The Great Dairy Debate

October 13, 2012 in Categories: , , by

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The value (or lack thereof) of dairy products is the second most fiercely debated topic within the paleo community (after carbohydrate intake).  Opinions vary dramatically from consumption of no dairy whatsoever, to only consuming dairy fat (such as ghee, butter and heavy cream), to only consuming raw grass-fed dairy, to only consuming fermented dairy or aged cheeses, to including any dairy on a regular basis.

The reason for this diversity of opinions is that the science is not clear cut.  There are strong arguments to be made both for and against.

Let’s start with the arguments against dairy.  Prof. Loren Cordain dedicates an entire well-cited chapter in his most recent book The Paleo Answer (a fantastic book for describing the nitty gritty scientific details behind the paleo diet) to the many reasons why milk should not be consumed in any form.  To summarize, what I view the strongest parts of this argument:

  • Milk is not as nutrient-dense as meat, fruits and vegetables.
  • Milk is highly insulinogenic, meaning it causes a large spike in blood insulin levels, disproportional to the amount of sugar and protein in milk.  This may contribute to the development on insulin resistance, at least in the context of a high carbohydrate diet.  Insulin is also pro-inflammatory.
  • Milk contains active bovine (cow) hormones which have the potential to alter our hormone levels.  The effects of dietary intake of most of these hormones have not been studied.  However, other hormones have been studied.  For example, the milk hormone Insulin-like Growth Factor-1 (IGF-1) has been linked to risk of breast, colorectal and prostate cancer, with the strong indication that consumption of dairy protein is a large contributor to blood IGF-1 levels 1.
  • Milk contains protease inhibitors which may contribute to the development of a leaky gut (see this post for a more in depth explanation as to why)
  • Milk increases mucus production.  This may aggravate conditions such as asthma but also creates excess mucus in the gastrointestinal tract which may irritate the gut lining and inhibit nutrient and mineral absorption.
  • Lactose is poorly tolerated by adults.  Approximately 25% of Caucasians (American and European) are lactose intolerant.  97% of Native Americans are lactose intolerant.  This argument does not apply to drinking raw milk since raw milk contains enzymes to help digest lactose.
  • Dairy is highly allergenic.  This is where I believe the chief argument against dairy lies and I will discuss this further below.

There are also some very compelling arguments for including dairy products in our diets.  Studies have shown that consumption of dairy, especially full-fat dairy products and fermented dairy products, can protect against Metabolic Syndrome (cheese, full-fat dairy, and fermented dairy), Type II Diabetes (fermented dairy only) and Cardiovasular Disease (cheese, full-fat dairy, and fermented dairy) 2-6.

Grass-fed dairy, especially the fat from grass-fed dairy, is an excellent source of fat-soluble vitamins and Conjugated Linoleic Acid, an anti-inflammatory and healing fat.  Fermented dairy is an excellent source of probiotics.  There are also some valuable proteins in dairy, such as glutathione (very important for reducing inflammation and protecting against oxidative stress) and whey (which may help prevent cancer).

There is also evidence that dairy proteins are beneficial for children due to their growth-promoting effects.  Traditionally, children would have received some breast milk until approximately 5 years of age.  In our current society, most children are weaned by age 1.  The current scientific view is that, provided cow’s milk is not introduced too early, it is a good substitute for human milk in terms of its growth promotion 7.

Yes, the science is not clear, although there seems to be a good case for including dairy fat in our diets.  This is why the standard paleo diet allows for ghee and butter, and in many cases heavy cream and full-fat sour cream.  Many people also include fermented dairy in their diets with great success.

However, one thing that is abundantly clear is that milk allergy is common.  Beyond lactose-intolerance, which can be treated with the aid of digestive enzymes or consumption of raw milk, allergy to milk proteins is very common.  Epidemiological reports of cow’s milk allergy (IgE antibody reactions to cow’s milk proteins) range between 1 and 17.5% in preschoolers, 1 and 13.5% in children ages 5 to 16 years, and 1 to 4% in adults 8.  It is not known how prevalent cow’s milk sensitivities are (IgA and IgG antibody reactions to cow’s milk proteins).  It’s important to note that goat’s milk is not as allergenic as cow’s milk.

Cow’s milk proteins are also known gluten cross-reactors, which means that those with gluten intolerance may produce antibodies against gluten that also recognize dairy proteins.  For these people, eating dairy is the same as eating gluten (more information in this post).  Very importantly, for people with allergy, intolerance or gluten cross-reactions to dairy proteins, even the trace dairy proteins in ghee can be a problem.

So, what do I recommend?  Caution.  I believe that dairy is probably okay for many healthy adults, especially full-fat, grass-fed dairy.  In fact, for healthy individuals, the benefits likely outweigh the risks.  However, for those battling autoimmune disease or other conditions where a leaky gut is a potential contributing factor, it makes the most sense to omit dairy from your diet for now.  As is my standard recommendation for all of the gray-area foods, I suggest leaving it out of your diet for at least 1 month, then try reintroducing it and see if you notice any obvious symptoms (this is the best way to determine if you are allergic or sensitive).

I am still trying to gauge my own tolerance for grass-fed butter.  My daughters both seem to do better without cow’s dairy in their diets (except grass-fed butter, which seems okay), but I have reintroduced grass-fed goat mineral whey protein powder into their diets and they seem to do really well with that (especially my oldest).  I also have intentions to try them with some grass-fed goat’s whole milk.  This is another highly individual aspect of a paleo diet and you really don’t know whether or not milk is good for you until you try living without and then try living with.

1. Crowe FL et al “The association between diet and serum concentrations of IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3 in the European Prospective Investigation into Cancer and Nutrition.” Cancer Epidemiol Biomarkers Prev. 2009 May;18(5):1333-40.

2. Louie JC et al “Higher regular fat dairy consumption is associated with lower incidence of metabolic syndrome but not type 2 diabetes.” Nutr Metab Cardiovasc Dis. 2012 Sep 26. pii: S0939-4753(12)00193-7. doi: 10.1016/j.numecd.2012.08.004. [Epub ahead of print]

3. Warensjö E, et al. “Biomarkers of milk fat and the risk of myocardial infarction in men and women: a prospective, matched case-control study.” Am J Clin Nutr. 2010 Jul;92(1):194-202. Epub 2010 May 19.

4. Sonestedt E et al. “Dairy products and its association with incidence of cardiovascular disease: the Malmö diet and cancer cohort.” Eur J Epidemiol. 2011 Aug;26(8):609-18. doi: 10.1007/s10654-011-9589-y. Epub 2011 Jun 10.

5. Sluijs I et al “The amount and type of dairy product intake and incident type 2 diabetes: results from the EPIC-InterAct Study.” Am J Clin Nutr. 2012 Aug;96(2):382-90. Epub 2012 Jul 3.

6. Bonthuis M et al. “Dairy consumption and patterns of mortality of Australian adults” European Journal of Clinical Nutrition (2010) 64, 569–577; doi:10.1038/ejcn.2010.45; published online 7 April 2010

7. Agostoni C and Turck D. “Is cow’s milk harmful to a child’s health?” J Pediatr Gastroenterol Nutr. 2011 Dec;53(6):594-600.

8. http://www.worldallergy.org/publications/WAO_DRACMA_guidelines.pdf

Chris Kresser has a terrific post Dairy: food of the Gods or neolithic agent of disease?

The Paleo Answer by Prof. Loren Cordain is an excellent resource.

 

Comments

The information about cross-reaction between gluten and dairy proteins makes so much sense to me! Thanks for this post. Also, where do you get/what brand of goat milk whey protein powder? I have been using a vegan rice based protein powder because it seemed the best of the worst, but would like to try the goats milk one.k

I forgot that some people want specifics, so what I use is use 16 oz coconut water as a base and blend in 5 slightly heaping tablespoons of the Caprotein, and 2 level tablespoons of the dried goat milk. During the summer months, I have access to raw, grass-fed goat’s milk, so I replace the dried goat milk and half the coconut water with the raw goats milk (8 oz coco water, 8 oz raw goat milk, 5 slightly heaping tablespoons Caprotein).

Posts like this are why I come back to this blog over and over and over. Scientific, practical, well researched, and clearly explained. You are a gift to the public well being – THANK YOU!

Sarah, have you come across research comparing the digestibility of cow’s milk proteins to other dairy proteins, such as goat or sheep? Our family care doctor, whom I found through the Paleo Physician’s Network, recommends no cow dairy but says that the digestibility of sheep and/or goat protein is so much better and therefore okay. Any thoughts on this?

Sheep and goat have less lactose, which might make it more digestible, but I havent seen anything saying that the proteins themselves are more easily digested. But, the casein is different, and is less allergenic than the casein in cow milk, so that’s a definitely a pro to sheep and goat milk. Many people do tolerate sheep and goat milk when they can’t tolerate cow milk.

W are from Austria and raw grass fed sheep alpian homemade kefir is our everyday breakfast. You know it is super thick like yogurt cause 8%fat it has 15 protein in cup I have big bowl so it is 30grams of protein and it has 300mg of omega 3 in cup so 600mg just in my breakfast. I can not imagine a day without it, so delicious nutrititious dnese breakfast. I just can not eat so much meat as paleo advice (bacon aggs breakfast, meat for lunch and dinner too) So I love our raw sheep kefir with wild moutanins blueberries or other fruit in season. Goat milk is not as thick cause lesser amount of fat also lesser amount of protein and omega3 and other vitamins and minerals. My daughter is eating with me every day and enjoy it a lot.

I have just startet reading your book a few days ago, so I haven’t startet yet. But I was looking at the re-introductionplan. I see that cheeses are at the last stage, but is it possible that cheeses like feta and chevre (two of my favorite), could be more easily reintroduced than other cow-milkbased cheeses. Looking at the list of no-nos cheese and creme/sour-creme, coffee, aubergines and tomatoes are the most difficult to give up.. I know it is silly to look at this now, before I start, as I should focus on what I can eat. But I already have given up a lot of the foods I love already, and I want to see a little hope of being able to eat some of the ones I have to give up.

The book is amazing by the way!

Vivian

It’s possible you might tolerate some cheeses better than others, but it’s best to wait and reintroduce them after you are feeling well enough to challenge your immune system. – Christina, Sarah’s assistant

I think it’s very individual. We’re in the well fermented yoghurt and a few selected well aged cheeses. Cream seems okay, but milk is a definite no. It sends my daughter’s blood sugars too high!

Fantastic post! Things have changed dramatically in our household since we switched to raw milk (along with yogurt and kefir). Although most people find the fact that I consume dairy “controversial”. It’s the first thing I’m re-introducing after the whole life challenge is over!

Thanks for this. I get a reaction to dairy, but it is a very slow progression. After about a week of cream in my coffee, I then get an arthritic flare-up (compared to other foods where it’s within 24 hours). I delude myself into thinking ‘it’s not that bad!’ then. I needed to read this for the eye-opener it is! My son’s eczema also has disappeared without dairy so we don’t eat much of it anymore. Still … it’s hard to let go of the cream in my coffee and the odd piece of cheese!

My reactions are the same way, slow and hard to pin down. It would be so much easier to have an immediate reaction.

As for your coffee, have you tried adding a Tbsp or 2 of coconut oil in, then whipping it in the blender for 15-20 seconds? It’s awesome!

I love your posts!
What do you think about bovine colostrum to heal a leaky gut / or help with Crohn’s disease ? I have read that a high quality product does not contain lactose or casein and is highly beneficial. I am lactose intolerant since my twenties (32 yo now), and since I have been diagnosed with Crohns in Sept 2012, the only dairy product I have is goat milk yogurt. I gave up all dairy except that one. Do you think I am silly to give a try to bovine colostrum ?

I have read that it is very beneficial in crohn’s disease too. But, I haven’t read the original scientific articles to see how well the science was performed, possible risks, allergic cross-reactions with milk, etc. (I’ll add this to my list of future posts). At this point, I do not know enough to recommend it or against it. Sorry, I don’t have a better answer for you!

PaleoMom – great website, I will refer people to it!.

Not sure if you care about this, but in your first paragraph, you spelled “heavy” as “heany”… just lookin’ out for you in case you want to correct it for future readers :)

Raw grass-fed milk is a great source of undamaged quality protein, probiotics, enzymes, vitamins, etc… I really like this article – worth reading: http://www.cheeseslave.com/top-ten-reasons-to-drink-raw-milk/

I hate to get off topic – but I like sharing info with other Paleo dieters. After a workout, I drink 12-16oz of raw milk (I live in NE and get it from a local farm), and add a scoop or two of whey protein that I got from this website: http://www.wheynaturalusa.com/products.html.

I am completely sold on the quality of protein from Whey Natural USA. The taste is unbelievable when mixed raw milk. I would definitely recommend at least trying their free sample.

Thank you! Typos happen and I’m always appreciative when people point them out. Thanks for the links too. I think if dairy is tolerated, whey can be really powerful in providing all of the amino acids and cofactors needed to make glutathione.

I buy raw milk. I have read a d researched this on Weston price. They sai its the only good milk to drink. What you think about raw milk?

Hi I wanted to say thank you for putting up all this information I can’t believe what a difference this autoimmune approach has made for my condition (osteoarthiritis and inflammation due to degeneration of joint capsules called modic changes) Im youngish but felt like 80 year old with constant pain in my joints and back only relief I had was with prescription drugs. I tried SCD previously but didnt eliminate dairy, nightshades etc. It helped my back but not the knees they got only worse. And I don’t do well with raw foods either at least not yet (weak spleen they call it in chinese medicine). I used to eat lots of salads, dairy and wholemeal bread not anymore.. I have had IgG test done and it showed reaction to dairy, eggs specially egg whites and yeast. I have to say that for the first time in many years I can see a glimpse of hope in horizon:)

Hi first time on the blog today and just getting started on my research. I’m curious if the research on dairy includes raw milk or if it’s strictly based on pasteurized and/or homogenized milk? My family just moved to 10 acres and we’re considering having our own dairy cow since raw milk is so tightly regulated.

This is an awesome explanation. I just added some dairy into my diet due to even more restrictions on things suggested by my doctor (I have to eat less fat, more protein — can I cry now?!), and I’m testing it out. Thanks for offering some great thoughts on dairy. :)

Good article. I can’t tolerate milk proteins at all. Two comments on BGH: Years ago, I had a friend who worked in a lab with bovine growth hormone. She said then that the milk industry was required to test milk for the presence of BGH before selling it, but were not required to test for the methylated version of it, which is what was present in the milk after the cows metabolized the hormone. Second anecdote: A skinny friend of my daughter’s started growing breasts when she was 7 – they disappeared when she switched to organic milk. Seems to me from this limited experience, that nobody should drink milk from BGH-fed cows.

Sarah, do you know if ghee contains any of the hormones present in other dairy products? I eliminated all dairy except for ghee for 6 months and then reintroduced butter, and then later raw goats milk kefir. Both reintroductions resulted in some pretty major hormone fluctuations in my body. I didn’t realize until then that raw and organic dairy naturally contains high levels of hormones. I do love my ghee, so I would honestly hate to give it up. Are the hormones strained out along with the lactose and casein?

Thanks for your quick reply. I did some more research and found a list of hormones naturally present in raw organic milk, and the majority seem to be protein and amino acid hormones, although there are steroid lipid hormones as well. Maybe ghee filters out the protein derivatives and simply leaves the lipid hormones behind, and therefore the effect isn’t as strong? Nutrition and its effect on the body is so fascinating. It looks like I should try eliminating ghee and reintroducing it, to see how my body responds. I’ve gotta be honest – I feel a little rebellious at the thought of giving up my beloved ghee. :-)

Thank you for this post. I agree that paleo must be a case to case basis, especially on how it deals with the grey-area foods. I tried a strictly paleo diet, eliminated all the non paleo foods as recommended by the diet. After which I re introduced raw milk and small amount of rice back to my diet. So far, so good, my body is feeling great more than ever. My next goal now is to introduced paleo to my kids. Another great hurdle for me, I am challenged to research on kid friendly paleo recipes, since they are picky eaters. But I know I’ll get there, slowly but surely.

My children 5 & 7 eat limited to no dairy. They do not like broth or leafy green veggies. Do you think that a calcium/magnesium supplement would be a good idea? Thanks

It would be worth doing a food journal for a week and seeing what their calcium, magnesium, phosphorous, vitamin A, vitamin D (K2 would be great too, but hard to get info on the content in food) and see how they’re doing before supplementing. Then, I always think it’s better to try and get nutrients from food. Have a look at http://www.thepaleomom.com/2013/09/why-dont-i-need-to-worry-about-calcium-2.html to see if there’s some good food sources that your kids will eat.

Just wondering which alternative milk would be the best for my kids (2 and 4 years old). I don’t have access to raw cows milk. They won’t drink goats milk. They don’t mind almond and coconut milk. I know that almond milk doesn’t have a lot of fat, and coconut milk has fat, but no calcium. What is the best option for them?
P.S.
Thank you so much for this site and all your expertise! I will be starting the autoimmune protocol in January to manage my Celiacs disease, Hashimotos, and psoriasis.

Your children don’t need milk! In fact it is very likely most cow’s milk could hurt them. Almond milk is great. Healthy fats from nuts as well as a balanced diet high in greens will be all they need.

I have crohn’s and could tolerate raw milk from healthy cows far better than the organic pasteurized and homogenized variety.

This article did not mention the specific effects that dairy products have on women in particular. It is suggested that most dairy products cause acne, among other things. There is also research indicating that full fat dairy contains more estrogen and progesterone than other dairy products. Before starting paleo I had a lot of half and half, 2% milk and cheese that would cause flatulence. Once I started paleo I eliminated those (and the flatulence, yay!) but I began drinking heavy cream in my coffee every day. Weeks later I noticed painful ovulation (a first) followed by the most painful menstrual cramps (think labor contractions) I’ve ever had. I didn’t want to believe it was the heavy cream (it was my last dairy indulgence) but it seemed the most likely culprit. I endured the painful ovulation and cramps for one more cycle to make sure it wasn’t a fluke and then cut out the heavy cream. Voila, the third cycle was normal. I also experienced similar (though not as bad) results when I switched to soy milk. Coconut and almond milk may be the only options for me.

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