Answers by Dr. Csaba Tóth (07.22.2020)

Q1: Portion size control / understand how much food you need

Keep the 100:35 meat:fat ratio and eat when you are hungry. This is the most accurate way. Once you have learned the diet, the goal is not to weigh the food because that is not lifelike.

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Q2: Is it possible to increase the amount of bone marrow and decrease the amount of fat instead?

Yes

Q3: Is non-flavored mead (honey, wine) allowed in the non-strict version? It's made from only water, honey and culture. Since honey allowed I presume only the latter (the fermentation agent) can be problematic. But some fermented food (like sauerkraut) is allowed, so it may not?

Wine is not supported.

Q4: I know we should avoid strong spices. How about a little herbs in our sausages like a pinch of coriander? Or parsley? Again if not on strictest protocol

Avoid them, they can increase intestinal permeability.

Q5: Are canned sardines (preserved in water and salt only) allowed?

In theory it may be OK. But don’t trust the food industry unconditionally. Also, there is nothing in sardines that is not to be found in grazing animals.

Q6: Is sauerkraut allowed, when feeling better?

Yes

Q7: What does the cocoa powder cause? Inflammation or leaky gut or other problems. Is 2-4 teaspoons of cocoa powder weekly total properly yet for a healthy person (like 1 cup of coffee daily)?

Avoid it entirely. It seriously increases intestinal permeability and results in inflammation.

Q8: My lamb carcass fat has branding on it...is that ok to eat, once fried? Or should I cut off the branding?

It's a matter of taste, I remove it.

Q9: 70% animal food 30% plant food is mentioned in PKD. Does that mean 30% of energy from plant foods?

No, it means volume. 

Q10: I am concerned about getting enough calcium, but I presume PKD would not include a bone meal powder/supplement — so what are the best foods to eat to ensure adequate calcium intake? Thank you.

Don’t worry, PKD is the only healthy diet that contains all the necessary nutrients in the right amounts.

Q11: I know PM recommends salting food to taste. But I’m a salt addict and I over-salt my food. I can’t help it. It has always been the case. Is it compromising my health improvements? Should I force myself to reduce salt quantities? Thank you.

Use as much salt as you want.

Q12: Another salt question: is Real salt considered the same as Himalayan pink salt and should be avoided?

Sea salt is best, but rock salts are not bad either. It is important that it is free of additives.

Q13: Am I eating enough fat and organs? I eat beef from a grass finished cow I bought off a local farmer. All the fat, suet, and organs (heart, tongue, liver, thymus, pancreas) were added to the grinder with the beef for grinding into minced meat. When I cook the patties, the outside is crisp and inside raw. I use the bones for broth. No nutrition label comes with this. (I also eat 2 organic egg yolks and 1 can sardines per day. Carnivore for 10 months)

If you are in ketosis and if you follow the rules you will get enough nutrients. As far as offal is concerned, only the result of the laboratory test gives an answer.

Q14: Is it terribly, terrible bad to include some cheese every now and then?

Yes

Q15: Csaba, I saw you had previously said "That in the case of athletes, eat above necessity not to 2/1 but in 4/1." Could you elaborate on the science of athletes eating and PKD?

I have very little time, but if someone asks for this as a service, I will gladly prepare an eating plan.

Q16: Thank you for answering our food Questions Csaba Tóth. My type 1 diabetes antibodies are now negative and I require no medications. (I took insulin medication for 13 years GAD and 1A2 positive). I initially ate fatty beef and lamb only for the first 8 months then I added very occasional eggs wild seafood. I feel best eating beef and lamb. At what stage during healing it is a good idea to see if honey, occasional seasonal fruit and vegetables are suitable to add in small amounts?

Antibodies may be also present in healthy people. Their level does not tell much as regards disease activity. A laboratory test, including repeated C-peptide measurement are required to assess food "expansion".

Q17: When will the English Version of the cookbook be released and where can we purchase one?

We tare doing our best but we have a lot of other work too. I think it will be ready later this year.

Q18: What problems may arise from eating too much fat (e.g. beyond the ratio 2:1 F:P)?

Nausea, vomiting, headache, nausea, slowing down, hypothyroidism, fatigue, etc.

Q19: How careful should one be with cross contamination in a shared kitchen? For example if my fork just touches a vegetable or something and then I put it in my mouth without realising, will this hinder healing?

You don't have to worry about vegetables. Dairy products, grains and vegetable oils can be dangerous as a contamination source.

Q20: I finally thought of my food related question. I’ve seen in your slide presentations that you may have treated dogs in the past. My understanding is that dogs need a higher level of muscle meat. Can you give a brief outline of meat/offal/fat ratios?

The body of dogs works in almost the same way in terms of digestion as it does in humans. A few little things are different.

Q21: Does the calculation using 0.6-0.8g of protein per kg of body weight take the bioavailability of food into account? I recall loosing muscle due to a colitis flare although I ate sufficient or excess protein. Could a decreased absorption be a problem?

Yes, it is possible, but hunger is the way to go. Eat when you are hungry. 

Q22: Any suggestions of easily digested meat. I just had an endoscopy and have duodenal ulcers gastritis a sliding stomach hiatus hernia and Oesophagitis. Nice! So far my attempts at eating fat have just caused nausea. It was pork back fat thou. I’ve ordered raw beef suet to see if that helps but won’t get it till next week. The local farmers market sells decent sirloins and ribeyes whole. I’m thinking of trying slivers of either of those raw in the hope it moves downwards past these nasty ulcers. Is that a good plan? Thank you.

Eat grazing animals or pigs. There is no difference in digestion. You may need a consultation.

Q23: What are the approved fruits once healthy?

Small amount, only for a healthy persons. But a piece of raspberry is not the same as a piece of banana!!!

Q24: Is eating liver only (may be more than 250gr a week) enough for those who can't eat other or have no access to other organs ?

No, bone marrow is needed too.

Q25: Vegetables recommended by PKD should be eaten raw or cooked?

It does not matter.

Q26: have 2 meals a day totalling less then 400 grams as recommended, but what about the bone broth soup? What rules apply there? Do I have to have the soup during one of the 2 meals? Does the soup itself count as a meal? Or it does not matter as if it was just water? I would love to know what Paleomedicina thinks about that.

It should be regarded separately and should not exceed 100-200 ml per day. In specific cases other advice may apply. It should be considered mainly as water. 

Q27: I've read that Csaba Tóth drinks coffee. When is it safe to try having a little bit

In case you are already completely healthy

Q28: Can one eat too many organ meats and not enough muscle meat?

Yes. Follow the rules both for meat and organ meats. 

Q29: Anchovies? Yay or nay?

There is nothing in them that would not be in the grazing animals. If you eat fresh, it can be good.

Q30: What's PM's take on carbonated water? I live in Sweden and we have very good tap water so I carbonate it at home.

Tap water is usually good, but the tap water is not OK if it is containing high amounts of magnesium, sodium or calcium.

Q31: If one can't get a hold of pasture raised marrow (which is the case for me now for maybe a month or so) is it better to skip marrow all together or can I eat regular marrow (not too bad quality)?

You can skip it for a month but not longer. There are excellent organ meat patés at www.eszkimokitchen.eu

Q32: What is PM view on high LDL (above 12mmol/L). Do they have any patients who started with a high LDL and in time were able to lower?

Yes, LDL only depends on what you eat.

Q33: I cannot get into ketosis, 1 week in from a carnivore diet, from keto previously for a year (when I was in ketosis), finding it impossible to hit 80% fat, I'm between 70 and 75% daily, 1gm carbs, rest protein. Can't get brains, marrow or sweetbreads here, do i just eat more pure lard or could there be something else going on here? I eat fatty grassfed beef, home cooked pork rind, some salmon or steak w fat, thanks! (.4 mmol ketones fasted in morning)

If you follow all the rules of the PKD, ketosis develops in 3-4 days max. In all cases

Q34: Is avocado one of the PKD approves vegies? And if so, in what quantity should it be consumed, and roughly how often is considered ok?

Avocado is full of biologically active substances. Not PKD cathegory.

Q35: Second start for me... and the plan drives me crazy

I can't give advice on that. If you are sick then an initial consultation may be needed.

Q36:Do we need to eat more than 250 gr of bone marrow per week if we can't find a good source of brain as brain is more nutritious?

No, they are interchangeable.

Q37: What is Paleomedicina's opinion on eating a 100% raw diet of raw meat and raw fat? is anyone in this group practising it? i personally have been eating raw meat and fat for over 2 years now and found digestion and energy much better. (i still eat some non-PKD approved items though). i would also be curious to hear the experts' opinion on eating wild caught fatty fish (mackerel, salmon, char...). is it beneficial for omega 3's and such (in case one is unable to source brains) or would you consider fatty ruminant meat superior in all regards

For the Homo sapiens the raw meat and fat are natural foods.

Q38: When carcass beef fat is melted by heat and turns liquid, does the fat undergo chemical changes? Why is the rendered fat harder for some people to digest? If the liquid fat is put in the refrigerator and solidifies, is the resolidified fat a different chemical composition from the original fat before it was melted?

The meltability of fats depends only on their fat composition and temperature. It is constant and hardly changes with heat treatment.