Why do I advocate whole milk and cream but in later steps suggest eliminating dairy?
The 12-step list assumes we are starting with the standard american diet. I have found that step one is very difficult without the immediate introduction of fats to substitute for the excess of sugar and wheat flour. Following an "eat what they ate" paleolithic diet has the flaw of eliminating dairy as not “orthodox paleolithic”. This is a mistake as the best weapons you have to replace unhealthy carb intake with fat in a convenient fashion (without eating brains, liver and marrow of wild game every day) are butter and milkfat. Remember, the paradigm is about paleolithic metabolism, not paleolithic food re-enactment!
Step one is enabled by taking the milk most people are already drinking and ramping up the fat content. Skim milk is less than 0.5% fat by weight and so is mostly water with milk sugar or lactose, and milk protein, including casein. Whole milk is 3.2% fat by weight and has 50% calories from fat, half-and-half is about 12% fat by weight and most of the calories are therefore coming from fat. (Cream of course avoids most of the lactose and casein because it's nearly all fat.) The satiety you get from the increased fat will make the step one elimination of sugar, HFCS and white flour possible. Step one and two really need to be simultaneous to be effective. My “diet” is more a high-fat prescription than a low-carb one. I believe that not only is saturated fat not harmful, but it is actually may be a key component to EM2 in a food-abundant environment.
Cream, butter, and cheese have little to no lactose as it has been either skimmed off or consumed by fermentation.
In addition to lactose intolerance, which is very common, there can be an immunologic reaction to casein (edit - and whey as well), the protein in milk.
Cream and butter are mostly fat of course, but both milk and cheese have casein. I do not think dairy is nearly as significant on a population basis as grain lectins, but it may be an issue. So I generally view butter and heavy cream as excellent and cheese and milk as less so. Most who have difficulty with dairy are just sensitive to the lactose, but there can be immune system issues with casein found in milk and cheeses. I believe casein serving as a molecular mimic to self antigens, and therefore causing autoimmune diseases, mainly occurs in the context of an already leaky gut. So if you do not have Wheat Germ Agglutinin and other grain lectins in your diet, the casein is not likely to leak into your blood stream. Multiple sclerosis may be linked to both gluten grain consumption and milk casein in this way. That is why I believe eliminating gluten grains minimizes the threat of dairy for most people. I believe getting to step 3 makes the milk prescription in step 2 safer in this way.
The advice to move milk up the list if you are sensitive just acknowledges that some are lactose intolerant and some may (theoretically) not tolerate the casein even after gluten grain elimination. (although some may be lactose intolerant and just think it's "normal")
I myself consume copious amounts of butter and cream, half and half and occasionally whole milk - but, no surprise, I consume zero gluten grains.
Again, the last two steps of dairy elimination are more for theoretical completeness as I find much less scientific evidence indicting dairy than grains. Dairy is not paleolithic historically, but as a relatively ubiquitous food class, definitely helps in acheiving the EM2 - the evolutionary metabolic milieu of low insulin levels and mimimal toxins from modern cereal grains.
The PaNu EM2 is not a diet composed of prehistoric food items, it is a metabolic state that we are trying to live in while eating foods that exist now.