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The Great Dairy Debate

October 13, 2012 in FAQ, Foods in Moderation, The WHYs of the AIP

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.

 

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Carbohydrate Recommendations For Kids

August 28, 2012 in Practical Tips, Practical Tips, Practical Tips, Sugar/Carbs

As adults, it can be overwhelming wading through the varying opinions on how many carbohydrates we should eat.  Many of us with a history of being overweight find that low to moderate carbohydrate consumption works very well for us.  Many others find success at either of the extremes of paleo carbohydrate intake: ketosis versus plenty carbohydrates from “safe starches”.  This is why I wrote my 3-part series on Optimizing Carbohydrate Intake for Your Body (see here, here and here).  However, this opened up the question from many of you:  what about kids?

In general, I’m not a big fan of counting macronutrients for kids (or anyone, if you can get away with it).  If you present your child with a variety of healthy foods, most kids will naturally eat what their body needs to be healthy.  However, it is the natural tendency of parents (especially parents who are trying to address their own health issues with a paleo diet) to worry about whether or not their child is getting the right amount of, well, just about everything.  It is also helpful to have some guidance as to what exactly you should put in front of your kids.  For example, is it healthy to let them eat as much fruit as they want?  I know my kids would gladly eat fruit all day!

When it comes to macronutrient ratios for kids, I think we can get a very good idea of how they should be eating by looking at the composition of human breast milk.  In prehistoric cultures, children likely received at least some breast milk until the age of 4 or 5 years, so it’s a pretty safe bet that the macronutrient ratio of breast milk is a good guide at least for kids up to that age.  Milk is considered the perfect food for growth of a young child and I believe that we can continue to use the macronutrient ratio of breast milk as a general guide for the diets of our children for as long as they are growing (after all, the macronutrient ratio of breast milk is often used to as a guide for carbohydrate consumption for adults!).

The macronutrient ratio of human breast milk is quite variable, depending on the diet of the mother, the amount the baby nurses, and the age of the baby.  There seems to be some signaling from the baby to the mother, and it is very likely that much of this variability reflects the specific dietary needs of the baby at that time.  The carbohydrate content of human breast milk varies between 57% to 70% (as a percentage of total milk solids).  Fat makes up 28-39% of milk and protein makes up about 7-10% (as a percentage of total milk solids) [1].  Translating this to a percentage of caloric intake (which is a far more familiar number for most of us) the carbohydrate content of human breast milk is 40-55%.  When these numbers are used to provide guidelines for adult carbohydrate consumption, an amount of glucose needed by the growing brain of a baby/child is subtracted (which is why The Perfect Health Diet ends up with a recommendation closer to 20-30% carbs for adults).  We don’t need to go to these lengths here (phew! because this has already been enough math for me for one day!) because kids brains continue to grow and develop, even until their mid-twenties (sorry if I just offended anyone in their early- to mid-twenties by calling them kids).

Your child’s carbohydrate need will probably vary with growth spurts, developmental spurts, and age.  On average, their carbohydrate needs will probably tend to go down as they get older (protein especially will take its place).  Caloric intake varies dramatically with growth spurts, developmental spurts and age as well, so it’s tough to convert this to a number of grams of carbohydrates your kid should be eating.  Instead, think of it this way:  to achieve 40% of their calories from carbohydrates, something like half to three quarters of their plates should be fruit and vegetables (including plenty of starchy vegetables).  The reason why 40% of calories from carbohydrates doesn’t just translate to 40% of their plate being fruits and vegetables is because non-starchy vegetables are not very carbohydrate/calorie dense (especially compared to whatever fat you may also have on the plate).

The point of this post isn’t to get you counting the carbohydrates your child is eating, but rather to point out that quite a lot of fruit and vegetables is just fine for your growing child.  And as long as they are eating some of their meat and healthy fats and you are presenting them with a variety of healthy food options (think meat, fish, organ meat, healthy fats such as avocado, olives, and coconut oil, green veggies, colorful veggies, cruciferous veggies, starchy veggies and all kinds of fruit), it’s probably not worth worrying about.

baby
1 Nutrition in Pediatrics: Basic Science, Clinical Applications  By Duggan, Christopher, John B. Watkins, and W. Allan Walker. Published by BC Decker Inc. 2008

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Gut Health for Kids

July 31, 2012 in For Babies, For Older Kids, For Younger Kids, Gut Health

(Created as a guest post for The Paleo Parents)

Gut health is essential for overall health.  A healthy digestive tract is efficient at absorbing nutrients from your food, protecting the body from foreign invaders including mounting appropriate immune responses when required, and at regulating a wide variety of hormones.  A growing number of health conditions are being linked to poor intestinal health.  As you already know, the foods you eat can have a powerful influence on your gut health (for more information on how grains, legumes and dairy contribute to a ‘leaky gut’, read this post, this post, and this post).  So, what about kids?  A paleo diet is a fantastically healthy diet for kids, as we consume only the most nutritionally-dense foods (I am very fond of the nutritional analysis presented in The Paleo Diet).  It is also a great starting place if your child requires a focus on healing the gut. 

Many of the recommendations for optimizing adult gut health (as outlined in here and here) are appropriate for babies and younger children.  However, getting a child to eat what you know is good for them can be a challenge!  Also, many of the supplements recommended to promote healthy digestion are inappropriate for children (such as digestive enzyme, hydrochloric acid, and apple cider vinegar supplementation; other supplements such as L-glutamine and quercitin should only be given to your child under the supervision of a medical professional).  So what can you do to help them?  Whether you are looking for strategies to heal your child’s confirmed or suspected leaky gut or are looking for ways to protect your healthy child from developing a leaky gut, here are some ideas for promoting a healthy gut for your child (including some practical tips for pulling it off!).

1. Start Them Off Right:  Breastfeeding your baby is the best way to ensure that their digestive tracts develop a healthy diversity of beneficial bacteria.  However, if you face insurmountable obstacles to breastfeeding or have gut dysbiosis yourself (or if your child requires antibiotic treatment), you may want to supplement with a source probiotics to help their digestive tracts establish this essential probiotic diversity.  I chose to supplement with a small amount of acidophilus for a couple of months before starting my youngest on solid foods (I didn’t know any better for my oldest and I still regret it).  I bought acidophilus/bifidus supplements in capsule form, broke open the capsules and put a tiny pinch of the powder in her mouth before nursing a couple of times a day, starting at about 3 months old.  I bought the highest diversity/quality probiotic supplement I could find and changed brands every time I bought a new bottle (I was taking it for myself at the time, so I went through a small bottle fairly frequently).  Other people achieve the same using fermented foods (for a baby or toddler who can’t chew raw sauerkraut, a little of the “juice” around the sauerkraut can be given on a spoon or mixed in with other foods).  It also helps not to start solid foods too early (typically, the digestive tract isn’t really ready for solids until about 6 months old).  I am a big fan of “baby-led weaning” which essentially means that you don’t start your baby on solids until they are ready to self-feed.  For both of my girls, that was around 7 months old (they could pick up small pieces of cooked vegetable or soft fruit, put it in their own mouths, chew and swallow), but many babies aren’t ready until older than this, and that’s okay!  If you are wondering what foods to introduce first, check out my post on paleo baby foods (this post is written for traditional introduction of solid foods, but the information is also relevant to baby-led weaning).  Don’t worry if your child is older and you missed your chance, because you can still…

2. Sneak Some Probiotics Into Their Diet:  Even after your child is eating solids, a continuous supply of good bacteria and yeast in their diet is good for them, especially if you are trying to restore gut microflora diversity after illness.  You can introduce these in the form of kombucha, yogurt and kefir (I’m a big fan of homemade coconut milk yogurt and kefir), fermented vegetables like raw sauerkraut and homemade pickles, and/or acidophilus supplements (you can continue to break open acidophilus capsules or switch to chewable tablets once your child is old enough).  Frequent small doses are more effective than one large dose, so 1 Tbsp of homemade kombucha or coconut milk kefir mixed in with your child’s food or beverage daily is a great way to go (do keep in mind that regular kombucha does have a small amount caffeine).  This is especially important after any infection requiring antibiotics or steroids and after stomach bugs.  Is this important to do if your child is healthy and you are just looking to prevent problems?  The answer is yes and no.  If your child is healthy now, they almost certainly have a healthy diversity of bacteria growing inside them now.  There is no added benefit to including a probiotic supplement in their diet.  Fermented foods however, are still beneficial as these help feed the good bacteria growing in their guts in addition to adding a much greater variety of beneficial bacteria than typically found in supplements.

3. Include some healing foods in their diet.  Homemade bone broth is rich in glycine, which is very important for healing the lining of the gut and reducing inflammation (for more information, see this post).  My 2.5-year old loves to drink plain bone broth, but it can also be added to mashed vegetables, smoothies and even homemade popsicles! Organ meats like liver (especially if grass-fed) contain Vitamin D, tons of vitamin and minerals, and more glycine than muscle meat.  Just because you don’t love liver, doesn’t mean your child won’t.  It’s a soft meat and many young kids find the texture more enjoyable than muscle meats.  If your child isn’t a big fan, check out my recipes for hidden-liver meatloaf and hidden-liver Turkish meatballs.  Oily cold-water fish is not only rich in omega-3 fatty acids (the highest omega-3 fish are salmon, mackerel, sardines, herring, kipper, anchovies, trout, fresh tuna, and carp) which helps resolve inflammation, but is also high in vitamin D and selenium.  My 2.5-year old loves brisling sardines and both my kids love poached or baked salmon.  There are dozens of neat seafood recipes out there, from salmon cakes to fish sticks (which could be made with haddock, cod, hake, halibut, sole, flounder, bass or perch which are all moderately high in omega-3), which may entice your child to eat them.  The medium chain triglycerides (MCTs) in coconut oil are known to have anti-microbial and anti-inflammatory properties.  Extra virgin coconut oil also contains a large amount of Vitamin E and other anti-oxidants and is wonderful for cooking just about anything, from paleo baking to scrambled eggs (or even just eating off a spoon!).  Coconut butter can be eaten by the spoonful or added to soups and curry dishes.  Full-fat coconut milk (which can be easily made at home) can be added to smoothies or used to make homemade kefir or yogurt.  Grass-fed meat (and butter and ghee from grass-fed diary) is rich in conjugated linoleic acid (CLA), a fat known to promote healing, as well as providing plenty of vitamins, minerals and having a balanced omega-3 to omega-6 ratio.  My kids love anything made with ground beef, from Swedish meatballs to tacos!

4. Avoid gut irritating foods, including foods you child has a sensitivity to:  Avoiding grains, legumes, dairy, processed foods and refined sugar will go a long way to improving your child’s gut health.  However, if your child is facing an uphill battle with health, there are some other culprit foods worth eliminating as well.  If your child has signs of Small Intestinal Bacterial Overgrowth (SIBO), you’ll want to limit starchy vegetables (see this post for a guide on which vegetables are okay for SIBO and which are better to avoid).  Another class of vegetables that can cause issues for some people are those high in types of sugar that qualify as FODMAPs (Fermentable, Oligo-, Di-, Mono-saccharides and Polyols).  Continued digestive symptoms after following a paleo diet may indicate SIBO or FODMAP-sensitivity (also known as fructose malabsorption).  There is a high degree of overlap between vegetables that are avoided to address SIBO and those that contain FODMAPs.  If you aren’t sure, try an elimination diet approach where you avoid all vegetables which may be problematic for 3-4 weeks and then slowly try reintroducing them one at a time to see if they cause digestive symptoms.  In addition to these vegetables, other foods may be problematic due to development of food sensitivities (this is common in children and adults with severely leaky guts).  You can evaluate whether or not these foods are problematic for your child using an elimination diet approach (where you leave the suspected foods out of your child’s diet for 3-4 weeks and then add them back in one at a time).  Sensitivities to eggs, nuts, seeds, and vegetables from the nightshade family (tomatoes, eggplants and peppers) are common.  Alternatively, you can find a naturopathic physician or chiropractor who can order a food sensitivity blood test (IgG and IgA).  Any foods that your child tests positive for in a food sensitivity test should be avoided completely for at least 6 months, after which you can reintroduce small amounts to see if the sensitivity persists (many sensitivities will disappear after the gut has fully healed).

5. Play and Have Fun:  Kids need both structured and unstructured play time, both active play and quite, focused play time, and both independent and social play time (with other kids and/or with adults).  Having this mix of different types of play is important for the developing brain, but also helps regulate hormones (like stress hormones, which are particularly important to gut health) and helps tire kids out for a good nap and a good night’s sleep (also critical for healing and staying healthy).  And making sure to take time to have fun with your kids is good for your stress levels too! 

6. Get them outside:  If you read my post on the importance of sunlight, you’ll remember just how important it is to be outside for a good amount of time every day.  For kids, it also provides space to run around and a stimulating environment for their developing brains to explore (you get to play and get sun exposure! Yay for efficiency!).  I aim to have my kids outside for at least 1-3 hours every day, weather permitting (I am a big supporter of playing outside in just about any weather as long as you’re dressed for it!).  Beyond the benefits of fresh air and exercise, sun exposure on their skin is essential for the formation of Vitamin D (you don’t want to let them get sunburned, of course).  Vitamin D is very important for healing and reducing inflammation.  If getting outside is not possible for you and/or your child or if you feel that your child may deficient in Vitamin D, it is worth talking to your doctor about a Vitamin D3 supplement.

7. Provide an environment conducive to sleep:  Sleep can be more or less of a challenge depending on your child.  One book that I really like for gentle sleep strategies for babies is The No-Cry Sleep Solution (also available in a toddler through preschooler edition).  The tips that have been most helpful for me and both of my non-sleepers are:  have a rock-solid routine (not just at bedtime but consistent structure throughout the day), put your kids to bed earlier rather than later (they will often sleep longer if they go to bed earlier), and have kids sleep in a cool, very dark room.  A white noise machine may also be helpful. 

8. Don’t make food a battle:  However you chose to introduce food to your child, whether or not you chose to give your child options or only give them what everyone else is eating, don’t make meals a battle.  This means having a realistic expectation of what and how much your child might eat, of how long they might sit up at the table, and of age-appropriate table manners.  Even if you are taking a firm stance, don’t argue or raise your voice.  Stress and food just don’t mix.  And stress can hinder healing.  Keep in mind that, when given a variety of healthy foods, the vast majority of children will naturally eat what their bodies need.  The two most important things that you can do to help your child learn how to eat healthily is do so yourself and present them only with healthy options. 

As a final thought, I believe you are already doing the most important thing you can to help your child get/stay healthy by learning about how food affects the human body.  If you are unsure how to apply any of these recommendations or whether they are appropriate for your child, please discuss them with your child’s doctor or alternative healthcare provider.

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