REVIEW 2 91 Journal of Vol. 1, 91–107, 2013 Nutritional Ecology and Food Research 1 In the 1970s and 1980s, medical 4 3 . This category of virulent bacte- E. coli CONSUMPTION Nowadays consumption patterns of milk products that and raw milk chiefly. 1. INTRODUCTION: (RAW) FULL-FAT MILK Human beings haveduring co-evolved 8,000 years with ofconsumption farm agriculture of animals man raw has and nating milk adapted animals. and to As the milk aof products cultural human characteristic from large beings, rumi- numbers ground, especially developed those a withafter genetic Caucasian adaptation the back- to sucklefound digest phase in lactose other (lactose-tolerance), mammals. a feature not were built up overof centuries milk are under is attack.tial controversially The negative discussed quality health in impactson relation or health to dangers promotion poten- of facing milk the intake claims in general, milk fats 2326-4225/2013/1/091/017 doi:10.1166/jnef.2013.1027 Ton Baars ...... 92 ...... 94 ...... 96 ...... 95 ...... 91 ...... 97 ...... 99 ...... 102 ...... 103 ...... 95 Discussion on Health or Hazard Raw Milk, Fatty Acids, Asthma and Allergies, EHEC, Health Discussion. Research Institute at Juchowo Farm, Juchowo 54 A, 78 - 446 Silnowo, Poland ...... 104 Research Institute of Organic Agriculture (FiBL), Ackerstrasse 113, 5070 Frick, Switzerland; ...... 97 ...... 98 ...... 101 ...... 104 ...... 98 Milk Consumption, Raw and General, in the ria can be presentchildren, in the the physical intestines, contactas faeces, with skin risk and farm factors. environment animals Anotherthe of as potential spread ruminating well danger to animals. as from Inis humans raw the young necessary of milk consumption (produced antibiotic intake of forpart resistance are direct raw forms therefore of consumption foods of included purpose including theseveral bacteria. versus raw population countries meant milk A as wants for is differentiation certified pasteurisation), to ofthe Grade-A because drink risk milk. milk of Hygienic raw qualities zoonotic control milk transfermilk of can to this and be certified significantly specific promote reduced. milk componentsre-evaluation their Since demonstrates of of the that health. raw evidence milk Raw has milk are increasedgrazing milk consumption protective that animals as is raw for is well needed. human produced as illnesses in the like intake asthma of and beneficial atopy, components a of milk from In the last decade,nutritional consumption and of health raw milk,products image milk contain and in a therefore general rangeonly mixed and of unwanted messages milk bio-active and are fats contents beneficial suffers presenttides. bacteria related from In among in an to this consumers. adverse milk, review, health Milk atopy. attention but regulation. Raw is also milk Heating paid changes is destroys totects a the not the single activity against benefits protective of asthma of factor enzymesacid milk and for and and consumption asthma within pep- for trans-vaccenic and the asthma, acid,of allergies allergies milk in governmental are and children. agencies fatty inversely Also and associatedargued acid milk medical that with composition fat raw societies, asthma pro- especially milk it andarticle the can is special atopy. be markers From not attention dangerous the rumenic advised is due position to paid to to consume the a any potential vero-toxicin raw presence producing milk. of It zoonotic bacteria. is In this Keywords: Copyright © 2013 AmericanAll Scientific rights Publishers reserved Printed in the United States of America 5.1. Animal Studies 5.2. Human Studies 6.1. Raw Milk and6.2. the Distribution Raw of Milk, AB Safety Resistance and Genes Zoonotic . Bacteria .7.1. Reducing Risks 98 by Adopted Regulations Acknowledgments References and Notes 4.1. Effects of Heat4.2. Treatment on Changes Milk in Contents Allergenicity Due to Heating of Milk 5. Studies on Health, Growth and Reproduction 6. Raw Milk Risks 7. Dealing with Risks 8. Conclusion: Raw Milk, Health or Hazard J. Nutr. Ecol. Food Res. 2013, Vol. 1, No. 2 3. Milk Fats and4. Protection Against Changes Asthma of and Milk Allergies After Heat Treatment CONTENTS 1. Introduction: (Raw) Full-Fat2. Milk Consumption Epidemiology of Farm Milk and Asthma and Allergies REVIEW scaatrsi ato h uia trans-fats. ruminal the of part characteristic as oe oepanteices fatm n aller- and hygiene asthma the on of based increase is hypothesis. societies the westernised explain within gies to model A AND MILK FARM OF EPIDEMIOLOGY 2. fat; reducing saturated recommend of intake agencies the government Hazard or and Health on societies Discussion the in General, and Raw Consumption, Milk n nml,hwvr stehg ee frmncacid rumenic of level graz- high from the fat is (C18:2 milk however, animals of animals, ruminating con- feature ing the from characteristic on fats A attack trans-fats, included. an all is of There sumption trans-fats. fatty n–6 and especially (FA) fats, animal acids of warn- consumption a the of is for epidemic There ing the problems. of cardiovascular because and variant, overweight no-fat or low-fat the as osmto r ugdt eunavoidable, be to judged are consumption EE)adsiatxnpouig(TC utpsof subtypes (STEC) coli producing E. shiga-toxin and enterohemolytic the (EHEC) disease concerning zoonotic for Information as potential milk. well con- the through as milk resistance to antibiotic relation raw milk of in of transfer discussed raw risk milk be from man; will raw and trials sumption on animal clinical treatment in evaluate heat consumptions to of effects and consump- fat on properties milk reflect and milk to raw tion, to allergies health and asthma potential of bacteria? a zoonotic as of seen presence be the it to due should reduction hazard or and allergy tolerance asthma milk of of of prevention terms digestion, in lactose support for health to lead consumption eilgcfidnso a ikcnupinadthe epi- in and the milk-allergies with consumption and children? asthma/eczema deal milk of to raw incidence how inverse on about findings controversy demiologic a is there upinlast h usinraised: question con- the milk to about doubts leads listed sumption weak- The with systems. pregnant people con- immune or targets ened adults be advice older only children, This young should treatment. women, heat milk after that sumed advise bodies ernmental 92 h olo hsrve ae st eeto h relation the on reflect to is paper review this of goal The SHAADALLERGIES AND ASTHMA c r ae sa example. an as taken are 9 8–10 t 1 n t rcro acncai (C18:1 acid vaccenic precursor its and 11) 12 ic h ontcdneso n a milk raw any of dangers zoonotic the Since itr fnwlfsyefcosi involved is factors lifestyle new of mixture A 5 ikpout hudb taken be should products milk o Baars Ton rdcs hc r aefrdrc osmto n a ihinrqaiyt rtc and protect milk to raw quality develop inner to high ways a on has is and focus consumption health. direct main human for up His support at safe taken health. Agriculture are been human biodynamic which have and for products, projects quality Professor organic research milk as in University raw research position Kassel about applied At a trained at (2005–2011). held a University Netherlands he As Kassel The research. (Silnowo, later organic in in Farm and applied years Juchowo (FiBL) husbandry, for 25 farm institute Agriculure animal worked biodynamic research Organic a he the up of ecologist at building Institute agronomic position is research he Research Poland a The In as at Pl). well position as a (CH) held Frick he 2011 Since 11 sarsace o ikqaiyi eaint nmladhmnhat aspects. health human and animal to relation in quality milk for researcher a is osrwmilk raw does 3 fca gov- official 6 7 Finally, t 11) aini al ieadtecnupino rai swell lactobacilli. as active organic with of foods consumption fermented the as and life early immuni- antibiotics active in of less sation use breastfeeding, reduced longer antipyretics, the and were associated lifestyle health this improved of with Elements children. disorders atopic control 6–15 less than had aged lifestyle children anthroposophical an that with showed societies Western within nbt amadnnfr hlrnwsfound. was children non-farm and milk farm farm of both protection the in study, PARSIFAL the in Later ln fterctl,as hlrna agrdiyfarms dairy larger at investigated. children were (UK) also Shropshire cattle, the in han- their where daily the and of in farms involved dling strongly family were families sized farm smaller total which PASTURE), on (ALEX, epidemiologi- done Europe the were bet- Central to in were contrast studies children In cal others. of than genotypes protected several ter that clear made aiysz n h eue naeo emne od rich foods smaller fermented of Lactobacilli. the intake life, in reduced early the and in size anthelmintics family hygiene- and use increased repeated antibiotics the the of households, others in disinfectants among and standards living, modern in m fcnupinefc,wihsoe htprotection that vol- showed a which pattern effect, second consumption a child. of as the ume of found status of authors farm consumption the the the Additionally, of with independent milk, atopy to farm and raw relation asthma reaction inverse for an test children, found of prick was groups three skin all milk in IgE ‘raw allergens and on farm’ the Based sep- on thereby consumption.’ ‘living farms, from fathers on effects living whose the not arating children but and labourers, countryside farm were the in living villages children non-farm in children, farm groups: three pared shaadalrisa rmr colaewsshown. was age emerging school later primary on life at of allergies year and and first asthma mothers their pregnant in both newborns by their consumption as the well milk as ALEX-study, farm environment the the farming the In from impact sensitization. hay protective asthma, allergic from and protected strongly fever chil- un-boiled, were consumed that milk and farm farms show dairy fresh could on allergies up studies grew and who The asthma dren children. to farm relation among in studies demiological tal. et ru-arädradMutius and Braun-Fahrländer 18 hwdteipc ftegntccmoetand component genetic the of impact the showed 13 .Nt.Eo.Fo e.1 91–107 1, Res. Food Ecol. Nutr. J. tde namr rdtoa lifestyle traditional more a on Studies 9 eiwdeee epi- eleven reviewed 8 h uhr com- authors The 14 15 17 , Baars 2013 Bieli 16 REVIEW 93 very 26 that ‘sum- 27 that the lifestyle 29 He used the level of 28 25 did not describe the way farm- 25 Therefore, it was postulated 16 that the farm children exhibiting high protection 10 Earlier, in the 19th century, it was observed For farm children and the offspring of pregnant farm An early epidemiological study on the health status of mer catarrh’ (allergicmiddle hay fever) and was upper onlyinquiry at present classes the in of varioushe the London society. did pharmacies After not andpoor. elsewhere, find making This observation a an is singlethe confirmed ISAAC by case study recent of based data; ona within hay information highly fever from positive 20 association amongsttry’s countries, is the gross present national between the incomethe coun- incidence as of a childhood measure eczema. for wealth and low incidences of asthmadren and were allergies in found. these Price farm chil- on a farm, theher way animals, of consuming living rawcare of milk of the products, the pregnant as newborn, mother welland who with as the is the bacterial in environment near at contact the with farm, animals is a beneficial against asthma consumed raw farmterial milk with load a of higher micrococci, bac- staphylococci and lactobacilli. teeth decay plus physicalbones structure as of a the jaws measurecompared and for farm cheek- a children healthyvalley youth in with development. farm the He childrencontact isolated in with Swiss other modernised, valleys Lötschen valley, who refined only salt came foods. was into imported; In forvillagers the the had rest a of Lötschen self-sufficient their life food,might the style. seem Although the anecdotal, study tion the from insights the into observationalnature studies the people on could health a act range situa- assituation of a close-to- of standard for children aWestern and lifestyle ‘normal’ brought adults health forth all before kindslike the of asthma, health allergies effects problems or of beingthe overweight. the children The nutrition consisted of mainlycows, of sourdough raw rye bread milk and fromconsumed raw goats milk once and cheese. Meat a was found week hardly and any vegetableson tooth the were decay traditional rare. among dietsernised the Price (4.6% diets valley of showed children all muchis higher teeth), plausible frequencies whereas that (29.8%). mod- the It the way Swiss of farm living childrenAmish and is children health very living situation comparable in of to Pennsylvania (US). traditional Here, mothers, the protection ismilk strongest and if if the both pregnant consumedthe mother had stable. raw a daily work routine in ers were milking andIn what those level days, ofporting wooden hygiene systems was buckets were present. used. andthe We presence wooden can of milk therefore fermentinghigh. assume trans- bacteria, In that like those lactococcus, days, was with even a ‘fresh high raw microbial milk’shown content. described Even milk nowadays it could be processed shop milk. Instronger this for study asthma the compared to risk atopy. reduction was farm children was done by Price. 23 Acine- Milk Consumption, Raw and General, in the Discussion on Health or Hazard as well as 19 who showed reduced 2013 20 (G121) and also the authors looked at the in the GABRIELA-study 24 10 (F78), a bacteria present in stable dirt. Within the large GABRIELA study (7,682 Lactococcis lactis Both ‘contact with cows’ as a farm factor and 21 22 The strongest implication of raw milk as a protec- atopy after raw milkraw intake. milk Protective and effectswere from shown. yoghurt both intake in New Zealand children among Northern-German children, tive agent came recently from diversity of environmental bacterialthat exposure there and was showed anbility inverse of relationship asthma between andindependent the the of proba- microbial living on diversity.ing Effects the on were farm. farms However, had childrena less liv- wider range asthma of because microorganisms of than the non-farm exposure children. to within the groupthat of the farm so-called ‘farm children.is milk’ drunk They mentioned by in first the earlieras confirmed majority studies of untreated, farm and milkexposed consumers un-boiled to (89.3%) farm un-boileding milk. farm the Many first milk had yearerence during of been group pregnancy, life, of or dur- milk farm both. which children Compared is with exclusively heat-treated,dren the the drinking adjusted ref- who shop odd were ratiotively exclusively for 0.59, chil- taking 0.74 raw andand milk 0.51 hay for was asthma, fever, respec- milk atopic whereas did sensitization the not lead consumption to any of significant heated difference compared farm to children) an overall protectionconfirmed. of ‘living on a farm’ was J. Nutr. Ecol. Food Res. 1, 91–107, Within the GABRIELA-study, Baars was greater ifA raw differentiation milk was wasand more made unpasteurised frequently according milk consumed. was torent inversely the associated eczema with symptoms, symptoms cur- not and with seasonal current allergic asthma symptoms.protective rhinitis, This but effect contrasts with of the protected the for asthma farming and statusThis allergic rhinitis, of was but confirmed the not among eczema. child Greek that children tobacter iwoffii ‘drinking farm milk’ weretion, independent suggesting factors that of theretection, protec- the are mucosal different airways pathwaysrisk and of the reduction gut pro- in respectively.sensitization The terms and hay of fever of oddtion farm children of ratios after cow’s consump- for milkFor asthma, were atopic respectively atopic asthmatic 0.68, 0.54milk’ children and remained the 0.43. the ‘consumption onlyhay of fever significant cow’s the ‘contact protective with factor.sumption’ cows’ For had and the a ‘cow’s significant milksitization con- influence. was Finally, independently atopic affectedstraw’ sen- by and the ‘contact ‘cow’s with tact milk with consumption.’ straw’ Overall, wasatopic the a dermatitis. ‘con- The strong authors protectivegalactan, suggest factor a that except plant-derived either for oligosaccharide arabino- hay present and in straw, or grass, thea bacteria protective and agent. fungi Inallergic in the and straw comparison might non-allergic of be children,in stool differences samples strains were of found of REVIEW ac a rae matta ebr’ otc during life. contact of newborn’s year than first impact the greater had nancy uecide eln ihavreratost ik In milk. also to can reactions milk adverse raw literature, with if life, the question dealing in different children later factor a important cure atopy however, an and is is, asthma milk it raw against of protection life for in intake early the of response immune the the of child. on priming the starts present the species already determined animal newborn immune of farm number the the The of of birth. training before impor- sensitization the most for The the life newborn system. are a early life of the of periods year until tant first phase the immune within prenatal exposures functioning the healthy Roughly, a system. develop Hazard or to Health on predisposition Discussion the in General, and Raw Consumption, Milk nrlto oaoi emttswr investigated. items were food dermatitis complementary atopic to six for relation of PASTURE, protection in study introduction to cohort early birth relation the the In in allergies. mentioned and asthma are factors tion developing of risk lower diseases. long-lasting atopic a subse- to system, leading in immune expo- quently early the especially modulate microbial exposures components, of These grass life. role and milk the farm that strengthen sure, stated studies and environment novel farm the the within elements tive erzdml n atuie n ooeie ikwas pas- milk (double homogenized milk, and a raw pasteurized In (DBRCT), and milk trial intolerance. teurized controlled milk placebo with blind children by sumed nfrs amcide r etrpoetdta non-farm than protected microorganisms better of children. are diversity children farm wider farms, the on immune to innate due the and trigger system, Microbes atopy. environ- not protected farm environment asthma, both microbial for the the studies of within diversity The GABRIELA element ment. protective the from the later Results showed diseases. and dermatitis allergic PARSIFAL atopic respiratory the for for as hold much not as might hypothesis hygiene 5 I .808)i hlrnwr aigsri HN001, 0.38; strain (HR: taking were HN019. years and children not if 0.39–0.83) 4 0.18–0.83) CI: at CI: at 95% 95% rhinoconjunctivitis eczema 0.57; of of (HR: years ratio prevalence prevalence two hazard cumulative years first the 4 the reduced Sup- in life response. cultures of inflammation probiotic and of immune SCFAplementation (SCFA). the acids affect fatty can within chain bacteria short producing probiotic-like yoghurt, of suggest possibility authors protective The 95% the 0.23–0.73). a 0.41; (CI): was (aOR) ratio interval There odd confidence foods. (adjusted 60% introduced of of reduction risk diversity overall independently for the effect introduction a protective risk of The strong 25%. of a the by showed introduction risk affect yoghurt of the additional life reduced item of each food year main and first dermatitis the atopic in practices ing 94 lhuhteei tog eetdyfudeiec that evidence found repeatedly strong, is there Although stated was it study, GABRIELA the on Based pr rmml etn eea te ietl n nutri- and lifestyle other several heating milk from Apart 24 30 h ohrscnatwt nml uigpreg- during animals with contact mother’s The li n Schaubs and Lluis 34 35 36 aet li htrwml a econ- be can milk raw that claim parents 31 32 umrsdteprotec- the summarised 22 33 htthe that Feed- 9 10 ol o ouetaydfeecsi h symptomatic and the milk, in to differences any intolerance responses. document reported not who could people in tested inl atuie n ooeie e oaqikallergic quick conven- a a to being response, led from milk, homogenised milk and shop con- pasteurised raw the tional, could selected whereas children a farm, of that biodynamic amounts is increasing observation controlled sume repeated placebo blind a double trial, a within children allergic ersdwoeml rteftyai composition. acid pas- fatty of the that from or mechanism different milk is the whole milk teurised therefore raw from and protection beneficial aspects, be of This might health which concentrates. several profile, FA and for a maize milk have not silage, with does fed milk farms also out dairy cows carried European from were conventional pas- by mentioned mainly affected studies at not farm is All composition teurisation. acid fatty milk’s The AGAINST PROTECTION AND FATS MILK 3. ntefis ot flf n iapaiga naeof age an at disappearing and appearing years. life allergy often 3 of milk to childhood, month Cow’s 2 early first milk. the to raw in indicating confined the respectively), usually to ml is reaction 27 and milder milk 23 a of versus amount minutes acceptable (41 homoge- lower challenged 192 intake a and and as being well pasteurized 162 as after versus to respectively) test (240 compared milk prick milk nized/pasteurized skin raw the the reac- by shorter to a challenged toward time when tendency contrast tion a seen in was was There milk reaction placebo. cow’s with No placebo. any the aller- receiving an with when showed any children reaction without All formula gic used. hypoallergenic was a components provoca- control, milk milk a controlled As placebo blind tion. double oral an and upino ulftml,a ela utr eue the reduced children. butter, pre-school as in well asthma con- as of PIAMA-study, milk, incidence the full-fat Within of asthma. prevalence sumption and decreased fever with hay associated of was milk skimmed anadls laigatrcnupino a ik Five milk. tested raw were of children allergic consumption milk after bloating less and pain ohr ihahg naeo rai ik( of milk organic children of intake study, high a cohort with mothers KOALA-birth prospective the ne ewe h tde ih ebcueo differences origin. of because milk be raw might in studies the between ences PF)(s at cd:EA P n H)a well (CLA as DHA) PUFA C18:1 and sor related DPA ruminant EPA, acids: as acids fatty fatty n-3-polyunsaturated (fish chain (PUFA) long very of from sum effects the protective independent the KOALA-study, the ae nbte oprdt agrn consumption. margarine to compared butter on was based asthma of reduction independent an PARSIFAL-study, a shown was n legcsniiain(toeya fage). of year one age) (at of years sensitization two (at allergic eczema and less had intake) product milk SHAADALLERGIES AND ASTHMA 38 t 37 1 eedistinguished. were 11) 41 rslswl epbihdeswee.Differ- elsewhere). published be will (results 36 edniswr on o esexperienced less for found were Tendencies htcnupino hl ikrte than rather milk whole of consumption that ae noroneprmna etn of testing experimental own our on Based .Nt.Eo.Fo e.1 91–107 1, Res. Food Ecol. Nutr. J. 35 40 c ihbt h rc test prick the both with 9 nteGra LISA German the In t 1adisprecur- its and 11 > 42 0 ftotal of 90% ihnthe Within 43 Within 39 , Baars 2013 17 40 In It REVIEW 1 C − 10 95 t 53 55 The avail- Before pas- 58 54 Phytanic acid as In mother’s milk, There is a change C for 30 minutes) 7 6 57 13 and its precursor c C (15 sec) and 92 11 t (average over 12 monthly sam- 1 10 increased. the enzyme activity is completely t − 57 C for 15 seconds). The anti-oxidant 11 and CLA 56 t 9 c 9/C18:1 In a review paper on the effect of pasteuri- Especially in summer, the differences in t 6 59 9. t 11 and an increase of trans-fatty acids as C18:1 t HEAT TREATMENT After Holder pasteurisation (62, 5 (20 sec) this was reduced to 1,381 and 4 bacteria ml the Holder pasteurizationpasteurization was (75 compared with the high properties of heateda milk considerable loss wereidase, of reduced which the and is activitywere there of one higher was gluthatione at of perox- higher the heating major temperatures. anti-oxidants. Losses teurisation, some milkpathogenic organisms. samples In a were largethat contaminated Swiss study, it with the was shown averagewas 20, number 180 bacteria of ml bacteria in raw cow milk 93% of theany human growth donor on breast routine samples bacterial did cultures. not show a chlorophyll derivate isacids part (BCFA) and of as thethe a cow’s branched diet. marker An chain inverse for fatty correlationacid the between concentration the green in phytanic milk roughagesilage fat in and plus the concentrate percentage in of the maize cow’s diet was found. able lysine inthe milk, protein which qualitypasteurisation; is however, in losses seen human weretemperatures. as now milk, higher a was at parameter also lower for lost after from grass-based animalsgrass feeding products only to onfed high a roughages total of yielding mixedsilage, cows ratio grass of kept silage conserved andin indoors products, concentrates. cows’ and like diets, Due maize a tofound. change There the in is changes a theCLA, reduction overall like of milk branched FA CLA chain profile FA, is several (lipase) or partly destroyed (amylase). plings). After pasteurisation at 72 sation of human milk, Holder pasteurisation completely respectively, whereas ultra-high-temperature (UHT)ment treat- led to bacteriologically sterile milk samples. 4.1. Effects of Heat Treatment onAlthough Milk Contents the FAafter pasteurisation, composition of milk is not changed 4. CHANGES OF MILK AFTER Pasteurisation of milk cantemperature be and in different time combinationsto span. of kill The unwanted goal bacteria,death. of which could heating lead milk to is disease or milk fat profile are strictly separable. and soy used inthe cooking. FA-profile This in led Western3 to diets, went a from where change 1–2:1 markers inand towards as ratio 10–25:1 also n-6/n- (COLOMBUS-study) of C18:1 C18:1 and C18:1 FA The Since 45 and it 7 Milk Consumption, Raw and General, in the Discussion on Health or Hazard 49–51 44 “when the Nowadays, the 25 showed that a dietary 2013 46 49 In mouse models, diets rich in The impact of season, region and 47 48 is the consumption of raw and raw fer- The change in the Western diet from n-3 25 “to bring forward a healthy next generation” 52 described the food habits of people with tradi- 9 (elaidic acid), whereas diets based on milk t 11, whereas similar results were found for Dutch 25 t 11 (vaccenic acid) and showed a low ratio between 9 t c A model to explain the differences between different Price from industrial origin and hydrogenisedin plant C18:1 oils are high products from organic andC18:1 biodynamic origin arethe high two in isomers. Bertschi et al. parallelism between the foodple habits described of all traditional peo- milk is a complexmakes food sense containing to over judgeFA. 200 a The single milk authors FA, profile showed it ratherintensity that than are season, the the altitude single main andDue factors to grazing affecting legislation and ainput voluntary milk in restriction fat the of cow’s profile. diet, concentrate the grass based summer organic season systems during duce showed such the a highest FAalso potential profile, in to especially lowland regions pro- inthe if Alpine main day regions, fodder and for but night the grazing cows. provides milk fat from grazedfor mountainous its pasture high levels is of well n-3 known FA, CLA and vitamins. organic milk intake. supplementation with conjugated linoleicalpine acid butter (CLA)-rich changed human breastCLA milk FA and increased could be shown thatetable a oils high during intake theitively last of 4 associated, margarine weeks and whereas ofwas veg- pregnancy inversely a was associated, pos- highfirst with maternal eczema two fish in years.diet the intake The is offspring’s quality immediately of reflected the in FA in the the breast mother’s milk. towards a surplusindustrial of trans n-6 FA as originatesmeat from consumed well increased from as amountscentrates monogastric increased and of animals levels the fed of use with of con- hydrolysed plant oils from palm mented foods as mainno elements in refined their sugarsshowed diets. high There or levels were of canned anti-oxidants, foods n-3 and and n-6FA-profiles PUFA. the in fat relationhypothesis. quality to health is based on the lipid- CLA significantly reducedhyperresponsiveness. IgE production and bronchial feeding on a range of FA-markers was evaluated. J. Nutr. Ecol. Food Res. 1, 91–107, Baars study, the so-called fish FA were investigated, tional nature-based diets.among An all interesting traditional finding peoplemainly was a that consumed “sacred food” inOne was relation present, of to thenutrition fertility main was implicit and necessities pregnancy. without of the food help choicetals. and of Also, doctors thea and farmers in special the the food presencenancy Swiss in of and Lötschen relation hospi- development valley ofthe to had the (raw the milk) young fertilitycows butter, children. support, made This were in preg- was grazing June near and the July glaciers.” REVIEW o’ ikalryafcsaot23 fchildren. of 2–3% about affects Milk allergy of milk Heating Cow’s to Due Allergenicity in Changes 4.2. non- the of importance milk. the raw on of raw be constituents unfiltered cellular should and focus filtered the the differ- milk, between no found Since were bacteria. harmful ences these of growth reduced iso yoyeadlcoeoiaewr 4 o88% activi- to the 74% and were milk lactoperoxidase donor and lower. lysozyme pasteurised reduced of in were ties 82% A to immunoglobulin 50% secretory and lactoper- lactoferrin, oxidase lysozyme, of concentrations the milk, eto irbsadrdc namtr responses. inflammatory reduce and microbes destroy ae ofeho rznhmnmilk. human frozen com- or 4.6-fold to fresh 1.8- to enhanced pas- was pared in milk pathogens donor bacterial teurised of proliferation the Therefore, including milk, neutrophils. and of macrophages, components B-cells, cellular T-cells, Hazard or all Health on inactivates Discussion the in General, and Raw Consumption, Milk atuie ikyeddardcinin reduction a yielded raw high- milk and of pasteurized milk, Holder-pasteurized properties milk, antibacterial Raw milk. the human on effects show- negative pasteurisation, ing after reduced inhi- significantly growth was bacterial bition The tested. experimentally was milk h omto fdsld od ewe ap-and/or kappa- proteins. between whey bonds and disulfide alpha-s2-casein via of of proteins formation formation whey the and the in tertiary micelles result casein native will between in and the aggregates protein absence changes the to its of treatment considered of structure Heat is because proteins milk. allergen, whey milk human main principle the the of be on one and Beta-lactoglobulin as patient processing. (LG) its the including of itself, predisposition food the the on depends food muooia opnnswr investigated, were components immunological nclto with inoculation eiia rpriso rs a o ikwscalculated was of milk lag-phase cow the raw and fresh of properties tericidal etaino eiulntv rti eed natime a on depends protein native their residual of of con- unfolding The centration the aggregation. and to conformations globular due compact denaturation undergo teins isA ,E 2adB2 ncnrs,teewere there and contrast, (36%), In C (15%), B12. (31%). B6 and acid vitamins B2 folic vita- of E, of losses concentrations D, significant the A, affect mins not did pasteurisation 6 iue nrwml o4 iue nalha treat- heat all in milk). minutes UHT 40 as well to as milk (pasteurised raw ments in minutes 160 rwhof growth aureus 0,5% n 6,respectively. 36%, and 52%, 70%, ikbigseiefo n atraadwt removal a with compared and was neutrophils bacteria raw and any macrophages filtered from of with sterile milk human being raw milk normal of capacity bial u ohaigo h ikconsumed. milk proteins the whey of in and heating changes atopy to with asthma, due correlated of were levels fever in hay differences children farm 96 62 ( 63 .aureus S. shrci coli Escherichia h ao ikpoenlcoern(F can (LF) lactoferrin protein milk major The .coli E. 61 nfehrwadpsersdhuman pasteurised and raw fresh in ) eaiet rsl xrse human expressed freshly to Relative .coli E. and .aureus S. ( .coli E. t38 at 66 69 and ) h euto fbac- of reduction The a eue from reduced was C a iksoe a showed milk raw , etsniiepro- sensitive Heat 10 .coli E. 55 62 legnct of Allergenicity Staphylococcus h antimicro- The h osof loss The 67 65 rwhof growth 60 n after and n the and Holder 68 In 64 hra tblt ftepoen aigit con irre- phosphatase account alkaline into (LF) increasing was taking of changes proteins order the versible The of protein. dam- stability each heat thermal for to different sensitivity is the age and curve temperature versus olbln(LG) toglobulin iigmlil ptpsa es mi ieaerequired are size in release. com- nm histamine 1 elicit Fragments least to possible. at epitopes binding multiple order antibody in bining long, the residues of make acid each amino to epitopes, 15 of IgE minimum two a least and which at response contain immune must an (around allergen stimulate Da an to 3,000 order than in healthy greater residues) its weight 25 need molecular and peptides a gut have whey the to milk of cows’ maturity Furthermore the functioning. as such factors by and cheese. process mature the ripening in the present during still degraded were not were teins immunological espe- the casein-degradation, in-vitro therefore of and level alphaS1-casein, for high cially a had ripening) of epecudtlrt noa rvcto ih36-month- cheese. with provocation Parmesan oral old an tolerate could people eprtr ramn a akn mxmmtempera- 55 (maximum processing high lacking at where ture was cheese, treatment Parmesan children temperature allergic matured milk fully cow’s in consuming found were results Similar in hr Gimnratvt a esrdwhen 70–80 measured over was heated immunoreactivity was LG milk diges- sharp stomach to a resistant tion, be strongly treatment. is to LG heat native shown after Although proteins been whey measure also to of used have immunomodulation was production proteins, Antibody allergens. milk about major represent the pro- which of these caseins, However, several80% on past. and the identified total in proteins been the teins of have globular 20% epitopes mostly for IgE-binding account are that proteins, LF and milk LA LG, as such a ietdsgicnl atrwt ua proteolytic human with faster significantly digested was in-vitro nodntrtdL iha grgtdstructure. aggregated an with LG denaturated into idn aaiyfrrtnl amtcai n i 3was the D3 parallel Vit 70 above and in heating acid that after palmitic reduced showed retinol, for and capacity LG ther- binding after of epitopes denaturation built newly mal the of site immunoreactive on,wihcrepne ihdtce epitopes. detected with corresponded beta-caseins of which fragments resistant gut found, pro- the the dietary with in connected response of immune and digestion inappropriate an incomplete causing an teins would to allergy connected IgE-mediated that denatura- be suggested after was infant LG it on of models, Based function destroyed. uptake be might the tion as well as port on nfehces aefo a,nnhae milk. non-heated raw, was from LG made cheese no fresh whereas in temperatures, found higher at sterilisation otetemlblt fL,vle eearayhg in high 66 already at were pasteurised values cheese LG, of fresh thermolability the to nifnsteetn ftepoendgsini affected is digestion protein the of extent the infants In < immuloglobulin-G g ecino aen erae.Tewe pro- whey The decreased. caseins on reaction IgE ieto oes twsosre htrwmilk raw that observed was it models, digestion < .Nt.Eo.Fo e.1 91–107 1, Res. Food Ecol. Nutr. J. atabmn(LA). lactoalbumin 73 ) 8 ftecwsml allergic milk cow’s the of 58% C). auePrea ( Parmesan Mature 74 < oge al. et Song oiesrmalbumin serum bovine C. ,cnetn aieLG native converting C, n vnhge after higher even and C 71 75 hrfr h trans- the Therefore 71 70 in-vitro ol en the define could hyproteins, Whey < > lactoferrin 0month 20 digestion 71 < , Baars 74 2013 Due lac- In 72 REVIEW C 97 Milk was 90 C, 15 sec), high The diet consisted of bread 84 Growth of rats on sterilized milk In a trial with 9 consecutive gen- it was mentioned that the heated 87 89 86 C, 20 sec) and UHT milk. In a comparison of three generations, cats Animals receiving sterilized milk could not 88 85 was about 10%terms less of after number of onepups pregnant year. females was The plus higher number reproduction afternone of raw in born of milk, the although pupsguinea in pigs, survived full both after recovery groups, of theconsuming scurvy fourth was heat-treated, found day dried in milk of theto powder group life. raw after In milk. changing and milk from different treatments: raw, sterilised at 96 and sterilised fullated cream with milk. the Theweight highest last gain weight was diet better gain, wasthe in whereas the sterilised associ- raw milk the milk group.and slope group In compared all of all to females groups,Although became all no pregnant furs were differences atraw fine the were and end found heated of in milk,milk the the growth group trial. reproduction between was ofmilk the group. reduced pasteurized to 51% compared to the raw the main partanced of with the a dietprotein vitamin-mixture. (66%) and In and fat theThere in all average were the diets values several diets, were highly for raw no significant bal- and differences differences pasteurised between wereand milk present. internal in organs. The growth,after animal fertility, weight raw litter was milk, always yield valuesThe higher fertility up over to 9 10%ments. generations difference was Especially very were in high found. there the in were all later treat- more generationsby pups (8th the born and end andFrom 9th), of the more the 4th of sucklingpups generation them phase born onwards, was survived after the highestwere raw total after raw weight milk also milk. of intake. different. Theically all Spleen internal heavier organs and in adrenals raw were milk systemat- fed animals, although not in milk could notmilk, be because the compared milkeach was with sterilized time. a twice In for normal a 30ings minutes could pasteurized follow-up be study repeated. only some of these find- pasteurisation (92 were fed with agroup diet received raw of milk, milk, anotherthird meat pasteurised one and milk cod condensed and liverraw the milk. oil. milk It One diet was showedwell reported normal as that growth a and cats normalof reproduction on bone pasteurized as a structure, milk whereas couldanimals cats not showed with successfully a an reproduce,structure diet aggressive the was behaviour changed. and their bone erations of rats, diets weremilk composed based powder on from freeze-dried differentbatch origins, of but milk: all raw, low from pasteurisation the (72 same produce any offspringraw after milk the animals 3rderations. could In generation, reproduce a whereas even critique, after seven gen- where milk wasany the compensational main effectstive food of effects found of vitamins, associated withthe the there heating five-week the are animals milk. development nega- without Ining of rats, pups at was two compared, weeks start- of age. 79 Milk After 76 Milk Consumption, Raw and General, in the Discussion on Health or Hazard 78 77 to determine the 83 2013 Antigens such as aggre- 69 in reaction on raw/crude- ver- The immunity response in sensitised in-vitro discussed the question, which underly- 80 81 82 REPRODUCTION Neerven et al. During anaphylaxis, there is an acute oxidative stress immunisation ofskimmed, mice pasteurized with and pasteurizedthe different antibody plus production milk homogenized, of allimmunized specificities types: with within pasteurized/homogenized the raw, milk group wasthan higher the group immunized with raw or skimmed milk. antigen-production sus processed/cooked food ingredients. Additionallyimmediate to IgE the reaction,delayed measurements immune reaction were based made onbody IgA, for production IgM and a against IgGsensitive anti- modified people food showed antigens. severecooked Allergy food immune via reactions non on IgE the production. mice depends on theproteins loose heating their temperature. allergenicity compared Sterilisedpasteurised to milk milk. raw milk and ing elements of rawthe cow’s milk protection consumption against contribute to allergies.of They heat-induced argued changes thatresponse. leads a to Denaturation chain an changeseral unbalanced the milk immune functionality proteins, the ofand microbiota-composition therefore sev- is the changed gut barrierfrom functions food are changed. allergic Serum people was used processing led to differencestreatment in of peptide milk patternstides tended and found to in heat increase digested samples. the number of pep- gated LA and LG,be induced taken after up pasteurization, bydirected could intestinal to not epithelial the cells, mast but cells instead of were Peyer’s Patches. J. Nutr. Ecol. Food Res. 1, 91–107, 5. STUDIES ON HEALTH, GROWTH AND 5.1. Animal Studies Several animal studies have beentreated done milk. with In raw theeration and studies, heat- intervals attention was and paid the to reproductive the gen- effects. In studies, After immunisation of ratsdenaturated, with native pure LG LG,reaction native caused in or a terms heat- urated of more IgE LG, intense productionincrease but immune compared in heat-denaturated tointestinal denat- LG mucosa tract, resembling caused inflammatory areaction delayed a cells instead type of hypersensitivity greater in aby Type total the I IgE allergic levels. gastro- reaction as measured in the respiratory tract.lowed In by mice the models,tein sensitization crossing aggregates fol- of andtested. the the Subcutaneous epithelial anaphylactic reactionssensitized barrier reaction mice and of gave has oral pro- milk different been and provocation reactions homogenized to of milk.body untreated When raw production given orally, wasreaction no (respectively found anti- 8 compared and 71% to of subcutaneous the animals). Baars enzymes than the pasteurized and high-heated milk. REVIEW n n ute ikpoesn,teeaeas differences also are there processing, milk further and ing phosphorus and calcium the metabolism. regulating fat- vitamins through is soluble ‘anti-stiffness-factor’ the of mechanism The raw fed those to contrast in syndrome) (known milk. Wulzen stiffness the muscular and as wrist so-called developed all milk. were raw which after triglycerides, lower pyru- and glutamate (GPT) urea, significant transaminase chloride, generation, vate for 6th found the were the from differences In males weight. of body serum (heavier) blood total Hazard their or to Health relation on relative Discussion the in General, and Raw Consumption, Milk iki rtr nat eutdi eue a absorp- fat reduced growth in bone resulted reduced and infants tion preterm in milk eo)adi rcro ntebidn fVtmnD3. Vitamin of building the in precursor a (proges- is stiffness. functioning and prevent teron) hormone could with kale) interacts (e.g., Stigmasterol feed deficiency. green this cream labile fresh for Also, heat raw responsible that were with showed (stigmasterol) cured analysis sterols Chemical be an others. arter- could also the among stiffness of but calcification However, to tissues due ies. pressure soft blood of in increase calcification causing places, nerirsuis iefrisac h a study cat the instance milk. for the like of studies, heating Neverthe- the earlier to vitamins. In due balanced important remain a still of differences received terms less, rats in feed- The the especially etc. of diet vitamins, compensation with the ratio and ing generations 9 over run ua entssoe ihrifcinrtsatrpas- milk. endangered after human rates where of infection trial higher teurisation randomised showed a heat- impact neonates in milk human clinical shown through The loss was properties milk. a immunomodular ing the is of of there loss effect of milk, protective mother’s the of of heating the Following Studies Human not 5.2. may diets modern in health immediately. on visible Therefore, become products. heating eating milk of are and we effects milk and the only impor- balance than in are things more other and Modern much diets. are heating through diets changes milk human baseline some on show view to tant stud- another Such nutrients. offer essential ies some heat-treated in the deficient and were offered, diets was ratio feeding pensational etain eesmlri h w groups. two the in con- similar (25-OHD) were serum D centrations 25-hydroxyvitamin lower values. and as blood calcium fed phosphorus well Serum children higher as but preterm phosphatase, milk in alkaline human measured pooled also pasteurised was gain weight 98 iaeatrhaigadtesiliaeut rdcinof production inadequate lipase. still own milk child’s the of the and inactivation heating the to after due lipase probably reduced, was tion iraia tde ngie pigs, guinea in studies animal lier pr rmtealrei feti eaint ikheat- milk to relation in effect allergenic the from Apart study rat the of element interesting The animals milk, skim heated with fed pigs guinea In 91 acu elto a ae lc ntewrong the in place taken had depletion Calcium 93 98 94 95 atuiaino mother’s of Pasteurisation ralwrgain. lower a or 91 oblne rcom- or balanced no 97 90 a absorp- Fat stelong the is 89 96 rear- or Lower 92 on ngot ae fcide spr fanutritional a unprocessed. of and part processed as milk, children of of evaluation rates growth in found ersdml upeetdwt o ie i n orange and oil liver pas- cod or juice. with milk and alone supplemented milk raw oil milk pasteurised on liver on teurised babies babies cod than in juice of orange found supplementation was additional gain without weight larger A school among 1920s, trials the the in of recalculation children statistical the In nw niirba gns hsipisasrosrisk serious a health (f.i., implies public them This to of agents. some antimicrobial has known and pathogens decades resistant Enterococci last aureus, multi-drug the in in occurred increase rapid A AB of Distribution the and Milk Raw 6.1. contamination well of risk of already the bacteria. transfer and pathogenic is Secondly, by the about, milk. warned of and raw risk described inno- in of the kinds microbes all is cent through there genes consumption (ABR) First, resistant the antibiotic milk. with associated raw risks of several are There RISKS MILK RAW 6. hwdtepeec fARgnsad led ninfants in already and, genes ABR of presence the showed ua wihd o ifrbtentetoml types). or milk effect’ protein two the fat, ‘milk between than the differ other not of do substances part (which by of sugar least case caused at rais- the be effect, that in could greater 70% possibility a have and the to boys of appeared ing the value milk of Raw the girls. case half the the only in con- had milk that milk raw pasteurized conclude of authors 70.1% sumption the and (49.8 Therefore, striking more pasteurized respectively). reduction even whereas was of respectively, increase length consumption 91.1% of of and the Reduction 66.0 to was girls. milk the due for increase than weight boys the among stronger fatboisamnsee a seilyslc o fur- for select selec- resistance. especially resistance may ther level of administered sub-therapeutic a risk antibiotics use practice, of higher any In a that pathogens. among is to tion problem leads The veal. antibiotics promot- and growth of extensive poultry as pigs, the husbandry in animal is ers in resistance fac- antibiotics drug driving of emerging The use the hospitals. behind in tor humans infected bacterial dlsatrdikn frwml oprdt pasteurised to and compared children milk. milk dried in raw or of efficient drinking more after was adults Calcium of retention nlnt n egtwssalratrcnupinof milk. consumption raw after to smaller compared was milk weight pasteurized and length in isdt h eeto f o ntne schoolteachers. instance, for be of, could selection and the randomized too to not being as biased were taken trials be not The should significant. trials early these on based eitneGenes Resistance 102 acu rmrwml sbte vial n the and available better is milk raw from Calcium 103 105 104 .Nt.Eo.Fo e.1 91–107 1, Res. Food Ecol. Nutr. J. esrmnsi h to finfants of stool the in Measurements r hwn eitneaantmost against resistance showing are ) n ed oicesdpolm for problems increased to leads and 99 twssonta h increase the that shown was it 100 fet were Effects 99 Results , Baars 2013 101 S. 86 REVIEW E. 99 The E. coli 116 (EHEC) in the numer- Escherichia coli The majority of outbreaks or Verotoxin building 112 Looking at the disease pattern 113 that causes foodborne and water- E. coli Listeria monocytogenes and enter these cells. EHEC is one of EHEC is a subgroup of STEC or VTEC: E. coli can develop rapidly (in this case, STEC 115 113 114 115 . Enterohemorraghic bacteria. To become virulent, different genetic char- E. coli Here we will especially discuss the virulent sub-strains recent outbreak in the HamburgGermany) area in (Niedersachsen State, June 2011EHEC showed are. how risky Fifty-threeple new people strains had died of diarrhoea. andwith In raw over this milk, 4,300 outbreak butfor peo- with it salads. New uncooked had high-risk vegetables pathovars nothingmechanisms and with to other sprouts aggregation do attributed to the consumptioncaused of by unpasteurized Campylobacter milkand and were resulted occurred in relatively in fewis private illnesses. Although homes a listeriosis serious foodbornebreaks illness, attributed there to areous no listing raw in milk the out- US. of includes atoxin phenotypically producing diverseborne population diseases. of Shiga coli acteristics must bethem present being in the the productionor of infecting Shiga strain, Stx2 toxin one (coding withria for of Stx1 attach variants), to itintimin the is eae) intestine also cells of necessary the that host bacte- (encoding for Shiga toxin encoding the most problematic zoonotic diseases,infective because dose. of its The low is incubation between 2–5 of days. theand Sero-groups O26, EHEC O103, O157 O111, O145 in belong humans to the major EHEC strains. in humans, thereferent is outbreaks. a Sometimes difference large numbersexperience in of abdominal virulence people only pain amongoutbreaks dif- and only diarrhoea a whilebut limited in with number other severe of complaintsfailure, people like hospitalisation are bloody involved, and diarrhoea,raw even kidney milk death. cases Although areless present, proven in raw comparison milkhuman to dangers contact, infectious seem animal to dangers contact,ground be from dirty beef human toilets, and undercooked to unhygienicboxes for environments children). (such A asfrom cross-contamination sand- bearers through is toilets a possible vector for the spread of EHEC. O104:H4), and itanimals, seemed were that the reservoirs human ofstrain this beings, new, antibiotic-resistant rather that than acquired the Stx2-gene. Outbreaks of O157 vary dramatically infrequency the of severity the ofuremic most syndrome illness (HUS). and serious the complication, haemolytic 6.2. Raw Milk, Safety and ZoonoticWith Bacteria raw milkdangers consumption exist. a The most listnection commonly of with reported potential raw riskslobacter in milk zoonotic and con- are EHEC/STEC. Listeria,2006 Outbreaks Salmonella, due between Campy- to 1990the milk and official consumption CDC invention) (Centers the data were for U.S. evaluated. according Disease to Control and Pre- , 105 107 110 In so- Typical Milk Consumption, Raw and General, in the Discussion on Health or Hazard In Swiss S. aureus 106 104 105 . Horizontal gene The genus Ente- 107 108 Enterococcus faecalis Also a larger propor- 2013 109 Similar results were found Gene transfer can take place 107 and to commensal bacteria can 106 Listeria spec. Streptococcus uberis 104 although only in U.S. studies, not in and 111 104 Listeria monocytogenes After testing 12 main antibiotics available for udder Raw milk is not the only vehicle for antibiotic resis- rococcus, as aexceptional typical ability part to acquire of andis the transmit considered ABR intestinal genes to flora, and of be has ABR a genes an worldwide. major player in the dissemination occur in the presencecolonic of fermentation. competing faecal microbiota in a tion of isolates within Staphylococcus were mentioned transfer of ABR determinants,elements mainly such via as mobileto genetic plasmids a large andresistant extent transposons, to to contributes the a increasing single prevalence or of to bacteria multiple antibiotics. cheeses, resistance from Enterococci tohigh tetracyline in were as organic as in conventional samples (60–61%). bacterial species thatfew, cause if mastitis any,tance in mechanisms to dairy other for bacteria, cows as transfer occurs have with of intestinal bacteria. antibiotic resis- for ‘erythromycin’-resistance (rawversus 23%), vs. although the pasteurisedwere overall lower levels 55% of than contamination used for for tetracyclin. fermented Also, milkantibiotic products in resistance or has starter in been cultures detected. probiotic cultures, European studies. Oneence of the might suggestions beantimicrobial for the drugs, this geographic which differ- farms. differences is in not allowed the at use US of organic Lactococcus spec. vertically, within thetally, bacterial between species, different but bacterial also species, horizon- like called ‘ready-to-eat’ productsquark, like genes raw resistantnumber milk to and cheese antibiotics transferred. and canteurisation Killing be reduced of increased themilk bacteria in prevalence though cheeses of pas- hadcheeses ABR (75% a genes. versus higher 37%). Raw prevalence than pasteurised J. Nutr. Ecol. Food Res. 1, 91–107, No differences were found inorganic penicillin and resistance between conventional cows. from organic rather than conventionalceptible farms that to were erythromycin, sus- contrast, pirlimycin in and a tetracycline. reviewies, article, a In evaluating lower prevalence 17farms of different was antibiotic stud- found, resistance on organic to Horizontal ABR gene transfer from pathogens, no differencesfrequency between could organic be andalthough conventional found there Swiss in should cows, of resistance be antibiotics a at organic strongorganic farms. cows restriction to There in show wastance higher the a than susceptibility cows tendency use for from for integrated drugcially production resis- in systems, espe- isolates from tant bacteria.high Fermented raw concentrations foods of can resistant often Enterococci. harbour Baars younger than two weeks, highdetected. numbers of such genes were REVIEW tl uvv nfehcessu otomnh fage. of months two to can up STEC cheeses milk; fresh fresh in in survive present only still not are Dangers fer. peec fSx n t2)wsivle htwshighly was human. that O157 involved in STEC was pathogenic of Stx2c) and intes- type Stx2 one the of mainly in (presence Sweden bacteria southern the the In of of tine. adherence presence the the for iso- by responsible human characterised All were samples. bovine lates the than Stx-genotypes in ar odi aessetfrSE 17afurther present?). and a (which (eae) adhesion features necessary O157 additional colonisation whether is STEC and aspects strain for Stx genetic pathogenic suspect all made of determination is before So, food structure. dairy its population resolve to homogenous needed genetically power laboratories discriminating iden- these further for However, the lack adequate O157:H7. be STEC might of tification laboratories health public in hswsas on o atccheeses. lactic for found also was This groups. non-O157 illnesses the most reported to with although belong people Europe outbreaks, from in milk isolates clinical raw O157 the with to of cases relation most in in dealing strains Hazard been or have Health we on Currently, Discussion the in General, and Raw Consumption, Milk ls o nyaetepeaecsdfeeti different in different of prevalences subtypes virulent the predominant the are countries, only sam- positive Not STEC 2.5% ples. respectively, only EHEC showed and data STEC Swiss whereas for positive were 5.7% and ugse htol rcino TCO5 tan in strains in disease O157 causing STEC with humans. associated of are reservoir fraction bovine a the only that suggested emnrwml n a ikces eeSE pos- STEC of were cheese 3% 2, is milk and raw respectively. samples 6 itive and 17, milk milk 2010 raw preva- raw In positive The German factor. countries. EHEC risk between or a different milk STEC as raw of identified and food disease, lence of only touched odds the having highest was age, the of had years ruminant 3 a under children In specific. lnse ncide r anyascae ihteO157 the with associated mainly group. are children in illnesses a eevisfrti organism. nonhu- this major for the reservoirs are sheep man and bovines in colonization but nneo t1 ihamnrt fioae abuigeae, harbouring isolates katP. of and/or minority predom- espP, a a with by Stx1, characterized of were inance strains STEC contrast, food was In dairy strains. variants, human-virulent Stx2 genes, with several is associated katP of clearly strains, and combination eae, a O157 Stx2, with STEC the together of of presence genotyping The necessary. differen- on genetic based Further tiation, outbreaks. foodborne larger two e fi,Sx,Sx,Sxc n hi obnto might combination this. their for alle- and reason Stx-gene Stx2c) the Stx2, the be Stx1, of the (f.i., being virulence les Stx2 Different and variants. Stx1 vari- production, main genomic toxin showing Shiga in O157, ations STEC of specification ther still bacteria milk. the in by active produced be toxins might some killed, are teria 100 u ognmcrsac,i snwpsil o fur- for possible now is it research, genomic to Due 118 123 .coli E. h ua sltssoe agrvariation larger a showed isolates human The 17H osntcueilesi cattle, in illness cause not does O157:H7 120 125 nFec a iksmls 21.0% samples, milk raw French In h urn oeua sasused assays molecular current The 124 113 hssri a orltdwith correlated was strain This 123 nTeNtelns twas it Netherlands, The In 119 ikfcoswr age were factors Risk 126 122 vni h bac- the if Even 116 117 .coli E. Reported tir gene, dif- 121 rt ahrta ito ogaei efaiasshowed bacteria. animals beef the concen- in of preva- roughage of numbers of the levels increased diet High affect a cows. than patterns rather in trate feeding O157:H7 STEC and of feed lence of however, types inconsistent, and are chain the Studies production heating. the through in farm killing the on measures hygiene odhgeepatcstruhu h odcani the is growth. bacterial chain and food contamination prevent of the to maintenance throughout key and practices application hygiene the cheeses, good that commercial concluded of was evaluation it bacteriological the In num- investigated on-farm the were The bacteria reduce environmental milk. that of ber measures the hygiene of and prac- monitoring management hygienic periodic aggressive by and achieved tices be can products its persons. infected bac- of virulent stools the the of in concentration sec- teria high of very the risk person-to-person, of a from because also transmission is tertiary and there ondary infection, primary the Besides ree a lae hmevscmae ocle kept calves to compared themselves indoors. cleaned had even or usd oeadhv oecnatwt nml dur- animals (salad). with are food faeces-contaminated contact who eating beings more or summer human have ing infected and the more well of as outside bacteria behaviour the the of pattern occurrence as this peak population the behind the summer For Mechanisms be September. a could bacteria. to had the July findings of from STEC rate summer hemisphere, growth during Nordic the temperatures increase Higher could shown. were bound- regional aries across patterns seasonal consistent review, fe 0dyo ieigadween ontcbacteria zoonotic cheeses no milk where detected. raw and be ripening US could of commercial 60-day 41 after in confirmed was o re itle grains. distiller dried for h hs fyugsok atraaesra hog the through in spread and, life are their bacteria of stock, herd. hours young 24 of first phase the the within found be can rnmsinadpritn ooiainrtsi the in rates increased colonization for persistent herd. responsible and be transmission can super-shedders called and colostrum with fed milk. those real than colonization of dences eesi a ikcudb olt oto h hygiene the control to tool a be could milk raw in levels h udhsbe etda 54 at heated been process, cheese has been the curd during long quickly when the during or and or cheese curd, hard sufficiently of the ripening of is STEC acidification milk of rapid after if Growth cooled, reduced herd. be the be should from can shedders removed STEC and Persistent a identified policy. maintaining and herd herds avoiding closed animal troughs, different water between of contact cleaning groups, and rearing emptying stable bedding, regular clean and bacte- Dry the pressure: reduce rial to mentioned were practices management rnmsinrue of routes Transmission ikrdcino TCcnetaini a ikand milk raw in concentration STEC of reduction Risk hdigfo ossosacmlxdnmc So- dynamic. complex a shows cows from Shedding 131 129 130 132 netdcle eto atr eels exposed less were pasture on kept calves Infected avsfdml elcr hwdlwrinci- lower showed replacers milk fed Calves hr r esnlsedn atrs na In patterns. shedding seasonal are There .Nt.Eo.Fo e.1 91–107 1, Res. Food Ecol. Nutr. J. 138 eidcmntrn fcoliform of monitoring periodic A 128 vni ebr avsSTEC calves newborn in Even .coli E. uig3 minutes. 30 during C 127 h aewsfound was same The aydpnigon depending vary 135 n five and 137 , Baars 2013 This 134 136 133 REVIEW S. In 101 “the “we all milk vs. 143 a adverse events any remarks that raw milk ( . It was stated, that 142 any The screening of raw expressed S. aureus 143 and gram-negative aerobic bacteria was less Nevertheless, the authors expressed their sur- 75% of samples, with 7%–36% of all samples > 144 , presents one of the biggest health issues. In a study milk). Additionally, Vuitton S. aureus Besides a technological approach to find solutions, it is that could beraw directly breast-milk. related Since toown the ingestion milk for of benefits preterm bacteriaadvantages of infants they in out-weigh using started any a an potentialthe dis- education mother’s bacteriological program quality toof improve of reducing the the deliveredimprove the milk pathogenic safety instead risks(control of by expressed system milk, pasteurisation. ofdeveloped a in To hazard-reducing HACCP which system control theof points) hazardous contamination microorganisms and was could multiplication be reduced. strive to zero-risk,risk however may an meanture immediate immediate and fight threat the to toous emergence sustainable zero risks agricul- of boththe other for discussion types health aboutmilk of and the fed more for to risks insidi- pretermabove the of pasteurised infants, mother’s environment.” raw milk. raw, One milk expressed hundredraw is percent human breast safe clearly milk preferred doesbetween not bacterial exist, intake but andlogical clear infant testing disease, correlations of and fail expressed microbio- growth breast in milk identifies bacterial containing pathogens. prise that they were unable to document mother’s milk delivered for prematurethese infants infants showed that withfrequently an exposed undeveloped immune tocoagulase-negative system large Staphylococci, were numbers whereasto of the milk-associated exposure frequent. necessary to look forenvironmental an prerequisites ecological and approach modes incontamination of which become transmission the clear. of Whatsures are to the improve ways the and immunethat mea- system they of can youngwill children handle so always the be loadlevel, present of it in is infectious necessary the bacteriabecome to environment? understand that resistant At why to some theEHEC animals strains farm shedders. can Rather of thanEHEC EHEC focussing in on without individual the animals, becoming presenceabsence it of makes as sense well to andtheir look on growth. at environmental In the factors expressedaureus human that milk, inhibit not EHEC,on but the role of commensalsstrains in were breast found milk, that severalsion were bacterial very of effective the in the growth suppres- of of raw milkdifferentiate consumption. milk This qualitiestion means at in finding milking terms ways anderally processing of to about rather hygienic the than speaking atten- dangers gen- of published studies ofon breast pathogenic milk bacteria microbiotaIn as are contrast, possible focused the sourcesthe species of normal diversity bacterial infection. flora and have the received little importance attention of so the Milk Consumption, Raw and General, in the Discussion on Health or Hazard “however, on the 2013 There is a tendency to 134 ). Slow rises of coliform- 1 − “A health risk after consumption of for instance, said: 50 cfu ml > 10 “The challenge is to maintain the native investigating the hygienic quality and pres- said: against general protection of the population; find- 139 140 141 The answer to EHEC contamination by official bod- Several issues seem to be relevant in the discus- values over timesignal and to single examine spikesthe the should equipment hygiene be cleaning during taken technique. milking as as a well as Vorzugsmilch is basically possible, because thezoonotic presence germs of in lowter doses jejuni as never EHEC canlook and be at technical Campylobac- excluded.” rather thanrisks ecological and solutions to to control tion. find In the his single presentationKneifel key at factor the within first the raw protec- milk symposium, ence of zoonotic(Vorzugsmilch) bacteria and in showing certifiedthis the milk German much type, raw better said: milk quality of ing acceptable waystion to chain rather reduce thanand the a a risks plea well-balanced in for discussion (non-existing) the about zero-risks produc- the pros and cons basis of currentnot knowledge, be raw recommended because milkOnce it the consumption might mechanisms can- contain underlyingeffect pathogens. the are protective better farm understood, milk serving ways a of processing safeCoenen, and and pre- preventive milk can be developed.” J. Nutr. Ecol. Food Res. 1, 91–107, The raw milktionally discussed, issue and has microbiologistsrepeatedly and been health warn officials controversially of and theResearchers danger dealing emo- of with rawresearch the often milk insert epidemiology consumption. a ofentific risk paper warning raw (see, at milk e.g., the thehis end review of conclusion paper their of that sci- Ref.than [9]). farm cooked After children milk who wereatopy, better drank Loss protected raw et from rather al. asthma and 7. DEALING WITH RISKS ies is to increasethe hygienic heating practices of (e.g., food washinging (milk hands), salads, included), the sprouts,farm avoidance etc., of and eat- and zooinfection avoidance animals. as of people Also, contact andrisk water with water sources can can are be bear beingtive non-thermal EHEC; re-evaluated. a processing Additionally, therefore, treatments source alterna- will(high be of pressure, investigated pulsed-electric field, ionizingradiation, radiation, and UV ultrasound) to inactivate STECalteration with to minimal sensory and nutrientit characteristics. has However, yet tocharacter be of determined food if will and be to changed what with level these the treatments. native Baars praxis on the farm.by The three outbreak described repeatedcoliform was milk bacteria preceded ( samples with elevated levels of status of the product andfore, to we get rid need of high its tech shady side. solutions.” There- sion ‘health orchoice hazard’: Freedom of food and nutrition REVIEW ulte,asn ntedsuso bu ikdnes is dangers, milk about discussion necessary. the in absent qualities, correct!” scientifically diseases” be would severe against of protection types significant a other with associated is product ainswosyta hycnol osm a milk. raw consume Vuitton, only of by can farmers stated also they by is that described This say cases investi- individual who but to at patients diseases look only zoonotic to with not patients also benefits sense from between studies makes case balance therefore gate a It on be risks. only man- should focusing and hygienic than there to rather risks relation least, health not in but practices impor- Last an best agement. be for among can farms illness tool these zoonotic tant period from of learn long To a evidence customers. over any its milk without raw deliver time to of able are that those from came inhibition lactis highest The milk. raw Hazard or Health on far,” Discussion the in General, and Raw Consumption, Milk ihterdcins iw nfo quality: food on connected views be reductionist should pasteuri- milk the for of differ-with meant opinion distinctly milk modern a bulk Our is sation. collected cheese, than in product processing ent milk raw for bet no rnigml hti raw. are is they that reasons, milk to drinking of enjoy unable number to are a able they for although milk from that commercial benefit find drink they people the after of of only the number sides milk balance significant both to A on advocates borderline. helpful between be polemic would present both positive, cases, single and of negative evaluation of scientific situations better complex A with healing. dealing analysed are requisites nrae iko rnmsino eeediseases.” severe of transmission author of risk packaging if increased legally sold from that be example can indicates an milk gives raw He where milk. Norway, raw of judgement anced n fetwti igecases single within cause the coincidence. effect evaluate a to and as methods individ- seen scientific often than accepted are is seriously There which more healing, of taken cases individual are ual reason, diseases some of for cases But anecdotal. as discounted and support health like promotion. words health with one connected needed, more is sup- is focus milk that research raw Another why health. understanding human of ports case-orientation ways on the focus open a could as well as focus environmental surpris- retail was modern milk our snow,cornucopia.” so, to least for or at have years relative undifferentiated, fifty Inuit ingly last the the that until terms because, multiple the have not 102 nte eeatisei oeaut ucsflfarms, successful evaluate to is issue relevant Another ntesinicdsuso,snl ae,aealways are cases, single discussion, scientific the In ttmn,wihsesas ob refrcow’s for true be to also seems which statement, a tanpouigabceicn nisin. bacteriocin, a producing strain a , 142 ugssti ann ecmltdwith completed be warning this suggests 146 a ikitne o osmto rs or fresh consumption for intended milk Raw esol d oti hta ecological- an that this to add should We tepouti soitdwt marked a with associated is product “the 142 147 h al o oebal- more a for calls who n concludes and ifrnito fmilk of differentiation A n ehd n pre- and methods and 145 Lactococcus 146 ta this “that btthe “but w do “we The h dpino h ytmwstoso n therefore period. and inter-war compa- slow the dairy too in by gradually was nies introduced system was the to however,pasteurisation answer of herds; possible UK adoption in a grades the tuberculosis as UK, of 1917 prevalence the in high In the introduced 1900s. were the milk in of varies even delivery milk countries in raw different between of very control is The milk countries. raw Western consuming of possibility The Regulations Adopted by Risks Reducing 7.1. one oa ,0 irso ikprdywr od nprevious In sold. were one day screening, their per in milk however, of studies, litres 3,800 total gmn rcie o a ar rdcina am with farms at man- production best dairy into raw research hand for more other practices for the need agement a On also labels. signalise san- warning she testing, and pathogen as standards, such itation regulations milk raw tional eaue hudb eo 5 below be should peratures nIay o igeptoe nayo h ape was samples the of any in pathogen single found. machines a vending not from Italy, milk in Testing days. three within be ann ae sapidt a htteml hudbe should milk if the farm that say a ( to from treated applied directly heat is amounts milk label small raw warning countries in a European bought most be in and and can ways milk upcoming Italy raw are sell In machines to practice. vending and milk cleaning control raw and to Slovenia, milking used the are indicators improve process whereas Tubercu- losis, like Brucellosis, pathogens EHEC, of Salmonella, presence the Campylobacter, for diseases. zero-tolerance after zoonotic a differen- looking is with There connection a indicators in process bacteria samples and between milk hygiene made tank vet- is bulk monthly tiation the of pro- In control creamery. not a erinarian standardisation and within further process milk, any heating of raw or background as the from consumption avail- duced made direct raw is controlled for milk legally This able a Vorzugsmilch. called selling milk, of shop possibility the is there nase oters fEE.Rsso Campylobac- be of can Risks ‘Vorzugsmilch’ from EHEC. Salmonella negligible. of as and risk lowered Listeria the been ter, to have bacteria answer coliform an max- for comparison the levels Vorzugsmilch, in in ‘Vorzugsmilch’ imum Recently, milk. in raw absent ‘normal’ poten- even to of or bacteria reduction zoonotic low and huge raw counts are a bacterial of Total already risk. system is health control tial there strict sale, a for with rawmilk of combination processing and in handling due milk, hygienic that, to showed cream- attention studies and to the These to hygienic sent pasteurised. be higher milk to raw much and eries ‘normal’ a grade-A than has standard ‘certified Germany shown zoonotic or in have ‘Vorzugsmilch’ milk’ studies raw so-called Several vending area. the from same collected that samples the milk in raw machines 99 of out three na dtra omn Jay-Russell comment editorial an In .jejuni C. 149 hrytrefrssre 0mcie n in and machines 60 served farms Thirty-three 120 150–152 > n one and 70 .Nt.Eo.Fo e.1 91–107 1, Res. Food Ecol. Nutr. J. )bfr osmto,soigtem- storing consumption, before C) .typhimurium S. 148 n osmto should consumption and C nGraysne1931, since Germany In eedtce from detected were 153 .coli E. le o addi- for plies O157:H7, , Baars 2013 REVIEW 0 0 0 0 0 5 103 feeding 710 300 30 00 90 60 40 33 not methicillin-resistant = 175 ca 00 01 84 01 49 This might also Year ; MRSA 1nd4 300 ca 00 80 21 50 11 E. coli 150 ca 00 30 51 81 69 “Those who believe that the num- 2008 2009 2010 not determined. 100 ca 00 81 00 91 81 nd nd 4 4 4 0 0 0 = ;nd 1 − 1 − 1 − 1 The percentage of positive samples for several zoonotic bac- 1 − 1 − − shiga-toxin producing subtypes of = HAZARD —Pasteurisation of milk negatively affectsand the digestibility the protection againstical asthma properties and atopy. present Immunolog- through in milk heating. raw A milkpinpointed range raw are of farm epidemiological lost milkfarm studies as or and the changed protective in agent,within non-farm both raw children. in milk are Themay only protective be beginning complex. elements to—Medical be understood doctors and andnot promote official the governmental consumption ofof bodies general its raw do reputation milk because asespecially potential for vehicles those ofraw groups zoonotic milk who illness, might intake:With profit Young regard most to children food from between and safety different pregnant it is types women. than necessary of just to milk. milk discriminate that Rawthe has safety milk not of is raw beenconsumption, far milk, increased pasteurized. hygienic which To more standards improve can duringcessing be the and pro- delivered for deliveryGerman direct of Vorzugsmilch. raw milk—It is is helpful, impossiblemilk like to delivery. reach in The 100% the pressureother zoonotic to hand, safety reach in can 100%market. raw frustrate safety, It the on makes the development senseples of to a of evaluate raw farms, andbetween milk understand where consumers exam- long-term and raw relationships milknot are suppliers been and present there any have incidence of disease. The immune system Staphylococcus aureus Raw milk typeSamples (N) Raw VZ ca Raw VZSTEC Raw VZ be true for raw cow’s milk. 8. CONCLUSION: RAW MILK, HEALTH OR Table II. teria of generalGermany (2008–2010); raw (derived from milk Refs. (raw) [150–152]). and Vorzugsmilch (VZ) samples in quoted, when they said: ber or typecan of be bacterial assumed contaminants toness, ingested affect especially the with incidence in milk and pretermdefine severity infants, safe of should limits, ill- not butraw attempt rather expressed to should milk to consider high-risk infants.” Salmonella ml STEC ml Campylobacter ml Listeria ml Yiersinia ml MRSA ml 154 a 0 0 0 08 08 0 7 139 Milk Consumption, Raw and General, in the Discussion on Health or Hazard should be 143 In the German 70 00 00 02 0 10 10 1 16.2 08 1 8 0 0 0 0 155 49 10 190110 160 10 150–152 2013 Raw milk Vorzugsmilch E. coli. 1 − 1 − 1 − 1,000) ml although a 100% risk reduction is illu- × 1,000) ml 1 − 1 156 × 1 1 − − − 1 − 1 Microbiology and somatic cell counts of general raw milk − 1 − shiga-toxin producing subtypes of = The routine control of the German Association of pro- These reports suggest that the presence of pre- and post- All positive samples were found at one single farm where a range of samples was ducers of Vorzugsmilch (BDVM)15 reported years that milk in was theof sampled about last for 100 EHEC: milk in samplesdeliverers per the up year examination from to the the Vorzugsmilch EHEC present was time positive. onlypotential one risk It within single shows this test type that for of milk. there is hardly any zoonotic data, rawsented milk separately and andthe the raw same data Vorzugsmilch findings from ishardly as 2008 other pre- any to studies positive 2010found (Table samples show and II). the In for indicatorsVorzugsmilch general, zoonotic for is a bacteria in hygienic were most processraw milk quality cases samples. of much better than general sive. If we make theHACCP comparison for with expressed the development mother’s of milkassessment a in for relation preterm to children, the Cossey risk et al. a J. Nutr. Ecol. Food Res. 1, 91–107, Bacillus cereus ml STEC Farms sampled (N)Milk samples (N)Somatic cell count ( 115 149 35 74 Table I. compared to certified Grade-A milk (Vorzugsmilch) in Germany. harvest control measures totion effectively might reduce be contamina- relatedraw to milk, the suggested reduction aszoonotic in one danger, the of pathogens the in measures to reduce the include somatic cellinary count incubation, (SCC), coliformtesting. plate counts, One counts, and of prelim- specificthe the pathogen most sale important ofcow recommendations health raw for (udder), milktime zoonosis at of and milking. farms processduce The hygiene is Vorzugsmilch certified at are the German the understrict farmers a strict microbiological who strict standards. control HACCP pro- In system Certified on as Grade and Vorzugsmilch A milk lowercell overall counts bacterial and counts,were the somatic found absence in of comparisonThe several to German zoonotic general Federal bacteria rawtrols Institute milk the for (Table zoonotic I). Risk pressure Assessment in con- food. Baars a long historytamination. of The producing five main safe testing milk parameters without suggested any con- Salmonella ml Campylobacter ml Listeria ml Coliform bacteria ml Staphylococcus aureus ml Escherichia coli ml Total bacterial counts ( STEC ml taken. REVIEW 104 Notes and References usage. English for paper the comments editing and in discussions assistance his plus for USA) (Michigan, Beals Acknowledgments: interest. of conflict no is There Interest of Conflict Hazard or Health on Discussion the in General, and Raw Consumption, Milk ieyta h aei refrthem. for true is is it same agents the infectious that gastrointestinal knowlikely other we STEC the though about Even every sample. less Not milk techniques endangered strains. an molecular STEC means use between to discriminate necessary to becoming health. is on neces- impact are —It the consumption evaluate milk to raw patients. sary intake on or milk studies consumers of control raw number Case limited from or effects small a negative within eval- and to tool positive scientific good uate a is approach human case-to-case to —A danger a become beings. we they cir- which the bacteria understand under zoonotic to cumstances ecology repress their investigating to be should working inves- than be —Rather should consumers well. milk as raw tigated of status health and 10. 3. 2. 1. 4. 9. 8. 7. 6. 5. .Deik .D utr .Hyhbet .Imberechts, H. 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