Raw Milk Reality: Is Raw Milk Worth the Risk? - by Chris Kresser

raw milk

In Is Raw Milk Dangerous, we examined the risk associated with drinking unpasteurized milk compared to the risk associated with consuming other foods, and with other activities such as driving a car. In Raw Milk Benefits, we covered some of the possible benefits of unpasteurized milk. In this article, I’m going to present a framework for determining whether raw milk is worth the risk for you and your family.

As I said in the first article, I’m not here to convince you to drink raw milk. I don’t work for a raw milk producer. I don’t make money promoting raw milk. I have nothing to gain if you decide to drink raw milk, nor do I have anything to lose if you choose not to.

This is a decision you have to make on your own, by weighing the risks vs. benefits and considering more personal variables such as your health status, risk tolerance, values and worldview. Every day we make choices that involve this kind of evaluation, whether we’re conscious of it or not. Each time we get into a car, for example, we are deciding that the convenience and efficiency driving offers is worth the risk of injury or death. We may not consider the decision in these terms – because we’re so accustomed to driving – but that doesn’t mean the risk isn’t real and we aren’t making a choice.

With that in mind, let’s discuss a few of the factors you might consider in your decision.

Are dairy products even necessary?

In a word: no. Humans have only consumed dairy products for a short period of our evolutionary history, and we thrived without them. No one suffers from “dairy deficiency”.

That said, I do believe dairy products can be beneficial when they’re well-tolerated. Several epidemiological studies have linked dairy consumption (especially full-fat dairy) with positive health outcomes. (1) While this does not prove causality, we also know that dairy contains healthful nutrients like fat-soluble vitamins, calcium, and conjugated linoleic acid (natural trans-fat), some of which can be difficult to obtain elsewhere in the diet. Fermented dairy products like yogurt and kefir can be particularly beneficial, especially for those with gut issues.

And we don’t eat only for health. We also eat for pleasure. Dairy is one of the most popular food categories around the world, equally beloved by people of all ages, ethnicities and walks of life. We have sayings like “butter makes everything better” and “crème de la crème” for a reason!

Do you tolerate pasteurized milk?

If you tolerate pasteurized dairy, and you’re concerned about the risk associated with raw milk, you might try to find a small, local dairy with grass-fed cows that uses vat or low temperature pasteurization. In contrast to the ultra-high temperature (UHT) pasteurization process used by large commercial dairies, vat pasteurization heats the milk to a lower temperature (145 degrees) for a longer period of time (30 minutes) and then cools it as quickly as possible. Proponents of vat pasteurization say that it tastes better than milk pasteurized with high temps, and it seems reasonable to assume that the nutrient loss would be less (although I haven’t seen any data on this).

An additional benefit of these small dairies is that many don’t homogenize their milk. As Cynthia pointed out in a recent comment, homogenization squeezes large casein micelle complexes through small pores to break them up. The micelles are held together by calcium phosphate. When the micelles are broken up in homogenization, the fats are exposed to calcium, which forms calcium soaps (“saponification”). Calcium soaps not only irritate the gut and make it leaky, but also decrease the absorption of protein, vitamins and minerals. (2, 3)

A similar option is purchasing raw milk, and then pasteurizing it at home. You can do this with a home pasteurization machine, or with your stovetop using the low-temperature method I described above. Click here for instructions.

However, even those that “tolerate” pasteurized dairy often find that they feel much better drinking unpasteurized milk. And of course if you’re one of the many  people that doesn’t do well with pasteurized milk products, raw milk is your only option if you wish to consume dairy.

Are you elderly, pregnant, immunocompromised or do you have young children?

In Is Raw Milk Dangerous I presented data indicating that the risk of developing a serious illness (requiring hospitalization) from drinking unpasteurized milk is very low: less than one in a million. I also pointed out that other foods like fish, shellfish, poultry, eggs, and beef are far more likely to cause illness than dairy products, even when adjusted for consumption.

That said, there is a risk of serious illness associated with drinking unpasteurized milk. And it’s important to note that this risk is more heavily weighted toward young children (under 3-4 years old), pregnant women, the elderly and those with less developed or compromised immune systems.

These illnesses can be severe. For example, in a recent outbreak in Oregon, a toddler and two young teens were hospitalized after drinking raw milk contaminated with E. coli 0157:H7, one of the most virulent foodborne pathogens. Two of them had hemolytic-uremic syndrome (HUS), a form of kidney failure. In another outbreak involving E. coli 0157:H7 this year in Missouri, two were hospitalized, including a two-year old with HUS.

On the other hand, it could be argued that growing children, pregnant women and people with under-functioning immune systems have the most to gain from the benefits of raw milk. This is illustrated by a comment from a reader on the last post in this series. He  recently had an intestinal transplant (both small and large) and is taking powerful immunosuppressant medication, which would certainly place him in the “immunocompromised” category. Yet he feels that unpasteurized milk has been a significant factor in his unusually speedy recovery. He is the only recipient of the transplant that he’s aware of that hasn’t returned to the hospital with sepsis and systemic infection. Shortly after the surgery, he attempted to drink pasteurized milk and got severe cramps and diarrhea and lost 10 pounds. Yet in spite of his doctor’s warning that he’d never be able to tolerate dairy (because all intestinal and multivisceral tranplant recipients become lactose intolerant), he has thrived on raw milk.

A story like this doesn’t prove that unpasteurized milk had anything to do with his recovery. But I’ve read about and heard from many people who’ve had similar – albeit less dramatic – experiences, and I also feel that raw milk kefir was a crucial factor in my own healing process. And as we discussed in Raw Milk Benefits, there is substantial epidemiological evidence that children that consume raw milk may be protected against asthma and allergic diseases.

What is your risk tolerance? And what is important to you?

The extremely small risk of developing a serious illness is enough to turn some people off to raw milk. That is a perfectly valid choice.

Others feel so much better when they drink unpasteurized milk that they’re willing to take the risk. Or perhaps they love dairy, but can’t tolerate pasteurized milk. Or maybe they’re a “foodie” and they simply prefer the taste of raw milk to pasteurized milk.

Each day we make choices, and take risks. We’re more aware of some than others. We are hundreds of times more likely to die in a car crash than develop a serious illness from drinking unpasteurized milk, yet that doesn’t stop us from driving (by ourselves or with our children). Some may argue that driving is a necessity, while drinking raw milk is optional. I would argue that both activities are optional, and whether we choose to do one or the other is simply a reflection of our priorities and preferences.


Two good alternatives to raw milk that I mentioned above are finding a small, local dairy with grass-fed cows that uses vat pasteurization and preferably doesn’t homogenize their milk, and purchasing raw milk and pasteurizing it at home. These may be ideal solutions for those that are concerned about risk, but have no problem digesting pasteurized milk.

If you don’t tolerate pasteurized milk, or choose to drink raw milk for any other reason, there are steps you can take to minimize the risk. That will be the subject of the final article in the series.

Now I’d like to hear from you. After reading this series, do you think raw milk is worth the risk? Why or why not? Please leave your vote and comment below.