Milk:  The only source of nutrition for newborns, the mainstay of sustenance for older infants and the backbone of nutrition for growing children.  The dairy-industry influence coupled with excellent marketing has created a well-worn niche for milk in our diets, even when toddlers outgrow their need for milk not derived from mom.  But for parents, navigating the best sources of milk, when to stop and which products to switch to when infants are no longer breastfeeding requires a healthy amount of skepticism and a PhD!

An 18-month-old boy presented to the office with four days of abdominal pain and frequency of stooling with a foul smell.  The patient did not have any fever, evidence of systemic toxicity, localized abdominal pain or concerning findings in the poop such as blood or mucus.  The only positive history was that Mom started giving him raw cow’s milk six weeks prior to this event.  The patient was noted to have mild abdominal tenderness diffusely on physical exam and no other findings.

The thinking initially was that this was likely an infection from the raw milk, even though the mom felt that it was from a good source.  He was given probiotics with 5 billion colonies of Lactobacillus species and the homeopathic remedy Sulfur 30c, three times a day for a few days.  (Sulfur is one of the best homeopathic remedies to keep in the first aid box when raising children!)  Probiotics have been shown in animal studies to reduce the risk of common food-borne infections, such as Salmonella infection, as well as the severity.¹ He felt better within 12 hours.  A stool culture grew out Salmonella five days later.  Because of his older age (greater than one year) and overall excellent health, antibiotic treatment was not recommended since non-typhoidal Salmonella infections are usually characterized by a self-limited illness.² 

The FDA regulations on raw milk (i.e., unpasteurized milk) is a clear no.  Raw milk is usually derived from goats, sheep, and cows and is known to contain potential pathogens such as Salmonella, E. coli, Listeria, Campylobacter, and others.  Some of the organisms can be particularly concerning for individuals without robust immunity as well as during pregnancy.  The FDA posits that pasteurization does not reduce milk’s nutritional value and kills pathogens.³ The CDC echoes the harm from drinking raw milk, but does note that the heating process of pasteurization inactivates some enzymes found in milk and reduces some nutrients such as vitamin C; but these factors are overshadowed by the risks from infection.⁴

End of Story?

Many integrative pediatric practitioners such as myself rely on The Weston Price Foundation and their publications for guidance on nourishment for children.⁵ Their position is 180 degrees in the opposite direction from the FDA and CDC.  According to their some of their experts, like Sally Fallon Morrell, raw milk is safe due to the fact that it contains lactoperoxidases, which uses a small amount of hydrogen peroxide to keep pathogens at bay.  It is found in all mammalian secretions, but levels are ten times higher in non-human milks like goat milk.  It’s also been used in the storage of milks, such as camel milk.⁶ Additionally, there are bioactive components, leukocytes and immunoglobulins, that can provide passive immunity.  Other bioactive components include a variety of polysaccharides, medium chain fatty acids, and various phospholipids that have various health-promoting roles. There are reported beneficial bifidobacteria species as well that would be killed in the heating process.⁷

Although historically there are many papers that have shown how raw milk outshines pasteurized milk nutritionally, whether our over-contaminated world is able to continue to sustain the right environment to produce raw milk is uncertain. However, there is a significant body of literature that has documented that children who drank raw milk even infrequently had less eczema and a reduction in atopic diseases, including a 41% reduction in asthma and 50% reduction in hay fever. Boiling the farm milk removed the protective effect.⁸ These findings have particular relevance today considering that asthma is now affecting approximately one-in-six to one-in-eight children, and eczema may be affecting up to 60% of infants in the first year of life.

Risks vs Benefits

It should also be noted that modern day milk production is highly industrialized with many possibilities for contamination as well.  Toxic solvents are also used to clean pipes in the processing plants where it is impossible to prevent residues from contaminating the milk.  There are mechanisms to ensure raw milk safety which should be sought such as the milk should come from pasture-fed cows, be full fat, free of infections (such as TB and undulant fevers), and produced at farms knowledgeable in testing of the milk, water, and cell counts/pathogens of the milk. Additionally, it requires being placed immediately in cold storage.

Politically, raw milk is a hot topic.  Various senate bills in different states are presently active to support the sale of raw milk (e.g., West Virginia, SB 58), and it should be noted that laws vary state-to-state.⁹ Internationally, the sale of raw milk products are challenged with legal actions against certain farmers involved in raw milk sales/herd shares and is presently occurring in New Zealand.  In the US, it is worth reporting that between the years 1966 and 2015, there have been 153,657 cases of raw dairy-associated infection, 188 hospitalizations, and 73 deaths with the death rate of .0005% from infection from consuming raw dairy products over a nearly 50-year period.

In the life of any practitioner who works with families, there is a daily conversation about milk, whether you are talking about formulas, transitioning from breastfeeding, or overall nutrition.  The larger looming question is does one case of likely raw milk contamination overshadow the many healthful benefits of raw milk for children?  Unfortunately, dairy intolerance/allergy is widespread and that has affected my prescribing.  Generally, I thoughtfully recommend decreased dairy intake after a child is weaned, only organic, lots of butter, and goat products are favored (fermented and raw when available after one year of age).  Again, individual assessments are key even while trying to create general guidelines.  Knowledge of the local laws in different areas regarding the purchase and consumption of raw dairy products is also a necessity.  As with everything we do in practice (and indeed, it is a practice), individual treatments and common sense should prevail.  Know your farmer, and you will know your food.

References

1. Casey PG, et al. A Five-Strain Probiotic Combination Reduces Pathogen Shedding and Alleviates Disease Signs in Pigs Challenged with Salmonella enterica Serovar Typhimurium; Appl Environ Microbiol. 2007 Mar; 73(6): 1858–1863.

2. Bula-Rudas FJ, et al. Salmonella Infections In Childhood. Adv Pediatr; 2015 Aug;62(1):29-58. doi: 10.1016/j.yapd.2015.04.005.

3. https://www.fda.gov/food/buy-store-serve-safe-food/dangers-raw-milk-unpasteurized-milk-can-pose-serious-health-risk

4. https://www.cdc.gov/foodsafety/rawmilk/raw-milk-questions-and-answers.html?

5. https://www.westonaprice.org/?s=raw+milk

6. Njage P., et al. Effect Of Lactoperoxidase-Thiocyanate-Hydrogen Peroxide System And Storage Temperature On Keeping Quality Of Raw Camel Milk. December 2010; African Journal of Food Agriculture Nutrition and Development 10(10); 10.4314/ajfand.v10i10.62897

7. Gyorgy P. et al. Bifidus factor. I. A variant of Lactobacillus bifidus requiring a special growth factor. Archives of Biochemistry and Biophysics. January 1954;48(1): 193-201.

8. Perkin and Strachan. Which aspects of the farming lifestyle explain the inverse association with childhood allergy?; Journal of Allergy and Clinical Medicine. June 2006;117 (6); 1201-1584

9. https://www.ncsl.org/research/agriculture-and-rural-development/raw-milk-2012.aspx