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Text Box: RAW MILK?

The International Society for Infectious Diseases operates one of the most valuable - even indispensable - tools for global public health.  ProMED is a highly-respected, moderated bulletin for the posting and exchange of information and data concerning emerging and important infectious diseases worldwide.   While not usually dealing with familiar and known diseases processes, ProMED posted the following article Aug 12 2007.  The first piece is a letter sent to ProMED from an advocate for the sale and distribution of raw milk.   The second piece is the response by one of the ProMED moderators in clear no-nonsense terms, summing up the universal position of health professionals. The summary is particularly well written, well referenced, and should be read carefully by anyone tempted to follow the current misguided fashion of drinking raw milk.            

Extract from ProMED Digest V2007 #408

A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases


 Date: Sun 12 Aug 2007
  Original letter from Sue Diederich <> (PROPONENT OF RAW MILK BEING AVAILABLE)

"Pasteurization became necessary when distillers decided to rid themselves of swill by installing dairies alongside their operations.
Feeding such incredibly low quality grain to cows enclosed in tiny areas produced disease which was passed along in the milk.

Proper sanitation has been proven beyond any shadow of a doubt to remove the disease factors from the cows themselves, as well as the teats when milking. Natural enzymes in REAL milk (ie: unpasteurized AND not homogenized!) actually kill off most potential
problem-causing bacteria within 36 hours, and that has also been more than adequately documented by both the USDA and the FDA.

Study after study proves that pasteurization and homogenization of milk eliminates much of the nutritional value of the product, which is the main reason for drinking it in the 1st place.

NOT ONE SINGLE INSTANCE of disease over the past 50 years has been scientifically proven against raw milk from responsible farmers. Many times it has been blamed, but never once proven.

Do some honest research, check out past issues of JAMA, NEJM, Lancet and other medical journals, THEN write for public consumption."

Sue Diederich
Palatine, IL



   -RESPONSE from ProMed Moderator LL

 [ProMED thanks Ms. Diederich for her comments. The following is in
response to her statements:

1. It is not clear what you mean by a "relationship is between dairy farmers and the distillation of alcohol".

2. Low quality grain is not the source of the unpasteurized milk contamination, which is generally due to the bacteria in the
intestinal tract of the cow or contamination of the cow udders.

3. Regarding whether raw milk safety and its increased nutritional value has been "adequately documented by both the USDA and the FDA, the following is from the FDA in 2004, "Got Milk? Make Sure It's Pasteurized"

"Pasteurization, since its adoption in the early 1900s, has been credited with dramatically reducing illness and death caused by contaminated milk. But today, some people are passing up pasteurized milk for what they claim is tastier and healthier "raw milk." Public health officials couldn't disagree more.

Drinking raw (untreated) milk or eating raw milk products is "like playing Russian roulette with your health," says John Sheehan,
director of the Food and Drug Administration's Division of Dairy and Egg Safety. "We see a number of cases of foodborne illness every year related to the consumption of raw milk."

More than 300 people in the USA got sick from drinking raw milk or eating cheese made from raw milk in 2001, and nearly 200 became ill from these products in 2002, according to the CDC.

Raw milk may harbor a host of disease-causing organisms (pathogens), such as the bacteria _Campylobacter_, _E. coli_, _Listeria_,
_Salmonella_, _Yersinia_, and _Brucella_. Common symptoms of foodborne illness from many of these types of bacteria include
diarrhea, stomach cramps, fever, headache, vomiting, and exhaustion. Most healthy people recover from foodborne illness within a short period of time, but others may have symptoms that are chronic, severe, or life-threatening.

People with weakened immune systems, such as elderly people, children, and those with certain diseases or conditions, are most at
risk for severe infections from pathogens that may be present in raw milk. In pregnant women, _Listeria monocytogenes_-caused illness can result in miscarriage, fetal death, or illness or death of a newborn infant. And _E. coli_ infection has been linked to hemolytic uremic syndrome, a condition that can cause kidney failure and death.

Some of the diseases that pasteurization can prevent are tuberculosis, diphtheria, polio, salmonellosis, strep throat, scarlet
fever, and typhoid fever.

Pasteurization and Contamination
- -------------------------------
The pasteurization process uses heat to destroy harmful bacteria without significantly changing milk's nutritional value or flavor. In
addition to killing disease-causing bacteria, pasteurization destroys bacteria that cause spoilage, extending the shelf life of milk.

Milk can become contaminated on the farm when animals shed bacteria into the milk. Cows, goats, and sheep carry bacteria in their
intestines that do not make them sick but can cause illness in people who consume their untreated milk or milk products.

But pathogens that are shed from animals aren't the only means of contamination, says Tom Szalkucki, assistant director of the
Wisconsin Center for Dairy Research at the University of Wisconsin-Madison. Cows can pick up pathogens from the environment
just by lying down, giving germs the opportunity to collect on the udder, the organ from which milk is secreted. "Think about how many
times a cow lays down in a field or the barn," says Szalkucki. "Even if the barn is cleaned thoroughly and regularly, it's not steamed.
Contamination can take place because it's not a sterile environment."

The Health Hype
- ---------------
Raw milk advocates claim that unprocessed milk is healthier because pasteurization destroys nutrients and the enzymes necessary to absorb calcium. It also kills beneficial bacteria and is associated with allergies, arthritis, and other diseases, they say.

This is simply not the case, says Sheehan. Research has shown that there is no significant difference in the nutritional value of
pasteurized and unpasteurized milk, he says. The caseins, the major family of milk proteins, are largely unaffected, and any modification
in whey protein that might occur is barely perceptible.

"Milk is a good source of the vitamins thiamine, folate, B-12, and riboflavin," adds Sheehan, "and pasteurization results in losses of
anywhere from zero to 10 percent for each of these, which most would consider only a marginal reduction."

While the major nutrients are left unchanged by pasteurization, vitamin D, which enhances the body's absorption of calcium, is added to processed milk. Vitamin D is not found in significant levels in raw milk.

"Pasteurization will destroy some enzymes," says Barbara Ingham, Ph.D., associate professor and extension food scientist at the
University of Wisconsin-Madison. "But the enzymes that are naturally present in milk are bovine enzymes. Our bodies don't use animal enzymes to help metabolize calcium and other nutrients."

"Enzymes in the food that we eat and drink are broken down in the human gastrointestinal tract," adds Ingham. "Human bodies rely on our own native enzymes to digest and metabolize food."

"Most of the native enzymes of milk survive pasteurization largely intact," says Sheehan, "including those thought to have natural
antimicrobial properties and those that contribute to prolonging milk's shelf life." Other enzymes that survive are thought to play a
role in cheese ripening.

Ingham says that pasteurization will destroy some bacteria that may be helpful in the fermentation of milk into products such as cheese and yogurt, "but the benefit of destroying the harmful bacteria vastly outweighs the supposed benefits of retaining those helpful microorganisms. Plus, by adding the microorganisms that we need for fermentation, we can assure a consistently high quality product."

Science has not shown a connection between drinking raw milk and disease prevention. "The small quantities of antibodies in milk are not absorbed in the human intestinal tract," says Ingham. "And there is no scientific evidence that raw milk contains an anti-arthritis factor or that it enhances resistance to other diseases."

Fans of raw milk often cite its creamy rich taste, says Szalkucki, who adds that it may be creamier because it is not made according to The standards for processed milk. "If you go to a grocery store and buy fluid milk, it's been standardized for a certain percentage of fat, such as 2 percent," he says. "Raw milk is potentially creamier because it has not been standardized and it has a higher fat content."

The Law
- -------
It is a violation of federal law enforced by the FDA to sell raw milk packaged for consumer use across state lines (interstate commerce).
But each state regulates the sale of raw milk within the state (intrastate), and some states allow it to be sold. This means that in
some states, dairy operations may sell it to local retail food stores or to consumers directly from the farm or at agricultural fairs or
other community events, depending on the state law.

In states that prohibit intrastate sales of raw milk, some people have tried to circumvent the law by "cow sharing," or "cow leasing."
They pay a fee to a farmer to lease or purchase part of a cow in exchange for raw milk, claiming that they are not actually buying the milk since they are part-owners of the cow. Wisconsin banned cow-leasing programs after 75 people became infected with
_Campylobacter jejuni_ bacteria in 2001 from drinking unpasteurized milk obtained through such a program.

Raw Milk Cheeses
- ----------------
The FDA allows the manufacture and interstate sale of raw milk cheeses that are aged for at least 60 days at a temperature not less
than 35 degrees F. "However, recent research calls into question the effectiveness of 60-day aging as a means of pathogen reduction," says Sheehan.

The FDA's Center for Food Safety and Applied Nutrition (CFSAN) is currently examining the safety of raw milk cheeses and plans to
develop a risk profile for these cheeses. This information will help FDA risk managers make future decisions regarding the regulation of these products to protect public health.

Ensuring Milk Safety
- ---------------------
The FDA provides oversight for the processing of raw milk into pasteurized milk, cottage cheese, yogurt, and sour cream under the
National Conference on Interstate Milk Shipments "Grade A" milk program. This cooperative program between the FDA and the 50 states and Puerto Rico helps to ensure the uniformity of milk regulations and the safety of milk and milk products. The program is based on standards described in the FDA's Pasteurized Milk Ordinance (PMO), a model code of regulations that can be adopted by the states in their own regulations.

Under the Grade A program, state personnel conduct inspections and assign ratings, and FDA regional milk specialists audit these
ratings, says Richard Eubanks, MPH, a senior milk sanitation officer on CFSAN's Milk Safety Team. "It's a rigorous process of inspection and auditing," he says, and "it covers from cow to carton," starting with the dairy farm and continuing through the processing and packaging of products at milk plants. Products that pass inspection may be labeled "Grade A."

The FDA Grade A milk program includes pasteurized milk from cows, goats, sheep, and horses. Raw milk and raw milk cheeses cannot be Labeled Grade A, since they are not pasteurized and not covered under the program.

A Sampling of Raw Milk Incidents
- --------------------------------
July 2004 - The Indiana Public Health Department advised consumers to check their refrigerators and freezers for raw milk cheese that may be contaminated with salmonella. Routine product sampling found the bacteria in lot number 139 of "Natural Raw Milk Cheese" made by Meadow Valley Farm after the cheese was distributed to farmers' markets and specialty food stores in parts of Indiana and Wisconsin.

2002-2003 - Two children were hospitalized in Ohio for infection with _Salmonella enterica_ serotype Typhimurium. These children and 60 other people in Illinois, Indiana, Ohio, and Tennessee developed bloody diarrhea, cramps, fever, chills, and vomiting from _S._ Typhimurium tracked to consuming raw milk. The milk producer voluntarily relinquished its license for selling raw milk upon
recommendation of the Ohio Department of Agriculture.

2000-2001 - In North Carolina, 12 adults were infected with _Listeria monocytogenes_ linked to homemade, Mexican-style fresh soft cheese produced from contaminated raw milk sold by a local dairy farm. Ten of the 12 victims were pregnant women, and infection with the bacterium resulted in 5 stillbirths, 3 premature deliveries, and 2 infected newborns.

1998 - In Massachusetts, 66 people received injections to protect against potential exposure to rabies after drinking unpasteurized
milk from a local dairy. A cow that died at the dairy was found to be infected with rabies. Transmission of the rabies virus through
unpasteurized milk, although not the common route of infection, is theoretically possible, according to the CDC."

4. Regarding: "NOT ONE SINGLE INSTANCE of disease over the past 50 years has been scientifically proven against raw milk from
responsible farmers. Many times it has been blamed, but never once proven," here are extracts of 2 postings from March 2007, only one of the 600 months (50 years) alleged to be raw milk disease-free months:

Salmonellosis, serotype Typhimurium, raw milk - USA (PA) 20070303.0748
- -----------------------------------------------
"This consumer advice is based on reports to the Department of Health about 2 confirmed cases and one probable case of _Salmonella [enterica_ serotype] Typhimurium infection among York County residents who drank raw milk from Stump Acres Dairy in February 2007. Additional cases of illness are suspected.

The Department of Agriculture has suspended sales of raw milk at the dairy and is ensuring that corrective action is taken and that multiple laboratory samples come back negative for salmonella before raw milk sales can resume.

As part of the investigation, ***the Department of Agriculture obtained 3 positive milk cultures from the dairy. A milk sample obtained from consumers also tested positive at the Department of Health's Bureau of Laboratories.***"

E. coli O157, unpasteurized milk, 2005 - USA (WA) 20070302.0741
- -----------------------------------------------
"Pulsed-field gel electrophoresis (PFGE) was used to analyze _E. coli_ O157:H7 isolates from stool samples from 8 patients; 7 (88.0 per cent) isolates had PFGE patterns that were indistinguishable (pattern A), and one isolate from an Oregon patient had a PFGE pattern that differed from pattern A by one band.

***_E. coli_ O157:H7 also was isolated from raw milk samples obtained from the farm and a shareholder. In addition, _E. coli_ O157:H7 was isolated from 7 environmental samples collected from the floor of the farm's milking parlor. All _E. coli_ O157:H7 isolates from milk and environmental samples had PFGE pattern A.***"

5. Throughout the references cited in the "see also" postings below, there are articles from Journal of the American Medical Association, New England Journal of Medicine, American Journal of Public Health, Journal of Infectious Diseases, Public Health Reports and others; no support for the consumption of unpasteurized milk is among them. -  Mod.LL]



[see also the following cases reported by ProMED:  Subscribers may retrieve the case reports using the file numbers shown.

Salmonellosis, free unpasteurized milk - USA (PA) (02) 20070810.2608
Campylobacteriosis, unpasteurized milk - USA (GA) 20070803.2520
Salmonellosis, free unpasteurized milk - USA (PA) 20070722.2354
Listeriosis, unpasteurized cheese - USA (IN) 20070425.1351
Campylobacteriosis, unpasteurized milk - USA (UT) (02) 20070324.1033
Campylobacteriosis, unpasteurized milk - USA (UT) 20070322.1004
Yersiniosis, listeriosis - Canada (ON): unpasteurized milk/cheese 20070319.0968
Salmonellosis, serotype Typhimurium, raw milk - USA (PA) 20070303.0748
E. coli O157, unpasteurized milk, 2005 - USA (WA) 20070302.0741

- ----
Foodborne illness, unpasteurized milk - USA (OH) 20060929.2794
E. coli O157, unpasteurized milk - USA (CA) (03) 20060929.2791
E. coli O157, unpasteurized milk - USA (WA): recall 20060929.2790
E. coli O157, unpasteurized milk - USA (CA) (02): background 20060927.2761
E. coli O157, unpasteurized milk - USA (CA) 20060922.2706
E. coli O157, unpasteurized milk - USA (OR, WA) (04) 20060121.0199

- ----
E. coli O157, unpasteurized milk - USA (OR, WA) 20051216.3622
Shigellosis, unpasteurized milk curds, 2004 - Lithuania (Vilnius) 20051203.3494
E. coli O157: H7, unpasteurized milk - Canada (ONT) 20050411.1047

- ----
Salmonellosis, raw milk - USA (Ohio) (03) 20030204.0308
Salmonellosis, raw milk - USA (Ohio) 20030105.0033
- ----
E. coli, unpasteurized milk - UK (England) (02) 19981031.2126
E. coli, unpasteurized milk - UK (England) 19981022.2080
- ----
Brainerd diarrhea - South Africa 19970126.0158]