passive diffusion has about 1% efficiency on average — but individual variation is significant and absorption rates around 0.5% are not rare. Note that these figures for passive diffusion assume supplemental B12 is taken while fasted; if supplemental B12 is taken with food, absorption rates via passive diffusion are about 30% lower.

This has two effects:

* B12 absorption declines by a factor of 50 on average, but sometimes by as much as 100.

* The requirement for absorbed B12 is roughly doubled, since B12 loss during enterohepatic circulation jumps from roughly 50% to roughly 99%.

So in theory, requirements for dietary B12 in pernicious anemia are raised by roughly a factor of 100 on average, but sometimes by as much as 200. This suggests doses of 100 x RDA ~ 250 mcg/day ~ 2 mg/wk would be necessary for the average person with pernicious anemia; doses as high as 500 mcg/day ~ 4 mg/wk would be necessary for some such people; and it looks probable that 5 mg/wk is high enough to ensure adequate B12 status in all cases of B12 malabsorption. (At least if taken on an empty stomach — if taken with a meal, a bit more, perhaps 7 mg/wk, would be needed.)

Note that such doses are readily available in the form you recommend (sublingual methylcobalamin):

https://www.amazon.com/Jarrow-Formulas-Methylcobalamin-Supports-Lozenges/dp/B0013OQGO6/ref=sr_1_3?crid=21NBUGKHWSY10&keywords=methylcobalamin+b12+5000+mcg&qid=1554700268&s=gateway&sprefix=methylcobalamin%2Caps%2C215&sr=8-3

In practice, to quote [1]:

“…Heinrich… discusses the suitable daily maintenance dose and finds 300 mcg daily to be adequate. Statistically this is correct, because this dose results in an absorbed and retained average quantity of approx 3 mcg, or slightly more than the normal daily turnover. However, considering the variations in absorption, a wider safety margin seems to be appropriate… Heinrich’s figures, as well as ours, show some absorption values far below average, and in our experience low values are found rather constantly in certain individuals. Heinrich refers to clinical trials, published by others, indicating that 300 mcg daily might be sufficient. Our more comprehensive material, followed up for a much longer period of time, showed that 500 mcg daily, although in general adequate, may give borderline serum B12 values in a few cases. In these patients normal values were rapidly restored by 1000 mcg daily.”

How would these doses effect healthy individuals?

Milligram doses of B12 are far above the saturation point for active transport, which typically is about 2 or 3 micrograms — so only roughly 1% of the dose (on average) would be absorbed, i.e. about 10 mcg for 1 mg/wk, or 50 mcg for 5 mg/wk. For comparison, typical absorption of B12 from food on PHD would presumably be almost 20 mcg/wk (two meals per day that saturate active transport). And if suggestions on intermittent fasting were disregarded, and B12-rich foods like liver were spaced out carefully over the enlarged feeding window to maximize B12 absorption, you could probably absorb almost 40 mcg/wk from food alone.

So a single dose of 5 mg/wk would result in more B12 absorption than one could get from food… but not by that much! (And the suggested dose of 1 mg/wk would result in significantly less B12 absorption than a healthy person would get from food.)

Now, most of these studies are with oral cyanocobalamin, rather than sublingual methylcobalamin. However, sublingual B12 does not appear to be significantly more bioavailable than oral B12: [2] suggests no significant difference in absorption between oral and sublingual cyanocobalamin, and [3] suggests no significant difference between oral and sublingual methylcobalamin. Unfortunately, I could not find any studies directly comparing the bioavailability of methylcobalamin to cyanocobalamin in the regime where absorption is dominated by passive diffusion. If there is a difference in bioavailability in this regime, my guess would be that methylcobalamin would be less bioavailable, on account of its significantly higher number of rotatable bonds [4, 5, 6]. But methylcobalamin appears to work as a treatment for pernicious anemia at doses similar to cyanocobalamin, at least in a couple of patients [7], so I presume the difference in bioavailbility cannot be too large.

Am I missing something here?

Best,
-Eric

[1] https://www.ncbi.nlm.nih.gov/pubmed/5751528.

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884303/

[3] https://www.ncbi.nlm.nih.gov/pubmed/17109579?dopt=Abstract

[4] https://www.ncbi.nlm.nih.gov/pubmed/12036371

[5] http://www.chemexper.com/search/cas/68199.html

[6] http://www.chemexper.com/search/cas/13422554.html

[7] https://www.ncbi.nlm.nih.gov/pubmed/11979747

Reply
- Paul Jaminet April 9, 2019 at 11:07 pm
  
  Hi Eric,
  
  Thanks for this analysis. I don’t think you’re missing anything in terms of understanding the papers … but if you assume a bit of uncertainty in all of the numbers, then it may be easier to understand the rationale. The idea is essentially that B12 is very safe so any excess is not harmful, while deficiencies can be a problem. If there were certainty that absorption from food was 50% while absorption from a supplement was 1%, then yes, you’d conclude that we should just get it from food and not worry about supplementing. But if you factor in a possibility of poorer absorption from food or better absorption from supplements, coupled with a risk from deficiency but no risk from excess, then it will make sense to supplement occasionally (once a week or once every two weeks).
  
  Best, Paul
  
  Reply
  - Eric April 10, 2019 at 12:25 am
    
    Hi Paul,
    
    My interpretation of these papers was that a supplemental dose of 1 mg/wk would be insufficient for most people with B12 malabsorption.
    
    On the other hand, a dose of 5 mg/wk would be sufficient for almost everyone with B12 malabsorption — and harmless for healthy individuals.
    
    So why recommend 1 mg/wk rather than 5 mg/wk? (The same company whose 1 mg tablet you suggest also makes a 5 mg tablet.)
    
    Best,
    -Eric
    
    Reply
    - Darrin August 19, 2019 at 10:55 pm
      
      Hi Eric,
      Thanks for all the comments.
      
      Any views on B12 5mg per week, versus 1mg 5 days per week. Would one give a better result over the other ?
      
      Thanks
      
      Reply
      - Eric August 29, 2019 at 1:17 pm
        
        Hi Darrin,
        
        For the reasons Paul discusses in his section about B vitamin supplementation (the box titled “Why Weekly Supplementation May Be Best”), I would lean towards 5 mg per week as an insurance policy. Higher doses more infrequently (e.g. monthly supplementation) may not be retained well.
        
        An alternative insurance policy is periodic lab testing. Vitamin B12 deficiency will raise methylmalonic acid levels in urine and blood; this is the most sensitive indicator. In more severe deficiencies, serum B12 will fall. If these lab tests look normal (especially if methylmalonic acid is in the bottom half of the reference range and serum B12 is in the top half), it seems safe to assume that supplementation would offer no benefit.
        
        Best,
        -Eric
      - Darrin August 30, 2019 at 1:59 am
        
        Thanks Eric
      - Ceco November 14, 2019 at 9:32 am
        
        Hi Eric,
        Don’t you think pairing 5mg B12 with 800 mcg folate (per week) will be best?
        
        Regards.
      - Eric November 14, 2019 at 12:41 pm
        
        Hi Ceco,
        
        PHD already provides plenty of folate from food (see for example chapter 35).
        
        Best,
        -Eric
Eddie Pena April 19, 2019 at 11:48 pm

Hello, Paul:

If Leucine is an attractive supplement for the body, then why not include it within the supplements field for those who fast? I think you may have had it on your site a while back but removed it?

Reply
Cy May 16, 2019 at 10:46 pm

In the second addition of the book it seems to me the supplement intakes are defferent….as in b5..in the book it says once a week and on here everyday

Reply
Stan May 21, 2019 at 8:36 am

Hello Paul,
I’ve noticed that it’s a standard practice in many hospitals to deliver glucose intravenously to patients for multiple conditions. Does this make any sense from a paleo point of view? I know glucose can help create ROS and boost the immune system, but I feel like so much glucose does more harm than good. What are your thoughts?

Reply
Gena June 30, 2019 at 6:01 pm

Dear Paul, are there any extra supplements (beside glucosamine, chondroitin, MSM, bone broth) would you recommend for OA? SIBO/issues with digestion after H. Pylori eradication? Thank you very much!

Reply
Holly July 2, 2019 at 2:29 pm

Hey Paul,
What do you think about Liposomal C & Glutathione? Any better absorption than acorbic acid crystals or NAC or just expensive hype & a waste of money?

Also, I’ve tried 3 different Creatine Monohydrate supplements because I know it’s one you recommend. Jarrow Creapure, Now Creatine Monohydrate Powder that you link to, & lastly Now Are-Alkylyn & all came with awful side effects for me. I noticed the benefits with the 2 powders at the gym- could lift heavier & for longer without it feeling more difficult & could see my muscles more, but I experienced headaches, bloating, Palpations, Insomnia & frequent urination with just the 5 grams a day- I even tried 2.5 grams & still had the side effects so had to quit despite the benefits I enjoyed. Then with Kre-Alkyln (buffered creatine monohydrate) I did not experience the benefits as I did with the regular CM, & I had side effects of difficulty breathing/anxiety so I quit taking it after about a week. What do you think could be happening? My husband quit the powder also because of GI/stomach distress. Is there a secret to taking it or is it common for some people to be intolerant to supplementation with it? I’m really bummed because the classic powder did give a boost at the gym.

Thanks Paul!

Reply
- Holly July 2, 2019 at 2:33 pm
  
  We follow the PHD diet, supplemental foods & daily & weekly supplement recommendations & doing well overall! Have gifted your book & tell many people about it, because PHD has been such a gift to us!
  
  Reply
Isaac July 18, 2019 at 1:07 pm

Hi there,

I had a quick question about your Vitamin A suggestions – I’ve heard overdosing can be unhealthy so I’m keen to get it right.

I don’t (and probably won’t) eat liver, so thought I’d better supplement some. My daily multivitamin contains 2500IU mixed beta-carotene and acetate (so quite low). I also usually eat 2 eggs most days, probably 5 days a week, and a can of sardines maybe 2 times a week.

So my question is, is there a ballpark amount of additional vitamin A supplementation you’d recommend?

Lastly, does the form make a great difference in terms of bioavailability? For example I can purchase retinol acetate tablets very affordably (much cheaper than good cod liver oil), just wondered if these are best avoided or should do fine.

Thank you for any help you can give me, and for the wonderful diet advice in your book, which has been a great help to me.

Reply
- Paul Jaminet July 18, 2019 at 9:12 pm
  
  Hi Isaac, you can find a detailed discussion in our week, but 25,000 IU per week is generally safe. Best, Paul
  
  Reply
Mandi H August 2, 2019 at 5:46 pm

I am wondering if there are any of these recommended supplements I should not take due to the fact that I have half my thyroid (partial removed because of tumor, not cancerous) and also I am on Lisinopril for blood pressure. I have heard blood pressure meds and thyroid meds don’t mix well with supplements.

Reply
John G. August 6, 2019 at 11:28 pm

Dear Paul,
Are there any deficiencies which can cause insomnia or prevent melatonin production?
Thanks.

Reply
- Paul Jaminet August 7, 2019 at 8:24 am
  
  Hi John,
  
  Deficiencies in ability to produce energy can cause insomnia. Some nutrients which can support that include magnesium, vinegar (acetate), citric acid (citrus fruits) and malic acid (apples) (to provide TCA cycle intermediates citrate and malate). Electrolyte deficiencies (especially potassium) or dehydration are also common causes of insomnia.
  
  Inflammation and circadian rhythm disruption are the most common causes of insomnia. Nutrients that support immune function to reduce inflammation include vitamin A, vitamin D, vitamin C, N-acetylcysteine, glycine, zinc, copper, iodine. Stopping eating in the afternoon, light exposure plus exercise plus food in the morning, no blue or green light at night, are good steps for circadian rhythm entrainment.
  
  Best, Paul
  
  Best, Paul
  
  Reply
Bret Malcolm September 26, 2019 at 3:34 pm

Hi Paul how come u don’t recommend coq10?

Reply
Ashley November 6, 2019 at 3:30 pm

I am currently living in Germany and can’t seem to find Vitamin A from cod liver oil. The only form I can find is beta-carotene. We aren’t liver eaters, so we were supplementing copper and vitamin A. Is beta-carotene a good substitute? From what I can find on the site it doesn’t seem to be but I’m not sure why (and I didn’t see anything in my book). Would cod liver be a better substitute or should we just forgo vitamin a supplementation? Any other ideas? Right now we just aren’t taking vitamin a or copper.

Thank you for the help!

Reply
Casey January 22, 2020 at 3:31 am

Hello Paul,

You write that we should all be consuming three yolks a day. This is evidently for adults, but what about children?

My 11.5 month old is eating two yolks a day. Is that too much? At what age should one increase to two and then three?

Thank you.

Reply
John March 6, 2020 at 8:57 am

Hi Paul,

Is the 1/4 pound liver recommendation raw weight or cooked weight?

Thanks.

Reply
- Hector March 8, 2020 at 2:20 pm
  
  Raw, but anyway the raw weight and the cooked weight should be about the same if you cook it gently just as the book explains, i.e. cooking with moist / cooking without dehydrating the food
  
  Reply
  - Hector March 8, 2020 at 2:23 pm
    
    …Although I’m not really sure about what I just said, so I’ll correct it: with potato foods it’s true that the raw weight and the cooked weight are the same, but meats tend to release juices especially if salt is added during cooking, so even if cooked gently they will weight less when cooked. So in conclusion, for liver, use the raw weight as a reference
    
    Reply
Alex April 15, 2020 at 5:01 pm

Hi Paul,

What recommendations do you have for tooth health? I follow all guidelines established such as brushing teeth twice a day and flossing, yet I cannot avoid the occurrence of caries. I also take Vitamin D 8000IU a day. Please let me know your thoughts.

-Alex

Reply
- Paul Jaminet April 15, 2020 at 6:00 pm
  
  Vitamin K2 is most important, magnesium also helps, also an extracellular matrix rich diet. Eating a balanced natural whole foods diet along the lines of PHD, without added sugar, is important. Eat sources of vitamin A such as carrots, eggs, liver. Circadian rhythm entrainment.
  
  Best, Paul
  
  Reply
  - Alex April 16, 2020 at 2:29 am
    
    Thank You!
    
    Reply
    - Sheryl Tunnicliffe April 4, 2021 at 8:47 pm
      
      And forgot to mention that it has been so for 3 years and counting!
      
      Reply
- Sheryl Tunnicliffe April 4, 2021 at 8:47 pm
  
  Hi Alex. I am not a health professional – just saying however I read somewhere that a mum of 13 children found the dentist bills a bit much and she took her children off whole grain products and what do you know…zero tooth decay! Not sure of the connection but thought I would mention it to you.
  
  Reply
Jason May 1, 2020 at 6:05 pm

Hi Paul,

I don’t understand the recommendation to supplement 50,000 IU/week of Vitamin A for those who don’t eat 1/4 lb of liver per week. Isn’t there almost as much Vitamin A in a whole pound of beef liver?

I find Vitamin A to be intimidating, especially after reading journal articles about liver damage from only 20,000 IU/day. Is there a good way to test for deficiency?

Thanks.

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Casey June 20, 2020 at 3:29 pm

I would like to chime in that I cannot understand the vitamin B5 recommendation of 500 mg. When I first began taking 50 mg daily, I slept extremely well for a few nights. Then I had terrible insomnia. I can take 50 mg now about once or twice a week and have great sleep that night. Anymore and the insomnia is back. So I am shocked at the recommendation of 500 mg per day.

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Holly July 16, 2020 at 7:14 pm

Hello Paul,
You helped me a about a year ago on hear & I wanted to give you an update. Since reducing the iodine to your recommended 225mcg & reducing supplemental selenium, I believe my health has improved- I have lost 7 pounds & weight is consistent, & my TSH went down to .93 & I know you say under 1 is good. Thank you for helping.

I have a question now about copper- I’ve read copper toxicity can cause cancer. Do you think copper pipes/plumbing in the home is a problem? I only drink filtered/distilled water so we’re not drinking from the tap & we shower instead of soaking in a bath. We follow the PHD supplements & diet, except we don’t supplement copper, but eat liver occasionally.

Thanks again!
Holly

Reply
- Holly July 17, 2020 at 12:37 pm
  
  Please excuse my typos! I wish there was an option to edit. 😳
  
  Reply
- Paul Jaminet July 18, 2020 at 10:24 am
  
  Dear Holly, thanks for the update! Glad to hear you are well – although we do think TSH of 1.5 is better than 0.93, which could be suggestive of a nodule in your thyroid that is over-producing thyroid hormone.
  
  Copper toxicity can be a problem but so can copper deficiency. Be sure you are getting adequate zinc as that will help limit copper toxicity. The National Research Council wrote a book on the subject of risks of leaching from copper pipes, see https://www.ncbi.nlm.nih.gov/books/NBK225408/, which was the basis for the EPA’s guidelines. I am not aware of evidence that would provide a basis on which to disagree with the current EPA guidelines for drinking water.
  
  Best, Paul
  
  Reply
  - Holly July 19, 2020 at 8:23 am
    
    Hello Paul, thank you so much for your reply! A year ago, my TSH was .80, so it went up to .93 in a year with a Free T4 of .89. Back in 2016, my TSH was 181 & that was when I was on high dose iodine (aproximately 10-12mg daily plus 200mcg daily selenium from about 2012-a year ago) Is there anything I can do about the nodule to correct this overproduction of thyroid hormone? Of course my Dr says “results are normal”, I strive for optimal. What can I do to get closer to a TSH of 1.5 & further improve my thyroid status?
    
    As long as we have copper pipes for our indoor plumbing at home would it be a good idea to take our 50mg zinc supplement daily rather than weekly? Further, is the risk great enough that you would consider the expense of changing your copper pipes to PVC?
    
    Thanks again!
    
    Reply
    - Paul Jaminet July 19, 2020 at 9:53 am
      
      Hi Holly,
      
      Sounds like you are doing the right things re your thyroid. High dose iodine often leads to thyroid injury which caused your hypothyroidism and then some hyperthyroid nodules. It seems you are healing. Time and good nutrition and good circadian rhythm entrainment are the keys. Extracellular matrix and vitamin C are valuable nutrients. Time will heal this entirely.
      
      50 mg zinc every day is too much. You can do up to 4 days per week.
      
      Best, Paul
      
      Reply
      - Holly October 17, 2020 at 9:17 pm
        
        Hello Paul,
        
        Thank you for the research article on copper pipes- sounds like nothing to worry about at all.
        
        Would you please give your opinion on the reliability of hair analysis? I recenttly sent a sample in & it came back I have low copper- so it looks like I need to be following your recommendations for daily 2mg copper supplement since I haven’t been eating liver regularly, (& I don’t do well on dark chocolate & nuts) & back off the zinc to the recommended 50mg once or twice per week, rather than several times per week.
        
        Also, the results said I have a manganese deficiency & I reviewed what you say in my PHD book on manganese & that you don’t recommend supplementing it. I don’t do well with eating nuts or shellfish & the hair analysis nutrition counselor is suggesting I take a manganese supplement- 30mg a day. I think that is an extremely high dose & don’t feel comfortable with that based on what you say. If I took any, it would be half a 10-15mg tablet a day max. Would you still advise against it or is there an exception in this situation?
        
        Been meaning to tell you I had started having a lot of chronic muscle/joint pain a while back & what seemed like gym injuries that wouldn’t heal & I decided to look back over your supplement list to see if I was missing something, & I saw Silica under optional & reliazed I’d quit taking it 2-3 years ago since it was optional, to save a buck. I decided to give it a try again & it reduced my pains by about 90-95% & it didn’t take long. I’m amazed!
        
        Thank you so much!
        Holly
      - Holly November 6, 2020 at 7:34 am
        
        Hey Paul,
        
        I’ve figured it out. You’re clear in your book to not take manganese in supplement form, so I will not do it. I will just try to eat some hazelnuts, macadamia nuts & pecans like you said. My guess is I fell for some pseudoscience claims again like I do occasionally with the hair analysis, but fortunately I didn’t buy any of their supplements they recommended based on it. I’m sticking with your solid, conservative supplement recommendations. From trial & error, I’ve found that’s best.
        
        Thanks!
        Holly
    - Casey August 5, 2020 at 8:10 am
      
      Hello Holly,
      
      We have copper pipes too and we even drink from the tap. Given your usage, I don’t see any reason for you to be worrying so much. Surely you’re not going to absorb much at all from it running over your hands/body.
      
      As for our tap consumption, our water is not chlorinated and we are very careful to sufficiently run the water before collecting it into a glass bottle. We also don’t collect any in the morning or after being away for some hours until after we have flushed the toilet since this evacuates the water that has been sitting in the pipes (and our water is unfortunately extremely soft so acidic! the harder your water, the less you need to even worry).
      
      Reply
      - Holly October 17, 2020 at 8:50 pm
        
        Thank you for your response Casey. Sounds like copper pipes are nothing to worry about.
      - Holly November 6, 2020 at 7:33 am
        
        Hey Paul,
        
        I’ve figured it out. You’re clear in your book to not take manganese in supplement form, so I will not do it. I will just try to eat some hazelnuts, macadamia nuts & pecans like you said. My guess is I fell for some pseudoscience claims again like I do occasionally with the hair analysis, but fortunately I didn’t buy any of their supplements they recommended based on it. I’m sticking with your solid, conservative supplement recommendations. From trial & error, I’ve found that’s best.
        
        Thanks!
        Holly
  - Dee October 6, 2021 at 12:12 pm
    
    Dear Paul,
    
    In your reply to Holly, you say, "we do think TSH of 1.5 is better than 0.93".
    
    This advice seems to be a significant change from your previous recommendation of 1.0 or less.
    
    For example, in the book you say, "even if you lack hypothyroid symptoms, try to get your TSH level around 1.0 mIU per liter", and "a TSH of 1.0 mIU per liter may still indicate inadequate thyroid function!"
    
    I would be very grateful if you could elaborate on your new recommendation of a TSH of 1.5, and why it is better than ~1.0.
    
    Or better yet, would you please consider writing a new blog article to address this issue?
    
    P.S. Just before I started the Perfect Health Diet three years ago, my TSH was 1.47 (taken mid-afternoon). Two weeks ago my TSH was 1.94 (taken early morning). I do not supplement with iodine because I eat seafood every day: sardines or salmon, 1/8 tsp seaweed seasoning (not kelp), and oysters once a week. Even though my health has improved on the PHD, I would have worried about this increase in my TSH had I not read this new guideline from you.
    
    Reply
    - Hector October 6, 2021 at 2:17 pm
      
      Hi Dee,
      
      While waiting for Paul’s answer, this might be of interest with regard to the previous recommendation.
      
      Paul had said in 2012 (!): “The science box on p 291 lists several studies, the HUNT study is a notable one (fn 41), those with TSH between 0.5 and 1.4 did much better than those between 1.5 and 2.4. If 1.5 were optimal then you’d expect the two groups to do equally well, so odds are something below 1.5, eg 1.0, is optimal” — source: http://perfecthealthdiet.com/notes/comment-page-1/#comment-109349
      
      Best,
      Héctor
      
      Reply
안녕하신가! August 21, 2020 at 9:21 pm

Hello, I’m Korean reader. I love your book.
I’m suffering from hyperthyroidism. I take one methimazole 6 times a week. I will follow your daily and weekly prescriptions. However, I will exclude Iodine. And I’m going to take in extra selenium. Do you have any other advice for me?

Reply
- Paul Jaminet August 21, 2020 at 9:30 pm
  
  Hi,
  
  Yes, to promote wound healing generally, it’s helpfully to eat more extracellular matrix — bones/joints/tendons cooked in soups and stews, and shellfish — with extra vitamin C, plus optimization of zinc, copper, and glutathione per the book. For glutathione, a reasonable approach is 1 g taurine taken in the morning and 1 g glycine taken in the evening. Circadian rhythm entrainment is always important for healing as well.
  
  Best, Paul
  
  Reply
안녕하신가! August 25, 2020 at 6:31 am

I am following your daily and weekly recommendations(vitamins and minerals). Is it okay to drinking colloidal minerals(now foodd) additionally? Is it excessive?

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안녕하신가! August 25, 2020 at 7:00 pm

I bought vitamin D. amount per serving is 250mcg(10000iu)

I’m worried that it is excessive if I take this 1 softgel every 3 days.

You recommended 40ng and 40ng is 0.04mcg. isn’t it??? 250mcg is so large than you recommendations.

I can’t understand meaning of 40ng/mg.

I have 250mcg(10000IU)
How can I do??

Reply
- Paul Jaminet August 25, 2020 at 8:28 pm
  
  Hi, you can take that twice a week in winter or once a week in spring and fall. Vitamin D stays in the body for weeks and it is not necessary to take a consistent dose every day.
  
  Best, Paul
  
  Reply
Brandon September 22, 2020 at 3:25 pm

Way to many pages of comments to search on. I am confused. Sounds like a multi vitamin is recommended but it is not on this list? Are the recommendations in addition to a multi or in replacement of a multi?

Reply
- Ben September 25, 2020 at 12:47 pm
  
  According to this page, they no longer recommend multivitams: http://perfecthealthdiet.com/2010/07/bowel-disease-part-iii-healing-through-nutrition/
  
  Main reason being that you don’t get the exact amounts you need, you get what the specific manufacturer considers to be what you need, which rarely matches the advice contained in the book.
  
  RE there being too many comments, my workaround is to use the search in the top right of the page – enter your keyword there and more often than not, you’ll find what you need as the community has already answered a lot of questions 😀
  
  Hope this helps!
  
  Reply
  - Brandon November 20, 2020 at 1:32 pm
    
    Thank you so much for the help!!!
    
    Reply
Ben September 25, 2020 at 12:38 pm

Hi Paul, thank you for all your amazing work! My girlfriend has ME/CFS and I’m loving your book as it gives me/her hope!!

We’ve implemented the macros, and now working on implementing the vitamins, however I’m getting stuck on something:

Does it matter what the vitamin pill casings are?

I’m seeing pullulan (which when googled says that it could mutate into cancer), cellulose, hypromellose, and the addition of a rice extract blend (which is organic but sadly contains sunflower oil).

I assume best bet is to get powdered where possible, but what about when pill form is required?

Any any all thoughts are much appreciated, thank you!!

Specifically, I’m looking at this for Magnesium, but am worried about the hypromellose and the added sunflower oil used in the flow agent: https://www.amazon.co.uk/Bisglycinate-Bioavailable-Love-Life-Supplements/dp/B01GVLNUO4/ref=cm_cr_arp_d_product_top?ie=UTF8#HLCXComparisonWidget_feature_div

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AP October 5, 2020 at 3:07 pm

Hi, have you got any specific recommendations for someone with OCD and depression , low triglycerides, acid folic and vitamin d? Many thanks

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Ben October 26, 2020 at 12:55 pm

Hi Paul, thank you for all the research you’ve done here, it’s amazing!!

A question on Zinc: is there a reason you specifically say 50mg per week instead of 7mg per day?

Since you specify in the book that 40mg per day is postively dangerous, wouldn’t it be safer if I took 7mg per day instead?

Thanks!
Ben

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Casey November 5, 2020 at 7:20 am

Hello everyone, I hope that the Jaminets will update this soon. Bone broth contains very little calcium. Hence Dr. Kaayla Daniel says that you should not drink bone broth for its calcium, but for other benefits.

https://www.thehealthyhomeeconomist.com/bone-broth-calcium/

Cheers.

Reply
- Holly March 5, 2021 at 1:12 pm
  
  I hope so too.
  
  Reply
richard February 13, 2021 at 11:01 pm

Hi Paul,

I was wondering if cod liver oil would be sufficient in place of a weekly serving of fatty fish. Also, would cod liver oil in addition to eating liver and leafy, green vegetables regularly be too much Vit A or copper?

Thanks

Reply
Holly February 21, 2021 at 1:43 pm

Hey Paul,

I’m rereading your book & discovered in the chapter on alcohol that including nutrients such as methionine, vit C etc can be helpful in insuring protective measures while consuming. I do enjoy a daily evening cocktail made of 1-2 ounces of high quality liquor.

My question is would it be beneficial to supplement L-Methionine, or do we get enough of it in our diet from meat?

Thank you!
Holly

Reply
Chip March 28, 2021 at 1:51 pm

What happened to the links to the recommended supplements?

Reply
- Chip March 28, 2021 at 2:00 pm
  
  Sorry. Ad blocker. All set.
  
  Reply
Etienne April 23, 2021 at 8:44 am

I think the Essenta Lithium supplement never became available, but Life Extension now makes a 1mg Lithium Orotate capsule.

Reply
Pete Samuels July 10, 2021 at 11:13 am

Dear Paul,
Can you please sort the top 3-5 nutrients people in first-world countries are most critically deficient in, that if supplemented will result in the largest overall improvement in health?

Thank you.

Reply
- Paul Jaminet July 10, 2021 at 1:59 pm
  
  Vitamin K2, vitamin D (winter), magnesium would be my top 3. Zinc is a very common deficiency, it needs to be balanced by copper. For the rest it makes more sense to think in terms of risk-reward trade-offs as some are worth supplementing because they are very safe even if the deficiencies are modest.
  
  Reply