Managing Potential Pathogenic and Herd Health Risks in Raw Milk Herds

The demand for raw milk is growing as more farmers and consumers  learn about its nutritional benefits, delicious flavor, anti-inflammatory functional proteins, bioactive compounds, farm sustainability and beneficial animal and environmental stewardship.[i, ii] Raw milk farmers can thrive in this emerging market and help their customers achieve robust health with strong immune systems, less inflammation, and less asthma and allergies.[iii, iv, v] 

Unfortunately, that service to consumers can be overshadowed if farmers aren’t diligent about managing the real food safety risks that can come along with raw milk and the farm environment. There is no such thing as perfectly safe food. Like other foods, if not properly produced and handled, raw milk may contain pathogens that may make customers sick. The resulting illnesses can be serious or, on rare occasions, even fatal.

People are depending on farmers to manage the food safety risks. Although the risks are small, they are real, and we encourage all raw milk farmers to take these risks seriously with ethical and moral commitment. The health of the individual cows/goats/sheep (or other mammals) and the overall raw milk dairy herd is of prime importance in ensuring that raw milk is low-risk and safe to drink. As more farmers become focused on producing low risk raw milk for direct human consumption, there is an increased interest in learning which specific human pathogens and herd health conditions may be of concern.  

Pathogens and Zoonotic Diseases Versus Herd Health Concerns

The main microorganisms that may be of concern for raw milk dairy herds include different types of bacteria and viruses.  Some of these microorganisms cause illness or disease that can be transmitted from animals to humans or vice versa (also known as zoonosis or zoonotic disease). We generally refer to these microorganisms as human pathogens.

Some other microorganisms of concern can cause health problems in the dairy herd, but are not generally considered to pose human health risks and/or are not transmissible through food. There is uncertainty about several microorganisms and possible connections to human health risks.

We recommend that every raw milk farmer build a good relationship with a veterinarian who can be trusted for advice in herd health management. As a helpful guide, this article provides an overview of the following microorganisms of concern.

• Zoonotic microorganisms (known human pathogens): Verotoxin-producing Escherichia coli (VTEC, such as E. coli 0157:H7, Salmonella enterica spp., Campylobacter spp., Listeria monocytogenes, Shigella spp., Yersinia spp., Mycobacterium bovis (tuberculosis), Brucella bovis (brucellosis), Coxiella burnetii (Q Fever), Avian Influenza H5N1, Staphylococcus aureus (S. aureus).

• Herd disease microorganisms (those not generally considered as human pathogens): Bovine Leukemia Virus (BLV), Mycobacterium avium subsp. paratuberculosis (MAP, Johne’s disease or paratuberculosis).

The guidance in this document is intended for educational purposes. Local disease conditions are important in determining the appropriate course of action, so it is recommended to consult with a local veterinarian in making decisions about herd health monitoring and testing.  

Three Variables for Illness

Bacterial, fungal, and viral pathogens need a host to survive and thrive, yet pathogens do not cause illness in every host. For a pathogen to cause illness, three variables must align:

• A pathogen must be present which is virulent and capable of producing harmful effects

• The pathogen load must be high enough to trigger illness

• The host must be susceptible to the pathogen

Farm families tend to have strong immune systems that are adapted to the microbial flora of the animals and the farm environment, so they are less likely to become ill from raw milk that could possibly contain some of these microbes. However, it is important for farmers to recognize that many consumers may have compromised immune systems or immune systems that have not been adapted to the farm microbial flora, such as those living in urban areas, those taking medications such as antibiotics, chemotherapy or other immune-suppressing drugs, and those exposed to toxins in the environment or in the food. Unlike the farmer and the farm family, these consumers may be at a higher risk of illness from exposure to pathogens that can be found routinely in the farm and animal environment.   

Sampling Techniques for Microorganisms

Determining whether there are microorganisms of concern in the raw milk dairy herd generally requires observation, physical assessment, and specialized laboratory testing. It is important to work with the herd veterinarian, the diagnostic laboratory, and/or consultants to evaluate the presence of microorganisms of concern on the farm. The aim of testing is to determine the presence of specific microorganisms on the farm, where the hazards are present within the farm, and whether the microorganisms are present in the raw milk.

Depending on the goals of testing, the samples may come from numerous sources such as slurry, manure, water, milk from individual teats, milk from a single animal, blood, urine, animal tissue, milk filters, bulk tank milk, bottled milk, or vending machines. Some tests determine the presence of microorganisms directly in the milk.  For some microorganisms, samples such as blood and milk are taken to detect antibodies or immune response in the animals against the microorganisms, rather than the microorganisms themselves.  

Risk Reduction Strategies

Healthy goats and cows can produce healthy milk that will nourish farm families and customers, but diseased or unhealthy animals can pass illness through their milk or through milk contaminated with feces.  With due diligence and care, raw milk can be a low-risk food for the nourishment of people.

Farmers can reduce the risks of human pathogens being present in the milk through various strategies including biosecurity measures, herd management strategies, milking practices, and milk handling measures. Some specific risk management strategies include:

• maintaining a closed herd or implementing testing and quarantine of any new animals before they are introduced to the herd,

• ensuring the animals are healthy and kept in comfortable conditions,

• monitoring for signs of mastitis (udder inflammation),

• monitoring for fever as a possible indicator of systemic disease,

• thoroughly cleaning the teats prior to milking,

• rigorously cleaning all equipment that will be in contact with the milk,

• rapid chilling the milk to <40ºF (<4°C) within an hour (or less) or milking, and

• performing bacterial testing of the milk on a regular basis for early detection of problems and to assure compliance with RAWMI Common Standards.[vi]

Regardless of the specific microorganisms that are present, conscientious raw milk producers should monitor their herds for illness and ensure that raw milk from unhealthy animals is not used for direct human consumption. Signs of illness can include poor appetite, lameness, poor body condition, rough fur or coat, runny nose, cough, watery eyes, diarrhea or discolored feces, fever, discolored urine, uterine discharges, swollen udder or quarter, reddened udder or teats, high somatic cell count (such as detected in the California mastitis test, even if not detected in every quarter), and/or abnormal milk (even if not detected in every quarter) such as milk that is thick, discolored, stringy, or salty.   

Human Pathogens of Concern for Raw Milk in Western Countries

Currently in the western world, the four most common human pathogens that have been associated with raw milk-related illness in humans are verotoxin producing Escherichia coli (VTEC, such as E. coli O157:H7), Salmonella enterica spp., Campylobacter jejuni, and Listeria monocytogenes. Less commonly, Shigella spp. and Yersinia spp. have been associated with raw milk-related illness in humans. When any of these bacteria are present in the milk at levels that are sufficient to cause infection, susceptible people may experience intestinal illness that may include severe illness or death.

VTEC (such as E. coli 0157:H7) are of particular concern because these pathogens can produce severe illness even with a low pathogenic load (few bacteria are needed to cause disease). For instance, although “the total case numbers of E. coli O157:H7 infections are lower than those of other enteric pathogens such as Salmonella or Campylobacter spp., the diseases caused by E. coli O157:H7 showed much higher hospitalization and fatality rates... Human infection caused by E. coli O157:H7 can present a broad clinical spectrum ranging from asymptomatic cases to [in rare cases] death. Most cases initiate with non-bloody diarrhea and self-resolve without further complication. However, some patients progress to bloody diarrhea… In 5–10% of [these] patients, the disease can progress to the life-threatening sequelae, HUS [hemolytic uremic syndrome, leading to kidney failure] or thrombocytopenic purpura [blood clots that can restrict flow of oxygen to the organs].”[vii]

Thus, pathogens in raw milk need to be taken very seriously. Some of the most common sources of pathogens in milk are manure, mastitis, and improper cleaning of milking equipment resulting in biofilms of bacteria. Researchers from Canada and Europe have studied the safety of raw milk intended for direct human consumption and found that raw milk can be a low-risk food when farmers are trained in risk management practices, implement careful production practices, and test their milk regularly.[viii, ix]

Pathogen testing of raw milk can be used to determine whether pathogens are present, however this testing can be expensive and is only meaningful if it is performed frequently. For small-scale farms that cannot afford frequent pathogen testing, Raw Milk Institute recommends bacterial testing at least monthly for hygiene indicators by testing for coliforms and Standard Plate Count (SPC). The RAWMI Common Standards aim for a rolling three-month average of <5,000 cfu/mL for SPC and <10 cfu/mL for coliforms. [vi]

Although these two tests do not directly detect the presence of pathogens, these tests serve as general indicators that the milk is being produced hygienically and in such a way that pathogens are less likely to be present. Coliform and Standard Plate Count testing can be performed at an offsite lab or with an on-farm lab (with results in 24-48 hours). After an initial investment in equipment, on-farm labs can greatly reduce testing costs in the long-term because the on-farm test cost is only $1-3 per test.

Now, we will proceed to a description of some of the common herd health or zoonotic pathogens.

Mycobacterium bovis (Tuberculosis or TB)

Tuberculosis (TB) is a serious disease both in animals and humans. Cattle who are infected with Mycobacterium bovis (TB) may show no outward signs of infection or vague symptoms such as weight loss and low energy.[x] TB can infect humans through contact with infected cattle or through consuming raw products from infected animals. In humans, tuberculosis can cause prolonged cough, lung, kidney, brain, and spine damage, and ultimately death if not successfully treated.[xi] 

In some continents and regions, bovine tuberculosis is one of the biggest challenges to low-risk raw milk production. For instance, many areas in Asia, Africa and South America have relatively high rates of tuberculosis in cattle and problems with TB contamination of raw milk.[xii, xiii, xiv, xv] For farmers in high-risk TB areas who want to produce raw drinking milk, a rigorous TB testing program of the entire herd and workers, combined with careful control to ensure that animals are kept out of contact with potential disease carriers, would be essential.

Nearly all states in the United States of America (USA) have successfully eradicated tuberculosis in dairy animals through national programs, involving extensive testing and culling of TB infected animals.[xvi] Canada is officially free of bovine tuberculosis.[xvii]  In the European Union, 17 countries are officially TB-free.[xviii, xix]

There are wildlife reservoirs of TB in many countries that may have TB-free dairy herds. For instance, badgers in the United Kingdom and Ireland, white-tailed deer in the USA, elk and bison in Canada, and brushtail possums in New Zealand are common carriers of tuberculosis in the wild.[xx]  Limiting interactions with wild animals is a very important strategy for protecting your herd from this disease.

In states and countries that have legal access to raw milk, annual TB testing for raw milk herds is commonly required by regulatory agencies. The Raw Milk Institute’s Common Standards recommend testing the dairy herd for TB at least annually.[vi] Farmers living in TB-free areas, where the herd has no contact with wildlife, may choose to rely on the tuberculosis-free status of their region in consultation with a local veterinarian. In some areas, it may be appropriate to test more often than annually, such as if TB is common in the region or known to commonly affect wildlife populations.

TB testing is generally performed by a trained veterinarian and involves giving a subdermal injection of TB antigens followed by measuring the swelling of skin at the injection site. Regulatory agencies take tuberculosis very seriously. Positive TB tests lead to immediate restrictions of movement of animals and suspension of raw milk dairy production.

If an animal is a reactor in the skin sensitivity test, then additional tests need to be performed on the animal and the whole herd. If the additional tests come back positive, then the animal is euthanized to investigate organs for disease involvement in a necropsy. Depending on local policies, if the autopsy finds no tissues affected by tuberculosis, the rest of the herd may be able to be spared.

Brucella bovis (Brucellosis)

Brucellosis is a serious zoonotic disease that also can cause disease in animals. In cattle, brucellosis can cause fertility problems including miscarriage, abortion, and retained placenta.[xxi]  In people, brucellosis can cause undulant fever which can have serious short term and long term health effects.  Brucellosis in people may include chronic fevers, liver inflammation, fatigue, bone and joint inflammations, and more serious inflammation of the heart and brain tissues.[xxii] There are brucellosis vaccines for cattle and some countries have official brucellosis vaccination programs. In the USA, the brucellosis vaccine may be required in some localities. Several years ago in the USA, this vaccine was improperly produced and caused Brucellosis to be contracted by those who drank raw milk from vaccinated animals.[xxiii]  

In some countries, brucellosis is one of the biggest challenges to low-risk raw milk production.  For instance, India and Central African countries have relatively high rates of Brucellosis in cattle.[xxiv, xxv] A rigorous brucellosis testing program, combined with careful control to ensure that animals are kept out of contact with potential disease carriers, are essential in areas such as these.

In the USA, nearly all states have successfully eradicated brucellosis in dairy animals.[xxvi] Canada is officially free of bovine brucellosis.[xxvii, xxviii] In the European Union, most countries are officially declared free of  brucellosis.[xxix] However, there are still wildlife reservoirs of this disease in some parts of Europe.

In the USA, states have varying requirements for Brucellosis testing. For instance, Pennsylvania requires annual brucellosis testing whereas California requires quarterly brucellosis testing for raw milk herds. The Raw Milk Institute’s Common Standards generally recommends testing the dairy herd for brucellosis regardless of location.[vi] However, farmers living in brucellosis-free areas whose animals have no contact with wildlife may choose to rely on the brucellosis-free status of their region in consultation with a local veterinarian. In some areas, it may be appropriate to test more often than annually if brucellosis is common or known to commonly affect wildlife populations.

Generally, brucellosis testing is performed on bulk tank milk using the “ring test” which detects the presence of Brucella antibodies. Brucellosis is taken very seriously by regulatory agencies. If the milk tests positive, then further testing can be performed to determine which animals in the herd are affected. If it is verified that animals have Brucellosis, the affected animals must be culled from the herd. This decision is driven by local animal health regulations. Beware that the ring test is not generally considered to be effective for goats or sheep due to a high rate of false positive tests.[xxx]

Although brucellosis is mainly associated with domestic ruminants and pigs, there are wildlife reservoirs for the disease in bison and elk in the USA, buffalo in southeast Africa, and Alpine ibex in the French Alps.[xxxi] Limiting interactions with wild animals is an important strategy for protecting your herd from this disease.

Coxiella burnetii (Q Fever)

Q Fever is an illness caused by the bacteria Coxiella burnetii. In dairy herds, Q fever can lead to reproductive problems such as infertility and abortions. In humans, most Q fever cases are asymptomatic, but some people can develop mild flu-like symptoms. Rarely, some people can develop serious illness with chronic Q fever.[xxxii]

The primary way people are exposed to Coxiella burnetti is through breathing in dust or air that is contaminated by manure or the animals’ bodily fluids. Transmission can also occur through direct contact with mucus, aborted fetuses, amniotic fluid, placenta, milk, or ticks. In some areas, cases of Q Fever are required to be reported to public health agencies.

Coxiella burnetti testing of raw milk dairy herds is not typically required by regulatory agencies. Coxiella burnetti testing is typically performed with serum antibody testing to evaluate whether the animal has been exposed to Coxiella burnetti. Thus, a positive test does not necessarily indicate that an animal is contagious or virulent at the time of testing. Further testing may be needed to determine whether Q fever is currently present. When animals have positive antibody tests, it is recommended to work with a veterinarian to determine if there is an active infection ongoing in the herd.

For overall herd health, Raw Milk Institute generally recommends testing for Q Fever prior to purchasing animals.  For existing herds with no clinical signs of illness, it is recommended to consult with a local veterinarian who is knowledgeable about local conditions in order to determine whether Q Fever testing is recommended.

Avian Influenza Virus H5N1

Avian influenza virus primarily affects birds and is spread across the globe with migratory birds. Avian influenza H5N1 is a type that has recently crossed over from wild birds into some bovine and porcine herds in the USA. Although avian influenza H5N1 can be highly pathogenic in birds, according to the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS), in cattle this illness primarily causes decreased lactation and reduced appetite.[xxxiii] The illness is generally mild, where many cattle in the herd show no signs of illness, and those who do generally recover within a couple weeks. Symptoms include weakness, dehydration, fever, lower milk production, and yellow-tinged, thick milk. The first symptom of Avian influenza H5N1 in cows is generally a fever which appears a few days prior to becoming clinically sick.

Knowledge about H5N1 avian influenza is limited. Like other flu viruses, H5N1 is a respiratory illness and not generally considered to be a foodborne illness. There have been reports of cats dying from exposure to H5N1 in milk, however it is not clear whether those cats had exposure to wild bird or poultry sources of the virus.

It is recommended to monitor the herd for illness and ensure that raw milk from unhealthy animals is never used for direct human (or pet) consumption. If there is an H5N1 outbreak in the herd, it is recommended to quarantine all symptomatic animals from the rest of the herd for 2-3 weeks, until all signs of illness have passed. It is recommended to consult with a local veterinarian to determine the best course treatment and any other precautions that should be taken. For existing herds with no clinical signs of illness, it is recommended to consult with a local veterinarian who is knowledgeable about local conditions in order to determine whether H5N1 testing is recommended.

Staphylococcus aureus (Staph A)

Staphylococcus aureus (S. aureus) is a common cause of mastitis in ruminants. It can be present in raw milk, but it is not generally considered to be a pathogen of human concern. However, it is a major and serious cause of chronic mastitis and degradation of the herd’s productivity.[xxxiv] S. aureus bacteria colonize the mammary glands and teats. Over time, scar tissue and abscesses develop in the udder and teats, thereby reducing milk volume and the infection may remain in the udder, even after numerous antibiotic treatments.

Milk culture testing can be used to determine if S. aureus is present in your herd. Most regulatory agencies do not require testing for S. aureus. However, there are exceptions such as New York, where the presence of S. aureus at low levels is allowed in raw milk, but high levels are not allowed. 

Animals infected with S. aureus may initially show no clinical signs, whereas thereafter clinical mastitis (udder swelling, udder hardness, abnormal milk, and elevated somatic cell counts) may appear and result in chronic infection.  S. aureus may be passed from mother to offspring through raw milk or nursing. S. aureus can also be spread among the lactating cows through milking equipment, teat dip cups, and the hands of farm workers. Flies may also transfer the bacteria.[xxxv]

S. aureus is generally resistant to many types of antibiotics and is difficult to eradicate from the herd. Not uncommonly, S. aureus can appear to be wiped out as determined via testing, but then it may appear again in later testing. Some small-scale farmers have reported success in treating S. aureus with the use of homeopathic medicines but it is not clear whether this could work in larger herds with widespread S. aureus. [xxxvi]

Because S. aureus can degrade the herd’s milk supply and cause recurrent mastitis, many farmers choose to perform herd milk culture testing.  Strategies for managing S. aureus include: [xxxv]

• Culling animals who test positive and maintaining a herd that is negative for S. aureus

• Bottle feeding calves and kids to ensure that S. aureus is not passed from mother to offspring (and ensuring that milk from infected animals is not fed to offspring)

• Segregating the milking herd to separate those who test positive for S. aureus

• Milking S. aureus-infected animals last, to ensure that the bacteria are not passed to uninfected animals via the milk machine and hands of farm workers

• Ensuring teat cups used on S. aureus-positive animals are not used on other animals (or rinsing and sanitizing such cups after milking infected animals)

Bovine Leukemia Virus (BLV)

Bovine Leukemia Virus (BLV) can affect the health and productivity of your herd. Although some animals with BLV may have signs of illness (such as labored breathing, loss of appetite, or tumors), nearly two-thirds of infected animals are sub-clinically infected (i.e. they show no signs of illness).[xxxvii] Some recent studies have theorized that BLV may be linked to breast cancer in humans.[xxxviii, xxxix] However, the research on this is inconclusive and was not able to make clear associations. 

BLV is destroyed by pasteurization. Raw milk naturally contains bioactive anti-viral and anti-carcinogenic compounds (which are destroyed by heat).[xl] These bioactive compounds affect human immunity and it is not known how they would affect any potential interactions with BLV. According to one of the studies investigating the link between BLV and breast cancer, “Numerous prospective studies on dairy consumption in various defined populations, however, including one study that carefully evaluated unpasteurized milk consumption, found no significant relationship between cow’s milk consumption and breast cancer incidence.”[xxxix]

BLV testing of the raw milk dairy herd is not typically required by regulatory agencies. For overall herd health, Raw Milk Institute recommends testing for BLV prior to purchasing animals. In existing herds with no clinical signs of illness, it is recommended to consult with a local veterinarian who is knowledgeable about local conditions in order to determine whether BLV testing is recommended.  Some types of BLV testing measure the relative levels of viral loads, with the results given as ‘Undetected, Low, Moderate, or High’. Animals who have no symptoms and test as Undetected or Low are considered to be low-risk animals for raw milk production.   

Mycobacterium avium paratuberculosis (MAP, Johne’s disease, Paratuberculosis)

Johne’s disease is an infection in the small intestine of cows and other ruminants. It is caused by Mycobacterium avium subspecies paratuberculosis (MAP) and can easily spread in the herd. Johne’s disease is a chronic gut infection that leads to weight loss, diarrhea, loss of body condition, and reduced milk production. Animals may contract MAP or already be infected with MAP at birth, yet it is possible that no signs of illness may appear for years.[xli] Johne’s is generally not considered to affect humans, thus it is primarily a herd health issue.

Some researchers have theorized that MAP may be linked to Crohn’s disease in humans, however the research is inconclusive. For instance, a study looking for connection between MAP and Crohn’s found that “The results do not support the hypothesis that Map plays a causative role in the etiology of Crohn's disease.” [xlii] According to another study, “Despite numerous attempts to demonstrate causality by researchers, direct microbiological evidence of MAP involvement in [Crohn’s disease] remains elusive. Importantly, it has not been possible to reliably and reproducibly demonstrate mycobacteria in the tissue of [Crohn’s Disease] patients.” [xliii] 

MAP testing of the raw milk dairy herd is generally not required by regulatory agencies in North America. For overall herd health, Raw Milk Institute generally recommends testing for MAP prior to purchasing animals.  For existing herds with no clinical signs of illness, it is recommended to consult with a local veterinarian who is knowledgeable about local conditions in order to determine whether MAP testing is recommended.

When cows or goats have the clinical signs of diarrhea, weight loss, and poor body condition (skinny-looking) while still eating a normal ration, it should be considered that they may have MAP and testing is recommended. The milk test that is generally used for MAP indicates relative amounts of antibodies to MAP that are present in the milk, and does not strictly indicate that an animal has Johne’s disease. To protect the rest of the herd, culling should be considered for any animal that shows ongoing signs of Johne’s illness or tests positive on antibody screening tests. 

My Herd Came Back Positive. Now What Do I Do?

We hope the above information clarifies some of the most common pathogens and herd health concerns. Be aware that testing results are not always clear. There are many kinds of testing protocols and different tests reveal different kinds of data. Depending on the type of test performed, a positive test result may be detecting the presence of antibodies against a disease (which would indicate a prior immune response to the illness rather than a current, active infection).

Additionally, some cows or goats may test positive for illness while appearing perfectly healthy with no signs of illness. In those cases, the farmer may choose to monitor the cows/goats closely and wait to cull until such time as there may be actual signs of illness. This is a decision to be made in consultation with a veterinarian. 

When culling is necessary, it should be done at a USDA-approved slaughter plant. Slaughtered animals that are suspected to have been diseased will be inspected by a USDA inspector to determine if the animal is fit for human food consumption. At that time, an official USDA determination is made about the disease status of the animal that will either confirm or nullify the initial assumption or diagnosis of disease. 

As an ethical raw milk producer, one of your most important and highest responsibilities is to assure that your raw milk herd is healthy and not spreading illness unto itself or any of your raw milk consumers. Whatever it takes to achieve and protect the optimal herd and consumer health will be the best decision. Be sure to have a good veterinarian to assist in these decisions. There are many kinds of tests, and being able to understand the specific test results will be critical to making the right decisions. The broader raw milk production community may also have answers to your challenge. Thus, stay connected to the larger community and its greater experience.  

Thanks to the RAWMI Advisory Board for reviewing this document.

References

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[iii] The protective effect of farm milk consumption on childhood asthma and atopy: The GABRIELA study. Loss, Georg et al. Journal of Allergy and Clinical Immunology, Volume 128, Issue 4, 766 - 773.e4 https://www.jacionline.org/article/S0091-6749(11)01234-6/fulltext

[iv] Lallès JP. Dairy products and the French paradox: Could alkaline phosphatases play a role? Med Hypotheses. 2016 Jul;92:7-11. doi: 10.1016/j.mehy.2016.04.033. Epub 2016 Apr 20. https://pubmed.ncbi.nlm.nih.gov/27241245/

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[vi] Raw Milk Institute, “Common Standards.” 2020. https://www.rawmilkinstitute.org/common-standards

[vii] Lim, J. Y., Yoon, J., & Hovde, C. J. (2010). A brief overview of Escherichia coli O157:H7 and its plasmid O157. Journal of microbiology and biotechnology, 20(1), 5–14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645889/

[viii] Whitehead J, Lake B. Recent Trends in Unpasteurized Fluid Milk Outbreaks, Legalization, and Consumption in the United States. PLoS Curr. 2018 Sep. https://pubmed.ncbi.nlm.nih.gov/30279996/

[ix] Berge AC, Baars T (2020). Raw milk producers with high levels of hygiene and safety. Epidemiology and Infection 148, e14, 1–7.  https://www.cambridge.org/core/services/aop-cambridge-core/content/view/ACCC5FD0AC2CEAB12379DFA902491115/S0950268820000060a.pdf/raw_milk_producers_with_high_levels_of_hygiene_and_safety.pdf

[x] Daly, R. (2020) “Tuberculosis in Cattle: What You Need to Know.” South Dakota State University Extension. https://extension.sdstate.edu/tuberculosis-cattle-what-you-need-know

[xi] World Health Organization. “Tuberculosis Fact Sheet.” November 2023. https://www.who.int/news-room/fact-sheets/detail/tuberculosis 

[xii] Ramanujam, Harini, and Kannan Palaniyandi. “Bovine tuberculosis in India: The need for One Health approach and the way forward.” One health (Amsterdam, Netherlands) vol. 16 100495. 30 Jan. 2023. https://pubmed.ncbi.nlm.nih.gov/36817978/

[xiii] Firdessa, Rebuma et al. “High prevalence of bovine tuberculosis in dairy cattle in central ethiopia: implications for the dairy industry and public health.” PloS one vol. 7,12 (2012): e52851. https://pubmed.ncbi.nlm.nih.gov/23285202/   

[xiv] Carneiro, P A M et al. “Milk Contamination by Mycobacterium tuberculosis Complex, Implications for Public Health in Amazonas, Brazil.” Journal of food protection vol. 85,11 (2022): 1667-1673. https://pubmed.ncbi.nlm.nih.gov/34788443/

[xv] Basit A, Hussain M, Shahid M, Ayaz S, Rahim K, Ahmad I, Rehman AU, Hassan MF and Ali T, 2018. Occurrence and risk factors associated with mycobacterium tuberculosis and mycobacterium bovis in milk samples from North East of Pakistan. Pak Vet J, 38(2): 199-203. http://dx.doi.org/10.29261/pakvetj/2018.038

[xvi] Animal and Plant Health Inspection Service. “Status of Current Eradication Programs.” United States Department of Agriculture. April 2024. https://www.aphis.usda.gov/livestock-poultry-disease/status-eradication-programs

[xvii] Canadian Food Inspection Agency. “Bovine tuberculosis.” Government of Canada. March 2024. https://inspection.canada.ca/animal-health/terrestrial-animals/diseases/reportable/bovine-tuberculosis/eng/1330205978967/1330206128556

[xviii] European Health and Digital Executive Agency. “Brucellosis (Brucella abortus, B. melitensis and B. suis).”  European Commission. 2022. https://hadea.ec.europa.eu/programmes/single-market-programme-food/veterinary-programmes/brucellosis_en

[xix] European Union Reference Laboratory. “Tuberculosis in bovine animals eradication in Europe.”  Visavet Health Surveillance Centre. Jan 2024. https://www.visavet.es/bovinetuberculosis/animal-tb/eradication.php

[xx] Miller, R. S., & Sweeney, S. J. (2013). Mycobacterium bovis (bovine tuberculosis) infection in North American wildlife: current status and opportunities for mitigation of risks of further infection in wildlife populations. Epidemiology and infection, 141(7), 1357–1370. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684113/

[xxi] Larsen, J. (May 2023) “Overview of Brucellosis in Large Animals.” Merck Manual Veterinary Manual.  https://www.merckvetmanual.com/reproductive-system/brucellosis-in-large-animals/overview-of-brucellosis-in-large-animals

[xxii] Corbel M, editor. Brucellosis in humans and animals: Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, World Health Organization. 2006 editor. https://iris.who.int/rest/bitstreams/51770/retrieve

[xxiii] Gruber JF, Newman A, Egan C, et al. Notes from the Field: Brucella abortus RB51 Infections Associated with Consumption of Raw Milk from Pennsylvania — 2017 and 2018. MMWR Morb Mortal Wkly Rep 2020;69:482–483.  https://www.cdc.gov/mmwr/volumes/69/wr/mm6915a4.htm

[xxiv] Holt, H. R., Walker, M., Beauvais, W., Kaur, P., Bedi, J. S., Mangtani, P., Sharma, N. S., Gill, J. P. S., Godfroid, J., McGiven, J., & Guitian, J. (2023). Modelling the control of bovine brucellosis in India. Journal of the Royal Society, Interface, 20(200), 20220756. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9991488/

[xxv] Imadidden Musallam, Andrée Prisca Ndour, et al.Brucellosis in dairy herds: A public health concern in the milk supply chains of West and Central Africa, Acta Tropica, Volume 197, 2019, 105042, ISSN 0001-706X. https://www.sciencedirect.com/science/article/pii/S0001706X19303304

[xxvi] Animal and Plant Health Inspection Service. “Status of Current Eradication Programs.” United States Department of Agriculture. April 2024. https://www.aphis.usda.gov/livestock-poultry-disease/status-eradication-programs

[xxvii] Canadian Food Inspection Agency. “Bovine tuberculosis.” Government of Canada. March 2024. https://inspection.canada.ca/animal-health/terrestrial-animals/diseases/reportable/bovine-tuberculosis/eng/1330205978967/1330206128556

[xxviii] Canadian Food Inspection Agency. “Fact Sheet - Brucellosis.” Government of Canada. May 2016.  https://inspection.canada.ca/animal-health/terrestrial-animals/diseases/reportable/brucellosis/fact-sheet/eng/1305673222206/1305673334337

[xxix] European Health and Digital Executive Agency. “Brucellosis (Brucella abortus, B. melitensis and B. suis).”  European Commission. 2022. https://hadea.ec.europa.eu/programmes/single-market-programme-food/veterinary-programmes/brucellosis_en

[xxx] Godfroid J, Nielsen K, Saegerman C. Diagnosis of brucellosis in livestock and wildlife. Croat Med J. 2010 Aug;51(4):296-305. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931434/  

[xxxi] Godfroid J. (2017). Brucellosis in livestock and wildlife: zoonotic diseases without pandemic potential in need of innovative one health approaches. Archives of public health = Archives belges de sante publique, 75, 34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5592711/

[xxxii] Wisconsin Department of Health Services. “Q Fever (Coxiella burnetii infection)” Oct 2021. https://www.dhs.wisconsin.gov/disease/qfever.htm

[xxxiii] United States Department of Agriculture, Animal and Plant Health Inspection Service. Mar 2024. “USDA, FDA and CDC Share Update on HPAI Detections in Dairy Cattle.”  https://www.aphis.usda.gov/news/agency-announcements/usda-fda-cdc-share-update-hpai-detections-dairy-cattle

[xxxiv] Cheng, W. N., & Han, S. G. (2020). Bovine mastitis: risk factors, therapeutic strategies, and alternative treatments - A review. Asian-Australasian journal of animal sciences, 33(11), 1699–1713. https://doi.org/10.5713/ajas.20.0156

[xxxv] Jones GM, Bailey TL, Roberson JR. (1998) Staphylococcus Aureus Mastitis: Cause, Detection, and Control. Virginia Cooperative Extension, Virginia Tech. https://www.thecattlesite.com/articles/679/staphylococcus-aureus-mastitis-cause-detection-and-control

[xxxvi] Macleod, G. The Treatment of Cattle by Homeopathy. Random House. 2012. https://books.google.com/books/about/The_Treatment_Of_Cattle_By_Homoeopathy.html?id=d92E1MECc48C

[xxxvii] Animal and Plant Health Inspection Service. “Bovine Leukemia Virus.” United States Department of Agriculture. Feb 2024. https://www.aphis.usda.gov/livestock-poultry-disease/cattle/bovine-leukemia

[xxxviii] Delarmelina E, Buzelin MA, Souza BSd, Souto FM, Bicalho JM, Câmara RJF, et al. (2020) High positivity values for bovine leukemia virus in human breast cancer cases from Minas Gerais, Brazil. PLoS ONE 15(10): e0239745. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239745

[xxxix] Buehring GC, Shen HM, Jensen HM, Jin DL, Hudes M, Block G. Exposure to Bovine Leukemia Virus Is Associated with Breast Cancer: A Case-Control Study. PLoS One. 2015 Sep 2;10(9):e0134304. https://pmc.ncbi.nlm.nih.gov/articles/PMC4557937/

[xl] Lin T, Meletharayil G, Kapoor R, Abbaspourrad A. Bioactives in bovine milk: chemistry, technology, and applications. Nutr Rev. 2021 Dec 8;79(Suppl 2):48-69. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653947/

[xli] Animal and Plant Health Inspection Service. “Johne’s Disease.” United States Department of Agriculture. Apr 2024. https://www.aphis.usda.gov/livestock-poultry-disease/cattle/johnes

[xlii] Jones PH, Farver TB, Beaman B, Cetinkaya B, Morgan KL. Crohn's disease in people exposed to clinical cases of bovine paratuberculosis. Epidemiol Infect. 2006 Feb;134(1):49-56. https://pmc.ncbi.nlm.nih.gov/articles/PMC2870362/

[xliii] John M. Aitken, Khoi Phan, Samantha E. Bodman, Sowmya Sharma, Anthony Watt, Peter M. George, Gaurav Agrawal, Andrew B.M. Tie, A Mycobacterium species for Crohn's disease?, Pathology, Volume 53, Issue 7, 2021, Pages 818-823,ISSN 0031-3025, https://www.sciencedirect.com/science/article/pii/S0031302521002348

10 Important Facts about Raw Milk and H5N1 Avian Flu

Let's cut through the media hype. Here's what you need to know about raw milk and avian influenza (also known as H5N1, bird flu, or HPAI).

1. Avian flu is a respiratory illness and NOT a foodborne illness.

2. There have been NO known cases of bird flu in humans from drinking raw milk.

3. There have been a small number of bird flu cases in farm workers working in direct contact with sick animals. Illness is generally mild, with conjunctivitis (pinkeye/eye inflammation) as main symptom.

4. In cattle, this illness is generally mild. Most of herd shows no signs of illness.

5. Ill cattle generally recover within a couple weeks. First symptom in cows is generally fever a few days prior to becoming clinically sick.

6. Symptoms include weakness, diarrhea, fever, lower milk production, poor appetite, and yellow-tinged, thick milk. Rarely, cattle can die from HPAI.

7. Affected cows respond well to drenching treatment with 5 gallons of water, antipyretic, probiotics, and a gut stimulant (i.e. yeast) for a few days.

8. HPAI directly affects the udder and milk production. Recovering animals may not fully regain milk production until next lactation.

9. In general, a dairy will move through bird flu and achieve “herd immunity” in ~6 weeks from start to finish.

10. Common sense precautions, just as for all other illnesses: Monitor your herd for illness. Quarantine animals who are ill and ensure that milk from unhealthy animals is NOT used for direct human consumption. Quarantine any new animals brought onto the farm to ensure they are healthy before joining the herd.

Here are some references for more detailed information:

• https://www.rawmilkinstitute.org/updates/h5n1-avian-flu-and-raw-milk-where-is-the-evidence

• https://www.colemanscientific.org/blog/2025/1/30/more-on-h5n1-and-cats-the-case-for-worrying

• https://www.nature.com/articles/s41586-024-08166-6

• https://pubs.acs.org/doi/full/10.1021/acs.estlett.4c00971

Advocating and Training for World-Class, Low-Risk Raw Milk for Pennsylvania, Delaware, and Beyond

Raw Milk Institute (RAWMI) recently traveled to Pennsylvania and Delaware in support of low-risk raw milk. Through training farmers, meeting with regulators, and visiting farms, we’re aiming to help ensure that raw milk is safe, embraced, and accessible in the northeastern states. 

BUILDING BRIDGES WITH REGULATORS AND FARMERS IN DELAWARE

RAWMI President Mark McAfee and Vice President Sarah Smith met with Delaware Secretary of Agriculture Don Clifton, alongside dairy farmers Steph and Gregg Knudsen, to discuss Delaware's recent raw milk legalization, proposed regulations, and ways we can all collaborate to ensure accessibility to safe raw milk in Delaware.

The Knudsens were instrumental in getting the legalization Bill passed so that more farms can thrive in Delaware. Mark and Sarah visited their G&S Dairy Farm to talk about the path moving forward now that raw milk is legal.

EDUCATING FARMERS FOR A SUSTAINABLE PATH FORWARD

Mark McAfee, Sarah Smith, and Dr Joseph Heckman taught a 3-hour seminar on World Class Raw Milk at the PASA Sustainable Agriculture Conference in Lancaster, Pennsylvania. Topics included

• History of raw milk

• Why raw milk farms are thriving

• Health benefits of raw milk

• Benefits of selling raw milk

• Safety and risks of raw milk

• Grass-to-glass raw milk risk management

• Raw milk testing

There were ~45 attendees from Pennsylvania, New Jersey, New York, Maryland, and Delaware. Attendees included farmers who are already producing raw milk, prospective farmers considering raw milk production, and students who were interested to know more about raw milk.

THANKS to Lancaster Farming newspaper for giving balanced coverage of this raw milk training class and the potential benefits of raw milk production for farmers. https://www.lancasterfarming.com/farming-news/dairy/demand-for-raw-milk-offers-opportunities-for-farmers/article_7b69a814-e401-11ef-93cf-b332916b01d8.html

PIONEERING FOR LOW-RISK RAW MILK

Edwin Shank, from The Family Cow dairy in Chambersburg Pennsylvania, is the farmer who pioneered on-farm bacterial testing for raw milk dairies. We're always happy to visit with Edwin and see how his multigenerational family farm is thriving. Edwin's farm is RAWMI Listed and we share his on-farm lab educational materials here: https://www.rawmilkinstitute.org/updates/on-farm-lab-testing-for-raw-milk-farmers

CONNECTING WITH AMISH FARMERS

There are many dozens of Amish dairies, but they can't generally access RAWMI’s online training materials. We want to make sure they have access to the information they need for low-risk raw milk production, regardless of any barriers to technology.

Several Amish farmers attended our training class in Lancaster, and we visited several Amish farms that are thriving with the current cultural shifts towards food security, local producers, and healthier foods to nourish the gut microbiome and immune system.

Overall, this trip was a resounding success! We were gratified to train more farmers in low-risk raw milk production and look forward to future collaboration towards successful rollout of Delaware’s recent raw milk legalization.

Advice for Farmers Considering the Switch to Raw Milk

In today’s unpredictable world, many dairy farmers are interested in selling raw milk. With it’s higher price point, raw milk provides sustainability for farmers while nourishing families and communities.

Demand for raw milk is increasing in recent years as consumers learn about raw milk’s significant health benefits. Raw milk consumption has been correlated to decreased rates of asthma, allergies, eczema, ear infections, fever, and respiratory infections. Raw milk consumption has also been correlated with improved lung health, and many consumers who are lactose intolerant can actually consume raw milk with no problems.  Plus, raw milk tastes great! Raw milk’s deliciousness is one of the main drivers for why consumers choose raw milk over pasteurized milk. 

It’s Not a Trivial Change

Switching from producing milk intended for pasteurization to raw milk intended for direct human consumption requires a huge shift in mindset and practices. Studies have shown that up to 27% of pre-pasteurized milk contains pathogens, whereas raw milk from well-trained farmers is very unlikely to contain pathogens.

Chart from “Two Types of Raw Milk” by the British Columbia Fresh Milk Project

The intent of this is not to denigrate farmers who produce milk for pasteurization. There certainly are some such farmers who operate very cleanly. However, their milk is generally still commingled with milk from other dairies (that do not follow hygienic practices) in the processor bulk tank.

Farmers who produce low-risk raw milk must carefully manage the cleanliness and hygiene of the farm as a whole from grass-to-glass. From the health of the herd, to cleanliness of the milking parlor, to the specific cleaning processes for the milk line, to ensuring rapid milk chilling, to regularly testing their milk, and everything in between, raw milk farmers have to be dedicated to taking their farm management to the next level in order to ensure that their raw milk is safe to consume.

For dairy farmers who are considering the switch to raw milk production, here are some specific guidelines for producing safe raw milk.

Cleanliness

Cleanliness is of paramount importance in producing raw milk. Your whole milking system, from udders to bottling, must be cleaned exceptionally well, or else there is a much higher likelihood that the milk will end up tainted with pathogens.

Udder preparation and cleaning is of particular importance, since dirty udders are the most probable source for pathogens in milk. Udders need to be clean and dry at milking.  For raw milk production, udder prep typically includes:

• brushing and/or cleaning the udders to make sure they are hygienic

• using a clean rag and towel for each cow/doe

• applying iodine-based teat dip, which is left on for at least 30 seconds

• wiping off the teat dip with a clean, dry towel

• stripping each teat with clean hands or gloves, and inspecting the milk to look for any signs of clotting, blood, etc.

More details on udder prep are given here.

Special care needs to be taken to ensure that the milking system, chiller, and tank are cleaned frequently and thoroughly.  Typically, the milking system needs to be cleaned after each milking with cool/tepid water first, followed by very hot alkaline cleaner, and then finished with hot acidic cleaner. Milk tanks need to be cleaned frequently, including complete disassembly and cleaning of the tank valve. We have more info on how to clean your milking equipment here.

Milk bottling should ideally occur in a clean, uncluttered room with smooth washable walls and floor. Care should be taken to ensure that the milk bottling room is kept clean and is not contaminated with manure or other filth.

Herd Health

Herd health is very important in raw milk production, as unhealthy animals are more likely to develop infection and mastitis which increases the likelihood of having pathogens in the milk. Your raw milk herd must be verified to be free of tuberculosis, brucellosis, and Johne’s disease. Biosecurity must be carefully managed to ensure that the herd does not come into contact with other animals (wild or domesticated) that may be carrying disease.

Rapid Chilling and Maintaining the Cold Chain

Under ideal growth conditions, bacteria counts double every 20 minutes.  Increased bacterial counts are associated with faster milk souring as well as greater presence of pathogens.  Decreased temperatures slow bacterial growth dramatically, and thus it is quite important to make sure that raw milk is rapidly chilled to slow bacterial growth. Ideally, raw milk should be chilled to 38F within an hour of milking. Keep raw milk cold throughout the bottling process and all the way through customer receipt of the milk. We have more info on how to achieve rapid chilling here.

Preventing Cross Contamination

Be aware that other farm animals such as chickens, rodents, birds, and pigs can pose a pathogen threat. For instance, chickens may carry salmonella and campylobacter, and cows/does that lie down in chicken manure may end up with pathogen contamination on their udders. Your milking herd should be kept separate from pigs and chickens. Chickens and birds should be kept out of the milking barn.

Milk stacking occurs when milk from subsequent milkings is placed in the same tank. Milk stacking is to be avoided as much as possible because it increases the likelihood of having bacterial problems. One bad batch can contaminate the rest. Additionally, milk stacking raises the temperature of the previously-cooled milk, making it more likely to support bacterial growth.

If your farm will produce both pasteurized and raw milk, you’ll need to take special care to ensure that the pasteurized milk is kept completely separated from raw milk. Pasteurized milk provides an ideal growth environment for pathogenic Listeria mono be can because there is no beneficial bacteria present to outcompete the Listeria.

Regular Testing

Don’t make the mistake of assuming that, just because your family can drink your raw milk with no problems, there are no pathogens present. Farm families have robust immune systems due to repeated exposure to the farm environment, so they are less likely to become ill from raw milk.  However, if you are selling raw milk to the public, you may end up with customers who have weak or impaired immune systems.  These customers will have a much lower threshold for illness from pathogens than farm families.

Testing is an important part of safe raw milk production. Testing provides a verification step that the practices and procedures are working well to produce low-risk raw milk. According to the Raw Milk Institute (RAWMI) Common Standards, raw milk should be tested regularly for coliforms and standard plate count. These tests provide a good indication of the hygiene, cleanliness, and handling of the milk. The Common Standards call for <10 coliforms/mL and <5,000 for SPC.

Take Care of Your Market

Selling to people versus selling to a processor: It’s an entirely different and very rewarding world. If you get it right, you’ll become a trusted brand and be beloved. 

As farmers who want to switch into the raw dairy market, besides following high standards for cleanliness and farm management, one of the biggest changes for you will be selling directly to people, kids, and families. You will no longer sell to a processor. The families you provide raw milk to trust you, and you’d better do an outstanding job! 

Building a market for raw milk does not just happen. Selling to a processor doesn’t require answering questions from end consumers or developing close consumer relationships. You’ll have to work hard to develop each relationship with your consumers, and be prepared to answer lots of questions. You must be interested in answering these questions and carefully researching to assure that the most current and accurate information is provided. All of this needs to be done with a warm smile :) and some compassion. 

As we say at RAWMI, “You don’t sell raw milk. You teach it”. If you teach enough, you can sell enough. It’s all about making that consumer connection with very high quality and safety. 

That means you become both a teacher and a producer.  If consumers don’t know what is so great about raw milk... they won’t buy it.  Why would they? They must learn first, then the sale is a done deal. Knowledge is gained and trust is earned before a sale is completed. 

Welcome to world of raw milk and directly nourishing people. 

We’re Here to Help

If you want more information on switching to raw milk production, please don't hesitate to ask. The Raw Milk Institute (RAWMI) trains and mentors farmers in the production of low-risk raw milk. RAWMI is a non-profit organization, so our training and mentoring is FREE for farmers. We also have brochures that can help with educating consumers about the benefits of raw milk. We'd be happy to help you in making sure you get off to a good start with raw milk. You can email us at contact@rawmilkinstitute.org.

Welcoming Four Farms in Tennessee, Nebraska, and North Carolina to RAWMI Community

The Raw Milk Institute (RAWMI) sends a warm welcome to four more farmers who have completed our Listing program!

RAWMI offers free mentoring to all dairy farmers. Whether they are milking one cow, a handful of goats, or a large herd, the principles of safe raw milk production form a foundational toolset that benefits all dairy farmers and their customers. 

Some of the farmers we mentor choose to keep it casual, and are satisfied to just ask us a few questions before continuing their raw milk journeys. There is another set of farmers, though, that is not content to just dip their toes in the water; they want to dive right in and take their entire milk process to the next level. 

For these farmers, we offer our (free) RAWMI Listing program, wherein we assist farmers in developing their own unique on-farm Risk Analysis and Management Plan, documenting their processes with written Standard Sanitary Operating Procedures, and identifying the Critical Control Points that are essential to their production of safe raw milk. RAWMI Listed farmers test their milk at least monthly for ongoing assurance that their processes are working well to produce low-risk raw milk. RAWMI Listing is the gold standard for raw milk producers.

Four raw milk farms have recently completed the RAWMI Listing process, and we extend them a warm welcome into our growing community!

Blueberry Dairy - Rogersville TN

Philip and Linda Hopkins’ farming journey began with an organic fruit orchard producing apples, pears, and blueberries. In early 2020, they felt that livestock would be a good addition to their farm, and goats seemed to be a natural fit with our rough terrain and limited grazing area.

Blueberry Dairy’s goal is to produce healthy, delicious milk and other dairy products by having happy, healthy goats. They are are strong believers in the family farm and are grateful for the opportunity to make that happen in their community. With the help of a RAWMI grant and support, Blueberry Dairy was able to build an on-farm laboratory for regular bacterial screening. This has been an essential step in ensuring that their milk is as safe as possible.

You can check out Blueberry Dairy’s Risk Management Plan and test results here: https://www.rawmilkinstitute.org/listed-farmers/#bberry

Chapman Family Farms and Dairy - Morrill, NE

Chapman Family Farms & Dairy is a raw milk dairy that is situated on the family farm of 158 acres. It is owned and operated by Elliot and Melanie Chapman. The dairy was started in 2020 to fulfill the passion Melanie has for cows. They started with one cow which has grown to about eight cows in milk at a time and they operate year-round.

Chapman Family Farms & Dairy is proud to supply the community with local, wholesome and nutritious products. They produce delicious low-risk raw milk for their community with the use of intentional risk management practices and on-farm lab testing. They have a small store onsite featuring raw milk dairy products along with local vendors, including beef and honey.

You can check out Chapman Family Farm and Dairy’s Risk Management Plan and test results here:

https://www.rawmilkinstitute.org/listed-farmers/#chapman

Milk Creek Dairy - Huron, TN

Julie Blankenship is a 3rd generation dairy farmer. Milk Creek Dairy is located in beautiful West Tennessee. Julie has a small herd of Registered A2/A2 Jersey cows. She is passionate about providing fresh, raw milk to the public for health benefits such as healing of gut and skin problems. Julie produces delicious low-risk raw milk for her community with the use of intentional risk management practices and on-farm lab testing (thanks to a lab grant from RAWMI).

You can check out Milk Creek Dairy’s Risk Management Plan and test results here: https://www.rawmilkinstitute.org/listed-farmers/#milkcreek

Towering Oaks Farm - Graham, NC

Towering Oaks Farm is a small family farm in Central North Carolina. They are committed to raising all of their animals in a healthy, happy environment because that makes a definite impact on the quality of the food products animals produce for us.  

In 2023, the Richardsons began producing raw milk for their family, Herd Share members, and Pet Milk Customers. Thanks to a grant from RAWMI, they were able to purchase the equipment for an on farm lab, and can now test their own milk more frequently than if they had to transport it to an off site lab. 

Towering Oaks is committed to providing their community with safe, clean, delicious, raw milk.

You can check out Towering Oaks Farm’s Risk Management Plan and test results here: https://www.rawmilkinstitute.org/listed-farmers/#towering

NOW IN STOCK: Raw Milk Institute T-Shirts, Hats, Mugs, and Booklets!

You’ve asked for it, so we’ve delivered! You can now purchase Raw Milk Institute t-shirts, hats, and mugs in our online store.

AND, our popular Booklet on Essential Principles for Low-Risk Raw Milk is now in-stock, too!

All items in our store have free USPS shipping in the USA!

Why Humans Drink (RAW) Milk

Why Did Ancient Humans Start Consuming Milk From Other Mammals?

10,000 years ago, early humans spent much of their time hunting, gathering, or fishing for food. Obtaining food was the dominant preoccupation of their lives. Imagine the reality for humans living prior to the advent of civilization. You can picture them living in crude shelters, wearing animal skins and using few tools. It was not like a 14-day survival challenge where they could call for a medic and be rescued. Eating and surviving were lifelong challenges.

You can hear the crying of babies and children that were hungry. Those cries are universal and have not changed over the millennia. The natural instinct to provide for the next generation was a compelling mandate which drove instinctual and natural innovation.

Early humans nursed their young, just as all mammals do. Nursing provided optimal nutrition for babies to survive and thrive. Breastmilk is a form of raw milk, serving as a complete food source that is perfectly designed to sustain life.

People observed animals in the wild nursing their young just as they nursed their own young. By capturing goats and aurochs (ancestral cow breeds), the people were able to collect their milk in pottery vessels. These humans would have learned quickly that milk from other animals was a complete, nutritious food. Being purposely designed to sustain life like no other food, this raw milk provided a steady source of readily available food for ancient humans.

Without refrigeration, any milk that wasn’t consumed quickly would naturally ferment into cheese curd and whey. The milk storage vessels likely contained bacteria cultures from previous milkings, and hence the culturing process was naturally reinforced with these bacteria.  The resultant curds could be stored and consumed over time. Curd contained a complete set of microbiome-friendly nutrients, and would be easy to digest due to its biodiversity. The humans could now bring along with them a portable supply of steady food. As long as they had sunshine, water, grass or shrubbery, and a mammal, they had food.  

Scientists have ample evidence that humans began drinking raw milk from animals at least 10,000 years ago. The evidence for the early use of animal milk is found in ancient clay pottery vessels, dental remains of Neolithic humans, and bone analysis of animal remains. Ancient baby bottles provide evidence that milk from animals was used to feed human infants at least 8,000 years ago.

The origin and dispersal of domestic livestock species in the Fertile Crescent. (Zeder, Melinda)

These agriculture-based civilizations were so successful that they spread across the Mediterranean region, Europe, Asia, and the Middle East over the next few thousand years. Humanity continued to domesticate additional species of animals; throughout history, many species have been utilized for their milk including camels, cows, goats, sheep, donkeys, horses, water buffalo, reindeer, and other mammals.

Those who consumed milk had a competitive advantage over those that did not have a steady source of readily available food.  This steady supply of food allowed for settlements and communities to develop. People no longer had to spend most of their time acquiring food, and could instead use their brain power to drive the development of sophisticated structures and towns. Domesticated animals became high value assets. As civilization advanced, those that owned milking mammals became wealthy and became the source of food for communities.

Selection of late Bronze/early Iron Age feeding vessels.(J Dunne, et al.)

Lactase and Genetic Adaptations for Milk

The domestication of mammals and consumption of their raw milk provided a source of biodiverse colonies of bacteria for the human gut. When people began drinking raw milk at least 10,000 years ago, these biodiverse bacteria began the genomic adaptation for lactase production and lactase persistence genes. Lactase is the enzyme responsible for breaking down lactose into digestible form. 

Humans who first began to consume milk from other mammals had not yet developed the lactase persistence gene. Nonetheless, they likely would have been able to readily digest raw milk because it facilitates the production of lactase enzyme in the intestinal tract. Archaeological evidence shows that humans were consuming raw milk for thousands of years before the widespread appearance of the lactase-persistence gene. This has led many researchers to the probably erroneous conclusion that Neolithic humans must have been fermenting or culturing milk to reduce or remove its lactose content.  

In reality, “lactose-intolerance” is primarily pasteurization intolerance.  Since raw milk facilitates the production of lactase, it is not likely that there were widespread issues with lactose intolerance in Neolithic populations. In all likelihood, these early populations would have been able to consume milk in its fresh form straight from the mammals, as well as in the lacto-fermented curds and whey which would form quickly without refrigeration.  

Stone carving at the ancient Sumerian temple of Ninhursag showing typical dairy activities. (Dorling Kindersley, The Visual Dictionary of Ancient Civilizations)

The competitive advantage provided by raw milk is not to be understated. Raw milk allowed humans to thrive in conditions where survival would have been difficult. It allowed them to migrate and proliferate from region to region with a steady supply of food. Those populations that consumed milk further adapted by developing lactase-persistence genes. Scientists now believe that the lactase-persistence genes were spread through natural selection. This means that the reproductive capacity and/or survivability of ancient raw milk drinkers was substantially increased compared to non-milk-drinking populations. The lactase-persistence genes would have facilitated the easy digestion of milk in many forms, including boiled or cooked milk. There is current evidence of lactase persistence genes in people from regions of Africa, Europe, Asia, and the Middle East. However, even those without the lactase-persistent gene can generally digest raw milk because of the raw milk bacteria that create lactase for the human gut. 

Pasteurization: A Technological Solution to a Manmade Problem

A 19th century illustration of "swill milk" being produced: a sickly cow being milked while held up by ropes. (Frank Leslie’s Illustrated Weekly)

By the mid-1800’s in America, some raw milk production had shifted away from farms and into highly-populated cities. Big cities did not have pastures or clean water, and the cows in city dairies were kept in filthy conditions with poor nutrition and poor animal health. Many of these cows were fed byproducts from alcohol distilleries, leading to illness in the cows. Raw milk, which had been safely consumed by humans for nearly 10,000 years, had become a source of deadly diseases such as tuberculosis, typhoid, diphtheria, and scarlet fever. 

In the late 1800's, it was recognized that raw milk being produced in these conditions was dangerous, and two solutions were proposed.  Pasteurization was one of the solutions which was proposed to eliminate pathogenic bacteria in the milk coming from these filthy conditions. The other solution was to actually produce the milk in hygienic conditions with healthy animals.  

It was known that raw milk was a superior source of nutrition for infants and children, so the American Association of Medical Milk Commissions (AAMMC) was established in the late 1800's to ensure a safe supply of hygienic raw milk. The AAMMC was in operation for nearly a century, certifying medical raw milk for use in hospitals and for feeding infants and children.  

Pasteurization was ushered in to address filthy conditions and unhealthy cows in cities.  It answered the question of how to commercialize dirty milk, rather than spending the time and energy it would take to produce clean milk from healthy cows. Clearly, over time, the pasteurization movement gained traction and became the standard for ensuring "safe" milk, yet pasteurization is known to degrade and damage many of the nutrients in milk. 

Raw Milk’s Role in the 2020’s

Now in the 2020’s, we are in a time of widespread immune depression, comorbidities, and compromised health. For most Americans, the competitive advantage of raw milk consumption has never been a reality. Raw milk’s immune-building properties and microbiome friendly traits have been forgotten. 

Instead, we live in the age of immune-destructive pharmaceuticals and antibiotics. Although life-saving in certain applications, these drugs also depress and damage the immune system and gut microbiome. Antibiotic resistance is now responsible for the deaths of tens of thousands of people every year in the USA alone. Furthermore, pasteurized milk is now recognized as a top food allergen and difficult to digest.  

Raw milk is an innate part of our healthy immune history, and is largely missing in our sterile, sugar-laden, preservative-laced, antibiotic-abusing modern diets and medical culture.  Safe raw milk has been rediscovered by those who study history and know the role of raw milk as a nourishing whole food.  Raw milk that is carefully and intentionally produced for direct human consumption is wholly different from milk being produced for pasteurization.  

So, the next time that someone says, “milk is for cows and not for humans,” share with them the intricate link between civilization and raw milk, and the competitive advantage that raw milk provided to humanity for 10,000 years. Many of these misinformed humans are in dire need of gut microbiome rescue like never before. Reach out to them with love, compassion and humanity. They need our support, nourishment, and education.    

REGISTRATION NOW OPEN: Feb 5th Pennsylvania Training on Producing World-Class Raw Milk

On Wednesday February 5th in Lancaster, PA, the Raw Milk Institute (RAWMI) will present a 3-hour seminar on Producing World-Class Raw Milk.

Whereas farmers producing milk for the pasteurized market often struggle to make ends meet, raw milk farms are thriving. Raw milk presents a unique opportunity for farmers to move into an expanding market by implementing intentional practices and higher standards to produce low-risk, delicious raw milk.

Raw milk is an exceptional farmstead product that brings all the added value back to the farmer with an incentive to work on quality. By selling directly to consumers, raw milk farmers are able to obtain greater financial rewards for their work, while consumers benefit from the improved flavor and nutrition. It’s a win-win for both farmers and consumers!

About the Training

This training workshop will be presented by the Raw Milk Institute (RAWMI) as part of the PASA Sustainable Agriculture Conference. This class will be from 9am-noon Eastern Time.

This RAWMI presentation will focus on:

• History of raw milk

• Why raw milk farms are thriving

• Health benefits of raw milk

• Benefits of selling raw milk

• Safety and risks of raw milk

• Grass-to-glass raw milk risk management

• Raw milk testing

• Building a successful raw milk market

Where to Register

Registration is now open through the PASA Sustainable Agriculture at: https://pasafarming.org/conference. Make sure to sign up for Wednesday attendance if you are going to attend our raw milk seminar.

Early Bird pricing is available through January 10th. PASA offers sliding scale pricing to attend the conference. If you will only be attending on Wednesday, the Early Bird cost is $70-$160 depending on your selected sliding scale level. Scholarships are also available through PASA.

Overcoming Hurdles for Raw Milk Legalization in Delaware

This article was written by Stephanie Knutsen, the dairy farmer who was instrumental in the successful legalization of raw milk in Delaware.

My journey to the legalization of raw milk in Delaware (DE) is quite unconventional, mainly because raw milk was not on my radar. Raw milk was illegal in DE and in the states around us, with the exception of Pennsylvania. I assumed it was going to remain so for quite some time. I certainly couldn’t make a difference, but wait… I did! Welcome to my story.

I didn’t seek out a legislator to champion the legalization of raw milk, but one found me! I received a phone call explaining that Senator Buckson was hearing from frustrated consumers about the lack of raw milk access in DE. He wanted to sponsor a consumer-driven bill to legalize raw milk sales, but wanted to tour a dairy farm and hear from DE dairy farmers before proceeding further. Little did I know that raw milk research and advocacy was about to take over my life.

We Drank Our Milk Raw, But Was it Safe to Sell to Others?

We have always consumed our own raw milk from G&S Dairy Farms without hesitation. I firmly believe people should have the right to weigh the risks and benefits to choose for themselves which foods to consume and therefore, I supported the idea of legalization. But, how did we feel about selling raw milk ourselves to the public?

I wondered:

• What is the real risk?  

• How many raw milk related illnesses are there?

• Would we be setting ourselves up to lose the farm in a lawsuit while trying to save it with raw milk sales?

• How could we live with ourselves if someone got really sick? 

These were questions I needed answers to.

Raw Milk Connections and Research

I remember sitting at the computer that night and typing “raw milk” into the Google search bar. By midnight I had landed myself on the Raw Milk Institute (RAWMI) website. The next day, I received the first of numerous personal phone calls from RAWMI Chairman Mark McAfee.  I was blown away with the knowledge, support, and guidance that Mark poured into me. RAWMI’s support proved instrumental in this legalization process. I was beginning to build my connections! These connections were a major key to our success story.

Many additional important connections came to me during my countless hours researching data, sifting through the bias on both ends of the spectrum, analyzing CDC datasets, and reaching out to experts across the country.  The more I studied, the more clearly I saw the raw deal that raw milk had been getting! For instance, I had heard that raw milk has "life threatening" risks yet in looking at the data, I could only find 2 confirmed deaths due to raw milk in nearly 20 years. This was despite the fact that millions of people regularly drink raw milk. The CDC estimates there are 3,000 deaths annually from food borne illnesses, yet they have only confirmed 2 deaths related to raw milk in ~20 years so the risks of raw milk were being greatly exaggerated.

With a newfound passion ignited, I no longer questioned if raw milk was a good idea for our farm. I could envision a future in dairy for our children for the first time! I committed myself to making sure that DE, which is referred to as “The First State,” was not going to be known as “The Last State” in regards to raw milk legalization.

Learning From a Failed Legalization Attempt

Once I empowered myself with the knowledge and facts, I needed to gather support. A failed attempt for legalization had been made ten years earlier. A friend, who also happened to be the Senate Policy Director, was able to access the recorded tapes from that failed legislation so we could understand who had opposed it and why.

Ten years ago, dairy farmers were worried someone would get sick and make the industry look bad. The Farm Bureau had been neutral about raw milk legalization, but both the Agriculture Department and Health Department were opposed. This understanding gave us a starting point for building support!

Building a Coalition of Stakeholders

Although there were 44 family dairies in DE during the previous attempt at legalization, there were now only 13 dairies remaining.  I reached out to these 13 family-run dairies in DE to share my research about safe production of raw milk. I also shared that the market for raw milk is growing and creates a path to sustainability for small-scale dairies. This resulted in an overwhelming amount of positive support for raw milk legalization by dairy farmers of Delaware. 

Next was the Farm Bureau, to see if they would potentially be willing to support raw milk legalization instead of keeping their previous “neutral” position. After meeting personally with the Farm Bureau administrator, we reached out to every county Farm Bureau and asked to speak at each of their board meetings. The timing was perfect since every Farm Bureau county hosts a legislative breakfast to inform legislators of upcoming bills and policies affecting farmers.

I presented on raw milk at each of these legislative breakfasts while the bill was still being drafted. The breakfasts allowed me to reach many legislators at once in a personal way. Much of our bi partisan support stemmed from these early face-to-face meetings where legislators could hear the whole story before they even knew about the coming bill. Soon we had every county board and then the state board of the Farm Bureau voting in support for raw milk legalization.

Building Bridges with the Opposition

We knew that the Agriculture Department and Health Department had previously opposed raw milk legalization. Instead of hiding what we were doing, we hoped to bring them along and give them the chance to learn more. This strategy proved successful over and over again.

With farmers and Farm Bureau on board, we were now well-positioned to meet with the Agriculture Department. Despite their longtime stance against raw milk, our Secretary of Agriculture was open to listening. I explained about consumer demand for raw milk, the economic impact to DE dairy farmers, the true risks of illness for carefully produced raw milk, and how we could further reduce health risks through regulations including bacterial testing with on-farm labs to ensure milk meets post-pasteurized standards for bacterial counts. By the end of the meeting, the Secretary of Agriculture was no longer opposed to raw milk legalization. We invited him to have input into the bill language and he eventually became our biggest and most powerful advocate!

We knew the Health Department was likely to be a tougher-sell on supporting raw milk due to entrenched beliefs about raw milk being dangerous. Senator Buckson called a meeting with the Health Department where he shared the “why” behind the legalization bill and mentioned that the bill might be passed due to bipartisan support. The Senator then invited the Health Department to provide input into the bill language to address their concerns. Although I would love to take credit for what happened in that room, all the credit goes to God. Miraculously, the Health Department agreed to be neutral on the bill!

Legalization Success

With farmers, Farm Bureau, and our state agencies on board or at least neutral, we introduced the bill with bi-partisan support in both the house and senate.  I could write a novel about every step of the way and the twists and turns we encountered, including the discovery of Bird Flu crossover to dairy!  Maybe I will someday, but that isn’t the purpose of this piece. We were successful and raw milk is now legal in Delaware!

Keys To Success

For those who want to advocate for legalization in other states or countries, I want to encourage you. Know that YOU can make a difference. Some of the keys to our success were the following.

• Raw milk is no longer just farmer-driven. It is consumer-driven by the countless people and families who deserve access to this special food.

• It was important to do the research and have fact sheets available with real data, including comparisons to other foods.

• It was crucial to reach out to stakeholders early on, especially to those who were opposed. It was scary and would have been easier to ignore the opposition and hope for the best, but with lots of prayer and bravery I sought after conversations with such people.

• An important approach that worked time and time again was to first just listen, show understanding for the concerns, find the common ground and move forward from there. By meeting people where they were, letting them feel validated and heard, and acknowledging that I too had felt that way, we were no longer enemies and we could have meaningful conversations where they were open to learning how my thoughts had changed.

• It was also important to build a strong team. Some of the key players on our team were the bill sponsor (Senator Buckson), his policy director, the agriculture advisor to the governor, Raw Milk Institute, Farm-to-Consumer Legal Defense Fund, Pete Kennedy (Weston A Price Foundation), and especially Peg Coleman (who provided scientific backing on risk assessment and valuable information related to the bird flu).

• I learned that emails proved to have very little impact and personal interaction was the winning ticket. My advice is to build as much support as possible early on, even before bill writing is complete.

• And lastly but most importantly pray! I saw God’s hand at work in this so many times and drew strength from that when I felt weary. He slayed some mighty giants for us along the way and I have to give him the praise and glory. Don’t be complacent. I knew very little about raw milk and look at what was accomplished. You can make a difference! If I could do it, you definitely can too!

Raw Milk, Asthma, and Lung Health

There are multiple peer-reviewed, scientific studies which correlate raw milk with improved lung health, both in childhood and adulthood.

Children Who Drink Raw Milk Have Less Asthma

Several large epidemiological studies of European children have found correlations between raw milk consumption and decreased rates of asthma.

PARSIFAL Study

The PARSIFAL study was designed to look at allergy risk factors in children. This large study of over 14,800 European children (from Austria, Germany, the Netherlands, Sweden, and Switzerland) investigated asthma and allergic diseases in relation to children’s exposure to different environments (farms, rural, suburban) and farm-fresh foods (such as raw dairy products, eggs, and vegetables). The PARSIFAL data relating to asthma and raw milk were published in December 2006 in the Journal of Clinical and Experimental Allergy [1].

The PARSIFAL study concluded that there is a "significant inverse association between farm [raw] milk consumption and childhood asthma." The study found that, regardless of which environment the children lived in, those children who drank raw milk had significantly lower rates of asthma than children who did not drink raw milk.

GABRIELA Study

The GABRIELA study was designed to investigate the genetic and environmental causes of asthma.  This study included over 8,000 European children (from Germany, Austria, and Switzerland), and was published in the Journal of Allergy and Clinical Immunology in August 2011 [2]. In this study, raw milk consumption was compared to consumption of boiled/pasteurized milk, and the level of exposure to raw milk in utero through school age was also accounted for. The study also looked into the children’s exposure to farm environments as a possible variable related to rates of asthma.

The GABRIELA study found that raw milk consumption is associated with significantly lower rates of asthma, and that this beneficial effect is independent of other farm exposures. It was found that early exposure to raw milk (at <1 year of age) and daily consumption of raw milk increased the beneficial effect in children who drank a mixture of raw milk and pasteurized milk. The consumption of only pasteurized milk “was not associated with any health outcome.”

PASTURE Study

The PASTURE study followed children from birth to age 6 years in order to gain a better understanding of the effects of raw milk consumption on asthma. This study of over 900 European children (from Germany, Austria, Switzerland, Finland, and France) was published in January 2016 in the Journal of Allergy and Clinical Immunology [3].

The PASTURE study concluded that, "Continuous farm [raw] milk consumption in childhood protects against asthma at school age." This study found that raw milk’s “beneficial effect on asthma increases over time. Recent consumption of farm milk seems to be more relevant than consumption in the first years of life, which extends the concept of early prevention to sustained prevention until school age and beyond.” 

It’s Not the “Farm Effect,” It’s the Raw Milk!

Some of the research correlating decreased asthma with raw milk consumption has been criticized as actually demonstrating that living on a farm is associated with decreased rates of asthma. However, several of the studies specifically analyzed the effects of living environments, and found that the beneficial effects of raw milk on asthma were indeed present even in children who did not live on farms.

Furthermore, a meta-analysis of eight health studies related to raw milk was published in the November 2019 issue of the Journal of Allergy and Clinical Immunology [4]. A meta-analysis is a quantitative statistical analysis which combines the results of multiple scientific studies, thereby allowing the researchers to derive overall conclusions about that body of research. The recent meta-analysis, written by a team of researchers from the Netherlands and Germany, concluded that when taken as a whole, the body of data from the previous studies shows that raw milk consumption in childhood has a protective effect on asthma “independent of other farm exposures and that children not living on a farm can theoretically profit from this effect.” 

Adults Who Drank Raw Milk in Childhood Have Better Lung Function

Agricultural Lung Health Study

There is evidence that raw milk’s beneficial impacts on lung health are not isolated to childhood. Evidence that raw milk has a beneficial effect on adult lung health is seen in the Agricultural Lung Health Study, which is part of the larger Agricultural Health Study that was designed to investigate how agricultural, lifestyle and genetic factors affect the health of farmers.  The Agricultural Lung Health Study data relating to lung health and raw milk were published in March 2018 in the journal Thorax [5].

This study investigated lung function in over 3,000 USA older adults, with a mean age of 63 years.   It was found that "raw milk consumption, particularly early in life, is associated with better pulmonary [lung] function in adulthood." This study found that childhood raw milk consumption was correlated with “higher forced expiratory volume” and higher “forced vital capacity”, leading the researchers to conclude that “the beneficial effect of raw milk is predominantly on lung growth.”

Low-Risk Raw Milk as a Therapeutic Tool

It is clear from all of this research that raw milk consumption is correlated with improved lung health.  Children who drink raw milk have lower rates of asthma, and childhood raw milk consumption leads to improved lung health that lasts into older adulthood. There is a growing body of evidence that raw milk is a low-risk food when it is produced carefully and intentionally [6, 7]. Thus, low-risk raw milk can be a powerful therapeutic tool for improving lung health.

References

[1] Inverse association of farm milk consumption with asthma and allergy in rural and suburban populations across Europe. Clinical and Experimental Allergy. 2007; 37(5):661-70. Waser M, Michels KB, Bieli C, Flöistrup H, Pershagen G, von Mutius E, Ege M, Riedler J, Schram-Bijkerk D, Brunekreef B, van Hage M, Lauener R, Braun-Fahrländer C; PARSIFAL study team. https://www.ncbi.nlm.nih.gov/pubmed/17456213

[2] The protective effect of farm milk consumption on childhood asthma and atopy: The GABRIELA study. Journal of Allergy and Clinical Immunology. 2011; 128 (4): 766-73. Loss G, Apprich S, Waser M, Kneifel W, Genuneit J, Büchele G, Weber J, Sozanska B, Danielewicz H, Horak E, Joost van Neerven RJ, Heederik D, Lorenzen PC, von Mutius E, Braun-Fahrländer C; GABRIELA study group. https://www.jacionline.org/article/S0091-6749(11)01234-6/fulltext

[3] ω-3 fatty acids contribute to the asthma-protective effect of unprocessed cow's milk. Journal of Allergy and Clinical Immunology. 2016; 137 (6): 1699-1706. Brick T, Schober Y, Böcking C, Pekkanen J, Genuneit J, Loss G, Dalphin JC, Riedler J, Lauener R, Nockher WA, Renz H, Vaarala O, Braun-Fahrländer C, von Mutius E, Ege MJ, Pfefferle PI; PASTURE study group. https://www.jacionline.org/article/S0091-6749(15)01731-5/fulltext

[4] The Beneficial Effect of Farm Milk Consumption on Asthma, Allergies, and Infections: From Meta-Analysis of Evidence to Clinical Trial. Journal of Allergy and Clinical Immunology: In Practcice, 2019. 8 (3): 878-889. Brick T, Hettinga K, Kirchner B, Pfaffl MW, Ege MJ. https://www.ncbi.nlm.nih.gov/pubmed/31770653

[5] Raw milk consumption and other early-life farm exposures and adult pulmonary function in the Agricultural Lung Health Study. Thorax, 2018; 73:279-282. Wyss AB, House JS, Hoppin JA, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758444/

[6] Recent Trends in Unpasteurized Fluid Milk Outbreaks, Legalization, and Consumption in the United States. PLOS Currents. 2018; 10. Whitehead J, Lake B. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140832/#ref27

[7] Raw milk producers with high levels of hygiene and safety. Epidemiology and Infection, 2020; 148, e14, 1-7. Berge AC, Baars T. https://www.ncbi.nlm.nih.gov/pubmed/32000877