What Went Wrong with Stanford Study? Seems There's Lactose Intolerance, and Maybe Something Else; What Cheesemaker Shutdowns Tell Us About Food Safety

That pioneering, scientifically rigorous study of raw milk's impact on lactose intolerance I described last April has been completed. I have to admit, I was surprised by the results.

I've spoken with so many raw milk drinkers who say their lactose intolerance disappears when they drink raw milk, I figured the study was a slam dunk to demonstrate that reality for the rest of the world.

But the study showed nothing of the sort. In fact, it concluded that raw milk and pasteurized milk are equally troublesome for individuals who are lactose intolerance.

What went wrong? It seems as if there may be two categories of individuals suffering from lactose intolerance. There are those who are clinically diagnosed, and then there are those who suffer the same symptoms as the clinically diagnosed, but aren't clinically diagnosed. The latter group may well be larger than the clinically diagnosed group, and it seems this group is the one that benefits from drinking raw milk.

But it's the former group that qualified to be in the study, while the latter group was sent home. More details in an article I did for Grist.  And a summary of the study concludes: "Claims that raw milk is well-tolerated by lactose intolerant individuals, as examined in this study, are unsupported and misleading for individuals with true lactose malabsorption. However, there are many potential health benefits associated with raw milk that remain to be tested in a similar objective, controlled study environment."

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In another Grist article, I've followed up on the intense discussion here concerning the crackdown on two small cheese producers--Morningland Dairy and Estrella Family Creamery. My argument is that these heavy-handed shutdowns point up two important facts. First, the U.S. Food and Drug Administration comes down much harder on tiny food producers like these, which haven't caused any illnesses, than it does on the giant Iowa egg producers that actually made people sick. Second, this FDA tendency is ever more reason not to give the agency dictatorial powers via the pending food safety legislation, S 510. It's clear FDA has all the power it needs...and then some.

497 raw milk consumers surveyed showed that 94 percent had lactose intolerance with dead milk but not raw milk.

Lots more to follow

I am in LA with dr heckman. Just did a big presentation with organic and USDA higher ups listening. They all had Opdc raw milk and cookies

Mark

The temperature of pasteurization is another very important consideration, which the study's authors may not have considered. Most commercial fluid drinking milk in America today is pasteurized well above the legal minimum, in order to extend shelf life. This has the effect of increasing denaturation of lactose, proteins, butterfat, and other nutrients and properties of the milk.

Minimal legal pasteurization is 15 sec. @ 161F (high-temperature short time) or 30 min. @ 145F (vat pasteurization). These two heat treatment are considered equivalent, because every 10 degrees F rise in temperature (over a given period of time) is equivalent to about 10x the heat treatment. It is a logarithmic scale. So, for example, 20 degree rise in temp. = 100 times the heat treatment, 30 degree rise = 1000 times the heat treatment, etc...

Now consider the case of UHT (Ultra-high temperature pasteurization), which literally sterilizes milk at over 280 degrees F. This is the way that most commercial organic fluid milk is processed in America.

If we take 170F to be the de-facto legal minimum (most HTST pasteurizers I have seen in cheese plants are sealed around 168F for 18 seconds) that means UHT pasteurization would be 11 orders of magnitude more heat treatment than regular pasteurization.

This means that UHT is ONE HUNDRED B-B-B-B-BILLION times the heat treatment of regular pasteurization!!!!!!

That's 100,000,000,000

The only reason that UHT milk needs to be refrigerated is because is not packaged aseptically. In other words the sterilized milk is contaminated by bacteria present on the cartons it is packaged in!

You can make cheese out of milk that is normally pasteurized. It helps to add calcium chloride, because pasteurization renders calcium less bio-available, and calcium phosphate (as part of the casein micelles) is critical to the coagulation process and formation of the curd. The cheese may not be as flavorful or unique as real raw milk cheese, but it can be made from minimally pasteurized milk.

Compare this to UHT milk, which will not coagulate and will not culture, because it has been so thoroughly destroyed by the extreme temperatures and pressure of ultra-pasteurization. You can't make cheese or yogurt out of UHT milk. You can't even make decent cheese out of milk that has been pasteurized above 180F, because the whey proteins become denatured and unfolded, and so the curd and whey will not separate normally.

One must wonder how the study was constructed, and if any of these factors were considered about how milk is pasteurized, because they certainly effect the biological properties of the milk.

I'm not able to download the poster PowerPoint document.

Amanda

Two thoughts come to mind. 1) The results of the study do not surprise me, and 2) How did they justify feeding the evil raw milk to people in a study?

The second thought doesn't really need discussion. The first - I've been in so many discussions about lactose intolerance that I already could have guessed what this study came up with. Most importantly, I belonged to several online breastfeeding groups for the 3 years I nursed our youngest, and lactose intolerance was discussed there, even more than here, intensely. Heatedly. If a person is allergic or physically intolerant in some way to the actual lactose molecule in the milk itself, lack of pasteurization makes no difference. They may even be intolerant to the milk of other species (goats) pasteurized or not. A good lactation consultant will be able to explain the details to you.

If it is not the lactose molecule itself that is the problem, pasteurization and other things done to the milk might make a difference. This study sounds like it eliminated all variables except the lactose itself.

Change the word, "lactose," to the word, "milk," before the word intolerance, and you have a completely different picture. There are oodles of other things in milk than lactose.

People can claim all they like in a survey, but that information is going to be taken in a more subjective light. Scientific evidence of real physical issues, confirmed by a doctor, speak more loudly. Focusing on the lactose itself is not going to help the raw milk movement. Denatured proteins; trace substances that affect the phospholipid bilayer and cellular gates, maybe, but not the lactose.

Scientists are going to split hairs. It would do us all well to understand the details of what is on which half of each hair. Especially Mark, if I may have the courage to write that and post it.

It doesn't sound like Stanford is finished with the topic though.

Gwen

Stanford will publish study next month. This study is solid and is step one.

A full discussion of the data will be posted thursday at Opdc

What Stanford did ( by exclusion ) is identify Pasteurization Intolerance.

Mark

Amanda,
Not sure what your problem is--I just did it again, and it downloaded and opened fine. Best to view it at 50% of size, on my computer.

David

David

The comments here and at grist show a complete confusion about the Stanford study and the Opdc surveys. In my mind it is very clear. What is needed is a more explanation to eliminate the confusion

It appears that some commenters think that Stanford used raw milk drinkers in their study???

Completely confused people reading your work here.

The data is very straight foreword on both Stanford and Opdc studies

Mark

It will be interesting to see the details of the inclusion/exclusion parameters used in the study when it is published. I and several acquaintances tried to participate in the study. We first had to take a survey to determine if we were eligible. If you had any significant symptoms after drinking milk, you were excluded from participation right from the start before any laboratory testing was done. Could the narrow range of inclusion parameters have created these results. Most of the people I know who can only tolerate farm fresh raw milk have strong reactions ("severe symptoms") when drinking commodity milk. They were excluded from this study for that reason.

It will also be interesting to see where they sourced their milk samples for the study. Was the raw milk from OPDC? Was the pasteurized milk a randomly selected commodity milk from the supermarket?

My family does well with raw milk. I can drink a lesser amount of organic non-homogenized pasteurized milk without symtoms now (but I boil it first). I cannot drink commodity milk, nor would I want to.

Some of my relatives (who drink properly produced raw milk in its raw form) say that all *pasteurized* milk should first be boiled . They say the pasteurization process is unnatural - you either cook the milk or your don't, none of this halfway stuff. Maybe they understood about MAP.

I do think there is more at work here than simply lactose intolerance. Perhaps it is pasteurization intolerance as Mark calls it although it's probably more complex than that.

Mark, how are your grant writing skills? Perhaps you could help secure a grant for a study of pasteurization intolerance. See if you can have UCSF School of Medicine do the study.
UCSF Medical Center is more open minded about integrated medicine and complimentary and alternative medicine (CAM) and nutrition. Stanford appears to be more closely tied to big Pharma.

"What went wrong with the Stanford study." I don't think anything went wrong with the study unless you can't accept the results (e.g., let go of your hypothesis when the data doesn't support it).

Two major strengths of the study include: 1) a medical diagnosis of lactose intolerance and 2) a blinded study where the participants didn't know what type of milk they were drinking.

The results provide a new hypothesis: the power of suggestion (placebo). Every anecdotal story should be subjected to similar studies to rule-in or rule-out the medical significance of raw milk. Simply put, how does raw milk perform for those with anecdotal stories if the person doesn't know if they are drinking raw milk? The time/temp of pasteurization really doesn't matter - it boils down to whether someone who doesn't know they are drinking raw milk reports the "benefit," while those drinking the control don't report the same benefit. In the Stanford study, there was no difference except for those who drank soy (non-animal) milk.

It is possible that raw milk has no specific health benefits beyond basic nutrition and taste. The Stanford study is reductionist, and Gwen points out further reductionist approaches to "find" the raw milk component to explain perceived benefits. But, there is another hypothesis to test. Do people who seek raw milk make other lifestyle changes that ultimately confer health benefits, and do these benefits get attributed to raw milk due to its hype and marketing? A larger, more comprehensive study might tease out confounding variables that don't relate to raw milk consumption. For example, there may be WAPF dietary principles that confer benefits holistically, and do so with or without including raw milk in the diet.

MW

I have often looked at anecdotal evidence as a source for raising questions and designing various experiments. One example included the discovery of a new class of antimicrobials..anyway..

From direct experience. We have several friends and acquaintances who have severe reactions to pasteurized dairy products consume aged cheese made from raw milk and also liquid raw milk without symptoms. A rather brave choice without talking their medication containing lactase. MW makes an interesting point in regard to holistic issues (intestinal microbial flora???), that would impact some other sort of lactose /dairy intolerance. Does the presence of lactase in raw dairy knock down the level of lactose to a tolerable level for some folks.

Also, when I think about metabolic intolerance, I often think about reactions to alcohol. There are many people, especially of Native American decent, who are more susceptible to alcohol than others-mainly because of a lack of adequate levels of alcohol deyhdrogenase. Those of us who only have one copy of the ADH gene-or low levels of ADH- even drinking a single beer has an effect..

Ive seen enough first hand evidence to disagree with MWs suggestion that the consumptions of raw dairy for people who have an intolerance to pasteurized dairy products is a placebo effect in all cases.

A larger, more comprehensive study might tease out confounding variables that don't relate to raw milk consumption.

Anda more comprehensive study may tease out confounding variables that do relate to raw dairy consumption.

There is more going on with the consumption of non-pasteurized dairy than a single narrowly defined experiment would indicate. That said-the Stanford Study is important in providing additional data based on the parameters used for a narrow clinical definition to set the experimental protocol. But, in my opinion (as an experimental scientist), it only raises more questions calling for a more comprehensive study as MW suggests.

Well, here is an unusual finding that may or may offer some kind of clue to what is going on -
we added ducks to our mixed farm this year.
Lo and behold, I have discovered that duck eggs give me horrendous indigestion, while chicken eggs are fine.
My dear spouse is the cooker of the eggs and many times I did not know which type of egg I had eaten, until I felt ill and confirmed that duck eggs were involved.

I've done a bit of research and can't come up with any explanation for this phenom, but I'm guessing I can't be the only person experiencing this. Could looking at how other types of food cause intolerance add insight?

We have sold duck eggs to people who have a confirmed allergy to chicken eggs (battery raised or pasture raised.).

We have enjoyed here several fine discussions about the problems inherent in reductionist, controlled-variable research. (In a nutshell, because of the near impossibility of controlling (or even identifying!) related variables, reductionist studies are poorly suited to complex questions.) Nevertheless, in our reductionism-is-king culture, researchers boldly go where they ought not, invariably discovering this or that, and then rationalizing rightness, often with a self-congratulatory attitude.

When simple, honest observation clearly tells you something, and then a hyper-focal study discovers otherwise, wouldnt the sane reaction be to question the study?

These days questioning a scientific study is, of course, heresy, but what is one to do but buck the system when truth is abrogated? Let the accusations of sour grapes come. Personally, I defer always to the macro view, for example noting the growing mountain of reductionist studies proving this or that medical fact while the population suffers new epidemics of heart disease, cancer, developmental problems, diabetes, asthma, and on and on.

My goodness. What might cause someone to argue that limiting exposure to the natural world is a winning health strategy? What factors are at play when the need to develop and maintain a strong immune system is down-played?

The problem that I see with this or any other "scientific" study is that our laws (ESPECIALLY our food laws) are written with the "science" in mind. Grant money (as stated above) is available to scientists with a hypotheses to prove or disprove.

Take the case in point of the use of antibiotics on factory meat and our elected official's current attempt to curb and limit their usage on livestock. The CAFO group is screaming that "scientific evidence" is not supporting that over use of antibiotics in the healthy herd is causing human resistance.

http://www.washingtonpost.com/wp-dyn/content/article/2010/10/30/AR2010103000071.html

Again, as a mom with a scientific background, I must say again that whereas I respect science and the scientific method, our scientific community's patronizing tone only reinforces that human's can only see a minuscule part of the whole -- that we are just simply not capable of understanding the extreme complexity of our natural systems, and presuming to is arrogant and incorrect.

Back to the point of this article -- I am afraid that whereas this study "proves" a conclusion about the "x" number of painstakingly chosen people who participated, it is not comprehensive enough to extend to include all of us -- raw milk drinkers or not, but conclusions such as this one will certainly impact our food choices through legislation that is sure to result from studies like this one. Once again I am afraid my food choices will be limited and I will be forced into civil disobedience.

In our experience, Mark's hypothesis of pasteurization intolerance is right on. Our milk is extremely clean (state SPC is generally under 250) and will last 18 days before souring. Several new customers with lactose intolerance have switched to us because their previous supplier's milk only lasted five days before becoming sour, therefore having a lot of lactobacillus in it.

I was worried because I assumed that the lactase produced by the bacteria was what made raw milk drinkable to the lactose intolerant, and our milk might not have enough lactobacillus to digest the lactose before symptoms began. But my assumption was wrong, even those who had severe gastrointestinal symptoms minutes after drinking pasteurized milk, have had no trouble with our milk.

From Alice:

"we are just simply not capable of understanding the extreme complexity of our natural systems, and presuming to is arrogant" Amen!

And there are many scientists who agree, at least those who still believe that science is really a verb--"sciencing" an ongoing query---...They (we) are becoming a vanishing small minority as corporate vested interests continue to expand their influence and control.

Steve-your observation...after thinking about it--same here.. Thanks, Ron

From David's 2/22/08 summary of our Michigan study of lactose intolerance:

"Some 2,217 Michigan consumers of fresh unprocessed milk (the Michigan study's term for raw milk) were surveyed, of whom 155, or 6%, said they had been told by a healthcare professional they had lactose intolerance. Of those 155, some 127 have no symptoms of lactose intolerance when drinking the fresh unprocessed milkwhich is 82% of those with the lactose intolerance diagnosis."

Despite the obvious problems in our study from a "gold standard" viewpoint (e.g., not random since only raw milk drinkers were surveyed, they self-reported, the study didn't have a "blind" or "placebo" control - just the observations of anecdotally-compromised mere non-scientific humans) - it was broadly based, significant numbers of people responded, and the relevant responses were carefully limited to those who had been informed by a healthcare professional they were lactose intolerant.

So, either 127 people were hallucinating, or they have something to tell us. Pretty sure, most of them won't go back to drinking pasteurized milk, anecdotally compromised though they may be.

When a clinical study ( of people that have never tasted raw milk and are highly reactive to pasteurized milk ) subject is faced with certain gas cramps and diarrhea when they are about to drink a double-blinded sample of unknown white stuff...this sterile somewhat frightening experience is not comparable to a farmers market consumer that has been told ten times by a trusted friend that raw milk does not cause lactose intolerance at all by personal experience.

The plecebo effect is unknown but could be exceedingly powerful and perhaps helps transition to a fully colonized ( from raw milk bacteria ) milk friendly gut flora.

I agree with Dr. Beals when he says that it does not matter what definitions or clinical breath tests are used to diagnose a person as lactose intolerant....that person does not need a clinical diagnosis with HBT...their bodies tell them directlya all they need to know through.....gas, cramps and diarrhea. That is all they need to experince to avoid pasteurized milk.

Stanford science was certainly reductionist and eliminated all but the toughest subjects that blew Hydrogen in the HBT test. Yet.....more than 400 people passed the "Beals test" and knew darn well that they were "pasteurization intolerant". Only 16 were screened into the Stanford study. The test only lasted 8 days. Stanford did say that there was a trend towards acclimatization with the raw milk phase. I want to see where this trend line goes in the next 20-30 days. Trends need to be tracked down and curiously investigated.

I actually embrace the Stanford study as a very important first step. A second step is needed.

I am meeting with Gardner next week. To further investigate the trend that was observed, I am going to try and convince him to allow all of these 16 people to drink raw milk for a month and see how many actually continue to have problems with Lactose Intolerance. They would know that it was raw milk they are drinking and they would know that it is not supposed to cause lactose intolerance. This would be the positive plecebo effect.

We will see if this is possible. OPDC will deliver free raw milk to them and then Stanford can survey them in a month.

There is definitely "pasteurization intolerance"...Beals, the OPDC survey and the Stanford study ( by exclusion) have shown this area to exist. If not, then scientists are in heavy denial and ignorring all of the self reported symptoms of illness. You can not blame people when they have gas, cramps and diarrhea. That by itself is worthly of evaluation....regardless of HBT test.

Mark

Perhaps this is what went wrong:

http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/

I'm not convinced that the diagnosis of lactose intolerance is commonly done properly. (See: http://www.merck.com/mmpe/sec02/ch017/ch017c.html#sec02-ch017-ch017c-1047).

Instead I think a lot of people diagnosed as lactose intolerant may be intolerant of other factors in milk.

Our son is not lactose intolerant but does not tolerate milk at all as he had the same reaction to lactose free formula as he did to regular. He can only tolerate formula with acid hydrolyzed protein.

Once the study is published we can look at the details of induction and see how confident we should be that there was no selection bias.

I'm also curious if they bothered to confirm that lactase and bacteria were present in the raw milk samples at the time of ingestion. Improper handle of the raw milk by researchers could impair the functioning of these two components (which are the assumed mechanism by which the lactose is digested for the consumer).

Completely off topic here, but in Ohio's governor race, Republican John Kasich won over Democrat Ted Strickland. For some of you who don't remember the details, Strickland sort of saved herd shares in Ohio a few years ago, when he told the ODA to "back off" farmers running them. With a new governor, I am curious to see whether or not this year, the ODA will pick up where it left off.

Gwen

Gosh, Gwen, I'd expect that a Tea-Party-driven Republican would be comfortable with less, not more government intrusion into the realm of personal choice......I too am curious.

I guess that would depend on what you believe the Tea Party to be.

Nutritionist Dr. Mattias Rath seems to think that the Tea Party of today is the same as the Brownshirts of Germany in 1933. Both of these supposed "grassroots" groups appear to be bankrolled by the Oil&Drug cartel.

Here is a link to the comparison of Germany in 1933 and the USA now.
http://www.profit-over-life.org/infos/president_obama_wake_up_america.html

This could explain much of the persecution of raw milk and small independent producers of real food.

Food for thought.

Somehow I have a suspicion that John Kasich -- a Wall Street Businessman -- is not going to be as sympathetic to cow-shares as Ted Strickland was -- a populist farm-boy.

The tea party "small government" rhetoric is just that -- rhetoric.

If they were really interested in smaller government spending, they would have opposed the wars in Iraq and Afghanistan. Current and past military spending (in the form of debt interests from the last 30 years of military build-up) account for roughly half of where your federal income taxes go.

See this analysis:

http://www.warresisters.org/files/FY2011piechart.pdf

Even under the Obama administration, military is accounting for 48% of your income taxes.

Don't count on the "tea party" to do anything about this. It may have started as a grassroots movement, but it was quickly co-opted by very evil corporate interests as Suzanna points out. The results of this election speak more to the general inability and unwillingness of the Democrats to fulfill their campaign promises of 2008 than it does about any kind of right-wing shift in popular thinking.

If we want freedom and democracy, we are going to have to fight for it ourselves. The tea party are not our allies. Local food and sustainable agriculture activists are. Peace and social justice advocates are. Not the "tea party", though.

Bill - my tongue, of course, was planted firmly in cheek with my previous comment. The Tea Party has co-opted the frustration of having gobs of money thrown at bank bonuses instead of a systematic relief program targeted at under-water mortgages. We need "trickle up," not more "trickle down." I share your skepticism that any real change in the issues we talk about in this blog, will be forthcoming from TP'ers.

BTW the kind of pie-chart such as you link to used to be published by the Office of Management and Budget - last seen, however, in about 2001 when the Bush administration replaced such easily-understood summaries with thousands of pages of computer print-out of the National Budget: obfuscation by inundation. There were similar charts showing the source of government revenues from taxes. As I recall, the portion of the government funded by individual income taxes was, from 1950-2000, nearly flatly constant (a slight dip down in 1980 under Reagan, but quickly recovered). The big changes in those 50 years came with sharp decreases in excise taxes and corporate taxes; the shortfall being made up by corresponding increases in the regressive social security/medicare taxes.

Clarity like this in basic facts would go a long way toward showing how much political talk - on both sides - is BS.

Whether it be red states, blue states, independents or Tea Party goers....

I am a TEAT Party guy feeding and healing all people.

It was amazing to see USDA extension people with Dr. Heckman in Long Beach this last weekend. They really did preach the new USDA initiative of "Know Your Farmer Know Your Food". Dr. Heckman was awesome and was probably more radical that even I was when I spoke as an organic raw milk farmer. He did a great job of defending raw milk as a healing food and as a right. He brought me along to be his very own farmer...we even had a "raw milk party" where 35 USDA and other COSA soil science professors met. What a great time. The dirt people really get biology and immune function. Something that the FDA could care less about.

When Vilsack preaches "Get to Know Your Farmer and Get to Your Food" and....John Sheehan says...."No way in Russian Roullette FOOD INC... NCIMS Hell....keep that farmer separated from that consumer by a pasteurizer, and a processor at least".

One thing for sure...The FDA is Fascist and the USDA has Organic Dirt on its feet and is listening. It is after all the "peoples agency" and was founded by Lincoln. Sheehan and Visack could never get along.

http://www.usda.gov/wps/portal/usda/knowyourfarmer?navid=KNOWYOURFARMER

OPDC sales broke all records once again this week. Our growth in CA this year is unexpectedly moving beyond our trended growth curves.

It is WOW on natural steroids!!!! This is sales with out raw butter. We added 50 more cows and that milk is gone...we thought we could make some butter, but it all got drank up!!

The truth sells itself!!! As TEAT Party guy....I know for sure that at least two departments in our government are in complete conflict. The USDA needs to Eat-Up the FDA food authority. The FDA has zero business being anywhere near our food supply. They might irradiate or sterilize it...no wait....they are already doing this!!??? Ouch!! Too Late....

In fact the recommendation to have the USDA take over all food authority was given to the USDA reps this last weekend in Longbeach.

One can dream!!??

Mark

I hate to be the cynical one, but if USDA takes over all regulatory authority of food safety from FDA, we're probably just going to see all the fascist bureaucrats and corrupt corporate money that was making FDA so bad start flowing over to USDA. Things have a way of working out like that in the U.S. government...

What is really needed is an independent syndicate of small sustainable farmers, to use collective action to promote the interests of sustainable farming. It is an unfortunate thing about the U.S. that our highly individualistic culture tends to make organizing such a syndicate very difficult. We only need look to European nations where GMOs are banned and traditional raw milk cheese enjoys special legal protections. This didn't come about by changes in government, it came about by grassroots organizing and agitation!

I've been mostly offline for a couple of weeks and am just catching up. Hey, I like the idea of a TEAT party! Now that is a political party I might be able to be wholeheartedly a part of, and it might even join the Democrats and Republicans who are honest and separate them from the ones who aren't, into a different kind of "no government" crowd. Count me in.