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Is Raw Milk Really Better?

I don’t drink much, if any, milk. A little cream in my morning coffee, good cheese [1] regularly, some yogurt [2] and kefir [3] on occasion are about the extent of my dairy consumption. But milk? That pure white untouched fluid gushing from swollen udders? No, not really. Not anymore. It’s certainly a nutrient-dense food, don’t get me wrong, and I’m good at breaking down lactose [4]. I just don’t see the need for it in my regular diet.

Ambivalence and lack of personal investment aside, I can’t ignore the bitter debate raging between raw milk [5] advocates and raw milk skeptics. I may not have a personal dog [6] in this fight (for what it’s worth, I seem to tolerate pasteurized milk just fine), and lots of Primal folks reading this are in the same boat, but many of my readers do drink milk — or would like to drink it if a healthier version existed. Raw milk may or may not be that version. Plus, it’s always interesting to wade into the fray to see whose claims are science-based and whose aren’t.

So let’s get to it.

What effects, if any, does pasteurization have on the nutritional content of raw milk?

It reduces the copper, iron, and manganese levels [7] present in raw milk. Of course, raw milk is a fairly modest source of these minerals. You don’t drink milk for the iron or manganese, and a 1922 study, for example, found that the average content of copper in fresh (raw) milk was 0.53 mg/L (PDF [8]).

It lowers vitamins B12, B1, B2, C, E, and folate concentrations [9]. And it degrades beta lactoglobulin, a whey protein that increases intestinal vitamin A absorption [10], possibly reducing the amount of vitamin A/retinol we absorb from the milk.

What about dairy intolerance?

When a 2014 Stanford study [11] concluded that raw milk has no beneficial effect on lactose intolerance, skeptics rejoiced. Before we grant them the victory, let’s look at the design of the study. Stanford researchers had put out a call for people who suffered from lactose intolerance when consuming pasteurized milk. 440 respondents showed up to the trial, all of whom had what they assumed to be lactose intolerance; in other words, they couldn’t drink pasteurized milk without stomach upset, diarrhea, and/or other acutely negative symptoms. After the screening, all but 16 were disqualified. How can this be? Were most of the volunteers lying? The researchers screened applicants using the hydrogen breath test, a method that detects the amount of hydrogen in a person’s breath following lactose consumption. If lactose is poorly digested by the host (you) and becomes food for gut bacteria [12], the gut bugs produce hydrogen which appears in your breath. A 10-20 ppm increase in breath hydrogen indicates clinical lactose malabsorption. The Stanford researchers admitted only those applicants who experienced lactose intolerance symptoms and whose breath hydrogen increased by at least 25 ppm after lactose ingestion. People who merely experienced symptoms were excluded.

Nail in the coffin? For clinical lactose intolerance, perhaps (setting aside the small sample size). If that sounds like a decisive “win” for the anti-raw milk crowd in general, though, I’m not convinced. Even though they may not necessarily have clinical lactose intolerance, many people still can’t tolerate milk. Sure enough, studies show that self-reported milk intolerance doesn’t help identify lactose malabsorption [13]. One isn’t necessarily the other. They still have gastrointestinal issues with milk, even if it’s not the lactose. Millions of raw milk consumers, some of whom flout the law and pay exorbitant prices to obtain the stuff simple because they can’t tolerate pasteurized milk, report complete cessation of symptoms when drinking raw milk. Are they all lying or mistaken?

The focus on lactose, then, may be a red herring. The real problem could be some yet-to-be-elucidated effect of pasteurization.

What about immune health?

In 2010, Chris Masterjohn wrote a post [14] extolling and, most importantly, explaining in great detail the “biochemical magic” of raw dairy proteins. The whey proteins beta-lactoglobulin and serum albumin in particular have a unique structure providing two thirds of the backbone required for making glutathione. So when animals — in this case, rats — consume raw whey, their glutathione levels increase because most of the work is already done. Undenatured whey proteins (which, since pasteurization denatured proteins, only comes from raw milk) are able to boost glutathione [15], the human body’s premier endogenous/homegrown antioxidant used to fight oxidative stress, improve immunity and prevent alcohol [16]-related toxicity, but this effect is greatly reduced or even absent once the milk is heated.

That’s all well and good for lab rats, but does this increased glutathione production lead to any real-world benefits for human raw milk drinkers?

We know that improving glutathione status through other means, like supplementation [17], certainly helps.

Taking NAC improves glutathione status and protects against PUFA and alcohol-induced oxidative stress [18].

Taking curcumin (bioactive component of turmeric [19]) improves glutathione status and also protects against PUFA and alcohol-induced oxidative stress [20].

Taking alpha lipoic acid improves glutathione status and the health of HIV patients [21].

According to Masterjohn’s calculations, the average 8 ounce glass of raw milk will help a person produce an additional 9.3 milligrams of glutathione, more than double the 4.5 milligrams a cup of pasteurized milk provides. To see if this might translate to benefits for raw milk consumers, let’s look at a pair of studies.

The first [22] examined children from rural communities in Germany, Switzerland, and Austria habitually consuming fresh raw farm milk. After adjusting for farm status (whether they lived on farms), specific location, age, sex, breastfeeding history, family size, and the presence of asthma in the family tree, raw milk consumption was protective against asthma. Compared to children who exclusively consumed pasteurized milk, less-than-daily raw milk drinkers were 40% less likely to have asthma and daily raw milk drinkers were 50% less likely to have asthma. Again, this is after controlling for all other variables that might affect asthma status. Furthermore, if a family boiled raw milk before consuming it at home, the protective relationship between fresh farm milk and asthma was abolished.

Another study from last year found that consumption of unprocessed cow’s milk protects infants from common respiratory infections [23]. Researchers tracked 983 infants from rural areas in Austria, Finland, France, Germany, and Switzerland through the first year of life, finding that raw milk consumption protected against rhinitis, otitis, fever, and respiratory tract infections. Raw milk-drinking babies also had lower C-reactive protein levels than other infants. Overall, raw milk consumption in the first year of life reduced the chance of fever and respiratory infections by 30%. Similar results were found among infants consuming raw milk boiled at home, but the associations were weaker than for untouched raw milk.

Neither study proves causation, but they’re both quite suggestive of real differences between raw milk and pasteurized milk when it comes to immune disorders, especially given what we know about the effect raw milk has on glutathione status — a major regulatory of immunity.

Is it safe?

Interestingly, raw milk is actually somewhat resistant to bacterial contamination and proliferation. As far back as 1929 (PDF [24]), researchers considered it common knowledge that “fresh milk… will inhibit the growth of a variety of organisms, while when milk is heated at a temperature of 80 °C or more the inhibitory principle is destroyed.” But it’s not immune to pathogens, and those who drink raw milk are more still more likely to get sick from milk-borne pathogens than consumers of pasteurized milk. And when a person does get sick from drinking raw milk, however rare it may be, it can be serious. Take the four children from Oregon [25] who ended up in the hospital after drinking milk contaminated with E. coli in 2012, or the Missouri outbreak that put two people in the hospital [26] with hemolytic uremic syndrome, a type of kidney failure caused by E. coli infection. No sugarcoating; it’s the simple truth that raw milk can be dangerous. However, the absolute risk of hospitalization from raw milk consumption is low [27]: about 1 in a million. Most things we do and eat are “risky,” in that they carry some modicum of risk. But they can still be worth doing or eating, like real brie cheese or raw oysters on the half shell or tacos at midnight from a Puerto Vallarta side street cart.

Are there actually any documented differences in people drinking raw vs pasteurized milk?

Beside the epidemiological studies of the European farm kids mentioned earlier, there’s not much in the literature to go on. However, it’s well-known that unpasteurized human breastmilk is better for infants than the pasteurized stuff, with an extensive body of literature showing the former’s superiority:

Infants given raw expressed breastmilk gain more weight. They’re less susceptible to infections. Those are major documented differences between raw and pasteurized milk drinkers. Sure, they’re drinking human milk, not cow or goat or sheep milk, but the salient point is that pasteurization is altering the effects of consumed milk. Proof? No. But it makes all those millions of people shelling out $14 a gallon for raw milk because they can finally drink milk again seem a little less crazy and a bit more justified.

Should you drink raw milk? It’s tough to say. Most adults aren’t really missing out on much by not drinking raw milk. But if you are drinking milk [34], a good, clean source of raw milk might be worth trying. And you can always heat it up at home if you’re worried about contamination. The tricky part about all this is that the population who stands to gain the most from regular raw milk consumption — children, those tiny humans who are still developing their immune systems and are most likely to develop asthma and rhinitis and other immune disorders, which raw milk may protect against — is also the most susceptible to infectious raw-milk borne diseases.

The decision ultimately rests with you. Yes, you, the individual reading this post. That decision should remain yours to make. Not a government agent. Not the FDA. Not me.

I almost forgot. I will sometimes keep a little raw milk on hand. Not for me. For my dogs. Yeah, after a particularly hard hike or play session, I’ll occasionally give the furballs some raw cow or goat milk. They love it and nothing changes in their stool. Dog owners know: a dog’s poop is a direct conduit to his immediate physiological state. If they eat something that doesn’t agree with them, they’ll let you know in the backyard right away. Now pasteurized milk? Another story entirely. They only got it once, and on accident. Terrible, stinky diarrhea. Audible farts [35]. Whining. That miserable hangdog look man’s best friend is so good at delivering.

What to make of this? Placebo [36] effect’s out. Dogs are smart in their own way, but these are dogs we’re talking about. Milks were all full-fat [37]. The pasteurized stuff was homogenized, which could have made a difference. All were organic. I’ve got to think it was the pasteurization.

This is a tough topic. There are definitely clear differences and some potential benefits to raw milk consumption, but there are also safety risks, however minimal and overblown. Raw milk might help your kid stave off asthma and optimize his immune function, but it could also land him in the hospital (if you’re one of the rare few).

The only person who can answer the titular question is you. So, let’s hear it down below:

Is raw milk worth it to you and your family? Do you notice differences when you drink raw milk? What about pasteurized?

Is raw milk really better, in your experience?

Thanks for reading, everyone.

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