Raw milk: Questions patients may have and how to answer

Raw milk—that is, milk from cows, sheep or goats that has not been pasteurized—can be contaminated with germs that can cause serious illness, hospitalization, or death. Unlike pasteurized milk, which undergoes heat treatment to kill harmful bacteria, raw milk can carry dangerous pathogens such as Salmonella, E. coli, and Listeria, responsible for serious foodborne illnesses. 

In the mid-20th century, pasteurization was introduced as a critical public health measure, dramatically reducing the risks associated with an essential staple of the American diet. Despite these advancements to protect public health, some have suggested that there are health benefits to drinking raw milk despite the lack of scientific evidence.  

While federal law prohibits the sale of unpasteurized milk across state lines, individual state laws govern the sale of unpasteurized milk within the state. However, just because the sale of raw milk may be legal in your state, does not mean it is safe to drink.

Here are some questions patients might have about raw milk, along with the answers that physicians should be ready to share.

Also known as unpasteurized milk, raw milk is milk that has not been pasteurized, which is a process that removes disease-causing germs by heating milk to a high enough temperature for a certain amount of time, according to the Centers for Disease Control and Prevention (CDC). This is a key food safety step in the process that kills microorganisms that can cause disease. 

First developed by Louis Pasteur in 1864, pasteurization is a widely used process that kills harmful germs by heating milk to a specific temperature for a set period of time. Through pasteurization, harmful organisms responsible for diseases such as listeriosis, typhoid fever, tuberculosis, diphtheria, Q fever and brucellosis are killed, according to the Food and Drug Administration (FDA).

Pasteurization does not affect the quality of the milk. Most of the nutritional benefits of drinking milk are available from pasteurized milk without the risk of illness that comes with drinking raw milk. 

No, it is not. The CDC and FDA warn against the consumption of raw milk. It is also the AMA’s position that all milk sold for human consumption should be pasteurized. 

Raw milk can be a source of foodborne illness, says the CDC. And while good practices on farms can help reduce milk contamination, it does not guarantee it is safe from germs. Drinking or eating products made from raw milk can expose people to germs such as Campylobacter, Cryptosporidium, E. coli, Listeria, Brucella and Salmonella. 

Between 1998 and 2018, raw milk was linked to more than 2,500 hospitalizations and three deaths, according to the CDC and FDA. But “since the early 1900s, pasteurization has greatly reduced milk-borne illnesses.”

These can include diarrhea, stomach cramping and vomiting. Foodborne illness can also lead to severe outcomes in some cases. Those severe outcomes include Guillain-Barré syndrome or hemolytic uremic syndrome and can lead to paralysis, kidney failure, stroke or even death, according to the CDC.

Most healthy people will quickly recover from illness caused by harmful bacteria in raw milk, says the FDA. But some can develop symptoms that are chronic, severe or life threatening. If you or your family member have consumed raw milk and get sick, seek medical attention immediately.

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The CDC recommends choosing pasteurized milk and dairy products by carefully reading the labels. It is also important to refrigerate perishable foods at 40º F or colder to slow bacterial growth. This is because bacteria can multiply rapidly when left at room temperature or in what is called the “danger zone,” which is temperatures between 40º F and 140º F, says the CDC.

Additionally, never leave perishable food out for more than two hours—or even one hour if exposed to temperatures warmer than 90º F such as in a hot car or at a picnic. And if food is expired or spoiled, throw it away immediately. A safe rule of thumb is: when in doubt, throw it out.

People with lactose intolerance lack the enzyme—called beta-galactosidase or lactase—that is needed to break down lactose into glucose and galactose during digestion. All milk, whether raw or pasteurized, contains lactose and can cause lactose intolerance in sensitive people.

No. The FDA has looked at scientific literature for more information on potential benefits and risks of consuming raw milk. The purported health benefits of raw-milk consumption have not been scientifically substantiated, yet the health risks of raw milk consumption are clear.

Highly pathogenic avian influenza (HPAI) A(H5N1) virus—commonly known as avian influenza or H5 bird flu—has killed millions of wild birds and caused sporadic outbreaks among poultry. There have also been outbreaks among dairy cows in the U.S. In 2024, there have been 61 human cases of bird flu in the U.S., 37 of which were due to exposure to dairy cattle, according to the CDC. 

 While the FDA has indicated that pasteurization is effective at eliminating infectious H5N1 virus in dairy milk, the HPAI A(H5N1) virus has been detected in unpasteurized (raw) milk collected from clinically ill and asymptomatic dairy cattle. As a result, the U.S. Department of Agriculture’s (USDA) has announced a “National Milk Testing Strategy,” requiring that raw (unpasteurized) milk samples nationwide be collected and shared with the USDA for testing to help protect the health and safety of the public.

Meanwhile, the CDC issued a Health Alert Network Health Advisory with recommendations that support consumption of only pasteurized milk and dairy products made from pasteurized milk. It is important not to consume unpasteurized “raw” milk or products made from unpasteurized milk because it can contain bacteria or viruses, such as the A(H5N1) virus, that can cause serious illness, hospitalization or death.