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

The Definitive Guide to Dairy

I knew going in this was going to be a tricky one, because dairy, especially raw and/or fermented full-fat dairy, resides in a Primal gray area. The literature, the evolutionary reasoning, and the anecdotal reports all unanimously point to sugar, cereal grains and legumes, processed foods, and industrial vegetable oils as being net negatives on the human metabolic spectrum, but dairy is somewhat different. The other Neolithic foodstuffs we can rule out because the science condemning them is fairly concrete and they weren’t on the menu 20,000 years ago. Heck, they weren’t just off the menu; they were basically unrecognizable as food in the raw state. Dairy, on the other hand, is a relatively recent food chronologically, but it is most assuredly and obviously a viable nutritive source in its raw form. It’s full of highly bioavailable saturated fat, protein, and carbs – in equal portions. You could conceivably survive on milk alone (I wouldn’t recommend it, but you could technically do it; try doing the same with honey or raw millet). Milk is baby fuel. It’s literally meant to spur growth and enable a growing body. Our bodies definitely recognize dairy as food, even foreign bovine dairy. But is it good nutrition?

I don’t know. I’m not sure anyone really does, in fact, which is why I place dairy firmly in Primal limbo. And so, this Definitive Guide to Dairy may come across as being a bit less than definitive, but that’s only because I’m being honest: we simply don’t know whether dairy is suitable for regular human consumption. Whether you include or exclude it from your diet, the decision must be borne from a review of the available literature (Cordain v. Weston Price, for example) with an assessment of the potential risks and benefits, followed by a personal assessment of dairy’s effect on your body (try it, then strictly eliminate it, and note the differences). If you’ve been eating dairy your entire life, your body doesn’t know anything else. In that case, you’ll want to fully drop it for at least a month to get an accurate assessment. Remember – pre-Primal, you probably “felt fine” eating grains and sugar every day. You may have to take the same approach if you really want to figure out what dairy does to you.

You could listen to Dr. Loren Cordain and other strict paleos who adamantly oppose all forms of it. They offer a number of reasons why dairy doesn’t belong in the human diet – mainly lactose intolerance and casein intolerance. Yet, the truth is,  lactose (a form of sugar) and casein (a form of protein) are both found in human breast milk, so each of us – and certainly every one of our ancestors – was not only able to tolerate but to thrive for some time during infancy depending on both of these “questionable” molecules. That’s the main thing that makes eliminating dairy a little less clear cut than eliminating grains and legumes. But let’s look a little closer at the intolerance issue.

Lactose Intolerance

The widespread presence of lactose intolerants, who still make up a majority of the world’s inhabitants, is somewhat compelling evidence that maybe dairy isn’t the ideal food many assume it to be. Worldwide, we see that most people aren’t adapted to lactose consumption after age four, when many of us lose the ability to properly digest lactose (actually gene expression for the enzymes involved in lactose digestion are down-regulated). Nevertheless, it would appear that among many people, most of whom can trace ancestry back to herding cultures, some adaptation has taken place that allows them to continue to effectively digest lactose throughout their lives. I would never argue that a lactose intolerant person should drink milk; if it makes you feel like crap, don’t eat it! At the same time, though, if that same person were to complain about getting enough fat in his or her diet, and olive oil and coconut oil weren’t cutting it, I would suggest incorporating some cream, butter, or ghee. Little to (in the case of ghee) no lactose to speak of, and you’d be hard pressed to come up with a better all-purpose cooking fat. Lactose intolerance won’t kill you if you ignore it. It’s actually pretty impossible to ignore rumbling guts, explosive diarrhea, cramps, and bloating, so I doubt the truly lactose intolerant will miss it.

Casein Intolerance

Casein is the primary protein in dairy. It shares structural similarities with gluten, a highly problematic grain protein that can shred the intestinal lining and lead to severe auto-immune issues. Bad, bad stuff, and a big reason why grains are so unhealthy. (And if you’re still not convinced that grains are unhealthy read this (PDF).) Now, paleo opponents of dairy say casein wreaks similar havoc on our guts, and it’s true that gluten intolerance goes hand-in-hand with casein intolerance. But is casein a primary cause of leaky gut, or does it slip in only after gluten has opened the floodgates? Once a floodgate is opened, any protein can enter and cause issues. And after all, casein is the primary protein in human breast milk…


Cordain thinks milk leads to cancer, citing a fairly impressive array of studies that seem to suggest a link between milk consumption and various types of the disease. He fingers betacellulin, one of milk’s epidermal growth factors, as the causal agent. In the fetus and suckling newborn, betacellulin helps with growth and tissue differentiation. It’s completely essential for growing infants. In adults, Cordain says it passes cleanly into the gut, completely intact and free to enter circulation, where it can bind to receptors and enhance cancer cell growth. What Cordain doesn’t mention is conjugated linoleic acid (CLA), which is also found in milk fat (especially raw, grass-fed milk, which is never included in any study) and has been shown to possess anti-cancer effects by inhibiting breast cancer cell growth and reducing the activation of insulin-like growth factor receptors (the same receptors Cordain identifies as sensitive to betacellulin). The studies Cordain cites as support of the milk-cancer connection are interesting, but their messages are muddled. As Chris Masterjohn points out, milk proteins mostly appear harmful only when separated from their natural fat. Low fat and skim milk appear to have associations with certain cancers (like prostate), while whole milk appears protective (of colorectal cancer) or neutral. It would be nice to see researchers take a good, long look at full-fat, pastured dairy’s effects on cancer rates. Conventional milk consumption probably isn’t advisable, but the jury’s still out on whether raw, pastured, whole milk is also problematic. We need more data.

Insulin Response

Milk is highly insulinogenic, more than most carbohydrate sources. We’re all aware of the dangers of chronically elevated insulin levels, but that’s also what makes milk such a popular post-workout recovery drink. If you’re insulin sensitive following a tough strength training session, milk’s insulin response can be an effective way to shuttle in protein and glycogen. I don’t do it myself, because I like to fast post-workout (and I don’t like the taste of regular milk) but some people swear by it. This is just speculation, but perhaps the potentially negative effects of milk are negated by the post-workout internal environment (starved muscles, depleted glycogen, insulin-sensitive tissue). Or perhaps those powerlifters are slowly but surely eroding their gut lining. To be on the safe side, maybe limit your milk drinking to immediately post-workout if you’re going to drink it at all.

There isn’t a whole lot of consensus on the subject. People with whom I normally agree on everything regarding nutrition have completely different takes on dairy. Some MDA forum goers report no ill effects, while others complain of joint pain and clogged sinuses from consuming even a single ounce of dairy. More than any other food, dairy seems to be entirely subjective. There is no “one size fits all” approach to it. To be on the safe side and to go “full Primal,” you would technically eliminate it completely, but that may be unnecessary for a relatively large number of people.

In a strange way, this entire blog is just a detailed, science-based map of my own personal journey augmented with anecdotes and experiments from others on similar, but slightly divergent, paths. Much of what I write is founded in science but based on my experiences, and this particular post is no different. When things are gray and murky and the science is unclear and far from definitive, I generally go with anecdote and personal, n=1 experimentation. Personally (and, in a way, this entire blog is just a detailed map of my own personal journey), regular dairy doesn’t generally agree with me. I don’t buy or drink milk. Having said that, I’m a big fan of heavy cream in my coffee and butter in my eggs (and on my steaks and vegetables). I like a nice thick yogurt sauce on lamb, and occasionally either Greek yogurt or fresh whipped cream with berries for dessert. I even have a bit of artisan cheese once in a while. It works for me. I don’t get cramps or gas, and I don’t get leaky gut symptoms from casein alone (gluten is another thing altogether). I’d say, on average, I consume at least one dairy item each day (usually butter), but that’s not a hard and fast rule.

As I mentioned in my book, I think there’s a continuum, a cascading scale of suitability when it comes to dairy. It’s not all created equal.

Raw, fermented, full-fat dairy is probably best.

Tons of traditional, fairly disease-free groups lived with dairy (just as tons of traditional, fairly disease-free groups lived without it), and they all included some form of fermented or cultured product. Cultured butter, yogurt, kefir, clotted milk, cheese – these are traditional ways of increasing shelf life, improving digestibility, and incorporating beneficial probiotics into the gut. Fermentation takes care of most of the lactose, and some posit that it may even positively alter the structure, function, and safety of casein.

Raw, high-fat dairy is next.

Raw butter and cream are minimally processed sources of good saturated fat. They’re free of most lactose and casein, and let’s face it: butter and cream just make everything taste better. If it’s essentially just pure, raw animal fat from grass-fed animals, without offensive levels of milk proteins and sugars, what’s not to enjoy? Ghee is another good choice, and though it technically isn’t raw, it is pure animal fat without a trace of lactose or casein.

Then raw milk.

I don’t advise regular consumption of raw milk, mind you, but if you can tolerate it (no stomach upset, no bloating, no gas, no intestinal issues) an occasional glass is probably OK as a sensible vice. Some farms will even supplement their raw milk with colostrum (the extra rich, “first run” milk that provides even more vitamins and nutrients), resulting in a lower-carb, higher-fat, higher-protein product. Look for that stuff if you’re thinking of buying raw milk.

Organic, hormone and antibiotic-free dairy (full fat, of course).

Bottom line: don’t consume non-organic dairy if you can help it. Avoid homogenized milk if you can, and try not to purchase pasteurized milk (organic or not) on a regular basis. If you’re out getting coffee or something, the regular half and half or heavy cream are fine, and Kerrygold makes a great pastured, pasteurized butter that’s available nationwide.

Other things to consider:

A2 Milk versus A1 Milk

Milk proteins are made up of different beta-caseins, which vary between cow breeds. There are two main categories of beta-casein: A1 and A2, each with different effects. A1 cows (Holsteins and Friesians) produce A1 beta-caseins, which release an opioid-like chemical upon digestion. This chemical, called beta-casomorphin-7 (BCM7), is a protein fragment that figures into the joint pains, digestive issues, and leaky gut symptoms that detractors typically blame on just casein. A2 cows (Jerseys and Gurnseys), on the other hand, produce A2 beta-casein, which has been vindicated. Raw, pastured milk tends to come from Jersey and Gurnsey cows; Holsteins and Friesians produce far more milk and so are used by conventional, factory dairy farmers. The Masai, for example, have A2 cattle.


Goat dairy is another option, with more fat (that’s never homogenized, even when pasteurized), less casein, less lactose, and fewer digestive issues. Structurally and nutritionally, goat milk is one of the closer corollaries to human breast milk, making it arguably more suitable for human consumption than cow’s milk.

In the end, is there a definitive stamp of Primal approval, or Primal disapproval? I just can’t go either way. Sometimes, the correct path is to admit that you simply don’t know. You can read all the blogs you want, pour over every comment, follow every link, and pontificate about every hunter-gatherer group on the planet, but if you don’t try things out for yourself – either by trying certain dairy products or by eliminating them and noting the effects – it’s all just speculation and hearsay. In the murky, milky world of dairy, it’s up to you to decide your ideal path.

Tell me about your experiences. Is dairy part of your Primal eating strategy? If so, what (butter, milk, yogurt, cheese, etc.) and how much?

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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. Milk is designed to taste good, as it needs to appeal to infants- a big ask of any whole food. There’s no reason why adults would stop liking milk, and the same goes for any other animal.
    I’m not sold on the benefits of dairy. Or the large amounts of meat that are encouraged on the paleo diet, for that matter. Our ancestors rarely caught animals, but had to survive mainly on seeds, vegetables and fruits. Diets varied from place to place but in general, the “gatherers” provided much more than the “hunters”. These large quantities of seeds and vegetables provided the calcium, along with most of our other essential micronutrients. Adults are not designed to consume milk of any species, this is why most people have somewhat of a reaction, whether they are aware of it or not.

    bee wrote on July 20th, 2013
  2. Drinking raw, unpasturized milk is a great way to get bovine tuberculosis. Not everything natural is better. Please be careful, and remember that pasteurization isn’t a plot by evil Big Government to ruin your health, it is a vital public service which prevents disease transmission. I wish you all good health, but please be safe.

    Beth wrote on August 5th, 2013
  3. Drinking raw, unpasturized milk is a great way to get bovine tuberculosis. Not everything natural is better or even safe. Please be careful, and remember that pasteurization isn’t a plot by Big Government to ruin your health, it is a vital public service which prevents disease transmission.

    Beth wrote on August 5th, 2013

    I don’t eat any form of dairy due to allergy, so this article didn’t really pertain to me. However, my younger son drank some raw milk while working on a dairy farm a few years back. He got campylobacter and lost 30 pounds in 3 weeks and it could have been worse (see link above). For me, I wonder, why risk it?

    SheGrok wrote on August 5th, 2013
  5. A1 Casein appears to be a huge problem for me. My autoimmune system would attack this protein as a foreign invader and I would get the same bloating and gas problems as I would get from gluten. As a result, my exhausted autoimmune system would not take care of other secondary low level infections such as sinus infections, bronchitis, athlete’s foot, jock itch, and dandruff. And to add to the misery, it occasional triggers migraine headaches as well; possibly from my body manufacturing caseomorphin from A1 casein (similar to gluteomorphin being manufactured from wheat gluten).

    James wrote on September 13th, 2013
    • My eye caught your post….I have the same reactions to protein and casein. I am too scared to try A2 milk..have you tried?
      I have more to tell you – warn you about these auto-immune reactions but I have to do something else right now. keep posting so remember to get back to you.

      Mandy wrote on September 14th, 2013
      • I have tried goat milk (Meyenberg brand) for the last few months and the various autoimmune related infections such as sinus infections, bronchitis, dandruff, etc. are continuing to lessen as long as I avoid A1 casein (Holstein Cow Milk) as best as possible (i.e. no Holstein yogurt, cheese, milk, buttermilk, and cream products). However, I seem to be ok with grass-fed butter (like Kerrygold). Goat/Sheep (A2 casein?) milk cheese, such as Pecorino Romano, seems to be ok in moderation. I am experimenting with goat milk Kefir, to see how I do with that. The good news is that I have been able to avoid catching the flu that wiped out the office a week ago, which tells me that my immune system is strengthening in the absence of A1 casein. I am eating sardines packed in water (or tomato sauce) and drinking pressure-cooked bone broths for my primary sources of calcium.

        James wrote on November 30th, 2013
    • Back to your allergies, I am guessing that you are referring to intollerances rather than allergies.
      I have been diagnosed with intollerance to mlk protein, gluten, and a slightly less severe intollerance to all the grains except for corn. In addition to that I react to gases released by mold of all forms so I am intollerant to that. I got hashimotos hypothyroidism when I lived in a moldy place and was told that I have it for life but when I moved to a dryer house it went and I felt great. However, when I moved to another place that had mold hidden under paint, the hashimotos came back and I got another autoimmune illness on top of that – systemic sclerosis. I was told by rheumatologist that there is no cure for the sclerosis but there is. Check out tetracycline therapy for arthritis. There is evidence that arthritis may also be auto-immune.
      Anyway, the point I am making is that if you don’t remove those foods from your diet, your body will have anti-bodies simply looking for something to kill and they are in a hyper alert state and can end up attacking your healthy tissues. Take action before it is too late

      Mandy wrote on September 14th, 2013
      • I agree, and I am taking action to remove the offending toxic foods (gluten and A1 casein), as best as possible. I have been wheat free since last year, and now cow casein free since August, with the exception of grass-fed butter.

        For corn, I have found that I can handle masa harina (lime treated corn), but not cornmeal. Corn on the cob also appears to be ok if eaten as an occasional treat. Vegetable oils are pretty much off limits for me. Even olive oil can give me stomach upset from time to time. Almost all legumes are off limits for me; especially soy. The exceptions appear to be green beans and frozen peas; maybe Anasazi beans are ok. I haven’t tried them yet. Starchy tubers such as potatoes, sweet potatoes, and parsnips are ok. Sprouted brown rice, sprouted brown rice flour, and sprouted oats are ok. For baked goods, I have found that Konjac Root powder is a good substitute for Xanthan gum. Both tapioca starch and corn starch are off limits for me. White rice is a problem; symptoms include plaque buildup between the teeth and blood-sugar spikes, along with an athlete’s foot flare up.

        The good news is that my teeth and gums have also improved, since removing A1 casein from the diet.

        James wrote on November 30th, 2013
  6. Raw dairy products can be extremely dangerous. There’s a lot of nasty stuff that can be lurking inside even the healthiest of organically reared and grass fed livestock.

    This was only brought to my attention when a friend required heart surgery to repair damage caused by Q fever. The source of the initial illness was traced to a short period of unpasteurised milk consumption from a combination of blood work and detective work.

    JDC wrote on October 12th, 2013
  7. Hello

    I have been consuming organic raw dairy now for over 5 months and I must say I have never felt better in my life. I believe too many people jump on the band wagon saying dairy is evil. Mind you the conventional commercial dairy is a whole other subject. I would not touch that stuff. I buy all my raw organic dairy includes: full fat milk full cottage cheese heavy cream butter strong kefir 1st colostrum
    from an Amish Farm. This is first rate of THE highest quality. I think if people were more open minded and put down the old school thinking of dairy and tried it from a local organic farm in its pure raw state they would firmly see and taste this goodness. The bigger the myth the easier it is to exploit and jump in. Please do your research on raw dairy and you will see why there is such an explosive movement for people getting into it. Now I must get to my fully loaded raw dairy shake : milk heavy cream home made raw coconut cream raw egg raw kefir 1st colostrum lime coconut flakes unheated honey a Lil fruit. Oh and the best thing about including raw dairy YOU LEAN OUT !! Yup that’s right- just eat clean and watch the magic happen

    Scott Belanger wrote on October 15th, 2013
  8. I myself practice Intermitent fasting warrior diet style doing 20hr fast with 1 meal a day after i do movnat i like 1 glass of whole organic milk from grass fed cows :)

    Timothy wrote on March 13th, 2014
  9. Mark, you say that goat milk is structurally and nutritionally more like human milk… I don’t understand that at all. From my own research, trying to find some justification for my own love of goat milk, I found that both goat and cow milk have more protein than human milk, and that goat milk has more fat than cow milk, both of which have more fat than human milk.
    The happiest facts that I know about goat milk are:
    1) that it has less lactose than either cow’s milk or human. Human milk has the most lactose of the 3, and the least fat. This explains the thin appearance of human milk, and its incredible sweetness. I will attest to these both personally, as I expressed milk for both my babies for several months when I went back to work…
    2) that goat’s milk has smaller fat globules in its structure, which tends to make it more digestible.
    I think I have also seen information to the effect that humans have raised goats and sheep for longer than cattle… which would argue for better tolerance.

    Marge wrote on April 6th, 2014
  10. dairy as a source of calcium is questionable also. I read somwhere that countries with the highest dairy consumption also have the highest arhritis rates.

    Farmer wrote on July 1st, 2014
  11. If you come from European (Caucasian) stock, you NEED dairy. Period.

    Lulz wrote on July 22nd, 2014
  12. My Great Experiment Correlating Sharp Prostate Pains While Consuming Dairy.

    Just wanted to mention my grandfather died of prostate cancer and I believe I have the same genetic predisposition because when I consume a lb of pastured Holstein butter I get random sharp pains in my prostate area. I get these sharp pains when I eat much less quantitites of Holstein grain fed butter as well.
    And these sharp pains also happen on the days that I consume a lot of carbs (while eating high fat, med protein) particularly in the form of medjool dates, bananas and walmart brand almond butter. And when I give up dairy or keep my carbs down the random prostate sharp pains go away. This was a great discovery for me.

    I just want to add another main point Cordain is against the consumption of dairy is because it stimulates the endocrine system and promotes prostate cancer in men and breast cancer in women. Just too many hormones in the milk.

    Here is an interesting article written by a Harvard Scientist on the relation of prostate and breast cancer with dairy consumption.

    Dan wrote on October 16th, 2014
  13. As an ethical vegetarian (refuse to eat something I couldn’t kill myself), I count on dairy fat for much of my fat needs. Not a fan of drinking the liquid stuff, but butter, ghee, cheese, sour cream, yogurt… gimme.

    Karen wrote on October 31st, 2014
  14. Just saw Mark Sisson of Dr Oz. I haven’t watched Dr Oz in a while & turned it on while cooking. I’ve def been doing the Paleo wrong. Veggies have not been the majority of my plate, but will be transitioning to that now! I also wonder about GOAT Yogurt & if it benefits people who were never breast fed, so they were never given those vital immune protection benefits. I’m trying to heal my Leaky Gut, so in addition to chicken broth, soup, i added Goat yogurt. It seems to agree with me and no digestive issues, but i cannot tolerate ANY cow dairy whatsoever. So i avoid cow dairy even organic. I haven’t had the nerve to try pasture grass-fed raised yet. I don’t plan on it, since Goat is doing fine. I will eliminate Goat yogurt eventually, to see if I notice any change. ~~Thanks for spreading word about Anti-inflammatory Paleo!

    crosswind wrote on December 19th, 2014
  15. Thanks for the healthy tips!

    Sonia wrote on February 24th, 2015
  16. The sale of raw milk is illegal in many states, including mine. Any suggestions? Can I order it from somewhere?

    Tracy wrote on May 25th, 2015
  17. I agree with all of this. Would you have links to any available studies you used for this articles?


    Monica Parodi wrote on June 6th, 2015
  18. The comments were more intertaining then the article… Ha ha ha I just wanna say in my personal opinion it has more to do with genetics. My grandpa is Hungarian we eat sour cream, cheese and yogurt on everything. I went vegan for a while and was covered with eczema, the dermatologist felt very strongly that I needed to add dairy back into my diet, gave me à long speech about genetics and how certain cultures developed an ability to actually digest certain elements of dairy that others couldn’t and that we needed the dairy for that reason. I thought he was fun of bull, however I added the dairy back and my skin issues almost completely mwent away. I’ve been eating kinda paleo kinda primal, I’ve kept Greek yogurt as a big part of my diet in hopes of preventing anymore skin issues other then what’s normal for me. Hopefully getting rid of yeast, and grains will help my issues go away 100%.

    Sarah wrote on June 23rd, 2015
  19. All I can say is that I drank milk all my life,then dropped it from my diet 4 months ago and lost 40 pounds

    Diego Paparella wrote on January 29th, 2010
  20. I was not a milk drinker during my childhood and still do not drink it by itself but I do use it for cooking, protein shakes, exc. I do LOVE cheese though. What I find interesting is that I had a food allergy test (IgG) and found that I’m allergic to gluten but not casein. I find that really odd especially if they do in fact go hand in hand. My opinion is…if you like it and your body can process it then enjoy it! I would only do organic though.

    Angela wrote on January 30th, 2010
  21. All I can say is that I wore shorts today instead of pants and it rained.

    Icarus wrote on January 30th, 2010
  22. if that is the ONLY thing you changed you got a point…otherwise, not so much.

    My guess is that you changed a whole lot of things about your lifestyle at or around that time.

    gl wrote on February 3rd, 2010
  23. Good for you, sincerely, but it’s just not that simple for a lot of people and it’s frustrating to read a post like this that seems to say it’s all anyone should have to do to lose weight. Not realistic, but again, glad it worked for you.

    darc wrote on October 8th, 2010
  24. Our normal production of satiation signals is disrupted by excessive insulin production. A similar effect is seen in cannabis use, which is one of the benefits touted for cancer patients as it improves appetite. Weight loss following cessation of dairy and/or gluten often occurs, especially if the individual is overweight.

    I do not agree with cannabis for cancer patients, as it usually results in increased carbohydrate consumption. Otto Warburg showed that cancer cells can only use glucose for energy and reproduction, so cannabis would likely increase consumption of fuel for the cancer cells and abrogate benefits from fats and ketone bodies.

    Ron wrote on March 7th, 2011
  25. Lolol best reply ever.

    Josh wrote on February 3rd, 2010
  26. lol…snort, hiccup…lol

    darc wrote on October 8th, 2010

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