Supplements

This page lists our supplement recommendations with links to products at Amazon. By purchasing via links on this page, you support the blog at no cost to yourself. Thank you for supporting our work!

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)
Vitamin K2
  • Recommended dose: 100 mcg MK-7
  • Pharmacological, possibly therapeutic doses: 1000 mcg to 5 mg MK-4
Magnesium
  • Use chelate (e.g. glycinate) or citrate
  • Daily dose 200 mg
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
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
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

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

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
More Probiotics
  • Bifidobacterium spp can help with leanness and weight loss.
  • Lactobacillus spp can help with small intestinal issues
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.
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
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
Silicon
  • Up to 25 mg per day
  • Most people would benefit from more silicon
  • Seaweed is a good food source
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
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
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
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
Molybdenum
  • We recommend 150 mcg to 1 mg per week
Taurine
  • We recommend 500 to 1000 mg weekly for healthy persons
  • Supports production of bile salts
Vitamin E
  • Red palm oil is a good food source
  • If supplementing, take mixed tocopherols and tocotrienols

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
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
Creatine
  • Supports muscle growth and preservation; especially valuable for the elderly
  • Up to 1 teaspoon (5 g) per day
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
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.

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

Thank you for supporting the blog by shopping here!

Want to search for more things? Search Amazon:


Leave a comment ?

4,320 Comments.

  1. What supplements do you recommend for children? Especially in high northern latitude with poor sun.

    • Vitamin D in the winter, K2, zinc, iodine, potentially calcium and magnesium depending on diet.

      • Hey Paul!
        Do you have specific recommendations based on bodyweight for children?
        I heared of 1000IU/10kg BW for Vitamin D3.
        How much K2, magnesium, zinc, iodine, vitamin c would you recommend?
        Also have you ever heared of OPC?

  2. Hello Paul,
    I’m 46 years old female with thyroid removed 20 years ago. There is only 1/8 left. Should I supplement with iodine and how much?
    I’m taking all the co supplements: Mg, Zn, Krill oil, vit A, vitamin C, b-complex once a week + 1000mcg b-12, kelp/potassium iodine 110mcg, following non-gluten diet, don’t smoke.
    Thank you Paul! You are great!

  3. Philip Madison

    Dear Paul,
    When taking larger dosages of iodine for gut infections (5-10mg/day) isn’t there the danger to completely sterilize our gut flora and kill even our heritage strains which cannot be recovered?
    Also what are your general recommendations for gut infections other than Iodine?
    Thanks.

    • Hi Philip,

      We don’t recommend large doses of iodine, rather 225 mcg/day. For gut infections the primary nutrient keys are vitamins A and D, vitamin C, vinegar, egg yolks, extracellular matrix or glycine, taurine. Intermittent fasting and circadian rhythm entrainment are also important.

      Best, Paul

  4. I’m curious why the liver recommendations are beef/lamb liver OR chicken/duck/goose liver plus dark chocolate.

    What is missing in the bird liver that needs dark chocolate to be included.

    And also why bird liver only included in the pre-natal recommendation?
    Thanks

    • Hi Josh,

      Ruminant livers are rich in copper, bird livers are not. Chocolate compensates for that. Pre-natal moms can eat beef or lamb liver, but they have to stop at 1/4 lb per week to avoid a copper excess, whereas they can eat up to 1/2 lb per week of bird livers. Pre-natal moms need some extra zinc and vitamin A, and excessive copper intake could compete for zinc.

      Best, Paul

  5. Hi Paul

    Would you recommend taking magnesium taurate and magnesium glycinate as a good way of getting magnesium, taurine and glycine? In these supplements I don’t think the amount of the amino acid component is stated – only the amount of magnesium.

    I know you’d say ideally glycine should be taken in the form of bone broth but I wondered if Mg glycinate would be good enough for those who don’t make as much bone broth as they’d like to due to time and energy!

    Thanks
    Harry

    • Hi Harry,

      Mg glycinate provides about 6x more glycine than Mg by weight, while Mg taurate provides about 10x as much taurine as magnesium.

      However, you need perhaps 25x as much supplemental glycine as supplemental magnesium, but only perhaps 2x as much supplemental taurine as supplemental magnesium.

      So taking 200 milligrams of magnesium as Mg taurate once or twice a week should take care of taurine too (although it’s probably more expensive than taking Mg citrate plus pure taurine).

      But there’s no way to get close to enough glycine from Mg glycinate without overdosing on Mg — if you don’t want to drink more bone broth, I’d try taking pure glycine powder for that.

      Best,
      -Eric

  6. I just read the book, I’m very surprise we should take that many pills :O

    John

    • Hi Jonathan,

      You can do a food-only version – Eric has been doing that. The supplement recommendations are based on a balance of risk vs reward and are focused on specific nutrients that are very safe in high doses, for which deficiency is very harmful, and in which deficiencies are common for reasons (many described in the book), such as water purification which removes soluble elements, lack of sunshine from indoor living which depletes vitamin D, lack of consumption of organ meats, cooking of food which reduces vitamin C content, and lack of time to eat vegetables. They are relevant to the average person who wants to implement the diet in the most convenient possible way.

      Best, Paul

    • Hi Johnathan,

      If you want to try a food-only version of PHD, here are a couple suggestions:

      (1) If you can get a nutrient from animal foods, make sure to do so — you don’t have to worry about toxicity from animal foods, so you want as much wiggle room as possible when it comes to plant foods.

      For example, animal foods in a typical week for me might be:
      – 3/4 pound salmon
      – 1/2 pound bird liver
      – 1/4 pound other organ meat such as kidney
      – 1 pound oysters (of the Pacific variety, which have about half as much zinc as Atlantic oysters — meaning you can eat more of them, thereby obtaining more of other nutrients)
      – 1 pound other bivalve shellfish
      – 12 duck egg yolks (equivalent to 20 chicken egg yolks by weight and micronutrient content, but lower in polyunsaturated fat — thus giving you more wiggle room when selecting plant foods)
      – 15 cups of bone broth (for extracellular matrix); you could also substitute some tendon if you like (1 cup bone broth = 1.5 oz tendon).

      Extra liver and other organ meats takes care of B2; all the shellfish takes care of B12 and taurine; extra liver (together with a normal amount of egg yolks) takes care of biotin; oysters take care of zinc.

      (2) Do not eat any ruminant liver — eat bird livers instead. And only eat small amounts of chocolate. Otherwise you will overdose on copper before you optimize everything else!

      (3) Steam food or make soups, which don’t require cooking oil. Replace the cooking oil with fatty plants like avocados (5 per week replaces the boron supplement), macadamia nuts (contributes to replacing the vitamin B1 supplement), or coconut milk — but not too much chocolate (see (2)).

      (4) For safe starches, focus on potatoes, sweet potatoes, and taro, which are more nutritious than white rice or plantains. This will take care of the B6 supplement (and help with a number of the others).

      (5) For sweet plants, select options that provide lots of vitamin C per gram of fructose — guava and bell pepper have the most; strawberries, oranges, papaya, kiwi, starfruit, and cranberries, are also decent sources.

      (6) Eat seaweed for iodine (4 sheets of nori replaces supplements); eat plenty of dark leafy greens like spinach both for B1 (along with macadamia nuts), and for magnesium.

      (7) Eat lots of low-calorie vegetables, and prefer those that are rich in vitamin C and pantothenic acid (the hardest nutrients to optimize from food alone). Examples include most varieties of mushrooms, endive, cauliflower, broccoli, brussels sprouts, bitter melon, acorn squash, butternut squash, cucumber, celery, radish, watercress, mustard greens, bok choy, chard, and arugula.

      You’ll still have to supplement vitamin D. It should be possible to get K2 from food too, but I haven’t experimented with that yet.

      Best,
      -Eric

      • Eric, this is so helpful – thx! I’m supplementing right now, as I learn to work in more home cooking. Some day hope to get all my nutrients from food. This is a great roadmap.

      • Hi Eric,
        Your diet overview is very helpful. Do you still eat a pound of Pacific oysters per week? I know they are rich in zinc but what about their cadmium levels?
        Thank you,
        Sara

        • Hi Sara,

          No, I switched to Atlantic oysters because I was concerned about cadmium.

          Atlantic oysters have about 3 times the zinc, and about 1/3 the cadmium. So to optimize zinc intake you would eat 1/3 pound Atlantic oysters. That provides the same amount of zinc, but an order of magnitude less cadmium.

          Best,
          -Eric

      • I live in Europe, so I had to learn about oysters in order to follow Eric’s suggestions. I’m sharing it here in case it’s of interest for Europeans.

        First, I had to learn that Americans seem to distinguish mainly between two types of oysters:

        1. Eastern oysters, or Atlantic oysters. They belong to the species Crassostrea virginica. They are smaller, flatter and have smoother skin. They’re more expensive. They contain ~37.9 mg zinc per 100 g wet wt and ~0.7 mg copper.

        2. Western oysters, or Pacific oysters. They belong to the species Crassostrea gigas. They are larger, with rougher skin. They contain ~16.6 mg zinc per 100 g wet wt and ~1.6 mg copper.

        Now, in Europe, about the 70% of oysters you find will be the later kind, western oysters, also named in Europe by: creuses oysters, French oysters, Japanese oysters, and ‘ostrón’ or ‘ostra rizada’ in spanish.

        The 30% left that you’ll find in European markets are mainly a specie called Ostrea Edulis (and it seems that they are only easy to find at Christmas time):

        3. Ostrea Edulis, also called: plates oysters, European oysters, flat oysters. They are closer to Atlantic oysters in appearance and nutritional values. They contain ~30.67 mg zinc per 100 g wet wt and ~4.83 mg of copper [1].

        There are also many other varieties, but they are close to impossible to find (at least I’ve never seen them) and contain less zinc, most of them about an order of magnitude less zinc [1]:

        • A. noae, 3.5 mg zinc per 100 g wet wt and 0.32 copper

        • F. glaber, 4.31 mg zinc per 100 g wet wt and 0.52 copper

        • L. tuberculata, 0.79 mg zinc per 100 g wet wt and 0.80 copper

        • M. varia, 23.4 mg zinc per 100 g wet wt and 5.00 copper

        • M. barbatus, 25.42 mg zinc per 100 g wet wt and 0.55 copper

        • M. galloprovincialis, 2.49 mg zinc per 100 g wet wt and 0.22 copper

        • S. marginatus, 1.95 mg zinc per 100 g wet wt and 0.19 copper

        Check the product label to know what you’re buying, but to help you distinguish between the main varieties, but this page provides good pictures: www . ediblebrooklyn . com/2015/a-brief-guide-to-oysters-and-their-shells/ (remove the spaces around the dots.)

        Regarding Cadmium, which is a concern with oysters:

        • Pacific oysters have Ostrea Edulis 3 to 8 mcg/g dry wt (0.3 to 0.8 mcg g–1 wet wt) [2]

        • Ostrea Edulis have slightly less than 1 mcg/g wt (min outlier ~0.6, maximum outlier ~1.7) [3], but I’m not sure if it’s referred to dry or wet wt as the paper doesn’t specify it; I think it’s wet weight as they used Inductively coupled plasma mass spectrometry, ICP-MS, which I think uses liquid samples, and later they refer to the cadmium consumption limit in Europe, which is expressed to kg fresh wt.

        • As for the Atlantic, I haven’t looked at it, but Eric says they contain ~1/3 the cadmium of Pacific oysters.
        [2] states the permitted limit of cadmium for human consumption is 1 mg/kg fresh wt or 1 mcg/g fresh wt. Farmed oysters usually contain more cadmium than wild ones (but are more environmentally sustainable).

        So, in conclusion, if you take oysters for zinc content following Eric’s suggestions but can’t find Atlantic oysters, European oysters may be an alternative, except that they have a little less zinc (30.67 vs. 37.9 mg Zn per 100 g wet wt) and a lot more copper (4.83 vs. 0.17 mg Cu per 100 g wet wt). So, the problem is, in order to optimize zinc by taking European oysters, you will easily overdose in copper, so be careful on that.

        Maybe M. barbatus are a better option, as they provide 25.42 mg zinc per 100 g wet wt and 0.55 copper, but I can’t find them in my local markets, and I haven’t looked at their cadmium content.

        The canned oysters I have found are the Pacific oysters. As for the dried oysters, they seem to come from China, South Korea, or Japan, they are also the Pacific variety, and the pollution of their oceans is worrisome to me.

        [1] http : //journal . pan . olsztyn . pl/Nutritional-Quality-of-Edible-Marine-Bivalves-from-the-Southern-Coast-of-Italy-Mediterranean,98890,0,2 . html (remove the spaces around the dots.)

        [2] https : //www . researchgate . net/publication/240809665_Cadmium_accumulation_and_loss_in_the_Pacific_oyster_Crassostrea_gigas_along_the_west_coast_of_USA) (remove the spaces around the dots.)

        [3] https : //www . ncbi . nlm . nih . gov/pmc/articles/PMC5083868/ (remove the spaces around the dots.)

        • Hi,

          I’m making a few clarifications to my previous message and adding some new information:

          — Yes, Ostrea Edulis, according to that study [1], contains slightly less than 1 mg per kg of *wet* weight. Of course we know that it’s *wet* weight not because they used ICP-MS (you could rehydrate any dry sample to analyze it — I was being naive when I said that), but because it is made clear when they compared the result to the 1 mg cadmium per kg of *wet* weight.

          — Just to be clear, some of the species that I listed are not oysters. E.g. Modiolus barbatus and Mytilus galloprovincialis are actually mussels. I don’t know if they might be colloquially referred as oysters in some places, as the paper [3] did. And by the way, Mullus barbatus is a fish (red mullet) whose cientific name can also be abreviated as M. barbatus — so beware the possible confusion with the mussel.

          — I said that M. barbatus had a good amount of zinc and a low zinc/copper ratio — however, I have looked at its heavy metal concentration, and it doesn’t look good. In this study [4], it contained about 1-2 mg Cadmium per kg wet weight, and about 2-4 mg Lead per kg wet weight. Other metals were not analyzed. In this other study [5], it contained a mean of 1,59 mg Cadmium per kg wet weight, and a mean of 2,55 mg Lead per kg wet weight. Other metals were not analyzed. This was made in north Adriatic Sea.

          It should be said that the first study used samples from Thermaikos Gulf, and the second study used samples from north Adriatic Sea. While I’m not familiar with these places, a quick search suggest that both are highly polluted areas. Maybe mussels from clean places don’t look that bad. However, note that the second study analyzed a total of four bivalves from that area, and the one that was most contaminated was M. barbatus standing out for lead, which suggests that it has a good affinity for these heavy metals. Therefore, I would avoid it.

          In my next answer to this thread I will comment on Pacific, Atlantic, and European oysters.

          References

          [4] https://pubmed.ncbi.nlm.nih.gov/20937411/

          [5] https://www.researchgate.net/publication/11998429_Consumption_of_bivalve_molluscs_in_Italy_Estimated_intake_of_cadmium_and_lead

          • Erratum:

            “— Yes, Ostrea Edulis, according to that study [1], contains slightly less than 1 mg Cadmium per kg of *wet* weight. Of course we know that it’s *wet* weight not because they used ICP-MS (you could rehydrate any dry sample to analyze it — I was being naive when I said that), but because it is made clear when they compared the result to the limit of 1 mg cadmium per kg of *wet* weight.”

        • Hi,

          I’m sharing a bit more information mainly of interest for Europeans.

          First, I’ve been able to find another kind of oyster called Crassostrea Angulata that appears to be relatively easy to be found in Portugal, Southern Spain or Italy — and by ‘relatively easy’, I mean that it may have a relevant local place after the 90% market share of the pacific oyster.

          However, I’ve found studies, e.g. [1], that consistently show that this oyster is able to concentrate heavy metals even in clean waters, so I have automatically discarded it and would avoid it for a frequent consumption.

          Second, I’ve closely looked at Crassostrea Gigas. As Eric said, it’s best to avoid this specie because they are high in heavy metals, even those in clean waters (e.g., those from French or Spanish coasts, see [2]).

          But there is an exception. The Crassostrea Gigas from Delta Ebro, in Spain, is low in heavy metals according to this study [3]. If you take the highest concentration in heavy metals from the ranges given in that study, so that we are in the worst case, you would have to eat a bit more than 2 kg of wet raw meat in order to reach the provisional tolerable weekly intake (PTWI) for a 70-kg adult (assuming oyster meat is 82% water, as in the study the concentration is given for dry weight). To put that into perspective, that is equivalent to eating around 10 kg of whole oysters! And in the best-case scenario, that would be around 25 kg of whole oysters. I don’t think anyone likes oysters that much.

          Oysters from Delta Ebro contain about 20% meat (i.e., 200 g of meat per 1 kg of whole oysters), and each of them weights 100-120 g. From [3] they contain 562 – 1127 mg of zinc per 1 kg of dry weight of meat only, which translates to 10 – 20 mg of zinc per 1 kg of wet weight meat only (assuming oyster meat is 82% water). So, each oyster from Delta Ebro would contain about 2,2 to 4,4 mg of zinc. That is consistent with the literature; for example, the NCCDB sets it at 16.6 mg. In the food-only version of the Perfect Health Diet, you would usually need about 100 to 300 g of oyster meat (raw weight), and for each 100 g of meat (raw weight), you would be getting 2 – 5 % of your PPTW for cadmium and mercury (and insignificant amounts of arsenic and lead). These amounts are assumable.

          Now, I’m still not totally satisfied with what I found, considering:

          — As for Ostrea Edulis there is not enough data to evaluate them. I have only found about 3 or 4 studies, but they provide incomplete panels of analysis. Most seem to agree that they are low in heavy metals, and they are probably higher in zinc, but we don’t know that well.

          — As for the Crassostrea Gigas from the Ebro Delta, I only have one study (or two, I can’t recall). But the study seems robust enough so that I do tend to think they are the best option that I can access (I don’t dare to generalize to every European). The Ebro river is not a saint: it has inputs from some waste, from mainly rice crops, from lead bullets from some hunters, and so on. But, if this study is reliable, we would need the pollution of the river to increase tenfold in the coming years to be at considerable risk of heavy metal poisoning (again, assuming that we are an adult and consume about 200 g per week of their meat – equivalent to about 1 kg of whole oysters). Or, perhaps more probable, that cultivation environment changes (e.g., if more water enters from the Mediterranean than fresh water, the heavy metal content will increase). But in conclusion, the given situation seems robust enough so that I would say that oysters from Delta Ebro are the best option. I will be consuming them personally, and I hope in the next few years you won’t see “crazy eccentric dies from eating oysters” in the news.

          — Of course, there will be studies I am not aware of (although I have looked at a few extensive reviews so maybe I’m not missing many more). As I live in Spain, when I found that the oysters from Delta Ebro were good enough, I didn’t look much more. But there may be good options in other countries as well.

          Finally, a word of caution: Oysters are one of the bivalves with which we have to be more careful because they combine both a moderate-high capacity to accumulate heavy metals and a relatively long-life span (they are grown for about 2 years). So, no one should buy Crassostrea virginica thinking that they are clean just because all other things being equal they are better than Crassostrea gigas. They can accumulate a lot of heavy metals too if the environment allows it. The environment is just as important, or more, than the specie.

          References

          (Putting them all is a pain, but the most relevant here are these)

          [1] https://pubmed.ncbi.nlm.nih.gov/9026143/

          [2] https://www.sciencedirect.com/science/article/pii/B9780081006740000217

          [3] https://link.springer.com/article/10.1007/s10661-013-3064-z

          • (P.S. In case Paul or Eric reads this, or anyone else, I don’t expect you to do my homework for me, but if you detect something off, please let me know. You know I’m clumsy sometimes!).

          • Erratum:

            “So, each oyster from Delta Ebro would contain about 2,2 to 4,4 mg of zinc. That is consistent with the literature; for example, the NCCDB sets it at 16.6 mg per 100 g of raw meat

          • Hi Hector,

            On cursory examination, I don’t see anything wrong with your data, but I do find it a bit surprising.

            Generally, the species of oyster is the most important factor, and the salinity is the second most important factor. Oysters do at least try to preferentially accumulate zinc over cadmium, but the effectiveness of this varies from species to species, and the mechanism is sodium-dependent so it works better at *high* salinity. In the data I’ve seen, which admittedly is all from relatively uncontaminated waters, these factors are both more important than the actual concentration of cadmium in the waters. Anyway, there could be some factor unique to the Delta Ebro, it just isn’t what I would have guessed.

            Best,
            -Eric

          • Hi Eric,

            Yes, it’s surprising! I have been contacting some companies to see if they are willing to provide me any analysis so we can confirm the results. I must also check the methods from this study with other studies, as I am not sure if they are “standard”. They transplanted adult oysters in the Ebro Delta and saw how their concentration of heavy metals evolved for two consecutive years — but there may be differences between the heavy metal affinity of adult oysters compared to those grown from seeds.

            By the way, the full dataset from that Delta Ebro study can be found in this one (as the authors used the same dataset for different studies): https://pubmed.ncbi.nlm.nih.gov/22940045/

            When I meant that the environment is so important, it is because I have seen analyses of both Pacific and Atlantic oysters that are very high in heavy metals. I haven’t done a systematic approach but that was my impression. Many U.S. coasts seem to be affected (e.g., South Carolina, Chesapeake Bay, Connecticut, Gulf of Mexico), as well as many from Russia, China, and Japan. (See some examples below).

            Although I don’t know how relevant it is for the consumer, as I am totally unaware of how the authorities handle these issues – my bad. I do imagine that these areas are not intended for the breeding or harvesting of any mollusks. Then, you would be right – it would be absurd to include in the comparison the oysters from heavily polluted areas if those won’t be available to the consumers; therefore, providing most sources will be relatively unpolluted, the most important factor would be the oyster specie.

            I should look at that. But so far, I see that the heavy metal limits that the authorities set for shellfish are relatively permissive because the per capita consumption is quite low. But for us, who want to consume more bivalves than average (especially me in the food planning that I shared), those permitted levels are risky. I have also seen studies in which shellfish sold to final consumers were found higher in heavy metals than the legal limits.

            Some examples of what I meant:

            — Cited from the Delta Ebro study: “In oysters from polluted coastal areas of Russia, Japan and the USA, levels as high as 10, 20, 30, 30, 6000, 20,000 μg g−1 dw of Hg, As, Pb, Cd, Cu and Zn respectively have been reported”.

            — C. Virginica from Campeche, Mexico, is not influenced by heavy metal concentration, yet they can be as high as 24.2 Pb or 7.8 Cd mg per kg of dry weight (other toxic metals undisclosed).

            — A curious case, this one is for mussels, and while it may not be that relevant here, I’d like to share it because is so peculiar: only 650 g of mussel meat per week from Urapukapuka would be enough to exceed the FSANZ limit for cadmium for a 70 kg adult, versus 7,00 kg for the average of mussels from other three locations. In this study, “mussels from Urapukapuka were selected as controls because it was assumed that shellfish from this more remote and well-flushed site had not been exposed to elevated concentrations of heavy metals from anthropogenic sources”. The other three locations had some pollution (two were influenced by residential development and boating activities; the other was influenced by residential development, geothermal and light industrial inputs from a river). Yet Urapukapuka won the cadmium contest – by a tenfold difference! After further exploration by the GNS, it was found that a hydrothermal sea vent was the possible source of this Cd.

            More examples can be found in the review that I cited (reference # 2 in my previous comment).

            By the way, everything kept the same, another factor seems to be growth time. For example, Pacific oysters that are genetically modified to be sterile and invest more in growth rate will have lower heavy metal concentrations, even though they have comparable biokinetics of metals. Those oysters are triploid (instead of diploid) and are used because they can be harvested year-round. Source: [https://scholars.cityu.edu.hk/en/publications/cadmium-accumulation-and-loss-in-the-pacific-oyster-crassostrea-gigas-along-the-west-coast-of-the-usa(992c546c-6536-4d5f-946d-f9b66e6ff6ca).html].

            The oysters commercialized from Delta Ebro are triploid indeed, but I don’t know about the oysters used in that study. I also do not know what percentage of commercial oysters are diploid vs triploid, but I have seen that France Naissain sells seeds for aquaculturists that can be diploid or triploid, depending on the needs, so at least not all oysters on the market will be triploid.

            By the way, that’s quite interesting information regarding the oyster’s metabolism. I wonder how you happen to know these things :grin:. Is it information you have learned in passing while searching for data in studies? Or do you specifically prefer to first learn about the subject theoretically, and then look at data (or the other way around)?

            Best,
            Hector

          • A correction:

            “C. Virginica from Campeche, Mexico, is not influenced by heavy metal concentration pollution, yet they can be as high as 24.2 Pb or 7.8 Cd mg per kg of dry weight (other toxic metals undisclosed).”

            And this is according to the criteria of the authors of the Ebro Delta study, who did not mark it within “areas influenced by heavy metal pollution”. Maybe they are wrong? According to this: https://www.numbeo.com/pollution/in/Campeche-Mexico, water pollution is high.

          • Hi again,

            Just to be clear, as a conclusion, what Eric says makes perfect sense. I’m looking at the data with the new perspective he’s opened up for me, and it’s as he says. I can agree now: generally, the species is more important than the environment (at least for oysters; I still have to look at mussels and clams, but hopefully we’ll find similar cases). This on the other hand is a good thing: it’s easier for consumers to control the species than the environment. Of course, it is still wise to check where our oysters come from, and to keep in mind that unexpected things can happen (places with no anthropogenic activity that nevertheless have peculiarities that affect heavy metal levels, like what Eric mentions about salt, or heavy metals that occasionally can occur naturally). But the cases that I had found are exceptions that prove the rule.

            Finally, more as a curiosity than anything really practical for us, it should be noted that the metabolism of oysters is complex (unsurprisingly). For example, for Crassostrea hongkongensis [https://www.semanticscholar.org/paper/Facilitated-bioaccumulation-of-cadmium-and-copper-Liu-Wang/f8798c38d23829f50c1f99af39ee5b4e7c72e952], “it was demonstrated that Zn accumulation in the oysters facilitated the Cd uptake in the oysters. One likely explanation was that Zn induced the metallothionein in the oysters, which provided additional binding site for Cd given its stronger binding with MT than Zn did. Because Zn pollution in Southern China estuary was a widespread environmental problem and oysters can accumulate very high Zn concentrations in their tissues, these excess Zn may then induce a higher Cd bioaccumulation in the oysters. A subsequent study further showed that Zn instead of Cu exposure enhanced the Cd bioaccumulation, whereas Cu and Zn exposure both significantly enhanced the Hg bioaccumulation (Liu and Wang, 2014). The increased tissue accumulation of Cd or Hg was mainly because of the increased storage in MTLP by Cu/Zn exposure as a result of different ligand inductions and affinities. Such results were supported by field measurements in which Cu or Zn accumulation contributed significantly to tissue concentrations of Cd, Cu, and Hg. Clearly, metal-metal interaction in affecting the tissue metal accumulation should be further examined. It is likely that environmental Cd concentration may not be high, whereas its accumulation in the oysters can be significantly enhanced because of the pollution of other metals. This should be taken into account when interpreting the tissue concentrations of metals in bivalves”.

            There are mathematical models that account for the affinity of oysters to concentrate certain heavy metals which Eric is talking about.

            Best,
            Hector


          • Hi once more,

            I just received some results from Institut de Recerca i Tecnologia Agroalimentàries that confirm the low heavy metals in Pacific Oysters grown in Delta Ebro.

            These are the data from two samples of oysters. In the columns below, first number is from 18/05/2020, second number is from 9/06/2020. Units in mg/kg of wet weight.

            — Zn: 161.29 – 147.32
            — Ni: 0.00 – 0.00
            — Cu: 14.71 – 11.94
            — Cr: 0.10 – 0.13
            — As: 3.75 – 2.99 (total arsenic)
            — Pb: 0.00 – 0.09 (legal limit is 1.5 mg/kg)
            — Cd: 0.03 – 0.14 (legal limit is 1 mg/kg)
            — Hg: 0.03 – 0.03 (legal limit is 0.5 mg/kg)
            — Mn: 0.00 – 4.31

            I find it strange that Mn is 0.00 in the sample from May but 4.32 in the sample from June. Also, arsenic is several orders of magnitude higher in this report than in the study (maybe they are reporting inorganic As in that study? I don’t see it mentioned). Apart from that, the data seems alright. Note that the samples are from May and June, precisely the months associated with heavier presence of pesticides and fertilizers coming from rice farming.

            The report also shows up the heavy metal content of other 4 species: mussels, razor clams, abrupt wedge shell, spiny dye-murex, and sea urchin.

            — The content in Hg and Cd of these other species is very low too, except for spiny dye-murex, especially for cadmium (Hg: 0,15 mg/kg and Cd: 2.77 mg/kg).

            — Pb for these other species is very low as well, except for sea urchin (0.76 mg/kg for one sample, 1.49 for the other) and a bit higher, but in safe levels, for abrupt wedge shell (we have 5 samples with range 0.14-0.34 mg/kg). Delta Ebro is an area that may have high Pb content especially for terrestrial animals, due to many decades of hunting and intense industrial and agricultural activities carried out in this area. But data is showing these bivalves aren’t prone to accumulate it.

            In conclusion, the data from Delta Ebro is very surprising. Crassostrea Gigas have been extensively studied and I have not seen any other site with results to this magnitude. You could find C. Gigas that are also very low in heavy metals in many other areas, but not as consistently as that study showed.

            By the way, oyster meat from Delta Ebro is also sold canned, but they are ~2,5 times more expensive than fresh, at 17.50€ the can of 170 g meat: https://www.botigadelebre.com/es/productos/ostras-del-delta.html

            Best,
            Héctor

          • Oops, this is the right data:

            — Zn: 161.29 – 147.32
            — Ni: 0.00 – 0.00
            — Cu: 14.71 – 11.94
            — Cr: 0.10 – 0.13
            — As: 3.75 – 2.99
            — Pb: 0.06 – 0.09 (legal limit is 1.5 mg/kg)
            — Cd: 0.13 – 0.14 (legal limit is 1 mg/kg)
            — Hg: 0.03 – 0.03 (legal limit is 0.5 mg/kg)
            — Mn: 2.78 – 4.31

            So ignore what I said here:

            I find it strange that Mn is 0.00 in the sample from May but 4.32 in the sample from June

      • Hi Eric, hi Paul,

        Based on your suggestions, it seems that you both favor nori over other seaweeds in order to obtain iodide (Paul suggest taking 2-4 sheets if one wishes to substitute supplements; Eric suggests 2-3 sheets for the food-only version of PHD — I think a nori sheet is about 2 g).

        I imagine that the main problems with seaweed are three:

        1. Sea vegetables can have a high affinity for heavy metals (so beware of those grown in polluted waters).

        2. Sea vegetables can have high halogen levels that can harm the thyroid, e.g. bromine.

        3. Some seaweed are too rich in iodide, which has potential to cause trouble (e.g. you would only need in the order of 0,05 g of kombu/kelp to get 200 mcg of iodide, so in the event of any deviation you may end up getting much more).

        On the gastronomic side, some are bland (as nori), while others are tough and rough (as kombu).

        On the bibliographic side, it’s not always easy to find data on seaweed. E.g. the fact that iodide is not usually included in the food analysis makes it difficult to know how much natural variability exists.

        I do know Paul advised against kelp, and he leaned towards KI –potassium iodide– even for low doses –the regular doses– of supplemental iodide.

        So apart from kelp being advised against, what are your thoughts on this topic — especially, how would you rank the commercial seaweeds that you are familiar with?

        Or maybe, if you are not so sure as to give a ‘classification’: Personally I’m interested to know if wakame is good in a daily basis (I calculate about 2 g/d plus the weekly seafood that Eric recommended) instead of nori, as wakame is cheaper, tasty in soups, and can just be eaten as a salty crunchy bite in lazy days. 😛

        • I would add that I’ve heard that iodine is very volatile. So as a precaution, if someone adds wakame to soups, it is best to do so once the soup is served (the dried seaweed will expand in 1-2 minutes) — and NOT to cook the wakame, as a precaution.

          (Kombu is a different story — it is added during cooking with the purpose to enrich the soup, and the piece of kombu is retired at the end. But if you do this, you cannot control or know how much iodide you are consuming).

  7. Thanks Eric

    OK I think I’ll stick to my magnesium glycinate for magnesium and take taurine separately. May consider higher doses of glycine separately.

    On the other hand, I’m trying to stay in ketosis for neurological symptoms and I believe Paul’s mentioned glycine may inhibit ketosis as it’s an exclusively glycolytic amino acid…

  8. Is there a big difference between all the vitamin choices like D3 one is 13 the other 30$

    • Hi Jonathan,

      The price difference is partly due to a quantity difference, one has 200 softgels and the other has 360 and a better oil. But, we don’t endorse any brand in particular, these just seemed to be good choices at the time we made the selection.

      Best, Paul

  9. Hi Paul, what do you think about the health headline news yesterday from the American Heart Association about Coconut oil being bad? P.S., thanks very much for responding to people on your website.

  10. Hi Paul, is it conceivable to create PHD for vegans, inclusive supplements?

    • Not really. We need some animal sourced nutrients for best health, so we would have to rename the diet. You can come pretty close however on a vegetarian diet that includes eggs and dairy. A pescetarian diet with eggs, dairy, and seafood would be just fine.

      Best, Paul

  11. Hi Paul,

    If you could recommend just one daily multivitamin, which would it be? I’m having trouble cross-referencing your recommendations against the available options. I’m trying to simplify and get my wife to take her vitamins. Wondering if you have any opinions.

    Thank you!
    Ryan

    • They don’t recommend any daily multivitamin. I’m in the same boat though – I really like being able to take a prenatal and I’m struggling to figure out a way to do this that’s not me taking 20+ pills a day (which unfortunately looks like what I’m going to have to do).

  12. Mr. Jaminet, thank you so much for this wonderful information. Greatly appreciated! My question is, can a daily kelp tablet replace the iodine recommendation above? Or possibly daily consumption of canned sardines? Thank you again.

  13. Hi Paul, long time no comment (from me);

    Should i count intranasally administered Iodine the same, dose for dose, as orally taken Iodine ? what do you think ?

    I read somewhere that sublingual usage of iodine is a valid way to get Iodine, ie. “placing drops directly under the tongue”.
    So i was thinking intranasal administration would work along the same lines.

    background: i started using a weak iodine solution (potassium iodide) via an intranasal spray in an attempt to resolve my chronic rhinosinusitis. It seems to helping, so i’m sticking with it.

    Thanks for all your help. 🙂

  14. Hi Paul,

    What do you think of Todd Becker’s case against nutritional supplements?

    http://gettingstronger.org/2013/08/the-case-against-nutritional-supplements/

    He warns against Vitamin C, D, and other supplements with very valid data and explanations. Very similar to Nassim Taleb’s, author of Antifragile, thoughts on not introducing anything post-natural to our diets

  15. Hi Paul I have followed your stuff for a good few years now and think you are the most switched on by far!

    I recently quit synthetic vitamin D (live in darkest Scotland) due to concerns that in its artificial form it could be doing more harm than good (as it is in effect a hormone).

    Would be very interested in your thoughts. Ain’t a lot of sunlight in Scotland and I am not sure that a sunbed is the right way to go!

  16. Hi Paul
    How often to supplement with Choline, Inositol and vitamin E, is once a week enough?

  17. In the past three years I have had 4 episodes of reacting to benzoic acid and sodium benzoate when either of these has been included in personal care products. I won’t drag through the long story of how I figured out what the offending substance was, but end result was that when I eliminated the product containing one of these, and waited 3 or 4 days the severe (truly severe) eye irritation subsided and disappeared. A few weeks ago I found myself in this terrible situation again and it was worse than any of the previous episodes, as the symptoms continued for days, becoming worse if I ate anything with benzoates. Bone broth was the only food that helped, but relief was only temporary. I read that benzoic acid is detoxed in the liver when combined with glycine; so, I have been taking lots of glycine powder daily and I am finally feeling hope that I’ll be back to normal. In the above recommendations you (Paul) suggest taking as much as 10 grams, so that’s what I’ve been doing yesterday and today, and I’m so much better.

    I’m guessing that my system has become saturated with benzoates and that it will take considerable time to get rid of it. I am also homozygous for MTHFR 1298, which, according to my 23 and me, means I will not effectively detox a whole host of medications. Good thing I don’t take any.

    Paul, do you know anything about what I’ve been going through?

    Thanks!! ❓ ❓

  18. It seems bone stock is actually not very high in calcium. I noticed the nutrition fact labels on the high quality products showed 0%-4% of the daily intake per serving. So I looked it up and sure enough, bone stock is not high in calcium. Is this a flaw in the perfect health diet plan? (which I have been following for years and is the best nutrition book out there in my opinion)

    • Hi Etienne

      Needs for dietary calcium are not very high, so the moderate amount in bone broth is enough along with that received from other sources.

    • Hi Etienne,

      The calcium content of bone stock may depend strongly on method of preparation. Calcium is 11% of the mass of bone, and it releases in the form of calcium phosphate which is 20% of bone mass. When we prepare bone stock at home, our bones lose 50% of their mass to the stock. It defies logic that the amount of none of that mass is calcium.

      That said, most people will find it easier to optimize their calcium intake by drinking mineral water. And mineral water probably more closely resembles the “Paleolithic” method of obtaining calcium.

      Best, Paul

      • Thank you for your response. I’ll weigh my bones next time I make a batch.

        Upon further reading, it seems the gritty stuff at the bottom of the stock pot is very high in calcium. I presume it gets filtered out in the commercial products.

        I remembered the cricket player hypercalcemia incident mentioned in the book. The NCBI article (“toxic” beef bone soup) concludes it was due to high vitamin D intake from fatty marrow.

      • Hi Paul,

        Are you saying broth contains calcium in the form of calcium phosphate?

        The solubility in water of calcium phosphate is only 20 mg / L (from https://en.wikipedia.org/wiki/Solubility_table).

        Best,
        -Eric

        • …But maybe if you add vinegar or another acid, the broth will contain monocalcium phosphate (PO_4^{-3} + 2 H^+ –> H_2PO_4^-)?

          The solubility of Ca(H_2PO_4)_2 in water is three orders of magnitude greater than the solubility of Ca_3(PO_4)_2.

        • Hi Paul,

          Here are some more details:

          It turns out that the leaching of calcium from hydroxyapatite (Ca_5(PO4)_3(OH)) —
          the main mineral of bone — in water is complicated, and depends on pH and the amount of solid present. That’s because the calcium isn’t just coming from the dissolution of calcium phosphate; the composition of the solid is also changing as phosphate ions get replaced by hydrogen phosphate ions. For example, calcium can leach from hydroxyapatite in a process like this:

          2 H^+ (aq) + 4 Ca_5(PO4)_3(OH) (s) –> Ca^{+2} (aq) + Ca_19(HPO4)_2(PO4)_10(OH)_4 (s)

          which releases calcium but no phosphate groups.

          See for example discussion here:

          http://pubs.acs.org/doi/abs/10.1021/cg801118v

          When making bone stock, there is a substantial excess of solid. So I think we want solubility “as measured by the excess solid method” as discussed in the above article. There is substantial disagreement from different measurements, but the order of magnitude for equilibrium calcium molarity with sufficient excess solid hydroxyapatite seems to be (just from eyeballing figure 1) about 10^{-pH/2}.

          That means that — if our bone was a block of pure hydroxyapatite — we would expect our stock (after reaching equilibrium) to have order of 10 mg / L of calcium at pH 7; order of 100 mg / L of calcium at pH 5; order of 1000 mg / L of calcium at pH 3. But we might not expect a correspondingly large amount of phosphorus.

          Best,
          -Eric

          • Hi Eric,

            Thanks for sharing this information–honestly it’s wonderful to see how scientific deductions are constructed.

            If you got the time for details, I wonder how you prepare your bone broth.

            You said you take about 10 cups per week, which according to you, would be equivalent to about 425 g of tendons. I’m assuming you get most of your calcium from these broths, but I may be underestimating how much calcium vegetables and seafood contain.

            So, I’d be interested in everything you may have to say, but let’s say for practicality that:

            1. Do you have any special consideration when you choose the bones? I imagine you choose the ones with the most extracellular matter, and prefer grass-fed or well raised over conventional, in order to avoid heavy metals. But is there something else you take into account that I am not aware of?

            Knee bones, ox feet, chicken feet, chicken carcasses, etc., seem all to be good options. Maybe I wouldn’t use chicken bones or carcasses because trimming the fat is a nuisance, as it’s polyunsaturated which stays liquid after refrigeration.

            Also, perhaps you favor those with a porous matrix?–it was my impression those leach more mass into the broth, maybe due to more specific surface, or maybe simply because more of their weight is collagen (I’m just guessing).

            2. How do you cook it? Method, time, further ingredients (vinegar?), stainless steel or ceramic pot, etc.

            E.g. I recall Paul said he didn’t add any herbs or plants, since this way the broth lasted longer in the refrigerator because it had no sugars and other fermentable compounds; and then, each day he would take a bowl, add new ingredients, and prepare a soup for a quick meal.

            I also recall he preferred the stovetop over the InstantPot. I don’t know why, but I noticed two things: (1) the liquid will keep boiling in the stovetop, but not in the slow-cooking option of the InstantPot. The movement must help leach more nutrients. And (2), when I have prepared bone broth by pressure cooking (either high or low pressure option in the InstantPot, being the high 15 psi), it greatly upsets my stomach. I don’t have a convincing reason why… It might be a problem with osmolarity? Or could it be some X compound that is formed at these conditions, like free glutamate? No idea, but it’s intriguing…

            In asking these things, I’m very interested to know if you do things to increase the calcium content of your bone broth.

            I imagine you do add some vinegar (how much?); are you aware if this could have negative effects on the other hand, such as by hydrolyzing proteins (as e.g. I mentioned free glutamate… but I guess it would require large amounts of vinegar to have a significant impact)?

            Another thing I do is not to add salt during cooking, as I’m using a stainless steel pot (European 18/10) in case it produces steel corrosion (it would be the perfect environment for that: salt water, different oxygen concentrations over and under the water, high temperatures…). But it’s useful to add it afterwards as a mean to help preserve it. Another great tip in that regard is to store it in the same pot in which it was cooked, so you make sure it’s antiseptic.

            Thanks,
            Héctor

          • Hi Hector,

            I typically make my broth from chicken feet plus water. The chicken feet I usually buy at the local farmer’s market, and I cook them in a very large stainless steel pot on the stovetop. I prefer chicken over beef for making stock, because I prefer to minimize the amount of red meat I consume, and it’s easy to remove the fat.

            I reuse the feet to make 3 or 4 rounds of stock, changing the water so that compounds that get extracted earlier don’t get overcooked. I boil the bones for 3 hours for the first round, 3 for the second, 6 for the third, then either give up and discard the bones or make a fourth round for about 10 hours before giving up.

            I pour the stock into jars with straight sides. After it gels in the refrigerator, I skim and discard the fat. (Chicken fat is, as you note, rather high in polyunsaturated fat.) I then transfer the solid block of stock out of the jar (this requires sliding a knife around the edge of the jar). The stock is typically solid enough at refrigerator temperature that it can easily be vacuum sealed. After vacuum sealing it, I mold it into a more convenient shape for storage than the shape of the jar, and transfer it to the freezer. Once the fats that might undergo peroxidation are removed, the stock is vacuum sealed to remove all oxygen, and it is frozen… it stays extremely fresh for a very long time.

            No, bone broth, at least the way I make it, is *not* a significant source of calcium (or phosphorus). The reason, as I pointed out above, is that calcium phosphate hydroxide has very low solubility at approximately neutral pH. In order to be a significant source of calcium, you would have to cook the bones at a pH of 3 or so. That’s practically the pH of pure vinegar. If you did that, your broth would be so acidic that I, and probably you too, would be unable to enjoy it.

            Most of my calcium comes with other foods, with cheese making the single largest contribution.

            Best,
            -Eric

          • P.S.: You might also appreciate that bone broth is one of the few foods that contains nutritionally significant amounts of fluoride. Fluoride tends to accumulate in animal bones and teeth, and the solubility of calcium fluoride is high enough that most fluoride in the bones will be released into the cooking water. The exact amount will depend on the animal’s diet of course, but the fluoride content of bone broth is likely similar to green/black tea (a couple of milligrams per liter). Note that a couple milligrams of calcium, or even tens of milligrams of calcium, is not nutritionally significant, but a couple milligrams of fluoride is.

          • Hi Eric,
            If you have time to briefly reply, I am curious to know why you limit your red meat and how much / often you eat it?
            Thank you.

          • Hi Sara,

            Because of epidemiological data linking red meat consumption to colorectal cancer.

            To be clear, if I had to guess, my guess would actually be that this correlation is not causal and large quantities of red meat pose no health risk. But I’m not certain enough to bet my life on it. So why should I?

            I probably average about half a pound of red meat per week.

            Best,
            -Eric

          • Hi Eric,

            Thank you! I will follow your recipe. One thing I like about chicken feet is that they can be easily stacked, as when I use beef bones they sometimes require too much water to cover them.

            Interesting to learn that your uncertainty with red meat also extends to mammalian extracellular matter, which is very different from meat at least in composition (but of course it will have things in common with red meat as it comes from the same animals).

            So, just to be clear, do you think that red meat from e.g. duck (not a mammal) is also uncertain? I’m asking with the Neu5Gc in mind, as it is concentrated in mammals, and I imagine other components that I don’t acknowledge are specific to mammals too and could be a speculative explanation for the uncertain cancer risk from red meat.

            (I don’t think (or know) that red meat from duck has been very evaluated in studies, so I think that kind of condemning it would be speculation over speculation; but I’m still interested to know what you decided.)

            Thanks,
            Hector

          • By the way, how many chicken feet do you buy to make enough broth for a week?

            According to Cronometer, each foot is about 35 g, of which 6.8 g is protein and 5.1 g is fat. So, assuming all the protein from the legs ended up in the broth, you would need about 63 legs to get 425 g of protein. That is equivalent to about 2.2 kg of legs.

            And, regarding calcium, since I can’t consume dairy I think I’ll have to use bits of softened bones mashed up in food. I think it’ll be the best solution. I’ll pretend I’m a caveman. :mrgreen:

          • (*When I said legs, I meant feet).

          • Oops, sorry, I realized you had said 425 g of *tendons*, not protein. So the amount of chicken feet required is much lower.

            I have found that a 100 gram serving of tendon contains 36.7 grams of protein and 0.5 grams of fat. So 425 g of tendons contain 156 g of protein.

            So you would require 1 kg of chicken feet per week.

          • …Hi again. This is to make the correction that Eric said nothing about avoiding extracellular matrix from mammals, so my discussion doesn’t apply. This is false -> “interesting to learn that your uncertainty with red meat also extends to mammalian extracellular matter, which is very different from meat at least in composition (but of course it will have things in common with red meat as it comes from the same animals)”.

            Lesson learned; I should not respond to messages right after getting up. Sorry! I wish I could edit.

          • Hi Hector,

            No, your comments are relevant. My apologies if I were a bit imprecise.

            By “red meat” I mean the way that the epidemiologists finding a link with colorectal cancer typically define it. In other words, the flesh of mammals. So not including duck, but including pork.

            I would include mammalian extracellular matrix because not enough people eat lots of extracellular matrix to distinguish its effects from other tissues epidemiologically. I would not include dairy because enough people do eat lots of dairy that it can be distinguished, and it is usually separated in epidemiological analyses.

            If the link with colorectal cancer were causal, and if Neu5Gc were the mechanism — *both* of which are speculative — then you would definitely want to avoid extracellular matrix of mammals, even more so than meat. Neu5Gc is an extracellular matrix compound, so that’s where it should be the *most* concentrated. Concentrations are usually significantly lower in dairy than in meat, by the way. And caviar also has a lot despite not being of mammalian origin, although the flesh of adult fish has almost none.

            Yes, I use about a kilogram of chicken feet to make a week’s worth of broth.

            Best,
            -Eric

          • Thank you Eric for your insight!

          • Thank you, Eric — It’s indeed confusing that there is a different meaning for red meat depending on whether you ask to population or scientists.

            And so it seems this loose definition is exploited to the detriment of public health. For years now I have known of the campaigns of Interporc (Spanish Inter-professional Agri-Food Organization for White Pork), which promoted on television the consumption of pork by literally saying that “it is our white meat”, “it is an essential part of the Mediterranean diet”, and “does anyone still wonder why we are the healthiest country in the world?”. E.g. of these ads: https://www.youtube.com/watch?v=ov4S1nBgIxw

            So I’m starting to understand how the world of nutrition is a mess. More often than not, it finds nutrients to blame with not very good reasons: saturated fats, cholesterol, fats in general, or perhaps being more refined and pointing to heme iron, TMAO, or whatever. Then, it ignores each food as a whole and makes up for generalizations: meat, eggs, or just all animal products, and some vegetable products such as coconut oil are bad because they contain them. Etc. This type of methodology, so convoluted, so demanding of interpretation and deduction, easily allows for biases in favor of the official mantra or in favor of commercial interests: look at these cuts of pork, how low in fat and cholesterol they are, and the color doesn’t deceive, truly white, healthy meat! Yet pork seems to be the riskier meat.

            (Eric commented on why official advice on nutrition is usually wrong: https://perfecthealthdiet.com/q-a/comment-page-84/#comment-1869203)

            I’m glad to learn that mammalian extracellular matter is one of the most concentrated sources of Neu5Gc. Paul said that it might be relevant in autoimmune disorders affecting the gut, blood vessels, or immune cells; [1] and precisely our family is affected by those. I’m very grateful that thanks to your advice I’ll do my broth with chicken from now on, and that *might* save us from a mistake. Thank you!

            [1] Here is the post: http: //perfecthealthdiet. com/2015/02/neu5gc-autoimmunity-hashimotos-hypothyroidism/ (delete spaces after dots)

  19. Julia Swanowski

    Hello Paul,
    If I take my daily 225mcg dose of Iodine together with my probiotics, is the Iodine going to kill the probiotics? Should I take them separately?

    Thanks,
    Julia

  20. Hello Jaminets! What do you recommend for those who need to workout? Pre-workout, Post-workout supplements or tablets? Or are there shakes I could make? Looking for daily nutritional items with a lot of protein.
    I love the book but would love some info on this!

    Much love,
    Tom

  21. Hi Paul and thank you in advance for answering my question. I’m 61 years old and quit smoking 30 years ago. I smoked for about 16 years before I quit. I’ve probably been deficient in vitamin A for a long time because I didn’t eat many foods high in vitamin A. I purchased a high quality Cod Liver Oil to start taking and I’ll include Vitamin K2, but how much? And should I DD more Vitamin D3 although the oil contains D. Do you have any other recommendations to add?

  22. Hello Paul,
    Should 200 mg of Magnesium be equal for both sexes?
    Should all men consider taking more magnesium, for example 500 mg instead of 200 mg?
    I’ve found I’m Calcium deficient. Will too much Magnesium displace calcium?
    Thanks Paul!

  23. Hello Paul,

    I’m a 135-pound 37-year-old Asian male applying what I’ve read in the Perfect Health Diet into my own diet. I was wondering if you have any supplement recommendations for Post-Finasteride Syndrome?

    Thank you!

  24. Hi Paul

    I’ve found a Vitamin K2 (MK7) supplement on Amazon UK which seems extremely good value compared to the Jarrow one I’ve been buying.

    https://www.amazon.co.uk/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=mk7+nu+u

    Do you think it looks reliable? The ingredients list is small and it claims to be a highly absorbent form so sounds good quality but I’m wondering how they manage to offer 365 tablets of 200mcg for only £15…

    Do you think it would be ok to take one of these every two days to meet your recommended dosage?

    Thanks
    Harry

  25. Hi Paul,

    In Europe acetylcysteine is also available under brand name ACC by Novartis.

    Is this the same form as N-acetylcysteine?

    Thanks!

  26. Hi! I’m new to the PHD but have a background in teaching evidence based medicine so I felt like this book was written for me! I am not a fan of taking a ton of pills so I’ve been trying to figure out how much supplementation I’ll actually need to do. I’ve been taking Optimum Nutrition Women’s Multivitamin (https://www.amazon.com/gp/product/B000GIQRW6/ref=oh_aui_detailpage_o06_s00?ie=UTF8&th=1) It does seem to hit some of the recommendations from the book though not all of them. However there are a lot of other things in the vitamin, so I was wondering if I could get your opinion on whether I should keep taking it or just use individual supplements. For reference, I’m a 34 year old woman, overweight, sedentary job, but I have begun learning Krav Maga and training for it at home.

    Thanks! This is the best health book I’ve ever read!

  27. Karl Wasserbrandt

    Hello Paul,
    What do you think about Magnesium Oil (magnesium chloride)?

    Is it true that it’s better for people with gut infections who have questionable intestinal absorption?

    Best,
    Karl

  28. Dear Paul,
    Can you please share how to use vinegar for gut infections?

    Thanks,
    Chelsea

    • Mix it with food and with water. The idea is partly to acidify the small intestine, making it a less hospitable environment for bacteria; and partly to provide acetate for production of acetylcholine (which supports gut motility) and acetyl-CoA (which supports energy production and immunity).

      Best, Paul

  29. Lorrie Anderson

    I’ve diagnosed myself with candida, leaky gut. I have Hashimoto’s Thyroiditis and fibromyalgia.The Keto diet was recommended to me, but I’m struggling with it. I had my gallbladder removed 3 years ago, so I had a bad feeling about how all the fats were going to wreak havoc on my body. I understand – now – the function of the gallbladder and the vital role it plays in food digestion. Two helpful things I discovered that are helping are, Betaine HCL and ox bile. However, I’m not eating the amount of fat that they recommend. I don’t want to lose weight, I want to maintain my weight and be healthy. I did discover that my carb intake was very high, even though it included no sugar. I was eating way too many carbs which included fruits – a banana and 4 dates that I added into my daily Garden Of Life raw protein smoothies, a half of an apple with almond butter for lunch, salad – with grated carrots and red bell pepper, plus a meat and either a small red potato, baked potatoe or white rice for dinner, and popcorn at night. I would appreciate any help you can give me. Thank you so much!

  30. Dear Paul,
    As of one week or so, I’ve been having serious sleep issues. I fall asleep easily, but I wake up 2-3 hours later and that’s all the sleep I can get in one night. I am already doing circadian rhythm entraining, I am avoiding caffeine, I tried melatonin in all kinds of dosages, I tried valerian root, but nothing seems to work. It’s not anxiety or stress related, as I don’t have a stressful life at all.
    The only notable thing that I can say is that I currently battling a gut infection which might be causing me some deficiencies. I am also supplementing magnesium but it’s not helping either. It seems progressive as well, each consecutive night I am getting less and less sleep. Again the problem is not falling asleep, but staying asleep.

    What could be causing this? Please help.

    Thanks,
    Stan

    • Hi Stan,

      I think as you guessed it is likely the gut infection. The peak immune response against bacteria is at 3 am or so, and inflammation makes you awake. So if you have anything going on in the gut which causes microbial cell wall components like lipopolysaccharide to enter the body at night, you will awaken around 2-3 am.

      You can try moving food intake earlier in the day, e.g. finish eating at 2 pm so that there is nothing in the digestive tract, then focus on remodeling gut flora. Vitamin A, vitamin D, vitamin C, glycine, taurine, N-acetylcysteine are good immune supports.

      Best, Paul

    • Stan, you may also want to make sure you are not eating too few calories. When I was trying intermittent fasting, I had a lot of trouble sleeping – turns out I simply was not getting enough calories in with two meals a day and my body was waking me up to say it was hungry.

  31. Hi, Hello,
    Anyone here dealing with MTHFR (supplements) on the PHD program? seems like the recommendation generally is to up Folate and B12. I don’t think Paul is a fan of supplementing high levels of B vits so I wondered how this advice might fair with a PHD bias. Personally I am A1298C so not a biggie but a concern. I always fall back to Paul’s advice as it is always moderate but I am believer in tailoring and on this issue I am unsure.

    • Hi Lorenzo,

      I’m fine with extra B6 and B12, but recommend extra choline rather than extra folate. Eat green leafy vegetables and egg yolks.

      Best, Paul

      • Interesting Paul, thanks for taking the time to reply.

        Chris Masterjohn got me thinking recently about my MTHFR issue again and he really said to increase Choline too.

        I see a lot of online advisors handing out big lists of supplements around MTHFR and really even if you have this SNP I don’t think you can assume that you do indeed have a big methylation issues.

        Paul, as always you are a breath of sanity…

  32. Hello Paul,
    Considering how crucial potassium is for health and how hard it is to obtain 100% RDA from food, isn’t it prudent to supplement some form of potassium?

    Thanks,
    Jim

  33. Good morning Paul,

    I see BCAA’s has been removed from the supplements list. Do you no longer recommend it and if not why please? I’ve been taking 5 grams daily and am wondering if I should discontinue it and just take glycine, creatine and collagen peptides?

    Thank you so much.

    PS: I agree with Lorenzo! I get lost at times listening to others recommending quacky cleanses and tons of possibly harmful, ineffective supplements, but so grateful for Paul and for his sensible, solid knowledge and advice and for getting me back on track.

  34. Hi Paul

    I’ve been having a big issue with abdominal bloating for the last three months, though I’ve always been prone to it, but it used to get worse progressively throughout the day. Now it is bloated the whole time. I have tried total fasting for two days, only eating fruit and veg. I am otherwise fit and healthy. Eat well and barely eat grains. I have done hardcore SCD diet for a few months a few years ago to try and clear it and actually it did get better but it took a few months. I take supplements and probiotics and digestive enzymes sometimes. I am not constipated and don’t feel discomfort, just belly blown up like I’m six months pregnant. I have read everything I can on the topic but nothing seems to work. What confuses me is that you’d think after two days of not eating anything it would go down. So maybe it’s not food related. I have noticed that I have hard knots to the left of my belly button when I dig my fingers right in and I can feel a heartbeat. stuck energy? Don’t laugh.

    • Yasmina Old – I hope you have consulted your doctor and at the very least had an ultrasound. My uterine fibroid (I can feel the hard knot of what I assume is the artery) has similar symptoms to yours but there could be so many other diagnoses that I hope you have had it checked out further.

  35. Hi paul.are the recommendations you make for vitamins and minerals safe to take for a lady who is 80 with blood pressure,type 2 diabetes ,high cholestrol,and anti-psychotic and asthma.she takes medicines as recommended.cheers.andy

  36. Hi, what would you recommend for a highly polycystic liver and kidneys? Liver is now threated with somatuline-injections, in a pre-transplantation program on the medium-long term. Kidneys are good for now.
    I combined before: NAC, taurine, zinc, glutathione.
    Thanks a lot. (I am 34 and female)

  37. Paul, can you advise on diet related ways to reduce melasma? I’m trying to get rid of mine by eating better, avoiding sun on my face (zinc oxide sunscreens, hats), and reducing hormonal disruptors that I know of.

    Thanks.

  38. Hello Paul, I bought yesterday probiotics Prescript Assist Caps. But reading your note regarding this probiotics, i would ask you more explanations if possible.
    “Prescript Assist includes soil-based organisms that are a little riskier and should be taken only occasionally, not continuously, for therapeutic reasons.”

    • Hi Danielle,

      Bacillus subtilis can cause a transient infection and/or inflammation. It is good at killing pathogens but also at killing healthy microbes and at exciting an immune response. If you have an infection in the gut, it may help you clear it by adding another factor killing the pathogens; but it is more likely to harm than help a healthy person. So I consider it a therapeutic intervention like a pharmaceutical drug, and one that you should self-monitor for side effects.

      Best, Paul

      • Hello Paul,
        From what I can find B. subtilis can actually increase Bifidobacterium:
        “Ingestion of significant quantities of B. subtilis is thought to restore the normal microbial flora following extensive antibiotic use or illness”

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC99781/

        Can you please post the studies regarding B. Subtilis killing good bugs?

        Thanks.

  39. Hi Paul
    My husband and I just started your diet and the supplements you have recommended. We have a 5 yr old also,curious if he should be on the same supplements maybe at half strength ? Appreciate your time.

  40. Is there any information/recommendations on what times of day to take these various supplements? Which should be taken with food vs without (and/or are okay to take during fasting period)? I wasn’t finding that info here or in the book.

    • For some we have recommendations, e.g. taking lithium early is discussed in the book. Generally with the first meal / about midday is best. Some like magnesium or glycine may improve sleep if taken in the evening. For most there is limited data but the general principle — nutrition/food in the daytime — should apply.

      Best, Paul

  41. Hi Paul,

    Have you decided against linking to recommended products? I’m not seeing them in Safari or Chrome.

    Thanks

  42. Great info! What supplements would you recommend if I don’t eat fish or liver?
    Thanks

  43. Hi Paul,

    You mentioned that you can get quite a bit of iodine from seaweed/veggies or seafood. Do you have any health concerns about radiation from Fukoshima affecting the quality of wild Alaskan Salmon?

  44. Hi Paul
    I’ve been following the gaps gut healing protocol with my family for 2 years. My son who is 12 still has lots of eczema and allergies to air borne triggers. Your diet is very similar to gaps. We supplement with bio kult. I understand eczema is the body detox mechanism I just don’t know why my son is still reacting and not healed after 2 years. We live in north Australia so get lots of sunshine. We eat raw egg yolks, bone broth daily, (liver not at all), ferments daily. It’s driving me crazy as we have worked so hard to help him heal. What in your opinion helps eczema and allergies heal. Thanks so much.

    • Hi Anna,

      Eczema is generally the result of excessive oxidative stress from a highly active immune system, leading to lipid peroxidation and depletion of polyunsaturated fats from cell membranes. You might want to read some of our posts on this, here: http://perfecthealthdiet.com/category/disease/eczema/.

      Some advice:
      – First, all the fermented foods you are giving him may be working against his recovery. Fermented foods are very high in amines which can be highly immunogenic. Try also promoting amine clearance with copper/zinc, molybdenum, and choline supplements.
      – Bone broth is also high in amines because the proteins degrade into amino acids which become amines with long cooking. Don’t cook broth longer than 3 hours, and consider stopping it. Also don’t serve any old meat.
      – The Biokult may also be aggravating the eczema. New bacteria require immune activity, you want to minimize immune activity.
      – Try cooking the egg yolks, as this will make the egg proteins more digestible and reduce any egg sensitivity/allergy.
      – Try to get a little more polyunsaturated fat in the diet in the form of extra egg yolks and omega-3 rich fish (salmon, mackerel, anchovies, sardines, herring)
      – Give him some antioxidant supplements: vitamin C (~5 g/day), glycine/taurine/N-acetylcysteine (for glutathione and bile), mixed tocopherols and tocotrienols (to protect the polyunsaturated fats from oxidation), fruits and vegetables, zinc and copper.

      After making those changes, let me know how he’s doing.

      Best, Paul

      • Hi Paul, my 19 month old also has eczema, chinese herbs have helped but he still has flares and I am following your diet. Would you recommend to stop all bone/meat broths, probiotics, yogurt, cheeses, dairy and fermented foods completely? What about supplements for a toddler? Thank you in advance.

        • Hi Kay,

          Yes, try cutting all histamine-rich, tyramine-rich foods such as fermented foods and see if that helps. Be sure he has adequate choline and zinc and vitamin E – zinc should be supplemented, choline supplemented if he’s not eating egg yolks, also get mixed tocopherols and tocotrienols and cut the capsules squeezing the oil into his milk, tend also to vitamin D, vitamin A, vitamin C, glycine, taurine, and a dietary source of copper – a bit of chocolate or nuts or liver.

          Best, Paul

          • Hi Paul. What about a 4 month old, breastfed baby with eczema? Would these same dietary recommendations apply for the mother?

            Thanks for any help you can offer.

  45. Paul, I continue to have many hypothyroid symptoms even though I follow PHD diet and supplement regimen. My TSH is normal (1.45), as is my T4. My free T3, however, is very low (1.8). Also, my HDL is high (115), as is my LDL. Are there other things you would suggest that I try to help with these issues? Thank you. Mary

    • Hi Mary,

      It’s hard to tell what’s going on from only this information. High HDL often signifies that the immune system has detected a eukaryotic pathogen, like a worm or protozoa. The high LDL could be due to the low T3. Check for iron status and donate blood if iron is high. Low T3 can signify starvation, are you undereating? Try eating more carbs.

      Best, Paul

  46. Paul, I don’t think that I’m undereating, but I am still underweight – 132 lbs., 5’9″. (I have gained weight since healing my gut from SIBO and repairing the mucousal lining after years of abuse from very low carb dieting. I was 120 lbs. earlier this year, when I had SIBO.) I think my gut is pretty healthy now, thanks in large part to your advice for supplements to help heal my gut and to following the PHD program. I am eating two meals a day, at noon and in the evening (8-hour feeding window), with safe starches at each meal – mainly winter squash and sweet potatoes, about 4-5 cups total a day. I do not eat fruit, mostly because it seems to trigger histamine and other immune reactions. I have a pretty severe histamine intolerance. I also eat quite a bit of healthy fat – mostly ghee and coconut oil. My ferritin level is 180. I’m not sure if this is high enough to warrant addressing by donating blood. Thank you for your help. Mary

  47. Evgeni Metodiev

    Hi Paul,
    Your work is marvelous and your website is one of the few places in internet where one can find the real information! I have some questions.
    If one is on tight budget and cannot afford to buy organic/ free range animals, is it OK to eat regular chicken liver or beef liver and to make bone broth from animals that are not free range or organic? My concern is the substances that can leach in the bone broth or be in the animals.
    What is your opinion?
    Thank you!
    Evgeni

  48. Hi Paul,
    Im following your diet since i’ve read your book,
    What Supplements do you recommend to my pregnant wife?
    Do you recommend fish oil for pregnant? Thanks!

  49. Dear Paul,
    My gums are receding despite eating and supplementing as indicated on the protocol for about three years. It hadn’t been an issue before. Is there anything in particular I can do to help? Thank you so much for all that you do.
    Regards, Melanie

Leave a Comment


NOTE - You can use these HTML tags and attributes:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

This site uses Akismet to reduce spam. Learn how your comment data is processed.