Kurt G. Harris MD

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 an animal-based diet high in fat, low in cereal grains and relatively low in carbohydrate.

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Reader Comments (528)

i dipped a bit into the hyperlipid blog you recommended in another discussion thread, and was surprised to see it recommending not only low carb, but a restricted protein intake as well. what's your take on that recommendation?
June 20, 2009 | jeff klugman

June 27, 2009 | Registered CommenterKurt G. Harris MD

Peter's approach seems to be derived from the optimal diet. You can search "optimal diet" on his blog. He reduces protein to the minimum by further increasing fat consumption and carving out protein. FWIW his wife does not seem to reduce protein as much.
The idea, I believe, is to absolutely minimize iinsulin levels. Recall that some insulin is required to handle the glucose that is manufactured via gluconeogenesis from the amino acids that we don't use. To me, it seems artificial to toss the egg whites and eat the yolks, and I can't imagine paleo humans engaging in such maneuvers. So it seems like the reverse of supplemenation to me, and just like I think there is no clinical difference between 15% carbs and 5%, I doubt if there is much benefit going from 65% fat to 85%.
I maximize fat, favoring sat fat from animal sources, then I let carbs and protein come along for the ride. I refuse to believe you must count, measure, or supplement to be healthy, but that is just my dogma, I guess. I infrequently do analysis of what I eat following my 12 steps (down to step 10 as I still do dairy) and I get 65% fat, 25% protein and 10% carbs. Animal protein sources have great vitamin content too, so that is another advantage of not minimizing protein artificially.

June 27, 2009 | Registered CommenterKurt G. Harris MD

i know you've recommended grass raised beef or bison, or wild game, but none of those are easily available. do you worry about the diet of the cows which produce your milk and cream? the diet of the chickens and pigs which produce the chicken and pork?
June 21, 2009 | jeff klugman

June 27, 2009 | Registered CommenterKurt G. Harris MD

Yes I prefer pastured dairy but I don't have a good local source for it yet.
For pork and chicken, pastured animals that eat bugs and grubs, etc where the animals are not artificially vegetarian are best - note that "free range" is meaningless if they are allowed to wander around but they are only fed concentrated grains. The non- ruminants are passing on the 6:3 ratio more than the ruminants, who to a degree are creating their fatty acids.
Generally, ungulate products will have a 6:3 ratio closer to normal than industrial grain fed pigs and chickens. Butter seems to have a not too bad ratio even in the standard grain-fed form.
I view these as refinements that are good but pointless unless all seed oils have been purged from the diet first.
the seed oils are causing the major damage, the grass fed beef or bison is fine tuning
seed oils may be just as bad as sugar and flour for some diseases

Grass fed beef and bison is freely available shipped to your house on the internet.
I have several nearby sources for bison - including a farm 30 miles away that raises bison.
Local grocery stores here carry bison and if you have a whole foods market or trader joe's they should have grass-fed beef.
So it's more expensive but pretty available

June 27, 2009 | Registered CommenterKurt G. Harris MD

..."prefer pastured dairy but I don't have a good local source for it yet." harris, md
Did you mean pasteurized dairy? In my clinical experience, I have found my patients to improve their GI function with the elimination of pasteurized dairy and the inclusion of raw dairy. The different types of high heating temps in the pasteurization methods cause a lysing of of the bacterial cell wall/membranes exposing the human gut to foreign proteins never before seen immunologically in hominid development.
Realize also, that cow's milk destined for sterilization is from cows not as scrutinized as cows in the raw-milk farms. Much more stringent hygiene controls are placed upon the raw milk cows than conventional; thus making "sterilized" milk more "dirty"....left over bacterial proteins and fractionated cell contents.
Not necessarily the cause, but I believe contributes to, the GI problems today. An interesting theory, but more aligned to our previous dairy consumption in the past....which is what grain elimination nutrition is based upon...alignment with our past.
My apologies if my dairy comments are off track from the grain thread here!
dr john
June 27, 2009 | dr john (drfitness@mac.com)

June 27, 2009 | Registered CommenterKurt G. Harris MD

Hello Dr. John
I did mean pastured in the completely grass fed and not-grain-fed sense. This is solely in consideration of the fatty acid ratios and how they follow through into the meat or milk.
I am aware of the putative advantages of non-pasteurized dairy. Peter at hyperlipid gives some good reasons to believe, as I do, and as you say, that the pasteurization process inhibits hydrolyzation of milk protein in the stomach, letting peptides arrive in the jejunum and possible causing local immune response in the gut wall, or more ominously, entering our systemic circulation via tight junctions made leaky by WGA or other grain related nasties.
That said, I think that in a wheat free diet with normal gastric pH, even pasteurized milk is far less threatening without the WGA. I am going to keep researching the unpasteurized milk idea and stay conservative about it for now. I think consuming ghee and avoiding milk and cheese would be another way to go if one were more concerned about casein than I am.

Thanks for your interest

June 27, 2009 | Registered CommenterKurt G. Harris MD

I recommended the diet to someone with lupus. She countered with the China Study. Are you familiar with it? Apparently two villages in China were studied and the one who ate meat got cancer and the other didn't. She also believes meat increases her inflammation. Do you have an opinion. I am a believer .

June 27, 2009 | Unregistered Commentersela

The China study deserves its own post. I am familiar with the authors and their vegan agenda. I have the book and may review it for the site when I get a chance.

Lupus is a very dangerous disease. You might recommend your friend read life without bread by Allan and Lutz and Dangerous Grains by Braly.

One problem with some of these autoimmune diseases is they may act like a fire - taking a long time to die out even when the source of original flame ( grains) is gone. Conventional medicine should not be abandoned while there are still symptoms even if grains are completely gone from the diet

The China study is just politically correct bull**** and could not do anything good for Lupus, IMO.

Good luck

June 28, 2009 | Registered CommenterKurt G. Harris MD

I have been reading and following your dietary recommendations regarding paleolithic nutrition. I started June 1 and about the 25th I began having an attack of gout on my right wrist. I have tried high protein low carb diets before with the same result of gout. Before trying high protein diets, I never had gout attacks. I am taking 1/2 75/50 Maxide daily for borderline high blood pressure. Do you have any information or suggestions as to the cause and prevention of these attacks?

July 5, 2009 | Unregistered CommenterJack S

Hello Jack

I can only give general dietary recommendations and not individual medical advice.

Hyperuricemia and gout are caused by fructose consumption and are not caused by protein consumption.

However, once you have gout, a high protein load with purine amino acids could exacerbate it, but is not the primary cause. One can emphasize cream, clarified butter and suet to keep from boosting your protein consumption beyond what you need.

Diuretics can interfere with uric acid clearance from the kidney and also exacerbate gout.

Find a cooperative physician who understands that gout is caused by fructose and not protein and get your uric acid levels checked.

Eliminating fructose, including from fruit, and exchanging carbs for fat without changing protein intake should help all features of metabolic syndrome, including hypertension and gout.



July 6, 2009 | Unregistered CommenterKurt G. Harris MD

What's your opinion of the Mens Health Abs Diet? I have lost about 15 pounds on it. I eat a smoothy each day with 2 or 3 servings of berries and 1 cup nonfat yogurt. A lot of salads and meat.

July 6, 2009 | Unregistered CommenterAndrew

Not familiar with that diet but you can probably guess what I think of fruit smoothies and nonfat yogurt if you read any of the content here.

July 6, 2009 | Registered CommenterKurt G. Harris MD

Just wondering what you thought of coconut milk. My favorite breakast is full fat coconut milk with some blueberries in it. I am curious why the full fat coconut milk has alot more carbs than the lowfat. What would make that difference?

July 8, 2009 | Unregistered CommenterJanice

Coconut oil is pure fat, mostly saturated (saturated is good). Coconut milk varies by brand but the cans in my larder show 17 g fat, (12 g sat fat) and 2g carbs and 1 g protein - about 90% fat by calories - excellent. You can see how one could live on coconuts and fish.

Not sure about why your "lowfat" would have less carbs. Read the labels carefully- it might be a chimera like the "fat free" cream at my local grocery store.

July 8, 2009 | Registered CommenterKurt G. Harris MD

Hi, I have recently found your blog via a response you posted on Stephan's (Whole Health Source) Blog. Thank you so much for taking the time to write this blog, the content is rich/fascinating and your writing style easy to understand.
I have some general questions, any response you have would be welcome.
1. Is this the best way to feed small children?
2. Any thoughts or resources about the auto-immune disorders( allergies, psoriasis, asthma, etc) and diet.
3. Do you discuss nutrition with your colleagues? I have many doctor friends, and they are just not interested. (I don't say much, but it seems they don't believe in a diet/health connection beyond nutritional pyramid dogma).
4. What about when people say that the lifespan of evolving humans was short, and because our lifespan is long is why the we have so many diseases today.
5. So, you think the second-opinions uk site is legit? (such a dodgy format)

I love your Jesus/John the Baptist statement. I currently put Taubes right up there too...

TIA, and looking forward to reading more of your blog,

July 9, 2009 | Unregistered CommenterKriss

Hello Kriss

Babies need fat even more than adults. Skim milk is a crime and I would not patronize a pediatrician recommending it.

Briefly, mom should eat healthy and wean as late as possible.

Solid real food when able, no formula ever, no gluten grains, yes to pastured butter, cream and cow's milk after a while and see how it goes. ZERO sugar pop, diet pop, candy, treats, juice boxes, no candy and minimal fruit. Difficult as your school will try to force them to snack constantly - lie and tell them your child has celiac disease and is allergic to sugar.

Autoimmune - no gluten grains, zero plant oils

Colleagues - some very interested and telling me to write a book, some think it's all BS

Lifespan? Fossil record shows biggest lifespan decrement with introduction of agriculture. Paleo man died of homicide, war and elemental threats. Inuit and native americans - not sure if they lived longer but they got much less cancer and CAD.

I like Barry Groves - his site just looks goofy

What is TIA?

July 10, 2009 | Registered CommenterKurt G. Harris MD

kurt, i have a hesitation over your proscribing grains altogether for a young child. it is my impression that pediatricians are blaming the skyrocketing rate of asthma, in particular, and atopy in general, to NOT ENOUGH exposure to allergens early in childhood. what's your take?

July 12, 2009 | Unregistered Commenterjeff klugman

Hi Jeff

My understanding is that the hygiene hypothesis implicates lack of exposure to microbes in early development as causing atopy.
Whether that is true or not, I see no connection to grains lectins and gliadin proteins, which start their insults to the gut via an innate immune response.

The hygiene hypothesis, from what i know of it, posits attenuation of the adaptive immune response via early exposure to infectious agents, not lectins in food.

Otherwise benign proteins like those in animal dander and pollen become allergens because the adaptive immune system is abnormally active, not just because you did not have a dog as a baby. I believe dietary elements promoting inflammation like excess linoleic acid from corn and soybean oil hyping the immune response are another plausible mechanism. Our american dietary devolution with massive increases in linoleic acid and fructose consumption has occurred over the same time period our environments have gotten cleaner. Also, some of the worst asthma morbidity is in low income inner city areas, which are hardly squeaky-clean, even without farm animals.

My own hay fever and allergic rhinitis, which I have had since age 10, has virtually disappeared on paleo eating - especially once i eliminated gluten grains and seed oils.

I think avoidance of wheat is even more important for children than adults. There is simply nothing whatsoever necessary in wheat and even non-celiac adults have villous injury with exposure to gliadin protiens and WGA.

Kids don't need their leptin and insulin receptors bound by WGA either. Early menarche in girls may relate as much to wheat and soy as fructose and elevated insulin levels.

July 12, 2009 | Unregistered CommenterKurt G. Harris Md

Thanks In Advance - T.I.A. - but I am going to thank you now, afterwards, too. :)
1. Advice well taken about feeding. I asked you this after reading 'Inermittant fasting and infrequent meals', specifically the comment about kids playing soccer (so true). I should have been a little more specific in my question.
Because breastmilk is about 40% carbs and we are not sure how long paleo people breastfed...although it is speculated (in my reading) that is was longer than 2-3 years...when should we switch to a lower carb content of meals for kids? or how long do they need extra carbs for growth? or do they even need them? (I know you are not specializing in kids..I am searching for this answer)
I appreciate your response to Jeff K.'s excellent comment, too, and am excited to learn more about wheat's potential implication in the early onset of menarche in girls...I had thought maybe it was the body's estrogen-like response to vegetable oils as explained in some of Ray Peat's articles...

2. I have recently been reading Gut and Psychology Syndrome by McBride, and similar info by the late S.V. Haas MD, about how the gut microbes use left-over sugars from carbs that can't be digested by damaged intestinal villi, ferment from those sugars, and give off toxins that affect the body in various ways. (reminded me of Peter (hyperlipid)'s post on FIAF). They say it is any non -monosaccharide forming carb, which implies more than just the gluten protein as the culprit to immune problems. hmmmmmm but maybe it is just if the gut is already damaged. I will keep reading!

5. I will have to give it another look.

Take care,
BTW, I can't help mentioning, I went to UWGB for one year and spent a summer in Door County., you are so lucky to live there!! (I am far away in the UK now...) ,

July 13, 2009 | Unregistered CommenterKriss


I like your website. I'm currently eating paleo after MarksDailyApple.com recommendation. The hardest thing for me is to get enough healthy fats. I try to put lots of butter on everything, eat almonds and bacon. In the beginning I was drinking lots of milk, but MDA recommends not drinking too much because of the high carbs. 1l of milk has about 50g of lactose sugar in it. I used to be a big milk drinker (always whole, from 1-4 liters per day usually) but that's a lot of carbs! I will try your recommendation of drinking cream, but what other ways are there to include more healthy fat into ones diet?

Also, what do you think about nut butters? I realize they were probably not made by cavemen. But almond butter consists of 100% almonds. Almonds were available. What is your opinion?

July 17, 2009 | Unregistered CommenterBleicke


I try to ask the question "what does the food do to your metabolism" rather than "Could paleo man have ever eaten this food." The amounts can matter more than the "was it ever eaten' formula

Almonds are one of those nuts that are not really nuts. An almond is actually the seed of an almond fruit and is analogous to eating a peach pit. What you think of as the shell is actually the hard outer endocarp of the seed.

Seeds as part of the EM2 were not and are not optimal as food. Non- domesticated almonds elaborate cyanide containing toxins, and all plant seeds have lectins, and contain phytates that bind minerals (that can be partially defeated by soaking, but why bother?).

Aprt from the plant not really "wanting you" to digest the seed, 100g of almonds has about 13 g of PUFA.
The 6:3 ratio of that PUFA is at 30-100:1 as it is nearly all linoleic acid. It's actually worse than it sounds as the O-3 is plant O-3s (alpha linolenic acid) which is poorly converted to the O-3s we actually need. Not good for your tissue 6:3 ratio.

In general there are no true nuts or seeds that help your PUFA ratios, and they all are rather high in PUFAs.

Also, I've seen almond butter that has soybean oil in it - beware of any packaged, processed foods.

Drink half and half or cream instead of milk

You can add butter to everything. I cook chili with grass fed bison or wild venison. I add 1.5 sticks of butter to the pot.

July 17, 2009 | Registered CommenterKurt G. Harris MD

i thought walnuts had better ratios of fats.

July 17, 2009 | Unregistered Commenterjeff klugman

Thanks for clearing that up about the almonds. I thought they were really good, but who knew?

But I have to ask again: what else can I eat? I tried drinking cream today (have to get used to the taste). I smother everything in butter. But there's got to be more! Just cream and butter gets boring really fast. Especially when they taste so similar.

And what about the sugar in milk? Isn't the almost 50g of sugar in 1 liter of milk too much?

July 17, 2009 | Unregistered CommenterBleicke


Walnuts are highly PUFA with O-6: O-3 ratios of 10:1 or more and once again, ALA is not efficiently converted to the EPA and DHA we need.

There are no seeds or nuts that actually improve your ratios only fish or cod liver oil can do that (besides reducing 6s)


Cream, Butter, Ghee, eggs, elk, deer, bison, beef, mutton, salmon, cod, trout, herring, sardines, brains, liver, kidneys, lamb....

Yes there is a lot of lactose in milk if you drink too much

July 17, 2009 | Unregistered CommenterKGH

There are some very sharp people out there, and I just wanted to let you know I think you're one of them. I consider this blog a tremendous resource of well thought out information. I am always pleased when a new entry from you shows up in my Google Reader. I've been eating in the fashion you suggest for more than a year now, and have never felt better. I have a general sense of well-being that I never achieved on a mainstrem diet. Like it or not, we are all still essentially cavepeople, so it does make sense to eat like one. It has worked perfectly for me at least. Thanks again.

Day (From Thailand of all places)

July 17, 2009 | Unregistered CommenterDay
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