Raw Milk: The Science, Risks, and Consumer Choice

Watch the video on YouTube: https://www.youtube.com/watch?v=YxeW8VVeMg4

Description:

Dive into the complex world of raw milk! Is it a misunderstood superfood or a risky health gamble? This video explores the science, risks, and consumer choices surrounding unpasteurized milk, separating fact from fiction so that you can be well informed.

What you'll discover:

What is Raw Milk?* We'll define raw milk and explain why it's different from what you find in most grocery stores. We will touch on the history of pasteurization as a public health achievement.
The Great Debate:* We'll present the main arguments from raw milk advocates. Are the purported nutritional benefits and allergy prevention claims backed by science?
Health Risks Unveiled:* We'll discuss the potential dangers of consuming raw milk, including harmful bacteria like Salmonella, E. coli, and Listeria. We'll explain who is most at risk and what precautions to take if you choose to drink raw milk.
Regulations & Global Perspectives:* Get a brief overview of the legal landscape surrounding raw milk sales in the U.S. and around the world.
Food Freedom & Consumer Choice:* We'll examine the philosophical and ethical considerations behind the raw milk movement. Is it simply about health, or is there something more?
Emerging Trends:* We'll touch upon new challenges like avian flu (H5N1) in raw milk and emerging technologies like milk acidification.

Resources:

For more information and to make informed decisions, check out these reliable sources:

Centers for Disease Control and Prevention (CDC)
Food and Drug Administration (FDA)
Food Standards Agency (FSA)

Join the Conversation:

What are your thoughts on raw milk? Share your experiences and opinions in the comments below! Let's discuss this complex issue respectfully and thoughtfully.

Raw Milk: The Science, Risks, and Consumer Choice

Raw Milk: Regulations, Preservation, and Health Impacts

Here are comprehensive answers to the three questions about raw milk, drawing from the provided sources:

What are the specific legal requirements and inspection protocols for raw milk production in countries or states where it is permitted, and how effective are these measures in ensuring safety?

The legal requirements and inspection protocols for raw milk production vary significantly by region, reflecting differing approaches to balancing consumer freedom and public health.

Examples of Regulations:

• United States:

◦ The FDA prohibits the interstate sale of raw milk [1]. However, individual states can permit the intrastate sale of raw milk [1]. As a result, regulations vary widely.

◦ As of 2011, 43 U.S. states allowed the sale of raw milk, with many imposing restrictions on raw milk suppliers due to safety concerns [2].

• Europe:

◦ In the European Union, member states can prohibit or restrict the sale of raw milk [3, 4]. EU hygiene rules mandate that raw milk and raw milk products must be labeled to indicate this [4, 5].

◦ Germany allows packaged raw milk to be sold in shops under the name Vorzugsmilch, subject to stringent quality restrictions and licensing [6]. Unpackaged raw milk can only be sold under specific conditions, including direct sale at the farm, same-day production, and a warning label stating "Raw Milk – boil before use" [7].

◦ In England, Wales, and Northern Ireland, raw milk can only be sold by registered producers directly to consumers (e.g., at the farm, farmers' markets, or through online sales) and must be labeled with a health warning [8, 9]. Farms undergo inspections twice a year, and the milk is sampled and tested four times annually [9, 10].

• New Zealand: Raw milk for drinking and raw milk products can be made and sold but are highly regulated [11]. Producers must be registered, and raw milk must be collected by the purchaser from the producer's farm or delivered to the purchaser's home [11, 12]. Registered raw milk suppliers must follow strict hygiene practices [12].

• Canada: While the sale of raw milk is prohibited, the sale of raw milk cheese aged over 60 days is permitted [2].

Effectiveness of Safety Measures:

• Careful sanitation practices during raw milk production can reduce health risks, but they cannot eliminate them completely [12].

• Testing raw milk for pathogens prior to consumption cannot be used as an alternative to pasteurization because potential pathogens can be diverse, variable, and unpredictable [13]. It is impossible to test every batch for every pathogen [13].

• A negative test isn’t a guarantee that raw milk is free from harmful germs. One batch of a farm’s raw milk can test negative for harmful germs, but the next batch can contain them [14].

• Even seemingly high-quality raw milk can still contain pathogens [15].

• The outbreaks and illnesses attributed to raw milk are alarming when one considers the extremely low volume of raw milk consumed [16].

• Despite regulations, outbreaks linked to raw milk continue to occur [16]. Between 1998 and 2018, outbreaks linked to raw milk led to 2,645 illnesses and 228 hospitalizations [17, 18].

Conclusion: While regulations and inspection protocols aim to enhance safety, the inherent risks associated with raw milk mean that these measures cannot guarantee complete safety [5, 12, 13, 15].

How do alternative preservation methods, such as milk acidification and the lactoperoxidase system, compare to pasteurization in terms of cost, effectiveness against various pathogens (including viruses like H5N1), and impact on the nutritional and sensory qualities of milk?

While pasteurization remains the most widely recognized method for inactivating pathogens in milk, alternative methods like milk acidification and the lactoperoxidase system (LPS) have been explored [19].

Milk Acidification:

• Effectiveness: Milk acidification to a pH between 4.1 and 4.2, typically using citric acid, has demonstrated effectiveness in inactivating both low pathogenic avian influenza (LPAI) H6N2 and highly pathogenic avian influenza (HPAI) H5N1 viruses in milk after 6 hours of treatment [19].

• Cost: Milk acidification is noted to be a low-cost implementation [20].

• Accessibility and Ease of Use: Milk acidification is considered an accessible and easy-to-use alternative to pasteurization [19, 20].

• Nutritional and Sensory Qualities: The source texts do not contain explicit information on how milk acidification affects the nutritional and sensory qualities of milk.

Lactoperoxidase System (LPS):

• Effectiveness: One study found that milk treatment with LPS was not effective for the inactivation of the H6N2 virus [19].

• Cost: The lactoperoxidase system is noted to be a low cost of implementation [20].

• Accessibility and Ease of Use: The method was selected for evaluation because of its accessibility and ease of use [20].

• Nutritional and Sensory Qualities: The source texts do not contain explicit information on how LPS affects the nutritional and sensory qualities of milk.

Pasteurization:

• Effectiveness: Pasteurization effectively kills raw milk pathogens without any significant impact on milk nutritional quality [21]. It eliminates harmful pathogens, including bacteria responsible for diseases like listeriosis, salmonellosis, and tuberculosis [22, 23]. Research has shown that pasteurization inactivates the H5N1 influenza virus in raw whole milk [24, 25].

• Cost: The USDA indicates that less than 50% of large dairy farms pasteurize non-saleable milk, with a much lower percentage occurring in medium and small dairy farms [19].

• Nutritional Impact: Pasteurization does not reduce milk's nutritional value [26, 27]. The nutritional value is the same for all milk across the board, except that pasteurized milk does not carry the risk of bacteria [28].

• Sensory Qualities: With the exception of an altered organoleptic [flavor] profile, heating (particularly ultra-high temperature and similar treatments) will not substantially change the nutritional value of raw milk or other benefits associated with raw milk consumption [29].

Comparison Table:

Feature

Milk Acidification

Lactoperoxidase System (LPS)

Pasteurization

Effectiveness

Effective against LPAI H6N2 and HPAI H5N1 viruses [19]

Not effective against LPAI H6N2 in the study [19]

Kills a wide range of pathogens, including bacteria and viruses [21-23, 25]

Cost

Low cost [20]

Varies; can be a barrier for small farms [25]

Accessibility/Ease of Use

Accessible and easy to use [19, 20]

Selected due to accessibility and ease of use [20]

Requires specialized equipment [30]

Nutritional Impact

Information not found in source texts.

Minimal impact on nutritional quality [21, 26, 27]

Sensory Qualities

Information not found in source texts.

May cause an altered flavor profile at very high temperatures [29]

What are the long-term impacts of raw milk consumption on gut flora and the immune system, considering both potential benefits suggested by the "farm effect" and the risks of foodborne illnesses, and what specific demographics might benefit or be harmed?

The long-term impacts of raw milk consumption on gut flora and the immune system are complex and not fully understood. The "farm effect" suggests potential benefits, but these must be weighed against the risks of foodborne illnesses [31].

Potential Benefits (The "Farm Effect"):

• Studies suggest a link between drinking raw milk and lower rates of asthma and some allergies [31, 32].

• Raw milk contains proteins and compounds that keep the immune system from over-reacting to allergens [32].

• Exposure to cows and straw, as well as raw milk, has been associated with lower rates of asthma, and exposure to animal feed storage rooms and manure with lower rates of atopic dermatitis [33].

Risks of Foodborne Illnesses:

• Raw milk can carry dangerous bacteria such as Salmonella, E. coli, Listeria, and Campylobacter [34-38].

• Drinking raw milk can increase the risk for illnesses like E. coli infections, salmonellosis, and listeriosis [39]. These can cause severe abdominal cramps, diarrhea, vomiting, and other serious complications [39, 40].

• Between 1998 and 2018, there were 202 outbreaks linked to drinking raw milk, causing 2,645 illnesses and 228 hospitalizations [18].

Specific Demographics Affected:

• Children: Children made up almost a third of outbreak patients in 2017 [41]. Foodborne illness from raw milk especially affected children and teenagers [38]. Children are more likely to be affected by E. coli [42].

• Pregnant Women: Pregnant women run a serious risk of becoming ill from Listeria, which can cause miscarriage, fetal death, or illness or death of a newborn [43].

• Older Adults: Older people are particularly vulnerable to food poisoning from raw milk [41, 44].

• People with Weakened Immune Systems: Individuals with weakened immune systems are particularly vulnerable to food poisoning from raw milk [36, 38, 41, 44].

Research Considerations:

• Most studies suggesting benefits are based on farm families, whose exposure to a diverse range of bacteria and allergens makes it tricky to pinpoint the reason for their lower allergy rates [41].

• Studies often state that further research should be carried out to understand this relationship better [41].

• Most studies alluding to a possible protective effect of raw milk consumption do not contain any objective confirmation of the raw milk's status or a direct comparison with heat-treated milk [31].

• Observed increased resistance seems to be related to the exposure to a farm environment or to animals than to raw milk consumption [31].

Conclusion: The decision to consume raw milk involves weighing potential immune system benefits against well-documented risks of foodborne illnesses [31]. Vulnerable populations, including children, pregnant women, older adults, and immunocompromised individuals, face a higher risk of severe or life-threatening complications [36, 38, 41, 44].

Raw Milk: Benefits, Risks, and Safety

Understanding Raw Milk

What exactly is raw milk, and how does it differ from the milk most people buy in the store?

Raw milk is milk from animals, such as cows, sheep, or goats, that has not been pasteurized to kill harmful germs [1, 2]. Pasteurization involves heating milk to a specific temperature for a set period to eliminate dangerous bacteria and viruses [3, 4]. The milk you typically find in stores has undergone pasteurization, making it safer to drink [5, 6].

What are the potential benefits that some people believe raw milk offers?

Proponents of raw milk claim it offers more nutrients, prevents allergies and asthma, and relieves lactose intolerance [7, 8]. Some believe raw milk contains beneficial bacteria that are destroyed during pasteurization [9]. However, these claims are not scientifically substantiated [10].

What are the potential risks associated with drinking raw milk, backed by scientific evidence?

Raw milk can harbor dangerous bacteria such as Salmonella, E. coli, Listeria, and Campylobacter [1, 2, 11]. These pathogens can cause foodborne illnesses with symptoms like diarrhea, vomiting, and fever [12, 13]. A Public Health England review found that raw milk was responsible for 26 outbreaks of intestinal infectious disease in England and Wales between 1992 and 2017 [11].

Is it safe to consume raw milk?

No, raw milk is not safe to consume [14, 15]. Health agencies like the FDA, CDC, and AAP agree that raw milk can contain disease-causing pathogens [15, 16]. Pasteurization is a basic public health measure that eliminates the risk of getting sick from milk [17].

Have any illnesses or deaths been caused by consuming raw milk products?

Yes, there have been illnesses and deaths caused by consuming raw milk products [18]. From 1987 to September 2010, there were at least 133 outbreaks due to the consumption of raw milk and raw milk products in the U.S., resulting in 2,659 illnesses, 269 hospitalizations, 3 deaths, 6 stillbirths, and 2 miscarriages [18].

What are some of the symptoms of illnesses that can be caused by consuming raw milk?

Symptoms of illness caused by consuming raw milk can include vomiting, diarrhea, abdominal pain, fever, headache, and body ache [12, 19, 20]. While most healthy people recover, some individuals can develop chronic, severe, or life-threatening symptoms [12, 19-21]. Pregnant women, older adults, children, and those with weakened immune systems are particularly at risk [1, 2, 12].

Raw Milk: Risks and Benefits

Understanding Raw Milk

What exactly is raw milk, and how does it differ from the milk most people buy in the store?

Raw milk is milk that has not been pasteurized [1]. Pasteurization is a process where milk is heated to a specific temperature for a set period to kill disease-causing pathogens [2-4]. This means the raw milk you obtain directly from a farm, for example, has not undergone this heating process to eliminate harmful bacteria [5]. Most milk available in stores has been pasteurized [6]. The purpose of pasteurization is to kill harmful organisms responsible for diseases such as listeriosis, typhoid fever, tuberculosis, diphtheria, Q fever, and brucellosis [3]. The absence of pasteurization is the key difference between raw milk and the milk you typically purchase in stores [7, 8].

What are the potential benefits that some people believe raw milk offers?

Some raw milk advocates believe that unpasteurized milk provides more nutrients, prevents allergies and asthma, and even relieves lactose intolerance [9, 10]. They believe that raw milk contains beneficial bacteria and enzymes that are destroyed during pasteurization [11, 12]. For example, some raw milk proponents claim that it contains lactase secreted by "beneficial" or probiotic bacteria which helps with lactose intolerance [12]. However, it is important to note that these perceived nutritional and health benefits of raw milk consumption have not been scientifically substantiated [13].

What are the potential risks associated with drinking raw milk, backed by scientific evidence?

The FDA, CDC, and AAP strongly recommend against drinking raw milk and eating products made with raw milk [14, 15]. Raw milk can carry dangerous bacteria such as Salmonella, E. coli, Listeria, and Campylobacter [8, 16-21]. These microorganisms can lead to severe diarrhea and vomiting, miscarriage, paralysis, and serious kidney problems in children [22, 23]. A 2019 Public Health England review found raw milk responsible for 26 outbreaks of intestinal infectious disease in England and Wales between 1992 and 2017 [16]. In addition to bacterial pathogens, raw milk can also carry the HPAI virus [24]. Milk from infected cows can carry the HPAI virus, and while it's still unclear whether humans can be infected with HPAI by drinking contaminated raw milk, the FDA considers it a high-risk food and cautions against consuming it [24].

Is it safe to consume raw milk?

No, it is not safe to consume raw milk [7, 15, 25, 26]. The FDA, the CDC, and the AAP all agree that raw milk is unsafe because it can contain disease-causing pathogens [14, 15]. According to Dr. Jorge Gutierrez-Merino, raw milk may contain many different pathogenic microbes, including some deadly bacteria, which could cause fatal infections, mainly in children, the elderly, and immunocompromised people [25]. Pasteurization was adopted as a basic public health measure to kill dangerous bacteria and largely eliminate the risk of getting sick from milk [27].

Have any illnesses or deaths been caused by consuming raw milk products?

Yes, illnesses and deaths have resulted from the consumption of raw milk products [28]. A compilation of data from the FDA based on CDC data, literature, and state and local reports from 1987 to September 2010, showed at least 133 outbreaks due to the consumption of raw milk and raw milk products [28]. These outbreaks caused 2,659 cases of illnesses, 269 hospitalizations, 3 deaths, 6 stillbirths, and 2 miscarriages [28]. It is also noted that the actual number of illnesses associated with raw milk is likely greater, as not all cases of foodborne illness are recognized and reported [28]. Between 1993 and 2006, more than 1500 people in the United States became sick from drinking raw milk or eating cheese made from raw milk [29]. The CDC reported that unpasteurized milk is 150 times more likely to cause foodborne illness and results in 13 times more hospitalizations than illnesses involving pasteurized dairy products [29].

What are some of the symptoms of illnesses that can be caused by consuming raw milk?

Symptoms of illness caused by consuming raw milk can include diarrhea, stomach cramps, vomiting, and flu-like symptoms, such as fever, headache, and body aches [30, 31]. Most healthy people recover after eating or drinking contaminated raw milk products [30, 32]. However, some people can have severe symptoms or can die from the infection [30, 32]. Raw milk is particularly unsafe for children under 5 years, people with immune conditions, adults ages 65 years and older, and pregnant women [30, 33, 34]. Pregnant women run a serious risk of becoming ill from Listeria, which is often found in raw milk and can cause miscarriage, or illness, or death of the newborn baby [3, 35].

The Science of Pasteurization: Safety, Nutrients, and Allergies

The Science of Pasteurization

How does the pasteurization of raw milk protect consumers?

Pasteurization protects consumers by killing harmful bacteria and viruses that may be present in raw milk [1-12]. This process eliminates disease-causing pathogens, such as Listeria, Salmonella, E. coli, Campylobacter, and others responsible for illnesses like listeriosis, typhoid fever, tuberculosis, diphtheria, Q fever, and brucellosis [2, 3, 5, 7, 11, 13-15]. Pasteurization makes milk safe to drink [9, 12, 16-22].

Different organisms respond differently to heat, so controlled scientific studies determine the length of time at a given temperature required to kill a specific organism [23]. The Grade "A" Pasteurized Milk Ordinance, updated every two years, guides pasteurization in the U.S. since 1924 [23].

*Pasteurization Methods*

*   **High-Temperature Short-Time (HTST) Pasteurization:** Milk is pumped through thin plates at high speed, reaching a minimum temperature of 161°F (71°C), held for 15 seconds, and then automatically checked for temperature [24]. HTST pasteurized milk typically has a refrigerated shelf life of two to three weeks [25].
*   **Vat Pasteurization (Batch Pasteurization):** Used by smaller-scale processors, milk is pumped into a temperature-controlled tank with a stirrer, heated to a minimum of 145°F (63°C), and held there continuously for 30 minutes before cooling [24].
*   **Ultra-High-Temperature (UHT) Pasteurization:** Milk is pasteurized at 275°F (135°C) for 1-2 seconds, providing the same level of safety as HTST but extends shelf life to three months under refrigeration [26]. When combined with sterile handling and aseptic packaging, it can be stored non-refrigerated for up to 9 months [25].

Does pasteurization affect the nutrient content of milk?

Research indicates no meaningful difference between the nutrient content of pasteurized and unpasteurized milk [3, 7, 17, 18, 20, 27, 28]. Pasteurization does not significantly reduce milk's nutritional value [18, 20, 29, 30]. Minerals are stable under pasteurization conditions, with minimal changes in their concentrations [31]. Studies show that pasteurization has no impact on milk mineral content and mineral bioavailability [31].

Specific Nutrients and Pasteurization

*   **Proteins:** The protein quality of pasteurized milk is the same as raw milk [32]. Studies have found no difference in protein digestibility between raw and pasteurized milk [32].
*   **Fats:** Pasteurization has essentially no effect on milk fat composition [33].
*   **Vitamins:** Pasteurization has little effect on milk vitamin levels [34]. While some studies suggest reductions in vitamins B12 and E, pasteurization increases vitamin A concentrations [35]. Milk is not a primary source of vitamins B12 or E, so the effects of pasteurization are negligible. Milk is a good source of vitamin A, and pasteurization appears to increase its concentration [35]. Pasteurization may lead to a decrease in vitamin C and folate, but milk is not a primary source of these vitamins. A significant decrease in vitamin B2 concentrations has been noted, but milk still contributes significantly to the recommended daily intake of this vitamin [35].

Does pasteurizing milk alter it in a fashion that can cause allergic reactions?

No, pasteurizing milk does not alter it in a way that causes allergic reactions [20, 36, 37]. The milk proteins that cause allergic reactions in dairy-sensitive individuals are present in both raw and pasteurized milk [17, 20, 36, 37].

Can drinking pasteurized milk cause lactose intolerance?

No, drinking pasteurized milk does not cause lactose intolerance [36, 37]. Lactose intolerance results from an insufficient production of the enzyme beta-galactosidase, needed to break down lactose [37]. Lactose is present in both raw and pasteurized milk at the same concentration, and pasteurization does not impact lactose concentration [37].

Does raw milk kill pathogens?

No, raw milk does not kill pathogens [18, 20, 38]. In fact, it potentially harbors a wide range of dangerous pathogens that can cause illness [38]. Pasteurization is the only method to achieve complete elimination of vegetative pathogens [39]. The FDA does not believe that Hazard Analysis and Critical Control Points (HACCP) can ensure raw milk safety [40]. Testing raw milk for pathogens is not an alternative to pasteurization because potential pathogens can be diverse, variable, and unpredictable [41]. The inability to detect pathogens does not indicate their absence [41].

Raw Milk: Legality, Risks, and Regulations

Raw Milk and the Law

Is it legal to sell raw milk for human consumption?

No, it is not legal to sell raw milk for human consumption in interstate commerce in the United States [1]. The FDA issued a regulation in 1987 prohibiting the interstate sale of raw milk [1, 2]. However, some states permit the intrastate (within the borders) sale of raw milk intended for human consumption [1].

Raw Milk Legality in Different States and Countries

*   **United States:** The sale of raw milk is permitted in some states, while others impose restrictions due to safety concerns [1, 3]. As of 2011, 20 states allowed some type of raw milk sale for direct human consumption [4]. Some states permit cow shares, and raw milk can be purchased for animal consumption in many states where retail for human consumption is prohibited [3].
*   **Canada:** The sale of raw milk directly to consumers has been prohibited under the Food and Drug Regulations since 1991 [5]. Provincial laws also forbid the sale and distribution of raw milk [6]. However, Canada permits the sale of raw milk cheese aged over 60 days [3].
*   **Europe:** In the European Union, individual member states can prohibit or restrict the sale of raw milk, but it is not banned outright [7, 8]. Under EU hygiene rules, member states can prohibit or restrict the placing on the market of raw milk intended for human consumption [8]. Individual member states can also implement stricter requirements, such as special sanitary regulations and frequent quality tests [8].

    *   **France:** Raw milk cheeses make up about 18 percent of France's total cheese production and are considered far superior to cheeses made from pasteurized milk [9]. Many traditional French cheeses have solely been made from raw milk for hundreds of years [9].
    *   **Germany:** Packaged raw milk may be sold in shops under the name Vorzugsmilch, with stringent quality restrictions [9]. Unpackaged raw milk may only be sold at the farm where it was produced, must be from the day of or the day before production, have a warning label "Raw Milk – boil before use", and cannot be used in communal kitchens [10].
    *   **Republic of Ireland:** The sale and production of raw milk are legal and regulated by the Department of Agriculture [11]. Farmers wishing to produce more than 30 liters of raw milk for human consumption are required to register with the department's Milk Hygiene Division and consent to random sampling of their products as well as regular inspections of their production facilities [11].
    *   **Nordic States:** Shops are not permitted to sell unpasteurized milk to consumers in Norway, Sweden, Finland, and Denmark [12]. All four countries allow limited "barn door" sales subject to strict controls [12].
    *   **Slovenia:** Raw milk has been available from refrigerated milk vending machines since 2010, subject to stringent regular control [12]. As of 2018, raw milk is also available in shops [13].
    *   **United Kingdom:** About 150 producers of raw milk are listed with the Food Standards Agency in England, Wales, and Northern Ireland [13]. They sell raw milk directly to consumers either at the farm, at a farmers' market, or through a delivery service [13]. The bottle must display the warning "this product has not been heat-treated and may contain organisms harmful to health", and the milk must conform to higher hygiene standards than dairies producing only pasteurized milk [13]. It is an offense to place raw milk or cream on the market for direct consumption in Scotland following a spate of deaths in 1983 [5].
*   **Australia:** The sale of raw milk for drinking purposes is illegal in all states and territories in Australia, as is all raw milk cheese [14]. This has been circumvented somewhat by selling raw milk as bath milk [14].
*   **New Zealand:** Raw milk for drinking and raw milk products can be made and sold but are highly regulated to offset the pathogen risk [15]. Producers of raw milk for sale to consumers must be registered, and raw milk must either be collected by the purchaser from the producer's farm or delivered to the purchaser's home [15].

Why is raw milk illegal in some areas?

Raw milk is illegal in some areas due to the health risks associated with consuming it [16-20]. Raw milk can contain harmful bacteria such as Salmonella, E. coli, and Listeria [17, 18, 20-24]. These bacteria can cause foodborne illnesses, leading to symptoms such as vomiting, diarrhea, abdominal pain, and flu-like symptoms [25-28]. In severe cases, these illnesses can result in chronic conditions, life-threatening complications, or even death [25-28].

Certain populations are more susceptible to infections originating in raw milk, including young children, the elderly, people with weakened immune systems, and pregnant women [18, 22, 24, 25, 29-31]. For instance, pregnant women run a serious risk of becoming ill from Listeria, which can cause miscarriage, fetal death, or illness or death of a newborn [31, 32].

Pasteurization is a process that kills harmful bacteria, making milk safe to drink [2, 33-43]. The FDA and other health agencies strongly recommend against drinking raw milk, emphasizing that pasteurization is a critical step in ensuring milk safety [18, 24, 25, 39, 44-48].

The Raw Milk Debate: Safety, Myths, and Misconceptions

The Raw Milk Debate

Why has raw milk become such a popular topic in social media wellness circles?

Raw milk has gained traction in social media wellness circles due to several factors, including a general anxiety about ultra-processed foods and a perception that "natural" foods are healthier [1]. This is reflected in social media where raw milk is often promoted as a "misunderstood" food, superior to pasteurized milk [2]. Influencers sometimes portray pasteurization negatively, contributing to the belief that it diminishes milk's nutritional value [1]. This narrative aligns with broader trends of anti-authority, anti-science, and anti-expertise sentiments, where skepticism towards established food safety practices is common [3].

Why are some people so passionately against pasteurization, as we see in some online videos?

Some individuals passionately oppose pasteurization because they believe it harms milk and that raw milk is a safer, healthier alternative [4, 5]. They claim raw milk offers more nutrients, prevents allergies and asthma, and relieves lactose intolerance [6, 7]. These beliefs tap into anxieties about processed foods, with pasteurization being portrayed as a dangerous byproduct [1]. However, experts and scientific evidence dispute these claims, asserting that pasteurization does not reduce milk's nutritional value and is essential for eliminating harmful pathogens [7-10].

What are some common misconceptions about raw milk?

There are several common misconceptions about raw milk:

• Myth: Raw milk is more nutritious than pasteurized milk [7]. Fact: The nutritional value of raw and pasteurized milk is essentially the same [7]. Pasteurization does not significantly reduce milk's nutritional content [9-12].

• Myth: Raw milk can prevent allergies and asthma [7]. Fact: There is no scientific evidence that raw milk can help with allergies or asthma [7, 13]. Studies suggesting a link between raw milk consumption and lower rates of asthma and allergies are primarily based on farm families, whose exposure to diverse bacteria and allergens makes it difficult to isolate the reason for their lower allergy rates [14-17].

• Myth: Raw milk is safe because it contains beneficial bacteria that kill dangerous pathogens [10, 18]. Fact: Raw milk can harbor various human pathogens, including E. coli O157:H7, Salmonella, Streptococcus spp., Yersinia enterocolitica, Campylobacter jejuni, Staphylococcus aureus, and Listeria [19-27]. These pathogens can cause foodborne illnesses, with severe outcomes for vulnerable populations [5, 23, 25, 26, 28-38].

• Myth: Pasteurization causes lactose intolerance [4, 7]. Fact: Pasteurization does not cause lactose intolerance [4, 7, 10]. Lactose intolerance is due to a deficiency in the enzyme lactase, which is needed to break down lactose, and both raw and pasteurized milk contain lactose [4, 18].

• Myth: Raw milk kills dangerous pathogens by itself [10, 12]. Fact: Raw milk does not kill dangerous pathogens; instead, it can harbor a wide range of harmful bacteria [13]. Pasteurization is the only method to achieve complete elimination of these pathogens [39]. Raw Milk as a "Natural" or "Whole" Food The idea that raw milk is a "natural" or "whole" food superior to pasteurized milk is a common misconception [1]. While it is true that raw milk is unprocessed in terms of heat treatment, this lack of processing does not inherently make it superior [2]. Pasteurization does not significantly reduce milk's nutritional value [9-12]. The primary purpose of pasteurization is to eliminate harmful bacteria, making milk safe for consumption, which outweighs any perceived benefits of consuming it raw [2, 3, 20, 23-27, 33, 40-53].

Are there any circumstances where raw milk might be considered "safer"?

No circumstances make raw milk truly "safe" because harmful bacteria can be present even in the best-managed farms [36, 54]. Careful sanitation practices during raw milk production can reduce health risks but not eliminate them completely [36]. Testing raw milk can reduce risks but it is not an alternative to pasteurization [55]. The potential pathogens present in raw milk can be diverse, variable, and unpredictable, making it impossible to test every batch for every pathogen before consumption [55, 56]. The inability of a method to detect pathogens does not indicate their absence [55].

What do food safety experts and public health officials say about the trend of drinking raw milk?

Food safety experts and public health officials strongly advise against drinking raw milk due to the associated health risks [3, 8, 42, 43, 46, 50, 52, 57-59]. Agencies such as the FDA, CDC, and American Academy of Pediatrics (AAP) emphasize that raw milk can contain dangerous germs like Salmonella, E. coli, and Listeria, which can cause severe foodborne illnesses [23, 25-27, 42, 43, 57, 60]. These illnesses can lead to hospitalization, chronic conditions, or even death, especially in vulnerable populations such as children, pregnant women, the elderly, and those with weakened immune systems [5, 15, 23, 25-38, 52, 57, 61]. Pasteurization is a widely used process that effectively kills these harmful germs without significantly affecting milk's nutritional value [2, 3, 20, 23-26, 33, 40-53].

Avian Flu in Raw Milk: H5N1 Virus Transmission and Inactivation

Raw Milk and Avian Flu

Has bird flu been detected in raw milk?

Yes, bird flu has been detected in raw milk [1, 2]. In late November 2024, California regulators recalled two batches of raw, unpasteurized milk from a Fresno dairy farm after detecting the bird flu virus in the milk [1]. This discovery occurred amid an ongoing public debate regarding the advantages and disadvantages of consuming raw milk [2].

How does the H5N1 virus found in raw milk impact calves?

The impact of the H5N1 virus found in raw milk on calves is an area of current concern with limited data available [3]. One study showed that mice fed with H5N1 virus-containing milk from an infected cow rapidly showed signs of disease and virus dissemination to respiratory and non-respiratory organs [4]. However, another study involving the inoculation of Holstein calves with a US H5N1 bovine isolate through their nostrils resulted in moderate nasal replication and shedding without severe clinical signs or transmission to other calves [5]. It's important to note that the aerosolized dose used for nostril inoculation in the latter study may not represent the exposure expected from calves ingesting milk containing H5N1 [3].

Can H5N1 virus-containing milk from an infected cow transmit the virus?

Yes, H5N1 virus-containing milk from an infected cow can potentially transmit the virus [4, 6]. The virus's tropism for the mammary gland in dairy cattle leads to a high viral load and shedding in milk, raising concerns about potential transmission to animals and humans [6]. Studies have demonstrated the pathogenicity of H5N1 virus-containing milk, with mice rapidly showing signs of disease and virus dissemination after being fed such milk [4].

What methods exist for deactivating H5N1 in raw milk?

Pasteurization is a widely recognized method for inactivating H5N1 in milk [7]. Both continuous flow high-temperature-short-time (HTST) pasteurization (72°C for 15 seconds) and low-temperature-long-time (LTLT) pasteurization (63°C for 30 minutes) have demonstrated effective inactivation of H5N1 in raw whole milk [8]. Another method is milk acidification [7].

What is the effect of milk acidification on the inactivation of influenza A virus H5N1?

Milk acidification has been identified as an effective method for deactivating influenza A virus H5N1 in milk [9, 10]. Studies have shown that milk acidification with a pH between 4.1 and 4.2 results in the inactivation of both low pathogenic avian influenza (LPAI) H6N2 and highly pathogenic avian influenza (HPAI) H5N1 virus in milk after 6 hours of treatment [7].

What pH level is recommended for milk acidification to inactivate the H5N1 virus?

A pH between 4.05 and 4.2 is recommended for milk acidification, with an ideal target pH as close to 4.1 as possible, to effectively inactivate the H5N1 virus [11].

How does milk fat content affect the virucidal effect of milk acidification against HPAI?

Milk fat content may affect the virucidal effect of milk acidification against HPAI [12]. One study observed viral inactivation only in milk replicates from a cow with higher milk fat content compared to those from a cow with lower milk fat content [12, 13]. This raises the hypothesis that milk with a higher fat content may have a greater virucidal effect [12]. Studies have demonstrated antimicrobial activity in digestion products of bovine milk triglycerides and membrane lipids [12]. Additionally, enveloped viruses like HPAI are lipid-sensitive and affected by fatty acids present in milk [11, 12]. However, further studies are needed to confirm the effect of milk fat on HPAI inactivation [12].

Raw Milk Safety: Bacteria, Risks, and Hygiene

The Science Behind Raw Milk Safety

What bacteria are typically found in raw milk, and are they typically of human origin?

Raw milk can contain a variety of bacteria, though they are not typically of human origin [1, 2]. Some of the bacteria found in raw milk include E. coli O157:H7, Salmonella, Streptococcus spp., Yersinia enterocolitica, Campylobacter jejuni, Staphylococcus aureus, Listeria monocytogenes, Mycobacterium tuberculosis, and Coxiella burnetti [3]. These microorganisms can cause a variety of foodborne illnesses [4, 5]. The origins of these bacteria are often from sources other than humans [1]. These sources include:

• Infected udder tissues (e.g., mastitis-causing bacteria) [1]

• The dairy environment (e.g., soil, water, and cow manure) [1]

• Milking equipment [1]

An exception is Streptococcus pyogenes, which has adapted to humans and can be transmitted to animals [2].

How can Streptococcus pyogenes in animals be re-transmitted to humans through raw milk?

Streptococcus pyogenes, a human pathogen, can be transmitted to animals and subsequently re-transmitted to humans through raw milk [2]. This process occurs as follows [2]:

• S. pyogenes adapts to humans and is transmitted to animals.

• The bacteria colonize in animals, such as infecting a cow's udder and causing mastitis.

• The infected cow udder sheds S. pyogenes into raw milk.

• Humans consume the contaminated raw milk, leading to the re-transmission of S. pyogenes as a human pathogen, potentially causing strep throat [2].

What are bifidobacteria, and why are they mentioned by raw milk advocates?

Bifidobacteria are bacteria commonly found in the gastrointestinal tracts of humans and animals [6]. They are a component of gut flora [6]. Raw milk advocates sometimes mention bifidobacteria as "good bugs" present in raw milk [2]. However, the presence of bifidobacteria in raw milk indicates fecal contamination and poor farm hygiene, as raw milk collected with proper hygiene should not contain these bacteria [6].

How does pasteurization affect human milk fat composition?

The sources do not contain information about how pasteurization affects human milk fat composition.

Traditional Milk Preservation and Fermentation Techniques

Here's a detailed response addressing traditional methods of milk preservation, fermentation, and yogurt production across different cultures:

Raw Milk in Different Cultures

Are there traditional methods of milk preservation or fermentation that have been used historically in different cultures?

Yes, various traditional methods of milk preservation and fermentation have been employed across different cultures throughout history [1, 2]. These techniques not only extended the shelf life of milk but also transformed it into a variety of valuable food products [2]. Some cultures have relied on allowing milk to sour naturally, resulting in products like acidified or sour milk [1]. Others have developed more complex processes like cheese making [2].

Traditional yogurt and cheese making serve as excellent examples [2]:

• Traditional Yogurt: In many African countries, sour milk is produced through spontaneous acidification of raw or, less frequently, boiled milk [1]. The milk is left in a covered container for 24-48 hours, allowing natural flora or bacteria from the vessel to initiate fermentation [3]. In Kenya, some communities add charcoal powder from specific trees for flavoring and coloring [4]. Additionally, smoking containers before fermentation helps prevent mold growth [4].

• Traditional Cheese Making: Concentrated fermented milks, created by spontaneous acidification of raw milk followed by partial draining, are considered possible ancestors to modern cheeses [2]. For example, concentrated fermented milk involves pouring raw milk into a calabash, gourd, or clay pot and leaving it at room temperature for 3-4 days [5]. Whey is removed, and fresh milk is added repeatedly until the container is full [5]. This process can take about a week, and the resulting product can last for another week at room temperature [5].

How do traditional and industrial-scale production of DAHI differ?

DAHI, a yogurt-like product consumed in the Indian subcontinent and Myanmar, has distinct production methods depending on the scale [6, 7].

• Traditional Method: Milk is heated to boiling and cooled to body temperature [8]. A small amount of DAHI or buttermilk from a previous batch is added (0.5-1% of the milk volume) as a starter [8]. The mixture is left overnight to sour and coagulate [8]. Insulation methods vary; in cooler regions like Nepal and Bhutan, the container is wrapped in cloth or hay or placed in a straw box to maintain a consistent temperature [8]. The final acidity typically reaches 0.9-1.0% lactic acid [8].

• Industrial-Scale Production: Urban dairy plants use homogenized milk, which results in a firmer DAHI [9]. Starter cultures containing lactic acid bacteria (Streptococcus thermophilus and Lactobacillus bulgaricus) are used [9].

In Nepal, some traditional DAHI production occurs without a starter culture, relying on natural flora on the vessel surfaces for acidification [9]. A semi-continuous method involves adding cooled, boiled milk to a wooden vessel containing a natural starter culture daily until the container is full [9]. Earthenware pots are commonly used, imparting a "muddy" flavor and thicker texture [9].

How is yoghurt made in Bolivia?

In Bolivia, yogurt production typically occurs at an industrial level, often introduced by private firms or international cooperation [10]. The process involves:

• Using whole or partly skimmed cow milk as the raw material [10].

• Heating the milk to 80°C for 60 minutes or 92°C for 15 seconds [11].

• Cooling the milk to 45°C and adding a pure culture of Lactobacillus bulgaricus and Streptococcus thermophilus (2-3% of the milk quantity) [11].

• Fermenting the milk for 3-4 hours at 42°C [11].

• The acidified milk is then stored at 6-7°C, with a shelf life of 15-21 days [11].

The resulting yogurt is similar to industrially produced yogurt in European countries, with the same color and homogeneous texture [11].

How is yoghurt made in the Near East Area?

Yogurt production in the Near East, including countries like Cyprus, Saudi Arabia, Turkey, Lebanon, Syria, Qatar, Jordan, and Egypt, involves various heat treatments and fermentation processes [12].

• Raw Materials: Cow, sheep, goat, or buffalo milk are used, depending on availability [13].

• Heat Treatment: Traditional methods involve heating milk to 80-90°C for 30 minutes, while large-scale units heat it to 85-90°C for only 15 seconds [13].

• Inoculation: Milk is inoculated with either a pure culture of Lactobacillus bulgaricus and Streptococcus thermophilus or yogurt from a previous batch (2-3% of the milk volume) [13].

• Fermentation: The milk is allowed to acidify for 2-3 hours at 42-45°C [13].

• Storage: Yogurt can be stored at 5°C for up to 7 days [13]. The final product typically has an acidity level of 0.8 to 0.9 percent lactic acid [13].

Raw Milk: Informed Choices, Risks, and Guidance

Here's some guidance on making informed decisions about raw milk, based on the provided sources:

Making Informed Decisions About Raw Milk

What should consumers look for when purchasing raw milk, if it is legal in their area?

If raw milk sales are legal in a consumer's area, it's crucial to exercise extreme caution and take specific steps to minimize potential health risks [1]. These steps include:

• Reputable Suppliers:

◦ Registered Suppliers: Purchase raw milk only from registered raw milk suppliers [2]. These suppliers are subject to hygiene practice regulations and are often required to sell raw milk directly from the farm or through home delivery [2].

◦ Direct Purchase: In England, Wales, and Northern Ireland, raw milk can only be sold by registered producers directly to customers at the farm (via bottles or vending machines), farmers’ markets, a farmer’s milk round, or direct online sales [3].

◦ Avoid Unverified Sources: Do not buy milk or milk products at farm stands or farmers' markets unless you can confirm that they have been pasteurized [4, 5].

• Handling Practices:

◦ Hygiene: Registered raw milk suppliers must follow strict hygiene practices [2]. However, even with careful sanitation, harmful bacteria may still be present [2].

◦ Temperature Control: Keep the milk chilled while transporting it from the farm [6]. Store raw milk at 4 degrees Celsius (39°F) or less in the refrigerator [6]. Throw it out if it has been left out of the fridge for two or more hours [6].

◦ Separate Storage: Keep the cheese wrapped in the refrigerator and separate from other ready-to-eat foods [7]. Ensure the refrigerator is between 2 degrees Celsius and 4 degrees Celsius [7].

◦ Utensils: Use separate knives and chopping boards for raw-milk cheese [7].

◦ Discarding: Discard the cheese on its use-by date [7].

• Questions to Ask:

◦ Pasteurization Status: Always inquire whether milk or cream has been pasteurized, especially for products sold in refrigerated cases at grocery or health food stores [5].

◦ Raw Milk Status: If purchasing cheese, ask shop or waiting staff if the cheese is made from raw milk. Look for labels that say "raw" or "unpasteurized" [8].

◦ Contact Information: When purchasing raw milk, provide contact details so the supplier can notify you if a batch is found to be contaminated [9].

Who are the groups of people who are at especially high risk for developing illness from consuming raw milk?

Certain groups of people face a higher risk of developing severe illness from consuming raw milk [10-14]. These vulnerable populations include:

• Children, especially those under 5 years old [10, 14-17].

• Pregnant women [14-18].

• Older adults, particularly those with underlying health conditions [10, 12, 14-17].

• Individuals with weakened immune systems, such as transplant patients and those with HIV/AIDS, cancer, or diabetes [10-12, 14, 15, 17].

For these groups, the consequences of consuming raw milk can be particularly severe, leading to chronic, life-threatening conditions or even death [19-21]. Pregnant women risk miscarriage, fetal death, or severe illness in newborns from Listeria [16, 18].

Where can people find reliable, science-based information about raw milk to make informed decisions?

To make well-informed decisions about raw milk consumption, individuals should consult reliable, science-based sources [22]. Here are some resources:

• Government Health Agencies:

◦ Centers for Disease Control and Prevention (CDC) [1, 17, 23-31]: The CDC provides comprehensive information on the dangers of raw milk, including outbreak data and safety recommendations [11, 32].

◦ Food and Drug Administration (FDA) [1, 31, 33-40]: The FDA offers detailed information on raw milk, including misconceptions, risks, and regulatory actions [21, 41-43].

◦ Food Standards Agency (FSA) [15, 44-47]: The FSA in the UK provides guidance on raw milk safety, regulations, and the importance of health warnings [15, 44-47].

◦ Ministry for Primary Industries (MPI) [2, 31, 48-50]: MPI in New Zealand offers information on raw milk regulations and safety measures for consumers [2, 31, 48-50].

• Academic and Scientific Reviews:

◦ Peer-reviewed studies and reviews in scientific journals offer evidence-based analyses of the risks and benefits of raw milk consumption [2, 4-9, 11-14, 16-18, 20-22, 24-32, 34-43, 46-139].

• Medical Professionals:

◦ Consult doctors or healthcare providers, especially if you are pregnant, elderly, have a weakened immune system, or are considering giving raw milk to children [19, 21, 74].

Milk Treatment: Alternatives, LPS, and Acidified Replacers

Here's a detailed response about alternative methods for treating milk, the lactoperoxidase system, and the effects of acidified milk replacers:

Pasteurization Alternatives

Beyond traditional pasteurization, are there alternative methods for treating milk to reduce pathogens?

Yes, in addition to traditional pasteurization, several alternative methods exist for treating milk to reduce pathogens [1, 2]. These methods aim to provide effective microbial inactivation while minimizing the impact on the milk's nutritional and sensory qualities [2]. Some of these alternative methods include:

• Thermosonication: This method combines heat and ultrasound to inactivate microorganisms [2].

• UV Treatment: Exposing milk to ultraviolet (UV) light can reduce the number of pathogens [2].

• Pascalization (High-Pressure Processing - HPP): This non-thermal method uses high pressure to inactivate microbes [1, 2].

• Pulsed Electric Field (PEF): PEF is another non-thermal method that uses short bursts of electricity to kill microorganisms [1, 2].

• Food Irradiation: This involves exposing milk to ionizing radiation to eliminate pathogens [2].

• High-Pressure Homogenization: This technique uses high pressure to reduce particle size and can also inactivate some microorganisms [2].

• Pulsed Light Technology: This method uses intense, short pulses of broad-spectrum light to decontaminate surfaces and liquids [2].

• Milk Acidification: Acidifying milk to a pH between 4.1 and 4.2 can inactivate certain viruses, such as the avian influenza virus H5N1 [3]. Citric acid is often used for this purpose [3, 4].

How does the lactoperoxidase system (LPS) affect the microbial inhibition and preservation of milk?

The lactoperoxidase system (LPS) is a natural antimicrobial system present in milk, involving the enzyme lactoperoxidase, thiocyanate, and hydrogen peroxide [5]. When activated, this system can inhibit or kill certain microorganisms, thus helping to preserve milk [5, 6].

• Mechanism: Lactoperoxidase catalyzes the oxidation of thiocyanate by hydrogen peroxide, producing hypothiocyanite, which has antimicrobial properties [7, 8].

• Activation: Activation of the LPS requires the addition of thiocyanate and hydrogen peroxide [9]. For example, sodium thiocyanate and sodium percarbonate can be added to milk to activate the system [9].

• Effectiveness: The effectiveness of LPS depends on the concentrations of its components and the specific microorganisms present [5, 10]. The FDA is not aware of any studies demonstrating pathogen reduction by inherent levels of xanthine oxidase (XO) present in raw milk [11].

• Limitations: The FAO/WHO states that the LPS is "not to render milk safer for consumption" and that "the safety of milk is only achieved through a combination of good hygienic practices and heat treatment of milk, independent of LPS” [6]. One study found that LPS was not effective in inactivating the LPAI H6N2 virus in milk [3].

What are the effects of a free-access acidified milk replacer feeding program on the health and growth of dairy replacement heifers and veal calves?

Acidified milk replacers are used to lower the milk pH, which inhibits bacterial growth [12].

• Benefits:

◦ Reduced Bacterial Growth: Acidifying milk to a pH between 4.1 and 4.4 reduces coliform and aerobic bacterial growth in raw bulk tank milk [13].

• Considerations:

◦ Palatability: Citric acid is often used due to its palatability and safety [4].

Dairy Farming: Safety, Quality, and Contamination Control

Here's an extensive exploration of the differences between milk production on small farms versus large industrial operations, methods farmers can use to ensure high-quality dairy products, and potential contamination sources:

Raw Milk and Farming: Safety and Quality

What are the key differences between milk produced on small farms versus large industrial operations, and how might that affect safety?

Milk production practices can vary significantly between small farms and large industrial operations, influencing milk safety.

• Scale and Management Practices:

◦ Small Farms: Small farms often have fewer cows, allowing for more individualized attention to animal health and hygiene [1]. They may use traditional methods, such as heating milk to boiling point and using natural starters for fermentation [1, 2]. Some small dairies are adopting low-temperature vat pasteurization to produce a product similar in composition to raw milk while reducing pathogens [3].

◦ Large Industrial Operations: Large operations manage thousands of cows, relying on standardized processes [4]. Milk is picked up in tanker trucks and delivered to processing plants [5]. These plants often use high-temperature short-time pasteurization to treat large milk volumes [6].

• Pasteurization Practices:

◦ Small Farms: A USDA study indicated that only a small percentage of small operations pasteurize non-saleable milk before feeding it to calves [4].

◦ Large Operations: A significantly higher percentage of large operations pasteurize non-saleable milk [4].

• Potential for Pathogen Contamination:

◦ Small Farms: Raw milk may become contaminated by animal poop and germs carried by insects and rodents. Animals being milked can also have diseases that contaminate milk [7]. High bacteria counts in raw milk often indicate poor animal health and farm hygiene [8].

◦ Large Industrial Operations: Outbreaks in large operations are often due to pasteurization failures or post-pasteurization contamination [9-14]. Contamination can originate from Salmonella-contaminated raw milk [12].

• Organic vs. Conventional Practices:

◦ Small Farms: Small farms that sell raw milk may operate under organic principles, which emphasize animal welfare and environmental stewardship [15]. However, even with these practices, milk can still be contaminated [15, 16].

◦ Large Industrial Operations: Industrial operations may prioritize efficiency and volume, potentially impacting animal welfare and environmental practices [4].

• Testing and Regulation:

◦ Small Farms: Raw milk producers are required to adhere to specific hygiene standards and undergo regular inspections [17]. Testing raw milk for pathogens may not guarantee safety, as contamination can be intermittent [14, 18].

◦ Large Industrial Operations: Pasteurization is mandatory for milk sold across state lines in the U.S. [19]. HACCP (Hazard Analysis and Critical Control Points) is used to ensure product safety through process control [20].

How can farmers ensure high-quality, safe dairy foods?

Farmers can implement various strategies to ensure the production of high-quality, safe dairy foods [17]:

• Maintain Animal Health:

◦ Healthy Herd: Ensure the herd is healthy and free from diseases like brucellosis and tuberculosis [21].

◦ Mastitis Prevention: Prevent and manage mastitis, as mastitic cows can shed pathogens into raw milk [22].

• Implement Strict Hygiene Practices:

◦ Sanitation: Follow strict hygiene practices during raw milk production to reduce health risks [17].

◦ Facility Cleanliness: Maintain clean milking equipment and facilities to minimize contamination [8].

• Monitor Milk Quality:

◦ Regular Testing: Sample and test raw milk regularly to detect harmful bacteria [21].

◦ Quality Indicators: Monitor routine quality indicators, though these may not always detect the presence of pathogens [18].

• Temperature Control:

◦ Refrigeration: Refrigerate milk and dairy products at 40°F (4°C) or below to prevent bacterial growth [16].

◦ Proper Storage: Never leave perishable foods like dairy products out for more than 2 hours (or 1 hour if exposed to temperatures above 90°F) [16].

• Pasteurization:

◦ Effective Method: Pasteurization remains the most effective method to eliminate vegetative pathogens in milk [23].

◦ Proper Execution: Ensure pasteurization methods are executed correctly to produce pathogen-free milk [24].

• Comply with Regulations:

◦ Registration: Register as a raw milk supplier to comply with hygiene practices and regulations [17].

◦ Labeling: Properly label raw milk with health warnings to inform consumers of potential risks [25, 26].

• Utilize HACCP Principles:

◦ Hazard Analysis: Implement a food safety plan under HACCP to reduce the probability of raw milk contamination, though it cannot ensure that raw milk is pathogen-free [14, 20].

◦ Critical Control Points: Identify and control critical points in the production process to minimize biological hazards [15, 20].

What opportunities for contamination exist in dairy environments?

Dairy environments present numerous opportunities for contamination, necessitating stringent control measures [5]:

• Animal Sources:

◦ Animal Feces: Raw milk can be contaminated by animal feces [7].

◦ Infected Udders: Pathogens can be shed from infected udder tissues, such as those with mastitis [8, 22].

• Environmental Sources:

◦ Insects and Rodents: Insects and rodents can carry germs that contaminate raw milk [7].

◦ Farm Environment: The dairy environment, including soil, water, and cow manure, can introduce bacteria into raw milk [8].

• Equipment and Handling:

◦ Milking Equipment: Milking equipment can be a source of contamination if not properly sanitized [8].

◦ Post-Pasteurization Contamination: Pasteurized milk can be contaminated post-pasteurization due to unsanitary conditions in the processing plant [9-14].

• Airborne Contamination:

◦ Air Quality: Airborne transmission of pathogens can occur in barns and milking areas [27].

• Water Sources:

◦ Contaminated Water: Water used for cleaning and sanitation can be a source of contamination if it is not properly treated [8].

• Human Handling:

◦ Human Contact: Workers can introduce pathogens if they do not follow proper hygiene practices [8].

• Biofilms:

◦ Biofilm Formation: Bacteria can survive in biofilms within processing systems, leading to persistent contamination [28].

Milk: Trends, Research, Safety, and Global Regulations

Here's an in-depth look into emerging trends and research areas in milk processing and safety, the workings of gentle pasteurization using microwaves, the health effects of exposure to cows and raw milk, the validity of raw milk health claims, and the variations in raw milk regulations globally:

The Future of Milk: Emerging Trends, Research, and Regulations

Are there any emerging trends or research areas related to milk processing and safety that are worth watching?

Several emerging trends and research areas in milk processing and safety merit attention [1]:

• Alternative Pasteurization Methods: Research into alternative methods for deactivating pathogens in raw milk is ongoing due to the potential challenges and barriers to the adoption of pasteurization of waste milk by dairy farms [1].

• Milk Acidification: Milk acidification is emerging as an effective, accessible, and easy-to-use alternative to milk pasteurization [1]. Research shows that adjusting milk to a pH between 4.1 and 4.2 can inactivate viruses like the highly pathogenic avian influenza (HPAI) H5N1 [1]. Citric acid is commonly used for milk acidification because of its palatability and safety [1].

• Lactoperoxidase System (LPS): Although earlier research in the conversation noted that the LPS was ineffective in inactivating the LPAI H6N2 virus in milk, further research into this and other natural antimicrobial systems may yield better results in the future [1].

• Non-Thermal Processing Technologies: Pascalization or high-pressure processing (HPP) and pulsed electric field (PEF) are non-thermal processes used to pasteurize foods [2].

• Avian Flu in Milk: The detection of avian flu virus fragments in milk is a new challenge for the dairy industry, spurring research to understand the risks to humans and the effectiveness of current interventions [3].

• Raw Milk and H5N1: Research is needed to evaluate the pathogenicity and transmission of preweaned calves fed H5N1 virus-containing milk originating from an H5N1-infected cow [4].

• Antimicrobial Action: It is worth noting that the enzyme lactoperoxidase is naturally present in milk and has an antimicrobial action [4].

How does gentle pasteurization of milk using microwaves work?

Microwave Volumetric Heating (MVH) is the newest available pasteurization technology [5]. It uses microwaves to heat liquids, suspensions, or semi-solids in a continuous flow [5]. MVH delivers energy evenly and deeply into the whole body of a flowing product, it allows for gentler and shorter heating, so that almost all heat-sensitive substances in the milk are preserved [5].

Does exposure to cows and raw milk affect rates of asthma and atopic dermatitis?

Studies have found an inverse relationship between raw milk consumption and asthma and allergies [6, 7]. However, these studies have been performed in children living on farms, not urban children [6, 7]. Exposure to cows and straw, as well as raw milk, were associated with lower rates of asthma, and exposure to animal feed storage rooms and manure were associated with lower rates of atopic dermatitis [8]. It has been suggested that the overall urban vs. farming environment and lifestyle play a role in these differences. For this reason, the overall phenomenon has been named the "farm effect" [7].

Does scientific evidence support raw milk health claims?

The FDA states that pasteurizing milk does not destroy any of its nutritional value [9]. Also, research shows only very slight differences in the nutritional values of pasteurized and unpasteurized milk [10]. The perceived nutritional and health benefits of raw milk consumption have not been scientifically substantiated, and the health risks are clear [11].

How do raw milk regulations differ around the world?

Raw milk regulations vary significantly by country, ranging from complete bans to regulated sales [8, 12]:

• European Union:

◦ Individual member states can prohibit or restrict the sale of raw milk [13].

◦ Raw milk and products made with raw milk must be labeled to indicate this [14].

◦ Special sanitary regulations and frequent quality tests (at least once per month) are often mandatory [14].

• Republic of Ireland: Since 2015, raw milk production has been regulated, requiring farmers producing more than 30 liters for human consumption to register and consent to random sampling and regular inspections [15].

• England, Wales, and Northern Ireland: Raw milk can only be sold by registered producers directly to consumers, with a health warning on the bottle [16, 17].

• Scotland: The sale of raw drinking milk is banned [16, 18].

• United States:

◦ The FDA prohibits the interstate sale of raw milk [19].

◦ Some states permit the intrastate sale of raw milk for human consumption [19].

• Canada: Health Canada advises against drinking raw milk, citing health risks [20].

• New Zealand:

◦ Most milk sold is pasteurized [21].

◦ Raw milk is a risky food for anyone who consumes it, with higher risks for young children and babies, pregnant women, older people (especially those with underlying health conditions), and people with low immunity [22].

• Singapore: The sale of raw milk for human consumption is prohibited [23].

• Asia: In many countries of Asia, laws prohibiting raw milk are nonexistent or rarely enforced [23].

Raw-Milk Cheese: Risks, Handling, and Double Pasteurization

Here's a breakdown of the risks associated with raw-milk cheeses, safe handling practices, and an explanation of double pasteurization:

Raw-Milk Cheeses: Risks and Handling

Are raw-milk cheeses also risky?

Yes, raw-milk cheeses can also pose risks [1]. Bacteria found in these cheeses originate from the raw milk itself [2]. While the cheesemaking process can eliminate some bacteria, its effectiveness depends on the cheese type [2]. Low-moisture or hard cheeses like parmesan or gruyere are generally safer [2]. Soft cheeses like camembert, brie, feta, or fresh cheeses may not have all the bacteria killed during production, leading to potential food safety concerns [3]. Other sources of bacteria can come from the cheesemaking environment including equipment and personnel, or cross contamination between finished products and raw materials [3]. Both pasteurised and raw-milk cheeses can be contaminated this way [3].

What should you do when keeping and handling raw-milk cheese?

If you choose to buy and serve raw-milk cheese, take care in how you store and handle it [4]:

• Purchase cheese from a reputable supplier [4].

• Keep the cheese wrapped in your refrigerator, separate from other ready-to-eat foods [4].

• Ensure your fridge maintains a temperature between 2°C and 4°C [4].

• Use separate knives and chopping boards for the cheese [4].

• Discard the cheese by its use-by date [4].

• Do not leave it at room temperature for more than 2 hours [4].

What is double pasteurization?

Double pasteurization involves a secondary heating process and can extend shelf life by killing spores that have germinated [5]. In places where it is allowed, milk is initially pasteurized when it is collected from the farm so it does not spoil before processing [6]. Many countries prohibit the labelling of such milk as "pasteurized" but allow it to be marked "thermized", which refers to a lower-temperature process [6].

Raw Milk: Benefits, Risks, and Pasteurization

Raw milk is milk that has not been pasteurized to kill harmful germs, including bacteria, viruses, and parasites that can cause diseases [1]. It comes straight from animals like cows, sheep, or goats and has not undergone the heating process to eliminate pathogens [2, 3]. The key difference between raw milk and the milk typically found in grocery stores is that grocery store milk has been pasteurized, while raw milk has not [1, 2]. Pasteurization involves heating milk to a specific temperature for a set period to kill harmful bacteria and extend shelf life [4].

Raw milk advocates believe unpasteurized milk provides more nutrients, can prevent allergies and asthma, and may even relieve lactose intolerance [5, 6]. They argue that raw milk offers several potential benefits compared to pasteurized milk [7, 8]:

• Better nutrition Raw milk advocates believe that pasteurization reduces or eliminates some vitamins and nutrients, with the result that raw milk contains more beneficial enzymes and nutrients than pasteurized milk [4, 6]. However, scientific evidence indicates pasteurization has minimal impact on milk's nutritional quality [5, 9-11].

• Allergy prevention Some suggest raw milk contains proteins and compounds that prevent the immune system from over-reacting to allergens, thus lowering rates of asthma and certain allergies [5, 6, 12]. However, research has shown that raw and pasteurized milk do not differ in their anaphylactic-sensitizing capacity when tested in animal models [13].

• Probiotics Some people believe raw milk contains beneficial bacteria that are destroyed by pasteurization and that these bacteria can promote gut health [12]. However, the bacteria found in raw milk are typically not of human origin, and raw milk can host various human pathogens [14, 15].

• Lactose intolerance relief Some proponents claim raw milk does not cause lactose intolerance because it contains lactase secreted by "beneficial" bacteria [5, 16]. However, all milk, whether raw or pasteurized, contains lactose and can cause lactose intolerance in sensitive individuals [16]. There is no indigenous lactase in milk [16].

Raw milk advocates also argue that raw milk can be produced hygienically and that it has health benefits destroyed in the pasteurization process [17]. They may also claim that indigenous microflora of raw milk produces nisin that kills pathogens, though there is no scientific basis for this claim [18].

The Health Risks of Consuming Raw Milk

According to health agencies like the FDA and CDC, consuming raw milk carries several health risks because it can harbor dangerous germs that cause foodborne illnesses [1-3]. These germs can be especially dangerous to people with weakened immune systems, older adults, pregnant women, and children [2, 4, 5].

Some of the specific health risks and pathogens associated with consuming raw milk include:

• Pathogens Raw milk can contain harmful bacteria such as Salmonella, E. coli, Listeria, and Campylobacter [2, 5, 6]. It may also contain parasites such as Cryptosporidium [7]. These microorganisms can lead to severe diarrhea, vomiting, miscarriage, paralysis, and serious kidney problems in children [8].

• Illnesses and Symptoms Drinking raw milk can increase the risk of illnesses like Escherichia coli (E. coli), Salmonella, and Listeria monocytogenes [9]. Symptoms of illness caused by consuming raw milk include vomiting, diarrhea, abdominal pain, fever, headache, and body ache [10, 11].

• Outbreaks and Hospitalizations Raw milk is more likely to cause foodborne illness, leading to hospitalization [12, 13]. Between 1998 and 2018, there were 202 outbreaks linked to drinking raw milk, causing 2,645 illnesses and 228 hospitalizations [1]. From the start of 2019 to mid-2023, there have been 10 reported outbreaks of illness associated with people consuming raw milk in New Zealand [8].

• Risks to Pregnant Women Pregnant women are at risk of becoming ill from Listeria, which can cause miscarriage, fetal death, or illness or death of a newborn [4, 14].

• Avian Flu Raw milk may carry the HPAI virus. Though it’s still unclear whether you can become infected with HPAI by drinking contaminated raw milk, the FDA still considers it a high-risk food and cautions against consuming it [15].

• Long-Term Complications Serious conditions associated with consuming unpasteurized dairy include Guillain-Barré syndrome, in which the body’s immune system attacks the nerves, and hemolytic uremic syndrome, which affects the kidneys and the body’s blood-clotting functions [16, 17].

Raw milk cannot kill dangerous pathogens by itself [18-20]. Pasteurization is the only method to achieve complete elimination of vegetative pathogens [21]. Although raw milk contains antimicrobial compounds, they are not present in high enough concentrations to kill pathogens and ensure raw milk safety [22]. Testing raw milk for various pathogens before consumption is also not an alternative to pasteurization because potential pathogens present in raw milk can be diverse, variable, and unpredictable [23].

Raw vs. Pasteurized Milk: Nutrition and Legality

Pasteurization does not significantly reduce milk's nutritional value [1-3]. Research indicates there is no meaningful difference between the nutrient content of pasteurized and unpasteurized milk [4, 5]. Minerals are stable under pasteurization conditions, with minimal change in their concentrations after pasteurization [6]. Studies show that the concentration and bioavailability of calcium, the most nutritionally important mineral in milk, is the same in raw and pasteurized milk [6, 7].

While some studies suggest that pasteurization may reduce the concentrations of certain vitamins such as B12 and E, it may also increase the concentration of vitamin A [8]. Furthermore, milk is not considered a significant source of vitamins B12 or E in the North American diet [8]. Although pasteurization can lead to a decrease in vitamins C and folate, milk is not a primary source of these vitamins either [8]. A decrease in vitamin B2 concentrations has been observed after pasteurization, but milk consumption still greatly contributes to the recommended daily intake of this vitamin [8].

The legality of selling raw milk for human consumption varies significantly by jurisdiction [9, 10].

• United States While the FDA prohibits the interstate sale of raw milk, some states permit the intrastate sale of raw milk for human consumption [9]. As of December 2004, 43 U.S. states allow the sale of raw milk [11].

• Canada The sale of raw milk is prohibited in Canada under the Food and Drug Regulations since 1991 [12].

• Europe In the European Union, individual member states can prohibit or restrict the sale of raw milk, but it is not banned outright [13, 14]. For example, Scotland has made it an offense to place raw milk on the market for direct consumption following deaths in 1983 [12, 15]. In England, Wales, and Northern Ireland, raw milk can only be sold by registered producers directly to customers and must be labeled with a health warning [16, 17].

• New Zealand Raw milk can be made and sold in New Zealand but is highly regulated [18].

• Asia In Singapore, the sale of raw milk for human consumption is prohibited [19]. In India, milk is often drunk raw, although milk supplied in major cities is sometimes pasteurized [14].

The Benefits and Safety of Milk Pasteurization

Pasteurization protects consumers by killing harmful bacteria and organisms responsible for diseases such as listeriosis, salmonellosis, campylobacteriosis, typhoid fever, tuberculosis, diphtheria, and brucellosis [1-5]. Louis Pasteur developed pasteurization in 1864 to kill organisms that cause spoilage [1, 4, 6]. Pasteurization was adopted in the U.S. before World War II, when milk was responsible for 25% of all foodborne illness outbreaks [4].

Pasteurization does not alter milk in a way that causes allergic reactions [7-9]. The milk proteins that cause allergic reactions in dairy-sensitive people are present in both raw and pasteurized milk [8].

Raw vs Pasteurized Milk: Bacteria and Lactose Intolerance

Pasteurized milk does not cause lactose intolerance [1, 2]. Lactose intolerance results from the body's insufficient production of the enzyme beta-galactosidase, which is needed to break down lactose [2]. Lactose is present in both raw and pasteurized milk at the same concentration, and pasteurization does not affect lactose concentration [2].

Raw milk can contain various types of bacteria [3-5]:

• Pathogenic bacteria Raw milk may harbor pathogens such as Salmonella, E. coli, Listeria, and Campylobacter [4, 6, 7].

• Other bacteria Raw milk may be contaminated with illness-causing bacteria such as Shiga toxin-producing E. coli (STEC) and the bacteria that causes tuberculosis [3]. It may also contain parasites such as Cryptosporidium [5].

• Bacteria from the animal Harmful bacteria live in the guts of even healthy animals and can be present anywhere on a farm [8].

• Bacteria from mastitis Milk from mastitic cows is more likely to contain pathogens such as E. coli, Staphylococci, and Streptococci [9]. Mastitic cows can also shed pathogens, including L. monocytogenes, Salmonella, and Coxiella burnetti, into raw milk [10].

• Environmental bacteria Listeria monocytogenes comes from environmental sources like soil and water [11].

• High bacteria counts High bacteria counts in raw milk indicate poor animal health and poor farm hygiene [12].

Pasteurization: History, Process, and Development

Pasteurization eliminates harmful pathogens by heating milk to a specific temperature for a set period of time [1-4]. This process either destroys or deactivates microorganisms and enzymes that contribute to food spoilage or the risk of disease, including vegetative bacteria [5]. Pasteurization is not sterilization and does not kill spores [6].

Louis Pasteur developed the pasteurization process in 1864 [2, 4, 5, 7-9]. Pasteur's experiments showed that the spoilage of liquids was caused by particles in the air rather than the air itself, supporting the germ theory of disease [5]. Pasteurization was initially used to prevent wine and beer from souring [9, 10]. It was adopted in the U.S. before World War II, when milk was responsible for 25% of all foodborne illness outbreaks [8].

Other key points in the history of pasteurization:

• Ancient roots Heating wine for preservation was known in China as early as AD 1117 and documented in Japan between 1478 and 1618 [11].

• Early experiments In 1768, Lazzaro Spallanzani proved that thermal processing could make a product "sterile" [11]. Nicolas Appert began experimenting with food preservation in 1795, placing food in glass jars, sealing them, and putting them in boiling water [11].

• Application to milk Franz von Soxhlet suggested pasteurization of milk in 1886 [12]. In the early 20th century, Milton Joseph Rosenau established standards for milk pasteurization [12].

• Mandatory pasteurization States in the U.S. began enacting mandatory dairy pasteurization laws in 1947. In 1973, the U.S. federal government required pasteurization of milk used in any interstate commerce [12].

Raw Milk: Regulations, Risks, and Health Concerns

Regulations and standards that governments have established to ensure the safety and nutritional quality of milk vary by jurisdiction.

Examples of regulations and standards include:

• United States Since 1924, pasteurization in the U.S. has been guided by the Grade “A” Pasteurized Milk Ordinance, a federal guidance document that is updated every two years to reflect current science and has been adopted by all 50 states [1]. Pasteurization equipment in the U.S. must meet stringent requirements that include sanitary design, safety controls, and material standards [1].

• European Union Raw milk and products made with raw milk must be labeled to indicate this [2, 3]. Member states can prohibit or restrict the placing on the market of raw milk intended for human consumption and implement stricter requirements, such as special sanitary regulations and frequent quality tests [2, 4, 5].

• England, Wales, and Northern Ireland About 150 producers of raw milk are listed with the Food Standards Agency [6, 7]. They sell raw milk directly to consumers, and the bottle must display the warning "this product has not been heat-treated and may contain organisms harmful to health" [6, 8, 9]. The milk must also conform to higher hygiene standards than dairies producing only pasteurized milk [6].

• New Zealand Raw milk for drinking and raw milk products can be made and sold but are highly regulated to offset the pathogen risk. Producers of raw milk for sale to consumers must be registered, and raw milk must either be collected by the purchaser from the producer's farm or delivered to the purchaser's home [10, 11].

• Canada The sale of raw milk directly to consumers has been prohibited under the Food and Drug Regulations since 1991 [12, 13].

Illnesses and deaths have been caused by consuming raw milk products.

Examples of illnesses and deaths include:

• Between 1993 and 2006, more than 1500 people in the United States became sick from drinking raw milk or eating cheese made from raw milk [14].

• Between 1998 and 2018, outbreaks linked to raw milk led to 2,645 illnesses and 228 hospitalizations [15].

• From 1987 to September 2010, there were at least 133 outbreaks due to the consumption of raw milk and raw milk products in the U.S. These outbreaks caused 2,659 cases of illnesses, 269 hospitalizations, 3 deaths, 6 stillbirths, and 2 miscarriages [16].

• From the start of 2019 to mid-2023, there have been 10 reported outbreaks of illness associated with people consuming raw milk in New Zealand [17].

• In England and Wales between 1992 and 2017, raw milk was responsible for 26 outbreaks of intestinal infectious disease, involving 343 people and resulting in 41 hospitalizations [18].

• In 2010 alone, raw milk has been associated with at least 8 documented outbreaks [19].

• In 1983, a spate of deaths in Scotland led to a ban on placing raw milk or cream on the market for direct consumption [12, 20, 21].

• In November 2024, California regulators recalled two batches of raw, unpasteurized milk from a Fresno dairy farm after bird flu virus was detected in the milk [22].

• In 2002, consuming partially heated raw milk and raw milk products caused 200 Americans to become ill [23, 24].

• In November 2015, four-year-old Apu Khangura died of hemolytic–uremic syndrome, and seven other children became seriously ill following the consumption of raw milk. In response, the Victorian government created new regulations [10, 25, 26].

Raw Milk: Risks, Handling, and Safety

Symptoms of illness caused by consuming raw milk can include:

• Vomiting [1-4]

• Diarrhea [1-5]

• Abdominal pain [2-5]

• Fever [3-5]

• Headache [1, 3, 4]

• Body ache [1, 3, 4]

• Flu-like symptoms [1, 2, 4]

• Severe abdominal cramps [5]

• Bloody diarrhea [5]

Some people can develop symptoms that are chronic, severe, or even life-threatening [2-4, 6]. Infants and small children, the elderly, pregnant women, and those with a compromised immune system are particularly vulnerable to food poisoning and should not consume raw milk [7]. Drinking raw milk can increase the risk for illnesses like Escherichia coli (E. coli), Salmonella, and Listeria monocytogenes [5]. In pregnant women, Listeria can lead to miscarriage, stillbirth, or premature delivery [5, 8, 9]. Some may develop haemolytic uremic syndrome (HUS), which is life threatening [10].

To properly store and handle raw milk to minimize the risk of getting sick, it is recommended to:

• Buy raw milk only from a registered raw milk supplier [11].

• Keep it chilled while transporting it home from the farm [12].

• Store raw milk at 4 degrees Celsius (39.2 degrees Fahrenheit) or less in the refrigerator [12].

• Throw it out if it has been left out of the fridge for 2 or more hours [12].

• Heat raw milk to 70 degrees Celsius (158 degrees Fahrenheit) and hold it at that temperature for 1 minute [12]. If a thermometer is unavailable, heat the milk until it nearly reaches a boil before drinking it [12].

• When purchasing raw milk, provide contact details to be notified if a batch of milk is found to be contaminated with harmful bacteria [13].

Additionally, bacteria found in raw-milk cheeses comes from the raw milk itself, and raw-milk cheeses can be contaminated this way [13]. If you choose to buy and serve raw-milk cheese, take care in how it is stored and handled [14].

• Buy cheese from a reputable supplier [14].

• Keep the cheese wrapped in the refrigerator and separate from other ready-to-eat foods [14].

• Ensure the refrigerator is between 2 degrees Celsius and 4 degrees Celsius [14].

• Use separate knives and chopping boards for the cheese [14].

• Discard the cheese on its use-by date [14].

• Do not leave it at room temperature for more than 2 hours [14].

Canadian Food Inspection and Milk Pasteurization Methods

The Canadian Food Inspection Agency verifies that food sold in Canada meets Health Canada's requirements through inspection and enforcement activities [1]. The Government of Canada is committed to food safety and establishes regulations and standards relating to the safety and nutritional quality of foods sold in Canada [1].

Pasteurization methods involve heating every particle of a food to a specific temperature for a continuous length of time in order to kill the most heat-resistant pathogen associated with that product [2]. Dairy processors can choose among several different types of pasteurization [3]. All of these methods should produce pathogen-free milk when executed properly [3].

Pasteurization methods include [4, 5]:

• Vat Pasteurizers (Batch Pasteurizers) Smaller-scale processors use temperature-controlled tanks with a stirrer, heat the milk to a minimum of 145 degrees Fahrenheit (63 Celsius), and hold it there continuously for 30 minutes [4]. Then, the milk is cooled and pumped out of the vat [4].

• High-Temperature Short-Time Pasteurization The most common method for commercial milk involves pumping milk through a series of thin plates at high speed to reach a minimum temperature of 161 F (71 C) [4]. Then it travels through a holding tube for 15 seconds, and the temperature is checked automatically [4].

• Ultra-High-Temperature Pasteurization Milk is heated to 280 degrees F (140 C), which destroys many spoilage organisms, giving the milk a significantly longer shelf life than with other methods [5]. Ultra-high-temperature products are processed in a sterile environment and packaged in sterile packaging, so they can be shelf-stable for up to a year before they are opened [5].

Raw Milk and Cheese: Safety, Risks, and Scientific Evidence

Raw-milk cheeses are part of the debate about raw milk safety because they can harbor bacteria from the raw milk used to produce them [1]. While cheesemaking can kill some bacteria, this depends on the type of cheese [2].

• Hard cheeses Safer raw-milk cheeses are low-moisture or hard cheeses like parmesan or gruyere [2].

• Soft cheeses The cheesemaking process may not kill bacteria in soft cheeses like camembert, brie, feta, or fresh cheeses, so these could have a food safety risk [2].

• Listeria Pregnant women are most at risk from Listeria monocytogenes and should avoid eating raw-milk cheeses [3].

• Contamination Other sources of bacteria can come from the cheesemaking environment including equipment and personnel, or cross contamination between finished products and raw materials. Both pasteurized and raw-milk cheeses can be contaminated this way [1].

• Labeling You can tell if a cheese is made from raw milk if the label says "raw" or "unpasteurised". If unsure, ask shop staff, or ask the waiting staff at a restaurant [3].

The scientific evidence does not support the health claims associated with raw milk [4].

• Lack of Benefits The FDA has stated that they look to scientific literature for information on the benefits and risks associated with raw milk and that while the perceived nutritional and health benefits of raw milk consumption have not been scientifically substantiated, the health risks are clear [4].

• No Added Nutritional Value Drinking milk and consuming dairy products is a great way to include calcium and vitamin D in your diet, but while these benefits are present in pasteurized milk, they aren’t made any better when the milk is "raw" [5]. The nutritional value is the same for all milk across the board, except that pasteurized milk does not carry the risk of bacteria [6].

• Allergies Both raw milk and pasteurized milk can cause allergic reactions in people sensitive to milk proteins [7, 8].

• Lactose Intolerance Lactose is present in both raw milk and pasteurized milk at the same concentration, and pasteurization does not impact the concentration of lactose [9].

• Antimicrobial compounds There is no scientific evidence to support the claim that the indigenous antimicrobial compounds in raw milk kill pathogens and ensure raw milk safety [10]. Raw milk does not contain a high enough concentration of these antimicrobial compounds to exert such an effect [10].

• PARSIFAL study The PARSIFAL study found an inverse association of farm milk consumption, not raw milk consumption, with asthma and allergy [11]. The authors of the PARSIFAL study clearly indicated in the paper that the “present study does not allow evaluating the effect of pasteurized vs. raw milk consumption because no objective confirmation of the raw milk status of the farm milk samples was available [11]." The authors of the PARSIFAL study concluded that “raw milk may contain pathogens such as salmonella or EHEC, and its consumption may therefore imply serious health risks… At this stage, consumption of raw farm milk cannot be recommended as a preventive measure [12].”

• Bacteria Bacteria found in raw milk are not probiotic [13]. Raw milk can host various human pathogens, including E. coli O157:H7, Salmonella, Streptococcus spp. Yersinia enterocolitica, Campylobacter jejuni, Staphylococcus aureus, and Listeria [13].

• Nisin There is no scientific basis for the claim that indigenous microflora of raw milk produces nisin that kills pathogens [14]. Any substantial nisin production in raw milk will only suggest poor hygiene and poor refrigeration [14].

• Studies show no difference One study used mice to evaluate the difference in nutritional values between raw and pasteurized milk and measured no significant difference in pasteurized to raw milk-consuming mice weights or birth weights [15].

• No cure There is no scientific evidence to demonstrate that raw milk has any effect on illness or allergies [16].

• Banned in some places In 1983, a spate of deaths in Scotland led to a ban on placing raw milk or cream on the market for direct consumption [17].

Raw Milk: Composition, Risks, Legality, and Safety

Raw milk is milk that has not been pasteurized [1]. Pasteurization is a process of heating milk to a specific temperature for a set period to kill harmful bacteria and viruses [2-4].

Raw Milk Composition and Production

• Raw milk comes directly from animals like cows, sheep, or goats [3, 5, 6].

• It has not been processed to eliminate potentially dangerous pathogens [3, 5].

• The composition of raw milk varies based on the milk source [7].

• In some regions, raw milk is produced through natural acidification, where milk is left to sit and ferment without added starters, relying on the milk's natural flora or bacteria from the container [7, 8].

Pasteurization

• Developed by Louis Pasteur in the late 19th century, pasteurization involves heating milk to kill harmful pathogens and extend its shelf life [9, 10].

• Pasteurization does not significantly reduce milk's nutritional value [11-16].

• Pasteurization involves heating milk to 161 degrees Fahrenheit (71.66 degrees Celsius) for 20 seconds to eliminate bacteria [17].

Legality of Raw Milk

• The legality of raw milk sales varies worldwide, ranging from complete bans to允许 direct sales from farms [9, 18, 19].

• In Scotland, the sale of raw drinking milk is banned [9, 20].

• In England, Wales, and Northern Ireland, raw milk can only be sold by registered producers directly to consumers with a health warning label [9, 21, 22].

• In the Republic of Ireland, raw milk production is regulated since 2015, requiring registration for producers selling over 30 liters and adherence to random sampling and inspections [23].

• In New Zealand, raw milk can be sold for drinking and raw milk products but is highly regulated. It must be collected from the farm or delivered to the purchaser's home [24].

• In the U.S., regulations vary by state. Some states permit retail sales, farm sales, herdshares, or sales for animal consumption, while others prohibit it [19, 25].

Potential Dangers and Health Risks

• Raw milk can contain dangerous bacteria such as Salmonella, E. coli, Listeria, and Campylobacter [5, 6, 26-31].

• These pathogens can cause foodborne illnesses with symptoms including vomiting, diarrhea, abdominal pain, fever, headache, and body ache [28, 32-35].

• Infections from raw milk can lead to severe complications like hemolytic uremic syndrome (HUS), kidney failure, strokes, and even death [31, 32, 36].

• Certain groups are more susceptible to severe illness from raw milk, including children, older adults, pregnant women, and those with weakened immune systems [5, 6, 20, 30, 37, 38].

• Pregnant women are at risk of listeriosis, which can cause miscarriage, fetal death, or illness/death of a newborn [32, 39].

• Between 1993 and 2006, over 1500 people in the U.S. became ill from drinking raw milk or eating cheese made from it [40].

• Unpasteurized milk is 150 times more likely to cause foodborne illness and results in 13 times more hospitalizations compared to pasteurized dairy products [40].

• From 1998 through 2018, 202 outbreaks were linked to raw milk consumption, causing 2,645 illnesses and 228 hospitalizations [41].

• A Public Health England review found raw milk responsible for 26 outbreaks of intestinal infectious disease in England and Wales between 1992 and 2017 [26].

Raw Milk vs. Pasteurized Milk: Claims and Counterclaims

• Advocates claim raw milk has more nutrients, prevents allergies/asthma, and relieves lactose intolerance [1, 11, 15, 42]. However, there is no scientific evidence to support these claims [11, 28, 43, 44].

• Pasteurization does not reduce the nutrients in milk [11, 45]. The nutritional value is the same, but pasteurized milk does not carry the risk of bacteria [11].

• Both raw and pasteurized milk contain lactose and can cause lactose intolerance in sensitive individuals [13, 46].

• The FDA states that pasteurizing milk does not destroy any of its nutritional value [16].

• Studies have shown no significant measurable difference in nutritional value between raw and pasteurized milk concerning growth and fertility [16].

• Some raw milk advocates suggest it contains beneficial bacteria that are destroyed during pasteurization, but the FDA refutes this [46, 47].

Avian Flu and Raw Milk

• Raw milk may contain the avian flu virus [48, 49].

• Public health officials in California detected bird flu in a sample of raw milk [49].

• A 2024 study showed that Influenza A virus could survive in refrigerated raw milk for several days [50].

• There were no immediate reports of human bird flu cases associated with milk recalls, but officials urged buyers to avoid drinking raw milk from affected batches [48].

Recommendations and Precautions

• Health agencies like the FDA, CDC, and American Academy of Pediatrics advise against consuming raw milk due to the risk of pathogens [51].

• The safest option is to choose pasteurized milk and dairy products [4, 52]. Look for "pasteurized" on the label [45, 52].

• If you choose to drink raw milk, buy it from a registered supplier following strict hygiene practices and selling directly from the farm gate or by home delivery [53].

• Keep raw milk chilled, store at 4 degrees Celsius or less, and throw it out if left out for over 2 hours [54].

• Heat raw milk to 70 degrees Celsius for 1 minute before drinking it [54].

• If serving raw milk, inform others that it is unpasteurized [54].

• Provide contact details when purchasing raw milk to be notified of contamination [55].

Other Considerations

• Raw milk can be marketed for animal or pet consumption in areas where sales for human consumption are prohibited [18, 45].

• Some manufacturers sell small-scale pasteurization equipment, allowing farmers to bypass milk processors and sell pasteurized milk directly [56].

• Some small dairies are adopting low-temperature vat pasteurization, which proponents claim produces a product similar to raw milk in composition [56].

Raw Milk: Benefits vs. Risks

When it comes to raw milk, people on both sides of the debate have strong opinions. Here's a breakdown of what proponents and opponents of raw milk would say, along with the reasoning behind their stances:

Arguments From Proponents of Raw Milk

• Nutritional Superiority: Raw milk enthusiasts believe that unpasteurized milk is more nutritious than pasteurized milk [1, 2]. They argue that pasteurization diminishes the vitamins, enzymes, and beneficial bacteria present in raw milk [1-3]. However, it is important to note that scientific evidence does not support the claim that raw milk is nutritionally superior [2, 4-6].

• Allergy and Asthma Prevention: Some proponents claim that raw milk can prevent allergies and asthma [2]. They suggest that raw milk contains proteins and compounds that prevent the immune system from overreacting to allergens [3]. However, most studies supporting this link are based on farm families, whose exposure to a diverse range of bacteria and allergens makes it difficult to isolate the reason for their lower allergy rates [7]. The PARSIFAL study, often cited by raw milk advocates, found an inverse association between farm milk consumption (not necessarily raw milk) and asthma/allergy [8].

• Gut Health and Probiotics: Advocates argue that raw milk contains beneficial bacteria that are destroyed by pasteurization [3, 9]. They believe these bacteria promote gut health and aid digestion. However, a 2015 review found 'limited' growth of 'probiotic bacteria' in raw milk [3]. The FDA states that bacteria found in raw milk are typically not of human origin and that raw milk does not contain probiotic organisms [10, 11].

• Lactose Intolerance Relief: Some claim raw milk is easier to digest for those with lactose intolerance because it contains lactase-secreting bacteria [2, 9]. However, all milk, raw or pasteurized, contains lactose and can cause lactose intolerance in sensitive individuals [9]. Raw milk does not contain the same types of microorganisms at similar levels as fermented dairy products that ease lactose malabsorption [12].

• "Farm Effect" Benefits: Some studies suggest a link between raw milk consumption and lower rates of asthma and allergies, particularly in children living on farms [3, 13]. Proponents attribute this to the proteins and compounds in raw milk that prevent the immune system from over-reacting to allergens [3]. However, this "farm effect" may be related to overall exposure to a farming environment rather than solely raw milk consumption [7, 13].

• Natural and Unprocessed: Proponents value raw milk as a natural, unprocessed food [14]. They may distrust modern food processing methods and believe that raw milk is a healthier, more traditional option [15].

Arguments From Opponents of Raw Milk

• Health Risks: Opponents emphasize the significant health risks associated with raw milk consumption [16-23]. Raw milk can contain harmful bacteria such as Salmonella, E. coli, Listeria, and Campylobacter, which can cause foodborne illnesses [20, 24-28]. These illnesses can lead to severe complications, including hospitalization, chronic conditions, or even death [29-35].

• Vulnerability of Certain Groups: Health experts warn that infants, children, pregnant women, older adults, and those with weakened immune systems are particularly vulnerable to the dangers of raw milk [7, 20, 25-27, 30, 36, 37]. For pregnant women, Listeria in raw milk can cause miscarriage, fetal death, or illness in newborns [29, 38].

• Lack of Substantiated Benefits: Opponents argue that the perceived nutritional and health benefits of raw milk have not been scientifically substantiated [6]. They point out that pasteurization does not significantly reduce milk's nutritional value and effectively eliminates harmful pathogens [38-42].

• Pasteurization as a Public Health Achievement: Experts highlight that pasteurization is one of the great public health achievements of the 20th century [43]. Before pasteurization, milk was a major source of foodborne illnesses and deaths [43-46]. Pasteurization has significantly reduced the incidence of milk-borne diseases [28].

• Outbreak Data: Opponents cite data showing that raw milk is responsible for a disproportionate number of foodborne illness outbreaks [19, 23, 28, 46-48]. The CDC reports that unpasteurized milk is much more likely to cause foodborne illness than pasteurized milk [23].

• Inability to Ensure Safety: Opponents stress that it is impossible to guarantee the safety of raw milk, even with careful sanitation practices and testing [46, 49-52]. Pathogens can be present in raw milk even if routine quality indicators appear normal [53, 54].

• Rejection of Anti-Science Sentiment: Some view the raw milk trend as part of a broader anti-science, anti-authority movement [43]. They worry that rejecting pasteurization is a rejection of established scientific and medical knowledge.

In summary, the raw milk debate is a clash between those who prioritize perceived naturalness and nutritional benefits against those who prioritize safety and public health.

Raw Milk Debate: Key Stakeholders and Involved Parties

Here's a comprehensive overview of the key stakeholders and involved parties in the raw milk debate:

I. Governing and Regulatory Agencies

• Food and Drug Administration (FDA): In the United States, the FDA plays a crucial role in regulating the interstate sale of raw milk, which is prohibited [1, 2]. The FDA and other health agencies advise against the consumption of raw milk due to the risk of pathogens [1].

• Food Standards Agency (FSA): In England, Wales, and Northern Ireland, the FSA regulates registered raw milk producers, ensuring they meet specific hygiene standards and labeling requirements [3, 4]. The FSA also reviews regulations concerning raw milk sales and provides guidance to consumers [3].

• Centers for Disease Control and Prevention (CDC): The CDC strongly recommends that the public avoid consuming raw milk or raw milk products due to the risk of contracting dangerous milk-borne diseases [1, 5].

• Health Canada: This Canadian agency establishes regulations and standards for the safety and nutritional quality of foods sold in Canada, including milk [6]. Health Canada advises against drinking raw or unpasteurized milk [7].

• Public Health England: This agency monitors and reports on outbreaks of intestinal infectious diseases linked to raw milk consumption [see Previous turn].

• State Departments of Agriculture: In the U.S., these agencies play a role in regulating raw milk sales within individual states, which vary widely [8].

• Food Standards Scotland: This agency provides guidance on dairy, including raw milk, to businesses in Scotland [9].

II. Producers and Sellers

• Raw Milk Farmers: These are farmers who produce raw milk and sell it directly to consumers through various channels, such as on-farm sales, farmers' markets, vending machines, and online sales [3, 10].

• Small-Scale Dairies: Some small dairies are adopting low-temperature vat pasteurization as an alternative to selling raw milk, aiming to produce a product similar in composition to raw milk while ensuring safety [11].

• Raw Milk Cheese Producers: These producers make cheeses from raw milk, which, in some regions, is legal if the cheese is aged for a certain period (e.g., over 60 days in Canada) [12].

• Distributors: In regions where raw milk sales are permitted, distributors may be involved in transporting raw milk from farms to consumers or retail locations [10].

• On-farm Vending Machine Operators: The increase in raw milk sales has been linked to a rise in on-farm vending machines, making the product more accessible to consumers [3].

III. Consumers

• General Public: This includes individuals who choose to consume raw milk for various reasons, such as perceived health benefits, taste preferences, or philosophical beliefs [13, 14].

• Children: Children are a particularly vulnerable group, and despite health warnings, they made up almost a third of outbreak patients in 2017 [15].

• Pregnant Women: Pregnant women are at higher risk from bacteria such as Listeria monocytogenes and are advised to avoid raw milk products [5, 15, 16].

• Elderly and Immunocompromised Individuals: Older adults and those with weakened immune systems are also more susceptible to severe illness from pathogens in raw milk [5, 15, 17].

• Advocates of "Food Freedom": These individuals believe in the right to choose what they eat, including raw milk, and often support direct marketing from farmers to consumers [18].

IV. Advocates and Influencers

• Raw Milk Proponents: These individuals and organizations promote the consumption of raw milk, often citing perceived health benefits and questioning the safety or value of pasteurization [13, 19]. Robert F. Kennedy Jr., for example, is a proponent of raw milk [19].

• Health and Wellness Influencers: Some social media influencers promote raw milk in wellness circles, contributing to the increasing public interest in raw milk [13, 20].

• Food Safety Experts: These experts, including Marion Nestle, strongly advise against drinking raw milk, emphasizing the public health benefits of pasteurization [21].

• Medical and Scientific Communities: Medical professionals and scientists generally caution against raw milk consumption, citing the established risks of foodborne illnesses [5, 14].

V. Other Involved Parties

• Public Health Officials: These officials monitor and respond to outbreaks of foodborne illnesses linked to raw milk, working to educate the public about the risks [19].

• Healthcare Providers: Doctors and healthcare providers treat patients who become ill from consuming raw milk and advise patients, especially those in vulnerable groups, about the risks [17, 22].

• Researchers: Scientists conduct studies on the safety, nutritional content, and potential health effects of raw and pasteurized milk, contributing to the body of knowledge on this topic [23-26].

This complex web of stakeholders illustrates the multifaceted nature of the raw milk debate, encompassing regulatory bodies, producers, consumers, advocates, and scientific experts.

Raw Milk: Trends, Safety Debate, and Regulatory Issues

Here are some major trends in the raw milk topic, based on the provided sources:

• Increased Sales and Interest: Despite health warnings, raw milk sales and public interest are increasing [1-3]. In the UK, raw milk sales nearly quintupled between 2014 and 2018 [1]. This rise is partly attributed to increased accessibility through on-farm vending machines [1, 4]. Social media and wellness circles also contribute to the trend [3, 5].

• Debate Over Safety vs. Benefits: The core of the issue remains the debate over the safety of raw milk versus its purported health benefits [2, 6]. Proponents claim nutritional superiority and allergy prevention [3, 7]. Opponents, including public health experts, emphasize the risk of foodborne illnesses [2, 6].

• Avian Flu Concerns: The detection of avian flu (H5N1) in raw milk samples is a new challenge, sparking further warnings against consuming raw milk [2, 8]. Research indicates that pasteurization effectively inactivates the virus [8].

• Regulatory Scrutiny: Raw milk sales are subject to varying regulations across different regions [9]. Some areas prohibit sales, while others permit them under specific conditions [4, 9]. Agencies like the FSA regularly review these regulations [4].

• Direct Marketing and Consumer Choice: A key aspect is the advocacy for direct marketing, where farmers sell directly to consumers [10]. This aligns with a "food freedom" movement, emphasizing the right to choose what to eat [10].

• Alternative Pasteurization Methods: Some small dairies are exploring low-temperature vat pasteurization to produce milk with qualities closer to raw milk while ensuring safety [10]. Novel processes, thermal and non-thermal, have been developed to pasteurize foods to reduce the effects on nutritional and sensory characteristics of foods and preventing the degradation of heat-labile nutrients [11].

• Government Recommendations: Multiple government and health organizations such as the FDA, CDC, and Health Canada, continue to advise against the consumption of raw milk, especially for vulnerable populations like children, pregnant women, and those with weakened immune systems [8, 12, 13].

• Raw Milk as Part of Anti-establishment Trends: Some experts believe the raw milk movement is part of anti-science and anti-authority sentiments [6].

Raw Milk Controversies: Safety, Freedom, and Science

Based on the sources and our conversation history, here are the major controversies surrounding raw milk:

• H5N1 Avian Flu Contamination: The recent detection of the H5N1 avian flu virus in raw milk samples has heightened concerns and sparked warnings against its consumption [1, 2]. This is a new challenge for the dairy industry, with health experts advising against consuming raw milk during the outbreak [1].

• Clash Between Food Safety and Food Freedom: A central controversy lies in the conflict between ensuring food safety and advocating for consumer freedom of choice [3].

◦ Public health officials and organizations like the FDA and CDC strongly advise against raw milk consumption due to the risk of foodborne illnesses [4-6].

◦ Advocates argue for the right to choose what to eat and support direct marketing from farmers to consumers [2].

• Raw Milk vs. Pasteurized Milk Nutritional Value: Proponents of raw milk often claim it has superior nutritional value compared to pasteurized milk [7]. However, many experts state that pasteurization has minimal impact on milk's nutritional quality [8, 9].

• The "Farm Effect" and Allergies: Some studies suggest an inverse relationship between raw milk consumption and asthma/allergies [10]. However, these studies often involve children living on farms, making it difficult to isolate raw milk as the sole factor. This phenomenon is known as the "farm effect," where the overall farming environment and lifestyle may contribute to the observed differences [10].

• Legality and Regulation: The legality and regulation of raw milk sales vary significantly across different regions and states [4, 11]. This inconsistency leads to ongoing debates and challenges regarding the extent to which raw milk should be accessible to consumers [12].

• Anti-establishment Sentiments: Some experts, like Dr. Marion Nestle, suggest the raw milk movement is tied to anti-science and anti-authority sentiments [3]. This perspective frames the controversy not just as a food safety issue but as part of a broader cultural trend [3].

• Efficacy of HACCP for Raw Milk Production: Some sources suggest that implementing Hazard Analysis Critical Control Points (HACCP) is difficult for raw milk production on farms [13]. Even with a HACCP plan, raw milk can still be found to contain pathogens [13].

Raw vs. Pasteurized Milk: Benefits and Risks

Here is an outline of the pros and cons of raw and pasteurized milk, according to the sources:

Raw MilkRaw milk is milk that has not been pasteurized to kill harmful germs, including bacteria, viruses, and parasites that cause diseases [1].

• Potential Benefits (claimed but often disputed):

◦ Nutritional Value: Advocates believe raw milk provides more nutrients [2, 3]. However, many experts state that pasteurization has minimal impact on milk's nutritional quality [4-12].

◦ Allergy and Asthma Prevention: Some suggest a link between drinking raw milk and lower rates of asthma and some allergies [3, 13, 14]. However, research indicates raw and pasteurized milk do not differ in their anaphylactic-sensitizing capacity [15].

◦ Probiotics: Believers in raw milk assert that it contains beneficial bacteria, but a review found limited growth of probiotic bacteria in raw milk [13].

◦ Enzymes: Raw milk contains natural enzymes, however there is no reported physiological role of milk indigenous or exogenous proteases in human protein digestion [16].

• Risks:

◦ Pathogens: Raw milk can carry dangerous bacteria such as Salmonella, E. coli, Listeria, and Campylobacter [10, 17-21].

◦ Foodborne Illness: Consumption of raw milk is associated with a higher risk of foodborne illnesses [22-24].

◦ Vulnerable Populations: The germs in raw milk can be especially dangerous to people with weakened immune systems, children, older adults, and pregnant women [18, 20, 25-28].

◦ Outbreaks: Raw milk is more likely than pasteurized milk to cause foodborne illness that can lead to hospitalization [22, 23, 29].

Pasteurized MilkPasteurization is a process that kills harmful bacteria by heating milk to a specific temperature for a set period [7, 30-32].

• Benefits:

◦ Eliminates Harmful Bacteria: Pasteurization kills harmful organisms responsible for diseases such as listeriosis, typhoid fever, tuberculosis, diphtheria, Q fever, and brucellosis [6, 7, 24, 31, 33].

◦ Safe for Consumption: Pasteurization makes milk safe to drink by killing bacteria [22].

◦ Extends Shelf Life: Pasteurization extends the shelf life of milk [34-37].

• Potential Drawbacks (often disputed):

◦ Nutrient Reduction: Some believe pasteurization reduces milk's nutritional value [2, 3]. However, research shows no meaningful difference in the nutritional values of pasteurized and unpasteurized milk [4-12].

◦ Loss of Beneficial Bacteria: Pasteurization destroys good bacteria as well as bad [13]. However, fermented dairy products made from pasteurized milk can have good bacteria developed or added during fermentation [13, 38].

◦ Flavor: Pasteurization can alter the organoleptic profile (flavor) of milk [11].

◦ Allergies: Some believe pasteurization causes allergic reactions. However, pasteurizing milk does not cause lactose intolerance and allergic reactions [8, 39, 40]. Both raw and pasteurized milk can cause allergic reactions in people sensitive to milk proteins [3, 8, 39, 40].

◦ Other: Concerns exist that pasteurization diminishes the positive aspects of milk, but most research does not support this viewpoint [9].

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Raw Milk: The Science, Risks, and Consumer Choice

Raw Milk: Regulations, Preservation, and Health Impacts

What are the specific legal requirements and inspection protocols for raw milk production in countries or states where it is permitted, and how effective are these measures in ensuring safety?

Raw Milk: Benefits, Risks, and Safety

What exactly is raw milk, and how does it differ from the milk most people buy in the store?

What are the potential benefits that some people believe raw milk offers?

What are the potential risks associated with drinking raw milk, backed by scientific evidence?

Is it safe to consume raw milk?

Have any illnesses or deaths been caused by consuming raw milk products?

What are some of the symptoms of illnesses that can be caused by consuming raw milk?

Raw Milk: Risks and Benefits

What exactly is raw milk, and how does it differ from the milk most people buy in the store?

What are the potential benefits that some people believe raw milk offers?

What are the potential risks associated with drinking raw milk, backed by scientific evidence?

Is it safe to consume raw milk?

Have any illnesses or deaths been caused by consuming raw milk products?

What are some of the symptoms of illnesses that can be caused by consuming raw milk?

The Science of Pasteurization: Safety, Nutrients, and Allergies

How does the pasteurization of raw milk protect consumers?

Does pasteurization affect the nutrient content of milk?

Does pasteurizing milk alter it in a fashion that can cause allergic reactions?

Can drinking pasteurized milk cause lactose intolerance?

Does raw milk kill pathogens?

Raw Milk: Legality, Risks, and Regulations

Is it legal to sell raw milk for human consumption?

Why is raw milk illegal in some areas?

The Raw Milk Debate: Safety, Myths, and Misconceptions

Why has raw milk become such a popular topic in social media wellness circles?

Why are some people so passionately against pasteurization, as we see in some online videos?

What are some common misconceptions about raw milk?

Are there any circumstances where raw milk might be considered "safer"?

What do food safety experts and public health officials say about the trend of drinking raw milk?

Avian Flu in Raw Milk: H5N1 Virus Transmission and Inactivation

Has bird flu been detected in raw milk?

How does the H5N1 virus found in raw milk impact calves?

Can H5N1 virus-containing milk from an infected cow transmit the virus?

What methods exist for deactivating H5N1 in raw milk?

What is the effect of milk acidification on the inactivation of influenza A virus H5N1?

What pH level is recommended for milk acidification to inactivate the H5N1 virus?

How does milk fat content affect the virucidal effect of milk acidification against HPAI?

Raw Milk Safety: Bacteria, Risks, and Hygiene

What bacteria are typically found in raw milk, and are they typically of human origin?

How can Streptococcus pyogenes in animals be re-transmitted to humans through raw milk?

What are bifidobacteria, and why are they mentioned by raw milk advocates?

How does pasteurization affect human milk fat composition?

Traditional Milk Preservation and Fermentation Techniques

Are there traditional methods of milk preservation or fermentation that have been used historically in different cultures?

How do traditional and industrial-scale production of DAHI differ?

How is yoghurt made in Bolivia?

How is yoghurt made in the Near East Area?

Raw Milk: Informed Choices, Risks, and Guidance

What should consumers look for when purchasing raw milk, if it is legal in their area?

Who are the groups of people who are at especially high risk for developing illness from consuming raw milk?

Where can people find reliable, science-based information about raw milk to make informed decisions?

Milk Treatment: Alternatives, LPS, and Acidified Replacers

Beyond traditional pasteurization, are there alternative methods for treating milk to reduce pathogens?

How does the lactoperoxidase system (LPS) affect the microbial inhibition and preservation of milk?

What are the effects of a free-access acidified milk replacer feeding program on the health and growth of dairy replacement heifers and veal calves?

Dairy Farming: Safety, Quality, and Contamination Control

What are the key differences between milk produced on small farms versus large industrial operations, and how might that affect safety?

How can farmers ensure high-quality, safe dairy foods?

What opportunities for contamination exist in dairy environments?

Milk: Trends, Research, Safety, and Global Regulations

Are there any emerging trends or research areas related to milk processing and safety that are worth watching?

How does gentle pasteurization of milk using microwaves work?

Does exposure to cows and raw milk affect rates of asthma and atopic dermatitis?

Does scientific evidence support raw milk health claims?

How do raw milk regulations differ around the world?

Raw-Milk Cheese: Risks, Handling, and Double Pasteurization

Are raw-milk cheeses also risky?

What should you do when keeping and handling raw-milk cheese?

What is double pasteurization?

Raw Milk: Benefits, Risks, and Pasteurization

The Health Risks of Consuming Raw Milk

Raw vs. Pasteurized Milk: Nutrition and Legality