What are the Top 10 Paleo Supplements?

Readers Summary:

  1. What are the Top Ten supplements to consider when changing to a paleo lifestyle?
  2. Why do I consider these to be the best core supplements for a paleo lifestyle?
  3. What is the most important to least supplement in a paleo lifestyle?

When a person decides to become optimal and eats a paleo/primal diet, there are many changes that occur to one’s RNA/DNA and to our epigenetic switches. Many of these bio-machinations will take months to give the full hormonal response, but there are some potential issues that can exist when a person implements a change to their life. One of the big issues to initially delineate is: What kind of paleo diet are you instituting? Many people eat a lot of grass-fed skeletal meat and avoid all offal at first. Others cut their carbs while others car-load based upon their activity levels. Some use a high-protein approach to control hunger, while others use a low protein approach if they are running a vegetarian regime. This blog will attempt to outline what someone might supplement if they are eating a standard paleo diet as outlined in a Paleo 1.0 book.  I recommend that people with disease consider altering their template to the Brain Gut 6: Epi-Paleo Rx.  Your lipid profile will thank you!  It is all about avoiding the dehydration in the change over from paleo to the Brain Gut 6: Epi-Paleo Rx.

Most people making the change to this lifestyle are coming from diet that is usually not optimal, like a SAD (Standard American Diet). Moreover, the USA food supply is so altered that most Americans are not getting the full nutritional value that they could or should get, that our counterparts in the rest of the world are getting, because of the practices in the food and agricultural industry. These practices have been allowed to occur by the USDA and federal governments inaction on many fronts. Recent decisions favoring Monsanto being able to genetically modify seeds and alfalfa are examples. They have gone after small farmers who are farming organically or farmers who produce raw dairy products. They have have also tried to make the lives of companies like Nutiva and Tropical Traditions miserable with regulations to protect genetically modified foods whose origins are usually from Monsanto. Given this legal and regulatory environment, we each have to make some adjustments to offset the losses of nutrient density in foods available in America. I think the world needs to pay attention to this, because we are major exporters of our foods globally. This is really bad news for the world.

supplement-EPA-DHA1. DHA/EPA

The reason is simple. Most people start their lifestyle change with excessive omega 6/3 ratios in their diet and tissues. I strongly recommend everyone getting a O6/3 blood assay done prior to making the shift. I did and mine back in 2006 was 37:1. Today its 4:1. I do not believe this would have been possible without the use of supplements in the beginning of my transformation, because of how badly our food supply is loaded down with O6 and stripped of O3. I created my version of the paleo diet (the Epi-Paleo Diet) based upon my labs, which was influence by the outstanding work of Dr. Stephen Cunnane.  We must consider that the O6 content in our systems may not just be from dietary sources. It could be caused by a modern mismatch in mammalian cell membrane biology that most are unaware of.  When you read about his work you begin to realize there is a lot more to the story of what is best for modern humans.  I cover his work in the Brain Gut series in Brain Gut 4: What was Homo’s Solution? and Brain Gut 5: Paradigm Drifts Paradigm Shifts: Epi-Paleo?.

Even food sources naturally high in O3s, like fish and meat, have been stripped by feeding farmed fish and cows corn and soy pellets loaded with O6s. The levels one should shoot for are based upon your current O6/3 level and your highly sensitive CRP. Most people will fall between 1-4 grams. The more inflammation one has, the higher dose one should consider. Increase your seafood intake could be a helpful move as well.  I think the ideal 06/3 ratio is below 6:1, and I think we should be careful before we bash 06 to the ground. I think that maybe unwise. I have a theory that may explain why modern humans concentrate O6s as a byproduct of all neolithic disease.  (Caveat: I am a much bigger fan of eating seafood in its evolutionary biologic package than I am in using Fish oil or Krill Oil).  When one begins to understand what DHA is used for in humans (brain function), we begin to understand how this PUFA is protected best in its evolutionary package (seafood) by Iodine in synapses and in many critical areas like the adrenal gland.  Other chemicals that protect the double bonds of this PUFA are made from DHA called resolvins, lipoxins, and protectins.  I cover these extensively in Brain Gut 4: What was Homo’s Solution?.  The Paleo Solution may not be Homo’s solution.  A paleo template is a great option to reclaim your health from a western diet, but there is a level above it when you have a large brain that may be riddled with inflammation.  A paleo diet may not go far enough for some of us; for example, you will find your LDL and HDLs will take 3-4 months to adapt on a Paleo diet.  These adaptations happen much quicker on an Epi-paleo Rx template because of the brain specific nutrients contained within it.

supplement-Iodine2. Minerals Iodine, Iron, and Selenium

This threesome is critical for optimal thyroid function. The most important mineral for a human with a large brain is Iodine.  I cover this later in the blog in the massively important Brain Gut 5: Paradigm Drifts Paradigm Shifts: Epi-Paleo?  The most common clinical scenario I see is thyroid disfunction, notable because because in my pathology book from the 1980s, it said thyroid disorders were quite rare.  Today, they have become ridiculously common.  Our epigenetics have been altered dramatically because most food is now manmade and processed,  our light is artificial light, and environmental toxins of all sorts have gone through the roof over the last 100 years.  When we eat man-made foods, we get neolithic diseases.  If the thyroid is not working well, free T3 levels will be low and likely unavailable to convert LDL cholesterol to the hormones the brain uses to control our 20 trillion cells. Remember that T3 and Vitamin A are cofactors in the conversion of LDL cholesterol to the steroid cascade. We covered this in the Hormones 101: Clinical thoughts revealed.  I would  also strongly suggest you read the follow up to that blog, called the Hormone 102 blog post.  Thyroid dysfunction is epidemic in the world where a Western diet is entrenched. One in ten adult American women have been diagnosed with thyroid disorders, and some endocrinologists suggest that as many as 25% of adult American women are afflicted with clinically detectable thyroid dysfunction.  I think this number is conservative and gets worse with every subsequent generation at the effect of epigenetics.

Severe iodine deficiency can cause hypothyroidism. But many physicians believe iodine deficiency is rare in the United States and other developed countries since the addition of iodine to salt. I am not so sure about this. I think it is related to water dehydration because fluorine replaces iodine in structured water in humans. Fluoridated water blocks re-hydration and cause us to lose sodium in our sweat and often times the amount of sweating becomes altered too. We actually can see a cerebral salt-wasting syndrome in those who drink water that is highly fluoridated. This is common in the Western US. Again, just because Iodine is in salt does not mean we absorb it if the water we use has a dielectric blocker in it.

The WHO (World Health Organization) estimates between 1.5 to 2 billion humans are iodine deficient.  The more red meat one eats, the more iodine deficient one can expect to become because iodine is bountiful in seafood in its primordial evolutionary package, not in red meat. Iodine is also found in sea vegetables and seaweeds.  Considering the work of Drs. Remko Kuipers, Cunnane, and Crawford about the importance of seawater in human evolution, it would make sense this is where our best supplies come from.  (Kuipers spoke at AHS 2012 @ Harvard.)

I have found women are most at risk for poor absorption of Iodine.  A classic finding is a low progesterone, low pregnenolone, and high estrogen level on their labs, with an elevated LDL cholesterol. This is a sure sign of severe dehydration due to Fluoride being a dielectric blocker to Iodine in water supplies. This affects brain cognition, especially if EMF is present, because the blood brain barrier become permeable with EMF and the fluoride can gain access to CSF and displace Iodine in the cerebral spinal fluid. After the thyroid gland needs, the distal portions of the human mammary glands are the heaviest metabolic concentrators of Iodine in the body. Iodine is readily incorporated into the tissues surrounding the mammary nipples and is essential for the maintenance of healthy functioning breast tissue.  In my opinion, the absence of Iodine plays a huge role in fibrocystic disease and the development of breast cancers.

One clinical finding I always ask about is the presence of fibrocystic breast disease.When it is present, the woman is likely suffering from an undiagnosed Iodine deficiency. I distinctly remember in medical school seeing a woman’s fibrocystic disease cured in less than an hour by an ancient physician who taught us how to examine a woman’s breasts. A woman had volunteered to be a guinea pig for us during our medical education, and on this day, we could not examine her without making her scream and cry because her breasts were so tender to palpation. Our MD proctor was about 80 years old ,and he too was a volunteer helping us learn our craft. He stopped me from examining her breasts, asked her a few questions, and then he asked us to leave the room. He applied Lugol’s solution to her vulva and her nipples, and we were able to examine her without any pain a half hour later. It made a huge impression on me. He had asked her if she was on any thyroid meds and if she had bad energy or weight gain. A lack of iodine was the source of her painful breasts!  Her labs did not reveal any major issues, either, because she had only been screened for TSH and not a free T3 or free T4 level. I never forgot this lesson on the thyroid.

When one begins eating a Paleo diet, your nutrient density and food substrate improve; your Iodine needs go up as your mitochondria are being asked to do more. Often with a Paleo diet, you get a relative Iodine deficiency for the first 3-6 months of adaptation. I ask my patients to eat shrimp twice a week for the first six months of the Paleo diet or to supplement with a kelp vitamin every third day which will do the trick for most people. I have people take higher doses if they drink fluoridated water. We can use Lugol’s or potassium Iodide to offset it a bit. Coffee does the Iodine 200-300 mcgs every other day if you eat seafood once a week. If you eat it more frequently, you likely don’t need any supplementation.

Iron. Clinically, Iron is not important to supplement because the Paleo diet is extremely robust in iron. This is one of the paleo diets biggest strengths but ironically few of their leaders know why.  Iron protects us from excessive environmental EMF’s.  Most paleo’s swim in a sea of it because of how they embrace modern technology.  But many of us forget our diet is only as good as what we absorb.   Most people changing to a paleo template have a leaky gut and leaky blood brain barrier because of EMF.  If gut dysbiosis is present (and it usually is to some degree) or there is a lot of fructose in the diet, Iron absorption could be a real problem. When one eats a lot of fructose in juices or in fruit (or HFCS products), one will increase absorption of Iron in the gut while also increasing serum Albumin. High Iron levels are not good. High Albumin levels can cause our free testosterone or estrogen levels to dramatically fall because the increased albumin binds them, much like SHBG does in obesity or in hypothyroidism. None of this is good for optimal.

supplement-SeleniumSelenium. For the thyroid gland to produce the most active form of the thyroid hormone T3, Selenium is essential but also helps regulate the amount of hormone that is produced. Remember, T3 is a co factor in steroid cascades and also in reversing muscle leptin resistance at UCP3. We need 200 mcgs a day, and one brazil nut daily can do the trick. Most don’t get enough Selenium. If you don’t eat brazil nuts, then I recommend a supplement every other day of 200 mcgs. It’s dirt cheap and easy to find. Selenium is critical in many stress-related processes, and is active in prevention of oxidative stress. by working with a group of nutrients that includes vitamin E, vitamin C, glutathione, and vitamin B3 to prevent oxidative stress. I wrote about selenium here in more detail. Se is one brazil nut a day or 200 mcgs a day. Fe is 325 mgs a day, and take it with a vitamin C to increase its absorption and help to lessen nausea.

supplement-VitaminD33. Vitamin D3

Vitamin D3 is a pro hormone and is vital to immunity and to other physiologic functions. Vitamin D3 is an important neuro-steroid hormone responsible for many elements in brain development and behavior. Vitamin D3 increases brain levels of glutathione, a powerful natural antioxidant that is the body’s most important tool for detoxifying and excreting heavy metals, and one that is rapidly consumed during oxidant stress from toxins and other sources. Vitamin D3 is made from LDL cholesterol in the steroid chain. Most vitamin D3 in the American food chain is added and is D2, not D3. This is especially true for dairy products. The active form of vitamin D is D3 and is made in our skin by sunlight. The best dietary source of D3 is fatty fish like salmon or other animal products. Few people have good dietary sources of vitamin D3. Vitamin D3 can also be made from sun exposure, but the dermatologists have done a masterful job of convincing many they will succumb to skin cancer if this is their major source of Vitamin D, so conventional wisdom in America guides people away from getting vitamin D3 this way, creating an epidemic of patients with low vitamin D levels. Most Americans fail to even get the too-low RDA of 400 IU from all sources. I would suggest you read my Vitamin D post here. I suggest a basal dose of 5000IU of D3 for most patients. For those who are suboptimal, I push this big time. And I am no fan of 50K of Vitamin D2 a week….its suboptimal dosing with a suboptimal form of Vitamin D for humans.

supplement-VitaminK4. Vitamin K2

In my practice, I see a lot of osteoporosis as a spine surgeon. This vitamin is one I test for quite often, and in my estimation, there is a bigger epidemic in low vitamin K2 levels than low Vitamin D3. The American diet is virtually depleted of K2. K2 is found best in raw dairy products, but raw dairy is hardly available anywhere in the US. Our pasteurized dairy is devoid of K2 because pasteurization virtually eliminates any K2 from the dairy. Vitamin K is also found in organic green leafy veggies like kale and spinach, but its levels in non-organic versions are dramatically altered.

What does Vitamin K do to make it so important? Vitamin K is the cofactor for the enzyme γ-glutamyl carboxylase, which converts specific glutamic acid residues in a number of substrate proteins to γ-carboxyglutamic acid (Gla) residues, which then serve to form calcium-binding groups in these proteins and are essential for their biologic activity. Carboxylation thus activates this family of Gla-proteins, which are involved in a number of the body’s essential activities, including blood coagulation, bone metabolism, vascular repair, prevention of vascular calcification, regulation of cell proliferation, and signal transduction.  K2 is also part of the protocol I use to re-engineer a gut flora.

While osteoporosis is its own epidemic due to leptin resistance, heart disease is the number one killer of men and women in the USA. A clinical study from Rotterdam, Holland revealed a correlation between long term adequate Vitamin K2 intake and a lower incidence of calcification of the wall of the aorta. Arteries with no plaque have been shown to have a massive increase in Vitamin K2 concentration in their walls and plaques when compared to arteries with arterial plaques. Vitamin K2 depletion is critical in developing heart disease, as seen in many longer term studies, like Framingham and the Nurse’s Study. There is a link of Vitamin K depletion in CVD, AD, and in liver cancer from viral hepatitis. Vitamin K is also recycled in the gut and uses the gallbladder as a conduit along with the enzyme VKOR. So in people without a gallbladder, there is a very real risk of Vitamin K depletion. Most patients I have checked with a history of cholecystectomy also tend to have very low HDL levels and leaky gut. This is a big clinical pearl I look for. The lowered HDL level allows for poor endotoxin clearance in the portal circulation, and this increases the plasma’s ability to oxidize sdLDL cholesterol also a factor in development of heart disease as well. The daily dose needed by humans is only 45mcgs per day. Even with this low requirement, we see a major epidemic in depleted vitamin K levels. Most vitamin K2 is made from the gut bacteria provided there is not dysbiosis. If there is, the clinical situation is worse. The best clinical measure of this is arterial calcification in the face of frank osteoporosis, with a low HDL and elevated LDL. Most patents show a high sdLDL on VAP testing as well. There are three isoforms of K, but my favorite for bone and heart health are K2 MK-4 subfraction. I think a mix of all isoforms is good for most people (K2 in mcgs doses are fine for regular patients) but for my bone and heart patients with calcified vessels, I put them on high dose K2 with MK-4 subfraction. Dosing can range 5-45mgs for these people. Vitamin K2 appears to be evolutionary related closely to Co Enzyme Q10 and may have evolved from Q10 after the appearance of molecular oxygen after the Cambrian Explosion.

supplement-PQQ5. PQQ

Many Paleo folks may not even know what this is. I call it the long-sought-after “exercise in pill form.” PQQ is pyrroloquinoline quinone, and is probably the most important B vitamin when one is transitioning from a sugar burning metabolism (which is what the Standard American Diet creates) to a fat burning furnace (Paleo/Primal diet). When I first began to blog, I started with a deep mitochondrial series. I think many questioned why I did so: your change to a Paleo diet it is really not maximized unless your mitochondria are optimal first. This was shown in the leptin series, as well at the muscle level (Oprah post). In my practice, helping my patients become leptin sensitive is one of the first clinical moves I make to light the pilot light of the mitochondria.

PQQ has two major effects that make it critical: it’s stimulatory to mitochondrial biogenesis. If you read my mitochondrial series from June of 2011, you will see why this is critical to reengineer a human to optimal. Since I have written extensively about leptin, energy efficiency is critical to optimization. If one is energy deficient due to leptin resistance (hormone cascade disruption) or due to poor mitochondrial function (inability to make energy well), there is little chance of getting someone to optimal quickly. My Leptin Rx solves the steroid cascade problem. PQQ is the tuneup that the furnace needs. Remember, our mitochondria are the engines that drive our metabolisms. If one is devoid of energy, we call that person a cadaver. If one is lacking energy, they are either leptin resistant or the owner of a bunch of bad mitochondria. Most people on a the Standard American Diet have a Nissan Sentra engine in their Ferrari body. There is a huge energy mismatch of what their bodies want to do and what they can do. This obviously affects basic functions and the ability to exercise, too.

The second major effect of PQQ is glycation control from AGEs and ALEs. One of the under-appreciated benefits of going Paleo is the huge change in dietary carnosine intake. What is carnosine? Carnosine is a multifunctional dipeptide that interferes directly with the glycation process. Carnosine has been shown to inhibit glycation early on, thus helping protect us against further damage as we age. Carnosine is found in large amounts in red meat and seafoods. When one makes the change to Paleo, the substrate for electrons in our food is red, grass-fed meat/seafood loaded with carnosine. A person eating a Standard American Diet is filled with mitochondria not optimally equipped to handle an acute change to massive carnosine. Some other little known facts in our Paleo community about carnosine is that its levels fall off rather dramatically in humans as we age. It has also been shown in research that high levels of carnosine are also seen clinically in humans with long telomere lengths. Long telomere lengths indicate longevity.

Longer telomeres are directly tied to mitochondrial health and optimal functioning. This biology was worked out by Nobel Prize winner Elizabeth Blackburn’s lab at UCSF in 2009. Having great mitochondria is critical if you are going to make the superior substrate jump in a Paleo lifestyle. It makes no sense biologically to eat great if your body’s engine cannot harness that power to transform your health. I recommend a higher dose of PQQ for all Paleo patients: 20mgs a day. If I eat a lot of meat and coconut oil because I worked out hard, I will dose even higher.

supplement-CoQ106. Co-Enzyme Q10

This one should be obvious, given what I just told you about PQQ. CoQ10 is a co factor in mitochondrial electron transfer, and in many stress reactions biochemically in the body. The higher our Q10 levels  in the plasma, the higher our zeta potential. This correlates to how well particles in suspension flow in a biologic system. The lower Q10 levels are, the more sticky things like LDL, platelets, RBCs, and HDL become. It means that LDL stays in the plasma too long because the LDL receptor in the liver is not as effective at grabbing it up from the plasma and it gets subjected to higher levels of oxidative damage because the lowered Q10 cannot buffer it from the oxidation. It then becomes oxidized and is deposited in arterial walls.

The ten in Q10 is for the side chains that scavenger free electrons to prevent free radical damage. They are what keep Q10′s zeta potential so high biologically to scavenger them. Having this fat soluble vitamin in excess is needed when providing better nutrient density to the mitochondria to make more energy so we can increase our exercise ability in any stressor we face. Honestly, I think within 10 years, we may find low Q10 levels are our single most important tracking mechanism for inflammation. CoQ10 is a critical supplement for those who eat a high meat and low seafood diet. Vegans and vegetarians measure the lowest zeta potentials. If they also happen to be endurance athletes, the data is even worse. Excessive endurance exercise increases our plasma oxidation from ATP loss and the stress hormone response. Most often, exercise is hormetic when things are in balance. When there is a CoQ10 depletion by neolithic diseases, statins, or by being generally out-of-shape, we need to increase dietary supplementation to optimize an Epi-paleo diet.

CoQ10 comes in two formulations: Ubiquinone and Ubiquinol, an oxidized form and a reduced form, respectively. Ubiquinol (the form I recommend) is three times more costly but is readily absorbed by the gut, while the oxidized version is not. Moreover, it is more difficult to manufacture Ubiquino, the reduced chemical form. It contains two hydroxyl (OH) groups instead of just one. This advantage allows it to bond with water molecules, and makes it more readily absorbable by our mitochondria in our cells for energy production. Ubiquinol is the biologically superior form of CoQ10 because it’s an electron donor, which makes it a very effective neutralizer of free radicals and the only form of CoQ10 that scavenges lipid peroxyl radicals that can damage the polyunsaturated fatty acids of your cell membranes. In my view, this is a massive benefit when you’re eating Paleo. You need far less when you are eating Paleo. The more bacon you eat, the more Q10 you will need. Depletion of cellular CoQ10 will not even support basic cellular function. A Paleo diet and higher activity level require optimal mitochondrial and cellular function because of the stressors put on mitochondrial energy supply and substrates. We will cover this later in my Mitochondrial Rx.

Remember, the heart muscle is critical to the increased activity levels some want in a Paleo lifestyle. Heart disease is a major killer in our country, primarily because of our diet. Findings at the 5th Annual International CoQ10 Symposium held in Kobe, Japan demonstrated the superiority of ubiquinol in a group of seriously ill patients with advanced-stage cardiac disorders. If this can help people close to death with severe heart failure, it is clearly critical to any human looking to optimize their life through their diet. This study revealed that clinically ill patients who suffered from severe heart failure readily absorbed ubiquinol CoQ10 into their bloodstreams (acutely and chronically by blood assays) and showed improvements in all health parameters. Another key point: those with autoimmune disease or Hashimoto’s really need to use only ubiquinol because they can’t convert from ubiquinone to ubiquinol well due to low B6 and B12 levels. They often need higher dosing.  This can be assayed in a lab test.  Now, we prove that CoEnQ10 is the first new drug to improve heart failure.

supplement-Magnesium7. Magnesium

Remember from the mitochondrial series or the Gnoll’s post that Magnesium is a co factor in making every last bit of ATP in the mitochondria. So if you don’t have optimal magnesium, you are not going to be energy positive or optimal. T2D have the lowest levels of Mg I have ever seen. The reason is dehydration.  Most people with T2D have an elevated BUN/creatine ratio.  This is a result due to excessive urination that diabetics have as one of their symptoms.  This also happens when people eat a paleo diet low in water or iodine.  When people begin to eat Paleo, they usually are depleted of iodine and magnesium. They also have a chronic dehydration that goes along with it.  They complain of poor sleep and develop constipation and muscle aches within the first few weeks of adopting a paleo diet. Magnesium will not work if the patient is also dehydrated because Magnesium is a hydrophillic cation.  You can best assess this with your BUN/creat ratio.  With my patients, I offset this with a pretty hefty supplemented dose of Magnesium Malate, usually two hours prior to bed. If they need more, I’ll add a morning dose. This should never be taken with AM Vitamin D3 because they compete with one another for absorption. I am also a big believer in the use of Epsom salts topically in those with big depletion risks.

There is another big benefit that comes with topical epsom salt use and that is increasing the sulfur intake topically as well. Those neolithic diseases that could benefit include T2D, sleep apnea sufferers, restless leg syndrome, and those with fibromyalgia. Sulfur intake is notoriously poor in vegetarian diets and helps explain why vegetarians suffer from so many skin and connective tissue disorders (psoriasis, eczema, dandruff, folliculitis [infected hair follicles], warts, and pityriasis versicolor; vitalize are some). Sulfur is an important component of our body’s proteins. It is present in our hair, skin, nails and tendons, and plays a critical role in maintaining the integrity and elasticity of connective tissues. After adopting a Paleo diet, if the patient still complains of persistent skin issues, I usually suspect a sulphur deficiency and recommend Epsom salt baths. Sulfur is an element that is part of four amino acids called methionine, cysteine, cystine and taurine. Sulfur is found in many animal meats and eggs, so longer term, it may not need to be supplemented on a Paleo diet. This is very common in Vegetarian-to-Paleo conversions, because vegetarians are so deficient and tend not to become ravenous carnivores right off the bat. Epsom salts are a nice way to get some sulfur into your body to get optimal. If you need more, you can consider a sulfur supplement like dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM). I like Magnesium Malate, 800 mgs two hours prior to bed. If you need more, add 400 mgs in the AM or eat dark chocolate daily.  For those with inflammatory brain diseases like obesity, multiple schlerosis, alzheimer’s disease, PD, and most any autoimmune disease, I use a special version of mag called Magnesium Threonate because it penetrates the CSF of the central nervous system, while no other formulation can.

supplement-Multivitamin8. Multivitamin

A multivitamin is critical, because of the various nutrient depletions in our food supply. Few people and their doctors are aware of how deficient we are in essential nutrients. We are down to the fundamental fact that the vast majority of Americans fail to obtain even the tiny amount of nutrients in their diets that the medical establishment says are needed. A Paleo diet provides a far better mix than the SAD, but when one makes the change from SAD to Paleo, one is starting with a deficit, as evidenced by bad body composition, poor energy levels, and altered hormones. In the January 23, 2008 edition of the Journal of the American Medical Association, the findings from a study that measured vitamin E levels in people 65 years and older showed that those with the lowest blood levels of vitamin E were 60% more likely to suffer physical decline over the three-year follow-up period. The same has been found for Vitamin D, Magnesium, Selenium and Iodine levels in various studies. Vitamin A is critical, because optimal levels are needed to convert LDL cholesterol to the steroid cascade with T3.

supplement-MSM9. B Vitamin Complex with Vitamin C added

They sell this really cheap in Sam’s Warehouse Club. If you want a better source look for a B complex that includes S-adenosylmethionine (SAMe) too! If you do SAMe is usually in a B complex formulation because SAMe should be taken with cofactors vitamin B12 and folic acid. Our body requires methionine and vitamin B-12 to synthesize SAMe (also a Sulfur containing protein), a substance that is involved with the production of DNA. DNA is hereditary material in humans and animals found in the nucleus and mitochondria of nearly every cell in our body. The only people I do not recommend taking SAMe are those with bipolar disease. Published research shows that methylation defects create a variety of DNA/RNA age-related problems, including neuronal and hepatic dysfunction. When we go Paleo, we are trying to optimize the liver and brain so this co factor is vital. Optimal methylation is critical for health and also a major factor in neolithic diseases like cancer and heart disease. In my view, you can not take enough B vitamins. They are critical. Always get your B12 level checked and your homocysteine level. Always try to make sure B12 is around 1000 on your testing. This is critical for optimal thyroid functioning and optimal methylation.


Most patients I see have sleep disturbances prior to becoming Paleo. I have written a special blog on DHEA that explains why people have sleep issues:  a bad diet causes spikes in inflammatory cytokines. Sleep is critical to become optimal. This is when all cellular repair is done by our body, governed by a cellular process called autophagy. Poor sleep is consistently seen with high levels of IL-6 in sleep research studies. DHEA levels tend to fall in both sexes dramatically after the age of 27 and directly correlate with poor sleep. DHEA decreases IL-6 in a dose-dependent fashion, but its use must be done through consultation with a physician. Many people use melatonin on their own for sleep without understanding the complex neural wiring between the brain, gut and pineal gland that must be taken into account before adding this to your routine. I find these two supplements very useful in the first six months of a making a change to a Paleo lifestyle. I use blood and salivary testing for tough cases to make a decision on care. I can not over-emphasize how critical reestablishing optimal sleep is to this lifestyle.

supplement-MelatoninMelatonin you can start with low dose at 2-3mgs two hours before bed and titrate for effect. Highest I have taken myself was 20 mgs when I had serious jet lag. DHEA for guys: I base it on labs, but most can take 50-100 mgs safely. The ladies could consider using the 7 keto version of DHEA and I would keep it below 50mgs a day without testing.  When a person has a diurnal pattern of cortisol that is abnormal in the AM or late night, you can bet the melatonin axis is off badly.   Read the EPCOTx protocol for re engineering gut flora and gut health to you will see how important melatonin really is. Prior to leptin’s ascension in the mammalian brain, I believe melatonin was the most important hormone all life followed because it signals when we are most chemically reduced and able to replenish all our ATP stores and recycle all our worn-out proteins from life’s daily grind.


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  • Neurol Sci. 2009 Jun;30(3):207-12.
  • Trends Endocrinol Metab. 2002 Apr;13(3):100-5. Review.
  • Neurosci Lett. 1996 Oct 4;216(3):183-6.
  • Cees Vermeer, Laviena Braam et al Vitamin K supplementation: A simple way to bone and cardiovascular health,AgroFOOD industry hi-tech, Nov/Dec 2003 17-20
  • http://www.lmreview.com/articles/view/vitamin-d-and-vitamin-k-team-up-to-lower-cvd-risk-part-II/
  • Int J Biochem Cell Biol. 1998 Aug;30(8):863-8.
  • Exp Gerontol. 1999 Jan;34(1):35-45.
  • Biochemistry (Mosc). 2000 Jul;65(7):843-8.
  • Langsjoen and Langsjoen AM. Supplemental ubiquinol in patients with advanced congestive heart failure. 2007. Presented at 5th International CoQ10 conference. Kobe, Japan.


  1. Dr. Kruse, thanks for another interesting an insightful post. I'm 40 years old and have been following the Primal Blueprint about two years. I believe it will be the pathway for long term health.

    I found your mention of sulfur deficiency leading to skin issues particularly interesting. I eat all kinds of meat (pastured and wild) and eggs, but do suffer from peri-oral dermatitus. I was diagnosed by a dermatologist late last year and agreed to go through the 30 day regimen of anti-biotics although I realize how bad they are for the gut.

    The condition cleared up within the 30 days, but I now have the issue again around the corners of my eyes.

    I can't imagine I have a sulfur deficiency, but am struggling to find out why I have this problem. Could you point me to any references where I could learn more naturla ways to treat this skin disorder?

    Thanks for your time and for your effort in composing such well thought out blog posts.


  2. Unless someone beats me to it, I'll try to work up an Amazon list of all these for Dr. K's approval.

  3. Hey Dr K,

    Great and highly informative post. You didn't specify a specific quantity/dose for PQQ above.

    Aside from PQQ, it certainly looks like Steph and my supplementation is on target (we are only missing PQQ).

    Thanks again for all that you do!

  4. Before hearing the name Jack Kruse 2 1/2 months ago I wasn't even taking a vitamin.

    Today I am taking 6 out of the 10 on this list.

    In the past when I would try taking a vitamin or supplement it just seemed like I would take it, and then pee it out in bright and pretty colors. I would take it for a few days and figure it was a waste of time and money. The one thing I have noticed is that since I have been taking them for a while now, those colors have disappeared most days. Does that mean that my body is starting to use it instead of eliminating it ?

  5. River Rance says:

    Would like to see recommended dosages per lb or kg.



  6. Thanks so much for this!!!! Just had my vitamin D checked and it was 42. Don't know if it was the correct lab, but my doc said it needed to be raised up to 50. Told her I would keep trying to get 15 minutes of sun per day. And surprisingly, she was open to everything I have been doing. I gave her your website Dr. Kruse, and she said she would read it. I will add these supplements as I can, and hopefully feel better than I do now.

  7. All this talk about sleep being crucial to health has me worried. I had a hysterectomy & removal of ovaries in 1993 and took oral synthetic hormones until early this year. I tapered off and discontinued and am struggling with hot flashes. I'm taking evening primrose oil and have had 6 acupuncture sessions which have eased the severity of the flashes but I still wake 3-5 times per night and feel tired much of the time. Is there any alternative but to go on hormones? And are bioidentical hormones more safe than synthetic? One last thing – because I am a competitive athlete, I cannot use exogenous testosterone (anti-doping rules) so would only be able to use estrogen & progesterone.

  8. Looks great. Byron Richards would be proud, although his list would be about 10 times as long. "You might forget to breathe, so maybe supplement with oxygen?" We could really go on and on about supplements for general health, but these are some important ones if the diet is lacking for some reason.

    I'm glad you mentioned that high iron levels are not good. I suppose the caveat for the iron supplement is to make sure that you are actually iron deficient and work with a doctor who will test your levels. See if I was to take iron supplements I would end up harming my health, but some other people could benefit from it.

  9. Doc… I had a stroke last spring (it was light and not a TIA) — my Cardiologist says I will be on Coumadin for life because of that… so my world right now is all about NOT getting too much Vitamin K — is there a way to balance this – so I can get enough Vitamin K to be optimal and still have blood coagulation in a safe range (inr 2-3) ??

    Thanks in advance!

    @Steve My recs in these cases are pretty simple. TIA/CVA are often treated with blood thinners but there is no rule that says it must be the Vitamin K depleting coumadin drugs. Most doctors are completely unaware that long term coumadin use (greater than 6 months) actually causes another problem that worsens arterial wall risk of rupture. That is arterial calicification from Vitamin K2 depletion. It is completely reversible if you get off of coumadin and replete the Vitamin K2. There are many other choices to thin ones blood. My advice is to mandate your doctor for a change in blood thinners to protect your bones brain and heart. I hope that many doctors become aware of the serious side effects of coumadin led Vitamin K depletion.

  10. @Stabby. Fe is a bigger issue for paleo men eating lots of carbs from fruit and juices post work out. I have had to have a few donate blood before they changed their diets a bit. I'd also point out that drinking coffee and green tea also decrease Iron absorption while fructose increase it tremendously in the small intestines. Coffee and green tea also increase Mg absorption and Manganese too. This limits copper too…….So coffee and green tea are really great for most paleo folks……..as long as the adrenals are OK.

  11. Thank you for this informative post. Is it possible to get enough K2 from our own intestines if we are eating the right probiotics, fermented and other foods?

    Also, PQQ seems to be in just about every vegetable food. Does the paleo diet not include enough vegetables for this, or is it mostly important to increase supplementation for awhile to correct a previous imbalance?

  12. @river some i can give but others require testing for optimal. Vitamin D and K for example. Im a big fan of high dose PQQ 20 mgs a day for the first six months on a paleo diet

  13. @exceptional. Yes it is but i have rarely seen it so call me a skeptic

  14. @raylynn you need to read my vitamin d blog. 42 is too low. There are ways of upping it now in winter time without sun because after sept 15 few can get it from the sun now. Our friends down under can……now

  15. @valorie. If youre deficient yes you will notice a change. As you adapt it will change. B complex vitamins make your urine yellow no matter what.

  16. @ william. This tells me you likely still have a gut issue. I would get it rechecked for sure. Our diet is only as good as what our gut absorbs.

  17. Any recommendation for a PQQ supplier? Amazon just has the Life Extension brand, and all their products have a bunch of clearly phony 5-star reviews so I'm not sure whether to trust a company with such dubious marketing practices.

    • @Ingenol I use 20 mgs of PQQ myself from LEF.org. I have seen other formulations and I do know that several compounding pharmacies are now making this for clients.

  18. The PQQ I found at Vitacost.com is made from fermented soy. Is that okay? I have been avoiding soy like the plague…

    • @Kaleein Fermented soy is Natto. And Natto is excellent source of Vitamin K2. It is used in Japan often. I have zero issues with it. Regular soy is garbage in any other form.

  19. Dr. K. thanks for the suggestion. What test should I look to have done to check for gut issues? For a little more info: I supplement with Magnesium, Vit D3, Vit K2, a probiotic, and fish oil. Thanks again!

    • @William. Look into organic acid testing and GI testing with a major lab like Genova or Metametrix. Just ask you doc or call the companies directly. If you dont have a doc who will help you they often can help refer you to someone locally who might help.

  20. Looks like I didn't do too bad figuring things out on my own. I remember recommending to my Mom (who's on statins and has *major* CAD) to take ubiquinol. (she didn't take my advice) But I had no idea that it could also be helpful for me. I also had no idea about iodine, selenium and PQQ.

    I've just started tracking my nutrition better and I'm noticing that I am regularly "short" on iron by about 1/2 the RDA. So at least now I have a value that I know how much to supplement.

    I was wondering though… Once we manage to right our metabolisms and eat a paleo diet for long enough, will most of us not need much supplementation in the future?

    • @Ceci Forget RDA on anything. Go by testing. Check your serum ferritin levels. As one becomes more paleo I do think supplementation will decrease from this core ten……but then there is then antiaging side of the equation to think about as a paleo ages. Most in this community are still too young to consider it but my patients are not and I advocate things as labs dictate or disease processes progress. I can tell you after 18-24 months most paleo's who supplement vitamin D3 will see a decreased dose as their receptors and binding proteins finally become saturated.

  21. Here is the Amazon list I put together:


    I hope I choose good products on there and that it helps some folks sort through what's available.

    Dr. K – If I've missed something, let me know and I'll edit/delete appropriately.

    • @Livinlite. thanks for doing this. I will have more blogs dedicated to types of supplements for certain diseases as we go ahead. I posted a while back on supplements to consider for peripheral neuropathy under my health tab on the right side of the page. The Concussion Rx has a few more in its blog too. That one was just written prior to this one.

  22. Thanks livinlite…I really have been wanting something like this …but more in depth. A site geared towards vitamins would be great that rates Vitamins based on what they have in them…absorption rates etc…

    It would be nice to have a site to go that lists places to buy vitamins rates all the vitamins based on important things like how well they absorb and what fillers they have if any. Discussions on which fillers are worse than others and why.

    I'm not even sure fillers used in Vitamins like cellulose and the extra stuff listed that is not the Vitamin are harmful or anything but there are many different fillers and I don't know if they contribute in any meaningful way or not.

    • @Jonathan Consumerlab.com is that site. You can join and they will answer many deep questions. I also would tell you to talk to your local compounding pharmacists as they are awesome resources and can often help answer your questions or source good supplements for you. I personally have high regard for LEF.org and have never had an issue with their products. I personally use some of their supplements.

  23. Chris Antenucci says:

    Great post Dr. K. I have a few questions: Do you think it's best to buy a multivitamin complex or each vitamin individually? Where do you feel probiotics should come on the list? How high on the list should sulfur be, and what do you make of the claim that vit D supplements may not be as effective as getting it through the sun because the cholesterol in the skin is in the form of cholesterol sulfate and is converted to vit D sulfate?

    • @Chris A good Multivitamin is fine. I think additional B complex and C are smarter. Sulfur is not high because a paleo diet usually includes a lot of eggs and eggs are loaded with S. If you are vegan or veggie making the change and have a lot of skin issues then S supplementation needs to be considered.

  24. Thanks for the list livinlite. I'm sure it'll be a big help for some folks.

    I had a "doh" moment as I read today's blog post. re…Epsom salt baths. My parents' generation swore by 'em. I literally smacked my forehead at forgetting that. Even in the tiny town I live in, epsom salts are readily available at the local drug store or grocery store.

  25. Dr. Kruse,

    I have a very serious question for you. I'm reading Anticancer right now for my uncle who lives back in China. I just learned he has nasal sinus cancer, not clear on the details exactly and I don't know him or his background well. He's receiving chemo soon. I am advocating for my parents to tell him to follow the Paleo Diet (I need them to translate for him) + take some key supplements. Do you think this is a good idea (the ketogenic diet) and are there any other specific steps or things he should undertake now? He's only 52 and I feel he has a great chance, but I don't want him entering chemo without a specific dietary plan. I'm not sure on protocol in China. I feel dietary support could save his life. Please share your thoughts and any additional resources for me to consult. Thank you Dr. Kruse.

    - Dan Han

    • @Dan H I think you should know if you read my blog that I think a keotgenic paleo diet should be the Rx for every patient with cancer or a new diagnosis of cancer. I would tell you to google Otto Warburg and you will see there is a lot of science behind these ideas. Dan I also like several special supplements for cancer. Turmeric and Resveratrol are too biggies and with cancer your D levels need to be 70-100 in my view to make sure immunity is optimal. If you are reading Anticancer now I think you already know why I think that makes a great deal of sense.

  26. Hi Dr. Kruse!

    What's your opinion on digestive enzymes and betaine HCl supplements? Some people feel they are very helpful. And actually, one woman on a Finnish low-carb forum just wrote that she had had problems with her weight until she added digestive enzymes. Now she has lost almost ten kilograms in a month and she thinks it's all because of her "Super Enzymes".

    I also would like to ask another question about digestion, if you have time… When I was on low-carb diet 2-3 years ago, I was eating a very hypocaloric diet (~1200kcal, I was a 17y male with BMI 21) because very often when I ate more than 40-50g fat per meal, I got a mild/moderate nausea around 1 hour after the meal. Sometimes I even felt so uncomfortable that I had to go rest to my bed, and I fell asleep, and slept usually an hour. When I woke up, the problem was gone.

    I also noticed that stimulation by artificial lights also made me more susceptible to that nausea problem. But… Have you seen this problem in your patients? Could it be related to, for example, some kind of bile deficiency?

    • @Vladamir I love probiotics and Betaine HCL in the right cases. The Nausea you likely experienced was from the imbalance of the incretin hormone system in the gut and your brainstem controlled by the vagus nerve. This is easily overcome with time and adaptation. To your question about the light……it plays a huge role via the pineal gland and its circuits to the the thyroid and to the hypothalamus. I would tell you to read my blog post about leptin and sleep being yoked.

  27. "The daily dose needed by humans is only 45mcgs per day"..

    .I believe that the daiy rqmt for vitamin D was established for coqgulation functions before it's role was known as a regulator of calcium and other minerls.

    In Japan they prescribe 45 mg a day as a treament to reverse ostoporosis. Do you recommend higher K2 doses for those with spine or structural issues or coronary calcification?

    Would I be correct in assuming there is also a connection between K2 defiiencies and osteoarthritis and loss of cartilage in the joints?

    • @Adrianna 45mcgs is a very low dose in my view. I do see a skewed patient population because of my specialty. I usually advocate a much higher dose to my patients. If you have symptoms of a leaky gut then the requirements should go up as well. Degenerative joint disease usually has K2 and leptin resistance at its core. Leptin is now being looked at in many joint fluid specimens by researchers and the early reports I have heard at meetings falls completely in line with my beliefs about DDD and DJD being linked to energy metabolism and inefficiency because of LR. Krill oils are another big thing to add with joint issues. It has a special marine algae product in it called ASTAXANTHIN. This product blocks enzyme MMP 13 which is found in all badly degenerative joints. MMP13 dissolves cartilage!! Bad thing!

  28. "4. Vitamin K2: In my practice I see a lot of osteoporosis as a spine surgeon. This vitamin is one I test for quite often and in my estimation there is a bigger epidemic in vitamin K2 levels than there is in Vitamin D3."

    What's the name of the test for vitamin K2?

    • @Pam that is a serum osteocalcin test. In Japan, they use high dose vitamin K2 to treat osteoporosis as a first line therapy. They also have another advantage there. They eat a lot of "Natto" that is fermented soy beans" and has more K2 than any food source known to man. I have sampled it an it is not a very pleasant thing to eat. I have been moving my practice away from the pharmaceutical options for osteoporosis because of the side effect profile is steep compared to K2 treatment.

  29. @JP If you had a formal Roux done you would have a short bowel and likely need higher levels of K2. But if you had a Jejunal switch or conduit you may not. I have a few patients who had the conduit and had chronic gut issues to do dysbiosis in the switched segment. This had to be treated by the GI docs with antibiotics and long term probiotics to overcome. Gastric Bypass patients are very tough to solve because all of them have some degree of leaky gut syndrome or a dysbiotic envirnoment present. In this group of patients coconut oil is very helpful because of its antibacterial, antifungal and antiviral properties.

  30. random question… how bad is tapiocha starch on a paleo diet?

  31. Dr. Kruse

    I'm hypothyroid and was tested low for Iodine. Supplementing with Iodoral caused some nasty side effects (insomnia, among other things) and caused my TSH to shoot up from 5.00 to 9.00.

    Any thoughts on this?


    • @Dru This can happen especially with those with autoimmune hypothyroidism. (Hashimoto's). I have also seen some Grave's patients to have to avoid iodine as well. I don't personally have a ton of experience with that but I bet an endocrinologist would. What did the dose escalation do to you clinically? Did you experience the excess salivation? Did you have other symptoms of iodine overload while you were on the Iodoral? Sometimes when free T4 is low and free T3 is normal, I ask myself is iodine low? Did you get pre-post urine challenge test results, and did they show any change in your levels? In Hashimoto's I always like to preload the patient with selenium before iodine and many problems with iodine go away.

  32. Green tea was found to be very high in PQQ containing some 30 ng/g of this substance. The only know foods that outshine green tea is parsley with 24 ng/g and Natto (a fermented soybean dish served in Japan) with 61 ng/g of PQQ. While you are hard pressed to find PQQ on labels of you favorite multi-vitamin supplement (as it does not make the list yet), drinking green tea regularly will provide enough of this new vitamin to keep you from becoming deficient

  33. Eric Anondson says:

    PQQ is a B-vitamin? Call me an ignoramus or confused, but which B is it?

    Also, will taking CoQ10 help reverse statin damage to muscles?

  34. Super post, Doc! I am taking everything but the PQQ so will add that. I just got the Anti Cancer book so am planning to dive into it. My friend with ovarian cancer is doing very poorly. :(

  35. Table salt is iodized, but the majority of salt in packaged/processed foods is not. It has to be labeled "iodized salt", and I've only seen one packaged item labeled that way. With high blood pressure so prevalent, many people are cutting down on salt at home. So we're getting way less iodine than we think.

  36. Dr. K:

    Great article!. I am also using PQQ from lef.org.

    One more question: Are you going to write about PREGNENOLONE (or comment on it)? My doc included this for "brain health". I wonder if it should be included in your "Top Ten" supplements.


  37. quote Jack: "that is a serum osteocalcin test."

    Thanks. I would have thought low undercarboxylated osteocalcin would be a better marker for vitamin K2 sufficiency?

    With osteocalcin, what you consider the optimum reference range?

  38. quote Werner: "I wonder if it should be included in your "Top Ten" supplements."

    Though it doesn't matters, but I already count many more supplements than 10 already.. ;-)

  39. @pam. Read this on osteocalcin testing. http://www.muschealth.com/lab/labtest.aspx?id=150…. I use my own labs references but this article is a good overview

  40. @werner. This list is just for those making the lifestyle change to paleo. I use NAC extensively in other applications. I dont believe all patients get treated with the same recipe. The recipe requires customization based upon clinical presentation and labs.

  41. Doc,

    Thanks again for everything you do. Question: which medical specialty is likely to know more about how to properly supplement aging parents on blood thinners with K2? I understand this is a tough one, but any pointers as regards labs, dosage and process that could point some open-minded physician to try this for my parents would be appreciated. Data: mother with Parkinson's and osteoporosis, on typical therapies, also being giving a blood thinner as a precaution for stroke by her MD. Too bad you are across the pond; Thanks!

  42. Greetings from Sweden. I have benefited from your leptin advice and thank you greatly for that. Enlightening stuff. Gratitude.

    Now a question of supplements – I ingest some amount of raw eggs in "eggmilk" for my coffee/tea (2 whole eggs per week cirka) and have seen you mention/recommend a coconut shake with raw eggs, which I assume contains some whole raw eggs per portion?

    Friends of mine who are in the gym/health scene have warned me about Biotin-deficiency due to the Avidin in the eggwhites. Do you recommend supplementing for that, or is it only necessary when consuming larger amounts?

    • @lina What your friends have told you is correct. Avidin can cause biotin deficiency. Biotin deficiency rarely occurs among healthy people, since the daily requirement of biotin is low for humans and it is very abundant in our food source. So eating raw eggs should not cause a major problem if your getting biotin in other meals without the eggs which most on a paleo diet do. Signs of a biotin deficiency are as follows:

      Initial symptoms of biotin deficiency include:

      Dry skin

      Seborrheic dermatitis

      Fungal infections

      Rashes including red, patchy ones near the mouth (erythematous periorofacial macular rash)

      Fine and brittle hair

      Hair loss or total baldness (alopecia)

      If left untreated, neurological symptoms can develop, including:

      Mild depression, which may progress to profound lassitude and, eventually, to somnolence

      Changes in mental status

      Generalized muscular pains (myalgias)

      Hyperesthesias and paresthesias

  43. Dr. Kruse-

    My pre-supplementation Iodine level was 61 (28-544). I first tried using extra strength Lugol's solution applied transdermally and was able to bring that level up to 354. After that I tried using Iodoral along the lines of Dr. Brownstein's recommendations (12.5mg to 50mg) and that's when I ran into major problems. I discontinued Iodine altogether without testing how far my iodine levels shot up from the oral usage.

    I experienced insomnia, muscle catabolism, mood changes, decreased cognitive function…I just felt plain WEIRD. I did not experience any changes in salivation.

    I do not have Hashimoto's (thyroid antibodies are fine). However, I just recently tested slightly high on Rheumatoid factor Iga as well as low complement C3 serum so perhaps there is some other auto-immune stuff going on.

    Free T4 is fine (I'm on Synthroid) but FT3 and Total T3 are very low and RT3 is high.

    I also have gut dysbiosis and maybe that's why I fared better with TD iodine application compared to oral. But maybe I'd be better off not supplementing with iodine at all.

    Thanks for your help.

  44. Joe Brancaleone says:

    I'm wondering about the availability of minerals /trace minerals from ingesting clay (esp. Azomite), any knowns about the attainability of the selenium, magnesium for human consumption? Or something unsafe about ingesting it? Or is it still altogether unknown as to the benefits… it sure made my near-dead garden explode.

    Also I typically throw a pinch or two of Celtic sea salt in my water thermos every day as well as sprinkle it on some meals. Any idea what that should adequately cover as far as minerals?

  45. @Laney. First get your parents off blood thinners that deplete vit k and cause arterial calcification…..namely coumadin. Switch them to lovenox, plavix or aspirin. Its good enough. Then get them on K2. Talk to your doc about options. When they say there is no options better you find a better option at doctor! Vitamin K2 is critical to health.

    Here is my answer to Steve earlier in the comments section.

    @Steve and Laney My recs in these cases are pretty simple. TIA/CVA are often treated with blood thinners but there is no rule that says it must be the Vitamin K depleting coumadin drugs. Most doctors are completely unaware that long term coumadin use (greater than 6 months) actually causes another problem that worsens arterial wall risk of rupture. That is arterial calicification from Vitamin K2 depletion. It is completely reversible if you get off of coumadin and replete the Vitamin K2. There are many other choices to thin ones blood. My advice is to mandate your doctor for a change in blood thinners to protect your bones brain and heart. I hope that many doctors become aware of the serious side effects of coumadin led Vitamin K depletion.

  46. @dru. Slounds like going back to TD maybe an option. I think you may need to test more because of the autoimmune disease to get things just right

  47. @joe…..best way to test this hypothesis is testing

  48. I am uncelar. Are you suggesting to take a multi vitamin and additional Bcomplex and C?

    Also, what are your thougths regarding creatine and glucosamine and condroiten. Thanks much.

    • @Steve Yes you need a multi plus a B complex with C. Creatine I have zero problems with but on a high protein paleo diet I see zero needs for it. I am not a fan of glucosamine or condroitin

  49. Dr. Kruse-

    Any ideas on what to test re: Auto-immune disease?

    I spoke to my internist today about the high Rheumatoid factor and low Commplement C3 and he said it didn't seem like a big deal but that he would refer me to a Rheumatologist. It might help for me be to able to put him in a particular direction.

    Also, looking at my past records…my Osteocalcin tested out at 10.5 (3.2-39.6). Should I be looking into Vitamin K2 supplementation?

    Thanks again.

    • @DRU anyone with RHeumatoid factor and a low C3 has a big deal. It appears your doctor does not know what is causing it…….referral and not minimization of the findings are in order. I bet you have very levels of IL1B too. Rarely checked by most docs but seen often in autoimmune conversions.

  50. Dr.Kruse

    I didn't know where to ask you this question it is regarding my sleep i hope you can tell me something.

    I have a problem with sleep it started about 2 years ago when i was working in another country for 3 months for almost one year i had terrible insomnia sometimese i didn't sleep for 4-5 days and i was feeling ok not tired at all.

    My sleep is better now but still not ok the weird thing is i never get sleepy at night i can go to sleep but i am not feeling sleepy or tired almost never if i don't sleep alot or none at all i will be ok in the morning not tired at all.

    The only time i become sleepy is right after i come from work around 2-3 o clock in the afternoon.

    My question is why am i never tired or sleepy at night?where does my body get energy from?

    I hope you can answer my question just a little.thank you

    • @Olle24 I have a few patients that have this too. Ironically most got it after traveling as well. I sent them to sleep doctors who got their issues worked out. It had a lot to do with low serotonin in their diet, extremely low DHEA-s levels and disordered circadian clock resets. All were cured but it took the help of a couple of experts.

  51. Thank you for your answer Dr.Kruse.
    I am gonna try and get some blood test but there are no good labs in my country.
    Do you recomend any supplements i could take for my problem?Would the leptin reset help?thank you

    • @Olle you can definitely try the leptin Rx reset. You might also consider getting some DHEA and Melatonin 3 hrs before sleep. I cant recommend dosage without labs. But you can easily research them both on the net and order them and ship them to you

  52. Dr. K,

    Think your blog is awesome! I'm learning so much and believe with paleo and what I'm learning here I will be able to achieve optimal health in time! Hoping to get my husband, parents, inlaws and siblings on board eventually as well when they see the changes in my health! I wanted to know which PQQ by LEF you use. The one lists rice flour as an ingredient while the others list gelatin, vegetable stearate, silica but says contains soybeans….safe to assume the rice flour is the better bet? I've not done soy in years….thanks for everything you do to help people get healthy! Sure hope healthcare can change one day. It's hard being in it seeing all they advise/tell people while you do the opposite….lambs to the slaughter willingly and it's sad and frustrating…..

  53. Dr. Kruse-

    What do you think of an osteocalcin level of 10.5 (3.2-39.6)?

    Also, have you ever heard of NAC contributing to insomnia/sleep difficulties?


    • @ Dru……that is a good level. Is the NAC expired? NAC gets converted to glutathione in the body and actually helps sleep by reducing IL6 and other oxidants of the night…….

  54. Nope. The NAC is from a fresh bottle.

    Maybe it's just a coincidence. I have a lot of variables to account for so maybe I'm barking up the wrong tree with the NAC being the culprit.

  55. Thanks for answering Jack! Have a great night!

  56. Thanks for answering Dr.Kruse yes i defenetly need lab test right now it's a little hard but i'm gonna get it done till the end of the year.

    Yes i'm gonna try leptin well i have been already doing it but not 100%.Thank you and have a nice day

  57. @Frank Your email was a gem. Please keep forwarding those papers. Here is your answer. L-Carnosine may go beyond scavenging ROS to reducing the production of ROS. It protects against and promotes healing of stomach ulcers and reduction of brain damage due to accumulation of beta amyloid and possibly due to malondialdehyde or hypochlorite anions. It can very likely be used as an anti-ischemic drug. Carnosine is an efficient chelating agents for copper and other transition metals, and Carnosine appears to protect neurons from zinc- and copper-mediated neurotoxicity. Carnosine appears to expand the resistance of rats to various induced stresses. It can be used in the treatment o severe gingivostomatitis. Carnosine is an immunostimulant. Carnosine is reported to have an ability to up or down-regulate cellular and enzymatic processes to bring them into normal range. For example, Carnosine can decrease platelet aggregation in patients with low clotting indices.

    Here is the best thing though….But the one reported fact about carnosine that really attracted attention was that it could significantly delay or reverse cellular senescence. This was long before the days of telomerase activation written about by Dr. Blackburn. Some studies by Mcfarland in 1994 indicate that Carnosine can delay senescence and promote formation of a more juvenile phenotype in cultured human fibroblasts, extending the Hayflick limit for reproduction of such cells by up to ten doublings. This is why I just scoff and laugh at some of the recommendations made by Dr. Rosedale with regards to protein. He seems to completely disregard this data and focus on CRON exclusively. I am open minded. The more I read about Dr. Blackburn's work the more convinced I am eating protein and keeping backround inflammation low is the holy grail of healthy longevity. Dude great email!

  58. @ ART Thanks for your kind words. Here is the your answer to your email in PQQ. Pyrroloquinoline quinone, is a redox cofactor available as a dietary supplement and in some foods, appears to have at least three central biological effects with powerful downstream health and longevity consequences: it stimulates the generation of PGC1-alpha, results in expression of SIRT3, and induces mitochondrial biogenesis. And yes it does tie into the Quilt at the MTor levee.

  59. Dr Kruse: How new is PQQ? I just saw in the New York Post an advertisment recruiting volunteers over 70 for a Cognitive Performance Research Study on a new dietary ingredient, PQQ. The email to participate in the study is PQQtrial@gmail.com

    I am assuming it is the same product?

  60. @steve its new to the world but not to doctors in the know. I have known about it since 2003 because it is part of my osteoporosis regimen. I think its funny it's now becoming mainstream.

    PQQ is a quinone, a bacterial redox co-factor and antioxidant. It is a natural dietary substance found in common foods, good sources being parsley, green tea, tofu, tomatoes green peppers, kiwi fruit and papaya.The roots of the original discovery of PQQ goes back to 1964 and the substance was first isolated in 1979 However, the biological significance of the substance has been discovered only through a chain of slowly-developing research. Much of the original research on PQQ was concerned with its roles in bacteria. PQQ was not known to be essential to human metabolism until 2003 and research on its central roles in stimulating PGC-1alpha and mitochondrial biogenesis was published until 2010.

  61. Ease my mind about nac and the pulmonary hypertension study. I want to use it but have hesitated due to that question. I can link it but you probably have run across it.

    • @Jim….Certain preparations taken to enhance athletic performance or stave off disease contain an antioxidant that could cause harm. According to new research at the University of Virginia Health System, N-acetylcysteine (NAC), an antioxidant commonly used in nutritional and body building supplements, can form a red blood cell derived molecule that makes blood vessels think they are not getting enough oxygen. This leads to pulmonary arterial hypertension.

      "NAC fools the body into thinking that it has an oxygen shortage," said Dr. Ben Gaston, UVa Children's Hospital pediatrician and researcher who led the study. "We found that an NAC product formed by red blood cells, know as a nitrosothiol, bypasses the normal regulation of oxygen sensing. It tells the arteries in the lung to 'remodel'; they become narrow, increasing the blood pressure in the lungs and causing the right side of the heart to swell."

      Gaston notes that this is an entirely new understanding of the way oxygen is sensed by the body. The body respond to nitrosothiols, which are made when a decreased amount of oxygen is being carried by red blood cells; the response is not to the amount of oxygen dissolved in blood. He says that this pathway was designed much more elegantly than anyone had previously imagined. "We were really surprised", he said.

      The research team administered both NAC and nitrosothiols to mice for three weeks. The NAC was converted by red blood cells into the nitrosothiol, S-nitroso-N-acetylcysteine (SNOAC). The normal mice that received NAC and SNOAC developed PAH. Mice missing an enzyme known as endothelial nitric oxide synthase did not convert NAC to SNOAC, and were protected from the adverse effects of NAC, but not SNOAC. This suggests that NAC must be converted to SNOAC to cause PAH.

      Jim, Humans don't equal mice. I take 1800 mgs a day. Using animal studies to propose novel hypotheses can be fun. However, we cannot extrapolate findings directly. This is important when discussing metabolic pathways and the effect of different diets. For instance, mice have a basal metabolic rate that is 7 times greater than humans, so a 40% calorie restriction in mice mimics a therapeutic fasting in humans.

  62. Hey doc, loving your blog. I've been eating primally for a few months now, but what I'm finding is that I'm getting sick – constant sore throat, runny nose and persistent cough – probably for around the last 3 months. Just when I'm getting better, I just get worse again. I'm seeing my doctor in a few weeks for blood tests, I know my vitamin D is ridiculously low (35 in March) so taking 3000iu daily, plus a B vitamin, but from this post looks like there should be a lot more I need to be taking! My query is whether there are any particular blood tests I should be asking for regarding immunity. I'm pretty low carb though I think this is beyond the "low carb flu" as I'm actually quite mentally alert and even though I'm physically sick I feel great (if that makes sense!) Any thoughts? Thanks in advance.

  63. tarte-tatin says:

    Dr. Kruse, in your blog about MSG and aspartame you said NOT to take phenylalanine because it causes neuroexicitation. I am taking several amino acid supplements a la Julia Ross. I'm taking L-tyrosine as well as DL phenylalanine (and vitamin d and many other aminos and stuff) and it is helping me so much with mood, energy and food cravings. Before taking these supplements I was having very detrimental and unprecedented food binges that after a 20 pound loss, shifted my weight back up 30 lbs. I have started the Leptin reset in conjunction with the supplements I feel like I'm experiencing a miracle – no cravings or insanity around food.

    Furthermore, I recently developed Temporal Lobe epilepsy out of the blue with no history of head trauma or anything that my neurologist could identify as a cause of its onset (I'm 39 years old). My question is, am I doing damage by taking the phynalalanine? I sure am feeling great on it and I don't think it increased seizure frequency.

    You know what seems to have an enormous impact on my seizures? The Leptin reset diet! It's incredible.

    Thanks in advance for any response.

  64. Fantastic blog! Are there any supplement companies that you recommend? What is your take on synthetic versus natural supps/vitamins?

  65. Doc, thanks for the NAC heads-up. Much appreciated.

    Any specific comment about taking Vitamin C together with it as part of the protocol? The cpnhelp.org site mentions 2x-3x the NAC quantity in grams and you seemed to imply something around 1.5-2x in when mentioning it previously. Also, any particular comment about Vit C baseline dosage in general?


  66. Jack,

    I really need your advice. Someone very close to me is HIV positive and has been so for about 5-6 years I think. He is only 27 and does okay simply because he takes Altripa, which I am sure you are fimilair with.

    I am trying to get him to eat a Paleo diet of any type but he is having difficulties. I would really love your input on why someone with HIV + status should go Paleo, how should their macro's look? What are the KEY supplements they should take? Are they the same? Whats your prognosis? Can he live till hes at least 50 with a good diet? He has not progressed into AIDS. He gets sick quite often with sore throats and sinus infections but nothing serious and it of course only follows a night of drinking…

    I am very worried about him. I feel like if he heres it from a Doc he'll take it more seriously.

  67. @bill…..this will be quick cause i have to operate on a spinal cord here shortly. I have many HIV patients and most don't die any longer due to the HIV cocktails we now have. Moreover, most are big time paleo lifestylers but most have serious hormone issues because of their cocktails side effects. This is the one group of patients who have huge issues with lipodystrophy and generally need a bigtime protein and fat diet and they are almost all on hormone replacement including HGH due to the lipodystrophy and inability to keep weight on.

  68. @John Regarding your question on Vitamin K2. Most adults in the US are deficient. Studies have shown that subclinical Vitamin K deficiency, is present in most healthy adults. You can read these two articles about this. Nice email and thanks for kind words.

    1. Booth SL, et al Assessment of Dietary phylloquinone intake and Vitamin K status in postmenopausal women. Eur J Clin Nut. 1995;49(11):832-841

    2.Knapen, MH, et al Vitamin K induced changes in markers of osteoblastic activity and urinary calcium loss Calcif Tissue Int. 1993 Aug; 53(2):81-85

  69. @Jeremiah I dont generally make recommendations for supplements. I tell patients to look into to consumerlab.com recs or due their own due diligence on companies.

  70. @tarte-tatin I was referring to the aspartate in artificial sweetners. Phenylalanine in excess can be a problem. Phenylalanine is a major product in many artificial sweeteners in the low carb community. These people also tend to be diabetic and may have a lot neural damage from their diet over the years. This was talked about in my peripheral neuropathy post. DL-Phenylalanine has a role in pain modulation in tough cases when other co morbid conditions are present and being controlled. So the use of phenylalanine needs to be put in context. If you do not have those risk factors or those diseases I could see you using it as a supplement. If you drink a twelve pack of soda a day and are a T2D I think you might be in deeper trouble longer term in regards to the excitotoxin issue.

  71. @ANNA you can ask them to run inflammatory cytokine panels and complement panels. I warn you they are not commonly done and can be expensive but can be very helpful in difficult cases to pin down the underlying mechanisms of why something is going on. Many people with non specific ANA antibody testing who dont fall into an autoimmune disease diagnosis will often have very dramatic cytokine test results. People with gut dysbiosis will also have pretty remarkable changes too. I have often wondered why Rheumatologists dont do more of this testing in these cases and I think it is a combination of knowledge, cost, and no insurance coverage.

  72. @Laney The more I read on Vitamin C the more I think we need. It really is used in a tremendous amount of stress reactions in the body. I also have seen some orthomolecular physicians really get some amazing results while using IV infusions of pretty high doses for treatment of various issues. I dont do this because insurance does not pay for it but if I came down with a serious metabolic disease I would certainly consider it if conventional of alternative therapies failed me. I see no real risk to it. As far as oral supplementation I think pretty high doses are tolerated but from my reading oral dosing dose not have equal effectiveness as IV dosing. I take about 2000- 3000 mgs of vitamin C daily.

  73. PQQ: What are the best "low FODMAP sources" for those without access to the supplements? As with other nutrients like Vitamin C, meat eaters should be deficient going by apparent need and intake, but are they really?

    Could it be higher concentrated in herbs or offal?

    Can we be sure all the PQQ in green tea actually makes it into the liquid? Maybe EGCG supplements to avoid fluoride in tea?

  74. @chang. Here is an interesting article making the links in animals i have already made in humans by observation over the last ten yrs.

  75. Should you take NAC with or without food?

    • @Sandra Gastric absorption rates are higher for most amino acids when taken on an empty stomach. This is likely true for NAC as well.

  76. Dr Kruse – I am going to start your top10 supplement program. I currently take a multi vitamin, C, D, B complex, fish oil. I constantly have issues with bruising. I bruise very easily. Will your top10 help with this or do I need something more? Thanks!

    • @Bev I used to bruise easily too. Not so much anymore. As a surgeon my first inclination is to tell you to beware of excessive fish oil and vitamin E supplementation because this can cause bleeding but I think the fact that I supplement a lot of K1, and K2 is why my bruising went away in 2007. In fact I had my knee surgery done while i was on 9 grams of fish oil a day and 400 mgs of vitamin E.

  77. Hi Jack, great post!!! You didn't mention Niacin, which is one of the first supps you recommended for me when I started Paleo in Feb. I admit I've cut back to 500mg/day (from 1500) b/c it makes my skin itchy. Should I continue taking it at all? Also, what about Folic acid? And still looking for your blog about synthroid, which I've been taking since 2006. Should I wean myself off it altogether by replacing it with CoQ10 w/ Ubiquinol, PQQ and Se supps (none of which I'm taking now)? Although my TSH levels are currently stable (2.99), my hair still falls out in the shower and when I miss a dose, I feel fatigued after 3pm. Thanks agan for all the great advice! You've truly saved my life.

  78. indigogirl says:

    Dr. K,

    I'm PB and on the Leptin reset. How much ubiquinol should I be taking?

    My B12 level is 617…my doc said it's OK, but you think around 1000 is better?


  79. @indigo. Sorry im so late responding but i am on call and its been nuts. I like b12 levels higher. If you have adrenal isues i like lots of ubiquinol with other things like mg and high dose vitamin c too. It all depends upon the context. This question is tough to answer without more data.

  80. @jodi i dont think you need it that much any longer…..considering you did the reset and out now firmly in HIIT mode at crossfit. Your outcome has been awesome. But if you want the truth i hate synthroid because it is synthetic and is not the same as our own human hormone…..and ifnyou want to step it up you need more tests……but as onenof my star pupils your results are nothing short of cool for this doctor. Keep posting fb shots. Your helping lots of my other young moms see what is possible.

  81. indigogirl says:

    Dr. K, thanks for responding. I don't seem to have adrenal issues. I take 2-3 g of C and about 800-1200 mg. magnesium. Is this enough data to determine how much ubiquinol I need? Better – what data determines how much I need? (hypothyroid, psoriasis, allergies, asthma, assuming leaky gut)

    You're doing a superb job educating us and arming us with references to bring to our physicians!

    • @Indigogirl I think the standard dose for healthy people is 100 mgs of ubiquinol. In someone with disease 400 mgs can be considered. If you have serious disease of multiple diseases you can consider 400 mgs twice or three times a day. As the dose of ubiquinol rises I also increase Mg and Vitamin C levels.

  82. Thrilled to have found this blog,but unable to find your Facebook page. Help!

  83. What's your take on dosing for CoQ10 and folic acid? No obvious health problems here, Paleo for about 12 years, about 15 pounds heavier than what I should be (but working on it!). 56 years old, female, very high hdl, very low LDL and triglycerides.

    For CoQ10, would 200 mg daily be sufficient?

    For folic acid, I've read that we are seriously deficient in this, and dosing can be as high as 3 to 8 mg.


  84. I started the mag malate 1 week ago. It causes me blotting and large amounts of gas. Will this go away with time, or is there something else I need to do?

    Thanks for the list as I was lost about what to take.

    • @Raylynn When I hear this I wonder if you also dont have a leaky gut? Do you happen to know your current HDL level? I bet its not the Mg Malate at all.

  85. I am week 13 of reset, and have not had any problem until now. Thought it might be the mag since I was very bloated the first day after taking it. Seems about an hour after taking it I develop gas. Bottle states it has 425mg of mag as malate. Maybe too much?

    Also, my finger nails and hair are growing very fast now that I am taking the vit d3. My level was 42 when drawn in September, so I'm thinking it has come up some. I consider that to be a positive of the reset!

    Thanks for answering.

  86. Hi Jack love the blog, thanks for spending your free time giving back like this. I am 31 yr old male, no known major illnesses but also no health insurance for about 4 years now. I had been running 40 miles a week for the past several months and have what I believe to be a stress fracture in the top of my foot. So I am stopping running for the standard 6-8 wks recovery time, started on Paleo again. From this I found your site, as someone who binges on sweets it is the holy grail. I currently take a multi, krill oil, 3000iu D3 and 500mg C, and money is always in short supply around here. So I wanted to ask what supplements would you take from your list above if you could only add 2 or 3 to your regimine.

    Thanks again

    • @Trevor. You might consider these recs for your specifics that you gave above. I would first stop running and heal my foot with a four month course of vitamin D3 (10000 iu a day) and two tablets of vitamin K2 (mk-4) a day. I would replace running with lifting very heavy things three times a week for 30 min a time with low reps and high weight. id also take 10 mgs of PQQ as well.

  87. Dr. Kruse, I have never heard of PQQ & some of the other supplements you mention, & would like to find them. (A google search turned up places I know nothing about for quality.) Given the minimally-regulated nature of supplements, can you recommend a reliable source for the supplements you list here & elsewhere on your site? I don't want to just go out to amazon.com or any old health-supplement site on the internet.

    • @Mimi Diet I would suggest you look into consumerlabs.com. They make these kinds of recs after they test the products and give you in depth answers about brands. Then you can be an informed consumer.

  88. Or recommend brands?

  89. Dr. Kruse, could you give some more hints about combining/not combining the supplements you r talking about in this article? Since I currently usually eat only once a day, sometimes twice, I would prefer to take most of the supplements recommend above more or less together during this one meal. Except for magnesium citrate, I drink that in the evening some hours before bedtime. I also avoid drinking tea (green, black, …) to the meals. And I don t take a multivitamin since I feel they are too unspecific and additionally most other supplements I take anyway contain different vitamin combinations so that I m kind of balanced over an entire week.

    Also please give me your ideas about supplements/doses for a 30 year old man who suffers from ADD and was a heavy drug abuser during the past years (mostly marijuana on a daily basis, occassionally amphetamines). He quit smoking months ago and switched to strict Paleo some weeks ago & following your recommendations for leptine reset. He always felt and still feels the need to eat horrendous amounts despite the fact that his stomach is full and already hurting. He always stayed rather skinny on the outside but has around 18% bodyfat and also looks "unhealty" and deadly fatigued. Since Paleo he also has the urge to eat lots of pure cocoa powder (100%, no additives) – around 2-5 table spoons a day with his meals (Serotonine? Tryptophane? Anti-oxidants? I guess the phytic acid might become a problem). It appears that his system is deranged by the munchies/binge eating with times of not eating at all from years of smoking weed and I wonder how he could especially support his body in getting things into order. Something like 5-htp? Tyrosine? Glutamine? Probiotics? Anything else?

  90. hello, I have both hashimotos and graves, manifesting in a hyperthyroid form. I have been in the midst of a flare for almost 6 months,can't seem to pinpoint why. I follow a relatively paleo/primal diet (however my carbs are probably in the 100- 150 range because I get ravenous easily…). Have noticed that I am unable to lose any weight and have put on 5 lbs in 5 months. Latest rt3 is 579. TSH undetectable. Salivary cortisol test is low in eve, normal other times. I am female, 5'9, 155. Also trying to get pregnant. I have a fatty liver (on sight only, tests are fine), slightly elevated Tri, extremely low LDL (can't recall number) and normal HDL. 109 fasting blood glucose. On 150 mg PTU daily. Does a high rt3 mean LR for sure? Should I focus on changing the LR or will that not be ideal in my current hyperthyroid state?

    • @Wesley Those number signify something is up. And I would suggest you see a doctor for a work up. I think the reset would help you immensely but I think getting baseline labs is a smart move first.

  91. Grammasmitty says:

    I've been taking an iodine supplement (Iodoral) for 3-4 months, dose 12.5 mg every day. I've read several times in different places that if you put iodine on your skin and leave it for 24 hours, it will be absorbed if you are deficient in iodine, but if not, it will not absorb. I gave blood just a couple of evenings ago and asked them to leave the iodine on my arm and was careful not to rub it off with anything. It totally disappeared after about a couple of hours.

    My question is, is this dosage too high? Is it OK or toxic? I have an appt. with a new doctor (holistic/natural treatments) but can't get in until January. I know I am very LR, IR, AR and will attack that problem when the testing is done. IN the meantime, what about the iodine supps?

    • @Grammasmitty testing would clear this up. I also would strongly suggest if you absorbed that much iodine that you start supplementing a bit of Selenium to prime your thyroid enzymes first.

  92. Henk Poley says:

    About point 10. "DHEA/Melatonin", are you sure it's not a simple D3 and B12 deficiency that needs to be corrected? See: http://www.youtube.com/view_play_list?p=35D93D525

  93. Henk Poley says:

    @Grammasmitty, just check scholar.google.com for "iodine (skin OR cutaneous) absorption".

    Off the top of my head only 10% of the iodine is absorbed through the skin, iodine converts to iodide because it's not very stable. Your body (thyroid, sexual organs) mostly needs iodine.

  94. I had been having problems sleeping, waking up after 5 hours and sometimes not being able to get back to sleep. During the summer I did my 2nd round of HCG and lost another 20 lbs for a total of 40. Then found Paleo and Leptin RX. Been doing Paleo for about a month. I found and started taking the following from your suggestion: Ubiquinol in 50mg tabs, PQQ 20mg, Vitamin B Complex 2 tabs daily, NAC 2 750 tabs, Omega-3 2 softgels. I am not sure how much of everything is the right amount. For the first two days I took everything in addition to my Multi Vitamin and D3 (15,000/day) I slept much better. Then today woke up after 4 hours of sleep ready to go. If I just lay there it is very upsetting so I got up and got to work. I'm a little leary to start taking DHEA on my own since it is a hormone. Is it safe to take without Dr. advice?

    • @ Pam I always like testing before DHEA recs. That being said most people have horrible DHEA levels after the age of 35. This is further found by testing IL 6 levels which correlate with low DHEA levels to a great degree to show massive sleep problems. All sleep problems cause metabolic alterations as well. One cant be optimal until sleep is restored.

  95. Grammasmitty says:

    Thank you for the reply. Have been supplementing with Selenium 200 mcg 4x a week for nearly 2 years. High Iodine dosage began about 4 months ago.

  96. Grammasmitty says:

    Oh, I also take magnesium citrate, potassium, small amount of calcium, Vit E (mixed tocopherals), D3 (10,000 a day), zinc, Ubiquinol, resveratrol, Alpha Lipoic Acid, L-Carnatine, C, high dose multi B, astaxanthin

  97. What part of parsley contains PQQ? Leaf or root?

    • @Daniel Great question. First off, parsley loses vitamins in the cooking process. In order to coax the most taste and nutrients from parsley, add it only at the final stages of cooking or sprinkle fresh over prepared food. Parsley is known as a rich source of a host of vitamins and minerals, including vitamin C (3 X more than citrus fruits), folic acid, beta-carotene – pro-vitamin A, potassium and magnesium. But lately it's been glorified yet again, this time by the Asians: Japanese research has recently discovered a new B vitamin (13), pyrroloquinoline quinine (or PQQ) is loaded in the leaf portion of parsley. PQQ, which is most likely connected to the vitamin B group, is involved in encouraging fertility, and researchers believe it has other health advantages for mitochondrial optimization and maximizing exercising effects. Good sources of PQQ are parsley, green tea, green pepper, papaya, nato (fermented soy beans) and kiwi. Eat the leafs and eat them raw!


  98. Dr.K

    For someone on a good Paleo diet with scalp dandruff, eyebrow dandruff, hyperkeratization issues, acne, dryish hair and skin, I have tested serum B12, folate and Mg. B12 is low at 300 pmol/l, serum Mg and folate are within range. I have read that you do not like serum Mg, but it is the only one available and I do not know other ways to measure Mg or detect a possible deficiency. Can Mg be too high as I see an old 4 year test that shows 1.58 mmol/l (0.7-1.2 lab range) or is it a useless test? I will be addressing my B12 deficiency shortly with supplementation, but wonder who is the bigger culprit for my hyperkeratization issues Mg or B12?

    • @crepitus This sounds like its eczema. When I hear this I have several thoughts……treatments first then considerations for root causes…….i bet you just want treatments! LOL First one is liberal use of coconut oil or olive oil topically applied to areas of interest. Next I got to high dose of 200 mgs 3 times a day of Vitamin E (a mix of all tocophrenols) with high dose Vitamin C (10-15 grams a day) You can also consider primose oil, Omega 3 or krill oils too. Probiotics are fine too because gut dysbiosis is a major player here too. Grandma say take Burdock root 300 mgs with each meal.

  99. Love your blogs and have a question I hope you can answer. I recently developed osteoarthritis in a couple of my finger joints (heberden's nodes) and have heard that this is common in postmenopausal woman. Since I am aiming for optimal rather than normal, what supplements would you recommend for this condition and will it cure it or stop the degeneration? Thank you for all of your generous time in answering questions and educating so many of us.

  100. I am wondering about Heberdens nodes too. Causes and how to reverse it.

  101. I just realized I am taking ALL of your paleo supplements except PQQ (I can't find it in stores) lol…quite a bit of cost there. I'm using them sparingly though

  102. Just got all the recommended supplements and started taking them. We'll see how it goes.

    And what Sue asked … I have NO cartilage in the middle joint of one finger (it is ugly swollen and PAINFUL) and am seeing/feeling similar bumps on several joints in my other hands (I blame it on decades of pounding typewriter keys … yeah I'm THAT OLD).

    I've been taking omega rich fish oil for a while and glucosamine for several years.

    ANY suggestions would be appreciated.

  103. From your experience, how do Vitamin K2 MK-4 levels respond to supplementation? I know this will be an individual thing, but can you give an average recommendation on reaching good levels fast and when to reduce to maintenance levels, say 1mg?

  104. I am a CF athlete without any known metabolic conditions,would these supps still be useful?

    • @Emmitt depends upon other factors but if you are fit and eating a paleo diet for a long time you likely wont need many supplements.

  105. Hi Dr. Kruse,

    I'm using/recommending bioidentical transdermal DHEA cream. The delivery makes sense since DHEA is used in the skin and you avoid the first pass of the liver when taken as pill form. I'll have a sample sent out to you by the company, see if you like it.

  106. Hi Dr.K Fantastic site, highly informative.

    Wish i had seen this years ago.

    I have had diabetes and hypothyroidism now for 3 years.

    The diabetes is contolled without medication, just fairly low carbs (approx 100 a day) and exercise,This helps me loose some weight, I weigh approx 5kg over the norm for my size.

    for the hypothyroidism I take Eltroxin 50mg daily.

    My HB1ac was 105.5 mg/dl 2 months ago, So my diabetes is reasonably well controlled, Imho.

    I know a few years ago when I had vit B12 checked it was low,

    below 180 (I recall the range on the chart was between (200 and 600 picogram/ milliliter ) this was actually the time I was told I was diabetic, just a few months later I was told I had hypothyroidism too.(makes me wonder if this was the cause) #

    I asked the clinic if i should take vitamin B12, they said no as it always changes depending on your daily meal. ,so I took no supplement.

    My total cholesterol a few weeks ago was circa 230 , the total now is just over 271 , I expect this is because I am on a high fat low carb diet(30 carbs a day) which I started only 3 weeks ago.I have already lost 2.5 kilo's,;) when In ketosis the total cholesterol would be raised for a few weeks.

    As I expect when the body burns stored fat , the total cholesterol reading would be higher.Does this sound logical ?

    As now the total cholesterol shows 271.

    And when my blood sugar averages are taken during the day are 15% Lower,which I am pleased with, especially when eating more fat in my diet.

    I do not take any vitamin/mineral supplements.at the moment.

    Are the 10 supplements above suitable for some one with type 2 diabetes and hypothyroidism ,

    Especially Co Enzyme Q10,As as I read somewhere it is not suitable for people hypothyroidism,

    And regarding goitrogenic food , like cabbage , is it okay to eat when cooked are the goitogens removed under cooking.

    In referance to medium chain triglycerides such as coconut oil , In your experience , would this help reduce triglycerides.

    I am doing the low carb high fat diet with exercise to lower my cholesterol as I prefer not to use a statin unless absolutely necessary,

    First I suspected the diabetes was the cause of my higher cholesterol, but my diet and exercise are reasonable,

    So now I suspect it maybe because my thyroid is not managed well, perhaps I need more than Eltroxin ,maybe the T4 in it is not being converted to T3,

    I asked my Doc, to do a blood test for this he just said take a statin , thats the best way but I do not agree,

    I sure would like a second opinion on the options I am taking.



    • @Shakeel In my opinion I would tell you to concentrate on eating a ketogenic paleo diet high in MCT for 2-4 months before you take any supplement. If you were going to take just one supplement I would make it magnesium. Two……PQQ. I also would suggest you follow the rules outlined in the Leptin Rx for the same length of time. My bet is your labs will shock your doc and then maybe we can convert him. When they ask you how you did it copy my blogs and hand it to them. Then have them call me for some brain surgery over the phone with some thoughts.

  107. Thanks Dr.Kruse, ,

    in regards to the Magnesium would magnesium Malate be fine,

    thanks for your opinion,It is certainly appreciated,



  108. Question about dosing on Iodine and side effects. I see note/comment above about insomnia as a side-effect.

    My wife was given a 12.5MG (12,500mcg) bottle and has been taking that daily. Seems way above what you suggest in your blog post.

    What kind of side-effects would we likely see?

    If she's eating fish/seafood 1-2X per week, is it acceptable to supplement with this higher dosage pill only 1-2X week as well?

    Should she just find a lower dosage Iodine supplement?

    How about taking supplemental Selenium to "pre-load" per your note above – suggestions, help would be appreciated.

    • @Kevin this is a great question. In the June 2011 FASEB journal, Dr. Bruce Ames revealed why most modest vitamin or mineral deficiencies can appear as we age. He calls it his triage hypothesis and I agree fully with it. With regards to Iodine I think most people in the paleosphere are regurgitating bad info. I always recommend pre loading the thyroid with a lot of Selenium for two to four weeks before beginning an iodine product. Humans have 12 selenoproteins, of which 5 are considered essential from a human evolutionary perspective with 7 being non essential. The body conserve the selenium for the top 5 and not the bottom seven in aging and in disease so we have a major problem. If you add iodine when you have a "low gas tank" in selenoproteins people blame it on the newly given iodine when the real truth is that it was the lack of selenium all along. Selenium is more important than most imagine for many thyroid disorders. I have told my readers that one brazil nut every other day is a great way to replace selenium naturally.

  109. Do you have an opinion on the iodine protocol outlined at Breast Cancer Choices? http://breastcancerchoices.org/iprotocol.html

  110. Thanks Dr. K! Okay, time to have her load on some selenium (1 Brazil Nut po every other day) – once she's done that for several weeks, should she be taking that high a dose of Iodine (12,500mcg po 1X Daily). Seems like a mega dose???

  111. Daniel Han says:

    Weirdly, I have allergies to all the tablets/capsules I've been taking. I don't know if its the magnesium stearate, glycerin/gel capsule components or titanium dioxide, but my skin cleared up nicely after I stopped all supplements. Just FYI as some people may have minor issues and would prefer powder form. I no longer need supplements though.

  112. Daniel Han says:

    Any thoughts on the omega-6 GLA i.e. evening primrose oil?

  113. I take iron supplements, and was told by the doctor who recommended them that I shouldn't take them with calcium supplements or any high-calcium food or drink (milk, yogourt, etc.).. . Can anyone tell me approximately how close to each other I can have an iron supplement and a cup of coffee with skim milk, without affecting the absorbancy of the iron?. . Thanks!.

    • @Gorah The answer depends upon your gastric emptying time. It you have no gall bladder you are going to have a major problem.

  114. Hi doctor Kruse!!! Please help me out here! I've been doing your diet for 6 months, all my cravings are gone, all my skin problems are gone.

    The only issue I have is zyrtec : I've been taking zyrtec (an antihistamine, though I'm pretty sure you already heard of it) for a long time. When I stop taking it, I get insomnia and horrible hives. What can I do to minimize these reactions? I wanna stop taking it once and for all, as it only makes things worse.



    • @Bruno Quercetin is a naturally occurring antihistamine. Why not try this as a replacement for a N-1 experiment. Keep us informed how it goes.

  115. Hello Jack,

    Thank you very much for taking the time to share your discoveries with us, the general population. I really appreciate it.

    I was looking to ask a question on the blog, but the response page wouldn't come up, so here I am.

    I was reading in the blog that antioxidants are not as effective when taken with dairy.

    Can you tell me please, which of the TOP 10 Leptin Reset supplements are antioxidants, so I can be sure not to take them with my soured raw milk (keffir) for breakfast?

    Thank you very much once again Jack. I appreciate your time.

    Kind regards Lee (Australia)

  116. Hi Jack

    I was just reading that almost all ocean fish are rich in selenium. I found the article here: http://www.vitalchoice.com/shop/pc/articlesView.a

    Was also wondering if Astaxanthin can be taken in place of CoQ 10? Just doing all my research before I start on the Leptin Rest Protocol.

    Hoping your day is going well, Susan

    • @Susan Im glad to hear you are doing your due diligence. You need Co Enz Q10 because of of theIf you look at the Mevalonate pathway for cholesterol synthesis. Take a look at this link. http://en.wikipedia.org/wiki/Mevalonate_pathway. One of the feedback loops for upregulation and down regulation of this pathway is serum Cholesterol levels. Since our Paleo approach has a higher intake of dietary cholesterol, it's plausible that HMG-CoA levels ( the rate-limiting enzyme in Cholesterol synthesis in the Mevalonate pathway) will be pretty low and the whole pathway itself will be pretty suppressed or down regulated. This has major implications to CoEnzQ10 too. Why?

      This pathway is also used to synthesize Ubiquinol (Co-enzyme Q10) in parallel to Cholesterol (not downstream of Cholesterol).

      In effect, our high cholesterol intake will have the same impact as Statins (suppress HMG-CoA levels) and Statins have been shown to decrease Ubiquinol levels in several studies. Here is the ultimate irony for you and your doctor. Most people when they change to a strict paleo template notice their LDL cholesterol goes up because we are forcing their mitochondria to move from a sugar burning metabolism to a fat burning metabolism. This effect is from hepatic LDL synthesis of the mitochondrial change, but the effect in the other 19 trillion cells in our body is that a paleo template actually lowers cellular production of cholesterol naturally because it reduces cellular stresses and controls cortisol release. We just cant assess it with a clinical blood sample because the liver's LDL production overshadows the rest of the bodies decrease. This is precisely why I tell all my patients I could care less what your LDL lipid profile says when you change to a paleo template. After 18-24 months you will notice your serum cholesterol levels normalize as the liver catches up to the rest of your body. This is also why lipid profiles are useless when someone is actively losing weight or changing their diet.
      The only things I care about in a lipid profile while you are changing is your TG and HDL levels. Why? I outlined that in the blog about what your VAP really tells us. I hope you now fully get my angle. The astaxanthin is something that is one of the more potent anti-oxidants to offset osteoarthritis, joint, muscle and bone disease. Totally different reason to use it and not tied to the CoEnZ Q10 rationale.

  117. Dr Kruse, thank you for all this, it's fascinating! Please keep writing!

    My questions:

    1. What are the best natural sources of PQQ, is drinking of quality green tea sufficient?

    2. What to make of natto (fermented soy dish)? High in PQQ and K2, but not paleo.

  118. @Jack I stopped taking Zyrtec a week ago. As I didn't have quercetin I bought it but it hasn't arrived yet (I only bought it friday, it should arrive wednesday morning). To be honest though, I'm not sure if I'm gonna need it : I only have mild itches, nothing serious at all.

    This is pretty cool, as in July I stopped zyrtec too and I started to have quite some rashes. I did eat eggs at that time though. Now I just eat grass-fed beef, vegetables, some lemons, herbs and coconut oil.

    I may try quercetin though, just to see what it does, and if I do I will report back.

  119. Do you recommend taking L-Carnosine as a supplement?

    • @Suzanne Nope……Why? If you are eating a paleo diet…..and I hope you are you should be getting between 1000 to 2000 mgs of it a day already

  120. I do my best to eat a paleo diet. Wild fish and grass fed meat are not so easy to come by in Germany and both are very expensive. I truly hope and believe that demand for such things will make them more available and affordable. I suppose I had the thought that a supplement might help.

  121. Dr Kruse, I have been on the leptin reset for about 5-6 weeks now. A doctor told me that vitamin d is stored in bodyfat, so if one is overweight, is there any point in taking it, if it's only just going to be sitting in bodyfat doing nothing? Is this true?

    • @ontoit Your doc is partially correct. Excess Vitamin D is stored in the fat. Very few of us have excessive Vitamin D. Where vitamin D is stored is in Vitamin D binding protein in humans. I wrote about that here. Vitamin D-binding protein belongs to the albumin gene family, together with human serum albumin and alpha-fetoprotein. It is a multifunctional protein found in plasma, ascitic fluid, cerebrospinal fluid and on the surface of many cell types. It binds to vitamin D and its plasma metabolites and transports them to target tissues.

      Help support your doctors education and give him a copy of my vitamin D blog and tell him about this answer. A great doctor loves to learn. A good doctor will be turned off by a patient who tries to help. A bad doctor will tell you the internet is loaded with garbage without reading the supposed garbage to make a better guess if this is true or not.

  122. Hi, Dr. Kruse,

    I "only" have about 10-12 pounds left to my goal, but have many other "issues (ha!)." I won't bother you with them, but think the Leptin Reset will help me. I have d/c all my coffee (two cups/day) and replaced it with a small mug of matcha green tea in the a.m.(which still has caffeine, but I assume is better for me?). I drink herbal tea with stevia throughout the day (even between meals)…

    What are you thoughts with drinking green tea after taking my supplements? My friend said they interact with absorption. Do you think this is true?

    Also, I have d/c my morning whey shake, too. Had no idea it was so bad for me. I did see your shake you make with the raw eggs (sans whey). Looks interesting! Would this be okay to have with, say, a few strips of bacon on the side for a BAB on the Reset?

    Thanks for your time and hard work; I really enjoy this site and am learning a ton!

  123. My tongue was not a very pretty thing as far as I can remember! It was full of plague not matter what I did. The edges were uneven and the tongue was bumpy. All of a sudden, I noticed that my tongue is smooth, even and pinky. I also realized that my saliva tastes different – a sort of sweet and fresh. There is no bad breath. Another good and unexpected benefit.

  124. Hello DR.Kruse.

    I want to buy a wholefood multivitamin supplement and i did found one supplement it is really good and from a famous manufacturer but i did see it contains Glutamic Acid HCI is it safe to take it?because i think i did read it is the same as monosodium glutamate i may be wrong this why i am asking you.

    Or do you recomend some good supplement?

    Thank you.

  125. Thank you Dr.Kruse i will take a look

  126. I have heard that to much beta carotene is not good. Most multi vitamins seem to have it, so what is your recommendation for the maximum amount of beta carotine that should be in a multi vitamin?

    Thank you

  127. Hi Doctor,

    I find your posts very insightful. I am 47 y/o female with diagnosed hypothyroid. Taking levothyroxin daily, but still feel sluggish, cannot lose weight, with poor memory function. My T3 and T4 levels are within normal limits. Exercising is very strenuous for me and I feel like I have absolutely no metabolism whatsoever. I feel like my homeostatic functioning is completely whacked. I know my diet is poor. Too high in fat, I'm sure. I do eat a lot of protein though. I love meat and shellfish. I currently take Garlic, Omega 3, Vitamin D, and folic acid. What is another change that I could make to increase my metabolic rate? How can I know if I"m iodine deficient?

  128. Dr. Kruse, I have been on Leptin RX for over 10 weeks.

    and lost at least 6% body fat.

    I am still studying hard to improve my understanding of leptin and our internal weight regulation system. Last week I came across this article (http://news.harvard.edu/gazette/story/2009/01/obesity-reviving-the-promise-of-leptin/). From evidence based on experiments done on mice, the article suggests that we may be able to restore leptin sensitivity by using TUDCA(Tauroursodeoxycholic Acid. Supposedly TUDCA does this by reducing ER stress. However, the dose used on the mice is 150mg/kg/day, and I plan on taking 1000mg a day. Do you think there will be a noticeable effect? I know I am genetically prone to leptin resistance from family history.

    I am only looking into this because my fat-loss has stalled for three weeks at 18% body fat and in spite of consuming less than 30 grams of carbs daily with 2100 calories of 50:50 protein to fat caloric ratio, I still feel hungry most of the time. I follow the leptin rx very strictly.

    • @Jae one of my colleagues who works with my uses TUDCA in his protocols for leptin. John Scott Major is his name. TUDCA has direct effects on leptin too…….but i have decided for me not to use any Rx drugs for my N-1. I think when you find something that is built into our DNA its best to let it self correct us back to allostasis. I think the big mistake in our paleo community is too much tinkering. I use the data from 2 million years of a RCT to dictate my decisions now…….not a panel of experts or hackers. How I hack diseases is decidely different than any one I know who does it. And Jae I had plateau's often over my first three years doing it…….that is part of the reset. Just surf the leptin wave to optimal……..dont fret or worry about tinker. You will become a rockstar soon enough. Enjoy the ride because it is amazing

  129. I'm very excited about all of this. I'm 53, obese, T2D (my blood sugars dropped dramatically when I did low-carb for a month in October)and I'd like to try the Leptin Rx. Do you have a recommendation for how to find a physician in my area to do a workup and blood tests before I start? Do you have a list somewhere of all the labwork you recommend? I am near San Francisco. Thanks so much for sharing all your knowledge and research!

  130. Larry Daher says:

    Dr. Kruse,

    Thank you so much for the information you provide. I learned of you for the first time last week via the Jimmy Moore podcast & I have spent a lot of time since then exploring your website. I have a question in regards to Vitamin K2 & spinal stenosis: do you know if there is any correlation between k2 deficiency and spinal stenosis. My father suffers from stenosis but is nervous about supplementing too much with k2. Any knowledge or studies about which you know would be greatly appreciated. Thank you again.


    • @Larry epidural steroids weaken bone by increasing cortisol and lowering vitamin D and testosterone……..K2 strengthens them. He could take up to 45 mgs a day like they do in Japan. I believe this is in the blog post too. K2 is quite safe

  131. Thank you very much Dr. Kruse.

  132. Dr Kruse do you have an opinion on soil based probiotics? http://drcarolyndean.com/2011/09/eat-dirt-it%e2%8


    would either of these be of any benefit for those of us with gut issues?

    I'd appreciate any thoughts

  133. Dr. Kruse, I take fish oil, D3, multi, Magnesium. I also take three prescription pills: ambien every night (can't sleep without it–i've had 2 sleep studies done. diagnosed with "insomnia" duh and "restless leg syndrome"), I'm on bcp for PCOS, and I take metformin for PCOS, not diabetes. I suffer from abdominal obesity, weigh about 205 (i lose a little then stop–abdominal weight doesn't budge), I can grow a beard, and I'm built like a line backer. I have poor exercise tolerance. Shortness of breath soon after I start. I currently slow-burn weight life 1x a week. And I eat low carb. Any ideas of what's going on with me?

    • @Jenny your a diabetic in waiting and your ctokine array would look like the best fourth of july display ever……you need to go VLC paleo and you need the Leptin Rx stat. Its time for you to totally change and change fast. Go to MDA on the nutriton tab and ask to speak to Shinjin on the monster MDA thread with my name on it……she can help you adapt. MDA= http://www.Marksdailyapple.com

  134. Dr Kruse, I can get coconut oil in many different varieties: fully fermented, lightly fermented, unfermented… from green coconuts, from ripe coconut… pressed and packed the same day as picked or sun dried and pressed/packed later. All organic, no chemicals used in processing. (This is what luxuries are afforded to you when you live in the Pacific!). Do you recommend one sort over another?

  135. I am 37, have osteoporosis, messed up hormones with no estrogen (no period since 2009), low T3/T4 (hypothyroidsm), and too much stress so a Leptin Recet is needed now. I am vere tired – absolutly no energy and I feel old.

    I have been dieting since my teens,eating tons of sugar and bread. Have read the chapter about insulin yesterday – I am not surpriced that I have osteoporosis, stress and bad metabolism.

    2007 stopped sugar but stil eating bread and fruit.

    Nov 2010 started Atkins

    1/1 2012 Paleo

    24/1 2012 Leptin Recet – I LOVE IT

    Since nov 2010 I have had 20-25g carbs a day, and for the first time in my life normal bloodsugarlevel.

    I note what I am eating at the monent so I know how to balance – a normal day has 1800-2000 calories, 120-135g protein, 20-15g carbs and 115-140g fat. Is that ok?

    Here are my lab-tests and the witamins I am taking:

    I take combined D3/K2, Bone strength, Multi vitamin, C-vitamin, Silica Complex, Magnesium Chloride and then Erfa thyroid + Pregnenolone + Selenium before bedtime, and I have B-complex that I havent startet at yet.

    In all it is:

    3,000mg C-vitamin

    1560mg Magnesium Chloride

    186mg Elemental Magnesium

    200mcg Selenium (+62,5ug)

    Boron 1,700 mcg (+50ug)

    Copper 2 mg

    Zink 30mg

    K2 145mcg (+100ug)

    D3 2,000IU (+7ug)

    Manganese 3mg

    Calcium 1,200mg

    Magnesium 700mg

    Pregnenolone 25mg

    Erfa Thyroid 3½ grain

    Perhaps I get too much???

    My lab-tests:

    D2+D3 total 131 (50-160)

    Potassium;P 3,8 (3,5-4,6)

    Sodium:P 139 (137-145)

    TSH 0,01 (0,3-4,0)

    T4 Free 15 (10-26)

    T3 total 1,21 (1,20-2,8)

    anti-TPO 40 (0-60)

    SHBG 218 (?)

    Testosteron free 0,0028 (?)

    ACTH 22 (?)

    LH 2,9 (?)

    FSH 13,7 (?)

    Prolactin 115 (64-432)

    Estradiol 0.03 (?)

    estrogen free 0,2 (?)

    Cortisol 421 (200-600)

    The bloodtest was taken at 11.20 AM

    Can I stop my osteoporosis and build bone again?

    For now I just want to say THANK YOU, because you give me hope – that means so much to mee.

  136. I have been reading ever since your answer :) So what I have found out is that my stress is a BIG issue in this – everything that I have been doing with diet, exercise, has been wrong – that is why I have osteoporosis today. And after reading I know what to do now, but my question is how much D3, K2 and magnesium do you recomend when you look at my lab-test ?

    When I took the lab-test i had breakfast about 5 hours before and some witamins – I was not aware of I was about to have any blood test taken that day – so perhaps I cant use the test to anything. If that is the case how much do you recomend as a safe dose of D3, K2 and magnesium?

    Do you think I get enough calcium when I only eat 20-25g carbs a day?

    Will I benefit from Krill oil?

    Hope it is not too many questions

    • @L My vitamin K2 blog lays out what you might consider shooting for. I can't tell about your D level because they are in european units so I can't say. I love Krill oil for osteoporosis, actually any muscle skeletal disease truthfully. You do not need excess calcium.

  137. I have combined D3 1,000 IU with K2 45mcg – would it be safe to take 3 of them 3 times a day so I in all take 9 of them? or is it so small an amount that it will not have any effect?

    And magnesium perhaps 1.000- 1500mg a day

    And 3.000mg krill oil

    • @L I have no idea what your D level is but I can tell you this…….1000 IU of D3 is pissing in the lake. That is a dose I would put a 2 yr old on. You need 5000 IU to 10000 IU a day. K2 45 mcg barely replaced your RDA assuming you have no leaky gut and have a gallbladder that works. Way too low for me too. 3 mgs of Krill? I use 500 mgs to 1500 mgs a day!!!!! No wonder your spinning your wheels! You need to discuss this with your doc and ask why they are using such low doses?

  138. Thank you Jack – D3 is going to be 10000 a day with 45mg K2 and 1000mg Krill.

    I have read somewhere that K2 has to be the MK4 to work properly – should I look for something special in D3 and magnesium?

    In DK most doctors belive that balanced meals (lots of carbs, lov protein and fat) will give you more than enough of the vitamins you need – Supplements is a waste of money!!! So I dont think that I am going to get any help from them :)

    • @L I agree on MK 4. Make sure the D3 has no omega six oils. I like D3 that has iodine added. On Mag avoid oxide……poorly absorbed. Also you can use epsom salts they work well and are cheap

  139. Hi Jack: Wondered if you recently saw the piece on LEF (link below) saying that retinol/Active Vit A (not Beta-carotene/Pro-A) competes with Vitamin D and can actually make D deficiency worse. They are suggesting avoiding multi-vitamins until the manufacturers stop putting so much retinol in A and limit to beta-carotene.


    • @Ben G I had not but I can tell you it does not surprise me. All the fat based vitamins need to be gotten in balance. Here is the interesting thing……Our food supply is mostly devoid of K2 and D3 for the most part……It has decent amounts of A. So what is worse worrying about toxicity or deficiency? Since I have been seeing people for 15 yrs I have yet to see on patent toxic on any of these vitamins but many hundreds deficient in some or all of them. So I view this through that optic. As a clinician I am going to worry about what I see most commonly. I do think there is a greater risk of toxicity today because people are aware of the deficiencies present and they might over supplement to compensate for it but I do not think this is a yesterday of today problem…….it could be a tomorrow problem in certain subgroups like the primal/paleo world.

  140. PQQ is pretty expensive, is Nattokinase 2000 fu's, a good substitue?

  141. Jack, have you read any research on melatonin causing frequent urination? I had been taking 3 to 5 mg for couple of months, but I was getting up twice a night. I stopped for a couple days and noticed I no longer need to get up and sleep thru the night.

    • @Jerry Melatonin usually cause the abolishment of nocturnal urination and does not cause it to my knowledge. If you're are going the reason is not melatonin. On January 16, 1997, the New England Journal of Medicine published the most extensive review about melatonin that has ever been published in a conventional medical journal. You should take a look at it.

  142. You state you only recommend DHEA for men after testing. What are you testing for in this case? I am 47 and have rather low testoterone (300's) ref range is 250-1000. Should I talk to doc about DHEA?

    My Vit D is great at 80, other labs look great, too.

    • @Tim talk all you want but without a test I would not treat you…….go get a DHEA or DHEA-S level done. You can do it yourself and you can buy your own DHEA after you know how bad your at. You do not need a doc for this one.

  143. Thanks Jack.

  144. Doesn't DHEA matabolize to Estrogen? Would it be better to supplement with Pregnenolone?

    • @Pat not all the time……..it depends upon intermediate drivers of the enzymes reaction. This includes the effect of temperature……low temps stop the conversion of DHEA to increase it to pretty high levels. High IL-6 levels force the conversion away from DHEA

  145. Am I correct that Pregnenolone converts to DHEA? Would Pregnenolone supplementation work better or not as well as direct DHEA supplentation? My DHEA levels are good for my age (61) but I've been told that I should shoot for levels of a 40 y.o. male. I tend to run high E2.

    • @Pat Going to make your head hurt………The biosynthesis of dehydroepiandrosterone (DHEA) from cholesterol involves only two enzymes, both cytochrome P450s. The conversion of cholesterol to pregnenolone is mediated by cholesterol side-chain cleavage enzyme (CYP11A1), which is found in the mitochondria. The cleavage of pregnenolone to DHEA requires both the 17alpha-hydroxylase and 17,20-lyase activities of CYP17, which is found in the endoplasmic reticulum. These conversions require pairs of electron transfer proteins or redox partners, which are adrenodoxin and adrenodoxin reductase for CYP11A1 and cytochrome P450-oxidoreductase and cytochrome b5 for CYP17. In addition, the steroidogenic acute regulatory (StAR) protein regulates the flux of cholesterol into the biosynthetic pathway and represents the mechanism of acute regulation. Finally, in addition to possessing CYP11A1 and CYP17, it is equally important that a steroidogenic cell not contain other enzymes that drain the flux of pregnenolone to DHEA. These characteristics are illustrated by the fetal adrenal cortex and the zona reticularis, which are dedicated to the synthesis of DHEA and DHEA-sulfate.

      The excess E2 can hurt the flux conversion……You want high pregenenolone levels and low E2 levels…….and not for a 40Yr old…….you want to be in the top quartile for a normal 25 yr old for optimal.

  146. Dr. K, here is an idea: would it be possible to make a synthetic molecule, similar to leptin, which activates the leptin receptor even in the presence of inflammation?

    Obviously, this is far from an optimal or desirable solution, it may have unintended consequences, and it may not even be possible. But it could greatly improve the lives of millions. And, no doubt, it would easily be the best-selling drug of all time.

    I'm thinking that such a drug would make the leptin reset phase easier–you could loose weight in spite of inflammation, then, as the weight came off and the inflammation goes away, you could wean yourself from the drug. Is anyone working on this strategy? Is there a supplement that might do the same thing? Thanks.

    • @Jerry Amgen has done this and failed. The reasons are many. When I get finished laying this all out you will understand why I did not go into more depth because the answer is found in the biochemistry. You cant out trick evolution with synthetic drugs

  147. So is it better to supplement with DHEA or Pregnenolone?

  148. Ok, thanks. DHEA is one of your Top 10 Paleo Supplements and mine is consistently low (166 mcg/dL) so I should supplement. But my E2 is high so I thought maybe Pregnenolone would be better. I guess there's no "right" answer.

    • @Pat there is a correct answer……but we are getting too close to practicing medicine here. When I am ready for skype consults you would be wise to consider that. I have many thoughts about your issues.

  149. Would k2 help with back pain?

  150. Thanks Dr. Jack. I hope it's sooner rather than later, as my life is basically on hold.

  151. Dr. Kruse,

    Thanks and I understand. I didn't know about your planned skype consults but I won't be able to participate. I'm lucky that I have limited internet access here at the VA. I'm just dreaming anyway as the docs here aren't going to give me any hormones. I'm what they call a short timer. But they've been calling me that for 40 years. I live vacariously for the most part but I appreciate your ideas.

  152. Dr Kruse,

    I stopped taking Malic Acid at night because it was making me, extrememly, tired during the day. I experimented and didn't take it for a week and then went back and the same tiredness and heaviness was felt. I noticed someone else on the blog had my same experience, but there was no answer. Is another form of Magnesium okay to take instead? Why would you think Malic acid would make some people extremely tired the next day?

    Also, I am going to start taking butter oil and cod liver oil instead of the K2 and D3. I like the thought of these natural sources much better. A local farmer told me they use the pill form d3 for fertilizer–yuck and no way.

  153. Dr. K, Checking around LE site for K2 supplement and found K2 as menaterenone or menaquinone. Which form do you prefer? Hopefully, I haven't missed that around here ….there's just so much fabulous information! Thank you so much!

  154. All my beef comes from a pastured farm, and I always turn the heart into raw jerky and eat it. (My understanding is that heat destroys the CoQ10.) Any need to supplement CoQ10 on top of this?

  155. @Denver All the fat soluble vitamins have to be eaten in balance. A, D3, K2, and E (all forms) This is easy to accomplish when you eat the Optimal type of paleolithic diet.

  156. Dr Kruse,

    Any advice for a rosacea sufferer? I've had the oral and topical antibiotics, and medicated shampoos, which work for a while then the rashes come back – mainly on my cheek. Not wanting to spend the rest of my life taking antibiotics I finished my prescription and never renewed it. Researching the condition I tried many of the published remedies, HCl tablets, amino acid supplements, avoiding dairy, coffee, spicy food e.t.c to no avail. I went primal last September to see if the dietry changes would help my condition. I heard about the Paleo Summit and have just finished listening to your presentation whch led me here. Any advice greatly appreciated.

    Thanks for your time.

    • @Niall most skin conditions are tied to a leaky gut. Read my leaky gut Rx on this blog. Search for it. It is a great resource.

  157. Dr Kruse,

    Thanks very much for the pointers. Lots of information there that'll I'll work through and implement for my specific circumstances.

    Appreciate your time and dedication.

  158. Dr. Kruse,

    The other night I cooked some grassfed meat (first time) for hamburgers and the next two days my GI tract was having issues. Do you think this is related to what you wrote, "A person eating regular american diet is filled with mitochondria not optimally equipped to handle an acute change to massive carnosine."

    • EAD its called adaptation for a reason. If you went into the Gym to lift weight would your bench 500 lbs right away? food and dietary choices are no different. Give them 30 days

  159. Dr Kruse,

    You just give, give and give. You clearly care and I am grateful to have you in our community.

    I was hoping you could answer a few questions from the prospective of an average adult male.

    1) I read that we should take fat-soluble vitamins together because they work synergistically. If so, is there a ratio of Vitamin D to K1/K2's you look for?

    2) Many supplements have very high levels of various items. Which should I avoid in supplements or receive in small amounts? Dr. Cannell of the Vitamin D Council recommends avoiding vitamin A in supplements completely.

    Is there an online resource you would recommend for "optimum" RDA figures?

    3) After consumerlab.org approvals etc, what would you personally be willing to pay a premium for? What would you go out of your way to avoid?

    Food-based, co-enzymed, ionic minerals… do they make a significant difference?

    4) And lastly… "other ingredients" listed in supplements; what preservatives do you try to avoid? Are stearates a cause for concern?


    • @JedEye 1. it depends upon what the context is and of course the labs.
      2. Not sure what youre asking here…….but when I bio hack someone I leave nothing to chance…..i tell them what they need.
      3. I like consumer labs but erin Fraser told me I should not……she is pretty smart. So I am now switzerland until I educate myself better
      4. I dont like stearates. I like compounded stuff but people do not like to pay……for optimal so they stay sick a bit longer.

  160. Thanks! I am interested in reading more about Erin Fraser, but can't seem to find the right person doing a google search. Interestingly enough, an amazon search only comes up with erotica. ;)

  161. Dr. K,

    I have severe adrenal fatigue and have always had low low dhea-s on labs; however, taking dhea has often made me depressed or experience feelings of even lower cortisol. How can I get around this issue as i'm resetting?

  162. Doc, You are awesome! Thanks for everything:)

  163. Doc, do you believe Irvingia/african mango that is being promoted heavily lately really improves Leptin Sensitivity?

    • @james it is supposed to increase telomere length too……that is its real benefit. I wrote this as my first ever quote on Paleo hacks where I now make myself sparse.

  164. Dr Kruse

    I have peripheral neuropathy, courtesy of a heavy fluoroquinolone course (6 weeks at high doses, mix of different FQ for prostatitis – with no improvement). I have been taking a B complex for months. Then I tested my serum B6 and it is EXTREMELY high.

    582 nmol/l (15 – 73)

    98.4 ug/l (2.5 – 12.3)

    I do not understand how this could happen as B6 is aqua-soluble! And my liver and kidney function seem to be fine per the blood tests. I know hypervitaminosis B6 is neurotoxic, so I stopped the B6 supp, gonna check my B6 levels again soon. The B complex I took is jarrow B-right, it contains 25mg pirydoxine, 10 mg P5P.

    So my questions are

    -What do you think may hvae cause this high B6 level, as the B complex vit doesnt contain THAT much and B6 is aqua soluble?

    -Can I take p5p without pyridoxine or is it still bad for be and could worsen neuropathy?


  165. Joyce Soos says:

    I have written to you before. I have mcs and es for 20 years now. I am hypothyroidal and have osteopenia and osteoporosis. I am 57. Most of the osteo problems are in my neck and lower spine. Since I came down with mcs, I have not been able to take a molecule of any supplement without getting a headache or 3 day migraine. It takes forever to work up to a normal amount, if possible. I now have dizziness whenever I eat anything. I would like to take your supplements but I really do not know how to avoid the stomach issue of dizziness and the headaches. What to do? Also, I love your blog! It is almost like only relying on food for my well-being. Thanks.

    • @joyce I will answer you again……..what part of CT and a paleo diet is a supplement? Start with your “I CAN’s” before you jump to your “I cant’s”……..that brand of thinking breeds mediocrity. Is this a harsh retort……yes, because you need to think better. This is precisely how one becomes mediocre. Do not let your feelings, thoughts, desires, or your wishes ever subvert your paleolithic genes……..when they do your telomeres pay the price. That is the entire point of the CT series here in one short answer. I reject all forms of mediocre. That is why the name of my website is Optimized Life.

  166. Joyce Soos says:

    I needed to hear that. I am doing the Paleo Solution first and see how I do. Will keep you posted. Thanks.

  167. Doc, what is your opinion of consuming Tempeh as opposed to Natto.

  168. I find Magnesium Citrate (not oxalate) to be a miracle supplement. My whole life only one nostril works at a time due to congestion. With 200-400 Mag Cit I feel a cool rush of air coming through. Anti-histamines never worked this good.

    I am reading more about magnesium L-threonate. My memory and ADHD attention is terrible. But I am very hesitant to take it taking it because it is shown to cross the blood brain barrier.

    What are the health risks of supplements that cross the blood brain barrier?


  169. @Jack Oh my! Please elaborate about Tempeh VS Natto.

  170. Doc I can certainly appreciate your point of view. In your opinion, what would be a better alternative to my regularly consuming tempeh as a good non meat source of vitamins & protein?

    • @Buzz…..I am not trying to be Snarky here……I do not believe you can be optimal without animal protein. Whole9 thinks maybe you can. You might want to go over and ask about their vegan/veggie recs but you wont find my bending rules here for any reason. I follow the rules of evolutionary biology to get me to optimal. I also dont buy 80% paleo either. You are what you are. If I thought sopy was OK i would have called my website the Sub optimal life. Eat soy is not part of that plan. It is the most processed food on the planet. I want you to be optimal. I hate diseases of all kinds. I think when we live this way we can avoid any of them. When we leave the door cracked for any reason bad things happen.

  171. Joyce Soos says:

    You know about my mcs and es. I am really confused as to what lab tests to get for me so you can see how I am doing. Mind you, this is only the first week of paleo. I found a lab in town to take care of the telomere test. Please advise as to what tests I should get. I am 5’4 inches and 143 pounds. With a blood panel test done about a year ago, my doc says I am normal! Thanks for your help.

  172. I have to say I get pissed when I read all the OMG–i feel so great stories. Don’t get me wrong–good for them, but what i am really pissed about is that I don’t feel better, and after an initial weight loss of 5 lbs, haven’t made any headway. I have been working towards going paleo/primal for some time, and finally got off grain and dairy (except for butter), so basically very low carb, high fat good fat/protein x4 mo. I ran across your website and started the leptin Rx 3 weeks ago and still don’t feel great. My story: I am 35 5’5 155lbs. i am always tired, never feel rested in the AM. and i have a headache/brain fog/memory problems everyday-(convinced the headaches are a side effect from epidural with baby 1 and 2), Hx of migraine x 20 yr, currently fairly well controlled w/magnesium. hypothyroid x 6 yr, on Armour 30mg, recently switched as I had increased headaches on levoxyl, seem to be doing better there. Chronic yeast problems-progressively worse, x 10 yrs (result of ABX in early 20s, really thought this would be much improved on PB, but hasn’t, still feel like i have an infection 24/7.
    I am in the midst of finding a Dr that is more natural minded and willing to do tests, think i found one, going to try to make an appt soon.
    Current supplements: probiotic, krill oil 3g, vit d 10,000IU (my levels have been right around 70s when tested) Ubiquinol 100mg, astaxanthin 4 mg, Candida clear/oreganol oil, Chelated Mg 800-1200 mg.

    after reading your blogs I bought Vit A 25000 IU (carlson-from fish liver oil)K2 (menatetranone), PQQ, and B-complex- but haven’t started taking them yet, also trying CT, but I hate being cold and finding it hard to adjust, but will continue to try.

    I plan on talking to Doc about getting cortisol test, omega 6:3 ratio, full thryoid, adrenal panel.

    Is there anything else that should be on my radar? I am sick of being sick tired and overweight! Thanks,and sorry for the novella.

    • @Csweet I bet when you get tested you wont be mad any longer……..I bet your testing shows a lot wrong.

  173. Jack, maybe this was already mentioned but I can’t seem to find it, do you have any links to some trusted supplement brands that you could recommend? 

  174. Jack, I have been told I have a leaky gut, Im Paleo, but have no sex drive & rarely have an urge for the bathroom! im taking 2 x Garden of Life Vitamin B complex, 1 x Magnesium Malate 1000mg, 3 x D3 drops 2000iu. Any ideas what I can take to sort these issues out?

  175. Hi Dr. K, great article. I’ve been searching the Internet trying to find out how much calve’s liver I can eat without getting too much vitamin A. Everyone seems to have a different answer so I wanted to ask you about it. Liver is one of my favorite foods and I usually eat about 16 ounces once a week. I would like to increase that to three times a week if it’s safe to do so. I take k2 and vitamin D (10,000 iu per day). Also I take magnesium maleate that has 425 mg magnesium, is this an optimal amount? Thanks!

  176. I have read mixed things about taking fish oil and I am confused. I have read if you have an auto-immune issue to be careful with the fish oil and I’ve also read poor 6:3 ratio could be the cause of an autoimmune issue. I’ve been paleo for a year, have played with the auto-immune protocol and am now trying the leptin reset. Basically I have ulcerative colits that didn’t really improve with straight diet and after a scope in December showed that the disease had progressed (something I already knew before getting the scope)I went on Asacol. Since being on the meds I’m pretty much symptom free, but don’t want to take med the rest of my life (GI specialist says this is my ONLY option). I’ve taken high doses of fish oil and none at all, trying to see a difference. I know pre-meds the high dose seemed to make bowel movements more frequent. Now that symptoms are more controlled, Im not sure if I should try a higher dose again. I really want to get off meds and am hoping the leptin reset will help with general inflammation, sleep, and stress. But I’m still slightly confused on some of the supplement stuff, especially the fish oil issue.

  177. Have you seen this miraculous video showing Glutathione and its effect on Parkinsons? http://www.youtube.com/watch?v=QHYey8vELTg

    Have you explored sublingual glutathione? Can that be a better options than glutathione precursers?

    • @Jedeye that is not new…..its pretty old and has been posted on one of the blog comments somewhere. Thanks for reposting it for others to see who have not seen it yet. Art DeVany has a liposomal glutathione called ultrathione that I think may be interesting.

  178. Thanks! I was just wondering if liposomal glutathione is effective because I read that taking it orally as a capsule does not work. So I was wondering if taking it sublingually may be more effective than taking precursors capsules orally.

  179. Dr K, PQQ is not available in New Zealand. Is there anything that works in a similar way? Thanks, Lauren

  180. Will do. Thanks!


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