Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
11 Jan

Dairy and Its Effect on Insulin Secretion (and What It Means for Your Waistline)

Insulin is an old, old hormone. Evolution has preserved its structure across hundreds of millions of years and hundreds of thousands of species. Fish, insects, reptiles, birds, and mammals all secrete insulin with fairly similar amino acid arrangements (insulin from certain species of fish has even been clinically effective in humans), so, clearly, it is a vital hormone. But insulin gets a bad rap in our circles. Why? With metabolic syndrome laying waste to the citizenry and with insulin playing an undeniable role, it’s difficult not to be soured on this hormone.

And yet we need insulin to shuttle all sorts of nutrients into cells, like protein and glycogen into muscles. It’s there for a reason, so to demonize it is misguided. It’s chronically elevated insulin and insulin resistance – you know, the hallmarks of metabolic syndrome – that are the problem. You might have noticed a softening stance on carbohydrates around the paleo and Primal blogosphere. I think it’s simply an acknowledgment that in healthy people with healthy glucose control and healthy insulin responses who engage in glycolytic activity, starch is fine in measured amounts. And if insulin increases to shuttle that starch and protein into the insulin sensitive muscle cells, so be it. That’s why it’s there.

But not everyone (anyone?) lives a perfect Primal existence. And even if you did an understanding of how insulin works and what foods and behaviors affect it’s production should be high priority. Especially for the millions of people immersed in the modern, industrial lifestyle, with deranged metabolisms from years of poor eating habits (i.e. most of us).

Which brings us to dairy and its effect on insulin.

Dairy intake, you see, stimulates insulin secretion. Lots and lots of it – more than can be explained by the lactose (a sugar) content. In fact, the lactose content of dairy doesn’t even have a big insulin effect when compared to other carbs. This is surprising to some, since the general understanding is that insulin is released primarily in response to carbohydrate intake. What gives? Well, in evolutionary terms, think about a growing beast needing to maximize the utility of every drop of the precious liquid. With dairy, it’s the protein plus the carbs that are responsible for the large insulin release. Take milk, the most egregious “offender.” Both skim and whole milk (PDF) elicit significant insulin responses that you wouldn’t predict from looking at their protein and carb contents, and the fat in whole milk doesn’t blunt it (maybe non-homogenized whole milk would be a different story… I don’t know). Cream and butter are not particularly insulinogenic, while milk of all kinds, yogurt, cottage cheese, and anything with casein or whey, including powders and cottage cheese, elicits a significant insulin response. In one study (PDF), milk was even more insulinogenic than white bread, but less so than whey protein with added lactose and cheese with added lactose. Another study (PDF) found that full-fat fermented milk products and regular full-fat milk were about as insulinogenic as white bread.

What’s going on here? It comes down to the amino acid composition of dairy proteins, specifically the amino acids leucine, valine, lysine, and isoleucine. These are the truly insulinogenic proteins, and they’re highest in whey (which is probably why whey protein elicits the biggest insulin response).

This isn’t new. I’ve written about protein’s insulinogenicity before, but dairy goes above and beyond Primal protein sources like meat, eggs, and fish. The question we should be asking is this: if you wish to include dairy in your diet AND have no issues with lactose or casein intolerance are the insulinogenic properties of certain types of dairy still problematic from the standpoint of health and/or weight control?

This study claims they are. Children were given strict diets of either lean beef or skim milk, and the skim milk diet induced hyperinsulinemia and insulin resistance after just seven days. It sounds troublesome, but they used skim milk – a refined, fundamentally altered food. I’m not prepared to render judgment. Another study found that dairy failed to improve insulin and the metabolic risk parameters in overweight and obese subjects, but it again used low-fat dairy instead of full-fat dairy. I’m simply not convinced they’re interchangeable.

If full-fat dairy really did have similarly negative effects on the insulin response that eventually led to the metabolic syndrome, you wouldn’t see studies showing that people who ate the most dairy fat were at the lowest risk for diabetes. You also wouldn’t see the high number of epidemiological studies (I know, I know) linking full-fat dairy intake with lower risk of heart disease and stroke, both of which are strongly linked with insulin resistance.

I think it’s more accurate to say that acute insulin spikes are different from chronically elevated insulin levels, especially when it comes to appetite regulation and metabolic derangement. Consider this study, whose authors gave either whey protein isolate or whey protein hydrolysate to subjects 30 minutes before a pizza meal. Subjects given whey protein isolate, but not hydrolysate, reduced post meal blood glucose and insulin levels, and ate less pizza. The whey still released insulin, but it didn’t linger for very long and it led to improved post meal numbers. It wasn’t chronically elevated. The subjects weren’t hungrier, contrary to what you might expect from someone who’d just experienced a jump in insulin.

No Easy Answer.

Dairy’s not for everyone. I don’t like milk, so I stick to good cheese, pastured butter, cream and the whey in Primal Fuel when I’m in a hurry, while avoiding most straight-up milk, but I think good milk may be fine for many people. As always, experiment. Dairy seems to stall weight loss for some people, so you might try taking it out of the diet if you can’t lean out. Dairy also seems to improve strength and mass gains for lifters, so you might try adding it if you’ve been lifting particularly hard. See what works, and what doesn’t. Insulin doesn’t have to be feared as much as it should be managed, just so long as the rest of your metabolic toolkit – in which insulin takes a prominent position – is in order, you’ve got stress dialed in (or out), you’re getting good sleep, and you’re putting in the necessary physical work.

It’s also important to consider the big picture when judging the suitability of various foods. It helps to tell stories about the food we eat, to think about narratives. Grains aren’t just little morsels of protein, carbs, and fiber bred for our enjoyment. They are baby plant eggs. Those macronutrients are there to sustain the seed’s growth and those micronutrients are there to protect it. They are the plant’s lifeline to immortality. They are literally shaped by the hand of evolution to survive and ravage the digestive tract of the poor sap that swallows them and discourage further consumption. Grain is only food because we deemed it so. Dairy? Dairy is objectively, absolutely food. Its fat, protein, and carbs are there to be consumed, albeit by young cows, sheep, and goats. It’s meant to spur growth, to pack on muscle and fat and weight. And yeah, eating dairy protein causes an insulin spike, but that can be useful if you know what you’re doing.

In the end, personal results matter most. Health outcomes concern us; detached insulin response numbers sitting in a table in some paper mean little if your personal experiences corroborate the evidence that consistently shows that untouched, full-fat dairy likely promotes better glucose tolerance, better weight control, and more resistance to chronic diseases like diabetes and heart disease. On the other hand, those studies mean little to the person whose weight loss stalls after a couple glasses of non-homogenized, raw pastured milk. Try as we might, we can’t – nor should we – ignore our own experiences. Have your experiences with dairy been positive or negative? Let the answer to that question supersede what PubMed says.

Some suggestions:

  • Go fermented. Stick to full-fat yogurt, kefir, and cheese.
  • Go heavy. Stick to butter, cream, and half-and-half.
  • Go pastured. Find a source of pastured dairy. From what I understand, Trader Joe’s carries a cream-top organic milk that hails from the Strauss Family Creamery in Northern California (they never provide sources, but the TJs stuff tastes remarkably similar to the glass bottle stuff from Strauss and the cream has the same consistency), which uses mostly grass and grass silage. Their “European Style Yogurt” also comes from Strauss and is very good (and cheaper than Strauss-labeled yogurt in other stores).
  • Go raw. Stick to trusted sources.

What are your experiences with dairy’s insulinogenic effects? They are very real, but do they seem to bother you? Are you worried about insulin spikes in response to dairy protein?

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Thanks so much for this topic. Gauging from the chatter on the message board, this is long overdue.

    I am one of those who is greatly impacted by dairy and its insulinogenic effect. I simply do not/cannot lose weight while on it and see little changes in body composition. In its absence, however, changes are happening quickly. My hemoglobin A1c also took a huge jump down as well.

    Butter and small amounts of heavy cream seem to be okay for me. Anything higher up on the dairy chain is the problem.

    Ginger wrote on January 11th, 2011
    • Six months ago I had high cholesterol, so, being reasonably health conscious I made immediate changes to my diet, the first being the full removal of dairy. Within three weeks, I’d lost about seven kilos, felt sharp and more engaged than I ever have. My skin looks better, a lot less ear wax, and, minimal suffering through the hay fever season. Maybe I was unaware of personal reactions to dairy, having always consumed it as part of a conventional diet.

      Franky wrote on January 17th, 2011
      • Yea, but was it pasteurized?

        Donnersberg wrote on April 17th, 2011
      • That is very interesting that dairy would have that much of an effect. I was allergic to milk (cows) when I was very young. I grew out of it shortly, but still avoid it during hay fever season as it seems to make things worse.

        Jeff wrote on June 8th, 2011
  2. I’ve given up on all dairy except butter and heavy cream, which brings up my question: what about heavy cream? The (so-called) nutrition label says one tablespoon of heavy cream is free of carbs and protein. Is heavy cream an almost pure fat like coconut oil/fat? I love cream but I do not have access to raw cream and must use the grocery store version of “ultra-pasteurized” heavy cream. Is this stuff a viable source of fat? (A very quick, very filling meal: two egg yolks, one whole egg, 1/4 cup water, 1/2 cup heavy cream, ground nutmeg, vanilla, 1 packet sweetener, mix well. Tastes like ice cream.)

    Phocion Timon wrote on January 11th, 2011
    • The packet of sweetener in that list could trigger an insulin response as I understand it – the sweet taste in the mouth triggers the system to cope with glucose regardless of whether it arrives in the stomach and then bloodstream.

      Kelda wrote on January 11th, 2011
      • Smelling food triggers an insulin response, as Gary Taubes wrote in GCBC. So let’s stop smelling food while we’re at it, I… guess? 😛

        Dana wrote on January 11th, 2011
      • Kelda’s right. That’s called a cephalic response. Artificial sweetener is perceived as so much sweeter by the tongue, that the brain (hence cephalic) responds by putting the pancreas on high alert in anticipation of a heavy sugar/carb load. Better off using actual “sugar.”

        Martha wrote on January 12th, 2011
        • That’s not correct. You do have a slight insulin response from artificial sweetener, but it is not as much as from sucrose. I just read a study about it the other day. Stevia has less of a response than Aspartame, both of which have a lesser response than sugar.

          Protein also triggers an insulin response, as does merely thinking about food. However the amount secreted is very small compared with the amount secreted if sugar is actually consumed.

          tracker wrote on February 8th, 2011
        • No,no,no,no,no!!!! This is the biggest myth that exists. A sweet taste in the mouth WILL NOT trigger insulin response. Carbohydrate intake will do it, and that’s it. Your body doesn’t “think” and therefore it cannot be fooled. Please people, this is JUST NOT TRUE!

          Alx wrote on August 29th, 2011
    • Heavy cream is what we use to make butter, absent the churning. You can consider it liquid butter.

      Don Matesz wrote on January 11th, 2011
      • Butter contains milk solids – that’s why it browns when you cook it and the little bits come out of the suspension after a few minutes of cooking. Clarified butter, or ghee, is the pure milk fat. And the taste is amazing…

        Jennifer wrote on January 11th, 2011
        • yes, but ghee is full of oxidised cholesterol, heavily processed food is bad, why should ghee be any different

          Simon wrote on January 26th, 2015
      • FWIW, in the process of churning, whey comes out of the butter. And the carbs are in the whey.

        MerryKate wrote on September 6th, 2015
    • Heavy cream has carbs. 1 tablespoon has 0.42 carbs. There is some rule that if the carbs per serving is <1, a label can claim "0g carb". Cream is not liquid butter. Melted butter is liquid butter.

      Anna wrote on January 16th, 2012
      • But at the same time, I would assume that we’re not talking about zero carb and we’re not drinking cream straight. I prefer to use mine in the butter state, as creme fraiche (on a taco bowl where the bowl is actually a bowl and not a fried tortilla) or, if the flavors call for it, whipped. For each of these, I would end up with so little carbs from the dairy that I’d get more in the vegetation.

        CocoaNutCakery wrote on October 11th, 2012
  3. So what about raw milk? It’s actually been used as a diabetes treatment, very successfully.

    I am currently doing a bit of GOMAD, half gallon of raw milk a day for some mass gain. Going very well so far.

    Ben wrote on January 11th, 2011
    • My question exactly.
      ALL those tests and people talking about how horrible they feel using dairy…wish they’d mention if it’s pasteurized dairy…cause that would explain it all.

      Donnersberg wrote on April 17th, 2011
      • If you think that warming milk to 160F for a few seconds is causing major satanic changes to it, you’d better stay away from sauna. That’s where humans bake for half an hour at a time at 180+F…and apparently none the worse for it.

        The unpasteurized milk cult is more a religion than a science, and it is impossible to conduct a rational discussion of microbial evolution with its adherents, in my experience.

        Farmer Pat wrote on February 27th, 2012
        • Good point, but don’t forget pasteurization kills all the bacteria. If other animals’ breast milk is anything like ours, that bacteria was selectively chosen and designed to beneficially colonize the gut – it’s nature’s perfect probiotic…

          mm wrote on May 30th, 2012
        • Heating milk above 140 degrees F does not simply kill bad micro organisms, it also changes the structure of the proteins and enzymes. Then there is the process of homogenization which also causes structural changes in the milk.

          Forest wrote on February 6th, 2013
  4. Great post!

    Aged and fermented cheeses from pastured milk are a good source of K2. The Rotterdam study found a strong correlation between K2 intake from Dutch cheese and reduced risk of cardiovascular disease.

    JD Moyer wrote on January 11th, 2011
  5. And here’s the link to the study:

    JD Moyer wrote on January 11th, 2011
  6. Very Weston Price. But, prior to animal husbandry and domestication non-human dairy would not have been consumed in any significant amount to have been considered part of regular diet, right?

    Maybe if you’re super thirsty you could catch a cow and suck on its udder? Or any other mammal? That just sounds crazy to me.

    But I think you’re spot-on that dairy can be used for body-hacking. Insulin is not the devil, and it has a proper role in evolutionary context. It all depends on your personal philosophy behind eating paleolithic.

    Andrew Brooks wrote on January 11th, 2011
    • People of European decent generally (but not always) have the adaptations to drink milk. Paleo man would not have, but we cannot ignor the small changes to genetics since then. Paleo man would have been able to make a cup, and milk is safe to drink for a few hours at room temperature. No need to suck an udder – that is just silly.

      Henry Miller wrote on January 11th, 2011
      • Yeah, they have the adaptation, it’s called fermenting the milk. Raw milk, left to its own devices, begins fermenting fairly quickly. You hardly need to be making your own lactase when the bacteria will do it for you. Even if you drink the stuff before it’s very far gone, if you’ve spent some time getting the lactic acid bacteria which are present in raw milk *anyway*, you’ve got yourself a pretty good gut colony going.

        Which would be why milk’s traditionally been consumed all over Europe, not just in those nations where the people have some sort of rareified mutation that lets them make lactase past weaning age.

        They seem to be making this claim about Swedes, you know, not about Poles or Russians or folks in the Caucasus. But those all drink milk. So do the French. So do the Irish. And on and on.

        Dana wrote on January 11th, 2011
        • “Rareified”? The majority of white people produce lactase past weaning age.

          Just because some study you read happened to be about Swedes doesn’t mean they’re the only ones. Yeah, there might be only 7% or so lactose intolerant people in Sweden compared to almost 20% in Poland, but it’s still a clear majority. Simply put, most people in Western, Eastern and Northern Europe do have genes for lactase persistence.

          What you describe is somehow more applicable to Southern Europe, but none of the nations you specifically mention are from there. Sorry, but all of that makes you sound remarkably religious in your anti-milk opinions. Why not check facts instead?

          Aleksandra wrote on September 18th, 2012
    • Wouldn’t it be easier for paleo man to hydrate himself eating a lot of fibrous veggies?

      js290 wrote on January 11th, 2011
      • Or just drink water? The rivers weren’t chock full of industrial wastes back then.

        Dana wrote on January 11th, 2011
      • if you lived on grass plains, it would be hard to find nice juicy veg to quench your thirst, if masai herd cattle, are they paleo, or industrialized?

        Simon wrote on January 26th, 2015
    • We didn’t used to build brick houses either.

      Dana wrote on January 11th, 2011
    • Any hunter gatherer, having downed a large mammal that was a nursing female, would drink the milk, as the bushmen of Africa used to before their way of life was destroyed. A huge source of nutrition in an overall diet? Probably not.

      Ken wrote on January 12th, 2011
      • Then again cavemen probably didn’t eat as many eggs for as many days of the years as some of us do so that would have also not have been a huge source of nutrition in our diet…

        mm wrote on May 30th, 2012
        • cavemen would have an egg binge during seasonal laying, eggs don’t run fast

          Simon wrote on January 26th, 2015
    • “The first person to discover that cow’s milk is drinkable was very, very thirsty.”

      In all seriousness, though, this argument frustrates me. Humans evolved to be one of the most adaptable species on Earth. It’s one of the primary reasons why we managed to populate six continents, every biome… everywhere. We did not become omnipresent solely because of our intellect; rather, it was our ability to adapt to any circumstances thrown our way that allowed us to thrive.

      One of those adaptations is not strict reliance on whatever our ancestors ate. It was the ability (and this ability is present in many animals) to eat anything that our bodies could recognize as food. And, as Mark Sisson pointed out above, milk is unquestionably a food. It is made specifically to be consumed, to be recognizable as a food, and we DO recognize it as a food. We are mammals, and so our bodies know what milk is. Not only that, but we are neotenous mammals, which means that we might more easily develop a tolerance for lactose as we age than other mammals. It’s not nearly as far of a jump, evolutionarily speaking, to be able to digest milk as it is to digest grains.

      CocoaNutCakery wrote on October 11th, 2012
  7. Liberte makes a great Greek Yogurt that is full fat and unsweetened. As a strength athlete I find I need dairy to get in enough protein (trying to weigh 240lbs lean) and this seems to be the best source other than cottage cheese.

    Nathan wrote on January 11th, 2011
  8. I find the whole dairy question fascinating. I’m convinced there’s alot more to the processed milk versus raw milk debate which has not surfaced. Research on raw milk practically halted since pasteurization was implemented. The last major push on raw was in the late 1920’s/early 1930’s where raw milk was actually used as a *cure* for diabetes (check “milk cure” from Mayo clinic research of that time). Amazing isn’t it? I do eat raw milk products and feel they benefit both my weight and health, but I’d love to see more research on it.

    Nina wrote on January 11th, 2011
    • Yes, I’m wondering that , too.
      All research is always done on pasteurized milk, and we all know pasteurized dairy of any kind is BAD.

      Last summer I drank 2-3 gallons of RAW goat’s milk per week and did not gain even an ounce.(not working out or anything)
      When the goat’s needed the milk for their babies and I had to go buy pasteurized milk from the store I gained 8 lbs within 2 months … funny how that works.

      Suvetar wrote on January 17th, 2011
      • I also find it difficult to really use the info about “main stream dairy” because it is so processed and therefore completely different from “Raw dairy” It’s like comparing apples to oranges. Both fruit, but soooo different. I incorporated full fat Raw milk into my diet with out making any other changes and lost 10lbs. It was just about 16 oz a day but the weight just melted off. A happy side effect!

        Beth wrote on June 6th, 2011
  9. Interesting. I eat a lot of butter, some cream and even less cheese, but very little whole milk (our milk is vat pasteurized and not homogenized) because it DOES stall my weight loss.

    I’d love to be able to see if raw milk has the same effect, but it’s so hard to obtain where I live.

    Jan wrote on January 11th, 2011
  10. I’ve given up on ALL dairy products and feel much better. My digestion is better and I don’t have chronic allergy-like symptoms. It’s also easier to lose weight eliminating all milk products. Perhaps I have some milk allergy? That said, it’s ludicrous why adult humans consume the milk of another species! What other mammal in the wild does that?

    Steve wrote on January 11th, 2011
    • How do we know what other animals do, they don’t use the same global web system we do to communicate!

      Kelda wrote on January 11th, 2011
    • We’re not in the wild. What other mammal uses laptops?

      Dana wrote on January 11th, 2011
      • I once saw a cat on a laptop. I had to get close to see, since he had a diffusing screen protector. He was definitely ordering some squirrel milk on his internets.

        nbot wrote on February 4th, 2011
    • Actually dogs, cats, any carnivore probably, will drink all the milk and cream they can, every chance they get. It’s a form of animal fat.

      tfarny wrote on January 11th, 2011
      • Just cleaned my kitchen cause my cat has spilled milk everywhere, my cats love (raw) milk!

        Udo Ede wrote on November 10th, 2013
    • As a matter of fact, all predatory mammals do =).
      Pregnant or lactating mamas are prime targets. A full udder is one of the first parts consumed. This is a common, notable sign of bear predation, for instance–a carcass found with only the viscera and udder missing. Smaller predators simply consume the whole small prey animal, lactation assembly included.

      We predatory omnivores are no different. We’re just more clever than most, and able to extract the dairy without actually killing the lactating mama.

      Some humans fare well on dairy, some don’t. Whole, raw, grass-fed milk is a staple part of my diet. Home-churned, cultured raw butter is a glorious, luxurious “vitamin pill”.

      Kate wrote on March 22nd, 2011
  11. Like Mark, I just plain don’t like milk, but cheese, greek-style yogurt, and cream are all things I consume with some regularity. Omelettes just wouldn’t be the same. I don’t notice and problems, and have gotten quite lean while consuming these, so I don’t see it as something I need to worry about. Like with all forms of anything that increases insulin secretion, the answer is the same: intermittent fasting. Get that insulin down by eating NOTHING sometimes, then the spikes are not only lower (higher sensitivity), but can actually be good as they get leptin levels up (refeeds). If you’re not allergic, eat cheese, it tastes good.

    Graham wrote on January 11th, 2011
  12. Amen

    Garth Whelan wrote on January 11th, 2011
  13. my son is a small farmer in VA, and he put me on to this organization: . the FDA is giving hell to small producers trying to sell their “clean” organic, raw, grass-fed, dairy products to people like us. makes me so furious….

    tess wrote on January 11th, 2011
    • it’s for your own good, but smoking’s ok,

      Simon wrote on January 26th, 2015
  14. I think at this point since I love milk in my lattes, I’m going to go with raw whole fat milk, raw cheese and raw butter in moderation and see how that goes for me. I too wish we could get more info on raw vs pasteurized though.

    Terri wrote on January 11th, 2011
    • I wouldn’t bother going to too much trouble to get raw milk for your lattes. When you steam the milk to 160 degrees to get the foam, you are essentually pasteurizing it.

      OctoberAmy wrote on March 5th, 2016
  15. I’ve just looked up ‘heavy cream’ on FitDay, but the problem with that is it measures it in ounces/grams, whilst we measure cream in the UK in ml (as it’s liquid – apart from clotted cream as it’s, well, not!)

    1 tablespoon (20ml) of double cream has the following macronutrient profile: –

    0.34g protein
    0.52g carbs
    9.5g fat (of which 5.95g saturates)

    Heavy cream seems to be considerably lighter; not as heavy as our whipping cream (which is NOT the same as yours), but heavier than what we’d call creme fraiche. According to FD, 20g of heavy cream contains 0.56g carbs, 7.4g fat (4.6g sat fat).

    I don’t have cows’ dairy at all (apart from cream) – I have goats’ dairy because the casein doesn’t upset my stomach like cows. I don’t have goats’ cream, because it’s very hard to come by.

    Goats’ butter seems to vary in fat content, from 80% up to around 90%, depending on bran (the brand I buy, which is fully pastured, is 88% fat).

    I also eat quite a bit of goats’ yoghurt (though I try to limit myself to a 4oz (100g) serving per day (I do mix it with double cream, though – am I intensifying the insulin response this way…?) The yoghurt’s from the same farm as the butter, so I know it’s also fully pastured. It’s 5.5% protein, 4.3% carbs, 7.3% fat (compare that to Fage, which I used to consume a lot, which is 10% fat, 6.8% protein, 3.2% carbs) – would I be better off going back to Fage…?

    I’ve not been feeling at all well since Xmas (it’s come on VERY suddenly, so I doubt it’s anything to do with anything I’ve eaten/eating, the rest of my diet’s pretty sound) but I have gained a mysterious 20lb from somewhere (that ain’t shifting) but I know damned well that you can’t gain 20lb of fat in a fortnight. I have a very swollen, sore, tender, belly, enlarged tender, breasts, pain & tingling in both arms (but particularly my left) I ache all over, don’t sleep at night, am exhausted all day (regardless of what my sleep at night’s like) and have had 2 very heavy, very long, periods in the space of less than 3 weeks – and I can’t get a doc to take me seriously!

    I’m mentioning this here in the hope that SOMEONE might be able to tell me what’s going on (I have PCOS, by the way). I’m REALLY watching what I eat, because there is NO WAY I can go out to exercise – hell I’ve no clothes that fit at the moment, either (I’ve had to borrow from my kid sis – I’m a 0-2 usually, and she’s a 10-12 (I’ve Americanised the sizes).I’ve gone from a UK 28C/30B bra to a UK 36DD (still had a couple in the back of the wardrobe!) Now, apart from the periods, everything I’ve read says it’s either cancerous – or I’m pregnant (and I know damned well it can’t be the latter!)

    I’m getting desperate! I was supposed to be returning up north last Friday, but I’ve not been well enough to go! I’ve gone from being a fit, healthy and active 36-year-old to being practically bedridden!

    I’m desperate! Being autistic doesn’t seem to help, either!

    Sarah wrote on January 11th, 2011
    • Keep asking for second, third, fourth, fifth … opinions at the GP surgery you are nearby, if no satisfactory answer, go to the next one – if you are away from home you can register as a temporary patient. Pregnancy is my most obvious spot from that list of symptoms but you rule that out. In someways it sounds like an acute allergic reaction but don’t delay it needs sorting one way or another.

      Kelda wrote on January 11th, 2011
      • I’m not allowed NEAR any surgeries at the moment. There are only 2 round here anyway.

        Wherever I go, I’m treated like crap. I can;’t help being autistic – it was how I was made.

        Right now I’m too exhausted to fight anymore.

        I’m sick of being sick
        I’m tired of being tired
        I’m f*cked with being f*cked.

        My Little Empire – Manic Street Preachers

        There’s no room in this world for a girl like me
        No place around where I will fit in

        Born A Girl – Manic Street Preachers

        You’re tender and you’re tired
        You can’t be bothered to decide
        Whether you live or die
        Or just forget about your life

        You’re Tender and You’re tired – Manic Street Preachers

        It’s all very well saying that but I can’t get anywhere with the PCT, PALS, ICAS – I’m terrified of using the phone and I’m on my own. But the periods? The first was 10 days and this, I think, has been nearly a fortnight.

        Thank you for listening, though. It means a lot…

        Think I’ll go to bed now. With any luck I might not wake up tomorrow…

        Sarah wrote on January 11th, 2011
        • Whatever you do, don’t give up. DON’T give up. Keep looking. Help is out there.

          Cj wrote on January 11th, 2011
        • I hope you are feeling a little better today – you are clearly in the UK, is it possible to email your local surgery with a brief description of your problems and a plea for sympathetic help.

          Or, have you considered just turning up at Accident and Emergency with your brief list and just sitting there until someone helps? I know you say getting out is difficult but if you could summon up the courage/strength … alternatively Samaritans might be in a position to get you help to your home.

          Kelda wrote on January 12th, 2011
        • Sarah,
          My daughter is 27 and has PCOS. She takes metformin, birth control pills and follows a strict diet and exercise program. I totally understand how you feel about the quick weight gain. Are you taking metformin? That made a huge difference for my daughter.

          Joanie wrote on January 18th, 2011
    • You say you are autistic – if possible can you take someone with you (your sister?) to explain on your behalf or perhaps better still write all the symptoms down and hand to the GP to read. It might just make the consultation easier for them and for you?

      Kelda wrote on January 11th, 2011
      • As far as I am concerned I don’t HAVE a sister. The clothes I have of hers she left here.

        It’s a long story, but it’ll be a cold day in hades before I speak to her again…

        Sarah wrote on January 11th, 2011
      • I’ve done the writing down thing – it’s either ignored, or I get a response along the lines of “I don’t have time to read this!”

        Sarah wrote on January 11th, 2011
        • Just a thought… what if you said you lost your voice? People may have more sympathy for that than autism, sadly.

          arfies wrote on January 11th, 2011
        • Sarah,
          I really feel for you. I understand that doctors don’t take the feelings of people with Autism seriously. I have a friend whose son is nonverbal and suffers from many problems (major gut disorder) and regular doctors want nothing to do with him. Anyway, the only kind of doctor that has taken his chronic intense pain seriously is a DAN doctor. I don’t know if there is one in your area, but that’s a doctor that would try to determine what is going on (unless he/she is not a good doctor, as can happen). I hope you find some relief very soon. Please don’t give up. You can find a solution. I know a lot about pain….I have chronic daily migraines. That’s why I’m trying this diet. Hang in there. Please.

          Ira wrote on January 11th, 2011
    • i’m 45 and got very heavy periods from taking fish oil. many people having surgery are told to stop taking fish oil 10 days before. but i don’t have your other symptoms. perimenopause can start in your 30s, but i haven’t heard of such extreme symptoms.

      vmary wrote on January 12th, 2011
    • I have PCOS too and understand how easily and quickly you can gain weight when it is uncontrolled, without any change to diet or exercise routine.

      I found that d-chiro inositol helped me immensely. It was the missing link that allowed my healthy diet and lifestyle to actually do what it was supposed to.

      Your symptoms (if pregnancy is completely impossible, as it is the first thing that comes to mind to explain your symptoms) sound like they may be related to either:

      Your body producing progesterone when it doesn’t ordinarily (this causes fluid retention and when progesterone levels drop after having been high (as in the second half of your menstrual cycle, after ovulation) it triggers the lining of the womb to shed.

      Or a worsening of the insulin resistance (and consequently all of the hormonal imbalances that ensue) associated with your PCOS, possibly from eating some small thing at Xmas which your body reacted badly to, or possibly the same thing caused by stress kicking your hormones out of order.

      You have a lot more challenges to deal with than most people and it’s obviously not easy. Good luck finding the doctor you need and deserve. If you ever want to chat about PCOS, please contact me via my website ( Maybe there’s information there that can help you.

      Anne wrote on November 18th, 2012
  16. I’m sticking with full fat milk in my tea, a little raw milk cheese, double cream in my coffee and some butter. I don’t appear to have a problem, I exercise more than the average person and I also use IF, in fact I’ve been trialling doing all my workouts fasted and then eating around lunctime (quite like the leangains principle) seems to be working thus far and has controlled my appetite/boredom eating much better.

    Thanks Mark for covering this one again. I suspect there is still more to be uncovered as the science develops because the insulin pathway is still not well understood in terms of its interaction with other hormonal pathways especially when heavily overloaded.

    Kelda wrote on January 11th, 2011
  17. It’s important to also keep in mind the way milk products were consumed when dairy was added to the human diet. Yes, it was raw, but it was also in different formats depending upon the season–fermented/fresh curd products in the spring, summer and fall and aged cheeses and butters during the winter. Domesticated animal lactation was (and should be) seasonal meaning dairy wasn’t consumed in the same quantities year-round. Where I believe that the Primal/Paleo methods of eating fall short is on mimicking the seasonality of nutrient supplies in fresh foods.

    Sandra wrote on January 11th, 2011
    • Excellent response!

      lisa wrote on January 11th, 2011
      • +1

        Zain wrote on May 21st, 2013
  18. Wow, I had no idea dairy gives even more of an insulin hit than white bread – I guess the horrible reaction I have to white bread (and, to some extent, bread in general) must be as much gluten intolerance as insulin resistance, though that still doesn’t explain why many of us react so badly to potatoes and rice and not dairy. Curious…

    Ann wrote on January 11th, 2011
    • I am gluten intolerant…was tested for other food intolerances, and potatoes, tomatoes, onions, were high on the list.
      I have spoken with other gluten-intolerant folks, and they have the same intolerances. Many GI people ARE intolerant to dairy as well, as the gut has been damaged.

      cjbrooks wrote on June 20th, 2011
  19. I quit all dairy beginning of Nov. Within a month, my skin was the clearest it has been since I was probably 12 (I’m 47 now!)

    Over the past 2 weeks, I reintroduced pastured butter since some people say it doesn’t cause acne the way other forms of dairy do. Alas, for me it seems it does…my skin is deteriorating rapidly :(

    I don’t mind not drinking milk, I’m OK with goat cheese…but no butter? That’s sad!

    Liz Chalmers wrote on January 11th, 2011
    • Oh, and I should note that eliminating dairy made no difference to my weight or anything else. Just skin.

      Liz Chalmers wrote on January 11th, 2011
    • If you’re okay with goat cheese, have you tried goat butter? That stuff is seriously DELICIOUS.

      Jan wrote on January 11th, 2011
      • I actually have some in the fridge now. But I need to quit all butter for a while to let my skin clear back up again, and then try goat, just so I know for sure if any continued problems are due to lingering effects of cow butter or goat butter.

        Liz Chalmers wrote on January 11th, 2011
    • Try clarified butter or ghee.

      Doug F wrote on January 12th, 2011
  20. Hi Mark,

    I’m taking a wild stab in the dark here.

    Mammalian babies drink a lot of milk right. Do babies have high insulin levels? If so do you think this leaves a lasting impression on our bodies that milk = rapid growth and therefore insulin spikes to capture the nutrients to feed that growth?

    Does that make sense?

    Steve wrote on January 11th, 2011
    • That’s a fascinating question. Insulin is a growth hormone so wouldn’t it make sense for the levels to be higher in babies and kids? Not only does it put sugar and fatty acids away, it also puts amino acids into muscles. HM.

      And then again, I’ve heard that babies spend some time in ketosis. I’d love to see that one verified too.

      Dana wrote on January 11th, 2011
      • Maybe that has something to do with gestational diabetes as well? I’ve heard that women who get it are prone to much larger babies, sometimes even dangerously so (in terms of difficult childbirth). So it would certainly appear that insulin levels are related to a baby’s growth, and that babies may well have higher levels in general.

        Ann wrote on January 12th, 2011
  21. Man, I wish I’d read this BEFORE ordering that 2lbs. of casein powder. ><

    I think I'm going to go back to doing a finger-stick before and after eating, so I can determine once and for all if dairy hinders my weight loss progress.

    In light of this information: Does that mean that the benefits of hemp protein should be revisited?

    Ava wrote on January 11th, 2011
    • Glucose monitoring to evaluate effects of dairy will likely underestimate as a proxy for insulin. As noted in the post, insulin is particularly sensitive to the dairy proteins in addition to the lactose. Proteins won’t show up in the glucose measure. Therefore, the finger-stick may read an acceptable value for the lactose portion, but the actual insulin will be higher due to the protein sensitivity. How much higher? Depends on the individual’s insulin sensitivity among several other factors.

      In other words, you would need to calibrate the glucose measurement to a real insulin test value specifically designed for the dairy you plan to evaluate.

      Asturian wrote on January 11th, 2011
      • That’s interesting, I hadn’t considered that angle when I last posted.
        So, you’re right that a glucose test wouldn’t be able to measure the insulin response to the milk proteins, but wouldn’t the test strips still measure the overall response to the consumed dairy? For example, if I tested myself prior to eating a hunk of (full-fat) cheese, and then tested 1 and 2 hours after; would a lower blood glucose reading not be indicative of an elevated insulin response?
        Please feel free to correct me if I’m wrong — I have a number of physicians who seem hell-bent on my having PCOS/insulin resistance, and I’m having a hard time getting a handle on just exactly how my food choices affect my BG.

        Ava Dahl wrote on January 11th, 2011
        • A glucose measurement from eating dairy will only reveal your response to the lactose (carb) portion of the dairy, not the dairy overall.

          Pre- and post-prandial testing for a hunk of cheese would show a low BG level even though your insulin response would be elevated due to the dairy proteins.

          If insulin resistance is your concern, you (like myself) would do best to avoid all dairy except perhaps ghee (clarified butter fat which has had all carbs and proteins filtered away). And of course, eat at the low-carb to ketogenic end of the primal spectrum.

          Asturian wrote on January 11th, 2011
    • I forgot to add.

      I stopped consuming dairy about 2 or 3 months ago, cold turkey. Surprisingly, I have had no cravings for it.

      Well technically I do still use dairy in the pure butter fat form of ghee. However, all of the lactose and proteins have been removed from this type of dairy.

      Asturian wrote on January 11th, 2011
  22. I think the point with dairy should be moderation. If your goal is to lose weight, then you can have some dairy, but not a lot. I see people saying, “Your problem is all that dairy. Get rid of it!” I say you can eat anything you want as long as you do so in moderation.

    Johnny wrote on January 11th, 2011
    • Which means you eat Doritos in moderation, right?

      There’s this persistent mythology that people get fat from eating too much. Some foods just plain aren’t good for a person, and that question varies depending on someone’s individual metabolic situation–but it doesn’t vary *that* much, since we’re all the same species.

      It’s looking, according to the research, more like the process of becoming obese drives the overeating, not the other way around. And there are usually specific things people want to overeat when they are getting fat. Generally those things are not steak, butter, and salads. Generally it’s things like the aforementioned Doritos, and sodas, and French fries… do you see a common denominator here?

      I don’t gain on dairy fat, but I might gain on lactose. I’m not willing to drink enough milk to find out. Kefir I get along with OK though, and yogurt too.

      Dana wrote on January 11th, 2011
      • Dana, until they’ve read Taubes (which I have – cover to cover) people seem incapable of really understanding that point, thanks of course mainly to CW. Sad but true. And there aren’t many people who are willing to wade through it unfortunately, and of course many just don’t like the reality of what he shows :-(

        Kelda wrote on January 12th, 2011
      • well expressed, Dana!

        tess wrote on January 12th, 2011
  23. there’s another issue with the studies that use skim (processed) milk and low fat – there is the issues of pasteurization which fundamentally changes all kinds of structures in the milk. I’m not suggesting that dairy is perfect when raw – but i’d be willing to bet it’s much better–

    DaiaRavi wrote on January 11th, 2011
  24. Wow, I wonder if my cottage cheese intake is hindering my fat loss. I really enjoy cottage cheese in moderation as a topping for certain foods and a base for things like egg salad. I might try to go without it for a week or two and see how I do.

    Rhys wrote on January 11th, 2011
    • Nearly all commercial cottage cheese has carrageenan in it, which acts like MSG. Be careful.

      Nancy wrote on January 11th, 2011
    • Cottage cheese is not aged, so there’s still plenty of lactose in it. That alone could stall you.

      People following the Atkins plan are told to avoid fresh cheeses while in Induction, and to stick only with aged ones, and not very much at that. Butter they can eat liberally. Cream, there’s a little bit of carb content there.

      Dana wrote on January 11th, 2011
      • Thanks for the information. I was just faced with buying cheddar that was aged 60 days versus some that was aged 24 months. Now I know which to buy next time.

        Usman wrote on January 13th, 2011
    • I’m wondering the same thing! I am on the slow-carb diet at the moment and while I have lost some weight, I expected a little more. I was using cottage cheese as a good low-priced source for a lot of protein, but I think I better just stick to tuna and meats!

      Camille in Slovenia wrote on January 14th, 2011
  25. I think that since milk is the only food that babies have for the first few months/weeks of life, one of the main purposes is to put weight on the baby to help it grow.
    Animals stop drinking milk when they are weaned off of the mother and don’t drink it again. Humans are the exception. It’s possible humans aren’t supposed to continue drinking it for the rest of their lives.

    cathyx wrote on January 11th, 2011
    • Except people like the Maasai seem to do fine on it. But again, they drink raw milk and it’s possible the stuff’s started fermenting by the time they get around to it, or that they have good gut bacteria from prior exposure to lactic acid bacteria which seem to be native to milk that hasn’t been heated.

      There’s a claim floating around out there that they’ve got a mutation that makes them continue producing lactase into adulthood. Haven’t seen any solid proof though.

      Dana wrote on January 11th, 2011
  26. and something else weight-wise on this topic – my partner – not an overweight woman for her height at the start of our lacto-paleo, was around 138 lbs. with no effort whatsoever, she has lost about 18 lbs during our 1st 3 months of lacto-paleo eating while our consumption of “good” dairy (cheese both hard and fresh-made with raw goats milk) has notably increased.

    What we DID drop totally was…..

    all grains and bread.

    ’nuff said-

    DaiaRavi wrote on January 11th, 2011
  27. I can’t help but feel we have to, as Mark says, experiment with everything to see how we adapt. Research is helpful but combined with personal experience, it can be hugely revealing.

    Alison Golden wrote on January 11th, 2011
  28. I’m about to go onto a mass-gaining cycle of lifting, and I’ve recently been trying to re-incorporate milk into my diet, especially as a post-workout beverage (damn sight cheaper than protein shakes, and I get a load of protein from my usual meals as is). I’ll letcha know how it goes in a month or two, if you want.

    Bennett wrote on January 11th, 2011
  29. I have found in myself a definite correlation between drinking cow’s milk and a grumbly tummy. I know it causes inflamation and is mucous inducing for I have watched out for it and experienced it. I’ve pretty much eliminated milk from diet completely. I absolutely love almond and coconut milk as a substitute for when I need it. I haven’t experienced any significant noticable changes when I eat cheeses, whether that’s derived from cow’s milk or goat sheep’s milk. I personally love goat feta cheese and enjoy it in my salads, among other dishes. My naturopathic doctor also recommended eliminating cow’s milk and subsequent products made for it.

    Dana wrote on January 11th, 2011
    • Grumbly tummy probably means lactose intolerance. You can eat cheese with no problem, so it’s likely not a casein allergy, which I think trips up a lot of people who have problems with milk. (If someone out there’s got tummy upset from aged cheese or heavy cream, that’s not lactose intolerance–you’re not getting enough lactose to bother you. Especially if you *aren’t* having tummy issues with whey protein.)

      Dana wrote on January 11th, 2011
    • If grumbly tummy means producing awe inspiring amounts of gas then you are probably lactose intolerant.

      It’s hard to miss, it’s like a “HOLY MOTHER OF GOD!” reaction.

      rob wrote on January 11th, 2011
  30. i think theres more to not just the dairy debate but the amino acid complex in food and its relation to weight and insulin clearance or resistance. i reall dont have answers, but i can literally down 10-12oz of cheese a day AS LONG as it is raw, and it has no bearing on my body composition. if i did that with store bought dairy it would be a totally different story. i am very interested in the amino acid connection to weight management.

    Mallory wrote on January 11th, 2011
  31. No milk is good milk. Too much hormones and such in that stuff these days, I think they’re is a reason that you stop drinking breast milk after a certain age, your body no longer needs it and you start eating a more appropriate diet.

    Bummer though, milk still tasted good to me when I quit.

    Nicky Spur wrote on January 11th, 2011
  32. now i’m really confused. I’m trying to put on muscle mass. (I’m 41, by the way, not a teen trying to GOMAD). Naturally ‘skinny’. The only way I can come near Mark’s recommendation of 1gm of protein per pound of body weight is to supplement daily (2 or 3 times) with whey protein.

    Is this doing my health damage due to the insulin response? Does this take the accute response into a chronic response due to the regularity of it?

    The whey is plain, unflavoured (I add cocao powder for taste).

    JP wrote on January 11th, 2011
    • I wouldn’t be too concerned with it, JP. I supplement with whey most days and put getting adequate protein ahead of any concern about whey/insulin. Especially, as I said, if you’re relatively active.

      Mark Sisson wrote on January 11th, 2011
      • Mark, here’s another big factor in the dairy debate – the breed of the cows you get your dairy from, A1 or A2 Cows.

        Google “The Devil in the Milk.”

        Dave from Hawaii wrote on January 12th, 2011
  33. I have been primal for 4 months or so and have noticed a slowdown with the weight loss (still have plenty to go to be in the optimal lean and healthy zone). I have been using heavy cream, butter occasionally, and cheese from time to time. Maybe I need to completely eliminate these as you mention, at least until I am at the point I want to be…sure will be hard but maybe that’s the trick.

    J wrote on January 11th, 2011
  34. A little off topic, but…What’s the primal take on almond milk? I can’t bring myself to use coconut milk in my coffee, but almond milk doesn’t have many carbs (mostly fat). Is this an acceptable alternative to something like half&half (after this post, I’d assume the insulin response would be lower, at least!).

    Kathy wrote on January 11th, 2011
  35. If you’re gonna cut out all grains on the grounds that it’s a recent addition to our diet, I say cut out dairy, too. It’s an even more recent addition to our diet. Plus, milk is intended for infants 😛

    Rachel wrote on January 11th, 2011
    • Milk’s an animal food and the proteins are more compatible with our bodies than wheat protein is.

      Dana wrote on January 11th, 2011
      • Lol…pretty sure casein is only present in milk!

        Rachel wrote on January 14th, 2011
  36. To paraphrase Dr. Rosedale, we’re getting fat because we can’t burn it. Perhaps a simple explanation for dairy stalling out weight loss is the saturated fat content. If your body is burning fat effectively, it’s may not be a big deal. But, if one is trying to lose one’s own saturated fat stores, then consuming more of it, particularly from a product that raises insulin levels, may not be helping. Just a wild and unqualified guess.

    js290 wrote on January 11th, 2011
    • If you have read anything at all about Primal eating, you’d know we don’t shy away from saturated fat in any other form (in fact we generally embrace it as the best thing since… well, ever). I don’t see why it would be the saturated fat that’s the problem, but rather some other reaction to the enzymes/proteins specific to milk.

      Uncephalized wrote on January 11th, 2011
    • If I’m in ketosis it doesn’t matter how much fat I eat, the point is that my insulin is so low that my body can process any fat that is in my system, whether it’s my fat or something else’s.

      If my insulin’s not up then there’s no mechanism to make me store the fat. No matter where it’s from, either I use it for energy or it gets breathed, sweated, or peed out. Buh-bye.

      Dana wrote on January 11th, 2011
  37. I have read that different breeds of dairy cows have different protein make-up, beta casein A1 attributed to a myriad of health issues, (serum cholesterol levels to weight), whereas beta casein A2 is a better choice. The dominate dairy Holstein being A1 and the Guernsey, Jersey, and Watusi, along with sheep and goat are A2. May be well worth looking into for those with issues.

    I have found a pastured, non homogenized, lightly vat pasteurized Guernsey heavy cream so far, but am having trouble finding raw in my area. The taste is incredible!

    Karla wrote on January 11th, 2011

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