CHAPTER 11:
DAIRY
* * *
“During and following our family’s Whole30, my son Jeremiah’s (type 1 diabetic) blood sugars have been completely under control … and they never have been before. His numbers normally jump from low to high extremes without any reason—we never knew what to do about it. It’s been very frustrating … but now his numbers are perfect. I can’t fully put into words how amazing this transformation has been. Thanks to the Whole30, I now know without a doubt that Jeremiah’s body is working the best it can and that I am doing my job as his mom to keep it that way.”
—Jacque G., New Orleans, Louisiana
* * *
The discussion of dairy* is one that interests many people and has no simple, black-and-white answers. There are many functional components of dairy that, depending on the source and the individual consuming it, can be highly problematic, generally benign, or even beneficial.
The real challenge is twofold: being honest with yourself about whether dairy is “just fine” or just the opposite, and actually finding a truly high-quality source of dairy if you are one of the people who benefit from it. Luckily, the Whole30 will help you with the first part of that challenge. In the meantime, let’s talk about some of the science about dairy consumption.
MILK: PERFECT
Cow’s milk is the perfect food ... if you are a calf. Likewise, human breast milk is the optimal food when you are an infant.
Milk is an excellent source of energy and building blocks to rapidly grow mammals that are too young to eat adult food, such as grass (cows) and a wide range of plants and animals (humans). Until a mammal’s digestive system (including teeth) has completely developed and it can eat whole food, mother’s milk supplies optimal nutrition.
But mother’s milk is not just an inert supply of carbohydrate, protein, and fat—though it contains significant amounts of all of those macronutrients. And yes, milk also contains calcium—but what is critical to understand is that milk is so much more than calories and calcium!
Milk is an energy-dense hormone-delivery system.
Milk is a blend of bioactive substances that not only promote aggressive growth of a very young mammal (doubling or tripling bodyweight in a very short period of time), but also ensure the complete development of the young one’s immune system. You are born with the basic framework of an immune system, but there are some missing elements which must be “supplemented” by consuming mother’s milk. In this context, milk is the perfect food, and the perfect messenger.
MILK: IMPERFECT
These growth, hormonal, and immunity messages from mother’s milk to newborn are biologically healthy and appropriate, when you are a calf or an infant. However, once weaned, calves and human infants no longer grow at such an aggressive rate, and their digestive systems and immune systems are complete. This means the growth and immunological messages from mother’s milk are no longer needed, nor appropriate.
And when the biological messages intended for a calf are being received loud and clear by your adult human body, they are even less appropriate—and potentially downright harmful.
To demonstrate how dairy products generally fail at least one of our Good Food standards, let’s talk about the already well known components of dairy (protein, carbohydrate, fat, and calcium), as well as some of the other lesser-known components.
MILK PROTEINS: CASEIN AND WHEY
Though there are dozens of dairy proteins, they can be divided into two categories—casein and whey. Casein makes up about 80 percent of total milk protein and acts as a source of amino acid building blocks that the calf can digest and turn into muscle, connective tissue, skin, hair, hormones, and enzymes and even form part of the structural matrix of bones and teeth. Calves are able to make good use of that species-specific protein supply to fuel their aggressive growth.
BUT AREN’T KIDS AND TEENAGERS GROWING TOO?
While children are still growing, they are no longer developing at the same aggressive rate as they did as infants. (Even teenage boys are not tripling their body weight in months!) Once they are weaned from breast milk, it simply doesn’t make sense to keep sending children the growth, hormonal, and immune messages they needed when first born—and it’s certainly inappropriate to send them biological messages intended for newborns of a different species. Growing kids do need adequate energy (calories!), protein, healthy fats, and micronutrients, but their age- and species-appropriate food is nutrient-dense omnivorous fare: meat, seafood, eggs, vegetables, fruit, and healthy fat sources like coconut, olives, and avocado. The bottom line: Once your toddler is weaned and eating real food, there is no need to supplement his or her healthy diet with cow’s milk. (Not to mention that dairy consumption has been linked to a variety of medical conditions in children, including acne, asthma, juvenile myopia, insulin resistance, and type 1 diabetes.)
There are also compounds in milk that have a specific physiological function—proteins and “peptides” (short amino acid chains)—in the body of the intended recipient (offspring). For instance, protein sequences embedded in casein’s molecular structure are released during the digestion process and send a message from mother to young.
Casein exorphins, or casomorphins (morphine-like substances derived from casein), are one category of these milk-derived protein fragments. Casomorphins are able to cross the gut barrier in young mammals (and in adults with increased gut permeability) and bind to opioid receptors in the enteric and central nervous systems. Casomorphins have been shown to slow down the movement of food through the gut (thanks to their morphine-like effects).
Again, let’s underscore the biological context here: the presence of casomorphins in human breast milk or cow’s milk is unlikely to be harmful to infants or calves (respectively), and probably serves to strengthen the bond between mother and young, improving feeding behavior and therefore improving the odds of survival of the newborn mammal. But the effects of these potently bioactive “food hormones” from another species on human adults remain largely unknown.*
DON’T MOVE MY CHEESE
Cheese is most commonly made from concentrated casein that has been blended with enzymes that partly digest the casein molecules, liberating some of these morphine-like compounds. Is it any coincidence that a large majority of our clients and seminar attendees say that cheese is the dairy product that would be the hardest to give up? No one knows for sure whether this represents a violation of our first Good Food standard (healthy psychological response)—but we sure do find it fascinating.
Casein, especially when it comes from aged cheese, also causes a specific type of immune system reaction called a histamine response in many people. (So for susceptible individuals, dairy would fail our fourth Good Food standard as well.) Histamine intolerance can cause headaches, GI upset, exacerbations of asthma, and seasonal allergies.
It is unclear what percentage of the population has this response, but until you have completely removed all dairy proteins from your diet for a period of time, you won’t know whether or not you are affected.
CASEIN AND GLUTEN
Casein shares some structural similarities with components of gluten. This means that gluten-sensitive individuals (including those with celiac disease) are less likely to tolerate casein-containing dairy products. Research suggests that about 50 percent of celiacs are also sensitive to milk. In genetically susceptible individuals, the incomplete breakdown of peptides with opioid activity like those from gluten or casein (in the presence of intestinal permeability) allows these fragments to enter the circulation and potentially influence neurological functioning, resulting in or exacerbating disorders such as postpartum psychosis, schizophrenia, and autism.
The other major category of milk protein is whey. Whey is a blend of multiple types of smaller proteins and hormones, including immunoglobulins, insulin, insulin-like growth factor 1 (IGF-1), estrogens, and other growth factors. (Remember, milk is a powerful growth promoter!) For this reason, milk is a highly insulinogenic food, which means that the combination of lactose plus whey dairy proteins causes the release of very large amounts of insulin when consumed.
This makes perfect sense: it all starts with biology.
The “building-storing” function of insulin is in complete accordance with the aggressive growth going on in those breast-feeding months. Lots of growth means lots of insulin is needed to aggressively store nutrients. But the remarkably large amount of insulin secreted in response to milk and whey protein intake is largely why dairy may fail our second Good Food standard for those with metabolic syndrome; in this population, it does not promote a healthy hormonal response.
DAIRY PROTEIN POWDERS
Marketing from some supplement companies will suggest that a large insulin response (especially after exercise) will help drive nutrients into cells to maximize recovery, but you don’t need an insulin “spike” after exercise to jam nutrients into cells, because your body is more insulin sensitive immediately post-workout. In this state, nutrient uptake is elevated—meaning you can “sneak” nutrients into cells without large amounts of insulin. In addition, the frequent insulin spikes from regular consumption of whey protein could be harmful in a manner similar to chronic overcarbsumption and the resulting hyperinsulinism in those with metabolic syndrome. We don’t believe whey protein supplements are a good choice for the majority of people (especially those who are insulin resistant and overweight), although they may be an easy protein source in specific circumstances for lean, insulin-sensitive, performance-driven athletes. (Casein protein supplements, while not highly insulinogenic, are poorly tolerated, and we never recommend them.) In general, opt for nutrient-dense meat, seafood, and eggs instead of nutrient-poor processed dairy proteins after exercise.
Anyone seeking to improve insulin sensitivity (or avoid becoming insulin resistant) would be best served by avoiding dairy products, including those that contain highly insulinogenic components, like sugar-sweetened yogurt or kefir, milk (regardless of fat content), whey protein powder, and, of course, ice cream. (Do we really have to tell you that ice cream is not healthy? And p.s., it’s not the dairy fat that’s the problem.)
Insulin is not the only potentially detrimental hormone increased by milk. Milk consumption also significantly elevates IGF-1, another powerful growth-inducer. IGF-1 promotes growth in children, but it is also associated with promotion (or indirect facilitation) of various cancers, such as breast, colon, and prostate. Of course, we’re not saying that if you drink milk, you’ll get cancer, but if you’re at high risk, consuming substances that increase the growth of cells, including abnormal cells, seems unwise.
MILK SUGAR: LACTOSE
But there is more to this story than just the protein fractions of milk—the carbohydrate component can also pose problems. The kind of carbohydrate found in milk is called lactose. While there are not huge amounts present in milk (and some other dairy products have very little because of processing), lactose is an issue for a surprisingly large percentage of people. Most infants digest lactose well, but after weaning, most of us lose the ability to convert lactose into usable forms of carbohydrate (glucose and galactose).
If lactose cannot be properly digested, bloating and gastrointestinal upset may result. In addition, consuming even small amounts of lactose may contribute to an imbalance of gut bacteria, promoting dysbiosis. For those who can no longer effectively digest lactose (i.e., most of us), dairy would also fail our third Good Food standard (promotes a healthy gut).
However, lactose intolerance is not our biggest concern with dairy, given its propensity to stimulate insulin production and potential to trigger an immune system response. In fact, many people who consider themselves lactose-intolerant (by observing that dairy makes them feel poorly) may have a sensitivity to dairy proteins as well.
Considering the various concerns raised by the scientific evidence, we think that a cautious strategy of eliminating milk (and dairy proteins) from your diet is both intelligent and healthy. Just as with grains, when you can get all the benefits of a food from other, healthier sources, why wouldn’t you?
WHAT ABOUT CALCIUM
Anytime we mention the whole “we don’t do dairy” thing, we inevitably get The Question:
“What about calcium?”
The Question is generally coming from the perspective that strong, healthy bones are important and that calcium builds strong, healthy bones. We do not disagree. But despite what the pro-milk ads would lead you to believe, the whole “strong bones” thing is a lot more complicated than that. There are three fallacies when it comes to the dairy-calcium-bones triad:
Building strong, healthy bones depends only on calcium.
Your calcium intake is the only thing that matters.
Dairy is the only good source of calcium.
Let’s break these down one at a time.
There’s no denying that calcium is important for bone health—calcium is the substance that gives bones strength, like bricks do for a building. But bones need more than just calcium to grow and stay strong. Vitamin C, vitamin D3 (technically a hormone), and vitamin K, along with minerals like magnesium and phosphorous, all play important roles in bone development.
Your hormones and inflammatory status also play a role in bone health—a fact that should not surprise you at this point. Chronically elevated blood sugar and cortisol levels and systemic inflammation all accelerate bone breakdown and inhibit the formation of new bone cells.
If the first fallacy is thinking that bone health is all about calcium, the second is believing that our intake of calcium is all that matters. If this were true, then how do you reconcile this:
The United States has one of the highest rates of osteoporosis in the world, despite having one of the highest calcium intakes.
It makes no sense ... unless there’s more to the story than how much calcium we’re taking in. And there is: It’s also about how much we’re able to absorb and retain.
Phytates (anti-nutrients) in grains and legumes, stress, and the aging process all inhibit calcium absorption. Acute restriction of dietary protein reduces calcium absorption and may be associated with significantly higher rates of bone loss. (Adequate protein, on the other hand, increases calcium absorption, and stimulates new bone formation.)
In addition, bone-healthy vitamin D3 and K are both fat soluble—meaning they require some fat in order to be absorbed into the bloodstream. So a low-fat diet (like the kind we’ve all been advised to eat for the last twenty years) may impair your body’s ability to absorb these two vitamins, which can also impair bone health.
We told you it was complicated.
THE SUPPLEMENT STORY
These factors are exactly why all the calcium supplementation we’ve been doing just isn’t working to prevent osteoporosis and bone fractures. See, osteoporosis isn’t caused by a lack of calcium. And studies show that calcium intake alone does not prevent fractures from bone loss. Taking calcium supplements gives you a short-term boost in bone density, but over time, your hormones (again!) will work against the extra calcium, and may even leave your bones more brittle than before. Bone-density drugs (bisphosphonates) like Fosamax and Boniva aren’t much better. They deposit a long-lasting compound in the bone, giving it the appearance of greater density, but do not build the kind of bone matrix that actually makes bones stronger. This can result in “dense” bones that are too brittle to withstand everyday activities.
Finally, too much calcium is just as bad as not enough. This excess calcium generally comes from a combination of dairy plus calcium supplements plus the calcium added to a variety of products, from antacids to orange juice to cereals. Too much calcium increases the risk of developing dangerously high levels of calcium in the blood, which can result in impaired kidney function, kidney stones, and high blood pressure. Furthermore, recent studies suggest that taking calcium supplements actually increases the risk of a heart attack.
Of course, a “just right” calcium balance is still necessary for overall health (bone and otherwise). But it’s high time we correct the “facts” promoted by years of industry-sponsored marketing and addressed the third fallacy.
Dairy is not the only good source of calcium.
You can find calcium (in bioavailable forms and significant amounts) in a wide variety of nondairy, nutrient-dense foods: vegetables (like kale, boiled spinach, collard greens, mustard greens, turnip greens, and bok choy); sea vegetables like nori; meat and seafood (like bone broth, sardines, anchovies, shrimp, oysters, and canned salmon); and nuts and seeds (like almonds, hazelnuts, and walnuts).
THE POWER OF GREEN
The calcium in vegetable sources may prove more bioavailable (useful to the body) than the stuff you get from milk. One study compared the absorption of calcium from kale and from milk and found kale the clear winner. (Yeah, kale!) Recent studies have shown that plant-sourced calcium in particular increases bone-mineral density and reduces the risk of osteoporosis. This is probably not just due to the calcium content of the plant—the complement of other vitamins (such as vitamin K), minerals, and phytonutrients work synergistically to provide additional benefits to bones. Yet another reason to eat your greens.
We think we’re in need of a summary here.
Your body likes balance. Remember Goldilocks? Not too little, not too much ... just right. And calcium doesn’t work in a vacuum, so too much calcium means your body is forced to compensate by adjusting levels of other vitamin and mineral stores, leaving you even more out of balance.
So how do you build strong, healthy bones without dairy and without supplements? The short answer is, just follow our guidelines! The food quality of our plan ensures a wide variety of micronutrition, includes adequate protein and fat, promotes a healthy hormonal balance and minimizes systemic inflammation.*
HEAVY STUFF
For all of you overachievers, here’s your bonus tip for building strong, healthy bones—pick up something heavy. Weight-bearing physical activity and strength training has long been linked to improved bone density. The compression forces of daily activity stress our bones in a healthy way. Our bones respond by building more supportive substances to structurally bear load. On the other hand, if we fail to stress our bones in this fashion (with a sedentary lifestyle or failure to use weights in our exercise routine), our bones will slowly waste away. In other words, use it or lose it.
Even if you follow all of our recommendations, however, you’ll find that you’re probably still not getting as much calcium as the Powers That Be insist is necessary.
Know what?
We’re not that concerned.
Remember, it’s not about how much calcium we’re taking in. And studies support the fact that you probably don’t need as much calcium as you think if the rest of your nutrition and lifestyle are supporting healthy, strong bones (and they are, if you’re following our plan!).
So skip the milk, eat your greens, get some sunshine, exercise regularly, and enjoy all of the health benefits of a nutrient-dense, anti-inflammatory, hormone-optimizing diet—including strong, healthy bones.
BUT WHAT ABOUT...
The dairy discussion always brings up a series of questions, all of which start with, “But what about ...?” Let’s address some of the dairy options, and whether or not we’d classify them as healthy choices.
What about pastured dairy?
Don’t be confused—pastured is not the same as pasteurized. Pastured refers to the way the animal was raised (mostly outside on pasture) and the food it was fed (in the case of cows, grass). Pasteurization is a process by which milk is heated, then cooled, in an effort to delay spoilage by discouraging microbial growth.
Cows raised in a natural environment and fed a natural diet are inherently healthier. A pastured (and ideally organic) dairy product will contain a larger percentage of healthy fats like conjugated linoleic acid (CLA) and omega-3 fatty acids and a healthier essential-fatty-acid balance. In addition, pastured dairy contains larger amounts of carotenoids (a class of antioxidants) and vitamins A and E, compared with conventional dairy. Finally, pastured, full-fat dairy will not contain protein remnants from a grain-based diet, which can be a problem for people with serious grain or gluten sensitivities.
However, simply sourcing dairy from cows that roam freely only sidesteps some of our concerns. Pastured, organic dairy still contains the same lactose, milk proteins, growth factors and hormones as conventionally-sourced dairy, which means it’s still not such a healthy option.
What about raw milk?
Proponents of raw milk will say that raw (unpasteurized) milk is a superior choice, since the pasteurization process destroys enzymes (such as lactase) that help digest some components of the milk. However, aside from those issues, all of the other concerns still apply to raw milk.
If you’re dead set on consuming milk, raw is perhaps a “less bad” option—but if you live in the United States, you’ll probably have to hunt hard for it, as selling raw milk is illegal in many states.
As for us, we can’t justify working that hard for something that’s still not optimally healthy.
What about fermented dairy?
Fermented dairy (such as yogurt or kefir) does have some advantages over regular milk. Since the bacteria in these foods have broken down a significant amount of the lactose and dairy proteins, people generally have greater tolerance for it.
The most commonly cited benefit of fermented dairy is its health-promoting bacteria, which help to maintain the balance of gut bacteria. You’ve probably heard of Lactobacillus acidophilus, one species famous for its beneficial properties, but there are dozens of other “friendlies.” (These are some of the bacteria “allies” we referred to in the discussion of the nightclub in Chapter 6.)
While you can obtain some benefits from consuming these bacteria, the delivery mechanism may still prove imperfect, and individual tolerance varies greatly. Feel free to play around with unsweetened yogurt or kefir after you’ve done the Whole30, but make sure it’s still pastured and organic. Conventionally-produced, sweetened, low-fat yogurt will not make you healthier, even if there is fruit on the bottom!
The good news is that yogurt is not the only place that you can find beneficial bacteria. Unpasteurized sauerkraut and kimchi, kombucha, and fermented coconut water “kefir” (as well as a probiotic supplement, if indicated) are good sources of beneficial gut bacteria without the potential downsides of most dairy.*
THE EXCEPTIONS
You may have noticed that we haven’t expressed any specific concerns about dairy fat. In fact, we’ll talk about butter and heavy (whipping) cream in the “More Healthy” section. Surprised? Check this out—research studies that compare full-fat dairy with reduced-fat dairy demonstrate better health outcomes with full-fat dairy. This is not an endorsement of whole milk—these benefits are largely due to the health-promoting properties of dairy fat, which we encourage eating all by itself in the form of butter or heavy cream. For example, pastured, organic butter contains little to none of the protein fractions, growth promoters, or hormones found in milk but has many beneficial compounds including vitamin K2, conjugated linoleic acid (CLA), and even those famous omega-3 fatty acids.
In summary, the question of whether eating dairy is healthy is complicated and depends on many factors, but we prefer to err on the side of caution. Why eat something that has so many potential downsides, especially when you can get all the nutrition your body needs from other, healthier sources?
As with our other “less healthy” foods, we recommend blending the science and our experience from the Whole30 program with some self-experimentation. Remove dairy from your diet for thirty days, so you can evaluate the effects the milk sugars and proteins are having on you. Most of our clients—especially those with acne, allergies, or asthma—experience great relief from their conditions when they stop consuming dairy, but until you try it for yourself, you’ll never know for sure.