Kurt Harris MD

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« Insulinogenic is not Hyperglycemic | Main | Crossfit Nutrition Eats its Young »
Saturday
Jan092010

A Taste of Dairy

Reader Beth writes in:

So, I just got my copy of Cordain's latest newsletter, and he has a longish piece on the problems with dairy, which intros with dairy's "high insulinemic response, recombinant bovine growth hormone, casein protein, or lactose intolerance" and then goes on at length about dairy, betacellulin, and increased stimulation of the EGF receptor which is linked to cancer. Given that Cordain is back-pedaling on saturated fats, it's certainly within the realm of possibility that he's not gotten this one right. But I know others who are down on dairy too. Certainly has me (a lay person) slightly concerned, though I'm still including good dairy from pastured cows when I can get it. Anyone have any comments on this question about dairy as it relates to cancer risk?

 

If I have a problem with Cordain's methodology, it's that he seems to decide that something should be bad, then marshalls everything he can find to prove it so. This is just what he did with saturated fat, with all those theoretical calculations based on wild game assays to prove that paleo man could not have eaten very much of it.

His "paleolithic principle" differs from mine in that he seems to start with "not available in the paleo period = bad" and then looks for harder science to support it. My method looks first at medical evidence and metabolism, then looks for which (not necessarily all) neolithic agents are likely to account for the diseases of civilization.

If you follow my methodology it is hard to get as excited about cheese and butter as wheat corn oil and fructose. I am not saying his concerns are baseless, it's just I would trust Dr. Cordain more if he had more things he was not so sure about. His certainty that dairy is harmful just sounds too much like his former certainty about saturated fat.

Later on I'll deal with some of those specific claims, some of which seem a bit overwrought.

I am not totally sure about Dairy. I have admitted this from the get-go.

My prejudice is that it is an order of magnitude less dangerous (I am not talking about lactose intolerance which is trivial - just avoid milk) than my three horsemen of Gluten, Fructose and Linoleic acid.

I think if we as health bloggers are honest about our uncertainty, then when we pound our shoe on the podium about things like gluten grains, we have more credibility. You see us reserve our most emphatic pronouncements for what we feel are the biggest threats. This is more robust and truly more scientific than hewing to some unified field theorem of diet that may be more elegant and attractive and sell better as a "system", but in the long run may lead us astray or morph into something like the government food pyramid.

Dairy and it's alleged dangers is high on my list of future blog topics.

For now I'll say it makes little sense to totally avoid dairy protein for it's insulinogenic sins if you still have even a trace of carbohydrate in your diet, and if you are that concerned you can stick to butter, cream and small amounts of cheese and be avoiding 90% of what Cordain is afraid of .

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    Setting: A coffee bar owned by Chris Owens (@singleorigin) ... they simply follow Chris wherever he goes; he's a legend like that. Coffee-house culture is key to their thinkering (at least that's what they tell themselves regularly; that, and "thanks to D

Reader Comments (43)

Hi Dr. Harris,

From a self-experimentation perspective, could we each evaluate the merits of dairy (preferably raw dairy) by testing these items on our own bodies and observing the feedback results. Feedback such as excessive mucous production, bad aftertaste, etc. seem like more locally empirical loops to tap into to me. In essence, n=1 deductivism. This approach is geared towards metarules: rules that we each can use to develop our own personal rules for deducing which foods/drinks we should and should not consume (and in what quantities). It's not blind empiricism in the sense that we search for logical principles (like the Paleolithic Principle) to test--we do our best to evaluate these conjectures a priori--but it's a process that respect biochemical individuality when we view it through the lens of tinkering with our own bodies. In my experience, given my ancestor's (Dr. Francis Pottenger) research on raw dairy, I tested his insights, as logical conjectures, on my own body, observed the results locally, and discovered that raw dairy functions well as a core component of my regular diet. That's enough (and the right kind of) evidence for me to continue self-experimenting with dairy.

Best,

Brent

KGH:

I take it as a given that any food that doesn't agree with you for any reason should not be consumed. The problem with a purely empirical approach is connecting cause - we seldom eat only one thing per time period - with the effect - the danger may be far in the future or even impossible to connect with the cause. You can't feel a chronic hyperinsulinemic state (just one example) soon enough to know you should avoid eating doughnuts and chips.

For these reasons, tolerating a food is a necessary but not sufficient criterion. Think of all the folks who tolerate various comfort foods to the point they would rather die than go without.

So I think your dairy stance makes sense, because you tolerate raw dairy, but I am assuming you have also read enough to think it's reasonable to keep eating long term as well.

January 9, 2010 | Unregistered Commenterepistemocrat

Hi Kurt.

It sounds to me that Cordain uses both Paleo principles:

In the case of saturated fat, he started with the conventional wisdom of the medical/nutrition establishment, and read that back into the interpretation of the paleo environment.

In the case of dairy, he's starting with the presumed paelo environment, and looking for medical/nutritional evidence to think dairy is bad.

Jim

KGH:

I am not talking about conventional wisdom but rather actual science. I agree, he is actually mixing up his paleo principle with CW. His method still runs the wrong direction, IMO. Cynics have pointed out it's easier to get books published if you indict sat fat, but in his case it may have been completely innocent. He is not an MD and I believe his PhD is exercise science. Not that that disqualifies him, but it may make it more difficult to face down the cardiology mafia.

January 9, 2010 | Unregistered CommenterJim Stone

The question about dairy is very different wrt short-term feedback (can I tolerate lactose?) versus longer-term affects (will this promote cancer?). Given this, n=1 deductivism works much better in the former than the latter. I care about both!

January 9, 2010 | Unregistered CommenterBeth@WeightMaven

In a deductivist context, if your measure were how you feel following consuming a food, wouldn't everyone falsify the inclusion of donuts in their diets after eating just one? Additionally, doesn't cause and effect become even murkier the longer our time frame of analysis becomes? That is, the longer we separate the inputs and the examination of the outputs. In order to not get Fooled by Randomness in the long-term, how can we trust our own bodies in the very short-term in hopes of producing the best outcomes in the end. There are two distinct steps: looking at long-term outcomes of others / looking at research / mythologizing and evaluating those merits, and then taking the action to experiment based on those conjectures on our own bodies. If we cannot trust our own bodies' responses, then what should we trust?

KGH:

"..wouldn't everyone falsify the inclusion of donuts.."

Brent, sometimes I wish you would speak english - I could sooner understand German better than some of your highfalutin' Talebian dialect :)

I said we can use use a non-negative bodily response as something necessary but not sufficient to indicate that it's OK to eat. We add "science" in any or all of its forms to that fundamental step.

Surely we could recognize that the body gives us positive responses to a variety of substances and activities -many mediated finally via dopaminergic brain pathways - that are distinctly bad for us long-term.

A Marlboro Red, the first dram of single malt, grandma's fudge...

January 9, 2010 | Unregistered Commenterepistemocrat

After suffering years of mucus build up in my nose which caused me to rarely get a good solid sleep...loud snoring and fitfull night....and after being somewhat diagonosed with mild sleep apnea, I ran across a GP years ago that advised me to eliminate milk for a while to test my tolerance to lactose. Instantly the mucus went away and I started getting an excellent 8 hours of solid sleep....much to my wife's relief.

Now that I have embraced the paleo lifestyle, I began to add a little full fat whipping cream with my berries, the
mucus is starting to make a comeback...so I guess I need to listen to my body and forget the cream that I love so much!

I have learned that the mucus is my body expelling something it does not like and wants to get rid of. Self experimentation and self observation are great.

I want to try raw milk and cream to see if I can tolerate the raw product. I suspect not, but I am willing to experiment.

KGH:

I had the same result with wheat elimination.

January 9, 2010 | Unregistered CommenterDexter

Hi Kurt,

I've enjoyed discovering your website. I had a couple of questions:

1. Why shouldn't dairy be considered the ultimate paleo food? It is, quite literally, the first food that humans consume/consumed.

2. I notice that when I eat at higher fat levels (for example, full-cream yogurts or lots of butter) I feel that my heart has to work harder in my chest? With this sensation, I imagine the heart laboring to pump the thick fats through my arteries. How is that healthy?


KGH:

1) I find the argument that cow's milk, which has much similarity to human milk, is a poisonous alien substance, yet the proteins found in the muscles and organs of the cow are the nectar of the gods a little inconsistent. I will once again point out that a fair number of those with casein allergy are also allergic to bovine serum albumin (BSA) in the muscle of beef. Yet no one suggests that beef is not paleo because some folks with a history of eating the SAD get a rash when they eat it. Same thing with shellfish. Hell, some people go into anaphylactic shock with prawns, even though hominids have eaten seafood for a million years or so.

Beware the seductive logic of paleolithic food re-eanctment. PaNu is not about historical re-enactmant - it is about health informed by many lines of evidence and reasoning.

I honestly think both casein and BSA, like ragweed and timothy grass, are only immunogenic in the presence of a perturbed immune system, the perturbation itself due to other elements of the SAD like gluten grains and excess linoleic acid. That is my working hypothesis.

2) If you are new to carb restriction or ketosis, there will be a transition period with higher catecholamines (adrenaline) from the adrenal gland to keep your blood sugar normal so your brain can function.

January 9, 2010 | Unregistered CommenterStudent

Peter from Hyperlipid mentioned this to a friend of mine when he asked about dairy:This is quite simple. Grains are designed to damage your gut, speed the throughput of non damaged ceral seeds, so helping the grain spread itself. As with most plants, they’re not on your side. Dairy is a gift from a mammal directly to it’s own offspring, 50% of the genome of which is common to its own genes. It is looking to maximise survival, not kill. The main problems might come from using a growth promoter type food in an adult. This I would accept as a potential problem but, if it was a reality, the various milk based societies should have stood out as highly disease prone, not a syndrome I recognise. I also tend to avoid the lactose but it’s not something I worry a great deal about.

I suspect a lot of lactose intolerance is merely occult gluten intolerance… No brush border means no lactase. Gluten trashes your brush border. I’ve got a paper somewhere but I’m replying from work…

Peter

Thought I'd share it with everyone.

KGH:

Yes, Peter's position is similar to mine. Arrived at independently but as usual he has more real science and probably eloquence to back it up. Search his site at Hyperlipid and you can find his arguments in all their sophistication.

One could argue that milk is more designed for consumption than muscles or organ of the aminals that elaborate it - because it is. It seems logical to think that if it causes a problem it is an accident - an innocent bystander like prawns or BSA or ragweed. Is it logical to think cows are defending their milk supply by evolutionarily anticipating (to get teleological for a minute) that crafty humans some time millennia in the future might imprison them and steal their milk on a Wisconsin dairy farm?

Does anyone think it is "not paleo" to breathe in late august? ( Ragweed season)

The lactose intolerance part bears repeating - many celiacs are lactose intolerant as their lactase production is diminished.

January 9, 2010 | Unregistered CommenterJeromie

when i was anemic, i was tested for celiac disease and didn't have it. since aug 09 i haven't had any grain at all- not a particle. i ate processed food twice since that time, and up until christmas i had a yogurt maybe once or twice a week. so my system was pretty cleaned out of fructose, gluten, and less so on the omega 6's since i eat grain fed everything (but take fish oil). so anyway, at christmas i started up on making puddings with whole milk, more yogurt, some grass-fed dairy cheese... the runny nose started, the toes and ankles started cracking (?) and the constipation started. is it due to dairy? so my experiment which began jan 1 is zero dairy until feb 1, when i will pig out on dairy. then i'll get probably the best answer that i can get. 75% of my genes are northern european, so i was expecting to have no problems of any kind with dairy. but it was strange that my chronic winter runny nose went away when i hardly had any of it and came back when i started including it again.

January 9, 2010 | Unregistered Commenterv

lol

Agreed; we are on the same page, comrade.

I do think that one of the goals of (health) science should be to investigate and create tools that empower people to set their own physiologies free. PaNu represents one such exemplary effort, for instance.

That's one challenge / framework that I have tried to spend a lot of time considering.

Best,

Brent

KGH:

Thanks for your comments and kind words- must get around to Taleb's books - I've read only excerpts so far.

January 9, 2010 | Unregistered Commenterepistemocrat

PS. And, as you stated nicely, we cannot rely on positive evidence (via dopaminergic brain pathways): we must, instead, as Dexter has done well, listen to our bodies for negative data points during our n=1 deduction efforts.

Cheers,

Brent

January 9, 2010 | Unregistered Commenterepistemocrat

Hi Kurt,

Thank you for your reply. Regarding your comment about the heart and adrenaline, I don't believe that the perceived effect of fat consumption on my circulatory system is similar to how I feel under adrenaline (in exercise, say). If I had to characterize it, it would be that the blood pressure goes up (which would be inconsistent with adrenaline, I think), rather than the heart rate, although I could be mistaken. It's like I can feel the pounding a little in my arteries around my neck and in my hands after I drink a lot of cream.

I have read your argument against gluten grains. I wonder why your hypothesis that wheat seeds have evolved "poisons" to deter consumption wouldn't apply equally to animals.

KGH: First, it's far beyond a hypothesis, it is well accepted that many secondary compounds are defensive - think poison ivy - and other than in the case of Pufferish, poisoning of predatore is not a typical animal defense strategy. Plants can't run away and don't have claws.


In other words, wouldn't we also expect animals to have evolved components in their flesh or milk that would poison human predators?

KGH: No animals can run or fight back and the purpose of milk is to feed to young mammals carrying on the animal's genes -why put poison in it to prevent human consumption at risk of poisoning your own offspring? I was pointing out that is an obviously silly idea.

January 10, 2010 | Unregistered CommenterStudent

I think I have this right, but would like to check with you.

Your working hypothesis is that dairy in and of itself is not problematic for the species (Homo sapiens).

Beyond that, I gather that lactose may cause some people problems, so they ought not to eat it.

In addition, that casein problems are less likely to be about casein than what the dairy cow eats?

I am curious about the latter in particular, because it would seem, then, that eating dairy from cows eating pasture, hay, gourds and such - no gluten grain - would suit the "casein sensitive" person.

Now, it does occur to me that it might take some while for a body to recover from gluten-via-milk, before it was ready to resume consuming casein.

I am sort of thinking "aloud," here and would be grateful for your clarification. And I understand you are not banging your shoe on the podium about dairy.

To me, dairy is a most natural food, and I have never bought the idea that other species don't drink milk after weaning, why should we? There are many animals that live differently than we do and that is not much of an argument, to me.

Thank you.

KGH: Casein protein structure depends on cow genetics, not feed. Hypothesis is casein, like BSA or other proteins in the diet, may be immune triggers in the presence of a compromised innate and adaptive immune response due to other elements of the SAD like gluten and excess n-6 PUFA.

I prefer grass fed due to better n-3/n-6 ratio.

January 10, 2010 | Unregistered CommenterBetsy

Cordain just pubished his latest newsletter (January 8, 2010 - Volume 2 Issue 5
(Originally published December 15, 2006) and it happens to have also this subject:

"Hazards of Dairy
I recently spoke at a conference at Harvard organized by Walter Willet, focused on dairy. As the science unfolds, we continue to uncover more information that the National Dairy Council is not going to like. It turns out that there may be much greater concerns than its high insulinemic response, recombinant bovine growth hormone, casein protein, or lactose intolerance. In this issue, I update you on my latest findings regarding how dairy can adversely affect your health..."
the rest you may read in his letter......

Another Reason Not To Drink Your Milk: Betacellulin

Although dairy foods comprise nearly 11% of the energy in the typical U.S. diet1, these foods were never consumed by every human on the planet as recently as 500 human generations (10,000 years) ago. Increasingly, data from tissue, human, animal and epidemiological studies demonstrate that this staple food has the potential to adversely influence health as would be predicted by the evolutionary template.

The Epidermal Growth Factor Receptor

Only 12 short years have elapsed since the discovery that humans bear a hormonal receptor in their gastrointestinal tract called the epidermal growth factor receptor. This trans-membrane, hormonal receptor is very unusual in that it is expressed luminally – meaning that it faces the gut contents rather than the bloodstream2, 3. The location of the EGF receptor puzzled scientists for years – why was it expressed luminally and what was its function4? Since, hormones always arrive at tissues from the circulation, why should the EGF receptor face the gut contents, which in effect are outside the body?

Function of the Gut Epidermal Growth Factor Receptor

It turns out that the primary function of the luminally facing EGF receptor is to stimulate healing and maintain the integrity of the cells lining the gastrointestinal tract3, 4. In humans, the primary source of the hormone (EGF) which binds to the EGF receptor in the gut comes from saliva5. So when you swallow your own saliva, it contains a hormone (EGF), which binds to the EGF receptor located in the gut to maintain the integrity and promote healing of the cells (epithelial cells) lining the gut (Figure 1).

KGH: Do you have a link to the newsletter? That would be more helpful.

January 10, 2010 | Unregistered CommenterGeorge

Dr. Harris,

First off I'd let to say "Thank you" for your wonderful blog. I only recently found it and find your data and opinions invaluable. Is it possible that folks who are lactose intolerant can take raw dairy? I have had issues with dairy in the past but started in with raw dairy last summer. Thoughts?

The Best,

Sandy Sommer

KGH: If it is truly lactose intolerance it should make no difference. Raw dairy may have different protein conformations that are more completely digested (possibly) but should be no difference in lactose

Jus eat butter and cream, and get your carbs ad proteins somewhere else. Milk is expensive.

January 10, 2010 | Unregistered CommenterSandy Sommer RKC

Have you seen the lecture udderly amazing?

http://video.google.com/videoplay?docid=9014552245997479572#

He says adults cant properly digest galactose from lactose, so it builds up in our tissues. He says therefore lactose isn't meant for food for any adult. He also talks about the dangers of casein.

KGH: LOL I must be half galactose by now - never heard that one. Galactose is metabolized fine unless you have autosomal recessive galactokinase deficiency.

Is it correct that you can't become allergic to a food or produce antibodies to it unless it (proteins) reaches the bloodstream? And if your gut is working, gluten wont reach blood, which means no antibodies which means the antibodies cant attack your villus making them leaky.


It seemed to me you have used the same reasoning on casein, BSA and other proteins. If they arent let into circulation, it cant cause problems. Am I right?

KGH: No - immunology is complex but antigens can interact at the mucus membrane. Coeliac disease is complex as well - it is not that simple.

January 10, 2010 | Unregistered CommenterMike

Peter from Hyperlipid said: "the various milk based societies should have stood out as highly disease prone, not a syndrome I recognise."

v says: what about the soy-based societies? everyone is down on soy, but are the japanese and chinese eating their traditional, soy-based diets disease prone? so peter's logic doesn't hold up.

KGH:

Peter's logic holds up fine. Have you ever heard of the most common autoimmune disease in the modern world?

Hashimoto's thyroiditis. Guess which soy-eating country Hashimoto lived in?

Soy is hip in the vegetarian world but it has it's origins in cultivation as a fixer of nitrogen in the soil. It's history as a food is much, much more recent. Unless it's fermented avoid it.

January 10, 2010 | Unregistered Commenterv

I hadnt ever thought about the adrenal hit when the body's adapting to Keto. I hover around 50-60g Carbs a day (Paleo), and I definitely struggle with cortisol issues as well as brain function (very spacey feeling and unable to focus). Sometimes this doesn't go away even after upwards of 4wks on strict Paleo. Still wondering if I'm one who needs more like 80-100g Carbs a day.
Do you have another post on here that addresses this more? Maybe I need to take another cortisol test (saliva). A few years ago it showed I was super low all day and then really high at night (opposite of what it should be). Recently I've just been going with acupuncture 'Bio-set' testing that has shown my adrenals are being taxed. I feel I do a pretty good job managing stress between my diet, 9hrs sleep+ a night, recovery from crossfit workouts, etc.

I'm a big fan of Robb Wolf's and wanted to thank you for posting that Crossfit article.
:-) Kari

KGH I am very wary of self-diagnosed "adrenal" disorders. I know that is a favorite of alternative medicine promoters. If you feel better with more carbs, eat them!

Acupuncture bio-set? Look, if you are at all skeptical of regular medicine, you should be even more wary of worthless alternative medicine snake-oil.

January 10, 2010 | Unregistered CommenterKOU

The most frustrating thing about dairy discussions is that it is treated, almost always, as a commodity; that is to say, one unit of dairy is identical to every other unit of dairy when in fact the value of fresh milk is very much linked to what breed of cow it came from, whether it is raw or processed, and whether or not the animal ate grains. I find it incredible to say dairy is bad when so many cultures that were free of chronic disease used it as a staple. Very few things are more nutritious than full fat, pastured, raw dairy products. Perhaps pastured eggs or liver takes the cake as far as nutrient density, but who is more generous in mother nature than the cow? My hypothesis is that milk is more allergenic than shellfish, for example, because of wheat and pasteurization/homogenization.

KGH: Perfectly stated - "Dairy" is about a specific as saying "food". Ghee and skim milk are as different as a steak and a cornbread muffin- why is it all lumped together?

January 10, 2010 | Unregistered Commenterzach

Kurt, the newsletter is an old one so is behind Cordain's pay wall. I'm happy to forward the email if you send me an address to my gmail account or DM me one on Twitter @weightmaven.

January 10, 2010 | Unregistered CommenterBeth@WeightMaven

Those who get muscus from milk might find this interesting.
http://thebovine.wordpress.com/2009/03/20/the-devil-in-the-milk-dr-thomas-cowan-on-how-a2-milk-is-the-answer-to-the-mystery-of-why-even-raw-milk-sometimes-does-not-seem-to-be-enough-of-an-improvement-over-store-bought/

If you google A2 milk or "the devil in the milk" you'll get a lot more info.

Most cows produce what is called A1 milk which contains a peptide BCM 7 which does not get broken down in the gut and when it crosses into the blood stream causes a host of problems including mucus secretion.

This from the article

"BCM 7 interferes with the immune response, and injecting BCM 7 in animal models has been shown to provoke Type 1 diabetes. Dr. Woodford presents research showing a direct correlation between a population’s exposure to A1 cow’s milk and incidence of auto-immune disease, heart disease (BCM 7 has a pro-inflammatory effect on the blood vessels), type 1 diabetes, autism, and schizophrenia. What really caught my eye is that BCM 7 selectively binds to the epithelial cells in the mucus membranes (i.e. the nose) and stimulates mucus secretion."

My father who has always had bad mucus from milk, has none when he drinks A2 milk. A2 milk is from a more ancient breed of cows. A1 is a more recent genetic variant.

KGH: Animal models are models. A1 vs A2 is confounded by other elements of the SAD and industrialization. Discussed on Stephan's blog.

If you are worried about casein just avoid it altogether. Why take a chance?

I'm happy for your father's n=1 experience, but i am curious. Does your father still eat bread or other sources of gluten? Has he eliminated industrial vegetable oils?

January 10, 2010 | Unregistered CommenterJulianne

Hi Kurt,
Unfortunately my father hasn't given up grains, although I have certainly shared my experience of taking them out of my diet. Grains don't seem to affect his mucus.

KGH MD: The point is that a gluten free diet may make him less sensitive to other things - like milk. Cart before the horse?

About 10 years ago he swtiched from teh high carb diet the hospital recommended, (which he had been following since bypass surgery 10 years earlier), to the Zone diet which made a dramatic difference to his health, energy and cholesterol levels. He also now has rock bottom CRP and fasting insulin as well. It took me a year to convince him to switch to the Zone, I don't think he sees any need to go paleo now although I know it would make an additional difference. He does eat only small amounts of grains and has cut dairy altogether.
Re oils, he eats a ton of avocado, macadmia and almonds, and uses virgin cold pressed olive oil mainly.

I'll keep working on it! I think he figures at his age (79) he'll be just fine with what he's doing now. He is far healthier than he ever expected to be given his family history, and he is still working.

January 10, 2010 | Unregistered CommenterJulianne

Hey Kurt.

I appreciate the difference between Conventional Wisdom and Real Science, however it's not always easy to tell the difference. I think Cordain thought he was starting from solid science when he tried to justify lower sat fat content in the paleo diet. Turns out there wasn't much science behind the lipid hypothesis.

So Cordain would have thought he was following your paleo principle with sat fat.

A fuller paelo principle would get into scientific epistemology, I suppose, and talk about how to make sure we're on solid scientific footing, and not being fooled by a convergence of opinion that's produced by something other than the evidence.

Even then it's still tricky at times, because we can't always sift the original research for ourselves. The glory of science is its attempt to codify practices that help keep us from fooling ourselves :-D

Keep up the good work. I'm enjoying your blog.

Jim

KGH: All cogent observations. Thank you.

January 10, 2010 | Unregistered CommenterJim Stone

does butter contain the same amount of casein and lactose as cream?

KGH: Cream > Butter > Ghee

Ghee is best is you want to stick to fats.

January 10, 2010 | Unregistered Commenterdave

Commenter "v" wrote:

"when i was anemic, i was tested for celiac disease and didn't have it"

I don't know about your specific situation, but I would be wary of false negatives. 3 or 4 years ago, before I started Paleo, I was tested for food allergies and was told that I was neither allergic nor sensitive to any food....a bit later, I start Paleo and lo and behold, the elimination of grains changed my life forever.

Am I a celiac? I dunno. Am I sensitive to gluten? Most probably. Can tests pick that up? I dunno.

But I do know that my migraines are gone and I can sleep soundly + 1,000 other benefits such as no facial inflammation etc etc -- and when I do cheat, guess what happens, the next day I feel almost hung-over.

January 11, 2010 | Unregistered CommenterPatrik

Hey Kurt,

I'd be interested in your thoughts on ketosis, especially long-term ketosis via carb restriction. Some say it's good because ketones are a more natural fuel for the body. Others say it's bad because it's stressful for the liver and can screw up thyroid hormones. What do you think?

January 11, 2010 | Unregistered Commenterkilton

Since ghee is just melted butter with the milk solids removed (or strained out), as Kurt says, it's the lowest in terms of casein and lactose. Removing the milk solids means that ghee has a higher smoking point than butter, so it's a good choice for frying. It also makes it very shelf-stable -- lasts a long time, though cold ghee (e.g., in the fridge) is a solid fat.

You can make it yourself if you have access to good butter. I also have been buying mine from these folks (http://www.pureindianfoods.com/).

January 11, 2010 | Unregistered CommenterBeth@WeightMaven

Hi Dr. Harris,
Thank you for taking the time to write these posts and responding to the subsequent comments, it is highly appreciated. My question is regarding the insulin surge from dairy carbs and proteins. I still eat white rice and sweet potatoes despite their high GL values because I eat them with protein and fats to slow down their digestion (I believe this is what you recommended in one comment on another post "GI only matters at the margin on a high carb diet IMO. 50g per day of potatoes is not going to kill with a high GI. Buffer it with fat and protein and split it between the 2 meals.") With this, is it fair to say that eating dairy (assuming raw milk for sake of example) with a full meal of meat proteins and other fats is fine if one is worried about insulin spikes?

Following your suggestions and your brother-in-laws, I'm eating Paleo plus dairy (cream, butter, and cheese) and white rice. I only have access to Stop & Shop Whipping Cream but it's still tasty. I usually only have cream (a lot of it) in the morning with my coffee and then have my first meal around 1. I might have a late afternoon meal or just have another coffee with cream. Dinner is later on. I get between 50-100g of carbs a day, just guessing as I don't weigh and measure. I stick to sweet potatoes, white rice, some veggies, almost no fruit, and a very small amount of honey (Paleo style macaroons are great). My wife and I are following your mantra of low fructose and o-6 oils, no wheat. We both started on Jan. 1 and feel great. I lost some holiday weight, about 3.5% of prior body weight, and she lost over 5% without stepping in a gym. We were not overweight to begin with either. The workouts (mostly crossfit stuff) are also going well for me.

Just wanted to pass along my experiences. Your blog has been an invaluable resource to keeping a clear head as its easy to get overwhelmed with all the stuff out there. Robb Wolf is great but it's always good to have another opinion on some matters, dairy being one example.

Thanks again and sorry for the long post.

KGH MD: Thanks for your kind words - sounds like you are doing great.

"Insulin surge from diary" - compared to what? Cream and butter have no insulin surge and a glass of milk simply cannot be worse than a potato. Stick to cream and butter and cheese and forget about "dairy insulin surges".

January 11, 2010 | Unregistered CommenterMark

There is a lot of mention of dairy being insulinogenic. Anecdotally, this is what I have seen as a type 1 diabetic. Beef causes my blood sugars to rise very high about 7-8 hours post prandial. So does cheese - in similar quantities. Butter and cream and full-fat yogurt do not. But the difference is a serving of cheese might be 1-3 oz. A serving of beef on a low carb or paleo diet might be 8-16 oz. So eating small amounts of cheese are not a problem, insulin-wise. However eating large portions of beef in particular, and other meats as well, require more insulin than 30g of carb - it's just much later on.

In an attempt to lose weight I need to keep my insulin dosages low - therefore I must limit my protein. Ditto on carbs. If I don't eat more fat and calories I am worried about stunting my metabolism. It seems very difficult to up your fat intake without dairy (cream, butter). That's just my pragmatic rationalization as to why I'm eating dairy. I do try to choose organic cream and pastured butter to minimize the hormonal gunk though.

KGH:

See the next post.

January 11, 2010 | Unregistered Commenterdee

Interesting points in this post. I now understand the distinction you are making better. I always thought that the paleolithic piece was the "observational study" that lead to the hypothesis that was tested and that the physiology ultimately determined what was healthy and therefore have considered butter to be "paleo".

But you state this much more eloquently "its not food reenacting" and "its about the EM2". And I now see that looking at the physiology first and then seeing how it fits in with evolution might lead to less confirmation bias, which is what the scientific method is supposed to protect us from.

Thank you for your response about adding muscle. Just an aside, if I set out to add two additional pounds of muscle to my body, the protocol would not involve supplements. The goal would be to get my current approximately 14% body fat to something more "paleo" :).

January 11, 2010 | Unregistered CommenterWalter Norris

Dr. Kurt:
You said, in reference to Juliane who wrote about her father being able to tolerate A2 casein and not A1:
"I'm happy for your father's n=1 experience, but i am curious. Does your father still eat bread or other sources of gluten? Has he eliminated industrial vegetable oils?"

I don't see the point of this question in this case. Even if he is still eating gluten/vegetable oils, exacerbating autoimmune problems, the only change he made was switching to A2 casein and that made the difference. So there is, at least for him (and me too), a difference in response to the two caseins.

In my own case, I have eliminated all grains and vegetable oils and still cannot tolerate A1 casein, even from raw, grass-fed dairy. I can tolerate raw goat's milk which is A2.

KGH:

Think about it some more.

If you have an allergy to ragweed is the cause the proteins in the pollen and the cure to wear a respirator?

If you correct your allergic diathesis with diet, does your immune system instantly return to normal?

In your case your allergy to whatever may not have gone away yet, and may never.

I am also suspicious of relying on n=1 subjective reports of "toleration' - everyone I know on the SAD tolerates bread and chips

January 11, 2010 | Unregistered CommenterJanet Gomez

Doc,
How do you feel about "Raw" Cheese? I had a small taste the other day (its been about my first milk product in about 6 months other then some pastured butter i use here and there) It was pretty tasty!
Chuck

KGH:
If by raw you mean made with raw milk, any cheese over 6 months old is always made with raw milk, if the label lists milk instead of pasteurized milk, it's made with raw milk.

January 12, 2010 | Unregistered CommenterChuck O

Dr Kurt:
Thanks for your reply. I do understand that neolithic agents are likely causing Juliane's father leaky gut, which allows proteins such as casein to be seen as antigens by the immune system. But his system only acts upon the A1 casein, not the A2. That was my point, there is quite a difference in the two proteins. I'm not saying diet wouldn't help him tolerate both types.

As far as my n=1 example, yes, I agree, in time I may be able to tolerate A1 casein. Again, my point is that there is something more allergenic about A1 casein since A2 does not bother me. It may be immaterial to you since you can tolerate either type but the information could be helpful to others whose gut is not as robust as yours.

January 12, 2010 | Unregistered CommenterJanet Gomez

Dr. Harris,

In an above comment (in response to "Student"), you noted that for those new to low carb, there is an increase in adrenaline in order to keep blood sugar normal. I am not new to carb restriction, and in fact eat and recommend a diet virtually identical to yours. I have eaten this way very consistently for over a year, and off and on for nearly a decade before that. However, I suffer from occasional panic attacks and anxiety. My heart often races and beats hard, and I "feel" like my adrenaline is high. Is it possible for the high adrenaline state you mentioned to persist in some people doing low carb even after they have acclimated to the diet?

David

KGH: Not usually. I recommend having your TSH, Free T4 and free T3 checked.

January 12, 2010 | Unregistered CommenterDavid

Doc-
This Kind
http://www.organicvalley.coop/products/cheese/cheddar/raw-mild-8-oz/

I came a crossed it the other day at my local health/organic store in town.

Great Blog BTW! I really enjoy it!

Chuck O

January 12, 2010 | Unregistered CommenterChuck O

Dr. Harris, just wanted to post my n=1 experience up.

I did a 30 day Paleo "Clean" from 23 Nov 09 to 23 Dec 09. No dairy, legumes, grains, or booze. Lots of pasture raised meat/eggs and vegetables.

I felt pretty great as far as energy levels, mood, and recovery (I'm a Crossfitter).

I didn't have a ton of gas on longer workouts as compared to when I was eating more carbs in the form of fruit and sweet potatoes. I know these are "Paleo", but I had decided to cut them out for the purposes of this experiment.

After reading your post on "PaNu and High Intensity Exercise" I decided to give it a go and started on 31 Dec 09. It was fairly simple to get into eating two meals a day as I was eating a lot of fat ranging between 200-250g, which put it at around 75% of calories per day, and seemed to diminish my hunger significantly. I was drinking 6-9 cups of decaf coffee with 1-2 tbsp pasture raised heavy cream. I was also taking in pasture raised sour cream, and a very small amount of non-pasture raised cheese every few days.

I started getting cold-like symptoms on 03 Jan 10 which lasted until 08 Jan 10. On 6 Jan 10 I went out of town and didn't eat any dairy while I was away. I was able to train on 09 Jan 10 and 10 Jan 10 and did fairly well relative to the group that I train with.

I took Monday off.

I started taking in heavy cream (all the cream was grass fed) and some non-pasture raised cheese again on Tuesday and started to get nasal congestion almost immediately. I worked out that afternoon doing heavy Push Jerks and then Tabata Sprints for four minutes. I nearly didn't complete the sprints.

I had some more cheese and cream this morning, and am going to have to take a day off as well because I am achy and congested again.

So my plan is going to be to eliminate all dairy (heavy cream, sour cream, cheese) for the next month, get back on a solid health footing, and then play around with a little bit of heavy cream again, but nothing else. I'll let you know how it goes.

Thanks so much for the blog, I've learned a lot.

January 13, 2010 | Unregistered CommenterBrian PCF

Hi Dr Kurt,

I need your help on a few things I'm not sure about:

Should coffee be decaf? And how about adding stevia to it?
If we're going to eliminate dairy, (dairy doesn't include butter or eggs, does it?), including cheese, how do we get enough fat so as to not have too high a protein diet, especially if cream (100% fat) will also be gone? What about eating a few tablespoons of coconut oil?
I don't see a mention of sour cream, but I eat a lot of that, with stevia, for dessert. It's about 95% fat.
The last 3 weeks I've eaten only grass-fed beef, liver, eggs, butter, coconut oil, cheese, heavy cream, and sour cream, coffee (not decaf) and stevia, no fruit, no vegetables, but I have lost no more than 1-2 pounds weight. I've also been getting intestinal cramps, possibly from the sour cream or other dairy, and heart-burn.

I'll appreciate it if you can offer some comments. Thank you for your time and effort and great ideas.

--
Regards,

---Robert

KGH: You can read the site some more and post this in the forums.

January 15, 2010 | Unregistered CommenterRobert Katz

If you need stevia to enjoy coffee, maybe you should try tea. :D

Stevia keeps sugar cravings alive, just like artificial sweeteners, natural or not. Who knows what trying to fool your body with a zero-calorie sweetener really does in your brain?

January 16, 2010 | Unregistered CommenterAstrogirl

Have you heard about secondary lactose intolerance ? It may be one devalued cause symptom from being gluten intolerant. When gluten is removed, lactose can be digested normally in some cases.

KGH: Yes I think that is likely true. Brush border damage - lactase insufficiency.

January 17, 2010 | Unregistered CommenterJohhny Bourdeaux PhD

great website Kurt
couple of points about milk - as far as paleo is concerned, dairy contains pretty much the same balance and type of nurients as the paeo diet and - apart from the minority who have "Problems" - could be seen as complementary to paleo principles. those cultures that are dairy based (Swiss and Massai etc) show exceptional health. the fact that milk is the key nurtrition of young animals suggests that it remains a very important key source of (delicious) food for animals (that includes us). As stated elsewhere, paleo nutrition is not about re-enacting the past, but interpreting the present using the past as inspiration. milk is, for most, a miraculous food not to be sniffed at (raw is best, but it must be whole, whatever).
Mark

January 18, 2010 | Unregistered Commentermark

Any implications for the use of whole milk, half-half, or cream with coffee and tea?

Milk blunts heart benefits of tea

http://www.lifeclinic.com/fullpage.aspx?prid=600797&type=1

KGH: More brachial artery reactivity nonsense. Skip the tea and drink cream.

January 19, 2010 | Unregistered CommenterStudent

Secondary lactose intolerance is how I discovered my primary gluten intolerance! After cutting gluten from my life, I'm able to consume any dairy I like.

Suddenly developing lactose intolerance in middle age is not something that should be ignored.

January 19, 2010 | Unregistered CommenterNicole

I've always been surprised by the ambivalence about dairy products within the "paleo" community. Even those who use and recommend dairy products do so with a shoe-ward glance and a shuffle... My perspective on dairy is that it is indeed an evolutionary appropriate food because there is a plentiful supply of fatty cultured milk in the stomach of every baby mammal. A calf's stomach can hold a gallon - that's a lot of curds. And if you let the stomach sit around the cave for a bit you get cheese.

My issue with the "paleo" community's concern with dairy is the overlooked distinction between cream and cultured milk versus lactose-rich milk (straight up). The latter does not seem to be an appropriate human food whereas the former is, in my opinion, indispensable to human health.

February 26, 2010 | Unregistered CommenterJM

I also live a low-carb-lifestyle,but I'm a little bit confused about
consuming dairy at the moment. I've read some articles which say that dairy causes osteoporosis because there is too much calcium and too little magnesium in it. The perfect ratio is 2:1, but milk has sometimes a 10:1 ratio and cheese 30:1. So that excessive calcium leads to calcification of the bones.

A long time I didn't get why the Massai and other milk-drinking
civilizations don't suffer from osteoporosis, but now I've found out that their soil is rich in mineral nutrients, therefore in magnesium. So they can get the proper ratio?

Our soils are depleted of magnesium. For this reason, I guess, also
pastured dairy isn't as healthy as it once was.

What do you think about this?

I love your blog!

Jasmin from Germany

KGH: Forget the acid/base thing as that is bunk. I avoid milk because it is easy to get too much of it and I don't need it.

September 30, 2011 | Unregistered CommenterJP

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