Episode 5 - Paleo vs. GAPS vs. Weston A. Price | Chris Kresser
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Episode 5 – Paleo vs. GAPS vs. Weston A. Price

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In this week’s show we discuss the similarities and differences between the Paleo, GAPS and Weston A. Price approaches to nutrition. Specifically, we explore:

  • The health of traditional cultures studied by Weston A. Price
  • Raw dairy, IGF-1 and cancer
  • Signs and symptoms of raw dairy intolerance
  • Raw dairy and healing the gut
  • Properly prepared grains – worth the trouble?
  • How to reintroduce and test your tolerance for dairy
  • A1 vs. A2 milk: significant difference or bogus theory?
  • Which is best: Paleo, GAPS or WAPF?

We covered a lot of ground, so the show’s a bit longer than usual (1 hour, 15 minutes).

Make sure to tune in next week – Kurt Harris will be our guest! More to follow soon about that.

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Full Text Transcript

Danny Roddy: Hello everyone, and welcome to The Healthy Skeptic podcast. My name is Danny Roddy and with me is Chris Kresser, health detective and creator of TheHealthySkeptic.org, a blog challenging mainstream myths about nutrition and health.

Chris, how are you doing, buddy?

Chris Kresser: Good, Danny. Good talking to you, as usual. Let’s see, what’s new? Just went to the gym this morning, feel pretty good. I was wearing my “Gluten is Bad, Bacon is Rad” t-shirt. Have you seen these? Diane Sanfilippo made them and she sent me one. It’s like my favorite t-shirt now.

Danny Roddy: It’s the Balanced Bites girl, right?

Chris Kresser: Exactly. So I wore this to the gym, and I definitely got plenty of looks. And then one person came up to me and asked me where they could get one, so.

But yeah, otherwise pretty good. We’re still house hunting, which as I mentioned, I just hate. There’s not a lot out there, too, and of course everything is ridiculously overpriced, but we’ve been in the same place for a little over five years, we’ve got our chicken coop, we’re totally settled. But it’s time to make the move.

Danny Roddy: You’re in the Berkeley area, correct?

Chris Kresser: Yeah, we’re right on the Berkeley/Oakland border. Literally. Like one side of our street is Berkeley and the other is Oakland.

Danny Roddy: Man, Northern California is the tops. I love it out there.

Chris Kresser: Yeah, I love it. And I’ve got to say, I’m enjoying these last couple days of spring time when the sun’s out again, and—you can probably relate to this as a Southern California guy. That’s where I grew up—when it starts raining for more than two or three days, I get seriously upset.

Danny Roddy: Yeah, no, I agree. In fact, after this podcast, I’m going to lay out on my sidewalk.

Chris Kresser: I understand that we need rain to make—this is why the Bay Area is so pretty, right? We get some rain, we get some green trees. But I wish there was some way it could happen and still be sunny most of the time.

Danny Roddy: Man, we are too spoiled, though. The rest of the country’s going through a snowstorm.

Chris Kresser: I know. I have patients on the East Coast, and they’re like, I haven’t been outside in three weeks. Nine feet of snow outside my door. And I’m trying to imagine what that would be like.

How are you doing?

Danny Roddy: Doing well. Bearing through school. As we talked about, it’s just sobering seeing how, I guess, consumed with calories my nutrition teachers are. I think as long as you get that perfect amount of calories, it doesn’t matter what you eat. My nutrition teacher was talking about how there are no bad foods, and that as long as you get enough calories you should be good, and I almost have to bite my tongue at every second of the class, but–

Chris Kresser: ‘Cause that’s worked out really well for us so far.

Danny Roddy: Well, I mean, the sad thing is, she’s a vegetarian and she has osteoporosis and she’s a calorie-counter, and, I mean–

Chris Kresser: We’re so tenacious, aren’t we, as humans? How do we—we’ll just hold on to the death. That’s the positive thing about this, you know. What if we could channel that determination in a more intelligent direction? It’d be amazing.

Danny Roddy: You kind of put the Paleo blinders on, I think, because—getting back into school, and seeing how other people think, it’s just kind of crazy, you know?

Chris Kresser: Well, more power to you, man. I don’t think I could do that.

Danny Roddy: Hopefully I will get through it.

Chris Kresser: Yeah. So, let’s do it, huh?

Danny Roddy: Thisis an exciting episode.

Chris Kresser: Hope so!

Danny Roddy: So we’re going to be talking about the Paleo diet versus the Weston A. Price diet, versus the GAPS diet.

Chris Kresser: The showdown!

Danny Roddy: The showdown between the three, because there is much confusion and much overlapping between the three of them. So, I think you approached me with the idea and I thought it was brilliant because I always find myself thinking about the exact same thing.

Chris Kresser: There’s some selfish interest. I get about four, five questions about this per day, by email or blog, so my new standard canned reply is going to be the link to this podcast.

Danny Roddy: All right, cool. Let’s get into it.

Chris Kresser: All right.

Raw dairy, IGF-1 and cancer

Danny Roddy: So the first one is from Alina Novak:

I have been Paleo for a few months and I’ve had great success. Recently I’ve been reading about the benefits of including raw dairy in the diet, especially as a source of the hard-to-get nutrient vitamin K2. There seems to be much conflicting information concerning raw dairy products. Some say the main protein, casein, boosts insulin-like growth factor-1 or IGF-1, which will induce growth and… cancer promoter. Where do you stand on this?

Chris Kresser: Oh boy. The dairy issue. Didn’t we—we talked about this last time, or—oh, I talked about it with Rob Wolf.

Danny Roddy: Kind of a duplicate, but that was a great episode if anybody hasn’t checked that out yet.

Chris Kresser: Yeah, so check that out—I think it’s episode 65, maybe? I just did an interview with Rob and we talked a lot about that.

But, in short—well, we’re going to talk about the difference between A1 and A2 milk, later in this episode. There’s another question. So I think I’ll set that aside for now and just say that, you know, there’s a lot of ways to gather scientific evidence.

One is to do observational studies where you look for associations between certain variables and disease. You look at a population and you see how much milk are they drinking, and you look for diseases and you try to find out if there’s a correlation between dairy consumption and disease.

Or you can do a clinical research study on isolated nutrients, like just parts of a food, like casein or whey or IGF-1, and then you can try to figure out mechanisms by which those nutrients could contribute to problems.

And then you can do clinical studies that just use whole foods, like milk, instead of breaking it down into the isolated nutrients. There are very few studies with whole foods because they can be problematic in several different ways, but it’s also unfortunate because we don’t eat isolated nutrients. I don’t know anybody who eats IGF-1. I know a lot of people who drink milk and eat dairy products.

I’m being cheeky, but it’s actually an important concept to understand. There’s a great paper that I shared on my blog a while back and an article I wrote. It was published in a major peer-reviewed journal. I can’t remember the whole title, but basically, these researchers were talking about the concept of food synergy, which means that you can’t really understand the benefit or harm caused by a food just by looking at the isolated nutrients. You have to understand how all those nutrients act together, in the way that they’re consumed in a food. That’s why taking supplements that are isolated nutrients, without knowing what you’re doing, can be pretty dangerous.

A good example of this is T. Colin Campbell. He’s the guy who wrote The China Study, which has been totally slammed to the curb by people like Denise Mayer and Chris Masterjohn. Part of his thesis is—his main thing is that animal protein causes cancer. And he based this idea on some of his research—which was quite pioneering at the time—which showed that casein, which is a protein in milk, causes cancer.

It’s true that it does, in studies that look at just feeding rats isolated casein. But what he neglected to mention is that whey, which is also found in milk, another protein found in milk, is anti-cancer. It has anti-cancer effects. So when you drink milk, it’s kind of a—the cancer-promoting effects of casein are balanced out by the anti-cancer effects of whey. And you never drink milk without whey in it.

So when you look at actual population studies of people who consume dairy products, you see mostly benefits. Several studies have been published that show that full-fat dairy reduces heart disease, reduces type two diabetes. There was a great study out of Harvard recently that showed that women who drink skim and non-fat milk are 80% more likely to be infertile than women who drink whole milk. So, I don’t see a lot of evidence of harm coming from dairy consumption in these whole population studies.

Now having said that, there is some evidence. And we’re going to talk about that when we talk about the difference between A1 and A2 milk. But I think dairy is a really individual issue. I think it can be a really healthy food if it’s well-tolerated. And that’s really the question: Do you tolerate dairy? For people with autoimmune conditions and a leaky gut, digestive problems, I think it’s probably not a good idea. For people who have intact intestinal barrier and who are otherwise healthy, I think it’s a really healthy food.

Danny Roddy: Chris, that IGF-1, that’s a precursor to growth hormone? Is that something we really don’t want in any way? Isn’t the whole point of fasting to increase growth hormone and other hormones?

Chris Kresser: Yeah, I mean, this is where it just gets so complex, and where I don’t trust that we have an understanding of how all of these compounds work in the body to be able to make those kind of determinations—like milk raises IGF-1, and IGF-1 can be proliferative, you know, with cancer, and so let’s take it out. I prefer to really focus more on food, and I do, you know, it is important to consider the isolated nutrients. But we have to put that together with all the other pieces in the puzzle before we come to a conclusion.

Signs and symptoms of raw dairy intolerance

Danny Roddy: Definitely a good point. Okay, let’s get to our next question. This one is from Dave White:

Is there any surefire way to know if one should not be consuming pasteurized or raw dairy products? What are the symptoms and signs to look out for?

Chris Kresser: Well, you know, the gold standard, I think, with any question about food intolerances is an elimination provocation protocol. I don’t trust the IGG food allergy tests. I think they’re bunk. There’s not a lot of support for them in the scientific literature at all.

And I was talking with Brian Walsh about this. He’s a colleague and a really great guy, a really super knowledgeable naturopathic doctor back in Maryland. And he was telling me about a thing that he did—he, or maybe one of his colleagues—where he drew his own blood on the same day, just took two different vials of blood, labeled them with phony names, sent them in to the same lab on that same day. And they did a test on each vial and they came back with completely different results. Like, one of them was, You’re going to die if you eat peanuts. And the other one was like, Don’t eat strawberries, and broccoli is out.

It’s just not a reliable way of determining food intolerances. And most allergists who are serious and at the top of their game, they don’t even use those tests. They use the elimination provocation protocol, which basically means you remove the foods in question out of your diet for 30 days, and then you add them back in, one at a time. And you only add them every two to three days, because you can have a variety of reactions to food.

You can have an immediate hypersensitivity reaction, which is like a true allergy where you eat a food and your eyes swell up, get puffy, and you have a severe initial reaction. Or you can have a delayed reaction several hours later, where you break out in a rash or you have milder symptoms like digestive stuff or brain fog or something like that. And you can even have a reaction the following day!

So it becomes really difficult to figure out how and if you’re reacting to foods as you reintroduce them, if you’re reintroducing them once a day, because let’s say you reintroduce milk one day, and then the next day you reintroduce, I don’t know, some grain in the morning, and then you feel bad at lunch. How do you know whether you’re feeling bad because of what you ate in the morning or the milk you had the day before?

So that’s one thing—take it out for 30 days and then add back in. In terms of the symptoms, that’s unfortunately more difficult to answer. Number one, you probably would have the same kind of symptoms you generally have. So, if you have a tendency to break out in skin rashes, then that’s what would probably happen. If you have a tendency to get an upset gut, then that’s what would happen. It would be an exacerbation of your current, of your typical, symptoms.

Or it could be new symptoms that you don’t normally experience. If you were the gut person, you might have skin rash or you might get brain fog, or you know. It could really be anything, so it’s really difficult to predict. But if you’re paying attention to your body and you know what your kind of normal symptoms are, just look for any exacerbation of those or any new symptoms that aren’t typical for you.

Danny Roddy: And Dave mentioned pasteurized or raw dairy products. I can guess you probably don’t suggest anybody consume pasteurized dairy products.

Chris Kresser: Yeah, I don’t generally, except for yogurt. Fermented pasteurized dairy products are one possible exception, because the fermentation—The problem with pasteurized dairy, we talked about on Rob’s show, is that dairy has lactose in it, the sugar lactose. And lactose requires lactase, the enzyme, to break it down.

Most people don’t produce lactase themselves. Raw milk, milk that just comes straight out of the cow, without pasteurization, has lactase in it, and that, of course, is nature’s wisdom. It’s got what we need to break it down right in there. And it also has beneficial bacteria, probiotics, that also aid us in the digestive process.

Pasteurization kills not only the lactase but the beneficial bacteria. So you’re left with kind of a—what I call a processed food. I think pasteurized milk is a processed food, whereas raw milk is a whole food.

However, when you ferment pasteurized milk products and make yogurt or kefir or something like that, you’re adding back in these beneficial bacteria. You’re not adding lactase, but the fermentation process itself consumes lactose. That is fermentation. The bacterial organisms in the yogurt are eating the sugar, the lactose, and that’s why it gets sour.

And the longer you ferment it, the less lactose it will have. So if you ferment yogurt for 24 hours, it will have almost no lactose left, and it’s very sour. So, that’s one exception I think, pasteurized fermented dairy products, especially if they’ve been fermented for a while, are safe. But I never recommend that anybody drinks straight up pasteurized milk.

Pasteurized cream is also probably fine, because it’s extremely low in lactose and same could be said for butter. Those are mostly fat, so you’re not dealing with the lactose issue there. It’s best to get organic, grass-fed butter and cream, if you can, but it’s really pasteurized milk that’s the big offender.

Danny Roddy: On a side note, I just recently had the Organic Pastures raw cream, and I think it was like tasting heaven. It was one of the best things I’ve ever eaten.

Chris Kresser: Yeah, it’s off the charts. I mean, raw cream is unbelievable. Too bad it costs like $12 for a little–

Danny Roddy: Yeah, it was outrageously priced.

Chris Kresser: Yeah, you’ve got to really love yourself to be buying that. It’s worth it.

Danny Roddy: It was really good.

Chris Kresser: There was another thing I wanted to say there, but I’ve forgot. So, hopefully, it’ll come back to me, since we’re going to be talking about this in the next few questions.

Danny Roddy: Well, okay. Let’s go to—oh, that was Dave’s. Okay, we’re going to go to Ellie Stuart’s question.

Chris Kresser: Okay, it just occurred to me, too, that we haven’t even started talking about the actual topic of this podcast, but trust me, people, we will.

Danny Roddy: We will!

Chris Kresser: There is a method to this madness. We’ll bring it all together in the end. Okay.

Raw dairy and healing the gut

Danny Roddy: Okay. On to Ellie:

Can raw dairy be used as a tool to heal the gut? I know Dr. Natasha Campbell uses it in small amounts in her GAPS protocol. Have you had any success with your patients?

Chris Kresser: Ah, there’s the topic. It came back to us.

So, just to make a distinction. She’s using probiotics to heal the gut, and raw fermented dairy is one of the possibilities. It’s not necessarily that raw dairy itself has a gut-healing effect, and in fact, it could have the opposite effect for somebody who already has a leaky gut. Which is why, on the GAPS protocol, the intro phase of the GAPS diet, there is no dairy allowed usually. There are some exceptions, but normally, the intro protocol is just the meat and vegetable broths, you know, for a period of time, until the gut barrier can restore itself. And then dairy is slowly added in over time.

And, in fact, raw milk would be the very last thing that would be added back in. The first one that’s added is ghee, because it has no milk solids and no lactose, and it’s primarily fat. And then, from there, it might be butter, it might be cream, or fermented cream, and then it might be kefir that’s been fermented for quite a while, and yogurt that’s been fermented for at least 24 hours. So there’s a hierarchy or a progression with dairy.

But, yeah, I think that the bacteria and yeast and other probiotic organisms in fermented dairy are really important to healing the gut over the long term. But in the early stages, when the gut is still leaky, dairy can actually be a problem, and it’s not just because of lactose, it’s because of casein. And actually, because of a particular casein called beta casein, which we’re going to talk about when we get to the A1 and A2 milk question.

So I wish I could make it a more black and white answer, but it’s really individual, it’s kind of tricky to figure out, and it just requires a lot of patience and experimentation and time.

Danny Roddy: Chris, how do the storebought pre- and probiotics compare to raw fermented dairy? Is it even comparable with the amount of microorganisms?

Chris Kresser: No. That’s a good question. There’s—one of these days, Danny, we’ve got to have a way to put up links that I suggest and talk about. We’ll get there. But there’s a website, I can’t even remember the link offhand, I’ll have to dig it up, but it compares the microorganism content of fermented foods versus typical, commercial probiotics.

And there really isn’t any comparison. The fermented foods generally have a much higher concentration of microorganisms, and they have a much more diverse, you know, representation of microorganisms. So whereas you might get two or three strains in a commercial probiotic that you buy in a store, there might be 10 to 12 strains in kefir of different bacteria and yeast.

In terms of prebiotics, it’s a little bit different, because there’s no live organisms. A prebiotic is just an indigestible starch or long-chain carbohydrate that we can’t break down in our intestine, so it makes it all the way to the colon, where it selectively stimulates the growth of certain bacterial species, like Bifidobacter.

And there’s a lot of controversy about prebiotics and whether they’re beneficial. Or there’s some. I think most people in the scientific community believe they’re beneficial, but there’s an increasingly vocal minority that is kind of raising the alarm bells.

In my experience, prebiotics can cause a lot of symptoms for people. They can cause gas and bloating, some pretty uncomfortable digestive symptoms, if people take too much at once. But I’ve seen them actually be extremely helpful in restoring proper gut flora balance. Particularly with Bifidobacteria, people who have low Bifidobacteria. Taking the prebiotics can really help boost that, because they selectively feed that particular species. And even taking Bifidobacter as a probiotic doesn’t seem to have that effect.

So it’s something I’m researching on an ongoing basis and if I see something that makes me change my mind, I’ll let you all know.

Danny Roddy: Like you said, we’re more bacteria than we are human.

Chris Kresser: Ten times more!

Properly prepared grains – worth the trouble?

Danny Roddy: Ah, cool. This next question is from Travis Wright. And this is one I’d actually love to hear your answer, because grains are a very hot topic. Okay, so Travis writes in and he says:

What is your stance on properly prepared grains? Is it a rat’s nest best avoided? I know Stephan over at WholeHealthSource.blogspot.com frequently consumes grains that he has soaked, which apparently removes antinutrients. Where do you stand on this?

[phone rings]

Chris Kresser: Oh, yeah. Sorry about that. That happened last time. Maybe next time I’ll remember to turn it off.

So. First of all, I don’t think we can say “grains” here. I mean, there is a lot of different grains, with a lot of different properties and antinutrient profiles, and so the procedure for inactivating the antinutrients for one grain is different than another, and in some cases—most cases—it’s not about totally inactivating them, it’s about reducing the antinutrients.

The best resource on this subject that I’ve come across is a previous article on the Weston A. Price Journal. Might be available online now, but it’s written by this guy, Remiel Nagel. And he goes into excruciating detail on what all of the antinutrients are in grains, in all the various grains, and what is actually required from a food preparation perspective to break them down, and then how much they can actually be broken down by food preparation. For anyone who’s interested in eating grains, I highly recommend reading that article, because you will feel very tired at the end of it, when you think about eating grains.

Getting back to the population studies. I think it’s difficult to say that all grains, that eating properly prepared grains, is going to lead to significant health problems in all people, ’cause we just don’t see that! There are cultures, like the Swiss, that I mentioned earlier, for example. Their diet was basically raw dairy and sourdough bread, like sourdough properly fermented grain. And I know this could get me in lots of trouble in the Paleo world, but it’s true. You just look at them, and they were healthy, and they were eating grains and drinking milk, so go figure!

But they were eating properly prepared grains, and they were definitely not eating all of the other food toxins that most people eat today, and their gut barrier was probably intact because of that. So, yes, it’s probably possible to eat properly prepared grains and be healthy. Now, having said that, when you read that article and figure out what you’ll have to do to properly prepare the grains, you may or may not think that it’s worth it to do that. I didn’t.

I used to eat the Weston A. Price way, and we’d eat some properly prepared grains, and we had our own sourdough starter that we would make sourdough rye bread with, and I just can’t be bothered any more. And I feel better even removing those from my diet, too. Which gets me back to the whole individual thing.

You know, it’s best to test this stuff yourself, don’t just take my word for it, or anybody else’s. Try eating some properly prepared fermented grains and see how you feel. And most people that I work with tend to feel better without them. And there are exceptions to that, but—

The other thing is that gluten is just—we’re just seeing so much research about the harmful effects of gluten. And fermentation, there’s some idea out there that really long fermentation of gluten can reduce the harm that it causes, and that may be true, but it’s still gluten. And there are thousands of studies that document the harmful effects of all of the different components of the gliadin complex. So I would definitely suggest that even if people are going to eat fermented or properly prepared grains—we’ve got to come up with a better name for that, ’cause the entire thing, properly prepared grains!—they should still avoid gluten-containing grains.

The two grains that I think are okay, and that I actually eat myself and recommend to my patients—provided they tolerate them, of course—are white rice, which always sends people for a loop, and buckwheat. Now white rice, you know, of course, a lot of people think brown rice would be the healthier choice. But brown rice has the bran, and all of the antinutrients and the toxins are found in the bran.

In white rice, that’s been removed. So what you have left over is just a starch, a long polymer of glucose molecules linked together. And presuming you do not have blood sugar issues, or you’ve got decent glucose tolerance and insulin sensitivity, there’s no problem with white rice. It’s a safe starch, a safe source of glucose. I wouldn’t make it, you know, something that you eat at every meal, every day, but it seems fine to eat it occasionally. It can be a healthy source of glucose, which is the sugar that our cells know how to make use of. Contrary to fructose, for example.

And then the other one is buckwheat, which is kind of a grey area. I always get this wrong, that all grains fall into one category, and I think they’re monocots biologically—or botanically—and I think buckwheat is a dicot. I could have that reversed. But the point is that buckwheat’s totally outside of the family that contains all the rest of the grains. So I find that a lot of people are able to tolerate buckwheat, especially if it’s soaked and fermented. Stephan Guyenet has a fantastic recipe for sourdough buckwheat crepes, WholeHealthSource.blogspot.com and those are pretty tasty, too.

I don’t eat buckwheat so much any more. I sometimes do, but I eat white rice a few times a week, but that’s it for me and grains.

Danny Roddy: I think the real question is, would you rather have a potato, or white rice?

Chris Kresser: I actually don’t do well with white potatoes. On the other hand, I eat sweet potatoes almost every day. I love sweet potatoes, and I do really well with them.

Danny Roddy: Yams or sweet potatoes?

Chris Kresser: I eat the whole spectrum. I mean, ’cause there’s like the white, there’s the yams, there’s the orange sweet potatoes, the orange yams, then there’s the white, and then there’s the Japanese—I don’t like the Japanese as much because they’re too sweet for me. But white potatoes, yeah, I don’t feel very good when I eat them, so I just don’t eat ’em. And as a substitute, if I feel like a starch that doesn’t have a little bit of sweetness, like the sweet potatoes, I eat yucca. You can make really good yucca fries, or taro, I can make taro chips that are really great with duck fat or lard. So there’s a lot of options.

There’s also lotus root and plantains, both green plantains and ripe plantains. Actually, for dinner last night, I had a pork chop—Cajun style pork chop, with chili powder and cumin and coriander, cooked in bacon grease—which is the best way to cook a pork chop, by the way. And then I had plantains fried in coconut oil, and then some winter greens. It’s kind of like a Cuban, South American meal. It was so good.

Danny Roddy: I had one of those Okanagan potatoes, the really bright purple ones, and I thought it was incredible. But yeah, man, I’m into yams. That meal that you just described is making me really hungry.

Chris Kresser: All right. So, I know we’ve got an A1/A2 question somewhere in here.

A1 vs. A2 milk: significant difference or bogus theory?

Danny Roddy: We do. That’s the one I was going to get to. So this one’s from Tim Lundeen:

How do you feel about A1/A2 milk per the book, The Devil in the Milk by Keith Woodford? A lot of evidence that A1 milk, most of what is in the US, can cause health problems, especially, you say, when someone has a compromised gut.

Chris Kresser: This is a great question, and actually, to be honest, it’s one that I hadn’t looked into in very much depth. I’d heard about the A1/A2 hypothesis a few times, but I hadn’t actually taken the time to explore it.

But I did some research on it, I actually bought a copy of Woodford’s book and I read it, and it was pretty fascinating. This idea is based on a hypothesis that was developed by a couple guys, Elliott and McLaughlin, in the 1990’s. I think they were both out of New Zealand. And the idea is that the protein in the milk of some cows and not others causes inflammation, immune disregulation, and diseases like type 1 diabetes, heart disease, and even things like schizophrenia and autism.

And the protein in question here is the A1 form of beta casein, which is the second most abundant protein in milk. And there are other variants of beta casein in milk, which are A2 and then B beta casein. So cow’s milk casein protein is a chain of 209 amino acids, and the only difference between A1 and A2 milk is at position number 67 in that 209-length chain. And at number 67 there is a proline in A2 milk, but histidine in A1. So the theory is that a bioactive peptide called BCM7 can be released by the digestion of A1 milk, but the proline at number 67 in A2 milk prevents this from happening.

Sorry if this is getting too complex, here. I know some people’s eyes are probably glazing over right now. But it’s actually necessary to understand this difference between A1 and A2.

So, in the A1 milk, the BCM7 can be released, that’s the theory, and the BCM7 has opioid properties and also cytomodulatory properties, and it causes oxidative damage. And, you know, opioids have an immunoregulatory effect, they disrupt the immune function and they can affect brain function, too. And then, of course, oxidative damage plays a large role in cardiovascular disease. So this was the basis for the theory that A1 milk contributes to heart disease and type 1 diabetes.

And there was some preliminary research, epidemiological, between-country studies, that seem to support this idea. For example, they notice that the incidence of type 1 diabetes was correlated with cow’s milk intake in certain countries, where they drank primarily A1 milk, but not in other countries where they drank A2 milk. They pointed out that type 1 diabetes is rare in children of the Masai tribe in Africa, and this is a tribe with really high consumption of milk, but they’re zebu cows, which are A2.

And then they looked at other countries like Finland, where there was a high milk consumption but the milk was from A1 cows, and they saw a significant correlation between type 1 diabetes and milk consumption, in those countries. So that was the idea, and certainly some of that seems pretty compelling, especially when you read it in the Woodford book, and it definitely got my interest.

But since that book was published, and even before that, there’s been several critiques of this hypothesis that A1 milk is the problem and A2 milk is not.

The first problem is that between-country correlations in epidemiological research are notoriously inconclusive. We have no idea if the people that develop type 1 diabetes in those studies were actually the ones that were drinking milk, and of course we can’t exclude confounding factors, for example the people in Finland who drink A1 milk and have a high incidence of type 1 diabetes also have a really strong genetic susceptibility to type 1 diabetes. And there’s just too many other potential confounding factors, between the lifestyle and diets and way of life in each country, to make these kind of between-country correlations reliable.

And keep in mind that early studies like this suggested that meat consumption was correlated with cancer, and that cholesterol was correlated with heart disease. And human evidence hasn’t shown that to be true, so we don’t want to make the same mistake here.

And then a couple days ago, actually, Mat Lalonde sent me some scathing criticism of the A1/A2 theory—about 14 PDF, full-text studies attached to the email, and we’re actually going to have Mat on the show, with Robb. I’ll mention that in a little while, at the end of the show. He’s a very sharp guy.

And after reading through some of that, there are several other problems. The original research that was done on this issue was performed in vitro, meaning in a petri dish, using a limited set of enzymes that the researchers thought would be involved in the digestion of casein in the gut. Now, the idea is that none of our enzymes can actually break down that BCM7, and this would allow it to pass into the bloodstream, especially in individuals with a leaky gut.

But this is a flawed idea, because we don’t actually know what all of the enzymes in the gut are or what their actions are, and it turns out that we’ve learned recently that there’s an enzyme in the gut called DPD-4, which is really good at cleaving the peptide bonds next to proline and fully breaking down the BCM7 peptide.

So Mat pointed out that there’s no study, at least that we’ve been able to find, where they actually found BCM7 in the bloodstream of a human being. And, of course, it has to get into the bloodstream to cause oxidative damage and disrupt brain and immune function.

So you might wonder, well, how do they even know that it causes these problems? Well, in the studies, chemists synthesize BCM7 in the lab and then inject it directly into the bloodstream of animals or people, or expose it to cells in a petri dish and see what happens. But, of course, that doesn’t mean that it gets through the gut into the bloodstream.

So that’s a huge hole in the theory. And together with the lack of strong—any kind of causative evidence, it’s hard to say that it’s—it’s hard to prove this to be true. Let’s just put it that way.

On the other hand, just because there hasn’t been a study that detected BCM7 in the bloodstream, that doesn’t mean there won’t be. Lack of proof is not proof against, and it’s certainly possible that BCM7 could escape digestion and get into the bloodstream in people with leaky gut. And, actually, I looked into this a little bit further, and I found a study that showed that in celiacs, they have decreased activity of that DPD-4 enzyme in the brush border membrane in the gut, which means the enzyme that is required to break that BCM7 down isn’t working very well in people who are celiac.

And we might assume that that’s true in people with gluten intolerance, or anyone who’s got kind of a screwed up gut or a leaky gut. So this could compromise their ability to break down BCM7, and if they have a leaky gut, which is almost certain with celiac and gluten intolerance, BCM7 could get into the bloodstream. So this might explain all of the anecdotal reports of people who are able to tolerate A2 milk but not A1 milk.

In any event, though, as I’ve said before, milk is probably not a good choice for anyone who does have a leaky gut, regardless of the protein morphology, whether it’s A1 or A2. Fermented milk products like kefir and yogurt, especially when they homemade and fermented for enough time—that reduces the lactose content and it might improve digestibility of casein, regardless of whether it’s A1 or A2. And then you have high-fat dairy like cream and butter, which is pretty low in casein anyway. For example, butter has a ratio of 80:1 fat to protein ratio, so there’s very little protein compared to fat.

I will say, though—I mean, this is just an N=1, one person’s experience—actually, two: my wife counts, too. We recently got our hands on some A2 milk. We’re lucky to have a local farmer who has some A2 cows and he sells it just directly to people who are interested in it. We bought a share in one of the cows, so we’re proud part-owner of an A2 cow now! And I’ll tell you what. It’s amazing! We were drinking Claravale milk before, which is—I guess it’s a combination of A1 and A2—but this milk is divine.

My wife brought it home, she brought home a half-gallon. And I went into the kitchen and it was already half gone. And I was like, Are you kidding me? Did you just drink a half-gallon of that? She was like, I can’t stop! And she’s pregnant, so it just felt like super, super nourishment for her.

And the fat content is higher in the A2 milk, so it’s really rich and creamy, and it tastes pretty good. I don’t generally drink milk, but I drank quite a bit of the A2 milk, and I didn’t have any issues at all. It’s kind of interesting. It doesn’t prove anything, but it’s interesting, nonetheless.

Danny Roddy: And the main producer of raw milk, at least in California, Organic Pastures—that’s A1, correct?

Chris Kresser: Yeah. I’m not aware of any main producer that’s using A2. I think the only way to get it is to talk to a farmer who’s aware of this. And in fact, this farmer—we talked to him about it, and he told us that he regularly has to send genetic samples to Europe to be tested to make sure—I’m not sure how there would be any contamination, unless there were bulls from A1 herds that were mixing in with the cows. I don’t fully understand that. But the point being that it’s kind of a challenge to maintain that, to make sure that everything is A2 all the time.

It’s not too easy to get. You really have to find someone who’s into this and look for local farmers and stuff. I heard in Australia, actually, there are some commercial brands of milk that are A2, and also in New Zealand, and people are kind of more aware of the issue there.

Danny Roddy: New Zealand, they’re really up on grass-fed meat, too. I think it’s like illegal to feed your cows grain. Or is that Australia?

Chris Kresser: I think it’s New Zealand, yeah. That’d be a good place to live for food, for sure.

Danny Roddy: Well I hope Tim appreciates the most thorough answer to anyone. A2 milk… [unintelligible].

Cool. Let’s get to our last question, the money question. Or, kind of the money question.

Chris Kresser: We made them wait like 55 minutes until we got to the episode topic, but, what can you do?

Which is best: Paleo, GAPS or WAPF?

Danny Roddy: Okay, so we’re going to talk about the GAPS diet, and I’m going to give you a couple of different questions. First, what is it? How is it different from Paleo and Weston A. Price Foundation diet? Let’s talk about the importance of bone broth; the importance of probiotics on the GAPS diet; and food versus capsules—we kind of already talked about that. And then we’re going to talk about how long do you need to be on the GAPS diet before you actually see results. A litany of questions.

Chris Kresser: Yeah. Part two? No, how much time do I have, and then I’ll know how much detail I can go in.

Danny Roddy: I think, what’d—we’re almost at an hour, I think?

Chris Kresser: We had a little drop-out there, somewhere.

Danny Roddy: Oh, yeah. We’re probably fifteen, twenty minutes?

Chris Kresser: Okay. So. GAPS stands for Gut And Psychology Syndrome, and it was created by a doctor named Natasha Campbell-McBride. She, I think, is originally Russian or from that part of the world, but she lives in the UK now. And the history of it is that her son, I believe, was born or developed autism early on in his life. And she, being a physician and a mother, was very concerned about the lack of effective treatments that were available.

So she decided to jump in and do her own research, and over time, she started to believe that there was a connection between nutrition and autism, and, specifically, she started to understand that there was a connection between leaky gut and autism, which—this woman was years ahead of her time. She is brilliant. Because now, if you look in the scientific literature, I’m actually—there’s a paper, sitting on my desk, right in front of me, right now, and I’ll read you the last sentence of the paper. This was just published. The last sentence of the abstract is:

“It is suggested that patients with major depressive disorder should be checked for leaky gut by means of IGM and IGA panel used in the present study, and accordingly, should be treated for leaky gut.”

So, this is a paper that was published in Neuroendocrinology Letters, a peer-reviewed journal. And this is about depression, but there are several papers that now link leaky gut with autism and other mental and behavioral illnesses.

So it’s real, and she figured it out a long time before we started to see this stuff in the scientific literature. So she developed a protocol for restoring gut barrier integrity with diet and probiotics, and that’s the GAPS diet. And it’s very similar to Paleo, and similar to Weston A. Price diet, except for that it removes grains entirely, which of course Paleo does too, but it goes a step further and removes all disaccharides and polysaccharides.

Now, when you look at carbohydrate, eventually it gets broken down into the monosaccharides, like glucose and fructose, which are then absorbed and utilized—well, glucose is, at least. Fructose is shunted to the liver, where the liver tries to get rid of it, because it kind of treats it as a toxin, but glucose just passes right through the intestinal barrier, goes into the bloodstream, and is rapidly taken up by cells.

But in order to break down the carbohydrates we eat into those single monosaccharides, there’s a digestive process that needs to happen. And the longer chains are of those sugars, the more difficult they are to break down. And when someone has a compromised gut barrier, or has intestinal dysbiosis—which they tend to go hand in hand—they have difficulty breaking down those longer chain sugars, which are the disaccharides and polysaccharides. And then those sugars linger around in the gut, where they provide food for pathogenic bacteria that feed on them, and proliferate, and cause further dysbiosis and further leaky gut.

So the idea is to remove these disaccharides and polysaccharides so that you’re basically starving the pathogenic gut flora and kind of rebalancing the internal environment and allowing the gut lining to heal. So when I’m saying polysaccharides, I’m talking about starch. Like, the safe starches that I’m generally in favor of, like sweet potatoes and yams and taro, and all this stuff, but also all grains, including white rice. And then the disaccharides would be things like milk sugar.

Now, I mentioned earlier that on the GAPS diet, some dairy products are allowed, but those are the dairy products that don’t have lactose in them any more, because they’ve been fermented, or that are primarily fat, like butter or ghee.

The other thing about the GAPS diet is that it contains large amounts of bone broths. These are homemade bone broth soups with chicken bones or beef bones, or any animal bones, fish bones, and the process of making these broths over—they’re simmered for a long time, and then the collagen and glycene released from the bones and the broth, those are used in the composition of our own intestinal and mucosal barriers. So it’s really important to eat bone broth, several cups a day, often, when you’re just starting on the diet, to help restore that intestinal barrier.

In fact, the intro phase of the GAPS diet for people who are in really bad shape, like if they’re having fulminate diarrhea, and just really severe symptoms—actually, the first few days will be just broth and meat, not even any vegetables, because the fiber in the vegetables can really irritate a gut lining that’s already severely inflamed. And then, over time, vegetables would be added back in, especially peeled vegetables with lower fiber, and lower fiber vegetables like carrots, and winter squash, and stuff like that.

Then you would start adding fibrous vegetables back in, and over time you start adding roasted and fried meats and start gradually expanding the diet further and further. But even on the full GAPS diet, grains are never permitted, and raw milk is kind of a grey area, because it has lactose. But it does have lactase, so I guess in certain cases once the gut lining has healed, that would be permitted, as well.

So GAPS is really more of a therapeutic diet for people who are trying to heal their leaky gut, and certainly the Paleo diet can do that, too, in the sense that it removes most of the things that would be likely to cause a leaky gut in the first place. But for some people, just removing those things isn’t enough and they actually need more support in the form of the bone broths and removing even the starch—the di- and polysaccharides. And then, of course, the probiotics, too, to restore the gut flora, which is an important part of healing a leaky gut.

In terms of how long to do it, it’s, again, really individual. I’ve had a patient recently who came to me who was scheduled for surgery to remove his colon. He had Crohn’s disease. He was having 12 to 13 watery bowel movements a day. It was a lot of blood, mucus, extremely depleted, skinny, you know—really, really sick. And I put him on the intro phase of the GAPS diet, just with the meat and the broth, no vegetables. Which is, you know, it’s hard! But when you’re facing surgery to remove your intestine, you’ve got a lot of motivation.

And he did this, and within three or four days, actually, he was down to three to four bowel movements a day, which he had never gotten down to, even with high doses of Prednisone and Asicol, the salicylate drugs drugs that he was taking. He couldn’t believe it. It was like a miracle.

And, of course, his doctors couldn’t believe it, too. They said, Must be a coincidence or, you know. It’s so bizarre. I can’t even believe that. Yeah, it just happened. Just coincidentally happened when he started eating only meat broth.

And he’s doing pretty well now. He’s not out of the woods yet, for sure, and probably never will be because he’s got a very intense version of Crohn’s disease, but he now understands how he can control his symptoms and get to a place where he’s able to live the life that he wants to live, instead of walking around with a colostomy bag.

Danny Roddy: That’s incredible. So it sounds like GAPS for people who are recovering from illness. Paleo, it’s a blanket recommendation. And then Weston A. Price for those who like to experiment?

Chris Kresser: Weston A. Price for those who really want to keep eating grains and they really have the time and energy to prepare them properly. And who do well on dairy products, because that’s a big part of the Weston A. Price approach, too.

Like I said, I give major props to the Weston A. Price Foundation, the work they’re doing, Weston A. Price’s research. I think you can’t really shake a stick at that diet, you know. It’s really solid and helpful, and it benefits a lot of people. It’s just that the population of people that I work with is somewhat skewed. They’re people that are dealing with a lot of chronic health issues, and I just see better results in my patient population when people remove grains entirely, with the exception of white rice and maybe buckwheat.

I also know plenty of really healthy, vibrant, robust people who are following the Weston A. Price approach. So, on that spectrum, there’s something for everybody.

Danny Roddy: That’s going to bring us to the end of this week’s episode. Chris, how can we find more of your work on the internet this week?

Chris Kresser: There’s lots of cool stuff coming up. I’m still working on the nine steps to perfect health series, getting close to the end. Just published, I think, the seventh step. And I’m actually excited about getting ready to do my first ebook, and I think the ebook’s going to be the nine steps to perfect health. I’m going to put all that stuff together, all those articles in one place, along with some really cool bonuses, probably including meal plans, recipes, probably guided stress management audio programs, stuff like that.

And I’m also, by popular request, going to be making the Grow a Healthy Baby seminar on nutrition for fertility, pregnancy and breastfeeding into some kind of product that can be accessible to people who aren’t in the Bay area. Because I’ve been doing that seminar live around here, but there’s a lot of folks around the country and around the world who’ve asked about how to get that material.

So I’m going to make it either an online, membership site type of thing, or a DVD with a printed manual. I haven’t figure that out yet, but it’ll be two to three hours of video, transcript and PDF, a quick start guide, and then also recipes, meal plans, frequently asked questions recorded by me, and a bunch of other stuff like first foods for the baby, and the role of blood sugar regulation during pregnancy, and how to prevent nausea, all that good stuff.

And then, really, really excited about what’s happening with the podcast. Next episode, we’re having the venerable Dr. Kurt Harris on, which I can’t wait for.

Danny Roddy: It’s going to be amazing!

Chris Kresser: Yeah, we’re really excited about that. We’re going to do something a little bit different, like we do normally with our show where we kind of pick two or three themes and stick to that, instead of just doing a grab bag of questions.

So we’re going to talk to Kurt, since he’s a fellow meditator with a longtime meditation practice, we’re going to talk a little bit about the role of meditation and mindfulness practice in dealing with the chronic illness and just the things in life that are difficult to face and sometimes difficult to change. I think that’s a salient issue in this world that doesn’t get talked about a lot.

We’re also going to chat with him about his great recent series about macronutrients, and why the quality of fats and carbohydrates is far more important than whether it’s a fat or a carbohydrate. And we’re going to talk a little bit about orthorexia, which is, I think, an increasingly big issue in the Paleo community. And if you don’t know what that is, you’ll find out. Tune in for sure next time.

And then, I’ll just give you a little teaser of something we’re also really excited about, which is—I don’t know, we don’t have a name for it yet. It could be something like Paleo-geek-orama, or –nerdapalooza, or something. But it’s going to be a special two-hour, two-part round table with Rob Wolf, Matt Lalonde and myself, a few really geeky Paleo folks who like to dork out on all the research in this world and talk about it, and that’s what we’re going to do.

We’re going to spend the first hour talking about the research that we’ve been seeing in the Paleo sphere, and in the scientific literature that’s related to gluten intolerance, and leaky gut, and the brain-gut axis connection, leaky gut-autoimmune disease connection, all that sort of stuff. And then the second hour, we’re going to answer your questions, so make sure—we’ll do a blog post ahead of time with more detail, and you can leave some questions for any of us there.

So that’s a lot, I know, but some exciting stuff so I wanted to let you guys know.

Danny Roddy: I can’t wait. I’m thrilled.

Cool, man. You can find me at twitter.com/dannyroddy and my website, dannyroddy.com

Keep sending us your questions at thehealthyskeptic.org using the podcast submission link. Guys, thanks for listening. Chris, it’s been a good one. Take care, buddy.

Chris Kresser: Been a pleasure. You take care, too.

  1. Dr collin campbell didn’t just test casein he said he tested various types of animal products. And scientist just discovered that red meat causes inflammation and cancer and it was a good study

  2. I’m sure you’re already aware of this but will throw it out anyway: cow breeds that contain the A2 variant of beta casein are the older breeds. In the US, if you can find farms that have Jersey and Guernsey cows, these will be A2, and as you pointed out Jersey cows are known for very high butter fat concentration (I buy Jersey chocolate milk from a farmer in MA’s Berkshires—delicious!). Most commercial dairies in the US keep Holsteins, A1 variant cows, because they yield 5-8 gallons of milk per day versus Jersey yield of around 3 gallons.

  3. Hi, I’m glad to read your blog giving so many informations. That is really helpful for me.
    I noticed that you mentioned “at number 67 there is a proline in A2 milk, but histidine in A1” and “there’s an enzyme in the gut called DPD-4, which is really good at cleaving the peptide bonds next to proline and fully breaking down the BCM7 peptide.” I thought that means the DPD-4 enzyme can make A2 milk to produce BCM7 peptide. I have a little bit confusion. Can you check it again? Thank you.

  4. Hi to the both of you and thanks for this interesting podcast. One sentence stuck with me and I would be very happy if you would clarify this one for me: Chris, when you say your patient is “not out of the woods yet, for sure, and probably never will be because he’s got a very intense version of Crohn’s disease” do you mean to say that forever he will have certain symptoms which cannot be controlled by diet, because his Crohn’s is so severe? Thank you very much for your time and effort to answer.

  5. Chris, just drove from Chicago to Florida listening to all your podcasts along with Robb’s, awesome. I was home visiting my sick mom who is on 8 different meds for things ranging from diabetes to high cholesterol. Learned so much listening to you. Thanks so much for what you do!

  6. Thank you very very much for this excellent podcast. It really helps fill the wide gap in knowledge about diet, nutrition and health.

  7. Hi
    Would you please spell the name of the writer and the name of article regarding antinutrients?

  8. Speaking of elimination diets and the lack of reliability of IgG testing, I have heard of another kind of testing to get at food sensitivities called MRT-LEAP. In theory this tests whether your immune cells release other kinds of chemicals besides antibodies, such as histamines, in response to certain foods. Have you heard of this test? What do you think of doing a test like this to help figure out the what to initially avoid in starting an elimination diet?

    Thanks,
    Kate

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