« Older Entries

FOLLOW DR. KO: What You Never Knew About Canadian Doctors Outside Canada

IMGImagine me, a single thirty year-old living in the bustling city of New York, out at a bar on a Saturday night.
“What do you do for a living?” – someone inevitably always asks.

Sometimes, for fun, I make up stories. I tell people that I specialize in cleaning elephant poo at the Bronx Zoo or something ludicrous like that. It is so much more interesting than just saying, “I’m a doctor.”

But when I do say that I am a doctor, people’s reaction is usually “Oh wow.” They think that I must live in luxury on the Upper East Side, drive a Mercedes-Benz or some other fancy vehicle, and travel to exotic lands every couple of months. They picture a doctor, noble and heroic, who goes to work every day and saves lives. Countless lives. They would imagine me shouting out a patient’s blood pressure, cutting them open, performing chest compressions, while pearls of sweat drip down my face, the sweat of hard work, of responsibility, of grandeur. Then the patient lives, wakes up, and thanks me with hugs and tears.

Well, all that is flattering, but none of it is true.

Read more

Bad breath

halitosisFoul breath—also known as halitosis—is an unpleasant condition that affects almost everyone. Because it is so widespread, determining and subsequently diagnosing each individual patient can be difficult. And it gets even harder because patients really can’t smell their own bad breath. But strong-nosed scientists have been discerning the truth bit by bit: there is now hope for those hoping to remedy their morning dragon’s breath.

Originally many believed that malodors originated in the stomach and blamed things like acid reflux, indigestion and gut flora. But what people are beginning to see is that in most cases of halitosis, the mouth is to blame. Halitosis originates from bacteria on the tongue, a condition known as tongue coating. The byproducts are largely responsible for bad breath in patients.  They produce what are known as volatile sulfur compounds (VSCs) such as hydrogen sulfide and methyl mercaptan. In order to then treat halitosis, efforts have focused on developing products that will either reduce these odiferous bacteria or neutralize the VSCs themselves.

The main form of treatment against halitosis is to simply brush the tongue to remove built-up bacteria. When halitosis persists, patients instead try to stop the creation of VSCs. By neutralizing the VSCs, the malodor does not volatilize, and the mouth does not stink. Some of the most successful neutralizing compounds have been zinc salts, chlorhexidine and hydrogen peroxide. Chlorhexidine can result in stained teeth, tongue numbness and burning; on the other hand, hydrogen peroxide can be highly oxidative and damaging to soft tissues. Zinc seems the best breath-fighting agent out there.

Zinc ions have a very high affinity for sulphur and can therefore inhibit the formation of stinky sulphur compounds by reacting with them before they leave the mouth. Zinc is also non-toxic and does not stain teeth, making it an ideal candidate to treat bad breath. While protocols to measure the efficacy of bad breath levels vary, the best measure of a persons’ breath is when the human nose smells it. And generally, these smell-tests result in accurate and reproducible results. When put to the schnoz studies show that mouthwashes, lozenges, and gums containing zinc in 0.2-0.5% are the most pleasant and effective in treating halitosis. It should not be used alone, however. A careful combination of good dental hygiene, eating plenty of fruits and vegetables, and drinking plenty of water will help minimize the smell.

Read more

Chickens, toads, and gluten sensitivity

Keratosis pilarisBy: Laurie Laforest
Keratosis pilaris is one of the many symptoms attributed to non-celiac gluten sensitivity in alternative medicine circles.  Keratosis pilaris – or “chicken skin” – is a benign skin condition reminiscent of permanent goose bumps.  I first heard the term keratosis pilaris on a episode of The Dr. Oz Show about gluten sensitivity [1], the premise being that keratosis pilaris results from fat malabsorption caused by gluten-induced intestinal damage.  Since my family and I have little patches of this on our elbows and knees, I was eager to learn what was really behind it.
It turns out that the link between “chicken skin” and gluten sensitivity is one of mistaken identity.  Keratosis pilaris is a type of follicular hyperkeratosis where excess keratin – a key protein in our outer layer of skin and in our hair and nails – plugs the hair follicule, sometimes trapping a small hair inside. [2]  Enlargement of the follicule and the presence of the hard keratin plug produces the characteristic rough and bumpy appearance; reddening may also occur.  Keratosis pilaris is quite common – it affects around 50% adolescents (80% of females) and 40% of adults – and seems to have a strong hereditary component. [3]
Phrynoderma – or “toad skin” – is another type of follicular hyperkeratosis that is typically related to malnutrition in developing nations.  Phrynoderma is what alternative medicine folks are actually thinking of (or they should be) when they speak about a diet-related bumpy skin problem.  The exact nutrient deficiency behind phrynoderma is not known, but the condition can be reversed by supplementation with essential fatty acids, vitamin A, vitamin E, or B-complex vitamins; different people seem to respond to different nutrients. [4-7]
So “chicken skin” (keratosis pilaris) is common and benign, while “toad skin” (phrynoderma) is uncommon in the developed world and a sign of a serious problem.  But could it still be possible that gluten sensitivity is at the heart of these conditions?  Most likely not.  Keratosis pilaris is not related to diet, although it does seem to occur more often in people with a high body mass index. [8,9]  Hormones could also play a role, since keratosis pilaris is more common during adolescence.  Still, keratosis pilaris can come and go throughout adulthood and may worsen during the drier winter months.
Even for phrynoderma, the gluten connection doesn’t pan out.  Let’s first consider celiac disease, an autoimmune reaction triggered by gluten that damages the small intestine.  Celiac disease is the worst-case scenario when it comes to gluten sensitivity – fat malabsorption is a classic symptom of untreated celiac disease, and there is a risk that celiac sufferers could be deficient in fat-soluble vitamins like A, D, and E.  But even though it might seem like celiac disease could produce the kind of malnutrition that leads to phrynoderma, phrynoderma is not one of the skin conditions seen alongside celiac disease [10], and fat-soluble vitamin deficiencies are also not found in newly-diagnosed celiac patients as often as one is led to believe on TV [11-13].  Now consider that non-celiac gluten sensitivity is not supposed to involve the characteristic intestinal damage (and, hence, the potential vitamin deficiencies) found in celiac disease [14,15], and you have no reason for the average person to suspect that their rough skin is related to gluten.
If you do have “chicken skin” or other roughening or reddening of the skin, it is best to talk to a dermatologist to properly identify your skin condition or to your doctor if you do suspect that you have celiac disease.  Most people with keratosis pilaris don’t even realize that they have it, but others may be plagued by large, unsightly patches of skin.  Mild cases can be improved by over-the-counter moisturizers; more severe cases can be treated by medicated creams that soften keratin and help remove the outer layer of skin.  Even though there is an abundance of advice on treating keratosis pilaris on the Internet, ask a doctor or pharmacist to direct you to the right products to use.

Read more

Opioid peptides: the heroin within?

Screen Shot 2014-11-07 at 10.36.51 PMBy: Emily Brown PhD

If you were to hear the words ‘opioid peptides’, they might not trigger much within your brain, other than that the former sounds a bit like opium and together they sound quite scientific. Opium (also known as poppy tears) is a dried substance or latex that originates, as the alternative name suggests, from the opium poppy. Beautifully intricate pipes of bamboo, ivory, silver, jade and porcelain have been carved over the centuries and used to vaporise and inhale the latex traditionally obtained by scratching immature poppy seed pods by hand. Numerous Empires including the Egyptian, Greek, Roman, Persian and Arab made widespread use of the drug, which was then the most potent form of pain relief available. This analgesic property is conferred by morphine, which constitutes approximately twelve per cent of opium and is chemically processed to produce heroin. Commonly known by the street names H, smack, horse and brown, among others, the effects of heroin will be well known by any ‘Trainspotting’ fans. What writer Irvine Welsh did not reveal, however, is that opiates such as heroin mimic the effects of naturally occurring molecules that can be generated inside our own bodies.

Opioid peptides are small molecules that are produced in the central nervous system (the brain and spinal cord) and in various glands throughout the body such as the pituitary and adrenal glands. These peptides can be divided into three categories (enkephalins, endorphins, and dynorphins), depending on the type of larger precursor molecule from which they are derived. Opioid peptides function both as hormones and as neuromodulators; the former are secreted in the blood system by glands and are delivered to a variety of target tissues where they induce a response, while the later are produced and secreted by nerve cells (or neurons) and act in the central nervous system to modulate the actions of other neurotransmitters.

Neurons are electrically excitable cells that process and transmit information through electrical and chemical signals that travel via synapses, specialised connections with other cells. These signals are transmitted across a synapse from one neuron to another by neurotransmitters. By altering the electrical properties of their target neurons and making them difficult to excite, opioid peptides can influence the release of various neurotransmitters.

Through these two different mechanisms, opioid peptides can produce many effects including pain relief, euphoria and altered behaviour such as food and alcohol consumption. The apparent connection between exercise and happiness has been explained at least somewhat by the release of endorphins, for example. Exercise is commonly recommended as a strategy for stress-relief and mood improvement, but less widely accepted forms of therapy might also be connected to opioid peptides. Evidence suggests that pain relief induced by acupuncture results from stimulation of opioid peptides – these peptides act through receptors on their target neurons, and chemicals that inhibit opioid receptor function have been found to reverse acupuncture-induced analgesia. Painful, stressful or traumatic events or stimuli can induce the release of opioid peptides, with the resulting euphoria and pain relief making the sufferer less sensitive to noxious events. Opioid peptides have been reported to affect the release of specific neurotransmitters such as dopamine and serotonin, but the response of the neurons that receive opioid-peptide stimulation depends on their excitatory versus inhibitory nature, making the outcome difficult to predict.

The words ‘opioid peptides’ may not have left a dazzling feeling of recognition within your memory upon first encounter, but these peptides act within the brain and wider body to influence a number of important functions. Although it is not easy to predict the effect of neuromodulators that alter the release of other neurotransmitters, there is little question that opioid systems play a critical role in modulating a large number of sensory, motivational, emotional and cognitive functions. Alterations in opioid peptide systems may contribute to a variety of clinical conditions, including alcoholism, obesity, depression, diabetes and epilepsy. Many questions still remain, particularly those concerning the exact role of opioid peptides produced within the body in relation to addictive and emotional behaviour and psychiatric disorders. Since these disorders are typically of a complex nature, seeking the answers to these questions is not a simple feat. Advances in genetics and genomics research that aim to explain function by studying our DNA are helping to pave the way. But perhaps if there is one thing that can help motivate our talented scientists to reach their challenging goals, a healthy dose of opioid peptide might be just the thing.

Read more

Protein supplements: powerful powder or powerful promotion?

protein supplementsGoogle the words ‘protein supplements for athletes’ and a number of links will appear in your browser. While apparently just a click away from learning the ‘truth’ about these dietary additions, it is advisable to consider the nature of whichever website you fall upon before hollering hallelujah. Company websites marketing protein supplements claim to give athletes the ability to ‘beat their best competition’ and to ‘get bigger and/or stronger’. Promasil, ‘the athlete’s protein’, for example, features seven of the world’s most powerful proteins. Imagine the industrial strength containers needed to keep these key ingredients from escaping. No more five dozen eggs a day to grow biceps the size of barges (the strategy adopted by Disney’s Gaston), a more palatable and practical solution is delivered in the form of a delicious flavoured powder. Since proteins are a major component of muscle, it surely makes sense that consuming more would result in extra bulk. But protein supplementation is not only about bodybuilding. For those more concerned about beating personal bests and leaving the competition trailing behind, protein supplements are also argued to directly enhance endurance performance and to optimise recovery of muscle function following exercise.

So how does it work? Naming a chocolate bar after a long-distance running event (and later rebranding using a word that sounds like underwear in British vocabulary – ‘Snickers’), no doubt taught the importance of carbohydrate as an energy source. Through reduced breakdown of carbohydrate during prolonged exercise, protein supplements are thought to enhance performance and to more quickly replete muscle glycogen (a specific type of carbohydrate) during recovery. By stimulating muscle protein synthesis, protein supplementation is also theorised to reduce muscle damage and speed up the recovery of muscle function. If you recently ran down a hill or lifted some weights, ideally not at the same time, you may later have felt soreness in your muscles, caused by damage to proteins that are required for muscle contraction. In such circumstances, rates of muscle synthesis and degradation are increased, and without sufficient protein intake, rates of degradation exceed synthesis and a negative net protein balance results. Consuming protein supplements during recovery from exercise should, however, promote the production of skeletal muscle (muscle that is attached to bones and contracts on demand).

Despite the logic behind these claims, a systematic assessment of the evidence to support or refute the relationship between the use of protein supplements and exercise performance, muscle damage and soreness, and recovery of muscle function has until recently been lacking. Earlier this year, Pasaikos, Lierberman and McLellan addressed this dearth by publishing two review articles in the journal Sports Medicine.  Examining publications reporting findings from ‘healthy human adults’ (no chimpanzees thankfully) between 18 and 50 years of age, they found no apparent relationship between recovery of muscle function, muscle soreness and muscle damage when protein supplements were consumed prior to, during or after a bout of endurance or resistance exercise. If supplemental protein was consumed after daily training sessions, however, beneficial effects such as reduced muscle soreness and damage became more evident. They also found that when carbohydrates were at optimal levels during or after exercise, protein supplements provided no performance enhancing effects. In particular, sparing of muscle glycogen stores was not supported as a mechanism leading to enhanced endurance performance.

Pasaikos et al. warned, however, that small numbers of participating adults and lack of dietary control limited the effectiveness of several of the investigations they examined. Since studies did not measure the effects of protein supplementation on direct indices of muscle damage or muscle glycogen, for example, the interpretation of the data was often limited. What does seem clear, however, is that if athletes maintain a healthy diet, by consuming enough protein and carbohydrate through traditional means (for example regular food), protein supplements are unlikely to generate record breaking results. Only when the healthy human adults involved in the studies examined by Pasaikos et al. were lacking in nitrogen (found in amino acids that make up proteins) and/or energy balance were performance enhancing effects of protein supplements found to be greatest. Endurance is of course built by training and not protein alone. Whilst Pasaikos et al. demonstrated the need for further high quality research on the potential benefits of protein supplements, a healthy diet, sufficient rest and undeterred dedication seem to be best recipe for success.

Read more

An Apple a Day!

appleAn apple a day may keep the doctor away and is a good idea title for a book, but it’s probably a bad premise for a scientific study. The other day, a friend of mine drew my attention to a headline in the UK Telegraph “Eating an apple a day improves women’s sex lives, study shows.” Bad grammar not withstanding, I defied my better judgment and decided to read the article. The Telegraph doesn’t have the best track record of health reporting. Recently they wildly misreported a study about edible flowers and true to form they botched this one as well.

The article makes a number of claims. It says that that apples have “been show to be an aphrodisiac,” that “an apple a day can improve the sex lives of women” and that they “boost sexual pleasure in healthy women.” These are impressive attributes for a simple fruit, so I decided to read the actual study this report was based on.

The study was published in the Archives of Gynecology and Obstetrics. Essentially researchers took 731 women and asked them how many apples they ate every day and then asked them to fill out a questionnaire about their sex lives in areas such as desire, arousal, satisfaction, pain, etc. Researchers found an improvement in lubrication and consequently in the total score, but not in any other area of the questionnaire. Here is an actual quote from the study, “No significant differences between the two study groups were observed concerning desire, sexual arousal, satisfaction, pain and orgasm.” (Interestingly, the group that ate less apples had a slightly higher satisfaction score 4.5 vs. 4.3). This strikes me as fairly convincing that apples are don’t affect the quality of women’s sex lives at least in terms of the metrics that actually matter. Having read this study, I cannot for the life of me figure out how the Telegraph could have generated their headline. I can only assume they didn’t actually read it and just parroted the press release.

Even if you accepted their one single positive finding, the study has a lot wrong with it. First off, it is not a randomized clinical trial. Even though the newspaper story seemed to imply that it was, here researchers simply asked women how many apples they ate and did not actually conduct an experiment. It is easy to image why women who ate apples on a daily basis would be different than women who did not. They were likely more health conscious, probably exercised more, and probably had a better diet overall. Those who ate more apples probably ate more bananas, more oranges, more pears and more fruits in general. Researchers did not ask about other fruits and they likely could have just as easily shown an association with kiwis or pomegranates. So why apples? I guess the link to the biblical story of Adam and Eve was too good to pass up. Of course, the fruit of the tree of knowledge wasn’t actually an apple but why quibble on details.

The newspaper article also then makes a number of claims that the benefits of apples are due to phloridizin and polyphenols.  This is pure speculation. This study, as I mentioned, did not measure any hormone levels or perform any tests on the apples themselves. It was purely the analysis of questionnaire sent out to women.  Clearly, throwing in a few “sciency” terms (and adding the requisite photo of an alluring women biting into an apple) made the article more appealing to the newspaper editors.

Apples are unlikely to improve your sex life and, while we’re at it, neither will oysters, chocolate, or ginseng. An overall healthy lifestyle with regular exercise and a balanced diet is probably your best bet (but admittedly this would make for a lousy headline). So what can we conclude overall about eating an apple day? No effect on sexual desire or satisfaction, great title for a book, and (from my point of view) it’s bad for business.

Read more

Trumpet Plastic Surgery

tiger trumpetThe world of instrument making is a peculiar blend of tradition and innovation. Once a good design is found, it’s rare for major modifications to occur. The big names we have heard of, Stradivarius violins (or as Homer Simpson says, “Strada-who-vious?”), or Steinway grands, are physically quite similar to their ancestors – a quality openly sought by musicians who buy these makes. More often, the innovation occurs from within the constraints of the traditional form of the instrument. We’ve switched out the cat gut for more resilient plastics (though you can still find the purist who swears by the older string type), and moved away from wooden piano frames, which has resulted in much fewer pianos spontaneously collapsing, releasing their strings, bound so tightly they could cleanly remove a finger. It’s therefore rare to come across a trumpet that’s almost completely made of plastic.

The “tiger trumpet”, a plastic trumpet that comes in a variety of vibrant colours, is the latest in a trend of professional quality plastic instruments. Likely inspired by the “p-bone”, a plastic trombone, and the first (and arguably, simplest) of the brass instruments to depart from its metallurgical heritage, the tiger trumpet is the answer to the trumpeter with a penchant for ‘toys’, which if you know any trumpeters, is all of us. At the highly affordable price of $295, I was able to get my hands on a beautiful blue and yellow model and examine it.

The horn itself is almost entirely made of plastic. It seems like a cop out to begin by saying that plastic has its limitations, as the horn is truly quite impressive. However, the basis of function of the valves still requires a small amount of metal, and indeed, with exception to a thin layer of aluminum which coat the valves, and supply the mechanical energy in the springs, the tiger trumpet is all ABS plastic.

Acrylonitrile Butadiene Styrene – for the more seasoned chemists, or the well-informed consumer, this plastic may ring a bell. You’ve probably come across it in the form of the beloved (and sometimes painful) children’s toy Lego, but it’s used in a variety of other applications. The plastic is rigid through a large range of temperatures, and when molten can be coloured with a variety of dyes. The plastic does have a drawback, and this is best told by the tale of the world’s largest auto recall of which several million cars manufactured by GM were subject. As it would turn out, ABS is prone to photo oxidation, and the mechanism of the seat belts in several GM SUVs made roughly over a 10 year period contained this plastic, which degraded, and was the cause os several hundred car accidents. Beyond the inherent wastefulness in the manufacture of most plastics, which use impressive amounts of petroleum products for their synthesis, photo oxidation, and solvency in acetone (keep that nail polish remover away from your trumpet) are the principal causes for concern with an ABS trumpet.

Read more

FOLLOW DR. KO: Medical Mission to Haiti – Paul’s last days and a few highlights

It was one of those happy endings. Paul, albeit still frail, was now smiling, eating, and chatting with his family. When I first met him, as described in my last post, he couldn’t even breathe on his own. He had been lying listless in the Intensive Care Unit (ICU) bed for days, skin and bones, barely moving a muscle. It was New Year’s Day, and I couldn’t think of a better time to tell him that he was ready to be discharged home.
Paul was one of my first patients on a medical volunteer trip to Haiti earlier this year at Bernard-Mevs Hospital. Paul had been admitted to the ICU for acute respiratory failure secondary to an exacerbation of chronic obstructive pulmonary disease. I had made it my personal project to find him the best treatment regimen with the very limited resources we had. Often, especially at night, I was the only physician covering triage, the emergency room, the inpatient unit and the ICU, and I had only my pocket medicine book to rely on. That, and my own judgment.
It is pretty amazing how quickly a resident physician can grow when forced to think and act by herself without the usual close supervision of an attending, as is the usual case during residency. I remember my second night shift when, while all the volunteers went out to dinner, I was assigned to stay behind to woman the fort. With a mere one and a half years of experience in internal medicine under my belt, it was a tad daunting to be left in charge of the entire hospital. Lo and behold, an ambulance rolled in with blaring sirens, bringing in a young man who was in a motorcycle accident. Just as I was evaluating this patient, another ambulance pulled in, followed by another. Just like that, I was in the entrance of the hospital, surrounded by three ambulances and a crowd of spectators. Seeing as we had our hands full, the third ambulance was diverted to MSF (Médecins Sans Frontières) France which was about 15 minutes away.
As I gave instructions to stabilize the motorcycle accident victim’s neck with a neck collar to prevent worsening of potential cervical spine injury, I tried to gather some history about my second patient. “He has high blood pressure” was all that I could obtain from the paramedics. He was a transfer from another hospital, and apparently they couldn’t handle him so sent him to Bernard-Mevs. No one could tell me what his latest set of vital signs were, or what symptoms he had, so I jumped into the ambulance to take a look for myself.

Read more

Beware of the new contrarian embrace of dietary fat

dietBy: Christopher Labos MD CM FRCPC

 Some of you may have heard about a new book called The Big Fat Surprise. The basic premise of the book is that fat is not bad for you and that you should eat more of it. When I first heard about this book and recovered from my apoplectic fit, I marvelled at how many times we can keep having the same discussion. Most diets can be lumped into two broad categories of either low-fat or low-carbohydrate diets.

 The notion that fat is associated with cholesterol and heart disease goes back several decades with research programs like the Framingham Heart Study and the MRFIT study, and initially led physicians to recommend low-fat diets as a way to stave off heart disease. The problem with this strategy was two-fold. First, as people sought out low-fat alternatives to their favourite junk food, companies simply took out the fat and added more sugar.

 Thus they were able to preserve the taste while still being able to label their food fat-free. As you might imagine, this did not translate into health benefits. As a result, most studies of a low-fat diet have been negative, and this fact is proudly proclaimed in the book.

The second problem with the low-fat diet is more subtle. Our understanding of fat and cholesterol has evolved considerably since those early studies. Now we speak of LDL and HDL (bad and good) cholesterol, rather than total cholesterol, as we once did. Also, instead of talking about total fat, we now talk about good fats (mono and polyunsaturated fats) that we get from fish and vegetable oils and bad fats (trans fats) that are present in fried foods. So a problem with the low-fat diet is that people reduced their intake of both good and bad fat, which essentially cancelled out the effects of each.

 Admittedly, the evidence for different fat sources is not rock solid. Although it is incontrovertible that smoking causes lung cancer, and that high blood pressure leads to a stroke, trying to prove that good fats are protective while bad fats are harmful is very difficult. There are a number of reasons why nutrition-based research is hard to do, but the main difficulty is that people’s diets fluctuate over time and rarely stay consistent.

The book I mentioned starts by poking holes in the evidence for good and bad fats, which is fair enough because, like I said, it is not perfect. It then goes on to state that sugar and carbs are the real enemy. For those of you who realized that this is essentially the Atkins diet repackaged, congratulate yourselves on an astute observation. Finally, it makes the rather bold claims that we should eat more fat and butter in our diet. This strikes me as a very bad idea.

 Although we can say that the evidence on trans fats is not as good as we would like it to be, no reasonable researcher out there is going to claim that they are protective. That is just ridiculous, and eating more trans fats is not going to make you healthier.

Of course we need some fat in our diet, just as we need some carbs and proteins for everything to work properly. I’ve always suggested people should get their fat from fish and vegetable oils rather than fried foods, that they should get their carbs from whole grains rather than sugary treats and baked goods, and they should top it all off with a little bit of protein (either from lean meats, fish, lentils or nuts). I thought about writing a book and calling it the Labos diet, but then somebody told me that it already has a name. It’s called common sense.

Read more

Raw Milk Is For Calves

calvesBy: Christopher Labos MD CM FRCPC

While I was down in the US recently, I discovered that one of the great debates going on that country is whether producers can sell unpasteurized milk. Raw milk has become the fad du jour with advocates claiming that it is safe and good for you. Sadly, neither point is true.

To understand the debate we have to go back to the beginning of pasteurization and to one of the greatest scientists of modern times, Louis Pasteur. Interestingly, Pasteur’s initial work had nothing to do with milk but with wine. He was commissioned to figure out why wine spoiled and turned to vinegar. He discovered that tiny microscopic organisms were present in the wine and caused it to spoil. It was the birth of the germ theory and the founding of a new field of medicine, microbiology.

To be fair, Pasteur didn’t actually invent the idea of heating a substance to kill the bacteria inside, that honour belongs to Nicolas Appert. However, heating a liquid to boiling would frequently change the taste of the wine and give it a more acidic flavour. Pasteur determined the optimal temperature and time required to kill the bacterial contaminants without affecting the taste. So French wine was saved, and the process became known as pasteurization in his honour.

It was Franz von Soxhlet, a German chemist, who first suggested in 1886 that pasteurization could be applied to milk. At the time, and into the early 20th century, milk was a common source of food borne illness, particularly tuberculosis and brucellosis. As a result of pasteurization and a policy to slaughter TB infected cattle, bovine tuberculosis fell drastically. While prior to 1917 it accounted for somewhere between 20-30% of TB cases, it now accounts for about 1%.

The main theme of the raw-milk lobby is that raw milk is safe, and that the bacteria in raw milk are the “good” bacteria. In fact, pasteurization was applied to milk specifically because it wasn’t safe and often transmitted disease. The raw milk literature often makes semi-scientific claims like “Staphylococci, Streptococci, Lactobacillis and Ent. faecalis in raw human milk inhibit pathogenic Staph aureus.” Clearly there is a lack of understanding here as Staph, Strep, and Enterococcus infections are very common and can be very dangerous if left untreated. If they had seen what I’ve seen, namely someone developing meningitis from a listeria infection they would sing a different tune.

The second major claim of the raw milk people is that pasteurization damages the milk and removes the health benefits. Well first off, you don’t really need milk to be healthy and milk consumption is rare in large parts of Asia and Africa. I drink milk daily because my mother made me drink a glass of milk with breakfast every morning and I fear that I am too old to break that habit now. Milk is a good source of calcium (and in Canada of Vitamin A and D because it is added to milk by the government to prevent deficiency). However, these vitamins and minerals aren’t going to be affected by temperature changes and so pasteurizing the milk will have no effect. Most expert organizations agree that apart from a change in the flavour, there is little nutritional difference between raw and pasteurized milk.  Raw milk enthusiasts make a number of other claims that raw milk will boost your immune system. Believe me when I say that if there were a way to “boost your immune system” we would be giving it to chemotherapy patients and those with HIV rather than wasting our time with this debate. The argument centers on the fact that raw milk contains leucocytes and other immune components that will help your immune system. Leucocytes, a.k.a. white blood cells, are the cells that fight off infection. Unfortunately, any leucocytes in milk came from the cow, and a cow’s leucocytes won’t do you any good. In fact they could theoretically do some harm because a cow’s leucocytes see your cells as foreign and would attack them (a concept in medicine we see in transplant patients called graft-versus-host disease). However, in the concentrations observed, they are unlikely to do much any good or harm.

It is possible to drink raw milk and not die in the same way that you can eat raw meat (steak tartar) and not die. But steak tartar is meticulously handled and carefully prepared to minimize the risk of bacterial contamination. However, the risk of infection is not zero and is not recommended for pregnant women or those with compromised immune systems. Sushi is also made of raw fish, but it too is carefully prepared and (in Canada at least) must be flash frozen prior to serving to kill off any bacteria. However, all this preparation incurs some cost which is why these products are somewhat more expensive and only served at fairly high end restaurants. Ordering cheap steak tartar at a local diner, much like buying sushi from a gas station, is no deal in the long run.

Raw milk is managed in the same way. The cows are well treated, fed only the best grain, allowed to roam free and generally treated better than we treat most humans. Importantly, they test their cows and milk for tuberculosis, listeria, and other bacteria and throw away anything contaminated. This is of course incredibly wasteful and costly. It also leads to the destruction of perfectly good food that would be fit for consumption if pasteurized. I know we have been blessed with an abundant food supply here in North America but wilfully destroying food seems wasteful to me when you consider how many people have to do without it.

Clearly, the people advocating raw milk will try to capitalize on the growing “natural is better” delusion that grips our society. It’s important to ask anyone that extols the virtue of raw milk if they have any financial interest in its sale, which of course they always do. So when it comes to raw milk, remember why we started pasteurizing it in the first place because if we forget our history we will be doomed to repeat it.

Read more

« Older Entries
Blog authors are solely responsible for the content of the blogs listed in the directory. Neither the content of these blogs, nor the links to other web sites, are screened, approved, reviewed or endorsed by McGill University. The text and other material on these blogs are the opinion of the specific author and are not statements of advice, opinion, or information of McGill.