Download Raw (Unpasteurized) Milk: Are Health

E D I T O R I A L C O M M E N TA R Y
Raw (Unpasteurized) Milk: Are Health-Conscious
Consumers Making an Unhealthy Choice?
Michele T. Jay-Russell
Western Institute for Food Safety and Security, University of California, Davis
(See the article by Guh et al, on pages 1411–1417.)
An increasing number of health-conscious consumers are seeking natural,
unprocessed foods, including fresh, locally grown produce, eggs, poultry, and
meats. Concomitant with this consumer
interest, the US Department of Agriculture created Know Your Farmer, Know
Your Food and the Farmers Market Promotion Program [1, 2]. These governmental programs seek to improve nutritional choices made by Americans with
the goal to reduce the incidence of obesity, diabetes mellitus, and other chronic
illnesses [3]. However, in the midst of
trends toward choosing less processed
foods is a growing consumer demand for
raw (unpasteurized) dairy products. Advocates promote raw milk for its better
taste and purported health benefits and
as a way for consumers to support small
dairies and local agriculture. At the same
time, the public health community
speaks in a nearly unanimous voice to
warn consumers, farmers, and retail
stores that sell the products about the
Received 1 September 2010; accepted 4 September 2010;
electronically published 8 November 2010.
Reprints or correspondence: Dr Michele T. Jay-Russell,
Western Institute for Food Safety and Security, University of
California, Davis, One Shields Ave, Davis, CA 95616 (mjay@
ucdavis.edu).
Clinical Infectious Diseases 2010; 51(12):1418–1419
2010 by the Infectious Diseases Society of America. All
rights reserved.
1058-4838/2010/5112-0010$15.00
DOI: 10.1086/657305
significant health risks associated with
raw milk consumption.
These risks are well documented and
include numerous foodborne disease outbreaks and illnesses linked to consumption of contaminated raw milk or products
made from raw milk [4, 5]. LeJeune and
Rajala-Schultz [4] reviewed the hazards associated with raw milk consumption and
pointed out that in the 21st century dairy
products are responsible for !1% of reported foodborne disease outbreaks in the
United States. In contrast, milkborne outbreaks comprised 25% of all disease outbreaks due to contaminated food and water in the early 1900s. The vast reduction
in milk-related illnesses during this period is attributed to the implementation
of pasteurization as a processing step and
improved sanitation and refrigeration
throughout the production chain. In addition, domestically acquired milkborne
tuberculosis and brucellosis have been virtually eliminated because of concerted efforts to control these diseases in the nation’s cattle herds.
The study by Guh et al [6] describes
the severe health consequences and costs
associated with a single Escherichia coli
O157 outbreak linked to commercial raw
milk. Although dairy products as a group
are generally considered low risk in the
epidemiology of E. coli O157 [7], reports
of hospitalizations and complications,
such as hemolytic uremic syndrome, as-
1418 • CID 2010:51 (15 December) • EDITORIAL COMMENTARY
sociated with contaminated raw milk appear to be on the rise, especially among
children [6, 8–10]. Findings from this investigation also highlight the importance
of secondary and tertiary transmission of
E. coli O157 wherein one child that drank
raw milk subsequently infected a sibling,
who was then the source of infection for
a third child. Advocates of raw milk frequently argue that consumption of raw
milk is a personal choice, but this outbreak
shows that it can be the source of a communicable disease with the potential to
spread to non-raw milk drinkers. The authors are to be commended for including
an economic analysis associated with this
outbreak, which revealed more than
$400,000 in medical and public health expenses. It would be beneficial if cost calculations became routine in foodborne
outbreak reports.
This outbreak occurred in Connecticut,
a state where retail and on-farm raw milk
sales are legal. The US Department of
Health and Human Services proposed a
new Healthy People 2020 goal to “increase
the number of states that have prohibited
sale or distribution of unpasteurized dairy
products” [11, p FS-3]. Although prohibition of raw milk sales and distribution
is an effective intervention strategy, the authors duly note that proposed regulations
to restrict retail raw milk sales in Connecticut after this outbreak failed because
of strong public opposition and lack of
political will. Despite a wealth of scientific
data supporting the effectiveness of pasteurization in protecting the public from
milkborne illness, there is a presumably
small but vocal segment of the population
that desires to consume raw dairy products. In lieu of bans, regulatory standards
and education may be the best approaches
to protect the public from exposure to
contaminated raw milk. Regulations
should include provisions such as pathogen testing, sanitation standards, and
warning labels. The authors state, “Notably, contamination occurred despite acceptable milking and sanitation procedures, according to regulatory standards”
[6, p 1415]. This finding suggests that
there is a need for more research into best
management practices for raw dairy production to reduce the risk of contamination in states where prohibition is not an
option.
In addition to regulation, education is
critical. Experts in infectious diseases are
in the unique position to provide leadership in educating consumers, farmers,
lawmakers, and the media about the relative risks of consuming raw milk. However, education efforts must be relevant to
the population likely to seek commercial
raw dairy products, a group that has been
described as health-conscious, well-educated adults [12]. For those who value the
perceived “probiotic” bacteria in raw milk
and eschew processed foods, messages
promoting pasteurization or even alter-
natives to pasteurization, such as filtration,
sonication, and irradiation, are not likely
to be effective. In addition, within the raw
milk movement is a distrust of conventional medicine, agriculture, and government, somewhat analogous to the vaccination controversy. Because many people
today visit the Internet for information on
health and nutrition, communication
strategies such as Web sites and social media are becoming important tools for risk
communication (for an example, visit
http://www.realrawmilkfacts.com).
In summary, it is important for health
professionals to educate themselves about
the debate surrounding raw milk consumption and be prepared to answer questions from the public about both safety
and health benefit claims.
Acknowledgments
Potential conflicts of interest. M.T.J.-R.: no
conflicts.
References
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farmer. Know your food. http://www.usda
.gov/wps/portal/usda/knowyourfarmer?navid
pKNOWYOURFARMER. Updated 18 August 2010. Accessed 20 August 2010.
2. US Department of Agriculture. Farmers
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.ams.usda.gov/AMSv1.0/fmpp/. Updated 2
July 2010. Accessed 20 August 2010.
3. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed.
Washington, DC: US Dept of Health and Human Services, January 2005.
4. Lejeune JT, Rajala-Schultz PJ. Food safety: unpasteurized milk: a continued public health
threat. Clin Infect Dis 2009; 48:93–100.
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Food safety hazards associated with consumption of raw milk. Foodborne Pathog Dis
2009; 6:793–806.
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2010; 51(12):1411–1417 (in this issue).
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coli O157:H7 outbreaks, United States, 1982–
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(June 2010). http://www.health.state.mn.us/
foodsafety/alert/ecoli0610.html/. Updated 21
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11. US Department of Health and Human Services. Proposed Healthy People 2020 objectives (food safety). http://www.healthypeople
.gov/hp2020/Objectives/ViewObjective.aspx?
Idp490&TopicAreapFood+Safety&Objec
tivepFS+HP2020%969&TopicAreaIdp22.
Updated 30 October 2009. Accessed 20 August
2010.
12. Bell M. Perceptions of raw milk’s risks and benefits. Research brief 83. University of Wisconsin,
Madison. July 2010. http://www.cias.wisc.edu
/economics/perceptions-of-raw-milk%E2%80
%99s-risks-and-benefits-research-brief-83/.
Accessed 30 August 2010.
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