The Crohnie

In 2007, the United States Department of Agriculture’s (USDA) National Animal Health Monitoring Service (NAHMS) surveyed US Dairy Herds on a nationwide basis.

They found that 68.1% of US Dairy Herds are infected with Mycobacterium avium subspecies paratuberculosis (MAP), an obligate pathogen which causes Inflammatory Bowel Disease (Johne’s Disease) in cattle, sheep, goats and other food animals. Paratuberculosis is present in milk from infected animals, and is known to survive commercial pasteurization. Live MAP has been cultured from US retail milk supplies.

Mycobacterum avium subspecies paratuberculosis is suspected of causing the human Inflammatory Bowel Disease known as Crohn’s Disease, and there is mounting scientific and medical evidence that at least some proportion of Crohn’s Disease is caused by MAP. If MAP does cause Crohn’s Disease, then it is certain that the primary route of transmission of MAP to humans is through contaminated dairy and meat products.

The NAHMS study also found evidence for MAP in 95% of large dairy herds, an unprecedented figure which shows that MAP is spreading rapidly and unchecked through US herds of food animals. Not only is the milk from these cattle infected with MAP, but their carcasses, which are used to make ground beef, contain billions of MAP organisms.

The testing method used to detect paratuberculosis is known to underestimate the true prevalence. To quote the NAHMS report: “Although environmental sampling is an effective method of detecting operations infected with MAP, it will not detect all infected operations. Thus, reported percentages will be less than the true prevalences.”

The full report is available from the USDA Animal and Plant Inspection Service (APHIS) website.

Johne’s Disease on U.S. Dairies, 1991–2007.

Liverpool, UK – 10 December 2007: Scientists at the University of Liverpool have found how a bacterium, known to cause illness in cattle, may cause Crohn’s disease in humans.

http://www.liv.ac.uk/newsroom/press_releases/2007/12/crohns-disease.htm

Crohn’s is a condition that affects one in 800 people in the UK and causes chronic intestinal inflammation, leading to pain, bleeding and diarrhoea.

The team found that a bacterium called Mycobacterium paratuberculosis releases a molecule that prevents a type of white blood cell from killing E.coli bacteria found in the body. E.coli is known to be present within Crohn’s disease tissue in increased numbers.

It is thought that the Mycobacteria make their way into the body’s system via cows’ milk and other dairy products. In cattle it can cause an illness called Johne’s disease – a wasting, diarrhoeal condition. Until now, however, it has been unclear how this bacterium could trigger intestinal inflammation in humans.

Professor Jon Rhodes, from the University’s School of Clinical Sciences, explains: “Mycobacterium paratuberculosis has been found within Crohn’s disease tissue but there has been much controversy concerning its role in the disease. We have now shown that these Mycobacteria release a complex molecule containing a sugar, called mannose. This molecule prevents a type of white blood cells, called macrophages, from killing internalised E.Coli.”

Scientists have previously shown that people with Crohn’s disease have increased numbers of a ’sticky’ type of E.coli and weakened ability to fight off intestinal bacteria. The suppressive effect of the Mycobacterial molecule on this type of white blood cell suggests it is a likely mechanism for weakening the body’s defence against the bacteria.

Professor Rhodes added: “We also found that this bacterium is a likely trigger for a circulating antibody protein (ASCA) that is found in about two thirds of patients with Crohn’s disease, suggesting that these people may have been infected by the Mycobacterium.”

The team is beginning clinical trials to assess whether an antibiotic combination can be used to target the bacteria contained in white blood cells as a possible treatment for Crohn’s disease.

The research was funded by Core and the Medical Research Council and is published in Gastroenterology.

I’ve just returned from Copenhagen, Denmark, where I attended the 8th International Colloquium on Paratuberculosis (at considerable personal expense: Copenhagen is EXPENSIVE!)

Current thinking among researchers in the field is that MAP itself is mostly not the culprit in the tissue damage. MAP’s role is to initiate an inflammatory response in the bowel, through some unknown process/antigen/inflammatory-pathway. This immune response results in inflammation of bowel tissue, whereby the cells of the intestine physically separate, to allow immune cells, primarily macrophages and CD4 + CD8 T-cells, to reach the site of infection. This leads to “leaky gut” syndrome , which permits the contents of the bowel (most accurately described as being similar to the contents of a sewer), to leak through the bowel wall, resulting in a *massive* inflammatory response against the many microbes present in the fecal stream.

At this point, the inflammatory process becomes self re-inforcing, with consequent runaway production of inflammatory cytokines such as Tumor Necrosis Factor alpha (TNF-alpha), various Interleukins, Interleukin-antagonists, etc.

In some patients, this results in granuloma formation, as the massively overstimulated immune system tries to contain the original MAP infection, present inside macrophages, which are unable to kill the “phagocytosed” (i.e. “eaten”) MAP, which have immune evasion techniques to avoid being killed by macrophages. The infected macrophage goes into overdrive, producing copious quantities of inflammatory cytokines, which cause it to be surrounded by a layer of CD4 T-cells, and then another layer of CD8 T-cells: a granuloma is formed, which contains the mycobacterial infection and cuts off the flow of inflammatory cytokines, but also has the unfortunate consequence of causing significant permanent scarring, thus leading to stenosis/narrowing of the bowel, and eventually strictures.

In other patients, for reasons unknown (although possibly related to the failure of the Th1 inflammatory response), this granuloma formation does not take place. Instead, the flood of antigens from the bowel contents infects the bowel “transmurally”, i.e. through the entire thickness of the bowel, leading to all kinds of scarring, and in some unfortunates, the formation of fistulas, as well as all manner of secondary infections. It is this sub-group of patients that responds best to treatment with wide-spectrum antobiotics, since it is secondary microbial infections that are primarily responsible for the tissue damage, with these secondary non-mycobacterial microbes being susceptible to non-mycobacterial antibiotic treatment.

Isolation of Mycobacterium paratuberculosis from milk by immunomagnetic separation.
http://www.ncbi.nlm.nih.gov/pubmed/9726853

Improved detection of Mycobacterium avium subsp. paratuberculosis in milk by immunomagnetic PCR.
http://www.ncbi.nlm.nih.gov/pubmed/11118722

Effect of chemical decontamination and refrigerated storage on the isolation of Mycobacterium avium subsp. paratuberculosis from heat-treated milk.
http://www.ncbi.nlm.nih.gov/pubmed/15214726

To read about culture methods that can determine MAP metabolism, see MT Collins excellent johnes.org site.

http://www.johnes.org/general/diagnosis.html#bactec

Live Mycobacterium avium subspecies paratuberculosis (MAP) has been cultured from retail milk purchased from stores in California, Minnesota and Wisconsin.

This means that American consumers are being exposed to live bacteria that are known to cause Inflammatory Bowel Disease (Johne’s Disease) in a wide range of animals, including dairy and beef cattle, and is suspected of being a cause of human Crohn’s Disease.

The most important points are

1. From May 2002 through April 2003, milk was purchased from stores in California, Minnesota and Wisconsin – three of the USA’s top 5 milk-producing states. (The other two are New York and Pennsylvania.)

2. Milk was tested for presence of viable MAP, using methodologies created in the 1990’s by British researchers, to study the presence of MAP in retail milk in the UK. It has been known since 1998 that United Kingdom dairy products are contaminated with live MAP.

3. Of 702 US samples tested, 2.8 percent contained viable MAP – that is, MAP bacteria that was alive, capable of multiplying and establishing infection, and capable of causing Inflammatory Bowel Disease in susceptible species.

4. Rate of positives was similar among states, but there was a seasonal effect. More positive samples were found during July, August and September.

This study confirms what we in the Paratuberculosis Awareness and Research Association have long believed: that American consumers are eating and drinking food that contains a live and dangerous bacterium, through the medium of MAP-contaminated dairy products.

On average 2.8% of milk cartons were found to be contaminated. Assuming that the average milk consumer drinks from a single carton of milk per day, this means that the average milk consumer is exposed to live paratuberculosis on average ten times a year. Consuming from 2 different milk cartons per day, 20 times a year, etc. This applies particularly to children, who are encouraged to consume milk, for the calcium and protein content. An average American child living in Minnesota, California or Wisconsin, if they consume from one milk carton per day, will have been exposed to live paratuberculosis up to 100 times by their tenth birthday.

The published results apply only to milk. Although research has shown that the food treatment methodologies used to manufacture other dairy products, such as cheese, chocolate, whey, etc, are incapable of destroying MAP, no US research has sought to determine the percentage of these retail dairy products also contaminated with live MAP. The majority of Wisconsin milk is used for cheese manufacture. Recent scientific results have shown that the methods to manufacture cheddar cheese do not kill paratuberculosis.

To this date, the food safety regulators in the United States, the Food & Drug Admninistration (FDA), have taken no action on the presence of live paratuberculosis in milk, dairy and beef products. The time has now come for the FDA to revise its policy of inaction, and to act immediately to protect American consumers from this dangerous bacterium.

If you believe that the US Government should put the interests of the American public before the interests of American Dairy and Beef Industries, and act to eradicate MAP from human food, please visit the PARA web site for steps you can take to help.

1. Original datasheet from American retail milk study
http://www.johnes.org/newsfiles/109216471862392.html

2. Articles about live paratuberculosis contamination in human food
http://www.crohns.org/map_food

3. Articles about the relationship between Mycobacterium avium subspecies paratuberculosis and Crohn’s Disease.
http://www.crohns.org/articles
http://www.crohns.org/research
http://www.crohns.org/treatment

4. Government agencies with responsibility for regulating Food Safety.
http://www.crohns.org/governments

5. PARA’s work to get the US Congress to help address this problem.
http://www.crohns.org/congress

6. What you can do to help.
http://www.crohns.org/help

Persistence of Mycobacterium paratuberculosis during Manufacture and Ripening of Cheddar Cheese.

Donaghy JA, Totton NL, Rowe MT.

Agriculture, Food and Environmental Science Division (Food Microbiology Branch), Department of Agriculture and Rural Development for N. Ireland, Newforge Lane, Belfast BT9 5PX, N. Ireland, United Kingdom.

http://www.ncbi.nlm.nih.gov/pubmed/15294829

Model Cheddar cheeses were prepared from pasteurized milk artificially contaminated with high 10(4) to 10(5) CFU/ml) and low (10(1) to 10(2) CFU/ml) inocula of three different Mycobacterium paratuberculosis strains. A reference strain, NCTC 8578, and two strains (806PSS and 796PSS) previously isolated from pasteurized milk for retail sale were investigated in this study. The manufactured Cheddar cheeses were similar in pH, salt, moisture, and fat composition to commercial Cheddar. The survival of M. paratuberculosis cells was monitored over a 27-week ripening period by plating homogenized cheese samples onto HEYM agar medium supplemented with the antibiotics vancomycin, amphotericin B, and nalidixic acid without a decontamination step. A concentration effect was observed in M. paratuberculosis numbers between the inoculated milk and the 1-day old cheeses for each strain. For all manufactured cheeses, a slow gradual decrease in M. paratuberculosis CFU in cheese was observed over the ripening period. In all cases where high levels (>3.6 log(10)) of M. paratuberculosis were present in 1-day cheeses, the organism was culturable after the 27-week ripening period. The D values calculated for strains 806PSS, 796PSS, and NCTC 8578 were 107, 96, and 90 days, respectively. At low levels of contamination, M. paratuberculosis was only culturable from 27-week-old cheese spiked with strain 806PSS. M. paratuberculosis was recovered from the whey fraction in 10 of the 12 manufactured cheeses. Up to 4% of the initial M. paratuberculosis load was recovered in the culture-positive whey fractions at either the high or low initial inoculum.

In the first recorded case of its kind, an unfortunate man in Germany who has HIV infection has tested culture positive for Mycobacterium avium subspecies paratuberculosis (MAP) infection of the intestine. He suffered consequent Crohns-like symptoms, including profuse diarrhoea, high temperature and severe weight loss.

The German researchers who diagnosed his condition warn that, given the high prevalence of MAP in European and US food animal herds, pasteurised milk could be a route for infection with MAP, and that immunocompromised patients are especially susceptible.

More info from

http://www.crohns.org/media/pr020724.htm
http://www.cdc.gov/ncidod/EID/vol8no7/01-0388.htm
http://www.ncbi.nlm.nih.gov/pubmed/12095444

I attended the UK Government meeting on MAP in milk last Wednesday, and wrote the following report.

====================================================
London, 5th Dec 2001.
UK Government adopts comprehensive strategy for eliminating MAP from milk.

The UK government today adopted a comprehensive strategy to prevent human exposure to the bacterium Mycobacterium avium subspecies paratuberculosis (MAP). MAP is believed by a growing number of scientists to be a cause of Crohn’s Disease, a lifelong, debiliating and incurable bowel disease suffered mainly by the young.

The Advisory Committee on the Microbiological Safety of Food (ACMSF), which advises the UK Government Food Standards Agency, today approved a comprehensive program of measures aimed at eliminating MAP from retail milk, as purchased by consumers. Previous research commissioned by the ACMSF showed that live MAP could be cultured from approximately 2% of retail milk on sale in the United Kingdom.

The strategy adopted by the ACMSF shows that the UK Government is taking the issue of MAP and Crohn’s Disease extremely seriously. As the ACMSF says in its strategy document: “…. the Agency has put to one side the question of whether or not there is a link between MAP and Crohn’s Disease. The Agency believes that precautionary action to reduce human exposure to MAP should start now and should not be dependent on waiting for the link to be proven.”

Among the raft of measures approved by the ACMSF are:

– Increasing pasteurisation times from 15 seconds to 25 seconds. Although some dairies had voluntarily adopted this extended pasteurisation time in 1998, the more stringent conditions will now become standard government recommendation.

– Stricter quality monitoring of pasteurisation plants. Due to the potential for MAP to survive pasteurisation because of defective or improperly operated pasteurisation machinery, dairies and farms will be closely monitored to ensure that they are complying with regulations.

– Improvement of on-farm milking practices. Because a likely route for MAP to infect milk is faecal contamination, on-farm milking practices are to be closely studied to find the most effective method to prevent this contamination.

– Elimination of MAP infection from herds. The ACMSF is initiating a multi-pronged effort to eliminate MAP from herds of food animals, including improvement of existing diagnostics, a national survey to determine the prevalence of MAP infection in UK dairy herds, and development of a improved vaccination methods to protect animals from the infection.

– Alternative pasteurisation technologies. The ACMSF is coordinating several research projects which are assessing the effectiveness of several novel pasteurisation methods against MAP. The methods being studied include high-pressure homogenisation, double pasteurisation, microfiltration and bactofugation.

The timetable by which these measures will be implemented will be finalised in another ACMSF meeting, to be held in London in January
2002.

PARA greatly welcomes these developments, and commends the UK Government on its willingness to act in the best interests of its citizens and the best interests of the public health. However, there are some further measures which PARA would like to see the UK Government undertake.

o Labelling of extended pasteurisation. Since it is not possible for the UK Government to mandate 25 second pasteurisation for all UK milk, for reasons of European regulation, there will still be some 15 second pasteurised milk for sale in the UK. In order that Crohn’s Disease patients and their families be able to differentiate between 25 second and 15 second pasteurised milk, it is vital that the pasteurisation time be labelled on retail milk containers.

o Elimination of MAP from beef. Milk is not the only route for transmission of MAP to the human population. MAP can also be transmitted through beef from infected cows, and there is evidence to believe that the standard temperatures used for cooking of beef will not effectively kill the organism. Although the comprehensive strategy to deal with MAP in milk is a welcome start, it does not deal with the whole MAP problem.

Paratuberculosis Awareness & Research Association is non-profit organisation of Crohn’s Disease patients, their families and friends who are dedicated to the following goals

1. To promote awareness of the disease-causing potential of the bacterium Mycobacterium paratuberculosis in the national community of sufferers of Crohn’s Disease and Inflammatory Bowel Disease; in medical, veterinary and food research communities; in governmental agencies and in the public in general.

2. To promote clinical trials of therapy effective against MAP as treatment for Crohn’s Disease.

3. To promote mandated national testing programs to ensure that the milk/dairy, beef and other products on our grocery shelves are free of contamination with Mycobacterium avium subspecies paratuberculosis.

For further information, please visit the PARA web site at

http://www.crohns.org/

As promised a few months back, I’ve managed to digitize the the BBC TV programs about Mycobacterium avium subspecies paratuberculosis (MAP), Crohn’s Disease and MAP contamination of milk and water. Apologies for the delay, there’s been quite a few technical hitches along the way. You can access them from

http://www.crohns.org/media/

Also on that page, you will find a U.K. government interim report on the MAP contamination of retail milk in the UK. The results are definitive and beyond all doubt: MAP bacteria are alive and growing in our retail milk.

MAP is in the milk supply, and it’s in the water supply. Antibiotics effective against MAP make Crohn’s Disease better. When will the US and other Governments wake up to the suffering of Crohn’s Disease, and how it could be prevented?

If you want to do something about this terrible situation, please join PARA and add your voice to the growing chorus calling for change.

The BBC ran five separate programmes on paratuberculosis and food safety over the last four days. They were

1. Thursday 30th March 2000 – Newsnight (BBC1 TV, 10 minute report)
2. Friday 31st March 2000 – Farming Today (BBC Radio 4, 12 minute report)
3. Sunday 2nd April – CountryFile (BBC1 TV, 12 minute report)
4. Sunday 2nd April – On the Record (Interview with Agriculture Minister)
5. Monday 3rd April – Farming Today (BBC Radio 4)

I have numbers 2, 3, 4, and 5 on tape, and hope to digitize them and make them available on the net, for you all to see first hand.

However, I am about to go away for at least three weeks, so it will probably be the end of this month before you get to see/hear them.

As you will understand when you see/hear the programmes themselves, this issue is far from old hat. The only reason why it keeps cropping up in the news is because STILL, despite continued warnings to the Food Safety and Health Authorities, almost nothing has been done about MAP and Crohn’s Disease. The risk of exposure to MAP and the possible resulting development of Crohn’s Disease is still born by one group alone: the consumer.

Until we get research funds to deal with this complicated problem, I’m afraid that the controversy is going to continue. What we in PARA are trying to do is to educate everyone involved on the the complexities of this situation, so that at least we can discuss the issue in common terms, rather than the rampant prejudice and polarization that characterizes this subject.

If you are at all concerned about this issue, or wish to read more, please visit the PARA web page, at

http://www.crohns.org/

For those of you living in Britain, consider yourself lucky that you have a truly free press. A combination of the large financial muscle of the Dairy Industry “Got Milk” advertising campaigns and the threat of “Oprah’s Hamburger” style SLAPP suits ensure that those on the other side of the Atlantic are denied the opportunity to see the other side of this very important story.