The Diet

The Perfect Health Diet

Here’s our Perfect Health Diet food plate:

PHD_Apple_plate cropped

NOTE: This is our new food plate, updated 2015. Foreign translations of the original food plate may be found here.

We recommend:

  • About 3 pounds [1.4 kg] of plant foods per day, including:
    • About 1 pound [0.45 kg] of safe starches, such as white rice, potatoes, sweet potatoes, and taro;
    • About 1 pound [0.45 kg] of sugary in-ground vegetables (such as beets or carrots), fruits, and berries;
    • Low-calorie vegetables to taste, including fermented vegetables and green leafy vegetables.
  • One-half to one pound [0.25 to 0.5 kg] per day of meat or fish, which should include organ meats, and should be drawn primarily from:
    • ruminants (beef, lamb, goat);
    • birds (especially duck and wild or naturally raised birds);
    • Shellfish and freshwater and marine fish.
  • Low omega-6 fats and oils from animal or tropical plant sources, to taste. Good sources include:
    • butter, sour cream, beef tallow, duck fat;
    • coconut milk or oil
    • palm oil, palm kernel oil, olive oil, avocado oil, macadamia nut butter, almond butter, cashew butter
  • Acids to taste, especially citric acid (lemon juice, lime juice, orange juice, grapefruit juice), lactic acid from fermented or pickled vegetables, vinegars, tannic acids from wine, and tomatoes.
  • Broths or stocks made from animal bones and joints.
  • Snacks or desserts from our pleasure foods: fruits and berries, nuts, alcohol, chocolate, cream, and fructose-free sweeteners like dextrose or rice syrup.

By weight, the diet works out to about 3/4 plant foods, 1/4 animal foods. By calories, it works out to about 600 carb calories, primarily from starches; around 300 protein calories; and fats supply a majority (50-60%) of daily calories.

In the shadow of the apple are foods forbidden because of their high toxin content. Notably:

  • Do not eat cereal grains — wheat, barley, oats, corn — or foods made from them — bread, pasta, breakfast cereals, oatmeal. The exception is white rice, which we count among our “safe starches.” Rice noodles, rice crackers, and the like are fine, as are gluten-free foods made from a mix of rice flour, potato starch, and tapioca starch.
  • Do not eat calorie-rich legumes. Peas and green beans are fine. Soy and peanuts should be absolutely excluded. Beans might be acceptable with suitable preparation, but we recommend avoiding them.
  • Do not eat foods with added sugar or high-fructose corn syrup. Do not drink anything that contains sugar: healthy drinks are water, tea, and coffee.
  • Polyunsaturated fats should be a small fraction of the diet (~4% of total calories). To achieve this, do not eat seed oils such as soybean oil, corn oil, safflower oil, sunflower oil, canola oil, or the like.

We highly recommend certain foods for their micronutrients. These include liver, kidney, egg yolks, seaweeds, shellfish, fermented vegetables, and bone broths.

We also recommend augmenting the diet with certain supplements. See our Supplement Recommendations page. These nutrients are deficient in modern diets due to removal of minerals from drinking water by treatment, depletion of minerals from soil by agriculture, or modern lifestyles that deprive us of vitamin D by indoor living.

We recommend tweaking the diet for certain diseases. Neurological disorders often benefit from a diet that is ketogenic; other conditions may benefit from lower carb diets. These variations are discussed in the book:

See the “Buy the Book” page for other purchase options.

Leave a comment ?


  1. Izaskun Azurmendi

    Hello From Spain!!
    I have read the book through some Australian friends. I have doubts about fasting adn some other things :smileWhere can I write to explain more about them? A friend has high potasium and cholesterol (familiar problem). What is the best she can do? Very interesting your book and work!!! 🙂 Thank you

  2. Paul,
    Talking with Alex leaf on the FB page, he believes and his wrote about, high fat with carbs causing insulin and glucose problems. He sited and wrote about studies showing over 15 grams fat with starch causing big issues. What is your take on this issue?? The studies looked true and was not hyper caloric. In fact a meal with 40+ fat and starch was very damaging in the text.

    • Paul,
      Does this issue matter👆👆? PHD meals for me adds up to 190 carbs and around 140 to 150 fat…Alex shows this causes insulin resistance even when not in caloric excess..

      • Hi Keven, I don’t know what the studies are, maybe you could link the thread you referred to. But transient insulin resistance in response to large meals is normal and not a matter for concern.

        Best, Paul

          • Melancholy Aeon

            I think Paul many people conceive of it as “normal healthy people have no insulin resistance ever” & “pre-diabetes & diabetic people have insulin resistance all the time.” It’s not well understood that it’s normal human physiology to have transient temporary insulin resistance after meals as a metabolic brake. It’s one of body’s many protective mechanisms. There are a lot of these false dichotomies in the common internet Paleo “wisdom.” Would you agree?

          • That would certainly be a big mistake, I don’t know how many people in the Paleo world would make that mistake.

            The bigger issue here is that macronutrients are toxins, insulin is not. So in a healthy person there’s no reason to be alarmed by transiently high levels of insulin or insulin resistance, it just means you ate a lot of food and your body is directing it to the safest places. Glucose enters the brain across a concentration gradient, hyperglycemia in the blood leads to toxicity to neurons, so hyperglycemia is potentially toxic; high insulin is not if it is physiological.

            Maybe in diabetics there is an issue with combining fat and starch, but in healthy people, it’s likely to be beneficial.

  3. Awesome! I’m learning a lot of things. Congratulations!

  4. Paul,
    Do you think spikes in blood sugar 140 to 150 then back is safe for longevity. I have been keto but looking to return PHD just can not get past this blood sugar spike

    • Hi Keven,

      That’s within the normal range for postprandial response, so I’m not sure it’s fair to characterize that as a spike. On low-carb you’re almost certain to go into that range after eating some carbs, because you’ll be naturally insulin resistant. The way to lower that number is to eat more carbs, more regularly. But I’m not convinced you need to lower the number. You may be worrying overmuch about a trivial concern.

      Best, Paul

    • Melancholy Aeon

      Hi Keven:

      I hear ya. Keto seems like a box you can’t get out of safely, once you find out it doesn’t work for you. Just as it takes time to adapt to keto, it takes a while to adapt back. I had to add starchy veggies back very slowly week by week. It took me about 12 weeks honestly to get back to PHD real food. You may just be going too fast for yourself at the moment. Good luck! 😀 😀

      • Melanchloy,
        Its a hard cycle to enter and exit from. My problem in full ketosis I improve in just about every area of my life, but my latest cardiovascular markers came back so messed up I had to rethink everything. Going for a cac test tomorrow, hope to find its just ketosis that has markers so far off..

        • Melancholy Aeon

          Hi again Keven:

          I hear ya. Just last night Peter Attia posted a blog update in which he finally admits ketosis only works for some guys, sometimes. Until it doesn’t, as sadly was your experience. Altho’ he has evangelized it, note he himself hasn’t followed it since 2014. I think he has more ‘splainin’ on this to do, and maybe even an apology for evangelizing from his medical position before he had any useful clinical experience. And yet I like Attia, I admire that he manned up & admitted his errors, which is more than many would do. Good luck with PHD to straighten out your health!

          • I still have to say though, I have never felt physically and mentely better than being deep in ketosis. I had a cac scan after with a 0 score so my fears is cut back on my markers. To be fair peter never said ketosis does not work and he stated he saw massive improvement in his pratcice and with his sister… I think this is such a tough topic to deal with.

          • Melancholy Aeon

            Happy May Day Keven!

            I’m glad you feel better. Ketosis worked for me for 8 years – until it really didn’t. Many people – perhaps the majority over time – share my experience, but I hope it works for you. I wish you well.

            As for Attia, listen to his recent 3 hour ramble with Joe Rogan, where in the last 45 minutes he confesses how often ketosis doesn’t work, admits finally how over-confident he was about it & his understanding of it & throws up his hands on his “broken patients.”

            Again, I like Attia – seems like a fun guy who cops to his habit of emotional eating. I admire his intellectual honesty to admit he was wrong in a public way. At the same time, I can’t imagine Paul calling people “broken” & giving up on them.

            Paul seemed eager to “unbreak” people by fixing their setpoints & deep metabolism in his retreats, which is something Attia hasn’t been able to achieve by his own admission. But Attia’s fundamentally on the same page as PHD, so I’m not downing him at all.

            Best wishes!

          • I did try to listen to that podcast, but did not even make it through the intro because of the language.. Thanks for your kind words!!!

  5. Paul, I have been following PHD for about a year now. For the first 8 or so months, I did well with the intermittent fasting (eating within 8 hour window) piece of the plan. But in the past 4 months, I’ve struggled in the sense that I feel very hungry first thing in the morning along with tired and drained and generally lousy. I haven’t made any changes to my diet during this time. Do you have any ideas about what might be causing this and suggestions for how to resolve it. I want to continue doing IT, especially because I’m prone to SIBO and I know that IT helps with this. Thank you. Mary

    • Hi Mary,

      Most likely is that you aren’t eating enough, either of food as a whole or of some part of the diet like carbs or protein. Have you been losing weight? I would try eating more first.

      Another possibility is that your eating window is too late in the day. You could try shifting it earlier. If you get hungry in the morning, snack. Make lunch your biggest meal — try to stuff yourself. Then try to finish eating a bit earlier in the day.

      For SIBO, 3 egg yolks a day, vinegar, vitamin C, N-acetylcysteine, vitamin D and A optimization will all help.

      Best, Paul

  6. Hi Paul,

    What course of action do you recommend for severe facial acne in women 20 years of age?


  7. Hi Paul,

    Is there anything to suggest that this diet could help alleviate or eliminate postorgasmic illness syndrome (POIS)? Apparently autoimmunity and hyperglycemia may be potential causes. Wondering how you might think about the relationship.


  8. Paul,
    I am curious about some best practices regarding acids. 1. Is vinegar or citrus juice preferred over the other, or should one not worry and just mix it up?
    2. Does it matter if the acid is added to drinking water, or is it better to add to food?
    3. Is an otherwise-healthy individual missing out on something if they follow PHD, but neglect acids?
    4. Is there a best time of day to consume? Would drinking early in morning with water negatively affect intermittent fasting/circadian rhythm entertainment?
    Thank you so much for your time!

  9. Dan Braunstein

    Hey Paul,

    What is your take on the nightshades? I have direct evidence that potatoes cause inflammation. I’m just interested on your take because you allow potatoes.

    Thanks, Dan

  10. Dan Braunstein

    Do you mind explaining the difference? I’m not sure I understand the difference between them. Wow. That’s interesting. Aren’t all potatoes tubers? This is really good stuff.

    • Yes all potatoes are tubers. The potatoe is just the tuber of the Solanum tuberosum species. So what he is saying is that the fruits produced by that plant cause inflammation. If you eat the leaves stocks fruit or even the raw tuber than it would cause irritation and or inflammation because nearly all nightshade species (including the potatoe plant) are toxic. The reason potaoes are edible are because the toxins in them are destroyed by heat.

  11. I have oxalate issues and plaintains and taro are
    high in these. I can eat some small red potatoes
    and small amount of white rice. Any other ideas on
    how to increase starches?

    • Hi Linda, try supplementing with N-acetylcysteine and zinc and eat adequate copper. Those may reduce endogenous oxalate production and enable you to tolerate more foods.

      Best, Paul

  12. In your book you recommend getting all your folate
    from food, I have MTHFR and Compt and have been
    supplementing with 400mcg of methyfolate – your
    feelings on this?


  13. Hi Paul,
    I suffer from hormonal migraines. I will get an attack at least once a month and they usually last from 5- 10 days. I have seen many specialists. Do you think this diet can help me. I have had them for about 20 years.

  14. Paul, I’m 6’3, 190lbs and I compete in weightlifting. Is it possible on the PHD to increase my Protein to 100g a day on the while lowering my Carbs to 80g a day and keeping fats at 65% of my Macros?

  15. Hello
    I am very new to the PHD. I am 72, spent most of my adult life at around 300 lb but over the last 3 years (since retirement) I exercise daily about 2-3 hours with a trainer. I went on the Keto diet a year ago and am now about 220 lbs. I have stalled in weight loss and would like to do the PHD. I understand the basic diet as you present it but I am confused about the weight loss PHD program. Can you suggest a place where I can see a few typical meal plans or a further discussion. I do not understand 500 calories in Ca bs, 300 in protein AND 500 calories in fat (but this group should not be in added fat such as coconut or MCT oil but in eggs, liver, beef and seafood etc). Aren’t these last protein? How is the 500 fat calories differ from the 300 protein calories?
    Thank you.

    • Hi Anita,

      For weight loss, best is to start by watching this talk:

      The most important single steps for weight loss are:
      – Eat natural whole foods — no processed foods with first ingredients starch/sugar/oil.
      – Minimize omega-6 fats. Avoid anything made from/with an oil that is high in omega-6 (e.g. soybean oil, corn oil, safflower oil, canola oil). In your own cooking, use coconut oil, dairy (butter, cream, sour cream, cream cheese), beef fat, or avocado oil/olive oil.
      – Eat 3 egg yolks per day, put vinegar on food, and generally optimize nutrition.
      – Circadian rhythm entrainment – this is described in Part V of the book.
      – After the above, next step would be intermittent fasting.

      Start with these and then you can refine from there. It’s hard to implement everything at once, so start with these key aspects.

      Best, Paul

  16. Hi Mr. Jaminet. Thoroughly enjoyed the book and I just wanted to ask a question regarding the dangers of omega 3 fats combined with alcohol and fructose. It will be easy for me to avoid alcohol when consuming my omega 3’s (which I will obtain from oily fish) but would you advise omitting the sugary plants and fruits on the days I have the fish or can I eat these a few hours either side of the fish? I like to try and have a little fruit and some carrots or beets every day, but if this is potentially dangerously if combined with oily fish then I will have to miss them out on those days if this is the safest option?
    Thanks for any advice,regards, steve

    • Hi Steve, I wouldn’t worry about fructose from natural whole foods like fruit and carrots, as the quantity is small. But if you indulge in processed foods with sugar such as soft drinks, or anything with added sugar, then stop doing it when eating omega-3 fats. Best, Paul

      • Brilliant, many thanks for taking time to reply Mr. Jaminet, I appreciate it. As a side note, I used to be a very low carb eater and I stayed slim and was healthy enough but always felt something was ‘missing’. I have added safe starches to my diet which has helped with variety and taste and I feel even better! I think your book is fantastic and I think the advice of eating natural foods either from out of the ground, the sea, plucked from a tree or killed, is the best advice anyone can be given. Regards, Steve

  17. Paul,
    Are you still eating 2 2pound meals a day?? Would you mind sharing what one of you meals has been lately??

  18. Keven, in the last chapter of the book Paul gives an excellent account of his daily meals. It might just be the most useful chapter in the book, as it’s an easy to follow guide for daily meals (think of bi bim bap, fried rice or pho soup)

  19. Dear Paul, I hope this finds you well. I was delighted to discover the sane, balanced and scientific approach of PHD after nearly 3 years on a raw vegan diet and about a month of Keto struggle.

    I embraced the idea of incorporating safe starches and eating some fruit again. However, since I started eating potatoes/rice and meat at the same meal I started experiencing long and heavy digestion. Burping, bloating, gas. And I feel as if food stays in my stomach for hours. The liberal use of fats (butter, avo, olive oil, coconut oil) seems to be slowing things down even more.

    What is your take on food combining/sequential eating for smoother and more efficient digestion? Here are some links to give you background if you are not familiar with the ideas.

    I would like to stay and get healthier on the PHD and hope the poor digestion when eating safe starches is something that can be improved.

    be well

    • Melancholy Aeon

      Hi Martin!

      I feel your pain. Years of extreme diets have likely compromised your gut flira, impairing digestion. I’ve been there myself. What are you doing to heal your microbiome? That will key. Good luck!

      • Melancholy, thank you for your thoughtful response. I am not doing anything in particular, just trying to embrace a more balanced diet. Any suggestions? Have you struggled with heaviness/indigestion from protein/starch combos?

        thanks and be well

  20. Cancer needs sugar to grow. There are no essential carbohydrates. When you deceased your sugar intake what did you replace it with?

  21. Paul,
    I am going to a full overnight schedule starting monday, and tips on how to minimize negative outcome a d stay healthy?? I believe I should stay with same sleep schedule even on off day right?? Should I stick with fasting and PHD level carbs, just rotated to fit my new life??

  22. Hello Paul!

    The diet plan you shared looks good. How much weight I can lose within one month by following this plan.


  23. Hello Paul,

    I was wondering about your opinion on the current interest in the Carnivore Diet? The results I’ve seen so far are all anecdotal, however there are some substantial claims of it helping to reverse auto immune diseases, and generally gaining optimal health. If soluble fiber and fermented foods are so necessary for the microbiome I do wonder how an all meat diet can be healthy. It does look promising, if a little extreme perhaps.



    • Hi Hans,

      I don’t think it’s healthy, although someone who is in good health could probably tolerate it for quite a while, especially if they eat shellfish and seafood and organ meats and stocks from connective tissue and eggs. But it won’t be fully nourishing and won’t be robust against all health threats, including many infections.

      Best, Paul

      • Thank you for the response Paul,

        Even in the last three months the carnivore diet has gathered even more traction. I’m sure you’re aware of the results posted by Paleomedicina in Hungary with regards to this diet fixing a huge number of chronic diseases.

        It does sound hugely beneficial for those who haven’t fully seen life changing results on Paleo/Keto diets.

        Eating shellfish, seafood and organ meats as well as stocks from connective tissue and eggs sounds like a necessary part of being fully nourished. What else are your reservations?.

  24. Paul,
    In determining the amount of protein to eat, do you recommend weighing meat before or after cooking? Thank you.


    • Hi Mary,

      Meat should be cooked gently so that its weight doesn’t change dramatically during cooking. Most weight loss will be from water loss which is a bad thing. Boiling, steaming, or pressure cooking meat will preserve weight and lead to minimal weight loss.

      One exception is meats that can be high in omega-6 fats, such as bacon or duck. There it is good to discard any fats that melt off the meat at gentle/normal cooking temperatures. Fat that stays solid and attached to the meat at normal cooking temperatures is OK to eat.

      Best, Paul

  25. Hey Paul,

    What recommendations would you give to someone with IBS?

    What about someone trying to maximize testosterone and muscle growth?



  26. Hello Dr. Jaminet,

    I just read your answer on one of questions below: “…So I would think reducing protein would make more sense than switching to plant protein, although beans are an excellent food if properly prepared (would recommend overnight soaking followed by preparation in a pressure cooker).
    Best, Paul

    This is a bit confusing since in your book you call legumes “almost-grains” and explain why: lectuns etc.

    So do you think soaked and thoroughly cooked lentils are ok?



  27. Thank you Dr. Jaminet!

    But please don’t call yourself Peter because it is a bit confusing too 🙂

  28. Hi Paul,

    Thank you so much for your insights so far. It was really helpful. I have a question regarding the PHD apple. I’m only 4 feet 11 and wonder if the recommendation shown in the PHD apple would really be applied to all “sizes”? I would think it must be less for me. It feels like I would be overeating if I did follow this guideline (that would be good for someone much taller and twice the weight :)). I couldn’t really find this answer anywhere, hope you can help me out.

    Thanks, Sandra

    • Hi Sandra,

      The quantities are based on a 2000-calorie reference diet. As a smaller woman you’ll be eating less than that, maybe 2/3 as much food. Generally speaking, you’ll need a slightly larger fraction of carbs and protein (and vegetables) and slightly lower fraction of fat, but roughly speaking the proportions of food types should be similar to those in the apple.

      Best, Paul

  29. Hi, Paul.
    I recently read your book and enjoyed it. I was wondering if your diet is good for those who are insulin resistant. Recent lab tests showed that my fasting insulin is very high. I am wondering if eating the amount of starches and sweet plants you recommend would be a problem for me. Thank you for your help.

  30. Hi Paul,
    I’m pleased to have found your excellent site and am browsing, hoping to learn more about this diet plan. I feel the need to adjust my eating habits due to various health and personal problems: uterine fibroid, ocular hypertension, hypoglycemia, bunions, anxiety, fatigue, mood swings, white spots on skin, abdominal fat, stiff/creaky joints. About two years ago I started Dr Thomas Rau’s maintenance diet (lots of veg and fruit, low protein, includes grains). Some improvement to my previous diet but still not ideal. Now I think I should avoid nuts, seeds and grains, add in some meat stews, change to fresh milk instead of almond. Am I going in the right direction? Do you have any advice for me so I can address my particular set of issues? Thanks so much.

  31. Paul,

    Have you heard any stories from autoimmune clients, where they’ve reversed positive ANA blood tests to Negative?
    Thanks for your tremendous work.

  32. Even if you lived to be 120 years old, you can delay death, but you cannot stop it.

    Essentially, we are all on the Titanic, a doomed ship destined to sink. Eventually, we will all die.

    ” As it is written, there is no one righteous, not even one..” -Romans 3:10
    “For the wages of sin is death..”-Romans 6:23

    BUT…the good news is there is a lifeboat available. Jesus Christ is the lifeboat! There is enough room for everyone.
    “For God made Him who knew no sin to be sin for us, that we might become the righteousness of God in Him.”
    2 corinthians 5:21
    So, though are physical bodies might die, all who BELIEVE in Him, will have eternal life in the age to come.

    “that if you confess with your mouth the Lord Jesus and believe in your heart that God has raised Him from the dead, you will be saved.”
    Romans 10:9-10

    • True, but being healthy in this life makes it easier to love others as we should.

      There is a story about St Francis of Assisi that before his death he prayed for forgiveness for the way he had mistreated his body during life. He realized at death that he should have cared for himself more. And indeed, we are called to love our neighbors as ourselves, not more than ourselves. Therefore we should love ourselves, if we are to love at all, and take care of ourselves.

      Best, Paul

  33. Please help us with vitiligo diet. I like to if we change diet plan eating gluten free diet or paleo diet when we can see changes in our body week or months

  34. I have severe anxiety and I feel a strong effect from the different foods I eat, in relation to my anxiety. I notice that whenever I eat carbs I feel absolutely terrible and my anxiety goes through the roof.

    I have tried many many medications and I have a horrible response to all of them. I feel like I need to find the right diet and you are the first person I’ve come across promoting a diet for optimum health who sounds genuinely intelligent and educated.

    You mention people with neurological disorders who benefit from tweaking the diet to be keto. Would you be kind enough to tell me if you have any suggestions for me, in relation to tweaking your PHD? Or your diet in general? I desperately need help. Thank you.

    • Hi Adam,

      Most likely you have a small intestinal bacterial overgrowth (SIBO) with some kind of pathogenic bacteria, possibly also H pylori infection. Have you been tested for that and treated with antibiotics?

      Here are some tactics that will help you:
      – Intermittent fasting with early day feeding. Leave a significant gap (at least 3 hours, preferably 5) between last calorie intake and bedtime.
      – Circadian rhythm entrainment. Crucial.
      – Vitamin A and D optimization. Crucial.
      – 3-5 egg yolks per day and 2 tbsp apple cider vinegar per day — take small amounts mixed in water and food throughout the day.
      – Glycine, taurine, vitamin C, N-acetylcysteine, extracellular matrix (from shellfish and bones/joints/tendons cooked in soups and stews)
      – The rest of the PHD dietary and nutritional advice.

      Best, Paul

  35. Prostate health
    Dear Paul,

    I have adopted the PHD to a large degree over the last 4 years ago. I have been doing fine with it and I am really grateful for your well-founded and balanced approach.
    Being now in my late 40’s, I get more concerned about prostate health. Looking at specialists’ advice relating to prostate cancer prevention, I find recommendations (for instance to reduce / avoid red meat, milk/dairy and even eggs and chicken, but to use more soy-based products. This is in contradiction to PHD.

    Had you ever specifically looked at such studies about prostate health or cancer?

    Kind regards,

    • Hi Dieter,

      I’ve looked and in general don’t find the evidence for those recommendations persuasive. I think one concession we can reasonably make is that there are hormones in milk that can have a pro-growth effect in cancers, especially estrogen or androgen sensitive cancers such as many prostate or breast cancers; see e.g. However, when we look at observational numbers, we see a modest observed association between whole milk consumption and prostate cancer progression,, but also an association between diary and lower all-cause mortality and longer life, Prostate cancer accounts for 0.01% of deaths in the US and generally less in other countries, so if you haven’t been diagnosed with it, it shouldn’t be driving your dietary decisions.

      Other considerations: processed meats (where you don’t know the ingredients or their quality) are risky; overcooked meats are risky (PAHs, etc, discussed in the book). But in general, gently cooked red meats and full fat dairy products other than milk like cheese or sour cream are healthful and beneficial.

      Best, Paul

  36. Radu Simionescu

    Dear Paul,

    Three years ago I have bought your book and followed the PHD for about 6 months. At that time my target was to improve sleep quality and to lose some weight. Soon after starting, I have noticed an improved mood and level of energy and also my weight went down, about 10 kg in 6 months. For the sleep, I can say it was some improvement, but the sleep problems were not completely solved.
    Anyway, after that initial period of 6 months, slowly, slowly I returned to the previous eating habits. And of course, the extra weight came back…

    BUT now I have decided to write you because I’ve been diagnosed with autoimmune cutaneous vasculitis, which I currently control with methyl-prednisone; as I am really scared about the long term possible side effects of such medication (diabetes, high blood pressure + many others…), I think PHD diet might help and I consider using it again. I would just like to ask you if you have any additional advice to give me (if I can particularize PHD somehow for my condition)?

    I assure you, your advice will be highly appreciated!
    Many thanks in advance!

    With king regards,


  37. Unfortunately, I have to take Concerta in the morning for my ADHD. Will this ruin my Morning fast? Also, are there any adjustments you’d recommend for someone doing PHD with ADHD?


  38. Dr Jaminet, I have been on PHD for about 1 1/2 years and have some challenging health issues.Right now my question is about a chronic infection that may be untreatable. I had TB 25 years ago and was treated successfully.Also I have had 2 IV and 1 oral chemotherapy for breast cancer that depressed my immune system off and on.Now I find my self with a Mycobacterium abcessus infection in my lungs that my Dr is holding off on treating because of toxicity and difficulty of treatment.I am having inhaled antibiotics for a pseudomonas infection also in my lungs.Any extra supplements or foods to assist with chronic infection?I already take NAC and supplements as you recommend.Also I am now off oral chemo and my immune system is recovering so I hope I can make some progress with these infections.Thanks for all you do. Mary

    • Hi Mary,

      So sorry to hear of your troubles. The keys are:
      – Extra vitamin A and D. These are the key natural antibiotics for epithelial surfaces like the lung, as they enable cellular production of antimicrobial peptides. I would take a one-time dose of 50,000 IU vitamin D3 and 200,000 IU vitamin A, then a daily dose thereafter of 5000 IU D and 10000 IU A until the infection is gone, then normal PHD recommendations.
      – Daily 1 g (1/5 teaspoon) NAC and 5 g (1 teaspoon) glycine, both for glutathione, plus 5 g/day vitamin C in divided doses.
      – Zinc and copper — eat beef/lamb liver and chocolate and some nuts for copper; for zinc supplement 150 mg/week.
      – Eat extracellular matrix (soups and stews made with bones/joints/tendons and shellfish)
      – Circadian rhythm entrainment — this is key! Attend to all five zeitgebers
      – Intermittent fasting
      – Good amounts of electrolytes — potassium from potatoes, tomatoes, and bananas, salt, and iodine 225 mcg/day, plus PHD magnesium and calcium.

      Best, Paul

  39. Hi, do you have alternative suggestions for a vegetarian diet? I can have eggs.

    Thank you, your comments would be very useful.

  40. Thank you Paul for the reply. 3 months later and more people have shared their success stories online with the regards to a solely animal based diet. It is fascinating. I’m sure you’ve heard of the guys at Paleomedicina who have have used this to treat a whole range of chronic diseases.

    If I did try temporarily following this diet, are there any recommendations or things to be wary of? You’ve mentioned eating shellfish/seafood/organ meats and stocks from connective tissues and eggs.

    Thank you

  41. Congratulations on the space program experiment!

    To the PHD: How do I determine how many calories to consume daily? In my age bracket my demographic seems to be ignored. I weigh 82 & would like to weigh 105 or more. (I had a severe weight loss about 15 years ago and haven’t been able to gain any of it back.) I think by your analysis on the retreat data a few years back that people who are underweight are probably 25% of the population. I think I am quickly becoming one of the frail elderly – at age 68. Help!

  42. Hi Paul,

    I’m writing to you bc I’m a bit desperate for help.

    I have severe pain problems (muscle, joints) and chronic migraines that limits my life a lot. I’ve tried different versions of ancestral eating and I’m still confused as to which way to go.

    I can’t handle any supplements at this point without getting a bad stomach ache. I’ve wanted to add magnesium and probiotica for example but I just end up in pain. Any soft drink or just a sip of alcohol has the same effect (I rarely drink them anyway, but just to give an example of sensitive I am).

    I’ve been diagnosed with Candida and disbiosis and Celiac.

    I now eat mostly according to PHD, with some exeptions occasionally, like something cooked with sunflower oil when dining out for example, or gluten free bread with buckwheat.

    I think the key is healing the stomach, how can I best do that without supplements? Can dairy be a problem? (I have sinus issues) How strict do I need to be? Do I need to follow a specific stomach healing protocol? I’m now thinking about following PHD strictly without dairy…

    I would be so thankful for your input!

    Warm regards,

    • Hi Leni,

      PHD should be the best diet, but you may need to adjust it to avoid foods you are particularly sensitive to.

      Some keys:
      – Intermittent fasting will give your digestive tract some time to rest and heal each night.
      – Circadian rhythm entrainment is key for all aspects but especially joints and immunity and healing.
      – Extracellular matrix from shellfish and soups/stews made with bones/joints/tendons/skin is critical for healing. Chicken soup!
      – I would avoid probiotics but vitamin A and D should be helpful, also apple cider vinegar in small amounts (not too acidic) throughout the day – use it to flavor water. Get 3-5 egg yolks per day. Vitamin C.
      – Get enough salt, iodine, and potassium (via tomatoes, bananas, potatoes). No need to get salt or iodine to excess, but be sure to get some of each every day.
      – Ask your doctor to check thyroid status and get hypothyroidism treated if it’s present. Generally any TSH of 3 or higher should be treated.

      Those will be the keys for you. Best of luck!

      Best, Paul

      • Thank you so much Paul! I will implement your suggestions immediatly. I’m feeling very hopeful. 🙂 I’ll let you know how it goes! Thank you again for all you do.

  43. Hi Paul,

    I noticed in your Perfect Diet recommendations you say not to include wheat or any products made from wheat such as bread. What are your thoughts on slow-fermented sourdough bread from whole wheat bread? Would the same recommendations still apply?

    • Hi Shameer,

      Sourdough is generally safer than other forms of wheat. In general, we’re cautious about wheat, but the main thing is that it shouldn’t be a staple food at 20-30% of calories — the dose makes the poison, so small doses are unlikely to be a problem.

      Best, Paul

  44. Hi Paul,

    I have been following your perfect health diet since I bought your book sometime around 2010, which is the year the copyright. I am 84 years old and in excellent health. I take no medications of any kind and walk a couple of miles every day. My wife is an excellent cook and prepares a great meal every day that always includes organic vegetables and fruit and some meat.

    The diet in your book that I follow includes 65% of calories as fat, 20% as carbohydrates and 15% as protein. I learned today from your website that your diet now includes 55% of calories as fat, 30% of calories as carbohydrate and 15% as protein. Apparently your current recommendations suggest 10% less fat calories and 10% more carbohydrate calories than was suggested in your first book.

    My question is, what benefit could I expect if I increased my carbohydrate intake and reduced my fat intake to meet your current recommendations?

  45. Hi again Paul,

    I should add that for many years I have been following your advice in the book to take two tablespoons of coconut oil daily to get the benefit of the ketones in the oil. I have probably consumed my weight in coconut oil over the years.

    After reading a number of articles about the deficit in brain glucose absorption that commonly occurs in the elderly, I started taking several tablespoons of ketone producing caprylic acid (C8) (MCT oil) daily to try to preserve my brain function by using ketones for supplemental fuel. (I was inspired to do this because my wife, who is 82, has a much better memory than I of past events.) I still take one tablespoon of coconut oil daily.

    While I have read a good bit about the ketogenic diet, it makes more sense to me to take the MCT oil rather than to try the ketogenic diet which would screw up the diet that I am accustomed to and which works very well for me.

    Best regards, Jack Cameron

    • Hi Jack,

      Great to hear from you, thanks for sharing and I’m happy you and your wife are so healthy.

      As far as carb percentages go, my advice would be to try increasing your carbs a bit and see if you feel better.

      Re supplementing caprylic acid (or exogenous ketones), I would do this toward the end of the overnight fast. The object would be to induce ketosis briefly on a daily basis. Many of the benefits of a ketogenic diet may come through ketone signaling, and getting into ketosis for a short time (30 minutes) daily may be sufficient to capture most of the benefits. It’s not necessary to eat an extreme low-carb diet to obtain those benefits, and I think you are smart to avoid an extreme low-carb diet.

      Best, Paul

  46. Hi Paul,

    I’m writing since I’m at the end of my rope with my current diet and health state.

    I’m a 26 year-old female who has a 5-year history of severely dry eyes and dry mouth, to the point of serious pain and inability to sleep. About 2 years ago, I began using a bioidentical progesterone cream and these symptoms went away nearly instantaneously. At this time, I was at a healthy weight. Soon after, though, I started a vegan diet, and gained ~40lbs in about a year. On top of this, I was then diagnosed with reactive hypoglycemia and PCOS and began to experience periods of extreme hunger/feeling faint during that time.

    After switching to a ketogenic diet about a week ago, I have lost a lot of bloating and my blood sugars feel more stable, but my dry eyes and mouth have returned with a vengeance (even with using my usual progesterone dose!).

    These health problems have become very frustrating for me. I have heard about issues with combining fat and carbohydrate, which made me particularly wary since the veganism caused me to gain so much weight, but I am desperate for my dryness symptoms to go away again. Do you think the PHD would work for me in terms of weight loss/blood sugar regulation/hormone regulation, or should I adjust the amounts of carbs/fats recommended by your program?

    Thank you.

  47. Hello Paul,

    I’m a 34 year old man and I just started your diet after being on-and-off somewhat slapdash keto diets for a few years. I’m a mostly healthy weight (145-150, 5’6″) but I have 10-15 lbs or so of fat around my waist that I would like to get rid of or replace with muscle, and also my lipid panel and blood glucose tests were a little out of whack recently (high TC, high LDL, high fasting blood sugar). I swim about a mile 3-4 times a week and do a moderate weight routine 3-4 times per week. I also quit coffee and diet coke three weeks ago because I felt like it made me very hungry, dried out, and unable to sleep well, and I required more and more to feel normal.
    Anyway, I’m writing because for a long time, I have been experiencing a weird dichotomy of my body feeling energetic and strong while my mind feels foggy and depressed beyond even normal caffeine withdrawal (I do drink some very light green tea to manage that). And what was causing my craving for more and more caffeine? I’m hoping regularly consuming starches will provide that mental clarity and energy in place of caffeine. I also have had a lot of trouble fasting, even though I used to be able to do very long (20 hours) multiple times per week in my late 20s early 30s. I have wondered if it was a thyroid thing so I started taking Now’s thyroid support supplement. Besides only having been on your diet about a week, is there anything I can/should take into consideration? Or just stick with it for awhile and see what happens?

    By the way, I am a singer, and I discovered your diet because I noticed my singing voice lost a ton of endurance, tone, and range when deep in ketosis and one day googling this phenomenon I came upon your article about mucins and it all clicked. Essential mucous membranes in the vocal folds might get depleted when carbs are too low. Just listen to Shawn Baker’s voice! My problem is I always went back to grain-based carbs to get my voice back in shape, only now am I going safe starches and cutting WAY down on PUFAs. My voice is getting back to being resilient and resonant!

  48. I’m concerned about the carbs especially if you have candida or an autoimmune disease. I’ve been following SCD which allows no potatoes or rice. Maybe I need to read more about why rice and potatoes are okay?

  49. Paul,
    I have been on PHD for over 2 years now. One problem I continue to have is that the skin on my scalp breaks out frequently while the skin on my hands is cracked and dry. Do you have any recommendations for this? Thank you.

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