by Annie Fenn, MD
My mission to find the freshest milk possible for making homemade ricotta cheese seemed relatively simple. I was pining for the sweet, cream-on-top milk that I had tasted while living with a family in Ecuador—milk so fresh that it still had a whiff of the highland grasses where the cow had grazed just hours before. My quest led me over the mountains from Wilson, Wyoming, to Victor, Idaho, where I found a farm producing raw milk. Along the way, though, I found a heated controversy over the health virtues of raw-milk pitted against the concerns over dangerous bacterial pathogens. Not wanting to expose my family to food-borne illness, I was determined to tease out the facts in the fiery raw-milk controversy that straddles not just the fields of medicine and public health, but also the arenas of politics, law, and personal freedom.
Raw milk is touted as a health panacea, said to improve the immune system and prevent asthma with its powerful enzymes, antibodies, and flora of bacteria. Raw-milk enthusiasts believe that a clean dairy farm with periodic bacterial testing poses very little health risk. Public health officials beg to differ, citing the incidence of outbreaks of Salmonella, Campylobacter, Listeria, and Escherichia coli O157:H7 (E. coli) that have been traced to unpasteurized dairy products—raw milk, ice cream, and fresh cheeses.
As a physician, I am acutely aware of how seriously ill you can become if exposed to these bacterial pathogens. Pregnant women, children, and the elderly are especially susceptible to food-borne illness, and bear the brunt of the complications. But as a food enthusiast and cheese-making novice, I am hesitant to give up using raw milk in my kitchen. The bright, herbal flavor and creamier mouth-feel makes it perfect for homemade yogurt, mozzarella cheese, ricotta, and buttermilk. The flavor of my homogenized organic supermarket milk, which I know has been pooled by farm conglomerates and shipped from a great distance, pales in comparison.
The Raw Milk Craze Food fresh from the farm is undeniably appealing, and the enthusiasm for raw milk is gaining ground. Nine million Americans—roughly 3 percent of the population—drink raw milk on a regular basis, either from cow, sheep, or goat. Enthusiasts are drawn to more than just the milk’s seductive flavor and richness; support of the farmer is the most common reason cited for drinking raw milk, followed by the belief that pasteurization destroys essential nutrients and the “good bacteria” that contribute to a healthy immune system.
Other raw-milk advocates are politically driven, arguing that they should be able to eat whatever they want without interference from the government. Only thirty states allow raw milk to be sold in stores for human consumption. Some states that prohibit the retail and/or farm sale of raw milk do allow consumption from your own cow. Consumers get around these laws by forming “milk clubs,” in which people purchase a share in a cow, and then divide up the milk; or by buying raw milk labeled as “pet milk” by black-market delivery services in what have been described as modern “moo-nshine” operations.
I live in Wyoming, one of the twenty states in which it is illegal to sell raw milk products, but I can drive thirty minutes across the Idaho border and purchase raw milk in a retail store in Driggs. In 1987, the Food and Drug Administration (FDA) banned the shipment of raw milk across state lines. Illegal interstate shipping of raw milk has landed some farmers in handcuffs, with hefty fines and, in some cases, their farms shut down.
Cheeses made with raw milk are deemed free of pathogens after being aged for sixty days (although outbreaks have occurred from raw-milk cheeses beyond this period), and are therefore legal to consume in all states. Fresh cheeses made from raw milk aged less than sixty days—like some of the finest cheeses from France and Italy—can neither be sold domestically nor imported.
Is Dairy a Danger? If raw milk is so good for you, why does the FDA state that it poses a serious health risk? Why have numerous organizations—including the American Academy of Pediatrics and the American Medical Association—drafted guidelines that clearly state that unpasteurized milk is unfit for human consumption?
Back in the days before pasteurization (which became standard in the 1930s), 25 percent of all food and waterborne disease outbreaks were caused by the consumption of raw milk. Bovine tuberculosis and brucellosis accounted for many of the serious illnesses, and most of the infant deaths. Today, cattle in the United States are virtually free of bovine tuberculosis and brucellosis, but a new set of modern pathogens has emerged.
Campylobacter, E. coli O157:H7, Salmonella, and Listeria are modern day germs that have spread to dairies and feedlots around the country, even small pasture-based farms. These pathogens are carried in the feces of humans and animals, and have contaminated a dizzying array of the food supply—not only through unpasteurized dairy products, but also through raw spinach, lettuce, sprouts, beef, cantaloupe, chicken, eggs, nuts, and even flour. Raw cookie dough, anyone?
You may recall when E. coli O157:H7 burst onto the public health scene with such virulence, killing four children infected by eating hamburgers at a Jack in the Box® in 1993. Since then, this particularly dangerous strain of E. coli has become an important health hazard, and the leading cause of kidney failure in children. E.coli bacteria enter the intestinal wall, secreting a potent toxin into the bloodstream. This sets off a cascade of changes in the blood, resulting in blood clots blocking the kidney’s delicate vascular network, and an acute kidney failure called hemolytic uremic syndrome (HUS). Children who develop HUS have a 30 percent chance of dying from the disease; the survivors are often left with lifelong impaired kidney function.
Give me the Numbers The Centers for Disease Control and Prevention (CDC) is the best source for information on who’s getting sick from unpasteurized dairy products, and where. A study released in March 2012 documents the extent of the problem in all fifty states from 1993 through 2006: there were 121 outbreaks that resulted in 4,413 illnesses, 239 hospitalizations, and three deaths. A disproportionate amount of those affected were children (60 percent), and most occurred in states in which raw milk is legal. Between 2001 and 2011, ninety raw-milk outbreaks sickened a total of 1,550 people.
Just recently, raw milk from Your Family Cow dairy in Pennsylvania tested positive for Campylobacter, infecting eighty people in four states. In an open letter posted on the dairy’s website, farmer/owner Edwin Shank acknowledged responsibility. “It was us … food from our farm has made people sick,” wrote the distraught Shank. The farm had passed all health inspections in the months prior to the outbreak. Interestingly, though, the milk sickened none of his children or farm employees. The dairy is once again up and running after passing a recent health inspection.
Twenty-seven cases of Campylobacteriosis have been documented in the last ten years in Wyoming, where it is illegal to sell raw milk. All outbreaks were linked to the consumption of raw milk: Two were from small dairy farms illegally selling raw milk; one was from a family cow that sickened all twelve family members.
Pasteurization is no guarantee of milk safety; 40 percent of the total dairy-related outbreaks in the CDC’s recent study were caused by pasteurized milk. In 2007, three Massachusetts men died after drinking pasteurized milk contaminated with Listeria in the bottling area of the facility in which it was produced.
Raw-milk enthusiasts criticize the government for underreporting when pasteurized milk causes illness, while raw-milk outbreaks create national headlines. That may be true, but infections caused by tainted pasteurized milk tend to be less severe. When pasteurized milk is contaminated, it usually happens after it leaves the farm, and by less virulent pathogens such as norovirus, which causes a mild diarrheal illness. There has yet to be a documented instance of E. coli O157:H7 infecting pasteurized milk. But as the Massachusetts case illustrates, deadly germs can contaminate even pasteurized milk if it is improperly handled. Raw-milk consumers nationwide account for a disproportionate amount of illness. According to the FDA, raw-milk outbreaks outnumber pasteurized ones 150 to 1.
Worth the Risk? Raw milk advocates acknowledge that raw milk is more risky to drink than pasteurized milk, but they believe the health benefits outweigh the risks. Milk that has not been subjected to heat treatment, turbulence, and filtration retains critical enzymes, carrier proteins, vitamins, and antibodies, they claim—all of which make raw milk a virtual super food.
As I delved into the medical literature addressing these health claims, I was struck by the paucity of information. While raw-milk health risks are relatively easy to document via outbreaks, the health claims are harder to prove. It’s not just raw milk; it is usually difficult to prove that any food truly prevents disease.
Does pasteurization and homogenization destroy all the nutrients and enzymes in milk, rendering it nutritionally inferior? Most agree that at least half of the Vitamin C is destroyed, but this may not pose an important health risk since it is so plentiful in other foods.
Many enzymes are destroyed since the level of heat needed to achieve pasteurization will cause other proteins to become denatured as well. While there is debate on whether or not humans benefit from these enzymes—which by definition are species-specific proteins designed for unique functions—they are crucial for cheese makers. The naturally occurring enzymes in raw milk are instrumental in crafting cheeses with complex flavors and textures, which result from the action of these enzymes on bacterial flora.
Raw milk retains its full complement of lactase, an enzyme needed to digest the milk sugar lactose, making it more digestible. Testimonials of formerly “lactose intolerant” raw-milk consumers are plentiful on pro-raw-milk websites.
Pasteurization destroys the stigmasterol (also called the Wulzen anti-stiffness factor) found in raw milk, a plant sterol thought to prevent cancer, inhibit cholesterol absorption, and slow the deterioration of arthritis. Stigmasterol is a precursor to vitamin D3 and progesterone in the body, and is also found in soy, legumes, nuts, and seeds. A modest body of literature supports the benefit of stigmasterol, although studies in humans are not available.
Raw milk’s ability to prevent childhood asthma and allergies is one health claim that has been studied scientifically. The most frequently cited study comes from rural Austria, Germany, and Switzerland, where 8,334 school-aged children were evaluated (by questionnaire) for asthma, allergies, and hay fever. Those fed raw milk were less likely to develop asthma independent of other farm exposures. Pasteurized farm milk did not show this protective effect. The raw milk did not reduce the children’s chance of hay fever or other allergies. The Swiss study is by no means definitive by most scientific standards, but it does add to the increasing body of evidence pointing to a protective effect of raw milk, consumed early in life, and a reduction in childhood asthma, and possibly allergies (as shown in other research).
If you are passionate about drinking raw milk, you should live in Idaho, where ninety dairies are licensed to produce it. The Idaho Department of Agriculture enforces high standards on the milk and cheese coming out of these dairies. Frequent testing of raw milk at the farms includes a check for the coliform count (a measure of the total E. coli-like bacteria), somatic cell count (which would also include white blood cells, an indicator of infection), and drug testing of cows.
Most importantly, Idaho has an excellent public health record, with no outbreaks linked to raw milk products, even though they have been “legal since forever,” according to Marv Patten, a thirty-five-year veteran of the Idaho Department of Agriculture who oversees all the milk production in Idaho. His department has been instrumental in getting the “backyard sales” of raw milk out in the open in order to provide better public health.
Born and raised (on raw milk) on a dairy farm, Patten acknowledges that he was in and around cow dung most of his life. Even though his state has one of the best public-health safety records in the country, he still believes that raw milk is “not as safe as a pasteurized product.” Patten admits that even with the most rigorous surveillance of the raw dairy farms, an outbreak could happen in Idaho. “The udder is a complex organ,” he says.
My research took me to Paradise Springs Farm in Victor, Idaho, where Mike Reid’s eight cows were feasting on the rapidly growing green grasses of early spring that give his alpine-style cheese its distinctive flavor. Reid’s farm is Certified Biodynamic, and all food and herbal remedies that nurture the cows come from his land.
Mike’s Brown Swiss cows have ample grazing pasture and a high quality of life. In fact, you could say the cows are treated like family. Reid has trained them to defecate before they enter the milking room, which is kept under strict sterile conditions.
I happened to be at Paradise Springs Farm the day the Idaho State Department of Agriculture’s officer was visiting, collecting samples of Reid’s milk for testing. Raw milk and raw-milk products are tested monthly in Idaho, and licensed Grade A raw-milk facilities are inspected at three-month intervals.
The Ultimate Test It was time to decide for myself. Was I in love with the flavor of my raw milk because it was fresh, or because it was unpasteurized? I brought home a gallon of Paradise Springs Farm’s day-old raw milk. Half was immediately refrigerated. The other half I placed in a heavy pan and heated to 161 Fº for fifteen seconds, then rapidly chilled it in a bowl set over an ice bath.
How did the raw milk compare to my home-pasteurized product? Both had the fresh, whiff-of-the-farm scent. Both had bright flavor and underlying herbal tones. In fact, the only quality lacking in my heat-treated milk was a certain loss of texture, although that was not unpleasant. And, presumably, some nutrients were lost as well.
Both versions of Paradise Springs Farm milk were superior to the organic big-name brand milk I had purchased at the supermarket. Pasteurized, non-homogenized milk from Reed’s Dairy in Idaho Falls, just ninety miles away, also had a bright, fresh flavor and full body, although not as pungent and grassy as my Paradise Springs Farm milk.
Deciding for Your Children We are fortunate to have dairy farmers and cheese makers among us who are passionate about their craft and meticulous about running their operations. Most adults can weigh in on the available data, balancing health benefits and known health risks, and make an informed decision whether or not to consume raw milk. But how do you decide for your children? Based on national data, kids are getting sick from raw milk, and it behooves the government to enforce policies that protect them.
I do indulge in raw milk on occasion, but I serve it to my children only after I have heat-treated it (they love the almond steamers I make with Paradise Springs Farm milk). When they are old enough to examine both sides of this controversial issue, they can decide for themselves.
Getting back to that homemade ricotta cheese, and my quest for the perfect fresh milk ... I found that no milk is perfect. But I don’t hesitate to use Paradise Springs Farm’s milk when making ricotta; the heat required for separating curds from whey is more than adequate to eliminate dangerous pathogens. I can have my creamy whole-milk ricotta with that sweet, herbal flavor, and still have peace of mind, too.
Milk Made Fresh Whole Milk Ricotta
Makes 3 cups
All you need to make homemade ricotta is four ingredients, a candy thermometer, and about an hour’s time. Your ricotta (literally “twice cooked” in Italian, traditionally made from boiling the whey left after making mozzarella) will have the fresh flavor and aroma of the milk you use, but will be heated to 190 ºF for 15 minutes, more than enough to pasteurize the milk. The curds will be more distinct, softer, and more flavorful than the rubbery cheese that comes in a tub at the supermarket and will beg to be eaten with a spoon, drizzled with honey, or tossed with pasta.
For creamier ricotta, substitute half and half or heavy cream for the yogurt. For more savory ricotta, use 4 cups of buttermilk in place of the yogurt and lemon juice.
1 gallon whole milk (not ultra-pasturized) 1 cup plain yogurt 1/3 cup fresh lemon juice (strained) 1 tablespoon salt
1. Place the milk in a large heavy pot, and heat slowly over medium-high heat until the candy thermometer registers 190ºF, stirring every few minutes with a wooden spoon to avoid scorching. A double boiler will help make this easier. 2. Add the yogurt, lemon juice, and salt. Stir gently with a wooden spoon for about 30 seconds. Reduce the heat to low or turn it off. 3. For the next 25 minutes, maintain the milk’s temperature at 190ºF by adjusting the heat. Do not stir the milk while the curds are forming. 4. Use a slotted spoon or a skimmer to gently lift the curds out of the whey, and transfer them to a fine mesh sieve or cheesecloth set over a bowl. 5. For a creamier ricotta, drain for 15 minutes; for a drier ricotta, drain for up to 30 minutes. 6. Store tightly covered and eat within 5 days.
Recipe adapted from Canal House Cooking by Christopher Hersheimer and Melissa Hamilton.
Beyond lasagne: 5 Perfect Uses for Your Homemade Ricotta:
Eggplant Rollatini Mix ricotta with ½ cup pesto. Grill circles of eggplant, and roll with ricotta cheese mixture, burrito-style. Bake covered with marinara sauce until bubbly, and top with chopped fresh basil.
Ricotta Crostini Mix ricotta with fresh herbs (mint, basil, chives) and top crusty grilled bread. Drizzle with olive oil.
Ricotta Cheesecake Substitute ricotta (drain for a full 30 minutes first) for the cream cheese.
Ricotta Gnocchi Serve with a creamy tomato sauce.
Breakfast Ricotta Sweeten with honey, a dash of vanilla extract, and a sprinkle of cinnamon. Serve with fresh berries, waffles, pancakes, or granola.
To see the full recipes for Amaretto Ricotta Cheesecake and Ricotta Gnocci, please visit jacksonholefoodie.com.
Annie Fenn, MD, splits her time between homes in Wilson, Wyoming, and Felt, Idaho, giving her ample opportunity to test raw milk in her own kitchen.
2 cups rolled oats
2 cups filtered water
2 tablespoons fresh yogurt from the Cosmic cows
butter and cream from Cosmic cows
Mix together and soak overnight, keep in a warm place.
Boil 2 more cups of water.Add soaked mixture.Top with butter, cream and raspberries or strawberries, or huckleberries.
Soaking makes it more digestible, and sustains you for longer!