Analysis

Introduction

Raw milk — unpasteurised milk sold directly from dairy farms — has been promoted in alternative health communities as a "living food" with unique health benefits, including curing lactose intolerance, boosting the immune system, treating asthma and allergies, and even offering protection against infectious disease. In the United States, interstate commerce in raw milk for human consumption has been prohibited since 1987 under FDA regulations, though intrastate sales are legal in many states. The raw milk movement gained particular momentum during COVID-19, when some advocates claimed raw milk could prevent or treat the disease, and accelerated again in 2024 when H5N1 avian influenza was detected in unpasteurised milk from infected dairy cattle.

Core Claims

• Raw milk contains beneficial bacteria, enzymes, and immunoglobulins destroyed by pasteurisation that confer superior nutrition and immune benefits.
• Raw milk cures or ameliorates lactose intolerance because live lactase-producing bacteria pre-digest lactose.
• Raw milk provides better vitamin and mineral bioavailability than pasteurised milk.
• Raw milk consumption protects against allergies and asthma (the "raw milk hygiene hypothesis").
• Pasteurisation is a government-mandated process primarily serving industrial dairy interests, not public health.
• Raw milk can prevent or treat infectious respiratory illness, including COVID-19 and bird flu.

What the Science Shows

Pasteurisation targets real pathogens with documented outbreak histories. The FDA, CDC, and peer-reviewed outbreak literature document that raw milk is associated with pathogens including Salmonella, E. coli O157:H7, Listeria monocytogenes, Campylobacter, Brucella, and Cryptosporidium. Between 1998 and 2018, the CDC documented 202 outbreaks attributable to raw dairy in the United States, causing 2,645 illnesses, 228 hospitalisations, and 3 deaths. Raw milk carries 840 times the risk of illness per serving compared to pasteurised milk (Langer et al., Emerging Infectious Diseases, 2012).

The enzyme and immunoglobulin claims are overstated. It is accurate that pasteurisation reduces some heat-labile proteins, including lactoferrin, immunoglobulins, and certain enzymes. However, the nutritional and immunological significance of this reduction in an intact adult immune system is minimal. The human gastrointestinal tract does not absorb intact immunoglobulins from bovine milk into the systemic circulation in meaningful quantities. Claims that raw milk immunoglobulins confer systemic immunity have no randomised clinical trial support.

The lactose intolerance claim is mechanistically weak. The Lactobacillus and other bacteria in raw milk do produce beta-galactosidase (lactase). However, transit time through the stomach (where pH is approximately 2, highly bactericidal) largely inactivates these bacteria before they can digest lactose in the small intestine. The gold standard for lactose intolerance management is fermented dairy products (yoghurt, kefir) where lactase activity is concentrated and bacteria are present at higher densities that partially survive gastric transit.

The allergy/asthma claim requires careful reading. The "farm effect" — reduced allergy and asthma rates in children raised on farms — is a genuine epidemiological finding. However, research (including the PARSIFAL and GABRIELA studies) attributes this primarily to exposure to diverse microbial environments in farm settings (barns, animal contact, farm dust), not specifically to raw milk consumption. A 2015 Journal of Allergy and Clinical Immunology analysis found that heat-treated farm milk showed similar effects, suggesting the mechanism is not raw-milk-specific.

H5N1 in raw milk is a documented 2024 finding. FDA and USDA confirmed in 2024 that HPAI H5N1 virus is present in raw milk from infected dairy cattle at levels sufficient to infect ferrets (an animal model). Pasteurisation at standard temperatures (72°C for 15 seconds) has been shown to inactivate the virus. The discovery prompted explicit public health guidance against consuming raw milk during the outbreak. Raw milk advocates who continued recommending raw milk as protective against bird flu were actively undermining public health guidance during an active outbreak.

Regulatory History

FDA''s prohibition on interstate raw milk sales (21 CFR 1240.61) dates to a series of major raw milk outbreaks in the 1970s–1980s. The restriction is based on epidemiological data, not dairy industry lobbying. States that permit intrastate raw milk sales show higher rates of raw milk-associated outbreaks than states that prohibit it, a natural experiment consistent with causality (Lejeune and Rajala-Schultz, Journal of Dairy Science, 2009).

Legitimate Context

The raw milk movement raises some genuine adjacent concerns: industrial dairy practices, animal welfare, environmental impacts of concentrated animal feeding operations, and the nutritional differences between pasture-raised and confinement-raised dairy are real topics of legitimate debate. The specific claim that raw milk is a health-promoting or disease-curing food that should circumvent food safety regulation is, however, not supported by evidence and is associated with documented outbreak harm.

Takeaway

Raw milk carries pathogen risks that pasteurisation was specifically developed to eliminate. Its claimed health benefits — superior nutrition, lactose tolerance, immune protection — are either unsupported by clinical evidence or attributable to farm-lifestyle exposure rather than raw milk itself. During the 2024 H5N1 outbreak, raw milk consumption posed a specific additional zoonotic risk. The raw milk cure narrative reflects broader distrust of food regulatory systems, but the specific curative claims have not survived scientific scrutiny.