Why do Americans keep drinking raw milk?

Early this spring, not long after federal agencies identified a strain of bird flu spreading among cow herds in Texas and eight other states, warnings began to emerge from US government agencies: Don’t drink raw milk. Raw milk, which hasn’t been through the pasteurization process, has always enjoyed some renegade popularity among certain corners of the US population. Most recently, wellness influencers have evangelized about its purported benefits, despite the health risks. In April, science emerged suggesting H5N1 viral concentrations were extraordinarily high in the udders of infected cows, raising concerns that their milk could cause infections in humans. Many health experts breathed a sigh of relief when studies showed the virus is killed in milk that’s been pasteurized — that is, heated to kill invisible microbial pathogens. Here’s the wild part: According to a recent report from the Associated Press, in the time since these announcements were made, weekly raw milk sales have gone up, not down — an increase of 65 percent compared to the same period last year. “It defies logic,” says Nicole Martin, a food scientist and the associate director of the Milk Quality Improvement Program at Cornell University. Does the uptick represent increased consumption among people who already drink raw milk or new interest from people now hearing about it for the first time? It’s not entirely clear, but according to a raw milk farm owner quoted in the AP story, “Anything that the FDA tells our customers to do, they do the opposite.” Pasteurization has been making the world’s milk supply dramatically safer since the late 1800s, and for just as long, a portion of milk drinkers have been rejecting that technology. Still, now is an especially important time to be aware of the risks of raw milk. It’s also an opportunity to better understand why people make certain choices even — or especially — when public health experts recommend against them. Raw milk has never been safe, but it might be especially risky right now For centuries, milk contamination was a leading cause of life-threatening diseases, accounting for dire diarrheal illness in young children and infections in people of all ages like tuberculosis, typhoid fever, scarlet fever, and diphtheria. In the 1860s, Louis Pasteur found that heating a liquid to a certain temperature killed any bacterial contaminants. He initially proved the concept using wine; it wasn’t long before the process was applied to milk. As milk production became more industrialized, pasteurization became more common, especially at larger commercial dairies. However, there was pushback from the outset: Some people complained pasteurized milk lacked flavor, and even government safety officials contended it was not as nutritious as raw milk. Although milk pasteurization became the law of the land with the 1924 federal Standard Milk Ordinance, raw milk consumption persisted, often extralegally — and with it, persistent outbreaks of infection. It’s now legal to sell raw milk for human consumption in many states. Although outbreaks of associated infections are more than three times as common in states that permit the practice, state legislatures are increasingly interested in passing laws that ease consumer access to raw milk products. There are lots of different ways germs can get into raw milk between cow and carton: They can sneak in via infected cow udders; flecks of soil, dirty water, or cow manure in a dairy farm environment; or milking equipment that’s been in contact with any or all of the above. Between 2000 and 2019, studies showed disease-causing bacteria were present, on average, in 3.6 to 6 percent of raw milk sampled as a matter of routine (in other words, these samples weren’t obtained to determine whether the milk had caused people to get sick). According to a study conducted by the Centers for Disease Control and Prevention and the Food and Drug Administration, there were 202 disease outbreaks in the US due to drinking raw milk between 1998 and 2018, leading to 2,645 illnesses, 228 hospitalizations, and three deaths. In 2017, nearly 5 percent of Americans were thought to consume unpasteurized milk products, including raw cheese, and raw dairy products led to 840 times more illnesses than pasteurized products. Drinking raw milk can cause a variety of different infections. Most include the classic gastroenteritis symptoms of diarrhea, vomiting, and abdominal cramping, and some are more likely to progress to more severe syndromes including muscle weakness or paralysis, kidney failure, and bloodstream infections. With these and many other raw milk-related infections, those at highest risk for bad outcomes are children, the elderly, and immunocompromised people. There’s no evidence yet that any humans have gotten infected with the latest strain of H5N1 as a result of drinking unpasteurized milk; the only human infection confirmed to date is in a dairy worker, who was likely infected by a splash of milk in his eye. However, during the recent outbreak, more than half of the domestic cats fed raw milk from cows on an affected farm died with flu-like symptoms, and the two who were autopsied showed signs of severe H5N1 infection. That raises concern that something similar could happen to humans. Although experts are of course worried about individual illnesses, they’re also worried about the population-wide effects of lots of H5N1 infections. Bird flu, like all influenza viruses, is notorious for its mutation abilities, which is why it’s so good at adapting to spread among different species. Every human infection is an opportunity for the virus to effectively throw a bunch of genetic mutations at the wall and see what sticks — that is, which mutations might make it spread easily among humans, potentially leading to another pandemic (although experts say we’re not there yet). Many claims about raw milk aren’t rooted in science, but not all are false Raw milk aficionados — including wellness milkfluencers who have been promoting its benefits on social media for the last several years — cite a range of reasons for preferring raw milk. The nutritional value of pasteurized milk isn’t meaningfully different from that of raw milk, as some claim without evidence. Heating milk to a high temperature for a short time — as most American pasteurization processes do — yields a minor decrease in some vitamins native to milk, says Martin. However, these vitamins, like vitamin C, aren’t ones milk is typically considered a good source of anyway. The FDA has a webpage dedicated to correcting all sorts of rumors about raw milk, like that it’s a good source of probiotics (it’s not) and that it cures lactose intolerance (it doesn’t). Still, people often repeat these misconceptions about the product on TikTok and Instagram. One difference between raw and unpasteurized milk that Martin acknowledges is real: Raw milk often has a higher fat percentage and a more distinct flavor than pasteurized milk, which can appeal to consumers. The flavor difference is largely attributable not to raw milk’s rawness, she says, but to the fact it’s from cows at one farm eating grass from one pasture rather than being pooled from cows from many farms eating different types of feed. Different diets create unique flavors in raw milk that some consumers really like. However, it’s possible to get pasteurized milk with local character from smaller, family-owned dairies that pasteurize milk from grass-fed cows who live on a single farm. Interest in raw milk may be less about milk and more about trust One of the most important reasons people may be drawn to drinking raw milk: They’re often buying it from a farmer they know and trust, says Martin, far removed from the big, industrial system that makes the processed food in most supermarkets, including pasteurized milk. They don’t trust that massive, largely invisible industrial system, and they have good reasons not to. What people see on a farm may give them a lot of confidence in its products. “People will say something along the lines of, ‘I know the farmer. I know how passionate he is. I know how much work he puts into it. I’ve seen the cows — they’re spotless,’” Martin says. Unfortunately, she adds, looks can be deceiving when it comes to ruminant biology. Immaculate cows can still transfer pathogenic bacteria into raw milk. Raw milk preferences may also stem from government distrust, says David Acheson, an infectious disease doctor and consultant who has led food safety efforts at the FDA. The Food and Drug Administration closely scrutinizes milk, he says, which is more of a negative than a positive for people suspicious of government authority. Government distrust is at a high point right now, says Acheson: “The way the government handled Covid tipped a lot of people against” having confidence in authorities. Statements decrying raw milk as unsafe remind people of the way experts arbitrarily arrived at a recommendation to distance six feet from others, closed beaches, and told people to wear masks even outdoors — all on the basis of shaky or no science, he says. Although the science on raw milk is much stronger than Covid-19 prevention science was, especially at the outset of the pandemic, “people put it all in the same bucket.” Raw milk’s appearance at the nexus of industrialized agriculture and wellness space creates opportunities for unexpected kinship. Its advocates come from all sides of the political and ideological spectrum and many different parts of American society. Acheson also wonders if some of the increase in raw milk consumption is coming from people newly raw milk-curious amid the furor of recent news coverage. Its proponents simply have savvier marketing than pasteurization advocates, he says. I can personally testify that a search for raw milk information online yields a distinct choice between pasty government websites and colorful, interactive sites created by raw milk groups. The difference is even more stark on social media, where hashtags favoring pasteurization lead to images of science projects, and those encouraging raw milk consumption lead to images of hot people with visible abs. It’s not just merchandising: Public health authorities haven’t figured out how to communicate with a skeptical public in a way that elicits trust rather than suspicion, opposition, and defiance, says Katelyn Jetelina, a San Diego-based epidemiologist who authors the popular Your Local Epidemiologist newsletter. “The trickle-down approach that we’ve always used,” says Jetelina, where health authorities communicate through official channels and expect the public to listen — “it’s just not effective.” Instead, Jetelina thinks public health experts should be equipping trusted messengers to educate the populations who already go to them for health information. That means the most effective evidence-based food safety messaging should perhaps be coming not from government agencies but from physicians and emergency medical technicians, she says — “and your fitness bros.”