Ep 175 What’s the deal with raw milk: Part 2

Family's children hospitalized with E. coli from raw milk

A family who switched to raw milk saw their daughter Jubilee develop hemolytic uremic syndrome from E. coli, requiring dialysis. Her brother Titus also got sick and developed pancreatitis and a staph infection from the contaminated raw milk.

"The results of the test came back. It's E. coli, she was told. Jubilee's kidneys are in danger."

Listeria mortality rate and risks to pregnant women

Dr. Nicole Martin explains that listeria found in raw milk has a mortality rate of 15 to 20%, and is particularly dangerous for pregnant individuals, children, and immunocompromised people, often causing miscarriage.

"Let's take a break and then get started. So, Erin, you talked a lot about what the landscape was like prior to the requirements, prior to the development of pasteurization and requirements for pasteurization. But I just want to frame ourselves there. Prior to nationwide requirements that all milk be pasteurized in the US, most of the estimates that I saw were that milk-borne outbreaks overall constituted at least 25% of all disease outbreaks that were due to contaminated food and water. Wow. Right? So that's like a really huge number. Today, milk and milk products are associated with, on average, and this varies a little bit year to year, but usually 1% or less of these types of outbreaks. Thanks to pasteurization. Phenomenal, yeah. And as we'll see, that does not mean that milk itself is a low-risk food, because like we talked about last week, milk is a beautiful medium for bacterial growth. It is. It means that pasteurization and the widespread use of pasteurization is the thing that has been preventing these outbreaks. So what I am going to do in this episode is lay the view of the land of what the risks of unpasteurized milk actually are today. Okay. I keep hearing, how do you pronounce milk? Okay. I was waiting for you to say this because I get made fun of for how I pronounce it every single. It's going to keep going, Erin. It's milk. And I feel like this is feeling very deja vu to me. And I think that we may have had this conversation during lactose intolerance. Absolutely, we did. You say milk, right? I don't hear a difference between what you're saying and what I'm saying. Milk. Where does milk come from? What do you say? Like a dialect. Milk? Milk? Milk? Milk. I'm sorry. There's a vowel change there for certain. Well, I'm sorry. Everyone's going to be so annoyed with how many times I say the word milk today. I just, I have to know. I need to look at like a dialect map to know where milk comes from. Did you pick it up in Illinois? Southern California? I don't know, Erin. I don't know. Okay. I don't know either. But I get made fun of for it on the regular. So apologies to literally everyone listening. I'm shocked that it didn't come out last week, honestly. That's fair. Yeah. I don't know. It's probably just because I didn't talk about milk as much. Sorry to like kick off this whole episode making you feel self-conscious. It's okay. I only say it a hundred more times. A hundred thousand. Okay. Listen, but that's where we're going to start, okay? We'll talk about the raw product that comes out of a cow, primarily. We're mostly talking about cow milk. And then related to that, I'll also talk a little bit about what the current legal landscape looks like when it comes to raw and pasteurized milk, not just in the US, but across the globe. Like how easy or how hard is it to actually get your hands on raw milk? Are there any associations between whether raw milk is legal and easy to get and its potential for causing harm? And then what the differences are truly between raw and pasteurized milk and hopefully break down some of the very egregious misconceptions that exist on the internet right now about this. Because there are some differences, but it is not what TikTok would like you to believe. No. I feel like calling them misconceptions is very generous. I know. It's like flat out lies. A lot of them really are. And we'll get into, I think, how those, like why,, I don't know, it's a very effective lice and we'll get into it. Totally. So one of the things that makes comparing the number of infections or the numbers even of outbreaks of disease from raw milk versus pasteurized milk difficult today in our modern system is that there are huge disparities in the number of people who are drinking raw milk versus pasteurized milk. So in the U.S., it's estimated that somewhere between 1 to 3 percent of the population is drinking raw milk, whereas close to 80 percent of Americans drink milk. Like, that's a huge—I didn't know that so many of us drink milk. And that's like, what does that mean? Does that mean like you're having a glass of 2%? No, this is based on surveys from like MMWR and like a bunch of other places that are just like, have you drank milk in the last seven days? Yes or no. And then sometimes it's quantified, how many glasses do you drink and blah, blah, blah. Right. So I guess, do I count as that? Would I check yes, because I had half and half in my coffee? Yeah. Yeah. Okay. Absolutely. Yeah. Okay. Yeah. But I don't know, if you answered the survey, would you have clicked yes or no? I don't know. Well, I just mean like, I guess it's for such a binary outcome, right? Like yes or no. It's like how much milk anyway? Erin, you're getting into like, this is a huge part of it, right? How much milk are you drinking? Are people who are drinking raw milk drinking the same amount as people who are drinking pasteurized milk? Like there is a lot of variability in any kind of like nutritional study that we're looking at. But if we just take a bird's eye view, probably about 80% or so of Americans drink milk. Only one to 3% of Americans are drinking raw milk. The vast majority of people who are drinking milk are drinking pasteurized milk. So if we're looking at numbers of people who get disease or the number of outbreaks, you cannot just compare the total number of outbreaks or the total number of cases in raw versus pasteurized milk. No. That will not give you an assessment of risk because that is not how statistics works. You have to compare the proportion of cases. You have to look at how many people are drinking raw milk? how much are they drinking, how many people are drinking pasteurized milk, how much are they drinking, and then figure out what is the likelihood that you would get sick from raw milk versus the likelihood that you would get sick from pasteurized milk. That is what you have to do. We often do not see the data reported in that way. So that is the first problem with how we report the differences in risk. But don't worry, we're going to today. So if we just look at those numbers first, there was a paper and I cited a bunch of different papers that looked at outbreak rates over different time periods, but I just picked the one that's the most recent. So a paper that looked at outbreaks in both the U.S. and Canada, where, by the way, it's totally illegal to buy raw milk or sell raw milk. Oh, like entirely. Yeah, it's not legal there. It still happens, but it's not legal. Okay. If you look at outbreaks in the U.S. and Canada from 2007 to 2020, in raw milk, there were 20 outbreaks, confirmed outbreaks of disease associated with raw milk that resulted in 449 confirmed cases, 124 hospitalizations, and 5 deaths. In pasteurized milk products around the same time, there were 12 outbreaks, 174 confirmed cases, 134 hospitalizations, 17 deaths, and seven fetal losses. And the majority of outbreaks in that time period, 2007 to 2020, were listeria in pasteurized products. And so that likely accounts for the increased number of hospitalizations, fetal losses, and deaths because listeria can be very serious. See our listeria episode for more. Yes. So just a few things right off the bat. Overall, even just the numbers, those raw numbers were higher in raw milk, right? But if you were to ignore statistics, you might say, well, it's much more dangerous to be drinking pasteurized milk. There were more deaths in pasteurized milk, right? But you would be wrong if that is the conclusion that you drew. And we do not have to air in math this because I wouldn't trust myself to do these statistics. That's a shame though. I miss some air in math. I love some air in math. I wish I could have done it. I thought about it, but luckily I found a paper that did the math for us. And they were looking at data. It was from a slightly different set of years. I think it was like 2009 to 2014 or something like that. Based on US data, they looked at how much milk and what type of milk products are people drinking. And based on all the outbreak data from that time, they estimated that a person consuming raw milk is 840 times more likely to become ill and 45 times more likely to be hospitalized from that illness compared to somebody drinking pasteurized milk. 840. 840 times more likely to become ill, 45 times more likely to be hospitalized."

Subclinical infections mean healthy-looking cows can shed pathogens

Cows can carry and shed dangerous bacteria into their milk without showing any visible signs of illness, making it impossible to determine milk safety by inspecting the farm or animals.

"Most years, over 95% of outbreaks and cases of disease from milk is from raw milk, not from pasteurized milk. And it is true that milk is not the biggest contender when it comes to foodborne diseases overall, whether it's raw or pasteurized. But again, that is because of pasteurization and because the vast majority of people are drinking pasteurized milk. Prior to pasteurization, 25% of foodborne illnesses were coming from milk because that milk was primarily raw milk. It's also estimated, and this is really important, for every case that is associated with an outbreak, like an identified, recognized outbreak associated with milk, there are likely 26 to 100 other illnesses that are never reported. So these are all underestimates. For, okay. For milk-borne disease. For milk-borne disease. Correct. Okay. The search for truth never ends. Introducing June's Journey, a hidden object mobile game with a captivating story. Connect with friends, explore the roaring 20s, and enjoy thrilling activities and challenges while supporting environmental causes. After seven years, the adventure continues with our immersive travels feature. Explore distant cultures and engage in exciting experiences."