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Menopause treatments can help with hot flashes and other symptoms – but many people aren’t aware of the latest advances

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theconversation.com – Naomi Cahn, Professor of Law, University of Virginia – 2024-06-07 07:41:41
Actor Halle Berry, standing in front of U.S. senators, proclaims that she's in menopause.
Tom Williams/CQ-Roll Call, Inc via Getty Images

Naomi Cahn, University of Virginia; Bridget J. Crawford, Pace University , and Emily Gold Waldman, Pace University

Menopause used to be a taboo topic in many quarters. Now, it's frequently in the news.

In March 2024, the White House announced an initiative to “Galvanize New Research on Women's Midlife .”
In May, Sen. Patty Murray introduced bipartisan legislation that would spend US$275 million to improve menopause care and midlife health.

The actor Halle Berry went to Capitol Hill to help draw attention to the measure. While she was there, she shouted: “I'm in menopause.”

This new focus on menopause and the greater openness to talking about it is occurring at the same time as scientific studies are underscoring the benefits of hormone therapy to treat menopausal symptoms – two decades after it suddenly fell out of favor.

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The three of us believe open discussions about menopause are long overdue. We write and teach about employment discrimination, aging and the law, and feminism. Having teamed up to write a book about menopause and the law, we are closely following the changes in how researchers assess the benefits of hormonal treatment and what that means for its availability.

Menopause basics

Technically, menopause is a point in time. It typically starts 12 months after the last menstrual cycle and marks the end of fertility, and it usually occurs between ages 45 and 55. It's preceded by perimenopause, a transitional phase during which menstruation changes but continues, that can last as long as a decade.

People who have gone through menopause are in postmenopause for the rest of their lives.

Menopause results from the body decreasing production of estrogen and progesterone, two hormones made by the ovaries. In the long term, estrogen loss also affects bone density, the cardiovascular system and other parts of the body.

Menopause can also occur early and abruptly, such as after the surgical removal of the uterus or ovaries.

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Each year, more than 2 million Americans reach menopause. Millions more are experiencing perimenopause at any given time.

While the average age of menopause is 51, there is variation along racial, ethnic and income lines. As life spans get longer, half the population may spend one-third of their lives in postmenopause.

In particular, Black women tend to experience menopause earlier than white women. Their symptoms, such as hot flashes, are more acute, and those symptoms last longer. But Black women are less likely than white women to receive medical care for these symptoms.

What about perimenopause?

During perimenopause, which typically begins after age 40, the body gradually stops making estrogen – often bringing on menopausal symptoms. It can be hard to know whether someone is experiencing perimenopause, as estrogen levels fluctuate and there is no definitive test to determine it.

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The most common symptoms are hot flashes and night sweats .

Other symptoms include sleep problems, depression, brain fog and vaginal dryness. Periods become irregular, and bleeding may be heavier. Not everyone going through menopause experiences symptoms – although 85% do – and their severity varies.

Hormonal treatment and controversy

Menopausal hormonal therapy, including estrogen alone and estrogen combined with progesterone, has been prescribed to help with those symptoms for decades. Hormones were also used to treat the long-term risks associated with menopause, including heart disease and osteoporosis.

By the year 2000, approximately 1 in 4 women used hormonal therapy. Then, in 2002, the preliminary results of one study shook the medical world.

They were from the Women's Health Initiative, a placebo-controlled study of menopausal hormone therapy that recruited thousands of women to analyze this treatment. Launched by the U.S. government's National Institutes of Health in 1991, it remains the largest women's health prevention study ever conducted.

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In 2002, an interim analysis found that menopausal hormone therapy was associated with an increased risk of breast cancer, coronary heart disease and stroke. The research was halted because of these results.

Within a few months, the use of hormone therapy to treat menopause symptoms fell by almost one-half. The share of all women using these prescription drugs plummeted to 4% within two decades and has been slow to bounce back despite the growing recognition of the limitations of the 2002 study.

A more complex story about menopausal hormone therapy has emerged in recent years, along with a careful review of the conclusions that led to the early termination of significant parts of the Women's Health Initiative study.

One concern is that the typical age of the women participating in that study was 63, meaning they were many years beyond perimenopause when they enolled in it.

Another was that the study focused on the role of hormones in the prevention of chronic disease, rather than the alleviation of menopausal symptoms. A third was that it only evaluated one form of hormonal treatment.

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Treatment today

Fittingly, many doctors are prescribing hormonal therapy for menopausal symptoms more frequently today – particularly for women who are under 60 when they begin to take it and had their last periods within the prior decade.

Hormonal therapy can be dispensed through tablets, skin patches, gels or vaginal suppositories.

Tablets offer the convenience of oral administration, while skin patches provide a steady release of hormones through the skin. Gels allow for easy application and absorption through the skin, offering flexibility in dosing. Vaginal suppositories target local symptoms such as dryness and discomfort more directly.

It is also available with synthetic or bioidentical progesterone, although it's not clear that those versions are safer or more effective.

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However, there are patients with underlying conditions for whom hormonal treatment is riskier than for others and should be avoided, including those with a history of breast cancer, other estrogen-sensitive cancers and coronary heart disease, among other conditions.

New, nonhormonal treatments for hot flashes are in development, too.

In 2023, the Food and Drug Administration approved fezolinetant, sold as Veozah. It's the first drug designed specifically to treat hot flashes and night sweats.

A second new drug may be marketed soon.

Antidepressants, epilepsy medications and other nonhormonal drugs are also being prescribed off-label to treat some menopausal symptoms.

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Moving forward

Unfortunately, many patients and even health care providers aren't fully aware of the latest evidence about effective treatments for menopausal symptoms.

Rates of menopausal hormone therapy use varies by race and ethnicity: White women have the highest rates, while Black and Hispanic women have the lowest. Without insurance, a month's supply of generic estrogen costs approximately $29. With insurance, costs may be much lower.

What all of the research shows is that symptoms should not be ignored, and individualized treatment is key. Given the new openness to discuss and deal with menopause, as well as potential research funding and new treatments, we're becoming more optimistic that this inevitable life stage may finally get the attention it deserves.The Conversation

Naomi Cahn, Professor of Law, University of Virginia; Bridget J. Crawford, Professor of Law, Pace University , and Emily Gold Waldman, Professor of Law and Associate Dean for Faculty Development, Pace University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Making art is a uniquely human act, and one that provides a wellspring of health benefits

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theconversation.com – Girija Kaimal, Professor of Art Therapy Research, Drexel University – 2024-06-20 07:24:22
The act of creating art serves as exercise for the brain and is integral to physical and mental .
hzechphotography/Moment via Getty Images

Girija Kaimal, Drexel University

When you think about the word “art,” what comes to mind? A child's artwork pinned to the fridge? A favorite artist whose work always inspires? Abstract art that is hard to understand?

Each of these assumes that making art is something that other people do, such as children or “those with talent.”

However, as I explain in my book “The Expressive Instinct,” art is intrinsic to human evolution and history. Just as sports or workouts exercise the body, creating art exercises the imagination and is essential to mental as well as physical well-being.

I am a professor of art therapy who studies how creative self-expression affects physical and emotional health. In our clinical research studies, my colleagues and I are finding that any form of creative self-expression – including drawing, painting, fiber arts, woodworking or photography – can reduce stress, improve mood and increase self-confidence.

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As a sickly child who needed to stay home from school a lot, I found that making art helped me cope. Today, creating art is my sanctuary. I use it as a sounding board to better understand myself and a way to recharge and learn from the challenges of life.

A bookmark covered in purple, white and yellow flowers sits on an open book.
Bookmark made with wildflowers and ink drawing, created by Girija Kaimal. ‘My aim here was to capture the beauty of nature and the work of the human hand.'
Girija Kaimal

The uniquely human attribute of creativity

Although everyone has their own concept of what defines art, one thing is universally true: Creativity is a defining feature of the human species.

How so? Well, human brains are not computers processing data. They are biological prediction machines that perceive the environment through memories and the senses, with the capacity to use that information to imagine plausible future scenarios.

These inherent predictive and imaginative capacities are the wellspring of humanity's abilities to survive and thrive – because self-expression is a safety valve that helps us cope with uncertainty. No one truly knows the future; they must live each day not sure of what will happen tomorrow. Art can help us all practice this imaginative muscle in a useful way.

In our study examining brain activity while using virtual reality tools to create 3-D digital artwork, my team demonstrated that creative expression is a natural state of being. The brain naturally uses fewer cognitive resources to be expressive and creative, compared with the brain power needed to do a rote task that requires conscious effort.

Seemingly ordinary everyday activities can provide opportunities to tap into one's natural creativity and imagination: whipping up a meal from leftovers, figuring out an alternate route to work, dancing a little jig in response to hearing a song, or planting and tending a garden.

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We have repeatedly found in our studies that even a single session of real and honest self-expression can improve self-confidence and reduce feelings of stress, anxiety and burnout.

This is partly because creativity activates reward pathways in the brain. Using our hands and bodies to express ourselves activates dopamine pathways and helps us feel good. Dopamine is a neural messenger that is associated with feeling a sense of hope, accomplishment or reward. Our brains are wired to secrete feel-good hormones whenever we move, create something or engage in any type of expressive activity.

Tapping into the creative resources within is one of the most underrated seeds of well-being in the world.

By comparison, bottling up or denying these feelings can cause distress, anxiety and fear because we have not processed and expressed them. This is probably one of the reasons why every community around the world has its own creative and expressive practices. Even our ancestors in Indigenous communities all around the world intuitively knew that self-expression was essential to emotional health and social connection.

Being unable to share our lives, keeping secrets and feeling isolated and lonely tend to worsen our health. To our brains, social isolation feels like a chronic disease because it interprets this loneliness and inability to express as a threat to survival.

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Since creative expression can engage the senses, it can also be a body workout: a sensual as well as emotional and cognitive experience. Being active in expression – be it art, music, dance, drama, writing, culinary arts or working with nature – imparts a sense of confidence and hope that challenges can be navigated and overcome.

A hand-drawn color portrait
Portrait artwork by Laila Ahuja, in progress.
Laila Ahuja

The role of art therapy

Given the integral role of art in our lives, it makes sense that making art can help people manage transitions, adversity and trauma, such as the stresses of puberty, the death of a loved one or experiencing a serious illness.

According to a global study, 1 in 2 people will experience a mental-health-related challenge in their lifetime, whether from life's challenges, genetic predispositions or a combination of the two.

This is where art therapy can come in. Art therapy is a regulated mental health profession in which clinical psychotherapists with extensive clinical training offer psychotherapy to patients with diagnosed mental health needs.

The origins of art therapy go back to attempts to treat soldiers struggling with post-traumatic stress during the 20th century's two world wars. Today there is evidence that traumatic experiences tend to be stored as sounds, images and physical sensations in the brain. When someone lacks the words to process these experiences through traditional talk therapy, art therapy can provide an indirect way to express and externalize those feelings and memories.

The process of making art can help people process feelings that they aren't able to put into words.

One of art therapy's unique strengths is that it provides nonverbal ways of communicating, processing and eventually managing the symptoms of post-traumatic stress disorder, or PTSD. In fact, in a recent study, my team has found that a personal history of trauma is related to how people react to evocative images. Images of distress and pain resonate with us when we have known similar kinds of distress ourselves. This implies that our life stories make us sensitized to distress in others and even personalize it more.

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Creative self-expression is especially relevant in coping with trauma because it provides an outlet through which a person can regain a sense of agency and control.

A brightly colored stem of orange and yellow flowers with green leaves sits on a notebook page with handwritten description behind it.
Botanical notes artwork made by 12-year-old self-taught artist Laila Ahuja as part of a summer exercise to practice drawing and learn about different flowers around the world.
Laila Ahuja

How to bring creativity into daily life

For those new to exploring art as a creative pursuit or for well-being reasons, engaging in creative activities begins with letting go of unrealistic expectations. Being creative isn't about becoming a famous artist or even a mediocre one. It is about allowing ourselves to flex the creative muscle that we all have and enjoying all the sensory and emotional aspects of imagining.

Next, think about activities that made you feel free to explore when you were a child. Did you like singing, playing in the outdoors, dancing, making up pretend plays, or writing little tales? Allow yourself to indulge in any and all of these creative pursuits that made you feel relaxed and joyful.

A cultural tradition, tinkering with electronics, making a gift for someone or simply paying attention to everyday beauty – any of these can be a creative activity. And just like any muscle, the more you exercise it, the stronger it becomes. Over time, you will notice yourself getting more confident and adventurous in your creative practices.

Whatever it is, make time for this creative pursuit every week – which is possibly the hardest step of them all. If it seems “unimportant” compared with the demands of daily life, such as work or family, try thinking of it as another form of sustenance.

Remember that creativity is just as critical to human health as eating nutritious meals or getting exercise and good rest. So as the Latin saying goes: “Plene vivere.” Live fully.

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A square box with the words 'Art & Science Collide' and a drawing of a lightbulb with its wire filament in the shape of a brain, surrounded by a circle.
Art & Science Collide series.

This article is part of Art & Science Collide, a series examining the intersections between art and science.
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Art and science entwined: This course explores the long, interrelated history of two ways of seeing the world The Conversation

Girija Kaimal, Professor of Art Therapy Research, Drexel University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Boost your immune system with this centuries-old health hack: Vaccines

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theconversation.com – Aimee Pugh Bernard, Assistant Professor of Immunology and Microbiology, University of Colorado Anschutz Medical Campus – 2024-06-20 07:24:38

When it comes to vaccines and immune , the results aren't too good to be true.

Jena Ardell/Moment via Getty Images

Aimee Pugh Bernard, University of Colorado Anschutz Medical Campus and David Higgins, University of Colorado Anschutz Medical Campus

There are a dizzying number of tips, hacks and recommendations on how to stay healthy, from dietary supplements to what color of clothes promotes optimal wellness. Some of these tips are helpful and based on good evidence, while others are not.

However, one of the easiest, most effective and safest ways to stay healthy is rarely mentioned: vaccination.

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We are a preventive medicine physician and an immunologist who want people to live the healthiest lives possible. Among the many research-backed ways to live healthier, we encourage people to eat well, exercise regularly, get good sleep and care for their mental health.

And when it comes to your immune system, nothing can replace the essential role vaccines play in promoting whole health. The protection that vaccines provide is an irreplaceable part of living the healthiest lifestyle possible.

Vaccines are essential to health

Some healthy people think they don't need a vaccine. But your immune system needs more than just a healthy lifestyle to protect your body when vaccine-preventable diseases come knocking on the door.

Imagine the cells of your immune system as athletes preparing for the Olympics. Just as athletes undergo rigorous and specialized training to meet every possible challenge they might face in their event, immune cells need to be primed and ready to fight off every pathogenic challenge you encounter.

Vaccines expose your immune cells to inactivated versions of a pathogen, providing them with practice sessions to recognize and combat the real threat with speed and precision. Vaccines ensure that your immune cells are at their peak performance when faced with the actual infection. Just as well-trained athletes can tackle their competition with skill and confidence, vaccinated immune cells can swiftly and effectively protect your body from diseases.

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If a person is unvaccinated and exposed to a disease they haven't encountered before, their immune cells are unprepared and must play catch-up to fight the pathogen. This leaves your body vulnerable to severe disease.

Without vaccination, even young, healthy people are vulnerable to diseases like the flu.

Even people at the pinnacle of health can unnecessarily suffer from vaccine-preventable diseases because their immune systems might not have been well-trained. Take the story of Austin Booth, a healthy and athletic 17-year-old who was not vaccinated for influenza. Just days after he started to feel ill, he died of the disease.

For healthy people, vaccination can reduce the risk of death from influenza by two-thirds. When people choose to skip vaccines recommended as an essential part of their overall health, there is a greater chance of serious complications or death from a vaccine-preventable disease, regardless of how healthy they may be. These people are playing a potentially life-altering and deadly game of chance.

Vaccine-preventable diseases are still common. In the U.S., hundreds of thousands of adults are hospitalized and thousands die every year from vaccine-preventable diseases such as influenza, pneumococcal pneumonia, respiratory syncytial virus (RSV) and COVID-19. And tens of thousands of adults develop cancer every year from vaccine-preventable diseases such as HPV.

Vaccines are the safest immune health hack

Many of the trendiest health hacks have little to no evidence of improving health. Some are even dangerous. But vaccines are one of the most tested and proven ways to stay healthy.

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Vaccines have been used for centuries. In the past 50 years, they have saved an estimated 154 million lives worldwide. Mathematical models estimate that a 25-year-old now has a 35% greater chance of living to their next birthday thanks to vaccines alone.

Smiling person rolling up sleeve to show bandaid on upper arm that reads 'fight flu'

Vaccines are a tried and true way to improve your health.

CDC/Robin Spratling

Not only are vaccines effective, but they are also safe. Yes, vaccines can come with mild and limited side effects – who hasn't felt a little sluggish or bumped their sore arm after getting vaccinated? More severe vaccine side effects are extremely rare. If you have concerns, talk to your doctor. As opposed to dietary supplements, trendy health hacks and even many over-the-counter medications, there are robust systems in place to test and monitor the safety and effectiveness of vaccines.

Of all the tips available to improve your health, one recommendation is clear: Even healthy, fit people need recommended vaccines to stay healthy and live well.The Conversation

Aimee Pugh Bernard, Assistant Professor of Immunology and Microbiology, University of Colorado Anschutz Medical Campus and David Higgins, Research fellow, Instructor of Pediatrics, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Raw milk health risks significantly outweigh any potential benefits − food scientists and nutritionists explain why

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theconversation.com – Juan Silva, Professor of Food Science, Nutrition and Promotion, Mississippi State University – 2024-06-19 07:45:26
Influencers extoll the benefits of drinking raw milk over pasteurized milk, but there isn't substantive evidence to support these claims.
AP Photo/Charlie Neibergall

Juan Silva, Mississippi State University; Joel Komakech, Mississippi State University, and Mandy Conrad, Mississippi State University

Despite an ongoing outbreak of bird flu in dairy cows, the popularity of raw milk has only risen. Advocates claim raw milk has superior health benefits over pasteurized milk. There is little evidence to support these claims, however, and the risk of serious illness is much greater.

Mississippi State University food scientists Juan Silva and Joel Komakech and nutritionist Mandy Conrad explain the difference between pasteurized and raw milk, addressing common misconceptions about the health risks and purported benefits of consuming unpasteurized milk. These questions are more important than ever, since cattle can shed viral material into their milk. Not only can pathogens end up in milk, but at least three farmworkers reportedly have contracted H5N1, the virus that causes avian influenza, in 2024. Farmworkers can get sick by handling infected animals or their byproducts, such as raw milk.

What is pasteurization? Does it destroy nutrients?

Pasteurization is a process that involves heating beverages and foods at high temperatures – over 145 degrees Fahrenheit (62.78 degrees Celsius) – to kill harmful microorganisms, such as bacteria, viruses and parasites. This reduces the total number of microorganisms in the product and also inactivates enzymes that could contribute to spoilage.

The taste, nutritional value and quality of pasteurized products aren't significantly affected by the process.

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While pasteurization can lead to some nutrient losses, the changes are generally minimal and outweighed by the benefits. Pasteurization typically causes minor denaturation of proteins and has little effect on fats and carbohydrates. While water-soluble vitamins such as vitamin C and some B vitamins, usually not abundant in milk except vitamin B2, can be partially degraded during pasteurization, fat-soluble vitamins (A, D, E and K, found in significant amounts in milk) are more heat stable and suffer minimal loss.

Thus, nutritional losses in milk due to pasteurization are generally small compared with the significant benefits of reducing foodborne illnesses and spoilage.

Is raw milk healthier than pasteurized milk?

Studies have compared the benefits of raw milk with pasteurized milk and have found little evidence that raw milk is superior to pasteurized milk. The perceived advantages of raw milk are outweighed by its health risks.

First, raw milk does not improve lactose intolerance.

Raw milk also does not have more vitamins than pasteurized milk. Milk is not a good source of vitamin C or other heat-sensitive vitamins, and pasteurization does little to reduce vitamin B2 or riboflavin, which is not as sensitive to heat. Moreover, Vitamin D is added to pasteurized milk to enhance your body's ability to absorb the calcium in milk.

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Assortment of milk products in grocery store aisle
Pasteurized milk is fortified with vitamin D and other nutrients.
Burke/Triolo Productions/The Image Bank via Getty Images

Fortified milk replaces nutrients that may be lost in the pasteurization process. Vitamin D is added to milk to enhance uptake of the calcium found in the milk. No single food is perfect, so it is OK for milk to lack some nutrients, as these can be obtained from other foods.

Some people believe that probiotics – foods or supplements that contain live bacteria beneficial to health – are more prevalent in unpasteurized milk and products made from raw milk. However, raw milk is generally lacking in probiotics and has significantly more harmful bacteria. Probiotics are added to many dairy foods such as yogurt after pasteurization.

Furthermore, a 2011 review of the available research on the health benefits of raw milk found that many of these studies were conducted with poor methods, meaning their results should be interpreted with caution.

What are the health risks of consuming raw milk?

The health risks of consuming raw, unpasteurized milk come from the harmful microorganisms that may be present.

Raw milk has been associated with hundreds of foodborne disease outbreaks. Between 1998 and 2018, 202 outbreaks resulted in 2,645 illnesses and 228 hospitalizations. More recently, from 2022 to 2023, there were 18 outbreaks and recalls associated with raw milk. A number of outbreaks and recalls associated with pathogens in raw milk have already occurred in 2024. In all cases, pathogens in the raw milk that cause human diseases were directly responsible for these illnesses.

Hind legs of cows standing in a stall
Pathogens from infected cattle can be found in their raw milk.
Tunvarat Pruksachat/Moment via Getty Images

Some illnesses from the pathogens in raw milk can have serious long-term effects, including paralysis, kidney failure and death.

Researchers found that areas where raw milk was legally sold in the U.S. from 1998 to 2018 had over three times more outbreaks than areas where selling raw milk was illegal. Areas where raw milk was allowed to be sold in retail stores had nearly four times more outbreaks than areas where sales were allowed only on farms.

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Is it safe to eat foods made from raw milk?

Many, if not all, dairy products made from unpasteurized milk are not safe to eat. A number of products can be made from raw milk, including soft cheeses, such as brie and Camembert; Mexican-style soft cheeses, such as queso fresco, panela, asadero and queso blanco; yogurt and puddings; and ice cream or frozen yogurt. Pathogens in raw milk can survive the processes involved in making these types of dairy products and thus be unsafe for consumption.

Only products that undergo a process to inhibit or kill harmful microorganisms may be safe enough to be made from unpasteurized milk. However, the potential for cross contamination of raw and cooked food as well as the survival of pathogens from inadequate processing is high when products are made with raw milk.

Can pasteurized milk still get you sick?

The few reported outbreaks associated with pasteurized milk can be traced to contamination after pasteurization. When handled properly, pasteurized milk is a very safe product.

The U.S. government requires farmers to destroy milk from herds infected with avian influenza. As of June 2024, 12 states have reported herds positive with H1N5, the virus that causes bird flu.

There is currently no evidence that consuming pasteurized milk from infected cows causes illness in people. Based on the evidence available, the Food and Drug Administration currently states that pasteurization is able to destroy or inactivate heat-sensitive viruses such as H5N1 in milk.

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Consuming raw milk, however, may pose a risk of disease transmission to people.

Can you gain immunity from H5N1 from drinking raw milk?

Some people believe that drinking raw milk can strengthen their immune system. However, there is no scientific evidence to support that drinking raw milk can improve immunity against disease.

Vaccines train your body to protect itself from future infections without actually getting sick from that infection. They do this by exposing your immune system to very small amounts of dead or significantly weakened pathogen.

Bird flu is spreading among dairy cows in the U.S.

Raw milk contains live H5N1 virus, meaning it could still infect you and make you sick. Rather than contributing to your immunity, raw milk exposes you to the virus at its full strength and can result in severe illness. Any protective antibodies that may be present in raw milk are likely degraded in stomach acid.

Moreover, people who contract bird flu from raw milk run the risk of transmitting it to other people or animals by giving the virus a chance to adapt and improve its ability to spread between people. This increases the risk of more widespread disease outbreaks.The Conversation

Juan Silva, Professor of Food Science, Nutrition and Health Promotion, Mississippi State University; Joel Komakech, Assisstant Professor of Food Science, Nutrition and Health Promotion, Mississippi State University, and Mandy Conrad, Assistant Clinical Professor in Nutrition and Dietetics, Mississippi State University

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This article is republished from The Conversation under a Creative Commons license. Read the original article.

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