Tag: raw milk

Understanding the Risks and Benefits of Drinking Raw Milk

Understand the many risks of drinking raw milk and don't be fooled by propaganda, such as that 'raw milk heals.'
Understand the many risks of drinking raw milk and don’t be fooled by propaganda, such as that ‘raw milk heals.’ (CC BY 2.0)

Surprisingly, more and more people are starting to drink raw, unpasteurized cow’s milk.

Or maybe that shouldn’t be too surprising as most people associate things that are raw or natural as being safer and healthier for them, often without understand the consequences.

Unfortunately, drinking raw milk can be dangerous, especially for young children.

There are plenty of risks and no real health benefits.

Drinking Raw Milk

Just as you would have thought, is basically “straight from the cow,” and hasn’t been processed or pasteurized.

Although most experts consider pasteurization to be one of the most important health advances of the last century, some people think that it removes nutrients and kills beneficial bacteria. They also claim that raw milk can taste better than pasteurized milk, which if you believe it, is really the only possible benefit of drinking raw milk.

It’s not even a good way to avoid growth hormones in milk, as most milk is now growth hormone free anyway and is labeled rBST-free.

Is raw milk healthier than pasteurized milk? There is no research to support that raw milk is healthier or, according to the FDA, that there is a “meaningful difference between the nutrient content of pasteurized and unpasteurized milk.”

In fact, the American Academy of Pediatrics states that “substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections.”

Dangers of Drinking Raw Milk

According to the FDA, raw milk can be contaminated with bacteria, including:

  • Brucella species
  • Campylobacter jejuni
  • Coxiella Burnetii
  • Escherichia coli
  • Enterotoxigenic Staphylococcus aureus
  • Listeria monocytogenes
  • Mycobacterium bovis
  • Mycobacterium tuberculosis
  • Salmonella species
  • Yersinia enterocolitica

These bacteria can cause people to get sick, leading to symptoms such as diarrhea, vomiting, fever, stomach cramps, and headaches. The Centers for Disease Control and Prevention reports that about 200 to 300 people get sick each year from drinking raw milk or eating cheese made from raw milk.

Another big danger of drinking raw milk that some people may overlook is that raw milk is very low in vitamin D. In addition to being pasteurized, processed milk that you routinely buy in a store is typically fortified with vitamin D, which is important to keep your bones strong.

Since young children are at big risk for getting sick from any bacteria that may be in raw milk and they need vitamin D, it is important that you not give your child raw, unpasteurized cow’s milk. In fact, the American Academy of Pediatrics states that “children should not consume unpasteurized milk or products made from unpasteurized milk, such as cheese and butter, from species including cows, sheep, and goats.”

We will have to add unpasteurized camel milk to the list, as that seems to be a thing now too.

Keep in mind that kids should also avoid unpasteurized fruit juices, including unpasteurized apple juice and apple cider.

Lastly, raw milk is about the same as whole milk in terms of fat content and calories. Experts recommend that children start drinking reduced fat milk, which has less fat and calories than whole milk, beginning at age two, you won’t be able to do that if your kids are drinking raw milk.

What To Know About Drinking Raw Milk

If you are still thinking of giving your child raw milk, keep in mind that “the AAP strongly supports the position of the FDA and other national and international associations in endorsing the consumption of only pasteurized milk and milk products for pregnant women, infants, and children.”

And remember that you are basically giving raw milk to your kids because you think it tastes better, as it certainly isn’t better for them, is missing key nutrients, and it could be contaminated with dangerous bacteria.

More Information on Drinking Raw Milk:

What is Causing your Child’s Diarrhea?

Often described as the "cruise ship virus," you can get norovirus infections in daycare centers, schools, or after eating at a restaurant.
Often described as the “cruise ship virus,” you can get norovirus infections in daycare centers, schools, or after eating at a restaurant. (CC BY-SA 2.0)

Why does your child have diarrhea?

Could it be the “stomach flu,” food poisoning, or just an intolerance to something your child eat?

Common Causes of Diarrhea

While parents often quickly jump to the idea of “food poisoning,”  infections are typically the most common cause of diarrhea in kids.

These include:

  • viruses – rotavirus (a vaccine preventable disease), adenovirus, and norovirus
  • bacteria – C. diff, Salmonella, Shigella, E. coli, Campylobacter jejuni, Bacillus cereus, Listeria, Cholera
  • parasites – Cryptosporidium, Giardia, Cyclospora

Not all diarrhea is caused by infections though. If the diarrhea lingers for more than a few weeks or keeps coming and going, then you might consider that your child might have a lactose intolerance, irritable bowel syndrome, Celiac disease,  or other non-infectious cause.

Hints of Diarrhea Causes and Risk Factors

To help figure out what might be causing your child’s diarrhea, consider these questions and share the answers with your pediatrician:

  • Does your child have bloody diarrhea (sometimes a sign of a bacterial infection)?
  • Is your child getting dehydrated? While that doesn’t tell you want is causing the diarrhea, it is a good sign that you need to seek medical attention.
  • Does your younger child (under age 2 to 4 years) have bloody diarrhea that is becoming jelly-like and episodes of severe, colicky abdominal pain (sign of intussusception)?
  • Is your child in daycare? Has anyone else recently been sick with diarrhea or vomiting?
  • Has your child recently been on antibiotics (a risk for C. diff)?
  • Does your toddler with diarrhea drink a lot of juice (Toddler’s diarrhea)?
  • Have you recently traveled out of the country (Traveler’s diarrhea)? Did your child get sick a few days later (could be a bacterial or viral cause) or a few weeks later (parasites have longer incubation periods)?
  • Has your child recently spent time on a lake or river and possibly drank untreated water (risk for Giardia infection)?
  • Do you have any high risk pets, including turtles, snakes, lizards (or other reptiles); frogs, salamanders, newts (or other amphibians); chicks, chickens, ducklings, ducks, geese, and turkeys (or other poultry); mice, rats, hamsters, and guinea pigs (or other rodents); or farm animals (all can be a risk for Salmonella)?
  • Have you recently visited a farm or petting zoo (risk for Salmonella and E. coli)?
  • Has your child recently visited a water park or public swimming pool (risk for Cryptosporidium)?
  • Does your child drink raw milk, unpasteurized juice, raw or undercooked eggs, or undercooked beef, pork, and poultry (risk for food poisoning)?
  • Has your child recently eaten leftover food that had been unrefrigerated for more than two hours (risk for food poisoning)?
  • Is the diarrhea worse after your child drinks a lot of milk or eats a lot of dairy (a sign of lactose intolerance)?
  • Does your child have alternating episodes of constipation and diarrhea (irritable bowel syndrome)?
  • In addition to chronic diarrhea, is your child irritable, with poor weight gain and other symptoms (a sign of Celiac disease)?
  • Does your child also have abdominal pain or just diarrhea?
  • Is your child taking any medications that might cause diarrhea as a side effect?

Once you have narrowed down the possibilities, blood and stool tests, including stool culture tests for bacteria, parasites, and viruses can sometimes help to figure out what is causing your child’s diarrhea. Keep in mind that these are usually reserved for diarrhea symptoms that are severe (bloody diarrhea, fever, weight loss, etc.)  or lingering for more than a few weeks.

And remember that the most common causes of diarrhea, including food poisoning and viral infections, typically go away on their own without treatment. In fact, you can make things worse if you treat some causes of diarrhea with antibiotics, including some Salmonella, Shigella, E. coli infections.

Still don’t know what is causing your child’s diarrhea? In addition to your pediatrician, a pediatric gastroenterologist can be helpful when your child has diarrhea.

What To Know About Diarrhea

While diarrhea is common in kids and we often don’t figure out the specific cause before it goes away on its own, there are clues that can help you figure out if your child’s diarrhea is caused by a virus, bacteria, parasite, or other condition.

For More Information on Diarrhea

Preventing and Treating Vitamin D Deficiency

More people seem to be getting the message that too little vitamin D in our diets can lead to health problems. In addition to being at risk of developing rickets (extreme vitamin D deficiency), children with milder forms of vitamin D deficiency can develop weak bones and muscle weakness.

Why is vitamin D so important?

Vitamin D is a hormone that helps our bodies absorb both calcium and phosphorous, two very important minerals that help keep our bones strong.

Without enough vitamin D, we absorb 85-90% less of the calcium in our diet! And then, to keep calcium levels normal, our bodies pull more calcium out of our bones, causing osteopenia and osteoporosis.

Some experts also think that a low vitamin D level is associated with other conditions that are not linked to calcium and our bones, including some psychiatric conditions. The American Academy of Pediatrics even states that “new evidence suggests that vitamin D plays a vital role in maintaining innate immunity and has been implicated in the prevention of certain disease states including infection, autoimmune diseases (multiple sclerosis, rheumatoid arthritis), some forms of cancer (breast, ovarian, colorectal, prostate), and type 2 diabetes mellitus.”

The role of vitamin D in preventing infections, cancer, or anything else beyond preventing and treating vitamin D deficiency (extraskeletal effects) is far from proven though. In fact, a 2010 investigation by the Institute of Medicine (IOM) didn’t find any evidence to support a role for vitamin D in any other health conditions besides supporting bone health.

Surprisingly to many people, the IOM report also found that most people in North America are already getting enough calcium and vitamin D in their diet and that getting too much can be harmful. They also warned that “the number of people with vitamin D deficiency in North America may be overestimated because many laboratories appear to be using cut-points that are much higher than the committee suggests is appropriate.”

Tests for Vitamin D Deficiency

Although vitamin D testing seems to becoming part of the routine screening tests that some doctors order, it is important to keep in mind that only those at risk for having low levels should be routinely tested.

Are your kids at risk for vitamin D deficiency?

These high risk children can include:

  • exclusively breastfed infants who don’t get a vitamin D supplement
  • babies born to mothers with a vitamin D deficiency, especially premature babies
  • children with chronic kidney or liver disease
  • children with malabsorption syndromes (Crohn’s disease, inflammatory bowel disease, cystic fibrosis, etc.), as vitamin D is absorbed with fats in our diet
  • obese children, because vitamin D is stored in fat tissue and is not readily available for use
  • children with dark skin, who live at high latitudes, and/or spend a lot of time indoors (less vitamin D from sun exposure)
  • children taking certain medications, including antiseizure medications and oral steroids
  • children who simply don’t get enough vitamin D – at least 400-600 IU of vitamin D each day, depending on their age. This might include vegetarians, vegans, and children who simply don’t drink vitamin D fortified cow’s milk, soy milk, or almond milk, etc., or other foods that are high in vitamin D.

If your child falls into one or more of these risk factors for vitamin D deficiency, then talk to your pediatrician about testing his vitamin D levels.

Although different tests are available, the test that is recommended by the AAP and the Endocrine Society is the serum 25(OH)D level (25-hydroxyvitamin D). This actually measures the levels of a prehormone of vitamin D, calcifediol, but is thought to give a good idea of a person’s vitamin D status.

This vitamin D test is preferred over testing 1,25(OH)2D levels, another test that is available, as those levels can be normal or even elevated when someone has a vitamin D deficiency. Similarly, measuring vitamin D levels (the active hormone) has not been found to be helpful. Instead, we use 25(OH)D levels as a marker for vitamin D levels.

Treating Vitamin D Deficiency

Is your child’s vitamin D level low?

That question is a actually a little harder to answer than you might realize. According to the IOM, in discussing cut-points for 25(OH)D levels, or what’s low and what’s normal, “At this time, there is no central body that is responsible for establishing such values for clinical use.”

The serum 25(OH)D level is typically defined as low (vitamin D deficiency) in children if it is below 20 ng/ml. Some experts think that a 25(OH)D level above 16 ng/ml is normal for infants and children though.

Experts do agree that a level below 5 ng/ml is a sign of a severe vitamin D deficiency.

Recommendations for treating children with low vitamin D levels depend on their age, and might include:

  • newborns: 1,000 IU /day vitamin D2 or D3
  • children 1 to 12 months old: 2,000 IU /day vitamin D2 or D3
  • children > 12 months old: 2,000 IU /day vitamin D2 or D3

These vitamin D supplements, together with adequate amounts of calcium, are usually continued for at least 1 to 3 months, at which time the child’s serum 25(OH)D level can be repeated to make sure it is responding to treatment.

“The upper limit for vitamin D is 1,000 to 1,500 IU/day for infants, 2,500 to 3,000 IU/day for children 1-8 years, and 4,000 IU/day for children 9 years and older, adults, and pregnant and lactating teens and women. Vitamin D toxicity almost always occurs from overuse of supplements.”

NIH Vitamin D Fact Sheet for Consumers

The Endocrine Society also advises that some children can take 50,000 IU of vitamin D2 once a week as an alternative treatment for vitamin D deficiency. Since you can definitely get too much vitamin D, be sure to talk to your pediatrician and make sure your child is getting the right dose before starting a treatment regimen for vitamin D deficiency.

Preventing Vitamin D Deficiency

Once you get your child’s vitamin D levels back into a normal range, it is important to take steps so that they don’t drop again.

To prevent vitamin D deficiency, the American Academy of Pediatrics recommends that healthy infants get at least 400 IU of vitamin D each day, while older children – toddlers to teens – get at least 600 IU. This vitamin D should come from some combination of:

  • foods that are naturally rich in vitamin D – salmon, tuna, shitake mushrooms, etc.
  • foods that are fortified with vitamin D – vitamin D fortified milk, orange juice, cheese, yogurt, margarine, and cereal, etc.
  • a vitamin D supplement – with just vitamin D, vitamin D plus calcium, or a children’s multivitamin

What about sunlight? Can’t your kids just spend more time in the sun to boost their vitamin D levels?

Although we all have the ability to make vitamin D when we are out in the sun, it isn’t considered a good source of vitamin D. Intentional, unprotected (no sunscreen) exposure to the sun has risks of sunburn and skin cancer. And it is very hard to judge how much sun exposure is necessary to get adequate amounts of vitamin D. The intensity of the sun’s radiation varies greatly in different parts of the world and at different times of year and will also affect how much vitamin D your body makes.

Other Things To Know about Vitamin D Deficiency

  • Raw milk, in addition to being unprocessed and unpasteurized, is unfortified and has very little vitamin D.
  • Although other foods may be fortified with vitamin D, in the United States, only milk, margarine, infant formula, and “fortified-plant based beverages” are mandated by the FDA to be vitamin D fortified.
  • In addition to low 25(OH)D levels, children with vitamin D deficiency will often have low phosphorous, high alkaline phosphatase, and high parathyroid hormone levels. These levels might be checked and monitored when kids are treated for vitamin D deficiency.
  • Vitamin D2 (ergocalciferol, derived from plants) and vitamin D3 (cholecalciferol, derived from animals) are two major forms of vitamin D. Some experts think that vitamin D3 is more potent than vitamin D2, especially at higher doses. Still, these prohormones are converted to the same active form of vitamin D (calcitriol) in the liver and kidney.
  • Some experts think that 25(OH)D levels between 21 and 30 ng/ml are a sign of vitamin D insufficiency in children, as in adults, and are a sign that the child needs more vitamin D in their diet.
  • Although the use of sunscreen can block the synthesis of vitamin D by blocking UVB radiation and has been blamed for lower vitamin D levels in recent years, many people likely don’t use sunscreen properly and don’t use it consistently enough and so “sunscreen use may not actually diminish vitamin D synthesis in real world use.”
  • Taking high doses of vitamin D is yet another nutrition fad which has been linked to serious consequences. Mega doses of vitamin D have been linked to kidney problems and tissue damage. That makes it important to stay below the upper limit that your child can likely take each day without causing harm, which ranges from 2,500 IU/day for toddlers to 4,000 IU/day for teenagers. Most only need 400 to 600 IU/day though.

Children with severe vitamin D deficiency are often managed by a pediatric endocrinologist or a pediatric nephrologist.

More Information on Treating Vitamin D Deficiency

  • AAP – Vitamin D: On the Double
  • The rise and inevitable fall of Vitamin D
  • Help Your Child Build Healthy Bones
  • NIH Vitamin D Fact Sheet for Consumers
  • Study – American Academy of Pediatrics Clinical Report. Optimizing Bone Health in Children and Adolescents. Pediatrics. Pediatrics Oct 2014, 134 (4) e1229-e1243
  • Study – Institute of Medicine Report. Dietary Reference Intakes for Calcium and Vitamin D. Released: November 30, 2010.
  • Study – The Endocrine Society. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, July 2011, 96(7):1911–1930.
  • Study – Misra, M. Vitamin D Deficiency in Children and Its Management. Pediatrics, Aug 2008; 122: 398 – 417.

Treating Hard to Control Vomiting and Diarrhea

Kids get vomiting and diarrhea for many reasons, but it is most often caused by a stomach virus.

Whatever the cause, even if it is something your child eat or food poisoning, you will want to know how to best manage your child’s symptoms to help them feel better quickly and prevent them from getting dehydrated.

Vomiting and Diarrhea

Although most people associate vomiting and diarrhea with the “stomach flu,” the flu virus doesn’t usually cause vomiting and diarrhea.

Instead, there are a number of other viruses, bacteria, and parasites that do, including:

  • rotavirus – a vaccine-preventable disease
  • norovirus – the “cruise ship virus,” but very common elsewhere too
  • Salmonella, Shigella, E. coli – food poisoning, animals
  • C. diff – associated with recent antibiotic use
  • Cryptosporidium – drinking contaminated water, swimming pools, water parks

If necessary, especially when diarrhea is associated with severe symptoms or is lingering, stool tests can be done to figure out the specific cause. Fortunately, diarrhea and vomiting often goes away on its own fairly quickly and these tests aren’t necessary. What will likely be necessary is keeping your child well hydrated until these symptoms stop.

Treating Vomiting and Diarrhea

For most kids with vomiting and diarrhea, you can:

  • continue breastfeeding on demand
  • continue their normal diet (feed through the diarrhea), including baby formula or milk, if they just have diarrhea and no vomiting or only occasional vomiting, giving extra fluids every time your child has diarrhea (about 3 ounces if your child is under 22 pounds and about 6 ounces if they are over 22 pounds)
  • forget about eating and concentrate on drinking if your child has a lot of vomiting, but start by offering very small amounts of fluid, perhaps starting with a teaspoon (5ml) every 5 or 10 minutes, and then slowly working your way up to a tablespoon (15ml) and than an ounce (30ml) or two over a few hours
  • take a break from drinking for 30 minutes if your child has a set back and begins vomiting again, and restart at 5ml, slowly working your way back up again as tolerated
  • watch closely for signs and symptoms of dehydration, including weight loss, decreased urine output (fewer wet diapers or going to the bathroom less often), no tears, or dry mouth with no saliva or spit, etc.

In general, when talking about fluids, we mean an oral rehydration solution, like Pedialyte. If your older child won’t drink Pedialyte, you can offer something like Gatorade, but keep in mind that sports drinks have more sugar, so can sometimes make diarrhea worse.

But do you really make your child eat and feed through the diarrhea if he doesn’t want to? Of course not. The idea is that you don’t restrict your child’s diet if they want to eat. If they are complaining of a stomach ache, just don’t feel good, or feeding them their regular diet makes the diarrhea or vomiting worse, then move to more bland food.

Treating Hard to Control Vomiting and Diarrhea

What if your child continues to have vomiting and diarrhea?

You should still avoid treating your younger child with over-the-counter remedies to stop diarrhea, including those with loperamine (Imodium) or bismuth subsalicylate (Kaopectate).

A prescription medication, Zofran (ondansetron), might be appropriate for some children with persistent vomiting who are at risk of getting dehydrated.

If your child has persistent vomiting and diarrhea, ask yourself these questions and share the answers with your pediatrician:

  • Does your child have any symptoms that might require immediate medical attention, such as high fever, bloody diarrhea, severe headache, severe abdominal pain, or signs of moderate to severe dehydration?
  • Has your child with chronic diarrhea (diarrhea for more than four weeks) been losing weight, had fever, or regular stomach pains?
  • Does your otherwise well toddler have chronic, watery diarrhea even though no one else has been sick, a possible sign of Toddler’s diarrhea?
  • Do you have any pets or contact with pets that could put your child at risk for a Salmonella infection, including turtles, lizards, snakes, and frogs?
  • Has your child visited a farm or petting zoo, which puts him at risk for a Salmonella or E. coli infection?
  • Did your child recently take an antibiotic, which puts him at risk for a C. diff infection?
  • Has your child been drinking raw milk or other high risk foods?
  • Has your child traveled recently, which puts him at risk for traveler’s diarrhea?
  • Did you put your child on the BRAT diet (bananas, rice, applesauce, and toast) even though they were eager to eat?
    Have you tried giving your child a probiotic?
  • Does your child now only have diarrhea after drinking milk, perhaps a sign of a temporary lactose deficiency?
  • Is your child better, with much less vomiting, but you are just frustrated that the diarrhea hasn’t gone away yet?
  • Is your child better, with much less vomiting, but you are just frustrated that she is still vomiting at least once each day?

While you should certainly call your pediatrician if your child’s symptoms are lingering, remember that almost everything about the idea of the “24 hour stomach flu” you have heard is probably wrong. In addition to the fact that it isn’t caused by the flu virus, the symptoms typically last more than 24 hours, at least in kids. The vomiting may get better in 24 hours, but diarrhea can easily linger for a week or two.

It is also important to keep in mind that most causes of vomiting and diarrhea are very contagious and can easily spread through the whole house if you aren’t careful. Remember to always wash hands, rinse fruits and vegetables, clean and disinfect contaminated surfaces, and don’t share food or drinks, etc. If you just do it when your kids are sick, it will be too late, as many illnesses are contagious even before you show symptoms.

What To Know About Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

More Information On Treating Hard to Control Vomiting and Diarrhea