Paleo Diet Q & A - Homocysteine

Dear Readers,

Here's today's edition of Paleo Diet Q & A regarding Homocysteine.

Dr. Cordain and his associate Pedro Bastos, were recently contacted by Ben Balzer, M.D. a well known Australian GP, friend and colleague regarding homocysteine issues. According to the American Heart Association, homocysteine is "an amino acid in the blood. Epidemiological studies have shown that too much homocysteine in the blood (plasma) is related to a higher risk of coronary heart disease, stroke and peripheral vascular disease."

Included below are Dr. Balzer's original correspondence, as well as the replies from Dr. Cordain and Mr. Bastos.

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Dear Loren and Pedro,

I was writing to a cardiologist today about homocysteine (alternate spelling: homocystine), among other issues. I don’t think I’ve raised it with you before, but it occurs that it may be of interest or relevance, so I’ve repeated it here below. Clinical medicine takes me up a few nutritional pathways that aren’t necessarily paleo, but as I always say paleo is the unifying field theory of nutrition, so it has always made it easier.

I’m a firm believer in homocysteine related issues, but the way modern medicine works it will never be driven hard as there is no commercial imperative--as all the treatments are vitamins and cannot be patented. Though there have been attempts to make a "drug" that will lower homocysteine, which would then magically spark interest.

I am also aware that choline has been given vitamin status and also participates in the 1-carbon cycle. Perhaps you could let me know how the choline intake of the SAD compares to our modern day urban hunter gatherer. Maybe we can shorten that to urban hunter gatherer, but I don’t think UHG will catch on, though it does have a caveman like ring to it.

What is amazing about homocysteine and triple B therapy is how little most Australian cardiologists knew about it. Yet when Lange published a highly flawed negative paper, they all knew about it overnight- highly suggestive of a commercial push.

Regards,
Ben

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Hi Ben,

Good to touch bases with you and hopefully we can get together when I am in Sydney in June. Although we havent done the computerized dietary analysis yet -- specific to homocysteine, it is almost certain that sub-artic hominids would have had high plasma concentrations of folic acid, B6 and B12 (see my paper: Cordain L. "The nutritional characteristics of a contemporary diet based upon Paleolithic food groups." J Am Nutraceut Assoc 2002; 5:15-24.) Hence hyperhomocysteinemia likely was not an environmental seletive pressure that routinely affected Homo until very recent times (evolutionarily speaking -- ergo the past 10,000 years). I suspect that modern western diets are significantly lower in choline-rich foods than diets based upon fruits, veggies, meats, seafood, nuts, fish, and organ meats. Once again, we have not done the computerized dietary analyses.

Best wishes,
Loren

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Hi Ben.

Good to hear from you. I definitely agree with Loren.

Regarding choline, I would just like to add that from computer analysing several types of diets, I have come to the conclusion that without eating liver or a high amount of egg yolks, it is virtually impossible to achieve 500 mg of choline a day. So, I believe our H/G ancestors got their choline from organ meats. Since today, most of us do not eat organ meats, I would like to know how we can ingest the choline we need.

Here’s a table from the Linus Pauling Institute with some dietary sources of choline. In addition, I would refer you to two papers: one by Bruce Ames on choline and another on food sources of choline and betaine.

Food	Serving	Total Choline (mg)
Beef liver, pan fried	3 ounces*	355
Wheat germ, toasted	1 cup	172
Egg	1 large	126
Atlantic cod, cooked	3 ounces	71
Beef, trim cut, cooked	3 ounces	66
Brussel sprouts, cooked	1 cup	63
Broccoli, cooked	1 cup, chopped	62
Salmon	3 ounces	56
Shrimp, canned	3 ounces	49
Peanut butter, smooth	2 tablespoons	20
Milk chocolate	1.5-ounce bar	20

By the way, here’s the adequate intake:

Adequate Intake (AI) for Choline
Life stage	Age	Males (mg/day)	Females (mg/day)
Infants	0-6 months	125	125
Infants	7-12 months	150	150
Children	1-3 years	200	200
Children	4-8 years	250	250
Children	9-13 years	375	375
Adolescents	14-18 years	550	400
Adults	19 years and older	550	425
Pregnancy	All ages	-	450
Breastfeeding	All ages	-	550

It would be very interesting to estimate the various micronutrient intake of various H/G diets based on Loren’s model.

Best wishes,
Pedro

Submitting Your Questions

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Ancestral Health Symposium

Dear Readers,

Dr. Cordain, Pedro Bastos, and Nell Stephenson have all been invited to participate in the first ever Ancestral Health Symposium to be held at the University of California at Los Angeles during the summer of 2011.

Mission: The Ancestral Health Symposium fosters interdisciplinary collaboration and translational efforts between research scientists, physicians, health experts/professionals, and patients who study and communicate about the human ecological niche and modern health from an evolutionary perspective to develop innovative solutions to our current health challenges.

For more information please visit: ancestryfoundation.org.

Paleo Diet Q & A - 13 February 2010 - No legumes for real?

Dear Readers,

Today's edition of Paleo Diet Q & A focuses on legumes and protein.

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Q: I was just forwarded your peanut manifesto & found it interesting. I love the concept of the whole foods Paleo diet, but no legumes? That goes against everything I have been taught about nutrition. I'm not veg, but eat a primarily whole foods/low animal protein diet. Exactly how would you get enough protein without meat & without legumes? Nuts alone cannot provide the protein & consumed in high quantities would add too much fat to one's diet. Between the protein, fiber & other nutrients, beans are so good for you. I understand the points about peanuts & don't disagree with that...too many peanut allergies out there not to mention the aflotoxin issue.

-Amy


A: Dear Amy,

From an evolutionary perspective, legumes are not part of the human's diet. Prior to the agricultural revolution regular consumption of legumes was not common.

As cereal grains, legumes are great sources of antinutrients, such as lectins, saponins or protease inhibitors which wreak havoc the hormonal and immune systems.

Increased intestinal permeability has been associated to many chronic low-grade inflammatory and autoimmune diseases, such as celiac disease, rheumatoid arthritis, type 1 diabetes or multiple sclerosis. Lectins and saponins are able to increase intestinal permeability hence increasing the risk of inflammatory diseases, see Dr. Cordain's scientific paper:

http://www.thepaleodiet.com/articles/Arthritis%20PDF.pdf.

Regarding the protein content, the paleo diet (based on high protein foods such as lean meats, fish or even eggs) has been shown to be superior in protein than a grain-legume rich diet, as you could see in Dr. Cordain's paper (http://www.thepaleodiet.com/articles/Origins%20Paper%20Final.pdf).

Regarding fiber, vegetables have the higher fiber content among all nutrients.

I hope this helps.
Maelán


Q: The research in The China Study would disagree with Dr. Cordain's findings re: animal protein being superior to plant protein. Although lean meats, like natural grass-fed beef, are certainly superior to corn fed factory farmed beef. Also to consider, Paleolithic people were not living into their 70s, 80s, 90s, 100s like people are today. I imagine that the average life span back then was about 30-35? Eating to make it to 30 is different than eating to live until you are 80+. Are you aware of the "blue spots" in the world, i.e. areas of the world with high numbers of centenarians? Those people eat a diet relatively low or devoid of animal products (the latter being in Loma Linda, California where there is a huge population of vegan Seventh Day Adventists) and probably consume a fair amount of legumes. The other areas are located in Central America, Japan & Sardinia.

I do find it disturbing that there appears to be an increasing number of cases of Celiac's disease and gluten-sensitivity in the world. I have developed an allergy to casein & am senstive to gluten (like many other people) so I understand the merit in limiting or eliminating the sources of these proteins. Has Dr Cordain done any research on sprouting legumes & grains & the positive effects it has on digestion? There is interesting research in that area.

I have immense respect for the evolutionary process, the scientists who study it and how it relates to our health today. Eating a diet of unprocessed, local food is undoubtedly a superior way to nourish oneself. There are many merits to the Paleo diet, but there appears to be some flaws as well. Has Dr Cordain's findings been replicated by any other scientists?

Thank you for your response.
-Amy


A: Dear Amy,

Thanks for your comments, I’ll try to clarify your doubts.

a) Regarding animal/plant protein: please see the discussion between the china study author, Colin Campbell, and Dr. Cordain. Since I believe you are a sophisticated reader you can draw your own conclusions from that report.

b) The popular belief that paleolithic populations did not lived into their 70s, 80s, 90s or 100s is a misconception, as you can read in Dr. Cordain’s scientific papers:

http://www.thepaleodiet.com/articles/Health%20Promotion%20Paper.pdf

http://www.thepaleodiet.com/articles/Counter%20Arguments%20Paper.pdf

Maybe you are not aware of the Kitava Study conducted by our colleague Staffan Lindeberg. This is a pre-agricultural population in Kitava-Papua New Guinea. It turns out that 6% of the population is between 60-95 years old, yet they are virtually free of western disease, such as type 2 diabetes, obesity, cardiac infarction or stroke. This number is not bigger due to the high childhood mortality due to infections and birth problems, among others. I will quote a piece from one of the above studies: “Actually, adoption of farming and settled living appears to have adversely affected longevity, precipitating a substantial decline to about 20 years. Life expectancy in London in 1667 was 18, and it seems likely that from the Neolithic Revolution until the late 18th century, expectation of life in “civilized” nations seldom or never exceeded 25 years. Thereafter, technological breakthroughs in food production, manufacturing, transportation, trade communications, and energy generation gave rise to what economists call modern economic growth”. (Eaton et al. Preventive Medicine, 2002).

The bottom line is that life expectancy does not rely much on nutrition.

c) Regarding your comments on “the blue spots” in the world I’ll copy a previous reply to a similar question by our colleague Pedro Bastos:

Concerning longevity, it is well known that caloric restriction is the only proven method to extend live in various animals including primates (1-6) .

One of the reasons why people from Okinawa live more is because they eat less calories than people from mainland Japan (7). Well, 2 of the 3 intervention studies with a Pre-agriculture Diet show that one people are advised to eat the food groups available in Paleolithic era they eat less calories, although they haven't been advised to do that (8, 9).

Some of the mechanisms by which caloric restriction is beneficial for longevity are:

1 - Decrease in visceral fat - a Paleo type Diet has been shown to do that (8)

2 - Decrease IGF-1/IGFBP-3 - by eating a low glycemic load diet and avoiding high fructose foods you will normalize insulin metabolism and your IGF-1/IGBP-3 may decrease (see this paper to understand what I'm saying: http://www.thepaleodiet.com/articles/Hyperinsulinemic%20Diseases%20Final.pdf )

3 - Decreased glycation - by eating a low glycemic load diet, ingesting plenty of carnosine (10), reducing fructose (11), avoiding galactose (12) and avoiding cooking at high temperatures, you will be decreasing glycation.

4 - Decreased glycolysis (14) - a low Glycemic load diet will achieve this.

5 - Elevated insulin sensitivity - the studies with the Paleo Diet have shown that it increases insulin sensitivity (8, 15)

Moreover, if you read some of Dr. Cordain's papers available here, you will see how the modern diet is responsible for most of the so called diseases of civilization, who normally aflict people in the post reproductive years.

Finally, it should be mentioned that many of the so called healthy diets that are being promoted for longevity and optimal health actually contain one or more characteristics of a pre-agriculture diet (The Paleo Diet), so presumably we would expect them to lead to better health outcomes. For instance, the diet of Crete (which was then used to formulate the Mediterrean diet) has a low w6/w3 ratio, contains plenty of fruits and vegetables and most of the fat is monounsaturated (16), just like pre-agricultures diets.

And the traditional diet of Okinawas is composed by fruit, vegetables, sweet potatoes (not potatoes, which contain harmful glykoalcaloids), rice (it doesn't include gluten grains, which are worse than rice), fish, fermented soy (it is better than normal soy, although it still has harmful saponins and lectins and as so, we don't advise it) and some pork, so it has a lower w6/w3 ratio and no trans fatty acids, which are very important characteristics of pre-agricultures diets.

Furthermore, it's not just diet: we also have to look at their lifestyle which is closer to the one followed by our H/G ancestors: sun exposure, exercise, good sleep patterns and acute stress (exercise) as opposed to chronic stress (the one we experience).

d) Regarding sprouting legumes: Yes, sprouted grains and beans are a much healthier option. When we 'sprout grains' we are allowing the seed to germinate and a shoot will emerge from the seed. This is the part that is cut off and eaten. Therefore, the seed itself is not actually consumed (as is the case with whole grains and wheat flours here the seed proteins and starches are milled and eaten). Since lectins are packaged long with the seed to protect against predation, once the seed sprouts, the lectin concentration diminishes within a couple days. At least by the end of a week, the sprouts should have no residual lectins. Gliadin and glutenin are the dominate proteins located in the endosperm of the seed. The starchy endosperm is located alongside the embryo (germ) within the seed and provides nutrients the embryo needs as it is sprouting and growing.

Therefore, there should be no gliadin or glutenin proteins in the sprout, but rather primarily non-digestible cellulous (dietary fiber). One can consume sprouted grains and beans without fear of anti- nutrients, however keep in mind that these are still nutritionally poor in terms of micronutrients. Leafy greens and other vegetables contribute high fiber AND a higher concentration of nutrients-grains are still 'nutritional lightweights'. I would like to add an amendment to my earlier statement: We can consume GRAIN sprouts without fear of anti-nutrients however, legume sprouts still appear to contain considerable concentrations of saponins--the secondary compounds responsible for increasing gut permeability. Alfalfa sprouts (which are actually in the pea family) have an especially high concentration.


e) Regarding your question: has Dr. Cordain’s findings been replicated by any other scientist? The answer is yes, as you can check in these scientific papers. In one of them (Lindeberg et al. Diabetologia, 2007) it was shown that a paleolithic diet was superior to a Mediterranean diet where they consume legumes and grains.

Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.
Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Cardiovasc Diabetol. 2009 Jul 16;8:35.

Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.
Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC Jr, Sebastian A.
Eur J Clin Nutr. 2009 Aug;63(8):947-55. Epub 2009 Feb 11.

Effects of a short-term intervention with a paleolithic diet in healthy volunteers.
Osterdahl M, Kocturk T, Koochek A, Wändell PE.
Eur J Clin Nutr. 2008 May;62(5):682-5. Epub 2007 May 16.15.

A Paleolithic diet confers higher insulin sensitivity, lower C-reactive protein and lower blood pressure than a cereal-based diet in domestic pigs.
Jönsson T, Ahrén B, Pacini G, Sundler F, Wierup N, Steen S, Sjöberg T, Ugander M, Frostegård J, Göransson L, Lindeberg S.
Nutr Metab (Lond). 2006 Nov 2;3:39.

A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease.
Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, Ahrén B.
Diabetologia. 2007 Sep;50(9):1795-807. Epub 2007 Jun 22.

Cordially,
Maelán

Paleo Diet Q & A - 9 February 2010

Dear Readers,

Today's edition of Paleo Diet Q & A focuses on fasting.

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Q: Hello,

You may have covered this issue already, I have not read that much of your work.

I thought I would point out though that Paleo humans likely went through periods of enforced fasting due to a lack of game or a temporary lack of success in hunting. In fact, there were likely alternating cycles of gorging and fasting. This alternating cycle would change the data on the Paleo diet as modern humans are not likely to be undergoing the fasting phase.

It seems like doing a study using the climate record might help as Paleo man may not have migrated as much as the animals that they hunted.

Have you already covered this?

Just another nutrition student,
Bob

A: Dear Bob,

We agree in that hunter-gatherers would probably have been forced to observe periods of intermittent fasting.

In our archive you can find a published issue of our newsletter (Vol. 1; Issue 3) where Dr. Cordain reports that hunter-gatherers usually ate a single meal in the evening and probably breakfast using leftovers from the night before. This makes sense as they spent the day engaged in foraging and hunting activities and returned to their camps in the sunset. Some of the beneficial effects of intermittent fasting are likely due to caloric restriction, a well as known interventions that increase health in animals and humans, and lifespan in animals such as hamsters, mice, rats, fish, insects and worms.

A feast-famine, exercise-rest cycle has been postulated as a healthful lifestyle similar to that of human beings in the paleolithic. Famine and exercise (simultaneously) decrease muscle glycogen and triglycerides stores increasing AMPK and GLUT4 expression. These two proteins are involved in glucose and triglycerides homeostasis, leading to an efficient storage of energy and increased physical performance. If hunting is successful, a replenishment of glycogen and triglycerides is produced. This is followed by a relative period of rest. This efficient storage of energy increases the probabilities of surviving during another famine/exercise period¹.

This should be a healthy way to improve health and physical performance from an evolutionary perspective.

1. Chakravarthy, M. V., Booth, F. W. Eating, exercise, and "thrifty" genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases. J Appl Physiol, 96 (1); 3-10.

I hope this helps.

Cordially,
Maelán

Success Story - The Paleo Diet and Type 1 Diabetes

Dear Readers,

The following post is a testimonial from a mother who's child was diagnosed with Type 1 Diabetes last year, and who has seen a significant improvement in her condition after adopting the Paleo Diet.

We encourage all our readers to share their success stories using the Paleo Diet with us.

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I have a most remarkable story! On September 10, 2009, I took my six year old daughter to the pediatrician for what I thought was a urinary tract infection. She had been very thirsty and going to the bathroom excessively. Little did I know that these were symptoms of hyperglycemia! Her BG was tested a 542 in the doctor's office, and she spent 2 days in the hospital. During that time she was diagnosed with Type 1 Diabetes. Her A1c was 10.8. Her IA-2 Ab was strongly positive, with borderline positive insulin Ab, but she had negative GAD-65 and ICA. This is consistent with Type 1 Diabetes. They sent us home to begin a regimen of insulin injections; one basal in the evening, and one before each meal. We did what any parent would do which is: what the doctors told us.

However, after a week or so, we realized we were counting carbohydrates in things like pop tarts. It seems absurd. We decided that all of us needed to clean up our diets. Since we worked out in a Crossfit gym, the diet that came to mind was the Paleo Diet.

What happened next is amazing! My daughter's insulin needs PLUMMETED. Over the next week we made numerous calls to the Endocrinologist to adjust her dosages downward. After about two weeks, she was completely off of insulin! That was roughly October 1st, 2009. She has continued with BG testing, endocrinologist visits, and the Paleo Diet, and as of this day (January 31, 2010) she has close to normal BG and requires no insulin. At her last Doctor visit (late December) her A1c was 6.6. We believe this will be in the 5's at her next visit in March. My challenge is to make a believer out of the Endocrinologist. He believes she is in "remission" and that it will surely wear off. But as more time goes by, I can see his curiosity beginning to awaken. He said that there are some cases of remission lasting this long, but if she makes it to a year, he will have to write a paper.

I’m going to hold him to it.

Sincerely,
JoAnne

Paleo Diet Q & A - 3 February 2010 - Milk During Pregnancy

Dear Readers,

Today's edition of Paleo Diet Q & A focuses on consumption of milk during pregnancy.

Q: Hi Dr. Cordain,

My sister is a few weeks pregnant and has been following the Paleo Diet for a couple months now. Her doctor just told her to consume lots of milk during her pregnancy. My assumption is that they want to make sure she's getting plenty of vitamin D and calcium. I have her on a 2000 IU/day vitamin D supplement as well as a calcium/vitamin D supplement. What are your thoughts/suggestions?

Drew

A: Dear Drew,

There is good evidence that up until 9,000 years ago in the Middle East¹ and 7,000 years ago in Northern Europe², no human being on the planet consumed non-human milk or dairy products.

So, on an evolutionary time scale non-human milk is a relative newcomer to the human diet.

By using the evolutionary template, and knowing that milk is species-specific, we would expect this new habit to have unintended consequences, which go much beyond lactose intolerance, which is, actually very common, since only a minor percentage of the world’s population continues to produce lactase into adulthood³.

Indeed there are several lines of evidence raising concerns with milk and dairy intake, such as:

1) Milk and fermented milk (yoghurt, for instance), despite having a low Glycemic Index and Load, elicit a very high insulin response and this has been shown repeatedly in intervention studies^4-9.

As you may be aware, constantly increasing insulinemia may down-regulate the insulin receptor and hence lead to insulin resistance^10-12. Thisin turn is the primary metabolic defect underlying The Metabolic Syndrome¹³, and may be a driving force in Obesity^{14, 15}. It should also be mentioned that a chronic state of Hyperinsulinemia may initiate a hormonal cascade that ultimately results in Cancer, Acne and Juvenile Myopia, among other diseases¹³ (as thoroughly documented in Dr.Cordain’s scientific paper Hyperinsulinemic diseases of civilization: more than just syndrome X which you can download here.

Indeed, a high bovine milk diet has been shown to cause insulin resistance in boys⁹. Moreover, dairy intake is strongly associated with a higher incidence of Acne^16-18 and moderately associated with Prostate Cancer^19-23.

2) Cow’s milk appears to be involved in certain Autoimmune diseases (AD):

• Various epidemiological studies have associated it with Type 1 Diabetes^24-31, especially when the initial exposure begins in the first months of life.
• Epidemiological studies have repeatedly shown a strong correlation between Multiple Sclerosis and cow’s milk consumption^32-36.
• There is molecular mimicry between Bovine Serum Albumin and Human Collagen Type 1, which has implications for Rheumatoid Arthritis³⁷. Indeed, case studies have shown that elimination of milk and dairy products from the diets of patients with RA improved symptoms, and the disease was markedly exacerbated on re-challenge³⁷.
• Bovine Milk is also implicated (or appears to have adverse effects) in other auto-immune diseases, such as Crohn's disease³⁸, Sjögren's syndrome³⁹, IgA nephropathy^40-42, Behçet's disease⁴³, and even Celiac Disease⁴⁰.

3) Hormones in Milk:

In addition to proteins, fats, lactose, vitamins and minerals, Milk contains various growth-stimulating steroid and peptide hormone and also catalysts, transporters and stabilizers that ensure their maximum bioactivity⁴⁵.

Here’s a short list of some hormones present in cow’s milk that could be problematic for humans:

• Insulin
• IGF-1
• Betacellulin (BTC)
• Estrogens (particularly Estrone Sulfate)
• Precursors of Dihydrotestosterone (DHT)

Insulin

Cow’s milk, as well as human milk (and presumably milk from all mammals) contains insulin^46-49, and we know that bovine insulin - BI (which differs from human insulin by three amino acids⁵⁰) survives pasteurization, because immunity to this hormone is common in children who consume cow’s milk or who have been exposed to infant formulas containing cow’s milk^51-54.

This not only confirms that BI is present in commercial pasteurized milk, but also in infant formulas and perhaps other dairy products (although direct evidence is lacking). Moreover, these studies provide evidence that BI survives the human digestive processes and crosses the gut barrier intact, although this could be related to the fact that infants have higher intestinal permeability than older children and adults⁵⁰. Nevertheless, various factors may cause the so called "leaky gut" in virtually everyone, so we shouldn’t dismiss bovine insulin altogether.

IGF-1

Cow’s milk contains active IGF-1⁵⁵, but this has been largely dismissed as irrelevant, since pasteurization (time and temperature are crucial factors) and fermentation appears to reduce its content^{56, 57}. Yet cow’s milk consumption, compared to various foods, is associated with higher plasma IGF-1 concentrations in humans (both children^58-61 and adults^62-66, which could be due to calcium in milk (which has been shown to increase IGF-1 in boys and girls⁶⁷), the effect of milk upon insulinemia (the high elevation of plasma insulin caused by milk drinking^4-9 could lead to a higher plasma IGF-1¹³) or indeed residual IGF-1 in casein⁶⁸ (the major protein in milk).

Betacellulin

Betacellulin (BTC) belongs to the Epidermal Growth Factor family of hormones⁶⁹, and it is found not only in cow’s milk⁷⁰ and whey⁷⁰, but also in cheese⁷⁰, so it survives pasteurization and processing. Although no direct evidence exists yet, bovine milk contains peptidase inhibitors which prevent human gut enzymes from degrading EGF⁵ (and most likely BTC) and a low ph, such as may be found in the gut, does not impair or prevent BTC from binding its receptor⁷¹. Finally, there is a luminally expressed EGF receptor in the gut, through which BTC may enter circulation⁶⁹.

Steroid Hormones

The major sources of animal-derived estrogens in the human diet are believed to be milk and dairy products, which presumably account for 70–80% of the total estrogens consumed^72-73. Furthermore, it has been pointed out that most milk for human consumption is obtained from cows in the latter half of pregnancy, when estrogen metabolite levels are greatly elevated^72-74. Confirming this, US researchers have measured estrogen metabolites in various milks and found that buttermilk contains the highest total amount of estrogen metabolites, followed by skim milk, 2% milk and whole milk⁷². So, estrogen metabolites appear to survive pasteurization, and Estrone sulphate, which comprises 45% of the conjugated estrogens in Premarin and Prempro, the most frequently prescribed hormone replacement therapy for menopausal women⁷³ has high oral bioactivity⁷³ and is the most prevalent form of estrogen in cow’s milk^{72, 73}.

There are also other steroid hormones in commercial pasteurized cow’s milk, such as progesterone, 5α-androstanedione and 5α-pregnanedione that are dihydrotestosterone (DHT) precursors⁷⁵.

As expected from the evidence presented, dairy intake is strongly associated with a higher incidence of Acne^16-18, moderately associated with Prostate Cancer^19-23, and mildly associated with ovarian cancer^{76, 77}.

Dairy consumption was also associated with an increased incidence of testicular^78-79, kidney⁸⁰ and head and neck cancer⁸¹, but very few studies looking at this have been conducted to draw more significant conclusions.

Although epidemiological evidence can’t show cause and effect and clearly many more studies need to be conducted, the current evidence strongly suggests that cow’s milk may be implicated in a variety of autoimmune diseases, certain cancers, as well as Acne.

4) Milk has a very high calcium/magnesium ratio and may contribute to some micronutrient imbalances.

Finally, there is evidence of higher fracture incidence rates in countries with higher milk and calcium intake82, some long term prospective studies have failed to show a benefit from drinking milk or taking calcium supplements83-85, and a recent meta-analysis, which analyzed 7 prospective cohort studies (170 991 women), 5 prospective cohort studies (⁶⁸ 606 men), 5 clinical trials, (5666 women, and 1074 men), and 4 clinical trials with separate results for hip fracture (6504 subjects), concluded that calcium intake doesn’t decrease the risk for fractures⁸⁶. And calcium intake is only part of the story – we need to consider the GI absorption and the renal excretion, and in these regards, vegetables from the brassica family have a clear advantage over milk.

I know this may sound overly alarming and exaggerated, but given what I know about milk, I have a hard time recommending it, even though it has some positive effects, such as being a cheap source of high quality protein and various micronutrients.

For those who are fortunate and have access to good (real) food and supplements (such as Vitamin D, which, by the way, may be needed in much higher doses than the ones provided by 3 or 4 servings of dairy a day) and adopt a diet more in line with the Paleo Diet, I believe milk is not necessary.

I hope this helps.
Pedro

References:

1. Evershed RP, Payne S, Sherratt AG, Copley MS, Coolidge J, Urem-Kotsu D, Kotsakis K, Ozdoğan M, Ozdoğan AE, Nieuwenhuyse O, Akkermans PM, Bailey D, Andeescu RR, Campbell S, Farid S, Hodder I, Yalman N, Ozbaşaran M, Biçakci E, Garfinkel Y, Levy T, Burton MM. Earliest date for milk use in the Near East and southeastern Europe linked to cattle herding. Nature. 2008 Sep 25;455(7212):528-31.
2. Copley MS, Berstan R, Dudd SN, Docherty G, Mukherjee AJ, Straker V, Payne S, Evershed RP: Direct chemical evidence for widespread dairying in prehistoric Britain. Proceedings of the National Academy of Sciences of the United States of America 2003, 100(4):1524-1529.
3. Swallow DM. Genetics of lactase persistence and lactose intolerance. Ann Rev Genet 2003;37:197-219
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Paleo Diet Q & A - 2 February 2010 - The Paleo Diet and Children

Dear Readers,

Today's Paleo Diet Q & A focuses on use of the diet for children.

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Q: Thanks for all of the hard work your team puts into this. I've been receiving the e-mail blog for quite some time, have read both Paleo Diet and Paleo Diet for Athletes books, and subscribe to a Yahoo Paleo blog as well. I thoroughly enjoy reading the information sent to me every few days including the archives.

One concern I do have is that the bulk of the information seems to be targeted toward adults. More specifically adults with health problems that have already occurred and are in many cases not being addressed or cured by "traditional" medical practices. As the kids grow I feel it is important to develop proper dietary habits now, not when they are older and dealing with the after effects of poor health.

In my personal case I have a young son who has had issues with asthma. We have sought medical help but my mind keeps coming back to the Paleo Diet. Is there more detailed information available to address the issues of babies, young children and some of the issues they deal with as they mature?

Again, thanks for the great job.
Murray

A: Hi Murray,

The subject of pregnancy, young children, and The Paleo Diet was discussed in Volume 5 Issue 24 of our newsletter, The Paleo Diet Update. Here is the full text of that article:

Pregnancy, Young Children, and the Paleo Diet
by Loren Cordain, Ph.D.

With the growing popularity of the Paleo Diet, we've received questions about adapting this diet for pregnancy, particularly with regard to the low fat aspect of the diet. Others are also asking for more information about adapting the Paleo Diet to the growth and nutritional needs of infants and young children. With a little modification, the Paleo Diet can meet these needs, help children escape the growing childhood obesity problem, build life-long eating habits to lower the risk of disease, and generate healthful, vital longevity. Here are some recommendations for using the Paleo Diet to optimize nutrition during pregnancy, infancy and childhood.

What about pregnancy?

Due to the metabolic changes that occur in the liver during pregnancy, women cannot tolerate protein levels as high as they normally could. This has been documented in both the anthropological and clinical literature. To accommodate this, higher fat meats, higher fat vegetables, and more carbs can be included in the Paleo Diet during pregnancy than most people eating the typical Paleo Diet will need.

Numerous studies have shown that fetal and infant cognitive development requires sufficient omega-3 fatty acids during pregnancy and nursing. Our ancestors got most of their dietary fat from leaner meat, which was a richer source of monounsaturated and omega-3 polyunsaturated fatty acids, than the meat from feedlot animals today. The Paleo Diet is high in mono-unsaturated fats, such as olive oil, and omega-3 polyunsaturated fats from fish. It also avoids feedlot meat to increase the omega-3 in our diet, and enhance the omega-6/omega-3 ratio to more closely resemble the healthful diet of our ancestors.

What about infancy (the first two years of a child's life)?

Hunter-gatherer children were typically introduced to solid food later than what is considered normal in the Western world. Studies of five hunter-gatherer societies (Kung, Ache, Inuit, Australian Aborigines, and Hadza) have revealed the average age of weaning to be 2.9 years. Hence, the early nutrition of hunter-gatherer infants is highly dependent upon mother's milk. Because hunter-gatherers typically consumed a diet higher in omega-3 fatty acids, mother's milk likely would also have been higher in omega-3 fatty acids than milk from the typical nursing Western mother. This difference is important in light of the studies indicating the importance of sufficient omega-3 fatty acids during pregnancy and nursing for cognitive development. For the Western mother, weaning at age 3 is impractical, but weaning should be delayed as long as possible (preferrably at least 1-1.5 years). After weaning, I recommend that infants be given a formula th at is enriched with both docosahexaenoic acid (DHA) and arachidonic acid (AA). Infants should not be given eicosapentaenoic acid (EPA) in the form of fish oil because it competes with AA metabolism and can result in impaired motor development and growth.

Human milk contains very little iron, but infants are born with iron stores sufficient to last 9-12 months. Pediatricians typically recommend that infants' first solid foods be iron-fortified cereals. Commercial baby foods, such as beef, pork, or chicken, are a better alternative to this. Hunter-gatherer mothers introduced their infants to solid foods by thoroughly chewing meat, marrow, nuts, seeds, fruits, etc. If you do give cereal to your infant, I recommend rice and not either wheat or oats.

Virtually all pediatricians recommend that cow's milk and other dairy products, such as yogurt, cheese, etc., be excluded from infant diets during their first year. Early exposure to dairy products has been implicated in increased risk of a number of autoimmune diseases, particularly type 1 diabetes.

What about when solid foods are introduced?

When switching to solid foods, I recommend focusing upon the same basic food types that I recommend for adults, such as fresh fruits and vegetables, fresh meats and seafood. There is evidence that the children's livers are less able to deal with high levels of protein (~30-40 % total energy). Hence, higher fat meats and fish should not necessarily be restricted to the same extent as with adults because this will help balance the protein levels. Higher fat plant foods, such as nuts and avocados, and healthful oils are also useful, but monitor for nut allergies. Omega-3 enriched eggs should be the egg of choice, and they are a source of DHA.

I don't advocate completely restricting processed food from children because eating involves behavioral issues. The best way to get a child to eat junk food is to completely forbid it. In our house, we serve typical Paleo foods in every meal. We stock very little processed food, so if our children are hungry, their choices are primarily healthy foods. We don't allow unlimited access to TV, computers or electronic games, but we do encourage outdoor play. For active children, I don't think that certain high glycemic load foods may be harmful. We do not restrict dried fruit, such as raisins and dates, and we encourage them to eat bananas, yams and sweet potatoes.

Finally, while societies often view being tall positively, it has a downside. It increases the adult risk for a number of cancers, particularly breast cancer in women. The nature of this relationship remains obscure, but our research group thinks that the relationship between stature and cancer risk involves the consumption of high glycemic load carbohydrates during childhood, along with an otherwise healthy diet that is high in protein. I fully explain how high glycemic load carbohydrates can increase height and risk of numerous chronic diseases in my published research article # 24. Cordain L, Eades MR, Eades MD. Hyperinsulinemic diseases of civilization: more than just syndrome X.

Please visit our web site to obtain a copy of Volume 5 Issue 24 of The Paleo Diet Update for a complete list of the references cited in this article.

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Dr. Cordain has also written the following comments:

The American Pediatric Society recommends that cow’s milk not be given in the first year ,and a number of studies indicate that it increases the risk for type I diabetes and other autoimmune diseases later in life. I have 3 boys (17, 15, 11) and none of them have ever consumed milk on a regular basis – In fact they rarely or never drink it. They eat cheese and ice cream occasionally, but certainly not daily or even once a week. The 17 yr old is a lean, high level high school swimmer and is 5’10”, 138 lbs. The 15 year old is 6’1” and 145 lbs and plays competitive ice hockey; the 11 year old is 5’4” about 95 lbs and plays all sports. None of them wears glasses, or have ever had acne & among them all there have only been 2 dental caries. We are not strict with the Paleo diet for them, but we never have stocked our house with bread, crackers, milk, candy, soda or processed foods. At every meal we provide a variety of fresh fruits, vegetables, meats, seafood and omega 3 enriched eggs. They eat potatoes, sweet potatoes, and some rice & some processed foods like sushi, beef jerky, fruit popsicles, tacos and other minimally processed foods. All parents want to give their children the best start possible. Our anecdotal successes may not be right for everyone, but they have worked for us.

Loren Cordain, Ph.D.

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In addition, Pedro has the following commentary:

During the first year of life, you should give a child human milk or a completely hydrolyzed infant formula (one study used a casein-based commercially available formula in children with high risk for Type 1 Diabetes).

Milk and dairy not only increase the risk for Type 1 Diabetes when consumed early in life, but they are also associated with various auto-immune diseases. Moreover, milk elevates insulin as much as white bread (having been shown to induce insulin resistance in boys) and it increases IGF-1 and decreases IGFBP-3, which is a hormonal pattern implicated in various cancers (prostate, breast, kidney, liver, etc.), myopia and acne.

Finally, milk proteins (especially alpha casein s1 and beta-lactoglobulin, which do not exist in human milk) are common food allergens, and milk is a source of various hormones (commercial milk from pregnant cows and cows who have mastitis and/or are intensively fed to gain weight rapidly have an even higher concentration of some of these hormones). This is another possible mechanism linking milk with hormonal dependent cancers. There various other reasons why I think non-human milk is not ideal for humans, but I tried to present the most important ones.

I know this may sound overly alarming and exaggerated, but given what I know about milk, I have a hard time recommending it, even though it has some positive effects.

In my opinion, the main benefit of milk is that it is a cheap source of high quality protein and various micronutrients. So, for those who are fortunate and have access to good food, milk is not necessary.

Instead of milk, I would continue using a completely hydrolysed formula (like the one used in the Type 1 Diabetes study – make sure it contains DHA and arachidonic acid [AA], or supplement your child's diet with DHA and give them egg yolks to get AA).

If you don’t have a choice and feel like you have to give them milk, I would opt for non-homogenized fermented goat milk (or goat yoghurt), which has much less alpha casein s1 than cow’s milk, and it may contain smaller concentrations of various steroid and peptide hormones. This is because it is fermented, the animal is smaller, and they aren’t typically treated like a cow.

Nevertheless, it most certainly will elevate insulin as much as cow’s milk does, and it will have an impact on the IGF-1 system. Moreover, apart from alpha casein s1, the protein profile of goat milk is similar to cow milk, so the possibility exists that it may also elicit an autoimmune response in some people. Also, there are reports in the medical literature of selective allergy to goat milk. Finally, both milks have a high calcium/magnesium ratio, and may contribute to some micronutrient imbalances.

Pedro