To cheese or not to cheese
My husband and I recently moved back from 2+ years living in Belgium. My mom was absolutely convinced we would have babies over there, but my response – “no way, I like non-pasteurized cheese FAR too much”. I just wasn’t quite ready to sacrifice the amazing experience of driving up to a random cheese farm in France and tasting their fare.
I certainly love my gooey, stinky, moldy cheese.
And this was, of course, another big concern when I got pregnant – none of my favorite cheeses for 9 months?
Here is what we are afraid of lurking soft cheeses: a little bacteria called Listeria monocytogenes that causes listeriosis. And I am going to start this post by saying – listeriosis is a serious, SCARY infection to expose a developing fetus to. A paper titled “Do We Really Need to Worry about Listeria in Newborn Infants?” by Oikike, Lamont, and Heath in The Pediatric Infectious Disease Journal concluded with a strong yes. Fatality risk is high and for babies that survive there is some evidence for long term disabilities. So, yes, there is absolutely cause for concern.
But, back to the cheese.
Really, what are these odds that this nightmare bug is hanging out in the wheel of brie you just picked up from Whole Foods?
First of all, check the label. It was probably pasteurized. Pasteurization was designed to kill bugs and it does this very effectively. So unless the cheese maker or the guy behind the cheese counter took a perfectly good piece of pasteurized cheese and slathered in in Listeria infected dirt, it is probably safe from bacteria.
To be safe – Stay away from unpasteurized cheese. I know, this is not new. Every pregnant lady, her friends, acquaintances, and every other person who likes to offer pregnant women unsolicited health advice knows this tidbit.
But why the scare about ALL soft cheeses and blue cheeses and moldy rinded cheeses in the name of just-to-be-safe?
New scenario – a friend is hosting brunch and serving fresh goat cheese on a baguette with a dribble of honey. It looks delicious. Do you have to decline just-to-be-safe?
Let’s consider the odds that this cheese is actually carrying Listeria.
In the US, sale of raw milk and its products is pretty widely against the law. California, along with 10 other states, does appear to allow retail of raw milk products but judging from the cheese available at my favorite cheese shop, even this legal status is limited. Check in on your state here: http://www.farmtoconsumer.org/raw_milk_map.htm#.
Ok, so I’m in California, land of limited cheese governance, do I have to be concerned?
In that previously mentioned article by Oikike et al., the authors openly admit that neonatal listeriosis is rare: 1.3/100,000 in the Netherlands, 5/100,000 in the UK, and 8.6/100,000 in the US. See something strange, though? The US, land of pasteurized cheese, has the highest low rate of infection where the Netherlands, a country that has absolutely no problem selling non-pasteurized cheese, is far behind.
Let’s focus on France, where it can be illegal to pasteurize cheese (as in the case of Roquefort) and the citizens and fromagers generally think Americans are silly when it comes to our fear of raw milk cheese. In a 2012 paper, published in Clinical Infectious Diseases, Goulet and colleagues surveyed the incidence of neonatal listeriosis from 2001-2008 in France. During this time, the rate of infection in pregnant women was 5.6/100,000 (still behind the US!). Yes, the authors note that pregnant women should avoid “specific at-risk foods” but they mostly point fingers at prepared foods, smoked fish, etc.; absolutely no mention of non-pasteurized cheese. Again, this is in France.
Focusing on the US, a 2012 paper by Langer and colleagues in Emerging Infectious Diseases titled “Nonpasteurized Dairy Product, Disease Outbreaks, and State Laws – United States, 1993-2006”, mined 13 years of CDC outbreak data. Their goal: to demonstrate that non-pasteurized dairy products are dangerous to our health. From this 13 year data set, a whopping total of 73 disease outbreaks were directly attributed to non-pasteurized milk products. Of these, 3, yes, 3, were from Listeria. And this number is not cheese specific.
Quick mental math: it appears that the risk of neonatal listeriosis is insanely low.
And those 8.6/100,000 cases of neonatal listeriosis in the US? most likely, not cheese related.
That goat cheese at brunch? Safer than leaving your house in the morning to get to brunch.
Advice to myself, I am going to continue to pass on the bologna and smoked salmon, but I will not hesitate to dig into a gooey, stinky block of slightly aged goat cheese that I love so much.
My recommendation? Try to find yourself some Bonne Bouche from Vermont Creamery…
don’t worry, its pasteurized.
the pregnant scientist 
Thanks for the great posting!!! However, I must say I am no closer to understanding what’s safe and what isn’t. After living in Europe, it seems that smoked fish is also a far more common fare than it is in the US (certainly this is true in northern, central, and eastern Europe). So, where is all this listeria coming from in the US? Is it really bologna and deli meats we should stay away from? If so, which ones? I am so thoroughly confused by this — some info I’ve found say that turkey is a “safe choice” while others do not. When my company has ordered salads and sandwiches for lunch, I have stayed away from the salads with blue cheese and goat cheese and opted for the turkey sandwich instead, based on the info I got from my midwife to stay away from soft cheese and blue cheese. Has that been the wrong choice? This issue is really driving me nuts!
Yes, this can absolutely make you nuts!
My guess is that the (slightly) higher rate of neonatal listeriosis in the US is more an indicator of our love for pre-packaged food here in America. The more hands the food passes through, the more likely bacteria is to hop on and make us sick. As you know from living in Europe, even the smoked fish doesn’t go through the iterations that some of the food ending up on our shelves goes through.
As for your question. Honestly, for me, I would go for the blue cheese and goat cheese and avoid the turkey. But, again, I am not a doctor so take this completely with a grain of salt. After seeing that crazy low figure for neonatal listeriosis, its not even Listeria specifically that scares me about deli meat. I just think about the times I have had food poisoning or had friends who had food poisoning. It’s never from cheese. Actually, a majority of those cases were from turkey. Maybe food handling around cheese is just a bit more careful?
In the end, I would absolutely not worry about the choices you have been making. As long as your company isn’t picking up lunch from 7/11, the turkey sources and the food handling is probably safe.
A very late comment here but great post and great blog. I am a pregnant and cheese-loving data analyst living in the UK and I have been HUNTING for facts about the actual risk of listeria as the guidance here seems to vary about what is unacceptably risky to eat. The UK dont seem to publish or even collect data on probable causes for listeria cases, there seems to be a bit from the States about cases linked to unpasteurised cheeses, turkey meat, and cantaloup melons (!!), but the only thing I found for the UK was that there was a significant outbreak linked to preprepared sandwiches sold in a hospital cafe… You are not safe anywhere 🙂
After a fairly fruitless search I decided that pasteurised soft cheese was ok if I bought and stored it as per the packaging, I checked this with my doctor and she was happy with that. I think I will pass on hospital sandwiches though…
It is frustrating because in my job if i made a recommendation “you may do X but should not do Y due to increased risk of Z” I would have to back that up with the expected risk of outcome Z happening with and without doing X and Y, and the significance of each as a factor, and any other significant factors that may affect the likelihood of Z happening, as well as sources so that people who wanted to understand why could look into it in more detail. But this information does not seem to be out there for so much of the advice given in pregnancy, let alone communicated with the advice itself, it frustrates me unreasonably.
All the best, and I hope things are going just great with the little one! Thanks again for the interesting blog.
Thanks!
Yeah, it’s pretty amazing how doctors, etc. love to leave a grey zone for pregnancy advice. Incredibly frustrating. But also a nice reminder that the even the “no no’s” in moderation are probably perfectly fine and that you are more at risk (a slim, VERY slim risk) by things completely off your radar (hospital sandwich!!!! gross!).