Tag Archives: autoimmune disease

cheering woman open arms at sunrise mountain peak wellness concept[This article discusses health improvements based, at least in part, on a ketogenic diet. Professor Loren Cordain and many others, including The Paleo Diet editorial review board, don’t recommend or endorse long-term ketogenic dieting for the general public. They do acknowledge that it can be effective if used short-term or as a therapeutic measure for multiple sclerosis, Alzheimer’s, and other diseases.]


The title of Dr. Terry Wahls’ book, The Wahls Protocol: A radical new way to treat all chronic autoimmune conditions using Paleo principles, [1] highlights issues vital to retirees or anyone facing autoimmune conditions. But it also modestly avoids the book’s central revelation: Wahls’ own personal experience dramatically improving severe multiple sclerosis symptoms.

An avid martial artist and cyclist when first diagnosed with MS, Wahls became progressively debilitated despite the best conventional medical care—including drugs and chemotherapy. Within seven years she was wheelchair-bound, only able to walk short distances using two canes.

A firmly committed conventional physician herself, she realized she needed to look beyond Western medicine and began her own research. This resulted in a carefully crafted, rigorous diet-and-lifestyle intervention that improved her health so dramatically she could walk without canes or assistance at four months and ride a bicycle (for the first time in 10 years) at five months. She remains fully active today, devoted to both widening awareness of health problems caused by the standard Western diet and to clinical research on replicating her personal results.


“How did I not know any of this?” (from The Wahls Protocol, p. 5)

Many hours on Google and PubMed eventually led Wahls to the Paleolithic or Ancestral diet, which became integral to her own protocol and recovery. She credits Professor Loren Cordain as a strong early influence in her research, including his book The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. [2] Wahls gradually abandoned her conventional Western (vegetarian) diet, and designed from scratch, by trial and error, an intensively micro- and phytonutrient-rich whole-food regimen. Her goal was not just to remove western staples like processed foods, grains, and legumes, but to add optimal levels of all vitamins and minerals needed to promote brain health—using food, not supplements.

The balance of macronutrients—heavy on vegetables, some fruit and healthy fats—that appears to have improved Wahls’ MS symptoms result in “mild ketosis.” Her protocol also includes regular exercise, toxin reduction, e-stim, whole body vibration, and decreasing stress. Some supplements may be used, but the bulk of nutrients are derived from whole foods. Her well-known TED talk [3] concisely introduces her protocol—and describes her remarkable personal resurgence. It is just as timely today as it was when it was recorded in 2011. It has been viewed (as of this writing) over 3 million times.


Many conditions, one etiology

Wahls views most chronic health issues, and specifically autoimmune conditions like MS, as essentially the same disease [4]:

“The primary driver of disease is biochemical dysfunction/accelerated aging due to mitochondrial dysfunction and cell membrane dysfunction. Fix those two things—cells begin to repair organs, organs function well, aging slows and often reverses, and the need for pharmacologic interventions decline and we need to steadily reduce and often eliminate prescription drugs…” [5]

In an email interview, Wahls reports success using her protocol “across a large swath of disease states across multiple specialties,” both helping patients and causing previously skeptical colleagues to reconsider her approach. [5] She emphasizes cellular nutrition, multiplying and strengthening mitochondria (the “engines” or energy-producing substructures in each cell) and the importance of treating the whole person to restore optimal biochemical processes.

Wahls, who added functional medicine to her own medical practice during her MS research, also notes that the basic whole-food, whole-person protocol can be at least as effective as a costly test- and supplement-intensive functional approaches. As many patients find, good functional practitioners are scarce—and typically not covered by health insurance. Extended functional treatment may cost thousands of dollars, including exotic lab work, versus a modest increase in the household food budget, with some funds earmarked for stress-reduction, natural detox and exercise.

Despite the success of her protocol, Wahls cautions that medical supervision is still important, especially for MS and other autoimmune patients taking medication. Each individual responds differently. Wahls recommends monitoring the protocol based on standard indicators including lipid profile, homocysteine, insulin and A1C levels. If adjustments are necessary, they typical involve changes in ratios of various vegetables, targeted supplements, or possibly the amount of dietary fat consumed.


Paleo vs. Keto in the protocol

The Wahls Protocol offers three versions or levels of the diet, all of which are built on six to nine cups of vegetables (and some fruit) each day. Wahls recognizes the initial difficulty of eliminating classic Western diet stressors, like sugar, grains, potatoes and dairy. These are first de-emphasized, then restricted, and finally eliminated in the third level, called “Wahls Paleo Plus.” This level targets “mild” ketosis and is credited by Wahls for reversing her MS symptoms.

Wahls includes exercise, e-stim, detox, and stress reduction in all levels.

“Wahls Paleo Plus” is unusually nutrient-dense compared to other ketogenic plans, and includes at least six cups of greens, sulfur-rich and colorful vegetables, along with coconut milk, seaweed, organ meats, and grass-fed or other carefully sourced protein. Ketosis should be consistent (but may be intermittent.)

Wahls observes, however, that no modern (or ancestral) hunter-gatherer populations maintain a year-round ketogenic diet, and that it may not be practical or even desirable, as we’ve pointed out on this website, to stay in ketosis indefinitely. She has come to favor cycling through periodic fasting (or a fasting-mimicking diet), other caloric restriction, and matching a ketogenic diet to the winter season of an individual’s ethnic background. [5]

This fosters therapeutic ketosis for a generous stretch of time each year, takes advantage of occasional controlled fasting to promote autophagy and detoxification, and allows “three-seasons” use of the less restrictive ancestral food choices in “Wahls Paleo” (the second level of the protocol.)


“Wahls Paleo” study results

Wahls estimates [6] that most of her patients choose the second level of the diet or “Wahls Paleo.” It follows many common Paleo guidelines, with the nine cups of vegetables as a foundation. No gluten-bearing food is permitted, and starches like legumes, brown rice, or potatoes are severely limited (two servings per week at most.)

Anecdotal evidence of patient success in her books (and on the internet) is strong, but Wahls has gone beyond word of mouth. Her intervention, typically at the “Wahls Paleo” level [5], has shown improvement or reversal of MS symptoms in multiple studies.

One study, first published in 2019 in PloS One, tracked changes in lipid profiles and the associated improvements in fatigue scoring. The intervention (diet plus e-stim, exercise, and stress-reduction) measurably reduced fatigue, a primary symptom of progressive MS, over 12 months. [7]

The same intervention was shown to improve gait and balance, primarily in mild-to-moderate progressive MS patients in a 2017 study first published in Degenerative Neurological and Neuromuscular Disease. [8] Wahls shared a related YouTube video showing some very marked improvements. [5,9]

Another important 2017 study, which first appeared in The Journal of the American College of Nutrition, showed that progressive MS patient scores for mood, cognitive and executive function, and anxiety were measurably improved by the Wahls intervention [10]. The authors noted, in particular, that the Paleolithic dietary component specifically improved mood and cognition more directly than the exercise or stress management. Fatigue, anxiety, and depression scores increased more gradually, but showed significant improvement after several months.

Finally, a 2019 study first published in Nutrients compared “Wahls Paleo” to a standard American “healthy diet.” Conventional nutritional bias is carefully balanced against Wahls’ recommendations and concluded that nutrient density was comparable in both diets (specifically that the Wahls diet is “safe” to follow.) [11]

Dr. Wahls’ work has important implications for treatment of all autoimmune conditions. Her success in reversing symptoms of a long-standing, progressive debilitating disease like MS, deserves much wider recognition.



  1. Wahls, Terry, M. D., and Eve Adamson. The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles. Reprint edition, Avery, 2014. (hereafter “Wahls”)
  2. Cordain, Loren. The Paleo Diet: Lose Weight and Get Healthy by Eating the Foods You Were Designed to Eat. Revised edition, John Wiley & Sons, 2010.
  3. Wahls, Terry. YouTube. 30 Nov. 2011, https://www.youtube.com/watch?v=KLjgBLwH3Wc.
  4. Wahls P. 47
  5. Wahls, Terry, M.D., email to the author, 9/3/2019
  6. Wahls P. 149
  7. Fellows Maxwell, Kelly, et al. “Lipid Profile Is Associated with Decreased Fatigue in Individuals with Progressive Multiple Sclerosis Following a Diet-Based Intervention: Results from a Pilot Study.” PloS One, vol. 14, no. 6, 2019, p. e0218075. PubMed, doi:10.1371/journal.pone.0218075.
  8. Bisht, Babita, et al. “Effects of a Multimodal Intervention on Gait and Balance of Subjects with Progressive Multiple Sclerosis: A Prospective Longitudinal Pilot Study.” Degenerative Neurological and Neuromuscular Disease, vol. 7, 2017, pp. 79–93. PubMed, doi:10.2147/DNND.S128872.
  9. Bisht, Babita et al. YouTube. 26 Nov. 2017, https://www.youtube.com/watch?v=tsOMPBS277Q.
  10. Lee, Jennifer E., et al. “A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.” Journal of the American College of Nutrition, vol. 36, no. 3, Apr. 2017, pp. 150–68. PubMed, doi:10.1080/07315724.2016.1255160.
  11. Chenard, Catherine A., et al. “Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern.” Nutrients, vol. 11, no. 3, Mar. 2019. PubMed, doi:10.3390/nu11030537.


High Salt Diet

Salt is everywhere today in our modern food environment. Over 50 percent of a typical household’s grocery spending goes into ‘ultra-processed’ foods which bring along with them a significant amount of salt (sodium chloride).1

But, in evolutionary terms, it’s only been a staple in the human diet for a very short time.

Our ancestors survived on a diet of less than 1,000mg per day for millions of years, before the introduction of salt into the diet some 5,000 years ago as a method for preserving food.2

Today, the average intake of salt in the general population is 3,400mg daily, much higher than the recommendation from the Dietary Guidelines for Americans, which says to consume less than 2,300mg per day as part of a healthy eating pattern.3

In fact, modern salt intake can be as high an 8,000mg per day in some parts of the world, the overwhelming majority coming from processed foods and eating out in restaurants.4

Our current high salt intake is therefore in tremendous excess compared to our ancestral past. Is this a cause for concern for human health?

The most obvious problem is the effect of salt on blood pressure. The evidence from high-quality observational and interventional studies reveals that excessive salt intake is associated with hypertension.5,6 It’s also widely accepted that high salt intake is linked with the development of cardiovascular disease, and it is heavily taxing on the kidneys with some evidence it plays a role in the progression of chronic kidney disease.7,8

A lesser known adverse effect of excessive salt intake is its role in autoimmune conditions like rheumatoid arthritis.


High Salt Diets, Innate Immunity & Autoimmune Conditions

The innate immune system is the body’s first line of defense, preventing the intrusion of foreign invaders. It responds to infection and other disturbances in homeostasis by activating the body’s inflammatory processes.

In 2009, a ground-breaking animal study found that excessive intake of salt increased skin concentrations of sodium. This increase activated macrophages of the innate immune system to clear the stored sodium through the lymphatic system.9 Macrophages, like many immune cells, can play multiple roles in the body; some macrophages (M1) are pro-inflammatory, while other macrophages (M2) are anti-inflammatory.10

The activation of anti-inflammatory (M2) macrophages has been shown to reduce the development of autoimmune disease.11,12 The problem with a high salt intake is that it increases pro-inflammatory and decreases anti-inflammatory macrophages.13,14

Why would this occur from an evolutionary standpoint?

It appears that infections increase sodium levels inside the cell, leading the local activation of pro-inflammatory macrophages to combat the intruding pathogen, while limiting it in the rest of the body. This phenomenon occurs at all key sites in the body – skin, kidneys, and genitourinary – where the body interfaces with the external environment.

In short, the immune systems response to increased sodium levels is an ancestral protection mechanism against foreign intruders at these locations.


High Salt Diet, Adaptive Immunity & Autoimmune Conditions

The adaptive ‘seek and destroy’ immune system is also impacted by high salt intake. The specialized cells of the adaptive immune system are activated by the detection of foreign invaders into various T-cells – Th1, Th2, Th17, etc. – in order to target specific intruders.

One important balance in the body is between pro-inflammatory Th17 cells and anti-inflammatory T Regulatory (Treg) cells. Activation of Th17 has been implicated in numerous autoimmune kidney diseases and renal transplant rejection, while Treg activity limits the progression of these conditions.15 Alarmingly, new research on high salt intake finds it increases Th17 and reduces Treg activity, thus potentially worsening autoimmune kidney diseases and likelihood of transplant rejection.16,17

In fact, an imbalance between Th17 and Treg cells has been associated with multiple autoimmune conditions. Emerging research shows a high salt diet could exacerbate a variety of complex conditions, including; multiple sclerosis18,19, inflammatory bowel disease20,21, systemic lupus erythematosus22,23, and acute kidney injury.24,25


To Sum Up

The immune system attempts to maintain homeostasis by keeping a balance between pro- and anti-inflammatory cells. High salt diets promote the activation of both the innate and adaptive immune systems and favor a pro-inflammatory milieu. While under normal conditions, it helps clear infections at the local cellular level, the consequences a chronic pro-inflammatory state due to hypersalinity appears to promote the development of autoimmune disease.

It’s still unclear whether the dietary manipulation of salt can mediate these effects, however, the evidence appears to support a more conservative approach to salt intake. As the majority of salt intake comes from processed food consumption, it’s another great reason to limit your consumption and adopt a ‘food first’ approach consistent with a Paleo dietary eating pattern.



  1. https://www.theguardian.com/science/2018/feb/02/ultra-processed-products-now-half-of-all-uk-family-food-purchases
  2. Intersalt Cooperative Research Group. Intersat: an international study of electrolyte excretion and blood pressure. Results for 24-hour urinary sodium and potassium excretion. BMJ 1988;297:319-328.
  3. https://www.cdc.gov/salt/pdfs/sodium_dietary_guidelines.pdf
  4. Evans, R et al. Emerging evidence of an effect of salt on innate and adaptive immunity. Nephrol Dial Transplant (2018) 1–7 doi: 10.1093/ndt/gfy362
  5. Smyth A, O’Donnell M, Yusuf, S et al. Sodium intake and renal outcomes: a systematic review. Am J Hypertens 2014; 27: 1277-1284.
  6. Joossens, J, Hill, M, and Elliott, P. Dietary salt, nitrate and stomach cancer mortality in 24 countries. Int J Epidemiol 1996;25:494-504.
  7. Lanaspa, M., Kuwabara, M., Andres-Hernando, A et al. High salt intake causes leptin resistance and obesity in mice by stimulating endogenous fructose production and metabolism. Proc Natl Acad Sci USA 2018; 115:3138-3141.
  8. Sundstrom, B, Johansson, I., Rantapa-Dahlqvist, S. Interaction between dietary sodium and smoking increases the risk for rheumatoid arthritis: results from a nested case-control study. Rheumatology (Oxford) 2015;54:487-493.
  9. Machnik, A., Neuhofer, W., Jantsch, J. et al. Macrophages regulate salt-dependent volume and blood pressure by a vascular endothelial growth factor-c-dependent buffering mechanism. Nat Med 2009;15:545-552.
  10. Sica, A., Mantovani, A. Macrophage plasticity and polarization:in vivo veritas. J Clin Invest 2012; 122:787-795.
  11. Jiang, H., Milovanic, M., Allan, D. et al. IL-33 attenuates EAE by suppressing IL-17 and IFN-c production and inducing alternatively activated macrophages. Eur J Immunol 2012;42:1804-1814.
  12. Parsa, R., Anderson, P., Gillett, A., et al. Adoptive transfer of immunomodulatory M2 macrophages prevents type-1 diabetes in NOD mice. Diabetes, 2012; 61:2881-2892.
  13. Jantsch J, Schatz V, Friedrich D et al. Cutaneous Naþ storage strengthens the antimicrobial barrier function of the skin and boosts macrophage- driven host defense. Cell Metab 2015; 21: 493–501
  14. Binger KJ, Gebhardt M, Heinig M et al. High salt reduces the activation of IL-4- and IL-13-stimulated macrophages. J Clin Invest 2015; 125: 4223–4238
  15. Sullivan JA, Adams AB, Burlingham WJ. The emerging role of TH17 cells in organ transplantation. Transplantation 2014; 97: 483–489
  16. Kleinewietfeld M, Manzel A, Titze J et al. Sodium chloride drives autoim- mune disease by the induction of pathogenic Th17 cells. Nature 2013; 496: 518–522
  17. Wu C, Yosef N, Thalhamer T et al. Induction of pathogenic TH17 cells by inducible salt-sensing kinase SGK1. Nature 2013; 496: 513–517.
  18. Wilck N, Matus MG, Kearney SM et al. Salt-responsive gut commensal modulates TH17 axis and disease. Nature 2017; 551: 585–589.
  19. Krebs CF, Paust H-J, Krohn S et al. Autoimmune renal disease is exacer- bated by S1P-receptor-1-dependent intestinal Th17 cell migration to the kidney. Immunity 2016; 45: 1078–1092
  20. Wei Y, Lu C, Chen J et al. High salt diet stimulates gut Th17 response and exacerbates TNBS-induced colitis in mice. Oncotarget 2017; 8: 70–82
  21. Aguiar SLF, Miranda MCG, Guimar~aes MAF et al. High-salt diet induces IL-17-dependent gut inflammation and exacerbates colitis in mice. Front Immunol 2017; 8: 1969
  22. Wu H, Huang X, Qiu H et al. High salt promotes autoimmunity by TET2- induced DNA demethylation and driving the differentiation of Tfh cells. Sci Rep 2016; 6: 28065
  23. Yang X, Yao G, Chen W et al. Exacerbation of lupus nephritis by high so- dium chloride related to activation of SGK1 pathway. Int Immunopharmacol 2015; 29: 568–573
  24. Spurgeon-Pechman KR, Donohoe DL, Mattson DL et al. Recovery from acute renal failure predisposes hypertension and secondary renal disease in response to elevated sodium. Am J Physiol Renal Physiol 2007; 293: F269–F278
  25. Mehrotra P, Patel JB, Ivancic CM et al. Th-17 cell activation in response to high salt following acute kidney injury is associated with progressive fibrosis and attenuated by AT-1R antagonism. Kidney Int 2015; 88: 776–784


Arthritis | The Paleo Diet
It’s often times a diagnosis of cancer, diabetes, multiple sclerosis (MS), or another disease which proves to be the pivot point for individuals to make significant changes to their eating and exercise habits. Whether the change stems from obvious reasons, like losing weight because obesity has been the causal agent for developing type 2 diabetes, or per the advice of their physicians to cut out gluten and dairy following an autoimmune diagnosis, these steps are reactive versus proactive.

If we were to exercise daily and eat foods that set us up for health, rather than sickness in the first place, would we be able to determine our destiny? Clearly, we can take preventative measures to lower our risk for obesity and type 2 diabetes by leading an active lifestyle, veering away from the typical, highly refined Standard American Diet (SAD), and implementing a Paleo diet.

But what about minimizing our risk for autoimmune diseases like rheumatoid arthritis (RA) with diet? Science suggests it’s looking quite promising.

Two studies presented at the American College of Rheumatology Annual Meeting in San Francisco show diet can significantly lower our chance for developing RA.1 RA is an autoimmune disease where the body’s immune system mistakenly attacks the joints, creating inflammation that causes the tissue lining of the joints to thicken, resulting in swelling and pain in and around the joint.2

For those following a Paleo regime, inflammation is hardly a foreign term, and you’re familiar with the notion that avoiding certain foods can help offset symptoms dramatically.3 But how does this scientifically factor into RA treatment or minimize risk altogether?

In the first study, researchers found “typical Western diets high in red meat, processed meat, refined grains, fried food, high-fat dairy, and sweets can increase a person’s risk of developing RA in comparison to Prudent diets (a diet low in total fat, saturated fat, trans fat, cholesterol and sodium which aid in lowering cholesterol and triglyceride blood levels and blood pressure)4 made mostly of fruit, vegetables, legumes, whole grains, poultry and fish.”

The second study found that “following the Dietary Guidelines for Americans can also lower one’s chances of developing the disease because they provide authoritative advice about consuming fewer calories, making informed food choices, and being physically active to attain and maintain a healthy weight, reduce risk of chronic disease, and promote overall health.”

How was this measured? By using the Alternate Healthy Eating Index, created to measure how well participants followed the Dietary Guidelines for Americans, researchers observed associations of the subjects’ diets and their likelihood of developing RA. The researchers noted those who best adhered to the Dietary Guidelines for Americans had a 33% reduced risk of developing RA when compared to those who did not follow the guidelines as closely. And, just as in the first study, the researchers noted that body mass index may be a modest intermediate factor linking diet and risk of RA.

A few questions arise. If the sole means of data collection was to review and analyze what the participants reported to eat, how accurate can the findings really be? Were findings measured upon accountability and how can we be sure participants didn’t take the liberty of “cleaning up” their food log entries, energy levels, or sleep patterns?

A colleague of mine joked in reference to a new client who’d touted the benefits of a new fad diet, “any eating plan is going to ‘work’ in comparison to what one did before, because before, they didn’t have one!”

Researchers state “the single-nutrient approach may be inadequate for taking into account complicated interactions among nutrients, and high levels of inter-correlation makes it difficult to examine their separate effects.” So grouping all foods into  one lump category (recall the list: “diets high in red meat, processed meat, refined grains, fried food, high-fat dairy, and sweets”) doesn’t differentiate between high quality, grass fed meats, from the corn-fed beef. Nor does the “diet made mostly of fruit, vegetables, legumes, whole grains, poultry and fish” distinguish the effects of antinutrients contained in legumes and grains,5 or the glycemic load of eating too much fruit.6

While I do agree that a healthy diet may prevent RA development, it’s a matter of deciphering what actually comprises a healthy diet. And from everything I’ve read and seen over the past decade, I certainly don’t need further convincing that a real Paleo diet can be the remedy to addressing a diagnosis of RA. By eating a diet rich in alkaline, anti-inflammatory foods, the body is armed with its best defenses and most equipped to stay diseases free for a healthy, long life!


1. “Diet May Determine Your Risk for Rheumatoid Arthritis.” ScienceDaily. ScienceDaily, n.d. Web. 16 Nov. 2015

2. “What Is Rheumatoid Arthritis?” What Is Rheumatoid Arthritis? Arthritis Foundation, n.d. Web. 16 Nov. 2015

3. Wahls, Terry L., and Eve Adamson. The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine. N.p.: n.p., n.d. Print

4. “What Is the Prudent Diet?” LIVESTRONG.COM. LIVESTRONG.COM, 30 June 2015. Web. 16 Nov. 2015

5. Stephenson, Nell. “Antinutrients, the Antithesis of True Paleo | The Paleo Diet.” The Paleo Diet. The Paleo Diet, 10 Mar. 2015. Web. 16 Nov. 2015

6. “Glycemic Index and Glycemic Load | The Paleo Diet | Dr. Loren Cordain.” The Paleo Diet. N.p., n.d. Web. 16 Nov. 2015

Where Does the Vaccination Debate Leave Paleo Followers? | The Paleo Diet

If you thought religion and politics were the most taboo topics at the dinner table, there is now definitely a third hot button topic to add to the list. The vaccine debate has become such a contentious issue that even many leading functional doctors and researchers with expertise on the subject prefer not to speak out. Regardless of what they may say, someone will likely be offended. And, knowing the answers are not black and white, there doesn’t seem to be enough room in print to truly delve deep into the topic.

Recently, pro-vaccination groups have become so frustrated with the layperson dispensing medical advice that their new mantra seems to be “just do it.” Yet anti-vaccine voices continue to fear the conflict of interest between pharmaceutical companies and doctors, and highlight a list of potential risks of vaccinating, which they believe can compromise long-term immune function and health.

How can the average person wade through these murky waters (that sometimes feel shark-infested!) and get sound advice for their children without offending their doctor or peers, but also avoiding being swept away by all the pseudo-science online?

Let’s take a closer look at both sides of the debate.


Most traditional medical doctors would say this is not even a debate. For them, the research is clear that vaccines save million of lives every year, therefore everyone should vaccinate their children. Most physicians will concede, and rightly so, that there are side-effects to vaccinations but state these negative reactions are very few and far between. For the overwhelming majority of physicians, protecting your child from preventable deadly diseases is an easy choice, especially for infant immune systems that have not yet matured to protect themselves fully from pathogens.

Overall, the research supports that vaccines are very safe and provide necessary and life saving protection to infants. The recent outbreak of measles in Disneyland this year is evidence that if too many people “opt out” of vaccinations, it compromises the health of other children. Herd immunity is a reality and you must have upward of 80-90% of the community vaccinated to provide protection to all. 1

Of course, the trump card for the pro-vaccination camp is the impressive list of deadly diseases that have been eradicated (or almost eradicated) since the use of vaccines. This includes diphtheria, influenza, hepatits A and B, measles, mumps, pertussis, pneumococcal disease, polio, rubella, congenital rubella, smallpox, tetanus and varicella. This great medical achievement has required years of research and dedication of generations of talented scientists and physicians and has saved millions of lives in the process. However, they argue that if a just 10% of the population is not fully vaccinated, these modern advances begin to lose their effectiveness.


The anti-vaccine debate seems to stem around a couple of key areas, neither of which is the heavily rumored link between the MMR vaccine and autism, which has been strongly refuted in the clinical literature.2

First, there is a concern that vaccines can cause harm and alter immune function in the long-term, leading to a greater risk of autoimmune conditions as we age. According to the Center for Disease Control (CDC) all vaccines do carry the risk of life-threatening allergic reaction, however this occurs in one child per million.3 Although the likelihood of these reactions is extremely small, for any parent of a child who has had a reaction to a vaccine, they would argue not small enough.

The National Vaccine Information Center (NVIC) states that certain vaccines may be linked to asthma, diabetes, chronic inflammation, autism, learning disabilities and other disorders.4 Of course, from a scientific perspective, the difficulty is that association is not proof of causation and, therefore, any number of other factors may have also contributed to these adverse reactions.

Those opposed to vaccinations also fear the adjuvants added to vaccines that are required to trigger the immune reaction that ultimately facilitates acquired immunity. Some researchers and physicians believe common adjuvants like thimerosal, aluminum, mercury, and formaldehyde possess potentially significant negative risks to children, even at the levels classified as acceptable and safe by the CDC.

On top of that there is concern about the sheer number of vaccines given today. In 1980, the CDC recommended 23 doses of 7 vaccines, whereas by 2013 the recommendations had dramatically increased to 49 doses of 14 vaccines between birth and 6 months. Can a newly forming immune system cope with this high burden of adjuvants? The pro-vaccine group believes it poses no threat; the anti-vaccine group believes this may predispose the population to increased risk of autoimmune conditions later in life.

From 2001 to 2009 rates of autoimmune diseases – like lupus, celiac disease, and type-1 diabetes – have increased dramatically and the CDC is unsure why this is happening.5

Environmental factors have been suggested as the most likely cause, however the rise in number of vaccinations does parallel the rise in autoimmune conditions over the past few decades. It has been suggested that vaccine use (or excessive use of vaccines and accompanying adjuvants) may negatively impact newly forming immune systems in infants and young children, scrambling the body’s immune response mechanism and leading to a greater likelihood of autoimmune type reactions. While there are some plausible biochemical pathways to support this, it would be virtually impossible to prove in a double-blinded placebo controlled study.

Perhaps the major hurdle that many patients have is the intimate connection between the pharmaceutical companies and the CDC, in what is a hugely profitable industry. With former employees of the CDC transitioning to the big pharmaceutical companies, how can the average person have 100% trust in a watchdog that is closely tied to the industry they regulate? While the majority of these fears may be unfounded, this type of relationship represents a clear conflict of interest, in particular in light of the rapid rise in number of vaccinations over the past 30 years.

Lastly, the right to “informed consent” is an ethical principle in medicine. It is the process of getting permission before conducting any healthcare intervention on a person. The fact that some states are now wanting to implement a 100% mandatory vaccination schedule goes against this medical principle and seems to add fuel to the fire for the anti-vaccine camp.

So, where does that leave us?

Today, there is so much rhetoric on either side of the debate it’s no wonder the average parent is confused and frustrated. For a parent whose child has suffered serious negative consequences from a vaccination, they will likely always regret allowing their child to be exposed, no matter if they are the one in a million affected. For the doctor, seeing a parent choose to not vaccinate and watch that child contract a completely preventable disease and risk spreading illness to others leaves a similar scar and frustration around fears of vaccination.

No one will argue against Mary Glodé, M.D., professor of pediatrics at the University of Colorado in Denver who states “immunizations are simply one of the greatest public-health achievements.” However, expert immunology researchers also admit “for the immune molecules that we know are important, almost nothing is understood about their mechanism,” highlighting there is much more to immunity than merely the antibody response of vaccines.6

For Paleo followers, an ancestral approach to life means honoring the wisdom of our evolution to build robust bodies and immune systems that can fight off disease. But with our modern day urban lifestyle, isn’t vaccination an opportunity to take the best of modern medicine and combine it with Paleo principles? I believe an open discussion with your family and doctor will lead to the best plan for you.



[1]Hyong Kim T, Johnstone J, Loeb M. Vaccine herd effect. Scand J Infect Dis. 2011 Sep; 43(9): 683–689.

[2]Demicheli V et al. Vaccines for measles, mumps and rubella in children. Cochraine Database Syt Rev. 2012 Feb 15;2:CD004407.

[3]CDC, “Possible Side-Effects from Vaccines,” www.cdc.gov, Feb. 4, 2014.

[4]National Vaccine Information Center, “Autism,” nvic.org

[5]//www.medicalnewstoday.com/articles/246960.php. Viewed Aug 10th, 2015.

[6]Garay, P. and McAllister K. Novel Roles for Immune Molecules in Neural Development: Implications for Neurodevelopmental Disorders. Front Synaptic Neurosci. 2010; 2: 136.

New Studies on Salt: Adverse Influence Upon Immunity, Inflammation and Autoimmunity | The Paleo Diet


The Paleo community clearly is not in complete agreement on all dietary issues. One of the more touchy topics is added dietary salt.  A number of popular (non-scientific/non-peer review) bloggers advocate the use of refined salt or various forms of sea salt added to recipes and meals.1 Highly salted meats such as bacon are wildly popular in the Paleosphere.2 Other concentrated, salty foods such as cheese, olives, canned sardines, tuna, anchovies, caviar, salted nuts, manufactured jerky, canned tomato paste, and other salted, processed foods frequently find their way into so-called Paleo diets. You will be hard pressed to find a Paleo diet cookbook anywhere that is completely free of added, salt – that is, except for one The Real Paleo Diet Cookbook (Houghton, Mifflin, Harcourt, New York, 2015).

I have written extensively on the health problems associated with added dietary salt – be it refined salt or sea salt. In the past two years startling, animal and human studies demonstrate that salt added to our diets doesn’t merely increase the risk for stroke, hypertension and heart disease,3, 4, 5, 6 but it also adversely affects immune function, promotes chronic inflammation and represents a previously unrecognized dietary factor in the pathogenesis of autoimmune diseases.7, 8, 9, 10, 11, 12


The USDA daily recommended intake of sodium is 2300 mg. However, it must be remembered that dietary sodium and dietary salt are not equivalent. 1 gram (1000 mg) of salt (NaCl) = 390 mg of sodium.  Hence 2300 mg of sodium would equal 5.9 grams of salt (NaCl).

In perhaps the most comprehensive study of hunter gatherers and non-westernized people worldwide, Denton demonstrated that their average dietary salt intake ranged from 0.6 grams to 2.9 grams of salt (NaCl) per day or 234 to 1131 mg of daily sodium.13 These numbers are derived from population wide urinary sodium excretion rates and are considerably lower than the USDA recommended value of 2300 mg sodium per day, and much lower than the wildly speculative values (3000 to 7000 mg sodium per day or 7.7 to 17.9 grams of daily salt) suggested by a non-scientific/non-peer review Paleo blogger.1


Consider Figure 1 below which demonstrates the sodium content of four contemporary Paleo foods: meat/seafoods (n=8), fruit (n=20) and vegetables (n=18). Note that meat/seafood averages 694 mg of sodium per 1000 kcal, vegetables 764 mg sodium per 1000 kcal and fruit 54 mg of sodium per 1000 kcal.

New Studies on Salt: Adverse Influence Upon Immunity, Inflammation and Autoimmunity | The Paleo Diet

Figure 1.  The Sodium Content of Contemporary Paleo Foods to Processed Foods.

Accordingly, contemporary Paleo diets averaging 55% to 66% of daily calories (range 2200 to 3000 kcal) from animal foods and the balance from plant foods would contain sodium intakes ranging from 1600 to 2200 mg.  These calculations show that unless processed foods containing added salt are consumed, it would be difficult to obtain the USDA 2300 mg recommendation for  daily sodium, and almost impossible to obtain a popular bloggers’ advice (3000 to 7000 mg sodium).1

If fruits were primarily consumed in lieu of vegetables for contemporary Paleo diets, the range of daily sodium intake would be lower still (900 to 1200 mg) which falls within the values of historically studied fully, non-westernized populations.13 With contemporary Paleo foods (fresh fruits, vegetables, meats, seafood, eggs, nuts etc.) and no added salt, you will be obtaining not only sufficient sodium intakes, but also therapeutically lower sodium intakes that are consistent with values that conditioned our species’ genome over millions of years of evolutionary wisdom.

Lowered, or no consumption of added, manufactured dietary salt will lessen your risk for hypertension, stroke and cardiovascular disease,3, 4, 5, 6 certain cancers,14, 15, 16 and now autoimmune and immune diseases, as well as multiple diseases involving chronic low level, systemic inflammation.7, 8, 9, 10, 11, 12


I have now laid out the necessary foundation for the focus of this article. So, let’s get back into the topic at hand.

Unexpectedly, experimental studies in the past two years have provided powerful, new evidence that high salt diets cannot solely be related to hypertension, stroke , cardiovascular disease3, 4, 5, 6 and cancer,14, 15, 16 but also to diseases involving dysfunction of the immune system, chronic systemic inflammation and autoimmunity.7, 8, 9, 10, 11, 12

Let’s not forget that cardiovascular disease, cancer and autoimmune diseases cannot proceed without chronic, low level inflammation, or that the typical U.S diet is a high salt diet.17 Would it be surprising that the typical western diet which includes 70 % or more of its calories as salt laden processed foods17 and 10 to 12 grams of sodium per day5, 7, 17 might have any adverse effects upon the immune system and diseases of chronic inflammation?

The evolutionary discordance template18, 19 would predict that any recently introduced dietary elements found in concentrations many standard deviations above or below those which conditioned the human genome over 2 million years of evolutionary experience, might adversely impact contemporary health and well being. Indeed is the case for immunity, inflammation and autoimmunity.


In April of 2013, before my recent retirement from CSU, I awoke to a flurry of emails from scientific colleagues around the world as well as from a few of my graduate students regarding two astounding papers that had just been published in the prestigious scientific journal, Nature.8, 9  These papers represented the first experimental evidence indicating that high salt diets fundamentally altered the immune system of experimental animals in a manner that promoted autoimmune disease.

Over the past decade, numerous studies (human, animal and tissue) have implicated a specific component of the immune system (Th17 or T Helper Cell 17) in a wide variety of autoimmune diseases.20, 21, 22, 23 The two papers on salt and autoimmunity published in Nature8, 9 were crucial, because for the first time empirical evidence demonstrated that high dietary intakes of salt were capable of up-regulating (increasing) Th17 cells in experimental animals and promoting autoimmunity.

OK – no big deal – these were just animal studies and until human studies were conducted, the link between dietary salt and the immune system, chronic low level inflammation and autoimmunity was tenuous.  The currency of science to demonstrate causality between diet and disease requires not just animal studies, but also tissue studies, epidemiological studies and most importantly experimental randomized controlled human trials.

Science typically moves slowly, but occasionally good ideas are rapidly pounced upon by scientists and researchers, thereby resulting in major leaps of knowledge.  Such was the case with salt and autoimmunity. Concurrent with the two animal studies on dietary salt and immune function,8, 9 came the first human study published by Zhou and colleagues, also in April of 2013.11 Their study showed that after a 7 day (short term) high salt diet (> 15  NaCl/day) compared to a lower salt (< 5 g NaCl/day), markers (CD14++ and CD16+) of pro-inflammatory immune responses increased.  CD14++ and CD16+ are molecules expressed on certain immune system cells called monocytes/macrophages. Normally, these cells produce pro-inflammatory cytokines (hormones) when bacterial infection occurs24, 25 or with autoimmune diseases.26, 27  Surprisingly, even a short term (7 day) high salt diet11 caused the human immune system to become inflamed, just as if it were being attacked by foreign pathogens24, 25 or during autoimmunity.26, 27

In the most powerful human study to date, Yi and colleagues have convincingly demonstrated that a high salt diet (12 g per day) promoted a pro-inflammatory immune response whereas a lower salt intake (6 g per day) reduced these effects and caused beneficial immune system changes. The sophistication and high scientific validity of this experiment occurred because it was conducted under metabolic ward conditions over a long (205 day) duration for a simulated spaceflight program (Mars520 Mission).7

With metabolic ward conditions, each and every meal or snack are exclusively provided to test subjects.  Consequently all nutrients (including sodium) are under strict control. During the experiment in an enclosed environment, daily salt intake was solely modified from 12 g/day to 9 g/day to 6 g/day for 50 + 10 days and then reversed back to 12 g/day for 30 days. During the high salt (12 g/day) stages of the experiment, the pro-inflammatory cytokines (localized hormones) IL-6 and IL-23 increased whereas the anti-inflammatory cytokine, IL-10 decreased. Further the high salt diet caused an expansion of white blood cells (monocytes) that occur during chronic inflammation, autoimmune diseases and cancer. On the low salt (6 g/day) diet, these deleterious immune system changes were reversed. Interestingly, during the high salt phase of this experiment, IL-17 was higher than during the low salt phase (P= 0.08). As I have mentioned earlier, numerous studies (human, animal and tissue) have implicated this specific component (Th-17) of the immune system in a wide variety of autoimmune diseases.20, 21, 22, 23

So, there you have it.  The most powerful and scientifically valid study in humans has indisputably demonstrated that a high salt diet promotes chronic inflammation and adversely affects the immune system.  Note that the high salt (12 g/day) phase of this experiment actually represents the normal (10-12 g/day) salt intake in the U.S.5, 7, 17 and that cardiovascular disease, cancer and autoimmune diseases cannot proceed without chronic inflammation.  It is not only irresponsible for certain Paleo bloggers1 to promote high salt diets, but potentially life threatening.



[1] Kresser K. Shaking Up The Salt Myth: Healthy Salt Recommendations. May 4, 2012.

[2] Huntley T.  The Path to Culinary Bliss: Home Cured Bacon.

[3] Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009 Nov 24;339:b4567. doi: 10.1136/bmj.b4567.

[4] Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence.  Mayo Clin Proc. 2013 Sep;88(9):987-95.

[5] He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009 Jun;23(6):363-84.

[6] Ando K, Kawarazaki H, Miura K, Matsuura H, Watanabe Y, Yoshita K, Kawamura M, Kusaka M, Kai H, Tsuchihashi T, Kawano Y. [Scientific statement] Report of the Salt Reduction Committee of the Japanese Society of Hypertension(1) Role of salt in hypertension and cardiovascular diseases. Hypertens Res. 2013 Dec;36(12):1009-19.

[7] Yi B, Titze J, Rykova M, Feuerecker M, Vassilieva G, Nichiporuk I, Schelling G, Morukov B, Choukèr A. Effects of dietary salt levels on monocytic cells and immune responses in healthy human subjects: a longitudinal study. Transl Res. 2015 Jul;166(1):103-10.

[8] Kleinewietfeld M, Manzel A, Titze J, Kvakan H, Yosef N, Linker RA, Muller DN, Hafler DA.  Sodium chloride drives autoimmune disease by the induction of pathogenic TH17 cells. Nature. 2013 Apr 25;496(7446):518-22.

[9] Wu C, Yosef N, Thalhamer T, Zhu C, Xiao S, Kishi Y, Regev A, Kuchroo VK. Induction of pathogenic TH17 cells by inducible salt-sensing kinase SGK1. Nature. 2013 Apr 25;496(7446):513-7.

[10] O’Shea JJ, Jones RG. Autoimmunity: Rubbing salt in the wound. Nature. 2013 Apr 25;496(7446):437-9.

[11] Zhou X1, Zhang L, Ji WJ, Yuan F, Guo ZZ, Pang B, Luo T, Liu X, Zhang WC, Jiang TM, Zhang Z, Li YM. Variation in dietary salt intake induces coordinated dynamics of monocyte subsets and monocyte-platelet aggregates in humans: implications in end organ inflammation.  PLoS One. 2013 Apr 4;8(4):e60332. doi: 10.1371/journal.pone.0060332. Print 2013.

[12] van der Meer JW1, Netea MG. A salty taste to autoimmunity. N Engl J Med. 2013 Jun 27;368(26):2520-1.

[13] Denton D.  Salt intake and high blood pressure in man. Primitive peoples, unacculturated societies: with comparisons.  In: The Hunger for Salt, An Anthropological, Physiological and Medical Analysis. Springer-Verlag, New York, 1984, pp. 556-584).

[14] D’Elia L, Rossi G, Ippolito R, Cappuccio FP, Strazzullo P. Habitual salt intake and risk of gastric cancer: a meta-analysis of prospective studies. Clin Nutr. 2012 Aug;31(4):489-98.

[15] Ge S, Feng X, Shen L, Wei Z, Zhu Q, Sun J. Association between Habitual Dietary Salt Intake and Risk of Gastric Cancer: A Systematic Review of Observational Studies.  Gastroenterol Res Pract. 2012;2012:808120. doi: 10.1155/2012/808120. Epub 2012 Oct 22.

[16] Hu J, La Vecchia C, Morrison H, Negri E, Mery L; Canadian Cancer Registries Epidemiology Research Group. Salt, processed meat and the risk of cancer. Eur J Cancer Prev. 2011 Mar;20(2):132-9.

[17] 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.

[18] Konner M, Eaton SB. Paleolithic nutrition: twenty-five years later. Nutr Clin Pract. 2010 Dec;25(6):594-602.

[19] Frassetto L1, Morris RC Jr, Sellmeyer DE, Todd K, Sebastian A. Diet, evolution and aging–the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet.  Eur J Nutr. 2001 Oct;40(5):200-13.

[20] Burkett PR, Meyer Zu Horste G, Kuchroo VK. Pouring fuel on the fire: Th17 cells, the environment, and autoimmunity. J Clin Invest. 2015 Jun 1;125(6):2211-9.

[21] Ryu H, Chung Y. Regulation of IL-17 in atherosclerosis and related autoimmunity. Cytokine. 2015 Apr 15. pii: S1043-4666(15)00126-X. doi: 10.1016/j.cyto.2015.03.009. [Epub ahead of print]

[22] Li D, Guo B, Wu H, Tan L, Chang C, Lu Q. Interleukin-17 in systemic lupus erythematosus: A comprehensive review.  Autoimmunity. 2015 Apr 20:1-9. [Epub ahead of print]

[23] Patel DD , Lee DM, Kolbinger F, Antoni C. Effect of IL-17A blockade with secukinumab in autoimmune diseases. Ann Rheum Dis. 2013 Apr;72 Suppl 2:ii116-23. doi: 10.1136/annrheumdis-2012-202371. Epub 2012 Dec 19.

[24] Rietschel ET, Schletter J, Weidemann B, El-Samalouti V, Mattern T, Zähringer U, Seydel U, Brade H, Flad HD, Kusumoto S, Gupta D, Dziarski R, Ulmer AJ. Lipopolysaccharide and peptidoglycan: CD14-dependent bacterial inducers of inflammation. Microb Drug Resist. 1998 Spring;4(1):37-44.

[25] Scherberich JE1, Nockher WA. CD14++ monocytes, CD14+/CD16+ subset and soluble CD14 as biological markers of inflammatory systemic diseases and monitoring immunosuppressive therapy. Clin Chem Lab Med. 1999 Mar;37(3):209-13.

[26] Chuluundorj D, Harding SA, Abernethy D, La Flamme AC. Expansion and preferential activation of the CD14(+)CD16(+) monocyte subset during multiple sclerosis.  Immunol Cell Biol. 2014 Jul;92(6):509-17.

[27] Kawanaka N1, Yamamura M, Aita T, Morita Y, Okamoto A, Kawashima M, Iwahashi M, Ueno A, Ohmoto Y, Makino H. CD14+,CD16+ blood monocytes and joint inflammation in rheumatoid arthritis. Arthritis Rheum. 2002 Oct;46(10):2578-86.

Autoimmune Disease: Drawing the Lines of Defense

The case for the Paleo Diet continues to grow as the modern diet leads to an epidemic of modern health problems. Over the last three decades, epidemiological data provide strong evidence of a steady rise in autoimmune disease, where the body fails to recognize the difference between its own cells and foreign invaders.1

We have to wonder why more people than ever are afflicted with the following conditions: multiple sclerosis, type 1 diabetes, inflammatory bowel diseases (mainly Crohn’s disease), systemic lupus erythematosus, primary biliary cirrhosis, myasthenia gravis, autoimmune thyroiditis, hepatitis and rheumatic diseases, bullous pemphigoid, and celiac disease.2 Indicators, based on the geoepidemiological distribution of autoimmune disease, point to an environmental factor.3 Although causality has not been proven, scientists hypothesize the answer lies in the relationship between the prevalence of industrialized foods and the environmental impact they have on our guts, specifically in the intercellular tight junctions of the epithelial lining.4


The idea of “leaky gut syndrome” has circulated for decades, but many health practitioners still don’t believe it actually exists, despite over thousands of published articles relating to intestinal permeability. Historically, the functions of the gastrointestinal tract have been believed to be limited to the digestion and absorption of nutrients and electrolytes, and to regulate water homeostasis.5 An additional function has been overlooked: to regulate macromolecules through the intestinal epithelial barrier mechanism, within tight intercellular junctions, to control the equilibrium between tolerance and immunity to non-self antigens.6

It shouldn’t seem that far fetched to believe molecules can pass from inside the intestines into the bloodstream, as only a single layer of epithelial cells separates the lumen from internal milieu.7 Our bodies even make modulating proteins, such as Zonulin, in response to certain bacteria and gluten8 that has been proven to open the intercellular tight junctions responsible for maintaining the integrity of the intestinal lining. When the intercellular junctions aren’t well sealed it allows for the passage of macromolecules into the bloodstream and triggers an immune response leading to intestinal and extraintestinal autoimmune disease as well as inflammatory disorders. 9


We are becoming more dependent on heavily processed food sources, 10 and evolving further away from what we are genetically designed to eat.11 There are seven food additives: sugar, salt, emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles, increasingly added to processed food and are finding their way in record numbers onto grocery store shelves.  These industrial food additives are believed to dissolve the epithelial barrier function, leading to increased intestinal permeability and activating the autoimmune cascade. The rate usage of the food additives has also matched the increased incidence and prevalence of autoimmune diseases during the last few decades. 12


The Paleo Diet, clearly more than the meat lover’s way to keep weight off, might be the only solution to avoiding the onslaught of food additives and their effects on our health. Most of these additives can be completely avoided when following the Paleo Diet.13  Further, Paleo food provides important nutrients, often at the therapeutic levels, as well as high levels of Omega 3 fatty acids, all necessary to maintain and repair the intestinal tract.14,15

The current research has barely scratched the surface for fully understanding the effects of food additives exposure on intestinal permeability and autoimmune disease. There is enough evidence for those with autoimmune symptoms or a genetic predisposition to minimize the exposure to all processed foods. The best line of defense for those at risk for autoimmune disease may be following the Paleo diet.

Eat for gut health. Eat Paleo.



[1] Selmi, Carlo. “The worldwide gradient of autoimmune conditions.” Autoimmunity reviews 9.5 (2010): A247-A250.

[2] Okada, H., et al. “The ‘hygiene hypothesis’ for autoimmune and allergic diseases: an update.” Clinical & Experimental Immunology 160.1 (2010): 1-9.

[3] Parks, Christine G., et al. “Expert Panel Workshop Consensus Statement on the Role of the Environment in the Development of Autoimmune Disease.”International journal of molecular sciences 15.8 (2014): 14269-14297.

[4] Hollander, Daniel. “Intestinal permeability, leaky gut, and intestinal disorders.”Current gastroenterology reports 1.5 (1999): 410-416.

[5] Diamond, Jared. “Evolutionary design of intestinal nutrient absorption: enough but not too much.” Physiology 6.2 (1991): 92-96.

[6] Fasano, Alessio. “Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer.” Physiological reviews 91.1 (2011): 151-175.

[7] Shanahan, Fergus. “V. Mechanisms of immunologic sensation of intestinal contents.” American Journal of Physiology-Gastrointestinal and Liver Physiology 278.2 (2000): G191-G196.

[8] Fasano, Alessio, et al. “Zonulin, a newly discovered modulator of intestinal permeability, and its expression in coeliac disease.” The Lancet 355.9214 (2000): 1518-1519.

[9] Fasano, Alessio. “Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer.” Physiological reviews 91.1 (2011): 151-175.

[10] Monteiro, Carlos Augusto, et al. “Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil.” Public health nutrition 14.01 (2011): 5-13.

[11] O’Keefe, James H., and Loren Cordain. “Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer.” Mayo Clinic Proceedings. Vol. 79. No. 1. Elsevier, 2004.

[12] A. Vojdani. “A potential link between environmental triggers and autoimmunity.”Autoimmune Diseases 2014.

[13] Lerner, Aaron, and Torsten Matthias. “Changes in intestinal tight junction permeability associated with industrial food additives explain the rising incidence of autoimmune disease.” Autoimmunity reviews 14.6 (2015): 479-489.

[14] Li, Yousheng, et al. “Oral glutamine ameliorates chemotherapy-induced changes of intestinal permeability and does not interfere with the antitumor effect of chemotherapy in patients with breast cancer: a prospective randomized trial.” Tumori 92.5 (2006): 396.

[15] Simopoulos, Artemis P. “Omega-3 fatty acids in inflammation and autoimmune diseases.” Journal of the American College of Nutrition 21.6 (2002): 495-505.

Intestinal Permeability | The Paleo Diet

In the U.S., Mexican cuisine has become enormously popular in the past 30 years. A recent USA Today poll1 listed the 15 “Best” Tex-Mex chain restaurants in the U.S. as follows:

  1. Chipotle
  2. Baja Fresh
  3. Qdoba
  4. Moe’s Southwest
  5. On the Border
  1. Taco Bell
  2. El Pollo Loco
  3. Wahoo’s Fish Taco
  4. Chevys Fresh Mex
  5. Chuy’s
  1. Del Taco
  2. Chili’s
  3. El Torito
  4. Taco Cabana
  5. Pappasito’s Cantina

It has certainly been argued that fast American “Mexican” food is a far cry from the authentic cuisine actually found in the 31 Mexican federal states. Genuine Mexican cooking clearly is not uniform from one area or State of the country to the next. The foods of northern Mexican States differ from those in the south which in turn vary from coastal regions. Distinctive cuisines have arisen in Oaxaca, Mexico City, Yucatan, Veracruz, Chiapas, Querétaro and other regions and reflect historical, cultural and environmental differences among these discrete geographical areas.

As with most eating traditions found worldwide, current day Mexican cuisine is derived from an amalgamation of people, cultures, historical events and available foods. Prior to the European “discovery” of the Americas by Columbus in 1492, the indigenous peoples of the area we now call Mexico were necessarily reliant upon native plant and animal foods that could either be collected wild or domesticated. Notable domesticated plant foods native to Mexico and the Americas were corn (maize), chile peppers (all varieties), tomatoes, squash, certain bean species (Phaseolus vulgaris [kidney, pinto, black and navy beans], Phaseolus lunatus [lima beans]), tomatillos, maguey (mescal), cassava, avocadoes, chocolate and potatoes, among others.

With the arrival of Europeans came the introduction of cows (beef, dairy products: milk, butter, sour cream and cheese), pigs (pork), goat, and sheep (lamb, mutton) which were rapidly incorporated into the native Mexican cuisine. Other European/Asian food introductions that are frequently found in the present day Mexican cuisine are wheat, rice, barley, hops, lettuce, onions, green onions (scallions), garlic, cilantro, limes, olives, olive oils, cumin, black pepper, vinegar, and sugar.

Regardless of the region or individual federal States, Mexican cuisine is characterized by the plant foods native to Mexico and the Americas and primarily include chili peppers (multiple varieties), tomatoes and corn (maize). Beans (pinto, black and kidney) follow a close second. Corn is most frequently made into tortillas and consumed almost daily, but also is used to make a wide variety of foods including tamales, sopes, drinks (atole, pozol) and soups. Chile peppers (all varieties) almost uniformly define Mexican cuisine as they are in one form or another (salsas, sauces, diced, chopped, pureed, dried, stuffed or pickled) included into foods and meals daily. These spicy foods add the characteristic flavor to virtually all Mexican dishes, but also the “heat” which characterizes this distinctive dining tradition.

What follows is a laundry list (obviously non-comprehensive) of Mexican dishes and beverages, some of which are found worldwide, others almost always in specific regions or federal States of Mexico:

  • Tacos
  • Enchiladas
  • Chile rellenos
  • Burritos
  • Fajitas
  • Quesadillas
  • Chimichangas
  • Tamales
  • Tostadas
  • Taquitos
  • Flautas
  • Carnitas
  • Empanadas
  • Sopes
  • Huaraches
  • Tlacoyo
  • Gorditas
  • Garnachas
  • Memelas
  • Chalupas
  • Salbutes
  • Panuchos
  • Entomatadas
  • Gringas
  • Molletes
  • Salbutes
  • Nachos
  • Chili con carne
  • Chili con queso
  • Ceviche
  • Huevos rancheros
  • Huevos divorciados
  • Huevos motuleños
  • Taco salad
  • Menudo
  • Tripas
  • Chorizo
  • Mixiote
  • Queso flameado
  • Carne asada
  • Chilorio
  • Birria
  • Salsa verde
  • Salsa roja
  • Salsa
  • Camarones
  • Jalapeño poppers
  • Black beans
  • Refried beans
  • Rice
  • Corn tortillas
  • Wheat tortillas
  • Corn chips
  • Tortilla chips
  • Totopo
  • Guacamole
  • Hot sauce
  • Fresh peppers (all varieties)
  • Dried peppers (all varieties)
  • Pickeled peppers (all varieties)
  • Pico de gallo
  • Mole sauce
  • Nopales
  • Mexican beers
  • Bohemia
  • Dos Equis
  • Corona
  • Carte Blanca
  • Estrella
  • Modelo
  • Pacifico
  • Sol
  • Superior
  • Tecate
  • Victoria
  • Tequila
  • Mescal
  • Pulque
  • Margaritas

Nutritional Shortcomings of Mexican Cuisine

Almost all of us have enjoyed some of these dishes and beverages, simply because the Tex-Mex food culture pervades American fast food restaurants and supermarkets. Unfortunately many Mexican dishes which have been produced commercially or in restaurants are not Paleo for the following reasons:

  1. Inclusion of cereal grains (corn, wheat, rice) or beverages made from grains (beer) in daily staple foods and recipes.
  2. Inclusion of beans (black, pinto, kidney, lima etc.) in many recipes and meals
  3. Inclusion of salt (either refined or sea salt) in almost all dishes, recipes and sauces

Intestinal Permeability

Besides being nutritional lightweights, cereal grains2 and legumes promote increased intestinal permeability. Wheat in particular contains at least three compounds known to promote a “leaky gut” including gluten, wheat germ agglutinin (WGA), and thaumatin like proteins. Corn, like all cereal grains, is rich in antinutrients including lectins which are known to decrease intestinal absorption of many key nutrients and may cause villous flattening.2 As I have previously pointed out beans and all legumes are concentrated sources of saponins which have been demonstrated in human studies to increase intestinal permeability.

When the cells lining the gastrointestinal tract become compromised leading to increased intestinal permeability (e.g. a leaky gut), it allows the gut contents (food and microorganisms) to chronically interact with the immune system. Accordingly, many immunologists now believe that increased intestinal permeability represents an initial environmental trigger for autoimmune diseases in genetically susceptible individuals.3-7

A leaky gut also allows entry of a compound called lipopolysaccharide (LPS), found in gut gram negative bacteria, into the bloodstream. Systemically, LPS may produce a chronic low level inflammatory condition called endotoxemia, which is increasingly being recognized as an underlying factor in insulin resistance, the metabolic syndrome, cardiovascular disease and obesity.8-11

In addition to gluten containing grains, WGA and bean saponins, a number of other foods and beverages commonly included in Tex-Mex cuisine also may impair intestinal barrier function and promote a leaky gut. These foods include chili peppers, tomatillos and unripe, green tomatoes.12 Because they contain ethanol, note too that all alcoholic beverages including Mexican beers, tequila, mescal and pulque may cause a leaky gut.

Chili peppers

Chili peppers are members of the nightshade family of plants and are among the most heavily consumed spices throughout the world. The table below shows the five most common species of chili peppers and lists a few of the more familiar varieties within each species.

Common Scientific Names | The Paleo Diet
Chili peppers are favorite spices throughout the world because of their pungent or “hot” taste and aroma. The “heat” from chili peppers comes from a group of compounds called capsaicinoids or capsaicins. The greater the concentration of capsaicins in the chili pepper, the “hotter” it tastes. More than 20 capsaicins are found in chili peppers, and their total concentrations range from 0% to more than 2% by weight. Daily per capita consumption of capsaicins in the U.S. and Europe is ~1.5mg whereas in India, Mexico and Thailand it is ~ 25-200mg. The table below shows the concentrations of total capsaicins in a variety of chili peppers and foods.

Concentrations of Capsaicins | The Paleo DietChili peppers seem to have both beneficial and harmful health effects. They have long been used in Mayan and Ayurvedic healing remedies and more recently have found therapeutic application in modern medicine with pain relief. One of the potential shortcomings of chili peppers is their ability to increase intestinal permeability, and herein lies perhaps their greatest threat to human health. As far back as 1998 it was suggested by Dr. Jensen-Jarolim and colleagues13 that chili peppers, because of their capsaicins “may modulate the absorption of low molecular weight food constituents that are involved in the pathogenesis of food allergy and intolerance.” This statement simply means that chili pepper capsaicins increase intestinal permeability13-18 and, therefore, allow gut microorganisms and food proteins access to our immune systems which in turn may promote allergy, autoimmune diseases and chronic low level inflammation.

The Bottom Line with Mexican Cuisine

If you are a Paleo Dieter and like an occasional night out with friends and family at your local Tex-Mex restaurant – go for it. Enjoy your enchiladas, tacos, chili rellenos, refried beans, chips, salsa and even sip a margarita. However, try to avoid wheat flour tortillas and beer.If you decide to have a margarita, order it without salt. For Paleo Dieters even better choices on a night out might be a Mexican salad with pork, chicken or beef; or a meat/fish tostada; or how about a beef, pork, chicken or fish main dish and replace the beans, rice and tortillas with a big salad or steamed veggies.

Even the most dedicated Paleo Dieter probably would find it difficult to be 100% compliant with all foods known to increase intestinal permeability. However you don’t have to. Most people find that by being about 85% compliant with the Paleo Diet, they experience significant improvement in their health and well being. Food elements typically found in Mexican cuisine which may increase intestinal permeability (flour tortillas, chili peppers, salsa, beans, tequila, beer, green tomatoes, tomatillos) operate in a dose dependent manner meaning that all of these foods must be regularly consumed to chronically increase the risk of a leaky gut. However here’s an important exception: If you have an autoimmune disease, you should be cautious in consuming Mexican cuisine or any food known to increase intestinal permeability.


Loren Cordain, Ph.D., Professor Emeritus



1. //www.usatoday.com/story/travel/destinations/2014/01/04/best-tex-mex-mexican-restaurants-food/4308625/

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

3. Fasano A. Zonulin and its regulation of intestinal barrier function: the biological door to inflammation, autoimmunity, and cancer. Physiol Rev. 2011 Jan;91(1):151-75
4. Fasano A. Surprises from celiac disease. Sci Am. 2009 Aug;301(2):54-61

5. Visser J, Rozing J, Sapone A, Lammers K, Fasano A. Tight junctions, intestinal permeability, and autoimmunity: celiac disease and type 1 diabetes paradigms. Ann N Y Acad Sci. 2009 May;1165:195-205.

6. Joscelyn J, Kasper LH. Digesting the emerging role for the gut microbiome in central nervous system demyelination. Mult Scler. 2014 Jul 28. pii: 1352458514541579. [Epub ahead of print]

7. Vaarala O. Is the origin of type 1 diabetes in the gut? Immunol Cell Biol. 2012 Mar;90(3):271-6.

8. Cani PD, Osto M, Geurts L, Everard A. Involvement of gut microbiota in the development of low-grade inflammation and type 2 diabetes associated with obesity. Gut Microbes. 2012 Jul-Aug;3(4):279-88.

9. Geurts L, Neyrinck AM, Delzenne NM, Knauf C, Cani PD.Gut microbiota controls adipose tissue expansion, gut barrier and glucose metabolism: novel insights into molecular targets and interventions using prebiotics. Benef Microbes. 2014 Mar;5(1):3-17.

10. Everard A, Cani PD. Diabetes, obesity and gut microbiota. Best Pract Res Clin Gastroenterol. 2013 Feb;27(1):73-83.

11. Jayashree B, Bibin YS, Prabhu D, Shanthirani CS, Gokulakrishnan K, Lakshmi BS, Mohan V, Balasubramanyam M. Increased circulatory levels of lipopolysaccharide (LPS) and zonulin signify novel biomarkers of proinflammation in patients with type 2 diabetes.Mol Cell Biochem. 2014 Mar;388(1-2):203-10.

12. Cordain, L. The Food – Autoimmune Disease Connection. In: Cordain, L., The Paleo Answer, John Wiley & Sons, New York, NY, 2012, pp. 161-179.

13. Jensen-Jarolim E, Gajdzik L, Haberl I, Kraft D, Scheiner O, Graf J. Hot spices influence permeability of human intestinal epithelial monolayers. J Nutr. 1998 Mar;128(3):577-81.

14. Han J, Isoda H, Maekawa T. Analysis of the mechanism of the tight-junctional permeability increase by capsaicin treatment on the intestinal Caco-2 cells. Cytotechnology. 2002 Nov;40(1-3):93-8.

15. Han JK, Akutsu M, Talorete TP, Maekawa T, Tanaka T, Isoda H. Capsaicin-enhanced Ribosomal Protein P2 Expression in Human Intestinal Caco-2 Cells. Cytotechnology. 2005 Jan;47(1-3):89-96.

16. Isoda H, Han J, Tominaga M, Maekawa T. Effects of capsaicin on human intestinal cell line Caco-2. Cytotechnology. 2001 Jul;36(1-3):155-61.

17. Komori Y, Aiba T, Nakai C, Sugiyama R, Kawasaki H, Kurosaki Y. Capsaicin-induced increase of intestinal cefazolin absorption in rats. Drug Metab Pharmacokinet. 2007 Dec;22(6):445-9.

18. Tsukura Y, Mori M, Hirotani Y, Ikeda K, Amano F, Kato R, Ijiri Y, Tanaka K. Effects of capsaicin on cellular damage and monolayer permeability in human intestinal Caco-2 cells. Biol Pharm Bull. 2007 Oct;30(10):1982-6.

Multiple Sclerosis Stymied with The Paleo Diet

Dr. Cordain,

I went Paleo after watching Dr. Cordain’s lectures on Multiple Sclerosis (MS) in the summer of 2012. I’ve had MS since 1991, but was diagnosed with Rheumatoid Arthritis (RA), as well, in 2012. The RA was reversed in 6 months, and the MS is currently being stymied, too! After 19 years of injections, I can’t even begin to explain what it was like to stop AND get better!

My parents went Paleo, too, so I’m always sending them fun information, recipes, books and the like. I started my website, www.incurablyrude.com, to share my experiences and hopefully help others, providing my thoughts on health, disability, Paleo, and life from a former scientist with MS and RA.

Thank you all for what you do. It is truly changing people’s lives!

Connect With Tracie

Dairy: Milking It for All It's Worth | The Paleo Diet

The Recent Evolutionary Introduction of Milk and Dairy

One of the rewarding benefits of having written a diet book that has become internationally known is the opportunity to travel the world and speak to tens of thousands of people about this engaging and life changing subject. My signature lecture, “Origins and Evolution of the Western Diet: Health Implications for the 21st Century” is based upon a scientific paper I wrote of the same name and published in The American Journal of Clinical Nutritionin 2005.24 In this lecture, I trace the chronological introductions of all the food groups and foods that have become part of the contemporary U.S. and western diet. When I lecture, I like to engage the audience so it becomes not just a solitary presentation by me, but rather a mutual give and take conversation among us all. When I get to the part about milk and dairy products, I pose a question to everyone, “How do we know that our hunter gatherer ancestors never ate this food group?” Some people furl their brows, scratch their heads and clearly are lost for words. In the ensuing pregnant pause before some raised hands can blurt out the correct answer – I flip to the very next slide. Immediately appears a ferocious, unruly herd of about 30 African Cape buffalo (both cows and bulls), snorting and pawing the earth with powerful hooves supporting their one ton bodies crowned by enormous menacing horns.

Enough said? Have you ever tried to approach a wild animal? How about milking one? Indeed – this is an impossible task to say the least. Until the dawn of agriculture 10,000 years ago and the subsequent domestication of dairy animals6, 18, 50 milk, butter, cheese and yogurt were never part of our ancestors’ menu.24, 35

Although 10,000 years ago seems unimaginably distant compared to a single human lifespan, it is very, very recent on an evolutionary time scale. Only 333 human generations have come and gone since we first domesticated animals (cows, sheep, and goats)6, 18, 50 and began to consume their milk. Consequently, as a species we have had scant evolutionary experience to adapt to a food that now comprises about 10 % of the calories in the U.S. Diet.24, 45 As such, milk and dairy products have an enormous potential to disrupt our health and well-being through a variety of means that I barely touched upon in my first book, The Paleo Diet. If you had any prior doubts about whether you should eat dairy foods, the information contained in this article should help you make an informed decision in the best interest of your health.

Milk and dairy products only became part of the current western diet during the period known as the Neolithic or “New Stone Age” which began about 10,000 years ago and ended 5,500 years ago. The figure below shows just how recent dairy foods and other staples of the western diet really are when evaluated on an evolutionary time frame.

Dairy | The Paleo Diet

Unless you are lactose intolerant, have an allergy to milk and dairy products, or have been a devoted follower of The Paleo Diet, most people don’t give a second thought about whether or not they should consume a food group that seems to be found nearly everywhere in the western diet. Your favorite dairy foods may include ice cream, chocolate milk, cheese, fruit flavored yogurt, kefir or fancy imported cheeses. You may even think that you are doing your body a favor by eating these calcium rich foods. Nevertheless, the bottom line is this: we are the only species on the planet to consume another animal’s milk throughout our adult lives. Humans don’t have a nutritional requirement for the milk of another species, nor do any other mammals.

An increasing body of scientific evidence supports the evolutionary caution that this dietary practice is not necessarily harmless. The table below shows the sources and amounts of dairy foods in the U.S. diet.45

Dairy | The Paleo Diet

These figures don’t entirely tell the full story, as dairy products are put into almost all processed foods. Take some time to read labels. If you are a milk chocolate addict, you are eating dairy – same for latte lovers. Non-fat milk solids, a major ingredient in chocolate, are also put into candy, cereal, bread, salami, bologna, sausages, baked goods, salad dressings, chips, condiments, soft drinks and literally any food that comes in a can, jar, bottle, bag or plastic wrapper. Even though these tiny residues of milk in processed foods seem to be trivial, you may want to reconsider. Later in this article I’ll show you how milk proteins and peptides (the building blocks of proteins) at even small concentrations have potential to promote allergies, inflammation, autoimmune diseases and other health problems.

The Milk Mustache Advertising Hype

Before I even get into the extensive science underlying milk’s unfavorable effect upon our health and wellbeing, let’s take a step back and look at the vast, hype advertising campaign that the milk processing industry has shoved down our throats for nearly 20-30 years. This glitzy promotional crusade called “Got Milk” depicts movie stars, sports personalities, politicians and just about any public figure you can imagine with a wet, white film of what appears to be milk on their upper lips. Implied in magazine ads, TV and radio commercials, and now social networks is the notion that all public figures with “milk mustaches” endorse dairy products, presumably because they are a healthy and nutritious food. Whoa! Let’s stop for a minute and touch bases with reality.

I haven’t drank a glass of milk in nearly 40 years, but if I were to, I certainly wouldn’t spill it all over my upper lip. I imagine that world class athletes, dancers and actresses with far better hand to eye coordination than I have, also would not make this clumsy maneuver. However, this issue really doesn’t matter and simply is part of the industry’s advertising strategy – if the movie stars and sports heroes do it, so should you. But more importantly, why would a Wimbledon tennis champion, an Oscar winning actress, or an Indy 500 race car driver blindly support a product they know virtually nothing about?

These public personas have spent their lifetimes honing talents, skills and knowledge specific to their life’s callings. But when it comes to understanding milk’s intricate influence upon our metabolism, hormonal function and long term health, most of these people are novices operating completely out of their areas of expertise without knowledge or understanding of the facts. You can’t really fault them for endorsing a product they know little or nothing about. Like the public at large, they have bought into the milk processing industry’s ad campaign portraying milk right along with motherhood, apple pie and the American way.

This is exactly the message the milk processing industry wants to convey to the general public because it sells more milk and dairy products – plain and simple. Is there a conspiracy by dairy industry middlemen, executives and CEOs to sabotage our health and promote disease? Of course not. These people by and large, just like the movie stars and sports figures who endorse milk, are uninformed and blindly believe in their product. They represent tiny cogs in a wheel that rolls directly in the face of at least 2.6 million years of evolutionary wisdom. To them, the “Got Milk” and “Milk Mustache” advertising campaigns simply represent a logical corporate tactic to increase sales and maximize profits of a supposedly nutritious and healthful product.

As was the case with saturated fats, whether or not people should consume dairy products is divisive within the scientific community because the human experimental and epidemiological evidence is not necessarily conclusive and still can be interpreted in a variety of ways. Does milk prevent disease, or does milk promote disease? Or is the answer somewhere in between? In an ideal world, this question could be decisively answered by well controlled human experimental studies conducted over entire lifetimes. Unfortunately, these hypothetical lifelong experiments in real people will never be carried out because they would be impossible to control, incredibly expensive and unethical. In lieu of these studies, conventional nutrition researchers are left with the four basic scientific procedures to unravel the milk drinking dilemma:

  1. Observational epidemiological studies
  2. Animal studies
  3. Tissue studies
  4. Short term human experiments.

Unfortunately, traditional nutrition researchers are unaware of, or don’t appreciate the most powerful research tool in all of biology. This concept could point them in the right direction when it comes to deciphering the conflicting information about dairy products and human health. By now you know what I’m talking about – the evolutionary template. Anybody who doesn’t use it, just as well may be running uphill in a football or soccer game or doing calculations with pencil and paper rather than a computer. When the evolutionary template is employed together with the four basic procedures scientists use to establish causality between diet and disease, then we can make sense of all the contradictory data and be pointed in the right direction of arriving at a correct answer.

Frank Oski, M.D.: A Pioneer Milk Researcher

Before I go any further, I’d like to bring up a quote that has influenced my thinking about science, biology, diet and life in general for most of my adult life:

“Those who cannot remember the past are condemned to repeat it.”— George Santayana105

I certainly am not the first scientist to recognize that milk and dairy consumption may have adverse effects upon our health. One of the most vocal opponents to milk drinking was a physician, Frank Oski M.D. (1932-1996) who served as the Department Chairman of Pediatrics at the State University of New York, Syracuse from 1972 until 1985 and as the Department Chairman of Pediatrics at Johns Hopkins University from 1985 until 1996. He was a member of the National Academy of Sciences and the author or co-author of about 300 academic papers and 20 books. A book he wrote in 1977 called Don’t Drink Your Milk,86 was decades ahead of its time. Here is a quote from this book which dovetails nicely with this article:

“The fact is: the drinking of cow milk has been linked to iron-deficiency anemia in infants and children; it has been named as the cause of cramps and diarrhea in much of the world’s population, and the cause of multiple forms of allergy as well; and the possibility has been raised that it may play a central role in the origins of atherosclerosis and heart attacks… In no mammalian species, except for the human (and the domestic cat), is milk consumption continued after the weaning period (the period of breast-feeding]. Calves thrive on cow milk. Cow milk is for calves.”

Evolutionary Clues to Cow Milk Consumption

When you apply the evolutionary template to milk drinking, it becomes absolutely clear that cow’s or any other mammal’s milk was never intended to nourish another species (i.e. humans) throughout their entire adult lives. Rather it was specifically designed by natural selection to encourage rapid growth, support immune function, and prevent disease in young suckling animals. New born calves, like most mammals are nearly helpless for the first few hours after birth. They are unable to stand up, much less sprint away from potential predators. For the first few days and weeks after birth, they can’t forage for food and are almost entirely dependent upon mother’s milk for nourishment.

Milk is designed to make young animals grow rapidly and to prime their immune systems and prevent disease by allowing hormones and other substances in their mother’s milk to enter their bloodstreams. This is a brilliant evolutionary strategy to encourage survival for young suckling animals at the beginning of their lives, but is a formula for disaster when adult animals (us) consume a food intended only for the young of another species.
One of the telltale signs that there may be something just a little awry with milk drinking is that about 65% of all people on the planet can’t do it without experiencing gas, bloating and digestive distress.60 Maybe we should be listening to our bodies? Many of you may have these symptoms and already know why they occur after drinking milk or eating dairy products, but let me explain the basic concept for those who don’t know.80, 116

Milk is a mixture of carbohydrate, protein and fat. Most of the carbohydrates in milk occur in the form of a sugar called lactose which in turn is made up of two simple sugars: glucose and galactose. When we consume milk, ice cream and other dairy products rich in lactose, it must first be broken down into these two simple sugars by an enzyme in our guts called lactase. As I mentioned earlier, about 65% of the world’s people haven’t inherited the genes to make lactase and are therefore lactose intolerant.60 The notable exception to this rule is people from Northern Europe and their descendants.80, 116 Because Northern Europeans maintain high gut lactase activity as adults, they can metabolize lactose into its two simple sugars and don’t experience gastro-intestinal upset after drinking milk. In the figure below you can see that the percentage of people with Northern European ancestry who can digest lactose without discomfort is much higher than almost all the other world’s people.80, 116

Dairy | The Paleo Diet

The evolutionary explanation for the information in this figure is quite simple. Most people on the planet can’t drink milk without gastrointestinal upset because their genes simply haven’t had enough time to adapt to this newcomer food.60, 80, 116 Milk represents foreign fare which lactose intolerant people reject, as should we all, whether we can digest lactose or not. The lactose evidence is like a canary in a coal mine, and hints at even greater health problems with milk and dairy consumption.

Milk and Dairy: Nutritional Lightweights

Based upon the dairy ad campaigns, bovine (cow) milk consumption appears to represent nothing less than an extraordinary food to perk up our health and avoid illness. This milky white liquid, served cold is touted as Good for Everybody and high in nine nutrients including calcium and vitamin D as listed on the milk processing industry’s website: www.gotmilk.com. If the truth be known, milk is a lousy source of vitamin D as well as the top 13 nutrients most lacking in the U.S. diet. Let’s take a look at the facts.

In a paper published in The American Journal of Clinical Nutrition,24 my research group and I pointed out how dairy products were nutritional lightweights when compared to lean meats, seafood, fresh fruits and vegetables. Based upon the 13 vitamins and minerals most lacking in the U.S. diet, our analysis showed that whole milk ended up near the bottom of the stack for all food groups. The highest source of these 13 nutrients were 1) fresh vegetables, followed by 2) seafood, 3) lean meats, 4 ) fresh fruits, 5) whole milk, 6) whole grains, and 7) nuts and seeds.

To even suggest that milk is a good source of vitamin D is a total stretch of the facts. In 2010 the official Institute of Medicine daily recommended intake for vitamin D increased from 400 IU to 600 IU per day for most people (32). Although this advice represents a substantial raise, it still falls far short of human experimental evidence showing that at least 800 to 2,000 IU per day is required to keep blood levels of vitamin D at the ideal concentration of 50 ng/ml.13, 14, 129, 130 An eight oz glass of raw milk (280 calories) straight from the cow without fortification gives you a paltry 3.6 IU of vitamin D (76, 128). At this rate, you’d have to drink a ridiculous 167 eight oz glasses of milk just to achieve the 600 IU daily recommendation. Because most of the milk we drink is fortified with vitamin D, then an 8 oz glass typically yields 100 IU of this nutrient.128 However, even with fortification, you would have to drink six 8 oz glasses (1,680 calories or ~ 75 % of your daily caloric intake) of whole milk to meet the daily requirement for vitamin D. If you wanted to reach the 2,000 IU level as suggested by the world’s best vitamin D researchers,13, 14, 129, 130 you would have to drink 20 eight oz glasses of fortified whole milk amounting to 5,600 calories. No one in their right mind would drink 20 glasses of milk a day, even if they could. As you can see from these simple calculations, whether fortified or raw, milk is an abysmal source of vitamin D. The best way to get your vitamin D is not by drinking milk, but rather by getting a little daily sun exposure as nature intended.131, 132

Milk, Dairy and Heart Disease: The Early Days

The history of modern medicine is full of starts, stops, and reversals in strategy for treating disease. One of the more remarkable tales in recent medical history involves peptic ulcers. This is a chronic condition in which the linings of the stomach or small intestine are eroded away causing painful internal wounds. Complications include bleeding and perforation of the gastrointestinal tract, which are potentially life threatening.

For the better half of my adult life, peptic ulcers were routinely attributed to excessive stomach acid production caused mainly by stress, or spicy foods or too much gum chewing. Even as recently as the mid 1980’s, ulcer patients were advised to take antacids, make lifestyle changes to reduce stress, cut back on spicy foods and stop chewing gum. However, as we will soon see, this advice didn’t do much to alleviate symptoms or cure the problem.

One of the more unusual ideas that surfaced to treat peptic ulcers came from an early 20th century physician, Betram Sippy (M.D.). Dr. Sippy authored an influential paper that appeared in the Journal of the American Medical Association in 1915 suggesting that peptic ulcers could be effectively treated by feeding patients milk and cream on a regular basis throughout the day.112 The good doctor’s advice became known as the “Sippy Diet” and was employed widely across the United States to care for patients with ulcers even as recently as 25-30 years ago.127

One of the downsides to the Sippy Diet, first recognized in 1960 by Dr. Hartroft and colleagues at Washington University in Saint Louis was that it noticeably increased fatal heart attacks in ulcer patients.17, 52 In Dr. Hartroft’s study three groups were examined at autopsy: 1) subjects with peptic ulcers who followed the Sippy Diet, 2) subjects with peptic ulcers who didn’t follow the Sippy Diet, and 3) subjects without peptic ulcers. The fatal heart attack rate was similar between subjects without peptic ulcers and those with peptic ulcers who hadn’t been on the Sippy Diet. However, the fatal heart attack rate in ulcer patients who had adhered to the Sippy Diet was a staggering 42%. Think about these statistics. Close to half of all ulcer patients following the Sippy Diet had succumbed from heart attacks! Thank goodness to us all that the medical community no longer recommends the Sippy Diet for peptic ulcers.

The reason that physicians no longer recommend the Sippy Diet or any other dietary regime for the treatment of ulcers is one of the most incredible and unlikely tales in all of modern medicine. For almost 100 years, peptic ulcers were looked upon as a disease of excessive stomach acid production caused by stress, spicy food – whatever. No one ever considered that this condition might be caused by an infectious organism. That is, until the publication of two revolutionary papers in 1983 and 1984 by two Australian scientists, Barry Marshall and Robin Warren, showing that 70 to 90 % of peptic ulcers resulted from infection by the bacterium Helicobacter pylori.74, 75 At first, these innovative publications were generally dismissed and discredited by the medical community. However, it didn’t take long for practicing physicians to realize that ulcers could be effectively cured simply by giving their patients a good dose of antibiotics. Unfortunately, it took about a decade for these brilliant scientists’ ideas to be accepted worldwide. Now, because of their ground-breaking insights, antibiotics are routinely used to successfully treat and cure almost all peptic ulcer cases. In 2005 Drs. Marshall and Warren were awarded the Nobel Prize in medicine for their discoveries.133

A forgotten piece of the peptic ulcer story is that milk and dairy consumption significantly increased the risk for cardiovascular disease and heart attacks. The information about Sippy Diets and heart attack risk has been buried in the scientific literature for nearly 50 years and is virtually lost to contemporary scientists. OK. Fair enough. I would no longer necessarily hang my hat upon 50 year old studies than I would drink a cup of milk. However, the knowledge, wisdom and insight of our parent’s, grandparent’s and great grandparent’s generations shouldn’t just be swept under the rug. Is it possible that they were actually on to something?

Milk, Dairy and Heart Disease: Contemporary Science

The data from the early 1960’s studies on milk and heart attacks certainly bear further scrutiny. As we move forward from the past, numerous studies support the view that milk and dairy products may not be heart healthy and “Good for everybody”. A 1993 epidemiological study by Drs. Artaud-Wild and co-workers involving 40 countries worldwide demonstrated that milk and its components (calcium, protein and fat) had the highest relationship with cardiovascular death rates for any food or nutrient examined.7 Similar results implicating milk consumption with high mortality from heart disease were reported by Drs. Renaud and De Lorgeril in 1989,100 by Dr. Appleby and co-workers in 1999,8 by Dr. Segall,107, 108 and by Drs. Moss and Freed in 2003.78 Epidemiological studies are notorious for conflicting results. Here’s a perfect example. In a recent 2011 meta analysis,114 scientists at the Harvard School of Public Health showed that dairy food didn’t affect heart disease risk one way or another. Milk and dairy didn’t make things worse for our cardiovascular systems, but they also didn’t make them any better.114

Good scientists almost always let you know the weak points and shortcomings of their experiments because these limitations are an integral part of the scientific method which allows us all to glimpse the “truth”. The authors of this Harvard study expressed an important concern about the validity and generalizability of their experiment that you need to know. These kinds of details often get swept under the rug as milk industry lobbyists promote their products, and as governmental agencies make dietary recommendations. Let me quote the scientists who conducted this analysis:

“Conclusions from this meta-analysis only apply to the small proportion of analyzable study populations included in this work, within milk intakes of ~200-600 ml/d. Moreover, the internal validity of the different studies included in the meta-analysis (e.g., methodology and confounding factors) also determines the quality of the present meta-analysis.”

For those of you that may not completely understand this scientific admission, here’s what it means. The amount of milk in this analysis only ranged from 200 to 600 ml. This total represents a modest quantity which translates to only one to three 8 ounce glasses of milk per day. In other words the amount of milk in this study was too low to know if higher milk intakes increase heart disease risk. If we go back to the 1960s study of ulcer patients following the Sippy diet, they drank two to three times this much milk, and nearly 42 % died from heart attacks.17, 52

Milk is a lot like a moving target with more than one bull’s-eye. Scientists aren’t completely sure which element or elements may underlie its adverse effects upon our cardiovascular systems.30, 37, 73 Milk simply isn’t just a creamy white liquid that is “Good for everybody” but rather is a complex mixture of many substances suspected of causing heart disease including its high calcium content, fatty acids, lactose and certain proteins. Because milk contains so many compounds that could potentially promote heart disease, it is difficult or impossible for epidemiological studies to sort out all the facts. Let’s take a closer look at some specific elements in milk which may promote heart disease.

Decomposing Milk and Heart Disease

Unless you haven’t watched TV or read a newspaper or magazine in the past 20 years, most people know that milk and dairy products are one of our best sources of calcium. The dairy manufacturing industry has pounded this message into our brains for decades – so much so that many women fear they will develop osteoporosis if they don’t consume dairy foods. Until just recently, the prevailing knowledge was that if a little calcium was good for us, then more certainly must be even better. Not necessarily so. If we look at the evolutionary evidence, it becomes immediately clear that it would be virtually impossible to achieve governmental recommended calcium intakes without eating dairy products. In 2002, I wrote a scientific paper covering this topic, and my analysis showed that modern day Paleo Diets provide us with only about 70% of the daily recommended calcium intake.23 Given this evolutionary clue, then it is not be surprising to find that the supra-normal intakes of calcium that can be achieved by milk and dairy consumption may just cause unexpected health problems.

A recent 2010 meta analysis published in the British Journal of Medicine by Dr. Bolland and colleagues from the University of Auckland confirmed the health hazards of too much calcium. Their comprehensive analysis involving 26 separate studies and more than 20,000 subjects revealed that calcium supplementation significantly increased the risk for heart attacks and sudden death.16 High blood levels of calcium are likely involved in the artery clogging process (atherosclerosis)99 because too much calcium may promote the formation and fragility of the plaques which block our arteries.134

Interestingly, high dietary calcium also tends to cause imbalances in magnesium5, 34, 110 and this mineral is generally protective against heart disease for many reasons. As far back as 1974, Dr. Varo at the University of Finland pointed out that high dietary calcium to magnesium ratios were a better predictor of heart disease than high calcium intake alone.120 Meaning – that if you got too much calcium and not enough magnesium in your diet, it puts you at an increased risk for heart disease. Because milk’s calcium to magnesium ratio is quite high (about 12:1),128 the inclusion of dairy products in our diets can easily raise the overall calcium: magnesium ratio to about 5:1,120 thereby reducing cellular magnesium stores and promoting heart disease. Note that our studies of contemporary “Paleo”diets confirm that the dietary calcium to magnesium ratio was much lower and close to 2:1.23

Supplementation studies of magnesium show that it reduces heart disease risk via multiple mechanisms. It improves blood lipid profiles,47, 97 prevents heart beat irregularities called arrhythmias,57 improves insulin metabolism,82 and lowers markers of inflammation.82 If you decide to consume dairy products, you effectively negate these therapeutic effects of magnesium either fully or in part. If milk’s high calcium and low magnesium ratio was not bad enough, let’s consider just a few other nutritional features in milk which further promote heart disease.

In the 1950’s and early 1960’s when nutritional researchers were just beginning to understand how atherosclerosis and heart attacks developed, it was assumed to be a simple plumbing problem. Eat too much saturated fat and cholesterol, and your total blood cholesterol levels skyrocketed which clogged your arteries thereby predisposing you to a heart attack or stroke. Unfortunately, these simplistic views did not standup well to the test of time, as hundreds of studies starting in the late 1980s showed beyond a shadow of a doubt that inflammation and immune reactions were just as important or more so in the artery clogging process (atherosclerosis) than either consumption of saturated fat or cholesterol.79, 84, 135, 136

So this brings us to a larger question. What elements in diet may be responsible for causing chronic low level inflammation now known to underlie not just heart disease, but also cancer and autoimmune disease? The evolutionary template once again brings us back to foods which we never consumed in our ancestral past. Is there any possibility that these Johnnie- come-lately foods such as, milk and dairy, grains and legumes may cause chronic low level inflammation and promote immune responses that lead to heart disease?

Milk is an incredible amalgamation of nutrients, proteins and hormones that have only recently been discovered and appreciated. It certainly is not the pure white liquid, high in calcium, vitamin D and other vitamins and minerals portrayed by milk manufacturers and their lobbyists. You may not know it, but milk is essentially nothing more than filtered cow’s blood. As such, it contains almost all of the hormones, immunological factors, and body altering proteins that are found in pure cow blood.11, 64, 65 However, let’s don’t get too alarmed at this information. Most of these compounds in milk have very short half-lives and are spontaneously degraded within minutes or hours after the manufacture of modern dairy foods. Consequently, they should not enter our bloodstreams. Further, a healthy human gut lining rarely allows intact, large proteins such as those found in milk hormones to bypass its protective barrier. So why should we worry? Are there proteins or hormones in cow milk which bypass the gut barrier and eventually get into our bloodstreams to wreak havoc with our immune systems and promote atherosclerosis?

Milk, Insulin Resistance and the Metabolic Syndrome

I’ve briefly touched upon the glycemic index, but let me get into a bit more detail about how this indicator of a food’s blood sugar response relates to milk and dairy. As many of you may already know, the glycemic index gauges how much a food raises our blood glucose concentrations. Processed foods such as white bread, candies, breakfast cereals, cookies and even potatoes have high glycemic indices because they cause rapid and marked increases in our blood glucose levels.38 As such, these foods tend to promote the Metabolic Syndrome which includes diseases of insulin resistance such as type 2 diabetes, hypertension, cardiovascular disease, obesity, gout and detrimental blood chemistry profiles.24, 31, 117 Real foods such as lean meats, fish, eggs, fresh fruits and veggies typically have moderate to low glycemic indices and are not associated with the Metabolic Syndrome.24

Normally, when our blood sugar levels soar after we consume high glycemic index carbohydrates, our blood insulin concentrations also rise in tandem. This is the usual response. Shortly after the glycemic index was developed in the early 1980’s, it was discovered that milk, yogurt and most dairy foods had low glycemic responses.38 Presumably, these foods should be healthy and help to prevent the Metabolic Syndrome. However, about 5-10 years ago experiments from our laboratory and others unexpectedly revealed that low glycemic dairy foods paradoxically caused huge rises in blood insulin levels,42, 55, 59, 87 even when milk is added to mixed meals.70 The table below shows that despite their low glycemic indices, dairy foods maintain high insulin responses similar to white bread.

High Insulin Response | The Paleo Diet

This information posed a challenge to nutritional scientists. It was unclear if milk’s insulin stimulating effect but low glycemic response was healthful or harmful. To date only one human study conducted in 2005 has addressed this question. Dr. Hoppe and colleagues at The Royal Veterinary and Agricultural University in Denmark put 24 eight year old boys on either a high milk or high meat diet for seven days. The high milk diet worsened the boys’ insulin response nearly 100 %, and the entire group became insulin resistant in just a week’s time. In contrast, the high meat eating group’s insulin levels did not change, and their overall insulin metabolism remained healthy.58 The results of this experiment are alarming, particularly if future studies also demonstrate this effect in teenagers and adults. As insulin resistance is the fundamental metabolic defect underlying the Metabolic Syndrome, it would not be surprising to discover that milk drinking may cause other diseases of insulin resistance.

Milk and Acne

Until 2002 the official party line of the mainstream dermatology community was that diet had nothing to do with acne.22, 25 This viewpoint was expressed time and again in all of the major dermatology textbooks and became the doctrine taught to newly minted dermatologists. If you didn’t know any better, you might think that this perspective was based upon hundreds or even thousands of carefully controlled scientific studies. When I first started to examine the link between diet and acne more than 10 years ago, this is exactly what I had expected. How wrong I was! As it turned out, the dogma that diet didn’t cause acne was based solely upon two poorly conceived experiments conducted in 1969 and 1971.25 In a series of papers from 2002 to 2006, I pointed out this flawed assumption to the dermatology community.22, 25, 26

My research rekindled the entire diet/acne debate, but more importantly we showed that acne was completely absent in two non-westernized populations who didn’t drink milk or eat processed foods.22 We suspected that both milk and foods with high glycemic indices caused blood insulin levels to rise steeply and remain high all day long. In turn, elevated insulin levels set off a hormonal cascade that triggered the known cellular events which caused acne.22, 25 My hypothesis that milk, in part, caused acne was verified by a series of epidemiological studies from scientists at the Harvard School of Public Health.1-3 Even more convincing was an experimental study carried out by Dr. Neil Mann and colleagues at the Royal Melbourne Institute of Technology showing that low glycemic index, high protein diets improved acne symptoms113 as did a more recent randomized controlled trial by Kwon and co-workers.138

As it has been less than 12 years since my study in The Archives of Dermatology (2002) revived the diet/acne debate, scientists worldwide have not completely worked out how milk drinking promotes acne. Some researchers share our view that milk’s exaggerated insulin response along with high glycemic index carbohydrates sets off a hormonal cascade that causes acne.137 Others suggest that hormones found in cow milk may be responsible,1-3, 139 whereas some scientists believe that both mechanisms or perhaps others are involved.140

Hormones in Milk

Milk may be advertised as a squeaky clean white liquid, high in vitamin D and calcium, but if the truth be known, it is filtered cow’s blood and as such contains almost all of the hormones and bioactive peptides (protein building blocks) found in blood itself.10, 11, 33, 36, 39, 40, 51, 64, 65, 91, 92, 95, 96, 111 Take a look at the table below (which is only a partial listing), and you can see the incredible profusion of biologically active substances found in milk.

Growth Hormones

Insulin, Insulin like growth factor 1 (IGF-1), Insulin like growth factor 2 (IGF-2)
Insulin like growth factor binding proteins, 1 to 6 (IGFBP-1, 2, 3, 4, 5, 6),
Betacellulin (BTC), Growth hormone (GH), Growth hormone releasing factor (GHRF), Transforming growth factor alpha (TGF α), Transforming growth factor beta 1 (TGF-β1), (TGF-β2), Platelet derived growth factor (PDGF)

Steroid Hormones

Estrogens (Estrone, Estradiol-17β, Estriol and Estrone sulfate), Progesterone, 20 alpha-dihydropregnenolone, 5α androstanedione, 5 α pregnanedione, 20α- and 20β-dihydroprogesterone, 5α-pregnan-3β-ol-20-one, 5α-androstene-3β17β-diol, 5α-androstan-3β-ol-17-one, androstenedione, testosterone, and DHEA acyl ester

Bioactive Proteins and Peptides

Relaxin, Thyrotropin releasing hormone (TRH), Luteinizing hormone releasing hormone (LHRH), Somatostatin (SIH), Gastrin releasing peptide (GRP), Calcitonin, Adrenocorticotropic hormone (ACTH), Prolactin, Thyroid stimulating hormone (TSH), Lysozyme, Lactoperoxidase, Lactoferrin, Transferrin, Immunoglobulins (IgA, IgM, IgG), Proteose-peptone, Glycomacropeptide, Plasmin, α Casein, β Casein, κ Casein, α Lactoglobulin, β Lactoglobulin, Bovine serum albumen (BSA), Gastric inhibitory polypeptide (GIP), Glucagon-like peptide-1 (GLP-1), Antitrypsin, Plasminogen activator inhibitor-1, α(2) antiplasmin , Butyrophilin, Xanthine oxidase, Mucin-1, Mucin-15, Adipohilin, Fatty acid binding protein, CD36, Periodic acid Schiff 6/7

Bioactive Peptides formed in gut from Milk Proteins

Casomorphins, α Lactorphin, β Lactorphin, Lactoferroxins, Casoxins, Casokinins, Casoplatelins, Immunopeptides, Phosphopeptides.

The trick for any of these elements to wreak havoc with our health and wellbeing is for them to end up fully intact and present in our bloodstreams. To accomplish this feat, these hormones, proteins and peptides must first survive pasteurization (the quick heating of milk to destroy microorganisms), homogenization and other processing procedures applied to dairy foods. Next they must survive the digestion process and resist breakdown by our gut enzymes. Finally, they must cross the intestinal barrier which normally blocks entry of whole proteins, hormones and large peptides into our bloodstreams. As unlikely as this series of events may first appear, it now seems quite probable that cow hormones in milk indeed enter our bloodstream, particularly if we have a leaky gut.

For a young suckling calf, it is a good thing for its mother’s hormones, peptides and immune factors to cross the intestinal barrier. This process assures the calf will get a healthy start in life, grow rapidly and develop resistance to disease. To insure that mother’s hormones and peptides are not degraded in the calf’s gut by various enzymes, milk contains substances called protease inhibitors which prevent this breakdown.91, 96, 141 The downside of milk’s protease inhibitors is that they also prevent our own gut enzymes from destroying cow hormones and peptides. So the stage is set. Many hormones and bioactive peptides in milk survive pasteurization and food processing. They also resist enzymatic breakdown in our guts because inherent compounds in milk protect them. Ultimately, in order to adversely affect our health, these substances must then bypass the gut barrier and enter our bloodstream.

It is apparent that this final hurdle is routinely overcome because so many people have allergies and immune reactions to milk and its various protein components.21, 29, 54, 61, 72, 85, 86, 118, 119, 142, 143 When intact hormones, proteins or peptides cross the intestinal barrier, the immune system takes immediate steps to neutralize or destroy any particle that is perceived as a foreign invader. Part of this process is to form antibodies against milk proteins which later may be involved in allergic and autoimmune reactions. Many of the proteins and substances I have listed in the table above show up as specific milk allergens. Meaning – that they had to either cross the gut barrier and interact with the immune system or via another body interface.

Unsafe Milk Hormones

Of all the milk hormones and bioactive peptides I have listed in the table above, very few have been examined directly in human experiments. Nonetheless, evidence from animal, tissue and epidemiological studies suggest that consumption of cow, goat or sheep milk by humans and the subsequent ingestion of hormones and bioactive substancs at best may be unwise and at worst may be responsible for a number of life threatening diseases. Let’s take a look at the most problematic of these hormones.


The regular, everyday milk you buy at the supermarket is loaded with bovine insulin.51, 64, 65 This cow hormone not only survives your gut’s digestive enzymes, but it seems to frequently cross the gut barrier and make its way into the bloodstream, as revealed by telltale signs from our immune systems.72, 118, 119 Because the structure of bovine insulin varies from the human form, if it enters circulation, it is immediately recognized as a foreign particle and flagged as such by the immune system. The large number of children who display immune system flags (antibodies) to bovine insulin means that it has likely crossed the gut barrier intact and has caused an immune reaction. Although the mechanism is not entirely clear, the presence of bovine insulin antibodies in our children’s bloodstreams is associated with a greatly increased risk for Type 1 diabetes.72, 118, 119

Type 1 diabetes is an autoimmune disease in which the immune system destroys beta cells in the pancreas, so that it can no longer make insulin. Type 1 diabetic patients then must take insulin injections for the remainder of their lives. This devastating disease most frequently strikes children before their teen years. Epidemiological studies have time and again identified cow’s milk as a major risk factor for the disease, particularly if children are exposed to milk or milk containing formula before the age of three.66, 69, 72, 118, 119, 121 The bottom line: milk is a potentially lethal toxin for infants and young children, but also for adults as you shall soon see.

Insulin like Growth Factor 1 (IGF-1)

Another hormone found in cow’s milk that may have disastrous effects upon our health and wellbeing is called insulin like growth factor 1 (IGF-1). As implied from its name, this hormone encourages growth. Unfortunately it not only promotes growth in healthy tissues and organs, but also in cancerous growths.104, 115 Like all milk hormones, IGF-1 is a large protein molecule that normally should not breach the gut barrier and get into our bloodstreams. Nevertheless, recent meta analyses of 15 epidemiological studies and 8 human dietary interventions by Dr. Qin and colleagues at Soochow University have shown without a doubt that milk drinking robustly elevates IGF-1 in our bloodstreams.92 This effect may occur directly from the additional ingested bovine IGF-1 that crosses our gut barriers, or via indirect mechanisms. You recall that milk drinking causes our blood insulin levels to rise sharply. Whenever blood insulin concentrations increase, a series of connected hormonal events simultaneously cause IGF-1 to increase. Over a 24 hour period, blood insulin concentrations are a good marker for IGF-1 concentrations. When one increases so does the other.144

Whether IGF-1 in our blood is increased either directly from ingested bovine IGF-1 or indirectly from milk’s insulin raising effects doesn’t really matter, as the end result is the same – milk raises our total blood levels of IGF-1 (92). This particular consequence of milk drinking is especially ominous because it encourages the growth of many types of cancer. Numerous worldwide, meta analyses over the past 40 years show beyond a shadow of a doubt that high blood levels of IGF-1 strongly increase the risk for prostate and breast cancer.104, 115 If this outcome doesn’t alarm you, perhaps additional meta analyses will. These comprehensive studies show that milk drinking also increases the risk for ovarian cancer in women.44, 68 If you or any close relatives have a history of cancer, one of the best lifestyle changes you can make to reduce your risk of these life threatening diseases is to wipe your upper lip clean of the milk mustache and get milk and dairy completely out of your life!


By now you can see that milk isn’t simply an innocuous high calcium food that builds strong bones, but rather is a concoction of body altering hormones, enzymes and proactive peptides whose wide ranging effects may promote cardiovascular disease, insulin resistance, cancers, allergy and autoimmune diseases. Another hormone in milk which may operate in tandem with other bovine hormones, proteins and peptides to promote cancer is estrogen. It is present in bovine milk in a variety of forms including estrone, estradiol-17β, estriol, estrone sulfate and progesterone.36, 40, 95

Before we go any further, you need to know how modern dairy farmers maximize milk production from their cows. Dairy farmers are in the business to make money, and the more milk they can get from a single cow in a year, the more money they make. Female cows, like all mammals only produce milk during the latter half of pregnancy and during the suckling period. So the trick for modern dairy farmers is to get cows to make high amounts of milk during the early months of pregnancy when milk is normally not produced. Dairy farmers achieve this goal by artificially inseminating cows within three months after they have just given birth. In effect, these cows become pregnant once again while they are still nursing the young of their previous birth. This contrived interference by humans causes the mother cow to produce milk 305 days out of the year. From an economic perspective, this strategy makes perfect sense – more milk means more money. From a dietary and health perspective, this practice may increase the estrogen content in the milk we drink.36, 40, 95 For men, milk drinking (whether be it from added estrogen or other mechanisms) greatly increases your risk for prostate cancer.43, 67, 93, 94, 103, 126


So far we have only closely examined three hormones found in milk. You can see from my table that we have barely touched the tip of the iceberg. Because most of these substances have been so infrequently studied in humans, we simply don’t know how they may influence our health and wellbeing. Nevertheless, at least one additional hormone in milk called betacellulin is worth examining.

Betacellulin was only recently identified in cow milk in 1999 (33). It survives pasteurization and occurs in milk, cheese and whey proteins.10 Tissue studies of a molecularly similar hormone (EGF) demonstrate that it likely survives our digestive enzymes.96 A low ph, such as may be found in the gut, does not impair or prevent BTC from binding its receptor.146 Further betacellulin doesn’t have to worry about getting past the gut barrier. It gains easy access to our bloodstream by binding a structure in the gut lining called the epidermal growth factor receptor (EGF-R).26, 56, 90, 145 This structure is found throughout most cells in our body, and when the EGF-R becomes over stimulated, it is intimately associated with the development and progression of almost all types of cancers.53, 81 Tissue experiments show that betacellulin powerfully stimulates the EGF-R – more so than any other hormone.<sup<145 Further, pharmaceuticals which block EGF-R stimulation act as powerful anti-cancer agents in humans and animals.28, 46, 81, 83, 88, 109

It will take many more experiments and years of research to conclusively show whether or not the betacellulin in milk contributes to the cancers associated with milk drinking and dairy consumption. But you don’t have to wait that long. By eliminating milk and dairy products from your diet, you will immediately reduce your risk of these cancers, as well as allergy, heart disease, and autoimmune disease.

Milk and Dairy: More Health Problems

The list of adverse health effects known to arise from milk drinking is seemingly endless. Let me briefly point out some additional conditions and illnesses in which milk and dairy products have been implicated.

Food Allergies

The table below lists the eight most common food allergies in the U.S. population.

Food Ranking | The Paleo Diet

These foods account for 90 % of all food allergies, and notice that milk tops this list.85 Milk is also the most common childhood food allergy, where it afflicts between 2-3% of children between the ages of 1 to 3. Symptoms include: stomach pain, diarrhea, skin rashes, hives, wheezing, infantile colic and anaphylactic shock which can be life threatening. By age 3 most (85-90%) children grow out of their milk allergy. So at first, this change appears to be a good thing, but the down side to childhood milk allergy is that it predisposes the child to other food allergies for the rest of their lives. A study by Dr. Høst at the University of Southern Denmark54 alarmingly revealed that 50% of all infants and young children who were allergic to milk later developed allergies to a wide variety of other foods before puberty. As was the case with Type 1 diabetes, early exposure to milk proteins is the key to whether or not your child will develop allergies. The crucial period for restricting cow’s milk is from birth until at least age 2 or 3.

One of the more interesting disorders related to milk allergy is infantile colic. If you are planning on having children, or know someone who is, you may want to bookmark this paragraph. When a healthy baby cries, screams or fusses intensely for more than three hours a day, three days a week, it probably has colic. Continual infant crying is considerably more than just a parental annoyance. Crying and its associated exhaustion to parents and infants may cause serious problems including stress to your marriage, breastfeeding failure, and shaken baby syndrome, which frequently results in infant death.

Today it is almost universally recognized by pediatricians that infants should never consume milk (except mother’s milk) or dairy products until at least age one or beyond. A series of human infant experiments carried out in the 1980’s revealed beyond a shadow of a doubt that whey proteins in milk were largely responsible for colic. A powerful experiment known as a double blind crossover conducted by Drs. Lothe and Lindberg at the University of Lund in Sweden71 demonstrated that colic symptoms disappeared in 89% of all infants when they were given a cow milk free diet.

OK, this is good news, but you may ask why this information is relevant in 2014 when cow milk is no longer recommend by pediatricians until after about 1 year of age for infants. An often forgotten, but important offshoot of these 1980’s double blind crossover experiments was that they were also repeated in milk drinking mothers who breastfed their infants. Not surprisingly, infants who’s Moms drank milk became colicky, indicating that certain elements in cow’s milk may have caused an immunological response in the nursing mothers that was transferred to their milk which in turn was transmitted to their babies, making them cry.21, 61 Any food that causes such distress in infants should be a warning to us. It may be possible that our babies are more in tune with their bodies than we are.

Excessive Mucus Production

Too much milk consumption has long been associated with increased mucus production in the respiratory tract and incidence of asthma. I have a memory a few years back of going to a high school cross country meet and watching these young athletes cross the finish line. I noticed a few runners were literally “foaming at their mouths” because they had so much mucus being produced from their respiratory system. I wondered if milk drinking had anything to do with it, but at the time, the science hadn’t yet caught up with my observation and those of others. An intriguing new (2010) hypothesis by Drs. Bartley and McGlashan, otolaryngologists from New Zealand9 may have found the answer.

Go back to my table of all the hormones and bioactive substances found in milk. You will notice under the category, “Bioactive Peptides formed in gut from Milk Proteins”, a substance called casomorphins. These compounds are produced in our guts from the breakdown of the milk protein, casein. One of these casomorphins, beta-casomorphin-7 directly stimulates mucus production from specific glands (MUC5AC) located in the gut. If the gut becomes leaky, which it invariably does on a typical western diet, beta-casomorhin-7 can then enter our bloodstream and travel to our chests where it stimulates mucus production from MUC5AC glands located in our lungs and respiratory tracts. A final piece of this puzzle is that beta-casomorphin-7 is much more likely to trigger mucous production if the lungs and respiratory tract are inflamed by asthma.

Parkinson’s Disease

Parkinson’s disease is a nervous system disorder that primarily affects areas of the brain controlling movement. Disease symptoms include tremors, stiffness and difficulty moving. You may best know this disease through its two most famous victims, Muhammad Ali and Michael J. Fox. Although the cause of Parkinson’s disease isn’t known, both genetic and environmental elements seem to be involved. Like autoimmune diseases it appears that environmental factors may be the most important triggers of this debilitating illness. When we talk about environmental origins of any chronic disease with an unknown cause, diet has got to be at the very top of our list. And the first items that we should examine are those foods which were not part of our ancestral human diet. So this line of thought leads us once again to milk and dairy products.

A comprehensive 2007 meta analysis by researchers at the Harvard School of Public Health has identified a high intake of dairy foods as a prominent risk factor for Parkinson’s disease.20, 89, 123 Men who consumed the highest quantities of dairy products had an 80% greater risk of developing the disease than men who ate the lowest amounts. These results are consistent with the Honolulu Heart Study examining 7,504 men who were followed for 30 years for the incidence of Parkinson’s Disease. There was a 2.3 times greater incidence of Parkinson’s Disease in the highest milk drinkers compared to those who abstained from milk.89

Currently, it is unknown how and why milk drinking increases the risk for this illness, but autoimmune mechanisms seem likely, particularly those directed at insulin.123 Other prominent and more studied autoimmune diseases associated with milk and dairy consumption are multiple sclerosis, rheumatoid arthritis and gastrointestinal diseases such as Crohn’s disease, ulcerative colitis and irritable bowel syndrome. When you adopt The Paleo Diet, you will reduce your risk for Parkinson’s disease and other conditions with autoimmune components because this lifetime nutritional plan eliminates milk and other foods associated with the development certain autoimmune diseases. In my new book, The Paleo Answer (John Wiley & Sons, 2012), I fully discuss how Paleo Diets may have therapeutic potential for autoimmune disease patients.

Milk and Senile Cataracts

Senile cataracts are cloudy opacities that form in the lens of the eyes as people age and can ultimately cause blindness. The bad news is that if you live long enough, you will probably develop cataracts. The good news is that you can probably forestall their appearance until very late in life by following The Paleo Diet. For people between 52 to 62 years of age, 42% develop cataracts. This percentage increases to 60% between ages 65 and 75, and rises further to 91% for people between 75 and 85 years of age.27 In the U.S. and other westernized countries, cataracts are treated by surgical removal, whereas left untreated they are the leading cause of blindness in older adults worldwide.

Milk drinking has a lot to do with cataract formation. In rats, pigs and guinea pigs scientists routinely produce cataracts in these animals, even before they reach old age, simply by feeding them high milk and lactose diets.98, 101, 124 As you recall, the main sugar in milk is lactose which is broken down into its two constituent sugars (glucose and galactose) by the gut enzyme, lactase. Numerous epidemiological studies show that lactose and galactose are involved in premature cataract formation.63, 77, 102 Due to the way cataracts form, we can probably never prevent them completely, but chances are good that if you adopt a dairy free diet, you can live most of your life, even into old age, without developing cataracts.

Milk Impairs Iron and Zinc Absorption

The table below lists the top 13 nutrients most lacking in the U.S. Diet.24

Nutrient Requirements | The Paleo Diet

Notice that zinc is number one. More than 73% of all people in the U.S. don’t get enough of this essential mineral. Iron is number six and about 40 % of the population is deficient in this nutrient. Milk and dairy products are lousy sources of both iron and zinc.24, 128 But to add insult to injury, the high concentration of calcium in cow’s milk strongly interferes with the absorption of both iron and zinc.19, 48 Meaning – if you were to add a slice of melted cheese to your barbequed burger, it would severely reduce the amount of iron and zinc you could absorb from the burger.

Both zinc and iron are crucial minerals for our health and wellbeing. Low iron stores are the most frequent cause of anemia, and in children and teens they can impair mental functioning. Pregnant women with iron deficiency are at greater risk for delivering pre-term babies, and low iron stores may adversely affect athletic performance and work ability. The list of health problems associated with zinc deficiency is seemingly endless, but includes: low sperm counts, reduced libido, reduced immune function, increased susceptibility to upper respiratory infections, acne, white spots on fingernails, rough skin, lack of sexual development, stretch marks, macular degeneration, reduced collagen and increased wrinkling. When you follow The Paleo Diet, you will be eating meat at almost every meal, and meat is one of the most highly absorbable sources of both zinc and iron.23

Milk and Dairy: Bone Health

One of the biggest selling points the milk manufacturers would like us to believe is that by drinking lots of milk we can reduce our risk of osteoporosis and future hip fractures. The foremost danger associated with osteoporosis is hip fracture in the elderly. Between 18 to 33% of all elderly people suffering hip fractures die within a year after breaking their hips. Not a pretty statistic. Although most people, including dairy lobbyists, believe that a low intake of calcium is a risk factor for hip and other bone fractures, if the truth be known, the data says, “It just isn’t so.”

A 2007 meta analysis of 170,000 women and 68,000 men from the Harvard School of Public Health reported that high calcium intakes had no therapeutic effect upon hip fractures,15 as did a similar meta anlysis of 39,500 men and women from Europe.62 In the Harvard study,15 a pooled analysis of five human experimental trials showed no benefit of calcium supplementation on non-vertebrae fractures, but rather showed that increased calcium intakes actually increased the risk for hip fracture.15 A follow-up 2010 meta analysis specifically examining milk consumption and hip fracture risk in 195,000 women and 75,000 men also showed that low milk intakes didn’t increase fracture risk, nor did a high intakes prevent it.12 These studies clearly show that we have been misled by the dairying manufacturers’ Milk Mustache and Got Milk Campaign. You may now be asking yourself, “If milk and dairy consumption don’t reduce my bone fracture risk, then why in the world should I consume these foods?” I have asked myself this very same question and cannot come up with a single reason to drink milk and eat dairy products.


Loren Cordain, Ph.D., Professor Emeritus


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