March 10, 2011

The Raw Details on the Raw Milk Debate

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Although unpasteurized milk has been consumed for centuries, it has never stirred up political, scientific and economic passions as forcefully as it does today. As an increasing number of people are consuming raw milk, public health officials have responded with aggressive campaigns to fight the rising tide. Farmers report being targets of “sting operations,” where FDA officials descend upon raw milk distribution sites to bust the setup. By other accounts, agents show up unannounced at farms with search warrants — not just to take milk samples for standard testing, but to interrogate farmers and confiscate documents. And my personal favorite, undercover FDA agents have reportedly posed as raw milk consumers, with the real intention of rooting out the players behind the various raw milk distribution rings. If this sounds like a drug bust, it’s because that’s almost what it is.

But just as marijuana consumption never bowed to the law, raw milk consumers and producers won’t simply give up either. Rather, they have dug in deeper, using their underground ingenuity to find clever loopholes. Some common ways include cow-share or leasing programs, buying raw milk labeled as pet food, and in one case, a couple registered their farm as a limited liability corporation to evade FDA regulatory authority. Why the need for these loopholes? The FDA has banned interstate raw milk sales since 1987, and only eight states allow it to be sold in grocery stores. Twenty-nine states allow its consumption, but its sale is strictly regulated and often limited to direct sales from farm to consumer.

Raw milk obviously can’t get you high, so why would consumers go through so much trouble to get their hands on this product? Advocates claim that raw milk is tastier, more nutritious, aids lactose intolerance and helps asthma. If these claims sound suspect, they pale in comparison to those of enthusiasts who swear it cures symptoms of ADHD and erectile dysfunction. Enticed by these purported miracle properties, it is no surprise that consumers will go to great lengths to maintain access to raw milk. Needless to say, the FDA does not agree with such claims. “Raw milk is not a magical elixir possessing miraculous curative properties,” insists John Sheehan, head of the FDA’s Division of Plant and Dairy Food Safety. “[It] is like playing Russian roulette with your health.”

Underlying this battle are the complex social, political, and economic issues of balancing consumer choice with public welfare, and protecting the rights of small family farmers who are up against industrial and factory farms.

With the substances that we put into our bodies on the line, it’s easy to see why so many people have an incendiary gut reaction. This all begs the question: Which side is right? How dangerous is raw milk, really? And how valid are the health claims?

The dangers

According to the Center for Science in the Public Interest, there are 76 million food-borne illnesses each year, leading to 325,000 hospitalizations and 5,000 deaths. Dairy products — both pasteurized and unpasteurized — only account for about 4 percent of that total. Clearly, dairy is just a small slice of the food-borne illness pie, but how much riskier is it to drink raw milk when the alternative pasteurized milk is available at every convenience store? Of outbreaks attributable to dairy products, the CSPI reports raw dairy accounted for 34 percent of those cases. Of strictly milk-related outbreaks, raw milk was responsible for 80 percent of them. That is certainly alarming given that raw milk only accounts for 1 to 3 percent of the milk market. This data suggests that raw dairy is 10-30 times more likely to cause an outbreak compared to pasteurized dairy.

Raw milk advocates dispute this data, claiming that the case reports of outbreaks are biased since officials will automatically assume raw dairy is the cause of the illness if it had been consumed, and will not consider other possible sources. Advocates also point to the fact that only a small fraction of food-borne illness cases are confirmed with genetic evidence linking the illness to a source, calling the indirect epidemiological evidence into question. Either way, advocates are probably bickering over a few cases at best, and a 10-30-fold increase in risk would likely hold up. But even if raw milk is that much more dangerous, perhaps its health benefits outweigh its risks if they are true. After all, widely accepted foods such as deli meats, cold hot dogs and smoked fish all have greater or comparable risks for spreading food-borne pathogens in relation to raw milk, and none of these have exceptional nutritional qualities.

The evidence behind the claims

As to nutritional quality, the science shows that most anti-microbial enzymes in raw milk retain some activity after pasteurization, but there is some loss of bovine immunoglobulins during pasteurization, which may provide lactogenic immunity in the gut. Additionally, pasteurization appears to kill lactase-producing bacteria, which would explain why lactose intolerant individuals (who lack the lactase enzyme) can consume raw milk (which itself contains lactase). There appear to be no significant changes in vitamin content during pasteurization, but raw milk does not contain the added vitamin D of pasteurized milk. In terms of the asthma claims, a cross-sectional, multi-center study involving over 14,000 children across Europe found an inverse correlation between farm milk consumption (presumably raw), and the prevalence of asthma and allergy. However, without a proven mechanism to explain this effect, it’s hard to convince medical officials of potential causality. There remains no evidence other than anecdotes that raw milk mitigates ADHD and erectile dysfunction, but despite the seeming absurdity of these claims, it will be hard to rule them in or out, considering that the government — with its staunch opposition — would probably never fund such a study.

The verdict

So where does this leave us? Should raw milk be allowed? Perhaps more to the point, is it okay to consume raw milk yourself? In answering these questions, it seems that both extremes should be avoided. There appears insufficient justification for using valuable government resources to bust a raw milk ring, but at the other end of the spectrum, you certainly shouldn’t drink raw milk with hopes of curing your asthma. Overall, it does not seem that drinking raw milk poses significantly more danger than other commonly accepted foods (how many people do you know who got sick from a sketchy late-night sushi joint?), but do know the risks. Milk-borne infections can cause fever, vomiting, diarrhea and, in more serious cases, kidney failure that can lead to death. And both the FDA and CSPI label it as a public health threat. Most importantly though, if you are daring enough to see what all the rage is about, know where the milk comes from. The sanitation of the farm and the hygiene of the milk-producing cows are critical. The most experienced raw milk consumers continue to drink it because they have complete faith in their source. You should, too.

For more information, and to see what the opposing sides say, visit the Westin A. Price Foundation’s website, as well as the FDA’s and CSPI’s consumer reports.

Ari Halper-Stromberg is a second year M.D.-Ph.D. student at Weill Cornell Medical College. He can be reached at arh2006@med.cornell.edu. What’s Up, Doc? appears alternate Fridays this semester.

Original Author: Ari Halper-Stromberg