The Paleo Diet and Crohn's Disease

Q: Can you comment on any reported results in curbing the symptoms of Crohn's Disease with the Paleo Diet. As I am a sufferer, I would love to know.

Thank you,
Shannon

A: Dear Shannon,

Indeed, inflammatory bowel disease (Ulcerative Colitis & Crohn's Disease) patients usually do very well with The Paleo Diet, as nutrients are one of the main environmental triggers of this condition. Crohn's disease is an autoimmune disease where the immune system mounts an attack against its own tissues - in this case the cells lining the intestine.

For an autoimmune disease to occur we need a genetic predisposition and an environmental trigger. The genetic predisposition depends on genes coding for the Human Leukocyte Antigen (HLA) system. One of the environmental triggers may be nutrition, besides infections, geography (vitamin D deficiency), physical trauma or vaccination.

One of the key points in this process is increased intestinal permeability. This means that the gut barrier allows increased passage of bacterial or food proteins (antigens) into peripheral circulation, skipping a process known as oral tolerance. Once antigens come in contact with the immune system located in the gut associated lymphoid tissue, they may elicit a T-cell mediated immune response against those antigens.

If the molecular structure of the dietary or bacterial antigens is similar to that of the HLA system (part of the immune system representing cellular mechanisms), chances are that a cross reaction between foreign antigens and self antigens (produced by T-cells) occur. This is termed molecular mimicry, and leads to self injury by the adaptive immune system.

Hence, decreasing intestinal permeability is one of the treatment targets. There are several nutrients known to increase intestinal permeability that you may want to avoid, at least until symptoms subside. Here is a list, with the noxious substances in parentheses:

• Cereal grains (lectins and gliadin)
• Legumes, including soya and peanuts (lectins and saponins)
• Tomato (tomato lectin and alpha-tomatin)
• Potato (lectins and saponins)
• Chili (capsaicin)
• Quillaja (foaming substance)
• Quinoa (saponins)
• Egg white (lysozyme)
• Alfalfa sprouts (saponins)
• Amaranth (saponins)
• Alcohol

Moreover, some nutrients exert an adjuvant-like activity (they stimulate the immune system), which is something you don't want to if you are suffering from an autoimmune disease. Nutrients containing adjuvants:

• Quillaja extract, found in root beer
• Tomato alpha-tomatine

Dairy products and vegetable oils also have deleterious effects upon your immune system.

I hope this helps.
Maelán

Lysozyme from Egg Whites Article

Dear Readers,

This past week our newsletter (The Paleo Diet Update, volume 6, issue 4) featured an article by Dr. Cordain on Lysozyme and Egg Whites, and autoimmune disease. Readers who are not yet newsletter subscribers may obtain a free subscription on our web site to The Paleo Diet Update.

Readers who would like to obtain a copy of volume 6, issue 4 of The Paleo Diet update may purchase a copy of this and other back issues from our web store.

Paleo Diet Q & A - Epigenetics, Flaxseed Oil

Epigenetics

Q: What do you think about epigenetics? Many scientists (in Germany) believe that the concept of the Paleo Diet is no longer tenable.

Thanks a lot, Michael

A: Dear Michael,

Epigenetics is defined as the science studying changes in phenotype or gene expression by mechanisms other than changes in DNA nucleotide sequence¹. The phenotype is someone's appearance which it's determined by the genotype (stable and heritable) and the environment (nutrition and other lifestyle factors) which give place to the epigenotype (heritable, labile and rapid)¹. Epigenetic changes are controlled, among other mechanisms, by methylation and histone modification. Altered methylation pattern and histone modification may lead to increased susceptibility to disease. E.G. cancer is associated to generalized hypomethylation and localized promoters hypermethylation¹. Histone manipulation may also increase or decrease disease susceptibility².

Both, methylation and histone manipulation are under the control of dietary substances. For example, methylation depends on SAMe availability, which in turn is influenced by vitamin B6, vitamin B12 and folate intake³, and long chain polyunsaturated fatty acids such as DHA⁴. On the other hand, certain substances such as garlic, horseradish, fiber, blueberries, apple, onion, nuts, berries, red grapes, broccoli, etc. are known nutrients involved in histone modification².

The Paleo Diet is rich is all of these nutrients⁵, hence it may exert positive effects upon epigenetics machinery leading to decreased disease susceptibility. Decreased availability of micronutrients is associated to disease severity, probably, through complex epigenetic mechanisms, and supplementation could improve those symptoms³. Improved epigenetic is influenced by metabolic programming during foetal and early life. These two periods are crucial for the developing newborn and future adult's health. Hence, The Paleo Diet may confer protection against several diseases improving the epigenetic programming.

We hope this is helpful.

Maelán Fontes Villalba
Pedro Carrera Bastos

References:

1. van Vliet J, Oates NA, Whitelaw E. Epigenetic mechanisms in the context of complex diseases. Cell Mol Life Sci. 2007 Jun;64(12):1531-8.
2. Delage B, Dashwood RH. Dietary manipulation of histone structure and function. Annu Rev Nutr. 2008;28:347-66.
3. Kemperman RF, Veurink M, van der Wal T, Knegtering H, Bruggeman R, Fokkema MR, Kema IP, Korf J, Muskiet FA. Low essential fatty acid and B-vitamin status in a subgroup of patients with schizophrenia and its response to dietary supplementation. Prostaglandins Leukot Essent Fatty Acids. 2006 Feb;74(2):75-85.
4. Muskiet FA, Kemperman RF. Folate and long-chain polyunsaturated fatty acids in psychiatric disease. J Nutr Biochem. 2006 Nov;17(11):717-27.
5. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O'Keefe JH, Brand-Miller J. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005 Feb;81(2):341-54.
6. Kemperman RF, Veurink M, van der Wal T, Knegtering H, Bruggeman R, Fokkema MR, Kema IP, Korf J, Muskiet FA. Low essential fatty acid and B-vitamin status in a subgroup of patients with schizophrenia and its response to dietary supplementation. Prostaglandins Leukot Essent Fatty Acids. 2006 Feb;74(2):75-85.

---

Flaxseed Oil

Q: I recently visited family and my brother is a new advocate of the paleo diet. For breakfast he made us "fakecakes" which had about 1-2 tablespoons of flaxseed in them that he ground in a coffee grinder. I had few a questions regarding the use of flaxseed in the Paleo Diet.

First, why are flaxseeds ok in the Paleo Diet but other grains (seeds) are not? My understanding for eliminating grains from the diet is the toxins that they contain, but flaxseed contains large amounts of cyanogenic glycosides, producing up to 139 mg/kg of hydrogen cyanide in raw human-grade flaxseed. I am sure flaxseeds are processed somehow before selling them but I don't know what process that is or what effect it has on the HCN concentration.

So, secondly...do you know of any studies on the amount of HCN in meals containing ground flasxseed and the chronic oral exposure of those amounts on humans? My understanding here is the HCN that isn't hydrolysed to formic acid in the stomach and doesn't bind to hemoglobin is converted to thiocyanate which hinders thyroid function.

Thank you for your time and any information you can supply.

Sincerely,
Tim

A: Hi Tim,

We think your thoughts are on the right track.

When Dr. Cordain wrote The Paleo Diet book, the advice to consume flaxseed oil was an attempt to balance the increased omega-6/omega-3 fatty acid ratio due to the exaggerated intake of omega-6 vegetable oils, especially linoleic acid, in the typical western diet.

Nevertheless, animal foods (fish, muscle meat and organs from wild animals) are good sources of w3 fatty acids. Therefore, when people eat these foods regularly along with vegetables and nuts, and avoid vegetable oils (especially oils rich in Linoleic Acid – Omega 6), they get a balanced intake of omega 3, omega 6, monounsaturated and saturated fatty acids. In this situation, there is no need for flax seeds to provide Omega 3 fatty acids and balance the Omega 3/Omega 6 ratio.

Here are some facts that support the notion that animal foods, vegetables and nuts provide the necessary Omega 6 and Omega 3 fatty acids in the right proportion:

1. Hunter-gatherers do not eat ALA from seeds or vegetable oils.
2. Nuts, green leafy vegetables and animal foods contain ALA.
3. The conversion of ALA to EPA+DHA is limited, due to low delta-6 and delta-5 activity, although ALA is highly oxidized (twice that of LA) (see paper by Freemantle et al). This means that at some point in history we included preformed sources of EPA and DHA and still need to do so. Animal foods (especially brain from wild ruminants and fish) are very good sources of these fatty acids.
4. The essentiality of LA & ALA in human metabolism has been questioned (see paper by Le et al.), as we relied almost on LCPUFA (Arachidonic Acid, EPA and DHA) during the Palaeolithic era (see Dr. Cordain’s papers on that here and here). Moreover, there is already some evidence showing that human metabolism could re-convert AA and DHA into LA and ALA respectively, hence AA and DHA would be the true essential fatty acids.
5. The possible toxicity from seeds and vegetable oils (HCN, saponins, lectins).
6. They are not used by current HG societies, and these populations show no signs of western disease, so this means that flax seeds are not necessary.
7. The well known positive health effects of fish oil supplementation (among other factors to improve omega-6/omega-3 ratio) in contrast with some possible adverse effects of flaxseed oil (like the epidemiological evidence that points towards increased risk of prostate cancer with flax oil consumption – see paper by Brouwer et al).

The bottom line from an evolutionary perspective is that flax seeds and/or flaxseed oil would not have been consumed by pre-agricultural humans. However, having said that, hunter gatherers always would have preferentially sought high oil plant foods as per optimal foraging theory. But, most high fat plant foods contain high MUFA (with the exception of coconut and palm oils).

Hope this helps,
Maelán Fontes Villalba

Additional reading: Effectiveness of different processing methods in reducing hydrogen cyanide content of flaxseed, Feng, et al.

Paleo Diet Q & A - Saturated Fat

Dear Readers,

This question has come up several times in recent weeks. Maelán's response warrants breaking this out from among the other questions answered in the original post. Included in this post is a link to Dr. Cordain's paper on the subject.

Q: I wanted to ask you why it is that you discourage saturated fats in the paleo diet? From what I have read their are healthy saturated fats from coconuts that are used for around 17% of the Kitavan diet. Also, what about tubers such as sweet potato and yam, do you think that consuming these in moderate portions (small enough to keep a low glycemic load) could be detrimental?

A: Regarding saturated fats:

Saturated fatty acids intake and the risk of developing cardiovascular disease (CVD) is a topic with a lot of controversy. In recent years a wide body of research has suggested that increased consumption of certain saturated fatty acids (Lauric acid, myristic acid and palmitic acid)
down-regulate LDL receptor and thereby increase LDL plasma levels, and this has been associated to increased risk of CVD. On the other hand, stearic acid (a 18 carbon saturated fatty acid) has been shown to decrease LDL plasma levels. However, this view is too simplistic as they are several other factors contributing to CVD, such as smoking, exercise, trans-fatty acids, increased omega-6/omega-3 ratio, free-radicals, nutrient deficiency, homocysteine, alcohol intake and low-grade chronic inflammation among others.

Moreover, some studies have suggested that there’s not enough scientific data to support the view that increased total or LDL cholesterol is an independent risk factor for CVD, but rather oxidized LDL. Plaque production is mediated by oxidized LDL but not LDL. Oxidized LDL can produce shedding of the inner layer of the artery namely glycocalix. Then oxidized LDL infiltrates in the intima of the artery. Oxidized LDL is eaten by macrophagues, a process known as phagocytosis, and therefore macrophagues are transformed into foam cells which produce the fibrous cap.

Once the fibrous cap has been produced we need to break it down in order to produce an ischemic event. Lectins and low-grade chronic inflammation are involved in the activation of matrix metalloproteinases which break down the fibrous cap.

In summary, high total cholesterol or LDL levels do not increase CVD risk but rather oxidized LDL. To produce oxidized LDL we need the factors mentioned above. Hence, consumption of saturated fatty acids is not an issue if we control several other factors such as those mentioned before.

Dr. Cordain wrote a book chapter where he shows that saturated fat consumption in ancient hunter-gatherer populations were usually above recommended 10% (American Heart Association) of energy from saturated fats yet non atherogenic.

The bottom line is that we do not recommend cutting down saturated fatty acid intake but rather decrease high-glycemic load foods, vegetable oils, refined sugars, grains, legumes and dairy.

I hope this helps.
Maelán

Link to supporting paper.

Paleo Diet Q & A - Snails

Q: Do you know if they ate snails in the paleo times? Thank you, Geha

A: Hi Geha,

The Paleolithic era stands for the "Old Stone Age" (Paleo means old; lithic means stone) and extended from 2.6 million years ago with the appearance of the first crude stone tools until the beginning of agriculture 10,000 years ago. During this period, it is estimated that at least 20 species of hominins (upright walking apes) existed¹. Because all hominins were omnivorous opportunists², land snails were almost certainly consumed on an occasional basis throughout hominin evolutionary history.

However, having said this, the first direct evidence for land snail consumption does not appear in the fossil record until 31,000 years ago at the Mumba-Hohle site on the shores of Lake Eyasi in East Africa^{3, 4}. The earliest archaeological evidence for land snail consumption in the Middle East has been dated to 22,000 to 23,000 years ago at the Kvar ‘Aqil site near Beirut, Lebanon³. The hominin that would have eaten these snails was our own species, Homo sapiens. Archaeologists interpret that snails were eaten because their shells were found in huge heaps called middens, and frequently were charred from being cooked⁵. Snail middens dating from 20,000 to 10,000 years ago and from 10,000 to 6,000 years ago are common in lands close to and surrounding the Mediterranean Sea^{3, 5}. The five most commonly consumed species of snails (Helix aspera, Helix melanostoma, Leucochroa candissima, Helicella setifensis, and Otala species) still occur in the Mediterranean region today.

If you don’t know, snail meat is considered a delicacy worldwide and is most commonly known from its French term, "escargot," an appetizer typically cooked in a sauce of butter, garlic and parsley⁶. Although three species of snails (Helix aspera, Helix pomatia) and the African snail (Achatina fulica) are most commonly consumed⁶, a large variety of snail species are eaten worldwide, depending upon location and availability. The cost of 1 kg of prepared snail meat is expensive and fluctuates between $5 - $13⁷. Snail meat, like fish, is high in protein and low in fat, and contains significant amounts of iron (see Table below). Give escargot a try, it’s a great Paleo appetizer.

Table 1. Nutritional value of snails. USDA National Nutrient Standard Reference, release 19 (2006).

Nutrients	Units of measurement for nutrients	Nutrient content per 100 grams of snail
Water	g	79.20
Energy	kilocalorie	90.00
Protein	g	16.10
Total lipid (fat)	g	1.40
Ash	g	1.30
Carbohydrate, by difference	g	2.00
Fiber, total dietary	g	0.00
Sugars, total	g	0.00
Minerals
Calcium, Ca	mg	10.00
Iron, Fe	mg	3.50
Magnesium, Mg	mg	250.00
Phosphorus, P	mg	272.00
Potassium, K	mg	382.00
Sodium, Na	mg	70.00
Zinc, Zn	mg	1.00
Copper, Cu	mg	0.40
Selenium, Se	mcg	27.4
Vitamins
Vitamin C	mg	0.00
Thiamin	mg	0.01
Riboflavin	mg	0.12
Niacin	mg	1.40
Vitamin B-6	mg	0.13
Folate, total	mcg	6.00
Folic acid	mcg	0.00
Folate, food	mcg	6.00
Folate, DFE	mcg_DFE	6.00
Vitamin B-12	mcg	0.50
Vitamin B-12, added	mcg	0.00
Vitamin A, IU	IU	100.00
Vitamin A, RAE	mcg_RAE	30.00
Retinol	mcg	30.00
Vitamin E (alpha-tocopherol)	mg	5.00
Vitamin E, added	mg	0.00
Vitamin K (phylloquinone)	mcg	0.10
Lipids
Fatty acids,total saturated	g	0.361
4:0	g	0.000
6:0	g	0.000
8:0	g	0.000
10:0	g	0.000
12:0	g	0.000
14:0	g	0.056
16:0	g	0.249
18:0	g	0.051
Fatty acids, total monounsaturated	g	0.259
16:1 undifferentiated	g	0.048
18:1 undifferentiated	g	0.211
20:1	g	0.000
22:1 undifferentiated	g	0.000
Fatty acids, total polyunsaturated	g	0.252
18:2 undifferentiated	g	0.017
18:3 undifferentiated	g	0.000
18:4	g	0.015
20:4 undifferentiated	g	0.000
20:5 n-3	g	0.119
22:5 n-3	g	0.099
22:6 n-3	g	0.000
Cholesterol	mg	50.000

References:

1. Wood B. Hominid revelations from Chad.Nature. 2002 Jul 11;418(6894):133-5.
2. Cordain L. Saturated fat consumption in ancestral human diets: implications for contemporary intakes. In: Phytochemicals, Nutrient-Gene Interactions, Meskin MS, Bidlack WR, Randolph RK (Eds.), CRC Press (Taylor & Francis Group), 2006, pp. 115-126.
3. Lubell, D. Prehistoric edible land snails in the circum-Mediterranean: the archaeological evidence. In, J-J. Brugal & J. Desse (eds.), Petits Animaux et Sociétés Humaines. Du Complément Alimentaire Aux Ressources Utilitaires. XXIVe rencontres internationales d'archéologie et d'histoire d'Antibes, pp. 77-98. Antibes: Éditions APDCA, 2004.
4. Mehlman MJ. Mumba-Hohle revisited: the relevance of a forgotten excavation to some current issues in East African prehistory. World Archaelogy 1979;11:80-94.
5. Lubell, D. Are land snails a signature for the Mesolithic-Neolithic transition? In, M. Budja (ed.), Neolithic Studies 11. Documenta Praehistorica XXXI: 1-24.
6. Ozogogul, Y, Ozogul F, Olgunoglu AI. Fatty acid profile and mineral content of the wild snail (Helix pomatia) from the region of the south of the Turkey. Eur Food Res Technol 2006;221:547-549.
7. Zymantiene J et al. Selected features of vineyard snails shell, their movement and physic-chemical composition of foot meat. Biotechnol & Biotechnol Eq 2006;20:82-87.

Paleo Diet Q & A - Calcium from where?

Q: While this style of eating and living makes sense to me, I am still left with the question of how to meet the Recommended Daily Allowance (RDA) for calcium. From all I've read on the subject, it's not possible to reach the RDA with vegetable sources (unless you include fortified soy or rice milk). Since dairy isn't part of your scheme, how does a person meet the RDA? Or do you disagree with the RDA?

A: Indeed, we relieve the RDA is higher than what you would need in a Palaeolithic type diet, because:

1. The absorption rate from brassica vegetables (e.g. Kale) is slightly higher than from milk (see attached paper) and as so (and also because they have numerous health benefits), we advise the daily intake of these foods.


2. A diet with lots of vegetables and fruit is net base yielding and in contrast a diet high in grains, cheese and salt and low in fruits and vegetables (which is a characteristic of the American way of eating) is net acid yielding and this increases calcium excretion.


3. The Paleo Diet is a High protein diet and this increases intestinal calcium absorption^{1, 2} and has an anabolic effect on bone³, particularly in the context of a net base yielding diet³.


4. By avoiding grains, you decrease anti-nutrient intake, such as phytates, which decrease magnesium⁴, calcium⁵ and zinc⁵ absorption.


5. The Paleo Diet is a Low Glycemic Load diet and as so, it does not promote Hyperinsulinemia as a high grain diet. It has been known since the year I was born (1975) that high blood insulin levels cause urinary calcium loss⁶.


6. Milk has a high Insulinotropic effect, and as so it may lead to an increase in urinary calcium excretion, for the reason outlined in point 5.

Links to Relevant Papers:

• RDA of calcium


• Dietary Acid-Base Balance


• Adverse Effects of Sodium Chloride on Bone


• Calcium absorption from kale


• Diet Evolution and Aging

References:

1. Kerstetter JE, Gaffney ED, O’ Brien O, et al. Dietary Protein increases intestinal calcium absorption and improves bone balance: An hypothesis.
   In Burckhardt P, Heaney R, Dawson-Hughes B. Proceedings of the International Symposium on Nutritional Aspects of Osteoporosis, 4-6 May 2006, Lausanne,
   Switzerland. Elsevier, 2007, pp 204-216.


2. Dawson-Hughes B. Protein intake and calcium absorption – Potential role of the calcium sensor receptor. In Burckhardt P, Heaney R, Dawson-Hughes
   B. Proceedings of the International Symposium on Nutritional Aspects of Osteoporosis, 4-6 May 2006, Lausanne, Switzerland. Elsevier, 2007, pp 217-227.


3. Sebastian A. Dietary protein content and the diet's net acid load: opposing effects on bone health. Am J Clin Nutr. 2005 Nov;82(5):921-2.


4. Bohn T, Davidsson L, Walczyk T, Hurrell RF. Phytic acid added to white-wheat bread inhibits fractional apparent magnesium absorption in humans.
   Am J Clin Nutr. 2004 Mar;79(3):418-23.


5. Cordain L. Cereal grains: humanity’s double edged sword. World Rev Nutr Diet 1999; 84:19-73.


6. DeFronzo RA, Cooke CR, Andres R, Faloona GR, Davis PJ. The effect of insulin on renal handling of sodium, potassium, calcium, and
   phosphate in man. J Clin Invest 1975;55:845–55.
   

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.

---

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

---

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

---

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

If you have specific questions about the Paleo Diet please send us an email at: questions@thepaleodiet.com

Please note that we receive a great amount of feedback, and are not always able to respond personally. We read all emails, and we are very interested in hearing your thoughts, learning about your experiences, and understanding what questions you have.

Questions and comments are forwarded to our team, who make every effort to provide answers for our readers. We often receive similar questions on a variety of topics, such as saturated fat, diabetes, weight loss, consumption of milk, and a host of other dietary and health-related subjects concerning the Paleo Diet and paleo nutrition.

The entire Paleo Diet web site is searchable, including our FAQ page. We encourage you to search or browse the FAQ page on our web site to see if the information you're seeking has already been documented:

http://www.thepaleodiet.com/faqs

We have a tremendous amount of information that we've provided in response to reader questions, and update our FAQs frequently - so please check back if you don't see the information you requested.

We also post questions and answers on our blog:

http://thepaleodiet.blogspot.com

You may also search our blog for subjects of interest. Go to our blog using the address above and use the search box on the right side.

Regards,
The Paleo Diet Team

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.

---

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

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