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Processed Milk and EOE 

Processed Milk and EOE 

There is mounting evidence that processed milk is the primary cause for the newly developing epidemic of eosinophilic esophagitis (EOE).  The rise of EOE began after the widespread consumption of ultra heat treatment (UHT) pasteurization and micro fluidization homogenization of our milk in the early 1990’s.   

Louis Pasteur recommended heating milk to 72° C for 15 seconds.  UHT heats milk to 140° C.  Homogenization is a process to reduce the fat droplet size so that milk doesn’t separate in the container.  This highly processed milk makes it very pleasing to the eye (uniformly white) and gives it a long shelf life.  In fact, it actually does not require refrigeration.  But in the American market consumers’ unease about drinking non-refrigerated milk has led to most milk being sold cold.  Prior to this ultra processing the cold was necessary to preserve the milk.   

Unfortunately, this ultra-processing (UP) markedly alters both the fat and the protein in milk in a way that creates inflammation in the esophagus.  Also, there are small amounts of detergent residue in milk.  Very strong detergents are used to clean the processing equipment in order to prevent biofilms.  This detergent residue causes a chemical injury that disrupts the normal intact cellular barrier in the esophagus.  These micro-fissures in the esophageal membrane allow the penetration of fat-protein nanoparticles which in turn instigate the incursion of the eosinophils.  Prior to UP there was no detergent residue in milk and the milk proteins/fats were large and did not infiltrate the esophageal lining. 

Finally, there is early evidence that strictly avoiding cow milk and its products (cheese, butter, yoghurt, ice cream) leads to healing of EOE.    

EoE: Feeding, swallowing issues differ from symptoms of GERD

EoE: Feeding, swallowing issues differ from symptoms of GERD

EoE is the acronym for eosinophilic esophagitis. Once thought to be an uncommon condition, it is now recognized as one of the most common reasons for feeding problems in infants and for dysphagia (difficulty swallowing) and food impaction in adults.

Until the early 1990s EoE was lumped in with the GERD diagnosis (gastroesophageal reflux disease). But in the ‘90s researchers started to recognize that EoE was a different critter. The clinical symptoms were different from classic GERD, and the patients tend not to respond to acid suppression therapy, or anti-reflux surgery.

In children EoE causes feeding problems, vomiting and abdominal pain. In adolescents and adults it causes discomfort with swallowing and food impaction episodes. The reason for these symptoms is inflammation in the esophagus caused by the presence of the white blood cell – eosinophil (as opposed to acid-related inflammation in GERD).

The eosinophil can be seen on biopsies taken from the esophagus during upper endoscopy. It is believed the eosinophils infiltrate the esophagus in response to either or both allergens and altered microbiome. The allergens can be either food allergies or airborne. It may sound weird, but part of the self-cleaning process of our sinuses is to filter allergens, wrap them in mucus and then send them out of the body via swallowing them. As these aero allergens pass through the esophagus they can elicit the eosinophil response.

Treatment consists of two main approaches. First is to identify and then avoid food and airborne allergens. Second is topical corticosteroids. These can be administered either by swallowing the spray from a steroid asthma inhaler, or by viscous preparation of a liquid asthma steroidal normally used in a nebulizer.