Kurt G. Harris MD

PāNu means paleonutrition. The "paleo" here signifies "old" and not necessarily paleolithic. The PāNu approach to nutrition is grounded on clinical medicine and basic sciences disciplined by knowledge of evolutionary biology and paleoanthropology. The best evidence from multiple disciplines supports eating a pastoral (animal-based) diet rather than a grain-based agricultural one, while avoiding what I call the neolithic agents of disease - wheat, excess fructose and excess linoleic acid.

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Using Dairy to substitute Fats for Carbohydrates

Why do I advocate whole milk and cream but in later steps suggest eliminating dairy?

The 12-step list assumes we are starting with the standard american diet. I have found that step one is very difficult without the immediate introduction of fats to substitute for the excess of carbohydrates. Following an "eat what they ate" paleolithic diet has the flaw of eliminating dairy as not “orthodox paleolithic”. This is a mistake as the best weapons you have to replace carb intake with fat in a convenient fashion (without eating brains, liver and marrow of wild game every day) are butter and milkfat. Remember, the paradigm is about paleolithic metabolism, not paleolithic food re-enactment!

Step one is enabled by taking the milk most people are already drinking and ramping up the fat content. Skim milk is less than 0.5% fat by weight and so is mostly water with milk sugar or lactose, and milk protein, including casein. Whole milk is 3.2% fat by weight and has 50% calories from fat, half-and-half is about 12% fat by weight and most of the calories are therefore coming from fat. (Cream of course avoids most of the lactose and casein because it's nearly all fat.) The hormonal satiety you get from the increased fat will make the step one elimination of sugar, HFCS and white flour possible. Step one and two really need to be simultaneous to be effective. My “diet” is as much a high-fat prescription as a low-carb one. I believe that not only is saturated fat not harmful, but it is actually the key component to EM2 in a food-abundant environment.

Cream, butter, and cheese have little to no lactose as it has been either skimmed off or consumed by fermentation.

In addition to lactose intolerance, which is very common, there can be an immunologic reaction to casein, the protein in milk.

Cream and butter are mostly fat of course, but both milk and cheese have casein. I do not think dairy is nearly as significant on a population basis as grain lectins, but it may be an issue. So I generally view butter and heavy cream as excellent and cheese and milk as less so. Most who have difficulty with dairy are just sensitive to the lactose, but there can be immune system issues with casein found in milk and cheeses. I believe casein serving as a molecular mimic to self antigens, and therefore causing autoimmune diseases, mainly occurs in the context of an already leaky gut. So if you do not have Wheat Germ Agglutinin and other grain lectins in your diet, the casein is not likely to leak into your blood stream. Multiple sclerosis may be linked to both gluten grain consumption and milk casein in this way. That is why I believe eliminating gluten grains minimizes the threat of dairy for most people. I believe getting to step 3 makes the milk prescription in step 2 safer in this way.

The advice to move milk up the list if you are sensitive just acknowledges that some are lactose intolerant and some may (theoretically) not tolerate the casein even after gluten grain elimination. (although some may be lactose intolerant and just think it's "normal")

I myself consume copious amounts of butter and cream, half and half and occasionally whole milk - but, no surprise, I consume zero gluten grains.

Again, the last two steps of dairy elimination are more for theoretical completeness as I find much less scientific evidence indicting dairy than grains. Dairy is not paleolithic historically, but as a relatively ubiquitous food class, definitely helps in acheiving the EM2 - the evolutionary metabolic milieu of low insulin levels and mimimal toxins from modern cereal grains.

The PaNu EM2 is not a diet composed of prehistoric food items, it is a metabolic state that we are trying to live in while eating foods that exist now.

Reader Comments (9)

Hi Kurt,

I just discovered your website from the Mark's Daily Apple forums and I'm currently reading through all of your entries. I have been grain-free for the past year and a half (with a few grain item treats occasionally) and am currently working on reducing my fruit consumption and further increasing my fat consumption. Currently, for breakfast I usually eat whole-milk Greek yogurt, which is fairly high and both protein and fat. I know that eggs/meat would be a more ideal breakfast, but yogurt is much more convenient for before work. How would you rate yogurt as compared to other dairy products?

Thanks for your input and keep up the great work!


PS I also work in the imaging field - I'm a research associate in a neuroimaging lab.

June 30, 2009 | Unregistered CommenterAriel

Hi Ariel

Thanks for visiting

Whole milk greek yogurt - assuming it is whole (I guess the word whole implies it is, huh?) and not a lowfat abomination loaded with sticky sweet strawberry jam like Dannon or Yoplait -its probably OK. I favor cream and half and half to emphasize the fat. Yogurt will be better than milk if lactose intolerant (many are no longer intolerant after stopping wheat)

If you want a fast breakfast, try pre-prepared hard-boiled eggs. Large mug - preload with 5 tablespoons whole cream - top off with your favorite coffee. Then, put 3 hardboiled eggs in your pockets and eat at your desk at work.

As long as you have cutout the morning glucose load of bagel, orange juice, toast, cereal, etc.. that's what counts. I skip breakfast entirely most days and eat breakfast food at lunch, which technically makes that a late breakast I guess.

Start tossing the traditional definitions of breakfast foods - try a grass fed beef or bison burger sauteed in butter with an egg over easy on top with green chili sauce on top plus the coffee with cream for breakfast. I also eat scrambed eggs for a quick dinner sometimes.

Which lab are you working in?

June 30, 2009 | Registered CommenterKurt G. Harris MD

Yes, the yogurt I eat is full-fat and has no added sugars (20g fat/12g protein/8g sugar per serving). I usually have eggs + meat for breakfast on the weekends (and sometimes for dinner - I love frittatas!) but I really like eating yogurt in the morning as well. I have an hour long commute to work because I take the bus and I prefer not to eat at my desk, so the yogurt (usually I add some chia seeds + cinnamon + wild blueberries) works really well with my routine. I have tried skipping breakfast, and continue to do so occasionally, but on days that I test subjects I sometimes don't go to lunch until 1:30-2 and my grumbling stomach can be a bit of a distraction!

The biggest dietary change I'm trying to make at this point is cutting back on fruit. It's especially hard right now because so many of my favorite fruits are in season (figs!) but I am hoping to enjoy them responsibly for the little while that they're available and cut back on other fruits, like the apple that I've gotten into the habit of eating after lunch.

I work at UCLA but I'm only a research associate - I'm planning on applying to graduate school next year.

July 1, 2009 | Unregistered CommenterAriel

Hi Kurt,

Great site- great information. I am pretty much eating a hyper lipidish diet. Lots of fatty meat, butter,cream and eggs etc. My only vice is too much cheese- cheddar. Does full fat cream cheese (creme fraiche/phily/ mascarpone) have same wonderful benefits as double cream/butter or is it more like a cheese in that it contains cassein and is insulogenic?

thanking you in advance


July 3, 2009 | Unregistered CommenterNathan S

i just want to second nathan's request for a discussion of cheese. i'm early on the learning curve here, and part of shifting my diet has increased my cheese consumption. a problem?

July 3, 2009 | Unregistered Commenterjeff klugman


I'm new to PaNu and I wanted to ask you some questions:

How old was your age you began to practice this kind of nutrition?

I live in Germany and there are for example whole milk with 3.5 % fat, but also carbohydrates of 10g per 100ml and of that 10g carbs are 9g sugar, is that okay or should I better avoid this milk?

My nutrition is a small amount of some products and it's hard to imagine to live with this few things, almost monotone I think. I started paleo last Thursday and avoid totally whole grains from this time.
Refined sugar, sodas and so on I am already avoiding quite a time.
I eat nuts (almounts, wallnuts cashew, hazels), honey, sultanies, cotton cheese, eggs, salad, low-fat curd (cheese), don't know the exact translation for it ('cause of the 60g protein and 20g carbs, 2g fat per 500g for breakfast with the nuts), tuna out of tins ('cause to expensive for me to buy fresh) and meat like pork and other meat (chicken and so on). Hm, that's all I think, veggies and some apples, bananas.

Like you can see not much of choice. Of course I can't buy me high-quality meat because of my budget.
But I try to eat as healthy as I can, I'm 24 years old, 76 of kilos, 1.84m tall and my fitness level is over average I think, doing just bodyweightexercises and some running both at least twice a week.

You wrote that fruits from trees like candybars, so I have to avoid them total?

You wrote that it's better to avoid dairy products, but I'm scared of the loss of protein for muscle gaining and to retain them. Your diet is high in fat, I'm a little afraid to gain fat instead of muscle. Is my fear unnecessary?
And another point is I don't know what to eat then. All the food would repeat too fast, always the same and stuff any advice or other things I could add to my eatingplan?

I use one supplement, fish oil.

And how long will it last until I see some results in feeling better, healthier, more energy?
Somehow I hope to look better from this diet, mean better skin, no need for long sleep, lean muscle mass and many other things.

I think I don't forget something to ask.



July 6, 2009 | Unregistered CommenterSylwester

Hey Kurt,
Great site, I found you through Free the Animal. I agree with your approach that we need to eat what makes us the most healthy and if that includes Twinkie's so be it (obviously they aren't but just trying to make a point). Too many people get caught up in the Paleo movement and will only eat what existed a million years ago instead of sticking to what will keep you healthy. So after all my research, I've come to similar conclusions as you: wheat is the devil and should be avoided (#3 for you) and industrial oils are no good anytime (#4). Very simple but if we got everyone to do that, I think we would solve our budget problem in no time!
What are you thoughts on sweet potatoes, white potatoes, and white/brown rice? I tend to avoid white/brown rice due to their anti-nutrient properties (albeit much less than wheat and legumes) but I see no reason outside of severe insulin sensitivity problems to avoid the occasional tater, especially when you have a workout coming up. What are your thoughts?
This basically leads into a discussion on insulin/GI/GL. I agree that insulin is an essential hormone and we all want to avoid hyperinsulinemia but I can't look past the Kitavan's. Relating this to dairy, what about the inordinate insulin response that dairy elicits? After watching Dr. Cordain's presentation on the Paleo Diet and MS, it is easy to see the problems with: wheat (WGA), legumes, and tomatoes when it comes to auto-immune issues but it seems that dairy needs that wheat adjoven (sp?) to do bad stuff. So as long as you're not eating wheat, dairy seems to be fine from that standpoint. Just wondering your view on insulin spiking foods.

Sorry for the long post but I love this stuff and it's exciting to find someone that thinks along the same lines as me. Thanks for your time.

July 8, 2009 | Unregistered CommenterMark

Hi Mark

Wheat may be more important than HFCS for some, but the 12 steps are a balance between science and do-ability for many folks. My blog tries to strike the balance between geeky science and simple rules that you can follow even if you are not an amateur biochemist.

If you peruse my site and then those of Stephan (wholehealthsource) and Peter (hyperlipid), you will see different attitudes towards carbohydrates and vegetables. Peter seems to regard vegetables as a tolerable nuisance as long as carbs are not too high - more or less garnishments or condiments to make the food more interesting. Stephan is more Weston-Price like in emphasizing careful traditional preparation of grains and paleo carbohydrate sources.

My own stance is much closer to Peter's but perhaps more for temperamental reeasons than anything else. Once you have eliminated grains, flour,sugar and starchy foods, your carb fraction is pretty low. Why would you purposefully seek out food you did not eat before that requires special preparation just to add back carbs? So Stephan may be right that "paleo" carbs are not harmful, but if you were not eating them before why start all of a sudden?

Until I see scientific evidence of a specific metabolic benefit to carbs, paleo or otherwise, I simply see no reason to seek them on purpose, with so many tasty animal products to choose from. So you will not see me very often encouraging specific vegetables, but I will also not purposefully avoid them if they are not grains or starchy.

What is the point of eating a sweet potato or a white potato, (disregarding the toxins) ? Are they that tasty? Is there something essential there? Eat a potato without butter or salt and it tastes like cardboard, IMO.

The second central dogma of PaNu (articulated here for the first time) is:

II. Favor foods that are defenseless when dead. Animals are safer to eat than plants.

Dare I say that we have no proof the Kitavans would be even healthier with less starch in their diet? Comparing them to modern europeans is a pretty low nutritional and health bar to hurdle over.

The answer to the Kitavans, and why they are not really paradoxical, may be that infrequent insulin spikes matter much less than more frequent and sustained high insulin levels. Also, their food availability may have them fasting a lot of the time. Maybe eating twice a day with 60% carbs is the same metabolically as 3 x a day with 25%?

Regarding workouts, I believe your insulin sensitivity will be enhanced by working out in the fasting state on purpose. I do strength training one day a week and run a few days as well. I am always on a 15 hour fast when I do so.

I think dairy is fine without wheat. I am constantly looking to be proven wrong. I think Cordain is right about grains but off base on lipids, acid base balance and a few other things.

July 8, 2009 | Registered CommenterKurt G. Harris MD

Hey Kurt,
This is going to be a great blog to follow, I'm very excited. Thanks for the quick response. I do follow Whole Health Source and Robb Wolf, great stuff. For me, I've decided to do what you do. I'm not going to turn away from starches if someone else cooks for me but other than that it's going to be fat, protein, some veggies and some berries. I train in Crossfit mostly but I'm looking to get into running. I'm not looking to break any records, just feel good and lean out (which according to Robb happens very quickly on less than 50g of carbs a day). By the way, I love the defenseless when dead, that's great!

July 8, 2009 | Unregistered CommenterMark
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