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.

BBC Televsion has produced a program about the high prevalence of Crohns Disease in Wales, its relationship to Mycobacterium avium subspecies paratuberculosis (MAP), and the presence of MAP in Welsh rivers.

You can watch the program online here (but unfortunately in very poor video quality, although the audio is fine). On the first page below, click the link “Watch the last show”.

http://www.bbc.co.uk/wales/programmes/sites/weekinweekout/index.shtml
http://www.bbc.co.uk/wales/programmes/sites/weekinweekout/updates/080325_crohns_disease.shtml

I want to draw your attention to a recent epidemiological study from Wisconsin, which studied the epidemiology of both Crohn’s Disease, and IBD in general, in children in the state of Wisconsin. You can read an abstract of the study here

Epidemiologic and clinical characteristics of children with newly diagnosed inflammatory bowel disease in Wisconsin: a statewide population-based study.
http://www.ncbi.nlm.nih.gov/pubmed/14571234

Generally, the results of this study cast doubt on the belief that Crohn’s Disease and IBD are caused by a “genetic predisposition” or abnormality.

The most important points to note are

1. The researchers found that incidence rates of IBD were equal among all racial and ethnic groups. This casts doubt on the perceived wisdom that certain racial or ethnic groups are more “genetically susceptible” to Crohn’s Disease and IBD.

2. 89% of the new (incidence) cases of IBD described were non-familial, meaning that there was no family history of IBD in 89% of cases. This further casts doubt on “genetic susceptibility”.

3. There were no difference in the incidence rates between rural and urban areas.

4. The researchers found that there were more than twice as many cases of Crohn’s Disease as Ulcerative Colitis.

The researchers conclude their summary with this statement:

“This study provides novel, prospective, and comprehensive information on pediatric IBD incidence within the United States. The surprisingly high incidence of pediatric IBD, the predominance of Crohn’s disease over ulcerative colitis, the low frequency of patients with a family history, the equal distribution of IBD among all racial and ethnic groups, and the lack of a modulatory effect of urbanization on IBD incidence collectively suggest that the clinical spectrum of IBD is still evolving and point to environmental factors contributing to the pathogenesis.”

The conclusion that “environmental factors contribute to the pathogenesis” is an important one.

That there was a “surprisingly high incidence of pediatric IBD” mirrors results from neighbouring Minnesota, where Mayo Clinic researchs noted in 1998 that, in Minnesota, “No pediatric cases of Crohn’s disease were diagnosed before 1954, but 17% of patients diagnosed in the last two decades of [our] study period were under the age of 20 years.”

Crohn’s Disease in Olmsted County, Minnesota, 1940-1993: Incidence, Prevalence, and Survival
http://crohn.ie/archive/research/epidem/olmsted.htm

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/

The highest incidence and prevalence of Crohn’s Disease in the world were reported from Canada last year.

In the province of Manitoba, in the period 1989 to 1994, every year 14.6 people per 100,000 developed Crohn’s Disease. This rate is significantly higher than the previous record of 11 people per 100,000 per year from North Eastern Scotland, itself a very high figure.

Manitoba
http://www.ncbi.nlm.nih.gov/pubmed/10342800

Scotland
http://www.ncbi.nlm.nih.gov/pubmed/1634058

Manitoba is, of course, Canada’s dairy belt, being nestled beside the Great Lakes. The land there is very flat and wet, and the large number of lakes, streams and rivers are very interconnected.

It is becoming clear that water supplies are an important distribution route for MAP, as is evidenced by the saturation of Netherlands dairy herds with Bovine Johne’s Disease (up to 100% of herds in some areas).

If the water supply is an important vector for MAP infection in the human population, one would expect high yearly incidences of Crohn’s Disease in areas where there is a large population of cattle and where Bovine Johne’s Disease (BJD) is endemic. Among areas that fulfill these criteria are Wisconsin, Florida and the Netherlands.

However, either there are no Crohn’s Disease epidemiology figures available at all for these areas, or figures that are available are ten years out of date.

Which is why we need to make Crohn’s Disease a compulsorily reportable disease.

How else can we track the rampant progress of a disease which has spread to more people than HIV, in every country of the developed world, albeit much more slowly (Crohn’s taking 87 years instead of HIV’s 25-30 years).

Unfortunately, there is no information available on the epidemiology of either Crohn’s Disease or BJD in Saskatchewan.

Source: The London Times, 25th January 2000.
http://www.the-times.co.uk/news/pages/tim/2000/01/25/timnwsnws02030.html?999

Crohn’s linked to bacteria in milk

BY IAN MURRAY, MEDICAL CORRESPONDENT

CROHN’S disease is almost certainly caused by bacteria found in milk – even if pasteurised – and drinking water supplies, according to research by a world expert on the chronic illness. John Hermon-Taylor of St George’s Medical School in Tooting, South London, says that up to 55 per cent of dairy herds in Western Europe and America are infected with the bacteria, which can survive the pasteurisation process. Water supplies become infected as the droppings from herds seep into the soil, down into natural aquifers.

The organism is called MAP (Mycobacterium avium subspecies paratuberculosis), which is difficult to detect and destroy. The normal pasteurisation process involves heating milk to 72C for 15 seconds, but to be sure of killing MAP it would need to be heated to that level for twice as long.

Crohn’s disease is not fatal but causes chronic diarrhoea, persistent abdominal pain, weight loss, tiredness and mental problems. Because it is not notifiable, the number of people affected can only be estimated but it is thought that up to 80,000 suffer from it in Britain, with between 4,000 and 8,000 new cases every year. The cost to the nation of sufferers’ medical care is estimated to be GBP 240 million a year.

Professor Hermon-Taylor, who has researched the illness for 20 years, said: “If there were no MAP I believe there would be almost no Crohn’s disease. It is certainly responsible for between 60 per cent and 90 per cent of all cases and I would think that it is more likely to be 90 per cent.”

His study, funded by Action Research, the medical charity, shows that MAP can live undetected in cattle for years. Infected cows secrete the bacteria into their milk and on to their pastures. Tests have proved that MAP causes chronic infection of the intestines of many animals, including four types of primates. American studies have isolated MAP from the breast milk of women with Crohn’s disease but not in women who do not have the illness.

“The problems caused by MAP in the milk supply constitute a public health disaster of tragic proportions, for which a range of remedial measures are urgently needed and for which the Government must take responsibility,” Professor Hermon-Taylor said.

He wants to see the Government reverse its decision to allow the sale of unpasteurised milk and to increase the stringency of the pasteurising process. Dairy herds ought to be tested for the infection and the illness ought to notifiable, he said.

Professor Hermon-Taylor said that anybody worried about catching the disease from milk could be certain of killing any MAP by heating it to 80C and then allowing it to cool before drinking it.

Source: The Guardian, 25th January 2000.
http://www.newsunlimited.co.uk/uk_news/story/0,3604,128597,00.html

Crohn’s disease ‘disaster’ blamed on pasteurised milk

What’s wrong with our food? – special report

Julia Hartley-Brewer
Tuesday January 25, 2000

Pasteurised milk infected with dangerous bacteria is responsible for a “public health disaster”, a leading medical specialist warned last night.

John Hermon-Taylor, head of the surgical department at St George’s medical school in Tooting, south London, claimed that a bacterium believed to cause Crohn’s disease, the inflammatory bowel disorder, was not killed by pasteurisation.

The bacterium, mycobacterium avium subspecies paratuberculosis (or MAP), was thought to be destroyed by pasteurisation, but Professor Hermon-Taylor claimed that his 20 years of research had proved that Crohn’s disease in humans was linked with Johne’s disease in cattle and passed on in pasteurised milk.

He called on the government to take urgent action to prevent the spread of the disease through unsafe milk. In pasteurisation milk and other foods are heated to destroy disease-causing micro-organisms and protect against putrefaction.

A ministry of agriculture spokesman said: “The government is carrying out its own research, and the advice from the department of health is that, on the basis of what is currently known, there is no need for anyone to change their dietary habits.”

A National Dairy Council spokeswoman said: “The dairy industry has already taken voluntary steps to increase the pasteurisation time, purely as a precautionary measure. This is only one of a series of hypotheses, and what is needed is further research.”

Crohn’s disease, which afflicts about 80,000 people in the UK, is a severe inflammation of the small intestine and the colon, sometimes requiring surgery. Symptoms include chronic diarrhoea, abdominal pain, weight loss, extreme tiredness and psychological problems, and it can produce ulcers and tumours in the bowel.

Government scientists researching a possible link between milk and Crohn’s disease are due to report this year. However, at present medical specialists assess the risk of infection from drinking a glass of pasteurised milk at one in 5m.

Prof Hermon-Taylor, who is funded by the charity Action Research, said: “The problems caused by MAP in the milk supply constitute a public health disaster of tragic proportions, for which a range of remedial measures are urgently needed, and for which the government must take responsibility.

“I am certain that MAP causes a substantial proportion of Crohn’s disease.”

Addressing the Royal Society of Medicine last night, he called for an immediate ban on the sale of unpasteurised milk and greater stringency in the pasteurisation process, including doubling sterilising time from 15 to 30 seconds.

He wanted the disease to be made notifiable, requiring doctors to report cases to the department of health, and for wide-ranging testing for MAP in dairy herds and the water supply. “I’m not scaremongering, but this disease ruins people’s lives,” he said.

“We need as a matter of urgency to carry out research to determine whether MAP is being conveyed from animals to the human population in water supplies.”

Crohn’s disease is not fatal. It is estimated there are between 4,000 and 8,000 new cases a year, costing as much as GBP 240 million a year in health care.

It has become five times more common in people aged under 26 in the past 20 years, and Anne Luther, director general of Action Research, described the problem in the UK as far greater than either the BSE-linked Creutzfeldt-Jakob disease or Aids.

Calls for a ban on unpasteurised milk – the raw cow’s milk known as “green top” favoured by 100,000 consumers, including the Queen – were rejected by the government last January.

Source: The Independent (London), 24th January 2000.
URL:
http://www.independent.co.uk/news/UK/Health/2000-01/PAmilk240100.shtml

Health scare over milk

By Karen Edwards, PA News

24 January 2000

A bug found in pasteurised milk causes Crohn’s disease, a leading medical researcher said today.

Professor John Hermon-Taylor of St George’s Medical School in London says the bug, an organism known as MAP (Mycobacterium avium subspecies paratuberculosis) is present in everyday milk.

The pasteurisation process fails to wipe out the disease, according to Professor Hermon-Taylor.

Crohn’s disease is not a killer, but causes chronic diarrhoea, daily abdominal pain, weight loss, extreme tiredness and psychological problems.

It affects an unknown number of people, believed to be up to 80,000 in the UK. It is thought there are 4,000-8,000 new cases every year. Figures are unclear because Crohn’s disease is not a notifiable condition.

But it is estimated to cost the nation as much as GBP 240 million each year in direct health care costs alone.

Professor Hermon-Taylor, who was funded by medical research charity Action Research, said: “The problems currently caused by MAP in the milk supply constitute a public health disaster of tragic proportions for which a range of remedial measures are urgently needed, and for which the government must take responsibility.

“Both through our own work and new research evidence from the USA I am absolutely certain that MAP causes a substantial proportion of Crohn’s disease.”

Professor Hermon-Taylor said the answer is to test dairy herds for MAP and adopt more stringent milk pasteurisation processes.

Some information about Crohns in Asia and diet in Asia.

Crohns disease was almost unknown in most parts of Asia until very recently. If it did exist before the last few years, it is likely that it would have been confused with intestinal tuberculosis.

For a table of statistics of prevalence of Crohns disease across the world, including Hong Kong and Japan, with references to the medical studies that derived the figures, see the URLs

http://crohn.ie/archive/epidem.htm
http://crohn.ie/archive/epistats.htm

In this table you will find several studies which refer to migrants who move from countries with low CD prevalence to countries with high CD prevalance, for example Morrocans moving to Belgium, West Indians moving to England, and South Asians moving to England. In all cases, the migrants were as likely to develop CD as the people of their new home country, thus lending credence to the theory that CD is caused by an environmental agent.

A recent study in Japan searched for a correlation between diet change and development of CD. They found that CD was highly correlated with a change in diet from the traditional fish/vegetarian based diet to a more western meat/dairy based diet. A strong correlation was found between CD and Japanese people who had changed to a meat based diet, but the strongest correlation was found in Japanese people who had changed their diet to include dairy products. To see an abstract of this study, see the URL

http://crohn.ie/archive/research/misc/japprot.htm

A possible explanation for this high correlation is the fact there is a very high risk that dairy products contain bacteria of the species Mycobacterium paratuberculosis, an organism which has for years been theorized to cause Crohns disease. Recent studies have provided further evidence that CD is indeed caused by this enteric pathogen, which causes a chronic intestinal disease, identical to Crohns disease, in many species of animals, including sub-human primates, cattle, sheep, goats, dogs, deer, chickens, gerbils, horses, llamas, etc.

If you wish to read more about this topic, I have gathered together the relevent research into one web site. The URL for this site is

http://crohn.ie/archive/welcome.htm