5. Asian countries previously free of Crohn's are experiencing an increased incidence as they begin drinking milk and keeping dairy herds.
Studies Showing MAP Survives Pasteurization
The first attempt to culture live MAP organisms from pasteurized milk took place in Ireland in the late nineties. Investigators obtained 31 cartons of pasteurized milk from 16 retail outlets and grew MAP organisms out of 20% of them. This caused a national food scare, widely publicized in the UK and the EU, and which received no media attention whatsoever in the US. Bowing to public pressure, the British government initiated a study of their own in which they sampled 1,000 cartons of milk and were able to grow MAP out of 30 of them. This was followed by more studies showing that MAP is the most heat resistant organism ever identified and that it can only be destroyed by at boiling temperature (212 degrees Fahrenheit or 100 degrees Centigrade).
Déjà Vu: Regulatory Agencies that Refuse to Regulate
As in the case of the banking regulators, whose inaction led to the economic collapse, the FDA and other government regulatory have caved in to the farm and other food lobbies they theoretically regulate. As a result, they continue to obstruct veterinary and medical researchers who have been fighting for twenty years for mandatory preventive measures to slow the spread of MAP. Despite dozens of studies from Europe, the Food and Drug Administration (FDA) persists in claiming MAPis eradicated by pasteurization.Likewise, the US Department of Agriculture (USDA) resists compulsory monitoring of herds for MAP or compulsory reporting of Johne's Disease or evencompromise measures, such as mandatory testing of animalsfrom infected farms or improved farmer education about MAP, Johne's Disease andbasic calf hygiene techniques that reduce MAP infection. This would seem the best place to start, given surveys revealing that 50 per cent of American farmers have never even heard of MAP.
Europe, on the other hand, employs the Precautionary Principle in its approach to all environmental toxins. In the EU public health agencies don't believe children should continue to be exposed to MAP while we wait for unequivocal proof that it plays a causal role in Crohn's disease. This could take decades (especially as most US funders continue to decline research proposals to study MAP infection in humans). They feel (as do I) that it's unconscionable to continue to expose children to a potentially fatal illness when simple and inexpensive public health measures could greatly reduce their risk of MAP infection.
In Europe public health measures have been extremely aggressive. In the late nineties the Netherlands, Norway and Sweden committed to total MAP eradication, based mainly on mandatory testing and reporting and improved calf hygiene, which has been largely successful. Herd screening for MAP and reporting of Johne's Disease is mandatory in most other European countries. In Australia the government has the ability to declare an infected area a control zone and require testing (and culling where indicated) of all cattle within that zone. While New Zealand (where I live) has no mandatory testing and reporting, there is major government support for research, farmer education and a promising cattle vaccine.
The Crohns/MAP Link: Implications for Treatment
Unfortunately the human consequences of allowing corporate lobbies to suppress medical information aren't limited to living in a country with the highest incidence of a potentially fatal but totally preventable illness. It also means that Americans with Crohn's miss out on important new treatments available in other parts of the world. With new evidence suggesting irritable bowel syndrome and microscopic colitis (afflicting 15-25% of Americans) may actually be mild, early forms of Crohn's, we are talking abouta public health issue affecting more thana quarter of the US population.
At present most North American doctors treat Crohn's with steroids and immunosuppressant drugs, which only offer temporary relief and do nothing to halt the progression of the illness. In some patients this approach may delay the need for surgery (when intestinal blockage or leakage becomes life threatening). However doctors in the forefront of Crohn's research feel continuing use of immunosuppressants may actually do more harm than good. If Crohn's is indeed a defective immune response to MAP infection, it makes no sense to administer drugs likely to compromise a patient's immunity even further.
Trials of antituberculosis drugs (in Europe and Australia) have resulted in long term full or partial remission in 40-60% of Crohn's patients who took them. There are also current clinical trials at the University of St George in London of a promising new vaccine which promises not only promises to protect children with a family history of Crohn's (or irritable bowel syndrome) but to halt progression of the illness in patients with existing Crohn's Disease (or irritable bowel syndrome).
Take Home Message for Parents: Boil the Milk
At present the vaccine, as well as antibiotic treatment, is still in the research phase. This means the primary emphasis, at present, must be on prevention. And until government regulatory agencies, such as the FDA and USDA, are willing to acknowledge the serious threat MAP poses to public health, it falls on health professionals and parent groups and advocates to get the word out about the best way to protect American children against MAP infection.
Obviously the safest approach is to avoid dairy products altogether. Where children are unable or unwilling to drink alternatives (soy or rice milk goats and sheep can also carry MAP so these may not be a safe alternatives), cow's milk must be boiled. New mothers with Crohn's need to be warned they can transmit MAP to their infants through their breast milk.
Parents need to be cautioned that beef can also carry MAP and must reach an internal temperature of 167 degrees Fahrenheit for at least 10 minutes for the organism to be destroyed. And people living in urban areas where the source of drinking water passes through intensively farmed dairy land (Spokane, Christchurch, Winnipeg and the Red River Valley in Minnesota are known hot spots) must boil their drinking water. Unfortunately MAP is not destroyed by chlorination or other conventional water treatments.
Recommended links:
