Let's start with a short quiz. Two men exit bathroom stalls after having a bowel movement. One washes his hands and the other doesn't. Which one would you rather shake hands with? If you value your health, the answer is pretty obvious. Why take a chance of picking up somebody else's colonic bacteria, which you will undoubtedly transfer to your mouth, unless, of course, you immediately wash your hands with copious amounts of soap and water?
Basically, this is the issue with pasteurized versus raw milk.
The health benefits of milk are many - but it doesn't serve the body if it's contaminated. Milk is an excellent source of calcium, protein, minerals and vitamins - including vitamin D in fortified milk. This is why two to three servings of milk and dairy products are recommended as part of a healthy diet.
What could make this wholesome, natural drink even better? My immediate answer is pasteurization. The milk is heated to a certain temperature for a minimum amount of time, killing disease-causing bacteria. Developed in France by Louis Pasteur in the 1860s, pasteurization became common in the United States by the 1930s, and it's the most reliable way to ensure milk is free of bacteria that can cause serious disease. But there are those who would argue that this proven method - which has drastically improved the safety of milk and saved lives - is somehow robbing milk of some of its inherent goodness.
Pasteurization is one of our greatest advances in food safety. Food safety is a hot topic as we find ourselves in the midst of a Salmonella outbreak at two Iowa egg producers, which has sickened more than 1,000 people and led to one of the largest egg recalls nationwide. Salmonella, which can cause diarrhea, abdominal pain, nausea, vomiting, chills and fever, is one of the bacteria killed in the pasteurization process in milk. In addition to Salmonella, unpasteurized milk may also be tainted with Listeria, E. coli, Campylobacter and a host of other nasty micro-organisms. The most common pathogen in raw milk is Camplylobacter which causes fever, cramps, diarrhea and, rarely, paralysis.
In the 1930s, before pasteurization was common, raw milk caused 25 percent of all food-borne outbreaks. At that time, the two major diseases from raw milk were bovine tuberculosis and brucellosis. Today's herds are virtually free of these diseases thanks to vaccines and eliminating sick animals from milk production operations. Our refrigeration and sanitation are also significantly improved, making storing and transporting milk safer.
However, raw milk is still risky today because, while you may imagine Bessie mooing placidly and chewing on green grass from a verdant pasture, that's just not reality. The dairy environment is an inherently dirty one. Cows are massive and messy animals. Their manure, which emerges as a liquid, tends to splash everywhere, including into milking equipment. Even the cleanest and most careful farm operations cannot eliminate this problem completely as it is, quite literally, the nature of the beast. It's in this fecal waste that harmful bacteria are carried and introduced into the milk. In addition, bacteria may be introduced during the handling and shipping process. The difficulty of safely transporting raw milk is part of the reason it is not allowed to be traded across state lines. States make their own rules about raw milk sales. In California, retail sales of raw milk are allowed but dairies must be licensed to sell raw milk.
Some raw food champions urge consumers to choose raw milk, calling it "real" milk. Pasteurized milk is no less real than the unpasteurized variety. What is very real is the risk of becoming ill from tainted unpasteurized milk, which is especially harmful to infants, children, pregnant women, elderly and others who have compromised immune systems.
Proponents of unpasteurized milk, or raw milk, argue pasteurization also eliminates omega-3 fatty acids, enzymes, vitamins and "good" bacteria from the product. And while pasteurization may eliminate some of these components, pasteurized milk still packs a hearty nutritional punch. The omega-3s and other nutrients can be easily obtained from foods that are far less likely to cause foodborne illness. Pasteurization does denature proteins, rendering enzymes inactive, but so does stomach acid. The nutritional value of the proteins is unchanged as the amino acids, which make up the proteins, are unchanged. In fact, there is no scientific evidence that raw milk is superior in any way. If you were to compare nutrition labels, raw milk and pasteurized milk are nearly identical.
Raw milk proponents claim that unpasteurized dairy products can prevent asthma and allergies in children - and European research did find some support for this. However, it was unclear if the immunity in the children studied came from living in a farm environment, drinking raw milk or both. Further, the researchers felt that the risks outweighed the benefits. Some describe raw milk as a virtual miracle elixir, pointing to it as a cure for everything from lactose intolerance and tooth decay to Crohn's disease, autism and cancer. These claims are largely based on anecdotes, not on scientific studies. Like all such claims, if it sounds too good to be true, it probably is. About the only remotely credible virtue is that unpasteurized milk tastes better - but taste is extremely subjective.
I like the idea of people eating more "locally," supporting local farms and buying produce in season. I also can't deny the idea that a hearty farm breakfast accompanied by milk that came straight from a cow to my table is a romantic one. But like most things that get romanticized, the reality doesn't always live up to it. I also acknowledge that some farms, and maybe even the majority, take great pains to wash cows' udders and teats before milking them and have in place other sanitation safety precautions. However, there have been ample examples where such precautions have not been taken.
It's also important to note that outbreaks can happen with many types of foods. In addition to the Salmonella-contaminated eggs, peanut butter and lettuce have been recalled in the recent past. Pasteurized milk has also caused outbreaks, as has deli meat. Pasteurization is not the same as sterilization. Milk can still be a rich environment for bacteria to grow, so it's important to handle it carefully and keep it refrigerated. In your own home, careful handling of raw meats, good hand hygiene and thorough washing of produce can go a long way to protect your family from food poisoning.
That goes to the heart of some of the arguments for raw milk - if all food carries some risk, why should this one be any different? Setting aside the unfounded claims that raw milk is a miracle elixir, some point out that each of us should be free to choose what they eat and drink. In California, with raw milk available from licensed dairies, you can choose. I would urge you to choose wisely, and to be informed. When you consider the scientific data available, it all points to pasteurized milk as the best choice for giving you that famous white moustache.
Follow Glenn D. Braunstein, M.D. on Twitter: www.twitter.com/CedarsSinai