My goal in yesterday’s post was to provide a quick overview of the data Pete Kennedy obtained from the Centers for Disease Control (CDC).
Just to clarify, this data came from the CDC, not from the Weston A. Price Foundation. Kennedy initiated a request under the U.S. Freedom of Information Act, which allows any citizen to seek data that hasn’t been publicly released. Unless the data is classified, the government is generally obligated to provide the information. The news media often use the Freedom of Information Act to obtain important data.
I intentionally avoided comparing the data on raw milk with that on pasteurized milk, except to note that there were more than ten times the number of pasteurized milk cases. I’m just not sure what to make of the difference. Kennedy feels that the numbers for both raw milk and pasteurized milk are so low, in the overall scheme of things, as to suggest that both products are among the least likely to make us ill. I think one could also argue that there shouldn’t be any illnesses associated with pasteurized milk, since supposedly all pathogens are killed through the intense heating. One other thing that stands out about the data: the illnesses from raw milk don’t follow any obvious pattern—for example, increasing or decreasing over the years. In the case of pasteurized milk, the data is skewed by a 1985 outbreak of Salmonella that hit more than 16,000 individuals, which is more than 80% of the total outbreaks for the 1973-2005 period.
As for Melissa’s argument that “any number of people getting sick should cause concern,” that’s fine in theory, but in reality, our public health authorities can’t be expected to stamp out every last vestige of pathogen; rather, they need to set priorities. And based on the numbers, raw and pasteurized milk aren’t high priorities.
What should the priorities be? I tried to get a sense of where the problems might be most severe by reviewing that 2005 CDC study that estimated 76 million people are hit by foodborne illnesses each year in the U.S.
The study is based on data from many sources, along with various extrapolations. Unfortunately, it doesn’t examine specific foods, but rather types of pathogens. Interestingly, the most common, accounting for about two-thirds of illnesses, are viral illnesses, especially Norwalk-like viruses. These aren’t associated at all with either raw or pasteurized milk, from everything I’ve read. E.coli 0157:H7 comes out pretty low on the list, accounting for less than 1% of illnesses.
The study states, “The assumptions underlying the Norwalk-like viruses figures are among the most difficult to verify, and these percentages should be interpreted with caution. Other important causes of severe illness are Salmonella and Campylobacter, accounting for 26% and 17% of hospitalizations, respectively.”
I’m not sure what to make of all this, and there is a lot to analyze here. I suspect the study’s authors didn’t attempt to highlight particular problem foods because they didn’t know (although presumably they had the data on milk that was provided to Kennedy).
I’m sure others of you can mine this data much better than I can. Once again, though, it seems as though regulators are spending disproportionate amounts of time on raw milk, especially given the whining by government officials that the Food and Drug Administration (FDA) doesn’t have enough personnel to inspect more than 1% of imported food. There’s certainly reason to be concerned about food coming from China, as just one source.
The comments from Linda Diane Feldt and Dan Corrigan about older people being unable to recall ever getting sick from raw milk are similar to comments I’ve heard as well, including from state regulators who grew up drinking the stuff, and now want to deny it to everyone else.
I was born on a dairy farm which my Dad managed in the late 40’s and we lived on another which he managed in the early 50’s. Ironically, he had to leave farming because after returning from the South Pacific in 1945, the farm he’d planned on purchasing had segregated the production (dairy) and sold off the retail delivery part of the business. You couldn’t make a living just milking the cows without having the profits from the retail business, so his dairying days eventually expired, careers changed and my early years on a farm came to an end.
Dad died over 6 years ago, well before I became interested in the issues discussed on this blog. I asked my Mom if she remembered what he would have thought about my enthusiasm for raw milk, and did we ever drink it as a farm family. She recalled that he never would have permitted it, notwithstanding that he (and she) surely drank raw milk growing up in rural America in the 20’s and 30’s. He was a progressive, scientific dairy farmer in suburban New York city, and later on Long Island. We have pictures of some of our cows with metal doors in their rumen to examine how they were digesting various feeds, under supervision of the State authorities. I have a certificate given for his herd’s freedom from Bang’s Disease (brucellosis) under a State-run vaccination program in 1948.
So, the "modern" techniques, and beliefs, in the late 40’s were the winds of change, and pasteurization was one of those changes, notwithstanding that I never knew of either of my folks getting sick from raw milk. I think that the evolving of this country after the twin terrors of the Depression and WWII caused a flight from farming, and the old-fashioned world that represented, into the brave future. So here we are.
"Or the memories associated with it? I think some of these farm kids didn’t enjoy eating only canned vegetables, canned meat, the same vegetables year afer year, having to work in the gardens all summer, and more milk than they ever wanted to drink."
I had the chance to chat about "the old fashioned food production and eating" with my nearly 88-yo grandmother a few weeks ago (she was born in 1919). She is in very good health, still drives during the day (although I think she stays quite local) and often is mistaken for being in her 70s. She and my 80-81 yo grandfather still travel by car several states away for various family gatherings, etc., with my grandfather doing the driving. They have lived a life of common sense and moderation, but she has religiously swallowed the low fat hype for a number of years, and that sort of confounds me.
I only see my grandmother every few years or so because we’ve never lived near each other (and the distances lengthened over time), but I realize that she hasn’t cooked "from scratch" in a long time and she considers that a blessing. I think some of her good health and longevity is due to just caloric moderation (moderation in everything, really) and regular exercise (she takes long brisk walks daily). Some of her siblings have not fared as well (colon cancer seems to be common in several of them and fatal stroke in at least one sibling) although several are still alive. Having a healthy, active husband 7 years younger for the past 40-odd years may help stay young, too :-). My mom attributes her mom’s good health to having teenagers in the 50s, 60s, 70s, and 80s :-).
Back to my point: my grandmother wasn’t really interested in thinking back to the days of hard work when she was growing up on a hardscrabble farm in Western Pennasylvania. She earned the money for her HS class ring (she was the first in the family to graduate from HS) by "dressing" chickens for her mother to sell. She couldn’t imagine why anyone would want to do that anymore when they could be bought dressed in the grocery store. She was amused that I wanted to know, but I think she thought it was a bit strange, too. She escaped that life of continual food production (my great-grandfather wasn’t a steady provider so I’m sure my great-grandmother had to be very resourceful at home).
So with this self-sufficient rural background, my grandmother embraced "modern" foods as they came available. But she did choose to breastfeed all 6 kids, even the last one born in the 60s when she was about 44-45yo), probably because it was more convenient and cheaper. How long each nursed I have no idea, but the first three were born within five years.
She didn’t have much to say one way or another about raw milk except that of course that’s the way they consumed dairy products back then "in the country" (& they tried to keep a family cow, pigs & chickens whenever possible because it made a huge difference in their ability to get by). But she has no problem at all getting her skimmed milk from the grocery store. Modern foods suit her just fine and she just isn’t interested in thinking or talking about the old foods. She has no sense of curiosity about dietary connections to various health conditions, other than she accepts the notion that saturated fat should be minimized.
But I have to wonder about diet in early life, with the home-produced food being a foundation for better health later on vs. modern foods in early life a possible cause for an earlier start of poor health. My grandmother’s children strike me as far less healthy than her generation. My oldest uncle (68-69yo) has had some serious acute illnesses starting around age 50 and is now type 2 diabetic, as is his 44 yo son (and his 42 yo daughter is very apple shaped). My own mother (65 yo) has had numerous but less serious annoying health issues since her 40s (IMO, some possibly created by her attempts to reduce cholesterol levels). One aunt (66-67 yo) seems fine as far as I know (but she’s probably taking statins), but the other uncle, who is not yet 50 yo, has MS and is near the end of a battle with multiple myeloma. Another aunt age 55 or so, is following the recommended AHA type of diet (lots of high fiber cereal products, lean meat, low fat, non-saturated packaged foods) but she appears to be in good health so far except mild polio when she was a kid (her husband grew up on a dairy farm and drank raw milk when he was a kid, but when I said I used raw dairy he thought I was crazy). Another aunt (younger than me, in her early 40s), was born with a facial birth defect (port wine stain) but otherwise appears healthy. I remember my grandmother mentioning that she only gained about 12-14 pounds during that last pregnancy, as advised by her doctor. She always attributed the birth mark to being 43 yo for that pregnancy, but now I wonder if diet or nutritional deficiencies could have been a factor if she was restricting her weight gain so severely.
Pete Kennedy, a lawyer with the Weston A. Price Foundation, told me that two Pennsylvania farms selling raw milk recently got tagged with the listeria smear (via a press release), even though the L. monocytogenes didn’t show up in a second test following detection of basic listeria. (It apparently requires two tests to confirm presence of L. monocytogenes.)
Thirteen years later when Chris became ill, there was nothing mysterious about what he contracted or how to treat it. When Shiga toxins are racing through the body, its the ultimate game of body chemistry balance to keep the body alive with outside interventions (blood transfusions, plasma transfusions, vitamins and minerals through liquid nutrition, kidney dialysis, a ventilator, blood pressure and cardiac drugs, antibiotics, and surgeries) until the Shiga toxins finish their damage and the body can begin to work again. It usually takes 10 to 14 days for the toxins to run its deadly course.
HUS (renal issues or failure) is only one organ that can be damaged from Shiga toxins due to food contamination from e-coli 0157:H7. There are certain types of cells that are vulnerable to Shiga toxins. These cells are located in the kidneys, pancreas and the brain. Thank goodness for Chris only is kidneys and pancreas took the Shiga hit, but his heart and brain were affected. During his two month stay in the hospital, Chris had a nephrologist (kidneys), gastrointestinologist (pancreas), cardiologist (congestive heart failure from fluid overflow), neurologist (seizure from high blood pressure) and a PICU doctor who consults with all of these doctors and then made the medical decision for Chris. Each doctor only deals with their area of specialty. Chris body was divided into four parts for treatment. We were told on a scale of 1-10, Chris was a 6 in severity.
As Ken Conrad pointed out, HUS can develop from other means, but in these situations the kidneys are the only organs affected. HUS involving e-coli 0157:H7 can cause multi-system damage: renal failure, heart attacks, strokes, blindness, seizures, pancreatitis, brain damage and colon damage.
I found the article http://www.nephrologychannel.com/hus_ttp/. I cut and pasted it below. It addresses the different risk factors for HUS. It was titled HUS/TTP.
Overview
Hemolytic-uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are microangiopathic disorders, that is, they are characterized by abnormalities (chiefly blood clots) that occur within the small blood vessels of the body. Both HUS and TTP are distinguished by blood clots within the capillaries and arterioles of many organs. Such clotting is associated with hemolytic anemia (low red blood cell count due to cell rupture) and low numbers of platelets (cell-like bodies responsible for blood coagulation).
Hemolytic anemia results from the fragmentation of the red blood cells when they pass through areas of thrombi (masses or clots) or turbulence in the circulation. Such forces shear the cells in half, producing cell remnants that appear as helmets and other odd shapes when viewed under a microscope. In fact, the diagnosis of HUS-TTP is aided by microscopic examination of the blood for sheared red blood cells.
Causes and Risk Factors
Although the exact cause(s) of HUS and TTP are unknown, experts believe that an abnormal, inflammatory reaction within the blood stimulates the deposition of platelet-rich thrombi. It has been observed that a circulating and/or missing factor in the blood perpetuates the process. Therefore, HUS/TTP patients often benefit from treatment that removes the plasma (fluid, non-cellular part of the blood) and replaces it with donor plasma.
Many diseases and conditions have been found to spur the development of HUS and TTP, including:
Enterohemorrhagic Escherichia coli (EHEC) infection. EHEC is a diarrhea-producing bacterium that has been associated with epidemic outbreaks of HUS in children. This particular bacterium (OH157:H7) has been identified in undercooked meat as well as other foods.
Pneumococcal pneumonia infection
AIDS (acquired immunodeficiency syndrome)
Drugs, for example, oral contraceptives, chemotherapeutic medications (mitomycin C, bleomycin, cisplatinum), immunosuppressive agents used during organ transplantation (cyclosporin, tacrolimus), stroke-preventing drugs (ticlopidine hydrochloride), quinine
Antiphospholipid antibody syndrome
Pregnancy and the postpartum period
Signs and Symptoms
The general symptoms associated of HUS-TTP are quite variable. Purpura (bleeding into the tissues) sometimes can be seen in the skin, and patients often complain of tiredness due to anemia. Some individuals with TTP may have neurological symptoms and fever.
Children who develop hemorrhagic colitis (colon inflammation and bleeding) due to E.coli may become infected as an isolated incident or as part of a large outbreak (e.g., identifiable exposure to food such as undercooked meat). Bloody diarrhea often occurs 3 to 4 days after exposure, with abdominal pain but usually no fever.
Diagnosis
HUS and TTP usually are diagnosed by the combination of low platelets and anemia caused by hemolysis. Other findings may include fever, renal failure, and neurologic abnormalities.
Treatment
It is essential to treat HUS and TTP, as the mortality rate without treatment is close to 90%.
Treatment involves:
Plasma exchange with fresh plasma. Plasma should be replaced on a daily basis until the platelet count normalizes ? typically after 5 to 15 treatments.
Plasma exchange with cryosupernatant of plasma. Individuals who are resistant to plasmapheresis (plasma removal and transfusion) with fresh plasma may need this more intense, twice daily regimen with plasma cryosupernatant (plasma derivative).
Additional medication with vincristine and intravenous gammaglobulins.
Relapses are not that uncommon in people who have had HUS or TTP. Such cases may require another course of treatment. One study reported a relapse risk of 36% over a 10-year period. Therefore, patients need to be followed-up indefinitely.
Children with ECHC associated HUS tend to have a self-limited disease and only require supportive care, unless there is severe or persistent disease. Prolonged follow-up in these patients is usually not necessary. Unfortunately, adults with ECHC associated HUS often require full treatment similar to that required by patients who have HUS-TTP unrelated to ECHC.
The entire 58 page report can be found at http://www.cspinet.org/reports/outbreak_report.pdf (underscore after outbreak)
Heres what they found:
CSPI tracked a total of 2,472 outbreaks with 90,355 cases of foodborne illness occurring between1990-2002. The top five single-food vehicles of outbreaks were:
Seafood and seafood dishes, with 539 outbreaks and 6,781 cases of illness.
Produce and produce dishes, with 293 outbreaks and 18,084 cases.
Eggs and egg dishes, with 277 outbreaks and 9,349 cases of illness.
Beef and beef dishes, with 251 outbreaks and 9,195 cases of food poisoning.
Poultry and poultry dishes, with 235 outbreaks and 9,612 cases.
Multi-ingredient foods, such as salads, pizza, and sandwiches, were linked to a totalof 330 outbreaks and 11,500 cases of food poisoning.
Foods regulated by the Food and Drug Administration (FDA) were the vehicles in two-thirds of the outbreaks in CSPIs database, while foods regulated by the U.S. Department of Agriculture (USDA) were the vehicles in one-fourth of the outbreaks.
Data for dairy was on pages 33-34. Of course what caught my attention were the 4 raw milk cases with e-coli 0157:H7 all occurring in different years affecting 23 people. This data was not on the CDCs list. However, the Oregon Dec. 1992 case affecting 6 people might be the one case on the CDCs list. The CDCs information only gave the source, bacteria and number of people affected. They did list a case affecting 6 people.
Another bit of information that caught my eye was all the different types of e-coli that have contaminated produce, specifically lettuce. This information is on page 30.