Why Raw Milk Standards Matter

Back in 2011 before the Raw Milk Institute (RAWMI) was formed, there were no universal standards for safe raw milk production. Consumer demand for raw milk was expanding, as people learned about the health benefits of raw milk as well as the negative effects of pasteurization. There was a growing body of evidence that children who drink raw milk have decreased rates of asthma, allergies, eczema, ear infections, fever, and respiratory infections. Whereas pasteurized milk is a top food allergen and difficult to digest, raw milk is actually a health-supporting food with rich therapeutic potential that is easily digested by most consumers. Yet, standards for raw milk varied widely from state to state and country to country. 

The occasional foodborne illness outbreaks that could be tied to raw milk continued to tarnish raw milk’s reputation.  And worse yet, some of these outbreaks actually led to life-threatening illnesses. As raw milk’s popularity grew, it was being consumed by a wider segment of the population including immune-compromised people. Whereas average healthy people are likely to have relatively mild symptoms from exposure to foodborne pathogens, immune-compromised people are more likely to have severe symptoms.

Perfectly Safe Food?

It is important to note that there is no such thing as a perfectly safe food. A CDC analysis of foodborne illnesses from 2009-2015 showed that the top food categories commonly linked to illnesses were chicken, pork, and seeded vegetables. Multi-state foodborne illness outbreaks have been linked to foods ranging from unpasteurized apple juice to ground beef to soy nut butter to lettuce.

Pasteurized milk is not perfectly safe, either, and is implicated in foodborne illnesses and outbreaks every year.  Although a wide range of foods including meats and vegetables are known to have the potential for causing foodborne illnesses, only raw milk is targeted by government regulators as a food to be completely avoided. Countries such as Canada and Australia currently have complete bans on raw milk.

Raw Milk Institute Method for Safe Raw Milk

The Raw Milk Institute was founded in 2011 to advance the cause of safe raw milk.  The numerous health benefits of raw milk make it an essential food, which is too important to be allowed to be systematically suppressed by regulators and government agencies. RAWMI sought to better understand the important factors in ensuring that raw milk was safe to consume.

In 2011-12, RAWMI brought together a diverse international group with the purpose of establishing standards for safe raw milk. This group included medical doctors and epidemiologists, nutritional consultants, veterinarians, food safety scientists, raw milk farmers, and raw milk consumers. This collaborative group developed the Raw Milk Institute Common Standards, which were initially released in 2012. 

The RAWMI Common Standards describe a three-pronged approach for the production of safe raw milk which consists of:

• Farmer training and mentoring

• Risk Analysis and Management Plan (RAMP) for the unique conditions on each individual farm

• Stringent yet achievable bacterial test standards for coliforms and Standard Plate Count (SPC)

The Common Standards Work!

Since their release in 2012, the RAWMI Common Standards have become a foundational part of low-risk raw milk production across North America. When farmers are well-trained, use careful production practices as laid out in their individual RAMP, and perform ongoing bacterial testing of their milk, they can produce raw milk that is ultra-low-risk.

Researchers from Canada and Europe have studied the safety of raw milk intended for direct human consumption, and have specifically considered milk from farms who implement the RAWMI Common Standards. They have found that carefully produced raw milk is a low-risk food which is fundamentally different from pre-pasteurized milk. The implementation of the RAWMI Common Standards has led to a significant reduction in raw milk-related illnesses and outbreaks.

The table below contrasts pathogen test data from pre-pasteurized milk vs. raw milk intended for direct human consumption.  As illustrated in the table, pathogen testing of pre-pasteurized milk samples has detected pathogens in up to 33% of samples.  In contrast, there were zero pathogens detected in thousands of milk samples from raw milk intended for direct human consumption. It is clear from this test data that pre-pasteurized milk is categorically different from raw milk intended for direct human consumption.

Data courtesy British Columbia Herdshare Association

Common Standards and RAMP 2020 Update

Knowledge about safe raw milk is continually advancing. With the review of the RAWMI Advisory Board and LISTED farmers, the RAWMI Common Standards and RAMP have recently been updated to include the latest information about best practices in raw milk production. The updated Common Standards and RAMP are also now inclusive of other dairy animals such as goats and sheep. The 2020 Common Standards and RAMP are available here:

Antibiotic Resistant Genes in Raw Milk - What Does the Data Really Mean?

Government-Funded Study Finds ZERO Pathogens in Raw Milk Samples!

That’s what the headlines should have read.

Instead, the study was titled, “Reservoirs of antimicrobial resistance genes in retail raw milk” [1]. The study, funded by the National Institutes of Health (NIH) and the United States Department of Agriculture (USDA), was not able to find any pathogens in raw milk. So instead they focused on trying to create fear of antibiotic resistant genes which were found to proliferate when raw milk was allowed to sit at room temperature for hours.  

Antibiotic Resistant Genes are Ubiquitous

Antibiotic resistant genes are everywhere. They’ve been found in every environment, including pristine habitats that have been virtually untouched by humans such as Antarctica [2, 3].  They’re even found in the dust of buildings [4].

“Antibiotics are ancient, dating back hundreds of millions of years. Resistance is therefore equally ancient, and the number of genes in the resistome is a reflection of the continuous co-evolution of small molecules in natural environments and microbial genomes.”  

-Gerard Wright, Nature Reviews Microbiology 2007 [3]

Given that they are ubiquitous in the environment, it is no surprise that there are antibiotic resistant genes in many foods [5]. Breast milk, too, contains antibiotic resistant genes carried on bacteria found in the raw breast milk [6].

Breastmilk and Antibiotic Resistant Genes

Researchers in Helsinki found that, even though breast milk contains antibiotic resistant genes, babies who were breast fed actually have less antibiotic resistant genes in their guts than babies who weren’t breastfed or who terminated breastfeeding early [7].  Researchers attribute this benefit to the fact that breastmilk promotes the growth of beneficial bacteria such as bifidobacteria, which can then outcompete the bacteria carrying antibiotic resistant genes. Like breast milk, cow’s milk has also been shown to support the growth of bifidobacterial [8]. 

Potential Dangers of Antibiotic Resistant Genes

Antibiotic resistant genes can pose potential health threats in specific circumstances. When antibiotics are taken, the intestinal microbiome is disrupted as both beneficial and harmful bacteria are killed off. This weakens our immune systems overall [9]. If there are antibiotic resistant bacteria present in the gut, taking antibiotics actually allows these bacteria to proliferate in the absence of competing bacteria. There can then be infection or illness which is not able to be respond to antibiotics. Antibiotic resistance is now responsible for the deaths of tens of thousands of people every year in the USA alone [10].

For example, C. diff. colitis (clostridium difficile colitis) is infection of the colon that results from disruption of the healthy bacteria in the gut, usually as a result of taking antibiotics. C. diff. can cause diarrhea, abdominal pain, fever, bloody stools, kidney failure, and even death. One of the best treatment options for severe C. diff. infections is fecal transplant. Severely ill C. diff. patients have a 92% cure rate from fecal transplants, which provide a healthy flush of poop from a healthy human donor into the colon [11]. The fecal transplant recolonizes the gut with healthy bacteria.

Zero Pathogens in Raw Milk Samples

Coming back to the study funded by the NIH and USDA [1], researchers found that antibiotic resistant genes proliferated in raw milk that was allowed to sit at room temperature for hours.  Their research showed that raw milk which was kept refrigerated had low levels of antibiotic resistant genes.  What this actually demonstrates is that raw milk from around the country is being produced very cleanly, resulting in low bacteria counts.

Most of the potential beneficial bacteria to be found in milk is from either fecal or soil origin. Yes…dirt is very good for you and a little poop does not hurt either [12]. It has long been understood that living in a farm environment has substantial health benefits over living in urban environments [13]. However, in our modern world with immune-compromised consumers, the raw milk standards have had to change.

For raw milk to be legal for sale and safe for the general public (including immune-compromised people), it must be very hygienic. It can no longer have dirt or poop in it. So, all that is left is clean, delicious, safe raw milk from deep inside the cow’s or goat’s udder. The government-funded study tested retail raw milk samples and they found ZERO pathogens! This should be celebrated as true progress towards farm cleanliness and testing.

“[Raw] milk samples in the present study were screened for Listeria spp., Salmonella enterica, and E. coli O157:H7. None were detected.”

-Liu et al. Microbiome 2020 [1]

Fermenting Raw Milk

For thousands of years, people have known how to ferment or “clabber” raw milk by simply leaving it at room temperature instead of refrigerating it.  In the absence of refrigeration, traditional cultures often consumed raw milk in fermented form [14]. Such milk would have contained ample beneficial lactic acid bacteria from the small amounts of dirt or manure that would have been present on the udders and teats of the milk animals, and would therefore quickly ferment at room temperature. 

In modern times, people have largely lost their taste for spontaneously fermented, sour raw milk. Raw milk farmers and consumers aim to maintain the sweet flavor of fresh milk as long as possible. The farmers do this by thoroughly cleaning the udders and milking equipment to ensure the milk will have low bacteria counts [15], as well as by rapidly chilling the milk and keeping it cold.  Consumers, too, work to make sure their raw milk is kept cold, even during transport.  Keeping raw milk cold allows it to retain its sweet taste and gives it a longer shelf life.

One useful point of information from the government-funded study was the finding that “spontaneous fermentation does not grow beneficial lactic acid bacteria”. This means that the very clean, low-bacteria count raw milk which is currently available in the USA may not ferment very well in the traditional way. The flavor of spontaneously fermented raw milk is not generally palatable to the modern raw milk consumer. Thus, most raw milk consumers actually work to make sure that their raw milk does not ferment and stays fresh and sweet.

Generally, raw milk consumers who intentionally ferment their milk will do so by adding beneficial bacteria such as yogurt starter or kefir grains. Kefir, in particular, is associated with a wide number of health benefits including lower blood pressure, decreased insulin resistance, tumor suppression and prevention, and improved composition of the gut microbiota [16-19].

The Bottom Line

The NIH and USDA-funded study found no pathogens in raw milk. This is further confirmation of the findings published in the January 2020 Journal of Epidemiology and Infection which concluded that “raw milk can be produced with a high level of hygiene and safety” [20].

The government-funded study focused on antibiotic resistant genes which can proliferate in raw milk that is left at room temperature for hours. However, it is no surprise that raw milk, like breastmilk and many other foods, contains antibiotic resistant genes. The presence of antibiotic resistant genes is not an issue unless the balance of good bacteria in the gut gets disrupted. Both breastmilk and raw milk are known to promote the growth of beneficial bacteria such as bifidobacteria. The study completely ignored the growing body of evidence that has shown that children who drink raw milk have decreased rates of asthma, allergies, eczema, ear infections, fever, and respiratory infections [21-23].

The best way to beat antibiotic resistant bacteria is to protect and nourish the biodiverse bacteria in the gut. You can do this by avoiding antibiotics and processed foods, which damage the gut and immune system [24, 25]. Instead, eat plenty of whole foods such as raw milk, milk kefir, grassfed beef, eggs, and fresh or fermented vegetables and fruits to feed the beneficial bacteria in the gut and allow it to thrive [26].

References

[1] Liu, J., Zhu, Y., Jay-Russell, M. et al. (2020) Reservoirs of antimicrobial resistance genes in retail raw milk. Microbiome 8, 99 (2020). https://doi.org/10.1186/s40168-020-00861-6

[2] Durso LM, Miller DN, Wienhold BJ (2012) Distribution and Quantification of Antibiotic Resistant Genes and Bacteria across Agricultural and Non-Agricultural Metagenomes. PLOS ONE 7(11): e48325. https://doi.org/10.1371/journal.pone.0048325

[3] Wright, G. (2007) The antibiotic resistome: the nexus of chemical and genetic diversity. Nat Rev Microbiol 5, 175–186 (2007). https://doi.org/10.1038/nrmicro1614

[4] Ben Maamar S, Glawe AJ, Brown TK, Hellgeth N, Hu J, et al. (2020) Mobilizable antibiotic resistance genes are present in dust microbial communities. PLOS Pathogens 16(1): e1008211. https://doi.org/10.1371/journal.ppat.1008211

[5] Fogler K, Guron GKP, Wind LL, Keenum IM, Hession WC, Krometis L-A, Strawn LK, Pruden A and Ponder MA (2019) Microbiota and Antibiotic Resistome of Lettuce Leaves and Radishes Grown in Soils Receiving Manure-Based Amendments Derived From Antibiotic-Treated Cows. Front. Sustain. Food Syst. 3:22. doi: 10.3389/fsufs.2019.00022

[6] Pärnänen, K., Karkman, A., Hultman, J. et al. (2018) Maternal gut and breast milk microbiota affect infant gut antibiotic resistome and mobile genetic elements. Nat Commun 9, 3891. https://doi.org/10.1038/s41467-018-06393-w

[ 7] Ravindran S. (2019) Breastfeeding May Help Protect Babies from Antibiotic-Resistant Bacteria. SPLASH! milk science update: January 2019 Issue. https://milkgenomics.org/article/breastfeeding-may-help-protect-babies-from-antibiotic-resistant-bacteria/

[8] Rova S, Rada V, Marsik P, Vlkova E, Bunesova V, Sklenar J, Splichal I. (2011) Growth of bifidobacteria and clostridia on human and cow milk saccharides. Anaerobe 17(5). https://doi.org/10.1016/j.anaerobe.2011.07.009.

[9] McAfee M, Smith S. (2020) Immunity, the Immune System, and Raw Milk. Raw Milk Institute website. https://www.rawmilkinstitute.org/updates/immunity-the-immune-system-and-raw-milk

[10] Centers for Disease Control and Prevention. (2019) More People in the United States Dying from Antibiotic-Resistant Infections than Previously Estimated. CDC website. https://www.cdc.gov/media/releases/2019/p1113-antibiotic-resistant.html

[11] Brandt L. J. (2012). Fecal transplantation for the treatment of Clostridium difficile infection. Gastroenterology & hepatology, 8(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365524/

[12] Akst, J. (2020) The influence of soil no immune health. The Scientist website. https://www.the-scientist.com/news-opinion/the-influence-of-soil-on-human-health-66885

[13] Wells, AD, Poole JA, and Romberger DJ. (2014) Influence of farming exposure on the development of asthma and asthma-like symptoms. International immunopharmacology, 23(1), 356–363. https://doi.org/10.1016/j.intimp.2014.07.014

[14] Levi, J. (2014) The Smoke Cured Fermented Milk of the Samburu. Presentation at Wise Traditions London 2014. https://westonaprice.london/videos/samburu/

[15] Smith, S. (2020) Udder Preparation for Raw Milk. Raw Milk Institute website. https://www.rawmilkinstitute.org/updates/udder-preparation-for-raw-milk

[16] Bourrie BC, Willing BP, and Cotter PD. (2016) The Microbiota and Health Promoting Characteristics of the Fermented Beverage Kefir. Frontiers in microbiology, 7, 647. https://doi.org/10.3389/fmicb.2016.00647

[17] Bellikci-Koyu E, Sarer-Yurekli BP, Akyon Y, Aydin-Kose F, Karagozlu C, Ozgen AG, Brinkmann A, Nitsche A, Ergunay K, Yilmaz E, and Buyuktuncer Z. (2019) Effects of Regular Kefir Consumption on Gut Microbiota in Patients with Metabolic Syndrome: A Parallel-Group, Randomized, Controlled Study. Nutrients, 11(9), 2089. https://doi.org/10.3390/nu11092089

[18] Guzel-Seydim ZB, Kok-Tas T, Greene AK, Seydim AC. (2011) Review: functional properties of kefir. Crit Rev Food Sci Nutr. 51(3):261-268. doi:10.1080/10408390903579029

[19] de Oliveira Leite AM, Miguel MA, Peixoto RS, Rosado AS, Silva JT, and Paschoalin VM. (2013) Microbiological, technological and therapeutic properties of kefir: a natural probiotic beverage. Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology], 44(2), 341–349. https://doi.org/10.1590/S1517-83822013000200001

[20] Berge AC, Baars T. (2020) Raw milk producers with high levels of hygiene and safety. Epidemiology and Infection. 148:e14. doi:10.1017/S0950268820000060

[21] Loss G, Apprich S, Waser M, Kneifel W, Genuneit J, Büchele G, Weber J, Sozanska B, Danielewicz H, Horak E, Joost van Neerven RJ, Heederik D, Lorenzen PC, von Mutius E, Braun-Fahrländer C; GABRIELA study group. (2011) The protective effect of farm milk consumption on childhood asthma and atopy: The GABRIELA study. Journal of Allergy and Clinical Immunology. 128 (4): 766-73. https://www.jacionline.org/article/S0091-6749(11)01234-6/fulltext

[22] Perkin MR and Strachan DP. (2006) Which aspects of the farming lifestyle explain the inverse association with childhood allergy? Journal of Allergy and Clinical Immunology. 2006; 117 (6):1374-81. https://www.jacionline.org/article/S0091-6749(06)00651-8/fulltext

[23] Loss G, Depner M, Ulfman LH, Joost van Neerven RJ, Hose AJ, Genuneit J, Karvonen M, Hyvärinen A, Kaulek V, Roduit C, Weber J, Lauener R, Pfefferle PI, Pekkanen J, Vaarala O, Dalphin JC, Riedler J, Braun-Fahrländer C, von Mutius E, Ege MJ; PASTURE study group. (2015) Consumption of unprocessed cow's milk protects infants from common respiratory infections. Journal of Allergy and Clinical Immunology.  135 (1): 56-62. https://www.jacionline.org/article/S0091-6749%2814%2901274-3/fulltext

[24] Watanabe K, Gilchrist CA, Uddin J, Burgess SL, Abhyankar MM, Moonah SN, Noor Z, Donowitz JR, Schneider BN, Arju T, Ahmed E, Kabir M, Alam M, Haque R, Pramoonjago P, Mehrad B, Petri WA. (2017) Microbiome-mediated neutrophil recruitment via CXCR2 and protection from amebic colitis. PLOS Pathogens; 13 (8): e1006513 DOI: 10.1371/journal.ppat.1006513

[25] Paula Neto HA, Ausina P, Gomez LS, Leandro JGB, Zancan P, Sola-Penna M. (2017) Effects of Food Additives on Immune Cells As Contributors to Body Weight Gain and Immune-Mediated Metabolic Dysregulation. Front Immunol.8:1478. doi:10.3389/fimmu.2017.01478

[26] McAfee M. (2020) Build Immune System Strength With Whole Foods: Drink Raw Milk! Raw Milk Institute website. https://www.rawmilkinstitute.org/updates/whole-foods-build-immune-system-strength

Immunity, the Immune System, and Raw Milk

Four Variables for Pathogenic Illness

Masks, social distancing, handwashing, testing: in the last few months, America has awoken to a whole new reality with an awareness that a compromised immune system is risky and dangerous. We are now talking about immune systems and compromised immunity like never before.  Yet, we haven’t been talking about host immunity, and why people have compromised immune systems.

We are the HOST and we have an immune system that protects us if it is strong. Bacterial, fungal, and viral pathogens need a host to survive and thrive, yet pathogens do not cause illness in every host. Scientists and doctors agree that in order for a pathogen to cause illness, four variables must align:

• A pathogen must be present

• The pathogen must be virulent and capable of producing harmful effects

• The pathogen load must be high enough

• The HOST  must be susceptible to the pathogen

Misplaced Focus on Compromised Immune Systems

Health professionals and the news media have avoided  discussion of our host immune systems, which naturally protect us all the time from pathogenic threats. Instead, they talk about how people with compromised immune systems and comorbidities (such as high blood pressure, diabetes, heart disease, and obesity) are being disproportionally affected by COVID19. Our American lifestyle and diet has predisposed large swaths of our population to having compromised immune systems and comorbidities.

Masks and social distancing aim to reduce the pathogen load, yet this narrative neglects the superior aim of strengthening the host. We have little  control over the strength of the COVID19 pathogen, and we can’t live behind masks forever, as we attempt to reduce pathogen load by social distancing and mask wearing  But what we can do is strengthen the host, and that means strengthening our own immune systems.

The best way to immunity is through

strong immune systems.

It is rare that healthy people with strong immune systems are significantly sickened by COVID19. As more and more antibody testing is performed on broad sectors of our population, it is being found that huge numbers of people already have COVID19 antibodies, even though they had no idea that they’d been exposed.  COVID19 has already become part of their adaptive immune response. “Herd immunity” is building whether we stand six feet apart, wash our hands or wear a mask….it is happening whether we like it or not.  The bigger question is: Are Americans up to facing this HOST threat?

Immune System Primer

The immune system is our body’s defense system that protects us from foreign invaders such as pathogenic bacteria and viruses. Immunity is developed by the immune system, and provides protection against illness from specific pathogens. Immunity from specific illnesses is achieved through both the innate and adaptive immune systems.

Image from MicrobeNotes.com

The innate immune system is a rapid–response, whole body protective system that blocks, controls, neutralizes and eliminates pathogenic threats. Elements of the innate immune system include our skin, white blood cells, killer T cells, the gut microbiome, mucus producing cells, tear duct lactoferrin, mucus membranes, lymphocytes, phagocytes, MAST cells, and cytokines. Our innate immune systems  protect us all the time if they are strong and functioning well. The very last thing you would ever want to do is injure or disable this system. Yet, that is exactly what we do whenever we take symptom relief medications which block mucus production or other natural systems that protect us. Antibiotics have been abused so badly that we now have tens of thousands of people that die every year from antibiotic-resistant bacteria. Our first-world innate immune systems and microbiomes have been damaged and  can no longer protect us.

The adaptive immune system is a slow-response system that creates specific immunity after the innate immune system has been the first line of defense. The adaptive immune system creates a long-term memory of the invader, thereby producing specialized antibodies against each specific invader. Antibodies can be likened to battle-hardened, experienced warriors who are ready to quickly protect against any similar attack that may come your way in the future. 

Vaccines aim to trick the body by introducing dead or weakened pathogens in an attempt to trigger the adaptive immune system to produce antibodies. It is possible to create immunity to a pathogen through vaccination and allowing antibodies to be created by your body’s adaptive immune response. Sometimes this works and sometimes it does not.

Creating antibodies means you must go to battle. Going into battle with a weak immune system is a serious risk! Having a strong, adaptive and resilient immune system is a powerful barrier to protect against bacterial, viral, and other threats.

We Damage Our Immune Systems

At the foundation of the immune system is the gut microbiome, which houses 70-80% of the immune system. In America we have embraced all sorts of things that weaken the gut microbiome: antibiotics, preservatives, GMOs, Roundup residues, high sugar diets, highly processed foods….these are all destructive to the gut microbiome and therefore they compromise the immune system. For instance, antibiotics weaken the innate immune system by disrupting the gut microbiome such that neutrophils and white blood cells are no longer able to react properly when threats arise. Antibiotics also weaken the adaptive immune system by reducing immunity to subsequent infection. Food additives such as preservatives effect immune cells and the inflammatory response, thus contributing to the development of comorbidities. Over the longer life experience, exposure to these foods and threats often manifests as chronic disease including diabetes, obesity, arthritis, asthma, whole body inflammation, heart disease etc.

Raw Milk and Milk Kefir Strengthen the Immune System

Nutrition is of prime importance in strengthening the immune system. Raw milk plays a very important part in building and strengthening both the innate and adaptive immune systems. Studies performed in Europe have shown that children who drink raw milk have decreased rates of asthma, allergies, eczema, ear infections, fever, and respiratory infections. These benefits are likely related to the active immune factors, biodiversity, prebiotics, intact protective proteins and other elements found in raw milk. Pasteurized milk does not confer these protective properties because the beneficial raw proteins and enzyme-based elements are denatured and inactivated by heat. Raw milk also contains antibodies which can be beneficial for the immune system.

Raw milk kefir is packed full of biodiversity and contains immune factors from the raw milk. Raw milk kefir is a powerful immune-building food which has been shown to stimulate and modulate the immune system, have a beneficial effect on the composition of the gut microbiome, and reduce allergies. Fermented milk has also been shown to reduce the duration of respiratory infections and colds in the elderly.

Raw Milk Is Similar to Breastmilk

Researchers have likened the protective effects of raw milk to those of breastmilk. Breastmilk is raw milk! Many “agents with beneficial anti-microbial or immune-modulatory effects are shared in bovine and human milk, such as immunoglobulins, cytokines, growth factors, lactoferrin, oligosaccharides, and milk fat globule membranes.”

A recent study of breastmilk from mothers with COVID19 in New York found that the breastmilk contained antibodies to COVID19. This means that infants of mothers infected with COVID19 would receive immunity-building properties directly through breastmilk. Similar effects have been demonstrated with hyperimmune cow’s milk, which has been shown to contain specific antibodies that may boost the immune system. When cows are purposely exposed to pathogens during the dry period, their colostrum contains antibodies to those pathogens for their calves at birth. Research at UC Davis is now investigating whether hyper-immune milk can be produced to protect humans from COVID19.

Raw milk is the first food of life. Its role is not just nourishment; raw milk protects the baby by building the immune system and contributing to a powerful gut microbiome. Over thousands of years of evolution, raw milk has been tested and refined by the trials of successive generations which allow only the best to thrive. The numerous immune system factors present in raw milk intentionally strengthen the baby’s weak immune system, with elements needed for both the innate and adaptive immune systems.

Personal Responsibility for Our Immune Systems

Personal responsibility is critical in building strong immune systems. A strong gut microbiome should be the goal of anyone looking for long-term immune system strength and the subsequent immunity that this brings. Doctors cannot help us with this. We must take responsibility for our own health by purposely building and keeping our immune systems strong. We can care for our gut microbiomes by providing them with whole foods which nourish our biodiversity. Like breastmilk, raw milk and raw milk kefir are self-contained immune system building super foods. Four variables must align in order for a pathogen to make you sick. You have control over the HOST variable and perhaps can reduce the load variable. You are very much in charge of your health and your ability to adapt to all threats, today and into the future.  Drink up your delicious raw milk and thrive!

FAQ About Raw Milk and COVID19

Got questions about raw milk and COVID19? We’ve gotcha covered!

• Can I catch COVID19 by drinking raw milk?

• Does raw milk strengthen the immune system?

• Does raw milk support lung health?

• Is raw milk healthier than pasteurized milk?

• I thought raw milk was unsafe. Isn’t pasteurization necessary for safety?

• Where can I find tested, low-risk raw milk?

• What if there aren’t any Raw Milk Institute LISTED dairies near me?

Check out questions and answers about raw milk and COVID19 here:

RAWMI Ripple - January 2020

January 2020 Edition

Dear Friend,

Welcome to the January 2020 edition of the Raw Milk Institute (RAWMI) Ripple. Herein you'll find information about the latest in the world of raw milk, including a new meta-analysis on the protective health effects of raw milk, the Interstate Milk Freedom Act, RAWMI training, and additional resources for raw milk education.

Meta-Analysis of Raw Milk Effects on Asthma, Allergies, and Infections

A recent issue of the Journal of Allergy and Clinical Immunology: In Practice published a peer-reviewed meta-analysis of eight health studies related to raw milk. A meta-analysis is a quantitative statistical analysis which combines the results of multiple scientific studies, thereby allowing the researchers to derive overall conclusions about that body of research.

The November 2019 paper, titled “The Beneficial Effect of Farm Milk Consumption on Asthma, Allergies, and Infections: From Meta-Analysis of Evidence to Clinical Trial” was written by a team of researchers from the Netherlands and Germany. The meta-analysis concluded that, when taken as a whole, the body of data from the previous studies shows that raw milk consumption in childhood has a protective effect on asthma, current wheeze, allergic rhinitis (hay fever), and atopic sensitization (allergies to environmental triggers).

When the previous raw milk studies were criticized, the detractors instead attributed the protective health effects to the farm environment rather than raw milk. However, the 2019 meta-analysis shows differently: “The effect particularly on asthma was observed not only in children raised on farms (OR, 0.62; 95% CI, 0.58-0.82) but also in children living in rural areas but not on a farm (OR, 0.60; 95% CI, 0.48-0.74). This demonstrates that the effect of farm milk consumption is independent of other farm exposures and that children not living on a farm can theoretically profit from this effect.” 

Interstate Milk Freedom Act HR 5410

It is currently illegal to sell raw milk across state lines in the United States. The FDA’s ban on interstate raw milk harms small farms as well as informed consumers, who purposely seek out raw milk for its health benefits and superb taste. The Interstate Milk Freedom Act HR 5410 seeks to prohibit federal interference with the interstate sale of raw milk. This bipartisan bill was sponsored by Representatives Thomas Massie (Republican from Kentucky) and Chellie Pingree (Democrat from Maine).

“Federal agencies, such as the FDA, that are part of the executive branch do not and should not have the power to shut down trade between peaceful farmers and willing consumers. It is Congress’s job to legislate,” said Rep. Massie. “Our Interstate Milk Freedom Act would make it easier for families to buy milk of their choice by reversing the criminalization of specific dairy farmers.”

“So many people across the country want to make sure their food is fresh and local—including fruits, vegetables, and even their milk,” said Rep. Pingree. “Raw milk is currently the only food banned for interstate commerce—an onerous regulation that hurts small farmers for selling milk straight from their cows to the consumer.”

It is time for the ban on interstate raw milk to be overturned. Ask your representatives to support HR 5410.

Northeast USA RAWMI Training

Studies have shown that raw milk has superb nutrition and protective health effects, but raw milk needs to be carefully and intentionally produced in order to ensure that it is a low-risk food. Through education, outreach, and research, RAWMI is working towards universal access to safe raw milk for everyone.

Earlier this month, RAWMI held raw milk training sessions at Rutgers University, the Northeast Organic Farming Association (NOFA) Massachusetts, and NOFA New York. These presentations focused on raw milk benefits as well as risk management for the production of safe, low-risk raw milk. 50 dairy farmers attended these three training sessions.

On February 6, 2020, RAWMI will be providing a 3&1/2 hour presentation on raw milk risk management at the Pennsylvania Association for Sustainable Agriculture (PASA) conference in Lancaster Pennsylvania. Mark McAfee, Sarah Smith, Dr. Joseph Heckman, and Edwin Shank will be presenting at this event.

International Milk Genomics Consortium Conference

The 16th International Milk Genomics Consortium (IMGC) Symposium was held on November 12-14, 2019 in Aarhus Denmark. This conference focused on milk and health from a sustainability perspective, with a wide variety of presentation topics including environmental challenges in milk production, effects of breastmilk and ruminant milk on the gut microbiome, structure and function of milk, and the superb nutrition of whole foods versus supplements.

The Raw Milk Institute was an official sponsor of this IMGC Symposium and provided sponsorship to Dr. Joanne Whitehead in attending to present her peer-reviewed, published raw milk risk analysis poster depicting the positive impact of “high standards, farmer training and frequent testing” on raw milk risk reduction.

New Resources for Raw Milk Education

The Raw Milk Institute has developed several new resources for educating people about raw milk.

RAWMI’s letter to medical professionals about the benefits and safety of raw milk provides a comprehensive summary of the latest science on the nutritional and health benefits of raw milk, therapeutic use of raw milk, the negative impacts of pasteurization, and the safety of raw milk.

In response to a request from RAWMI LISTED farmers, RAWMI has also developed a new trifold brochure about the benefits of raw milk. This brochure can be used at the point-of-sale or online to increase awareness of the benefits of raw milk. Email sarah@rawmilkinstitute.org if you want to make use of this brochure.

LISTED Farmers Quarterly Meeting

RAWMI LISTED farmers are able to connect and share with other raw milk farmers during quarterly video conferences. At the most recent video conference, farmers from 11 RAWMI LISTED dairies discussed issues including challenges to exclusive grass-feeding, recent problems and lessons learned, marketing, and the erosion of the “organic” label.

Ancient Baby Bottles Reveal Ruminant Milk Being Fed to Children

Raw milk has been nourishing children for millennia! The oldest baby bottle-like vessel found thus far is nearly 8,000 years old. Recently, three independent lipid analyses of residue from ancient baby bottles has been performed. These analyses have provided evidence that ruminant milk (such as cow, sheep, or goat milk) was being fed to children thousands of years ago.

Take care all of you RAWMI producers, consumers and all of you interested in raw milk!

Letter to Medical Professionals about Raw Milk

The Raw Milk Institute has written a letter addressed to medical professionals about the benefits and safety of raw milk. This letter provides a comprehensive summary of the latest science on the nutritional and health benefits of raw milk, the negative impacts of pasteurization, and the safety of raw milk.

Feel free to share this letter far and wide! It can be used to educate your family doctor or other healthcare professionals about why you choose to drink raw milk. And it can also be given to interested family and friends who want to know more about raw milk.

Raw Milk Institute Board of Directors

RawMilkInstitute.org

December 2019

To: Medical Professionals and Healthcare Providers

Re: Raw Milk as a Low-Risk Therapeutic Tool

EXECUTIVE SUMMARY

Several medical associations, including the American Academy of Pediatrics, Canadian Medical Association, and Australian Medical Association, promote a position against consumption of raw milk or raw milk products.  The stated reasons for this position are that raw milk may contain dangerous pathogens  and that raw milk does not possess any benefits over pasteurized milk. However,  these conclusions are outdated and in conflict with the most up-to-date peer-reviewed and internationally-published research.

It is true that raw milk produced as “intended for pasteurization” and sourced from  Concentrated Animal Feeding Operations (CAFOs) is generally unsanitary and unsafe to consume raw.  Such milk is being produced in conditions where animal health is compromised, antibiotics are utilized, hormones are used to stimulate higher levels of milk production, there is an abundance of manure, and there is a corresponding high rate of pathogens.  This type of milk is generally commingled with milk from multiple dairies, which increases the risk of pathogenic exposure. This type of raw milk is actually defined under the Grade A Pasteurized Milk Ordinance.  At the Raw Milk Institute, we agree that consumption of this type of raw milk is high risk.

However, raw milk that is carefully and intentionally produced for direct human consumption is a low-risk food with superb nutritional benefits. This type of raw milk is wholly different from raw milk being produced in unhygienic conditions. Raw milk intended for direct human consumption is produced in sanitary conditions, with much care to ensure that the animals are healthy and that the milk is clean. This type of raw milk is tested often and held to rigorous standards to ensure that it is being produced in a way that discourages pathogen growth.  

Carefully produced raw milk has numerous health advantages over pasteurized milk. Whereas pasteurized milk is now recognized as a top food allergen and difficult to digest, raw milk is actually a health-supporting food with rich therapeutic potential and is easily digested by most consumers.  Like breastmilk, raw milk is a living whole food which provides excellent nutrition along with health-supporting enzymes and probiotics. Raw milk has a superior nutrient profile, whereas pasteurized milk has diminished nutrition with denatured proteins and fats. People who are lactose intolerant can often consume raw milk with no maldigestion, due to the presence of a variety of living bacteria which facilitate production of lactase enzyme in the intestines. Numerous scientific studies have shown that raw milk is correlated with decreased rates of asthma, allergies, eczema, otitis, fever, and respiratory infections. Raw milk also aids in recovery from antibiotic use, and provides many gut-healthy probiotics and enzymes.

Carefully produced raw milk is a health-promoting food that has been maligned because of the simple fact that people are confusing it with commodity milk that has been produced with the intention to be pasteurized. Doctors and healthcare professionals routinely warn patients that raw milk is unsafe to consume, but there is ample evidence that this conclusion is not applicable to carefully-produced raw milk. For the health of your patients and clients, please consider the following information about the benefits and safety of raw milk.

Nutritional Benefits of Pasteurized Milk vs. Raw Milk

Pasteurized milk is now known as one of the foremost allergenic foods [1]. Scientific evidence against pasteurized milk is mounting: for instance, a study of nearly 800 European children found that children who consumed pasteurized milk were more likely to show signs of milk allergy, whereas children who consumed raw milk were protected from milk allergy [2]. The process of pasteurization denatures and destroys many nutrients, so much so that synthetic vitamins are added back in after pasteurization.

The CDC argues that, "Most of the nutritional benefits of drinking milk are available from pasteurized milk" and "the heating process of pasteurization inactivates some enzymes in milk but scientists do not believe these enzymes are important in human health"[3].  These conclusions are clearly outdated and in conflict with the most recent research. Current science has shown that pasteurization has a negative effect on the nutritive qualities of milk, and the impact is not inconsequential.

Pasteurization of milk has been shown to:

• Reduce the bioavailability of calcium and phosphorus [4, 5],

• Reduce the presence of copper and iron [6],

• Reduce Vitamins A, B Complex, C, and E [3, 7, 8],

• Destroy beta-lactoglobulin, thereby decreasing intestinal absorption of Vitamins A and D [9, 10],

• Destroy probiotics [11], including lactobacillus and pediococcus, and

• Inactivate beneficial enzymes, including lactase, alkaline phosphatase, and lactoperoxidase [12, 13].

In many ways, raw milk can be likened to breastmilk: they both contain a wide array of beneficial nutrients, enzymes, vitamins, and minerals, in their natural form which is most easily utilized by the body. Both raw milk and breastmilk are designed to provide excellent nutrition and strengthen the immune system . It is widely acknowledged that breastmilk is the best food for the early years of life, however raw milk is a natural next step after breastfeeding. Raw milk, and especially raw milk from pastured animals [14],  is a great source of calcium, iron, Vitamins A, D & K, phosphorus, zinc, conjugated linoleic acid (CLA), and omega-3 fatty acids, plus many beneficial enzymes and probiotics.

Raw milk contains many types of beneficial enzymes, yet these enzymes are inactivated by pasteurization. For instance, raw milk contains protease enzyme, which aids in digestion of proteins [13], and lipase enzyme, which aids in digestion of fats [15].   Lactoperoxidase is a naturally occurring antimicrobial enzyme in raw milk [16]. Alkaline phosphatase enzyme is attached to the fat globules in raw milk; intestinal alkaline phosphatase enzyme is associated with decreased inflammation and lower rates of cardiovascular disease and Type-2 diabetes [17]. These and numerous other beneficial enzymes in raw milk are inactivated by pasteurization.

Beneficial probiotics in raw milk are diverse and abundant. These raw milk probiotics have a number of known health benefits. For example, raw milk contains a variety of living bacteria which facilitate the production of lactase enzyme in the intestine, which has been shown to help with lactose digestion in lactose intolerant people [18]. Lactobacilli "typically inhibit pathogenic organisms, reduce lactose intolerance, increase the immune response and often are gastrointestinal isolates... Other milk and dairy isolates that exhibit probiotic properties include strains of Lactococcus lactis as well as a variety of Pediococcus, Leuconostoc, Enterococcus and Streptococcus isolates... Strains of P. freudenreichii, and to a lesser extent P. acidipropionici, have begun to attract attention as potential probiotics as a consequence of studies revealing an ability, either alone or in combination with other probiotics, to reduce pathogen adhesion to mucus, increase bifidobacteria counts in the gut, aid in restoring a healthy gut microbiota, improve bowel movement, alleviate inflammatory disorders and reduce allergy development in infants" [19]. Probiotics are destroyed by pasteurization.

Health Benefits of Raw Milk

From 1893-1999, the American Association of Medical Milk Commissions  (AAMMC) certified clean, safe raw milk for human consumption and even medical therapeutic use. This certified raw milk was recognized to be of therapeutic benefit for infants, children, and adults [20]. This milk was used effectively in hospitals around the United States and was used to treat a wide variety of chronic diseases, including cardiovascular disease, renal disease, liver disease, hypertension, edema, asthma, arthritis, tuberculosis, and diabetes [21, 22, 23].

Dr. Charles Porter MD published the book Milk Diet as a Remedy for Chronic Disease, which details his use of a raw milk diet in the treatment of over 18,000 patients over the course of 27 years. Dr J.E. Crewe MD, one of the founders of the Mayo Foundation, successfully used raw milk in his medical practice for over 15 years, and said that the "results obtained in various types of disease have been so uniformly excellent that one’s conception of disease and its alleviation is necessarily changed... When sick people are limited to a diet containing an excess of vitamins and all the elements necessary to growth and maintenance, they recover rapidly without the use of drugs and without bringing to bear all the complicated weapons of modern medicine" [22].

More recent scientific studies have shown that raw milk is associated with a number of tangible health benefits:

• A study of over 8,000 European children showed that raw milk consumption is associated with significantly lower rates of asthma and allergies [24].

• A study of over 900 European children concluded that, "Continuous farm [raw] milk consumption in childhood protects against asthma at school age" [25].

• A study of over 14,800 European children concluded that there is a "significant inverse association between farm [raw] milk consumption and childhood asthma, rhinoconjunctivitis, sensitization to pollen, a mix of food allergens, and horse dander" [26].

• A study of over 3,000 USA adults concluded that, " Raw milk, if the main type of milk consumed in childhood, was also associated with reduced risk of atopy" and current raw milk consumption in adulthood intensified this beneficial effect [27]. 

• A study of over 3,000 USA adults concluded that, "raw milk consumption, particularly early in life, is associated with better pulmonary function in adulthood" [28].

• A study of over 900 European children concluded that, "Early life consumption of raw cow's milk reduced the risk of manifest respiratory infections and fever by about 30%" [29].

• A study of over 4,000 European children found that consumption of raw milk was associated with a strong protective effect against eczema [30].

These studies specifically compared raw milk to pasteurized milk, and have concluded that raw milk has significant health benefits over pasteurized milk.

Safety of Raw Milk

It is important to note that there is no such thing as a perfectly safe food [20]. An analysis of foodborne illnesses from 2009-2015 showed that the top food categories commonly linked to illnesses were chicken, pork, and seeded vegetables [31]. Pasteurized milk is not perfectly safe, either, and is implicated in foodborne illnesses and outbreaks every year.  CDC outbreak and illness data since 1972 shows at least 82 deaths from pasteurized dairy products.

The CDC outbreak and illness data which is used to assert that raw milk is unsafe does not distinguish raw milk intended for pasteurization from raw milk that is carefully produced and intended for direct human consumption. The FDA has no standard for raw milk intended for human consumption. It has only the Pasteurized Milk Ordinance (PMO).  It is known that raw milk intended for pasteurization often contains pathogens; studies have shown that up to 24% of this type of milk tests positive for pathogens [32]. Additionally, the CDC data used to implicate raw milk includes outbreaks and illnesses from “bathtub cheese” (i.e. Mexican-style Queso Fresco made illegally at home); queso fresco is inherently more dangerous than raw milk, and is associated with more serious outbreaks and illnesses. The CDC data reports only two deaths from raw dairy products since 1972, and both of these deaths were associated with queso fresco.

Nearly 10 million people in the USA were consuming raw milk regularly as of 2007 [33], and the number of people consuming raw milk is likely to be higher now given the growing popularity of raw milk. An independent assessment of raw milk risks from 2000-2007, which excluded queso fresco-related illnesses and outbreaks, concluded that there was a "a roughly 1 in 94,000 chance of becoming ill from drinking unpasteurized milk during that period... During the 2000−2007 period, there were 12 hospitalizations for illnesses associated with raw fluid milk. That’s an average of 1.5 per year. With approximately 9.4 million people drinking raw milk, that means you have about a 1 in 6 million chance of being hospitalized from drinking raw milk" [34].

Furthermore, recent improvements in raw milk risk management methods and training have led to a significant reduction in raw milk-related illnesses and outbreaks.  The Raw Milk Institute, founded in 2011, has developed farmer training and Common Standards for raw milk which is intended for direct human consumption. These rigorous standards and training result in low-risk raw milk, as documented in a 2018 peer-reviewed paper titled, " Recent Trends in Unpasteurized Fluid Milk Outbreaks, Legalization, and Consumption in the United States." This paper concluded that, "The rate of unpasteurized milk-associated outbreaks has been declining since 2010, despite increasing legal distribution. Controlling for growth in population and consumption, the outbreak rate has effectively decreased by 74% since 2005" [35].

A Balanced Viewpoint About Raw Milk

Commodity raw milk and dedicated raw drinking milk are categorically different foods.  It is clear that raw milk produced with the intention to be pasteurized is likely to contain dangerous pathogens. However, raw milk that is carefully produced for direct human consumption is subjected to rigorous testing and standards. Evidence has shown that this type of raw milk is a low-risk food.

Raw milk has superior nutrition and significant health benefits over pasteurized milk.  Raw milk contains greater bioavailable nutrients than pasteurized milk, as well as a wide array of beneficial enzymes and probiotics which are known to have benefits on the immune system and gastrointestinal tract.  Raw milk consumption has been correlated with increased resistance to allergies, asthma, respiratory infections, otitis, and eczema.  Thus, raw milk can be an important therapeutic tool.

If you would like more information about raw milk, please feel free to contact the Raw Milk Institute by email at contact@rawmilkinstitute.org .

The Raw Milk Institute is a 501(c)3 non-profit organization dedicated to mentoring and training farmers in the production of safe, low-risk raw milk.

References

[1] Frequently Asked Questions About Food Allergies. Food and Drug Administration website as of November 7, 2019. https://www.fda.gov/food/food-allergens/frequently-asked-questions-about-food-allergies

[2] Atopic sensitization in the first year of life. Journal of Allergy and Clinical Immunology. 2013; 131(3):781-8. Depner M, Ege MJ, Genuneit J, Pekkanen J, Roponen M, Hirvonen MR, Dalphin JC, Kaulek V, Krauss-Etschmann S, Riedler J, Braun-Fahrländer C, Roduit C, Lauener R, Pfefferle PI, Weber J, von Mutius E; PASTURE Study Group. https://www.jacionline.org/article/S0091-6749(12)01975-6/fulltext

[3] Raw Milk Questions and Answers. US Department of Health & Human Services, Centers for Disease Control and Prevention website as of November 6, 2019. https://www.cdc.gov/foodsafety/rawmilk/raw-milk-questions-and-answers.html

[4] A Comparison of Raw, Pasteurized, Evaporated, and Dried Milks as Sources of Calcium and Phosphorus for the Human Subject. Department of Food Economics and Nutrition, Kansas Experiment Station, Manhattan. 1928. Kramer MM, Latzke E, Shaw MM.

[5] Assessing the effects of severe heat treatment of milk on calcium bioavailability: in vitro and in vivo studies. Journal of Dairy Science. 2010; 93(12): 5635-43. Seiquer I, Delgado-Andrade C, Haro A, Navarro MP. https://www.ncbi.nlm.nih.gov/pubmed/21094734

[6] Effect of processing on contents and relationships of mineral elements of milk. Food Chemistry. 1994; 51(1): 75-78. Zurera-Cosano G, Moreno-Rojas R, Amaro-Lopez M. https://www.sciencedirect.com/science/article/pii/0308814694900507

[7] Influence of thermal and other manufacturing stresses on retinol isomerization in milk and dairy products. Journal of Dairy Research. 1998; 65(2): 253-60. Panfili G, Manzi P, Pizzoferrato L. http://europepmc.org/abstract/med/9627844

[8] A systematic review and meta-analysis of the effects of pasteurization on milk vitamins, and evidence for raw milk consumption and other health-related outcomes. Journal of Food Protection. 2011;74(11):1814-32. Macdonald LE, Brett J, Kelton D, Majowicz SE, Snedeker K, Sargeant JM. https://www.ncbi.nlm.nih.gov/pubmed/22054181

[9] Intestinal uptake of retinol: enhancement by bovine milk beta-lactoglobulin. American Journal of Clinical Nutrition. 1989; 49(4): 690-94. Said HM, Ong DE, Shingleton JL. https://academic.oup.com/ajcn/article-abstract/49/4/690/4732752

[10] Evidence for beta-lactoglobulin involvement in vitamin D transport in vivo--role of the gamma-turn (Leu-Pro-Met) of beta-lactoglobulin in vitamin D binding. FEBS Journal. 2009; 276(8):2251-65. Yang MC, Chen NC, Chen CJ, Wu CY, Mao SJ. https://febs.onlinelibrary.wiley.com/doi/full/10.1111/j.1742-4658.2009.06953.x  

[11] The growing role of probiotics. Harvard Men's Health Watch. 2018. Harvard Medical School. https://www.health.harvard.edu/staying-healthy/the-growing-role-of-probiotics

[12] Alkaline Phosphatase Testing for Milk Pasteurization. Dairy Foods Science Notes. 11-07. Department of Food Science, Cornell University. https://foodsafety.foodscience.cornell.edu/sites/foodsafety.foodscience.cornell.edu/files/shared/documents/CU-DFScience-Notes-Milk-Alk-Phosphatase-11-07.pdf

[13] Proteolytic Systems in Milk: Perspectives on the Evolutionary Function within the Mammary Gland and the Infant. Journal of Mammary Gland Biology and Neoplasia. 2015; 20(3-4):133-47. DC Dallas, NM Murray, J Gan.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637187/

[14] The Role of Trees and Pastures in Organic Agriculture. Sustainable Agriculture Research. 2015; 4: 47-55. J Heckman. http://www.ccsenet.org/journal/index.php/sar/article/view/50105

[15] Lipases in bovine milk and the relationship between the lipoprotein lipase and tributyrate hydrolysing activities in cream and skim-milk. Journal of Dairy Research. 1975; 42(2): 255-66. HB Castberg, T Egelrud, P Solberg, T Olivecrona. https://www.ncbi.nlm.nih.gov/pubmed/237941

[16] Contribution of the lactoperoxidase system to the keeping quality of pasteurized milk. Journal of Dairy Research. 1999; 66(1):73-80. Barrett NE, Grandison AS, Lewis MJ. https://www.ncbi.nlm.nih.gov/pubmed/10191475

[17] Dairy products and the French paradox: Could alkaline phosphatases play a role? Medical Hypotheses. 2016; 92:7-11. Lallès JP. https://www.sciencedirect.com/science/article/abs/pii/S0306987716300500?via%3Dihub

[18] Effect of a single dose of lactase on symptoms and expired hydrogen after lactose challenge in lactose-intolerant subjects. Clinical Pharmacy. 1992; 11(6):533-8. Sanders SW, Tolman KG, Reitberg DP. https://www.ncbi.nlm.nih.gov/pubmed/1534729

[19] The complex microbiota of raw milk. FEMS Microbiology Review. 2013: 37(5), 664-98. Quigley L, O'Sullivan O, Stanton C, Beresford TP, Ross RP, Fitzgerald GF, Cotter PD. https://academic.oup.com/femsre/article/37/5/664/541439

[20] Securing Fresh Food From Fertile Soil, Challenges to the Organic and Raw Milk Movements. Renewable Agriculture and Food Systems, Cambridge University Press. 2017. J Heckman. https://www.cambridge.org/core/journals/renewable-agriculture-and-food-systems/article/securing-fresh-food-from-fertile-soil-challenges-to-the-organic-and-raw-milk-movements/18325E375E068A538E07EF4E6F6ABA22

[21] Porter, Charles Sanford. Milk Diet as a Remedy for Chronic Disease. Burnett P.O., California, 1911. https://archive.org/details/milkdietasremedy00portiala/page/n1

[22] Use of Milk in the Treatment of Human Disease. Proceedings of the 29th Annual Meeting of the United States Live Stock Sanitary Association. 1925. Crewe JE. https://www.usaha.org/upload/Proceedings/1897-1929/1925_TWENTY_NINTH_ANNUAL_MEETING.pdf

[23] Macfadden, Bernarr. The Milk Diet: How to Use the Milk Diet Scientifically at Home. 1923.

[24] The protective effect of farm milk consumption on childhood asthma and atopy: The GABRIELA study. Journal of Allergy and Clinical Immunology. 2011; 128 (4): 766-73. Loss G, Apprich S, Waser M, Kneifel W, Genuneit J, Büchele G, Weber J, Sozanska B, Danielewicz H, Horak E, Joost van Neerven RJ, Heederik D, Lorenzen PC, von Mutius E, Braun-Fahrländer C; GABRIELA study group. https://www.jacionline.org/article/S0091-6749(11)01234-6/fulltext

[25] ω-3 fatty acids contribute to the asthma-protective effect of unprocessed cow's milk. Journal of Allergy and Clinical Immunology. 2016; 137 (6): 1699-1706. Brick T, Schober Y, Böcking C, Pekkanen J, Genuneit J, Loss G, Dalphin JC, Riedler J, Lauener R, Nockher WA, Renz H, Vaarala O, Braun-Fahrländer C, von Mutius E, Ege MJ, Pfefferle PI; PASTURE study group. https://www.jacionline.org/article/S0091-6749(15)01731-5/fulltext

[26] Inverse association of farm milk consumption with asthma and allergy in rural and suburban populations across Europe. Clinical and Experimental Allergy. 2007; 37(5):661-70. Waser M, Michels KB, Bieli C, Flöistrup H, Pershagen G, von Mutius E, Ege M, Riedler J, Schram-Bijkerk D, Brunekreef B, van Hage M, Lauener R, Braun-Fahrländer C; PARSIFAL study team. https://www.ncbi.nlm.nih.gov/pubmed/17456213

[27] Early-life farm exposures and adult asthma and atopy in the Agricultural Lung Health Study. Journal of Allergy and Clinical Immunology. 2017; 140 (1): 249-56. House JS, Wyss AB, Hoppin JA, Richards M, Long S, Umbach DM, Henneberger PK, Beane Freeman LE, Sandler DP, O’Connell EL, Barker-Cummings C, London SJ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429211/

[28] Raw Milk Consumption and Other Early-life Farm Exposures and Adult Pulmonary Function in the Agricultural Lung Health Study. Thorax. 2018; 73(3): 279-82. Wyss AB, House JS, Hoppin JA, Richards M, Hankinson JL, Long S, Henneberger PK, Beane Freeman LE, Sandler DP, O'Connell EL, Cummings CB, Umbach DM, London SJ. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758444/

[29] Consumption of unprocessed cow's milk protects infants from common respiratory infections. Journal of Allergy and Clinical Immunology. 2015; 135 (1): 56-62. Loss G, Depner M, Ulfman LH, Joost van Neerven RJ, Hose AJ, Genuneit J, Karvonen M, Hyvärinen A, Kaulek V, Roduit C, Weber J, Lauener R, Pfefferle PI, Pekkanen J, Vaarala O, Dalphin JC, Riedler J, Braun-Fahrländer C, von Mutius E, Ege MJ; PASTURE study group. https://www.jacionline.org/article/S0091-6749%2814%2901274-3/fulltext

[30] Which aspects of the farming lifestyle explain the inverse association with childhood allergy? Journal of Allergy and Clinical Immunology. 2006; 117 (6):1374-81. Perkin MR, Strachan DP. https://www.jacionline.org/article/S0091-6749(06)00651-8/fulltext

[31] Surveillance for Foodborne Disease Outbreaks - United States, 2009-2015. US Department of Health & Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/67/ss/ss6710a1.htm

[32] Two Types of Raw Milk: A Comparison of Pathogen Contamination Rates. British Columbia Herdshare Association. 2019. http://www.bcherdshare.org/education/two-types-of-raw-milk-lab-evidence.pdf

[33] Population Survey Atlas of Exposures, 2006-2007. Foodborne Diseases Active Surveillance Network. US Department of Health & Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/foodnet/surveys/FNExpAtl03022011.pdf

[34] Raw Milk Reality: Is Raw Milk Dangerous? 2019. Kresser C. https://chriskresser.com/raw-milk-reality-is-raw-milk-dangerous/

[35] Recent Trends in Unpasteurized Fluid Milk Outbreaks, Legalization, and Consumption in the United States. PLOS Currents. 2018; 10. Whitehead J, Lake B. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140832