Scientific Interpretation of "Milk Beverage Contains Botox"

1.
Background information
Recently, a message about “children’s milk drinks containing botulinum toxin, which can cause leukemia” has been circulating in WeChat Moments, etc.
, which has aroused great concern among parents
.
Will botulinum be contained in milk beverages? What is Botox? What's the harm?
 
2.
Expert interpretation
(1) Botulinum toxin does not cause disease by itself, and the botulinum toxin produced by it is the culprit
.

Clostridium botulinum (Clostridium botulinum), also known as Clostridium botulinum, is a gram-positive bacillus that grows in a normal temperature, non-acidic and anaerobic environment.
It is widely distributed in soil, silt and animal feces
.
The bacteria of botulinum are not toxic, but under strict anaerobic environment and suitable temperature (18～30℃), botulinum spores may germinate, grow and form botulinum toxin, which is the pathogenic toxin.
The culprit, and is the most virulent type of neurotoxin known natural toxins
.

 
However, when the pH of the food is lower than 4.
5 or higher than 9.
0, or when the ambient temperature is lower than 15°C or higher than 55°C, botulinum spores cannot reproduce and cannot produce toxins
.
Moreover, boil at 100°C for 10 minutes, the botulinum toxin can be destroyed and lose its pathogenicity
.

 
(2) Botulinum toxin poisoning mainly damages the nervous system
.

Botulinum toxin poisoning is divided into poisoning type and infectious type; there is no obvious seasonal difference, it can occur all year round; there is no obvious age and gender difference; generally there is an incubation period, the incubation period is 12 to 72 hours, the length of the incubation period and food intake The amount is related to the botulinum toxin content
.

 
Most of the botulinum toxin poisoning that occurs in adults is of the toxic type
.
Patients generally have prodromal symptoms such as dizziness, fatigue, nausea, and vomiting, followed by symptoms of nerve palsy, muscle paralysis, etc.
In severe cases, suffocation and heart failure caused by respiratory muscle paralysis and death, but the patient’s perception, body temperature, blood pressure, blood picture and other physical signs Generally normal
.
Most of the botulinum toxin poisoning that occurs in infants is an infectious type, with an incubation period of 3 to 30 days
.
In the early stage, symptoms such as sudden constipation, crying, and weakened breast-sucking power, followed by neurological symptoms
.
Among them, 95% of the reported cases are infants between 6 weeks and 6 months, most commonly in infants between 3 and 4 months.
The reason is that the infant’s intestine lacks the protection of the normal flora and the bile acid that inhibits clostridia growth (common in Intestines for young children and adults)
.

 
    (3) Leukemia is a type of blood system disease whose etiology is not yet clear.
So far, it has not been found to be related to botulinum
.

    Leukemia, commonly known as "blood cancer", is a type of malignant clonal disease of hematopoietic stem cells.
Clonal leukemia cells proliferate and accumulate in bone marrow and other hematopoietic tissues, and infiltrate other tissues and organs due to uncontrolled proliferation, differentiation failure, and obstructed apoptosis.
, While normal hematopoiesis is inhibited
.
The exact cause of human leukemia is still unclear.
There are many factors that may be related to the occurrence of leukemia, including viral infection, genetics, radiation, chemical poisons or drugs
.
So far, the scientific research community has not found an association between the occurrence and development of leukemia and botulinum
.

 
    (4) Beverages are not high-risk foods for botulinum toxin poisoning
.

    Foods that cause botulinum toxin poisoning are usually caused by food raw materials that have been contaminated by botulinum toxin, contain botulinum toxin, and are not heated sufficiently during processing, which leads to food poisoning
.
Due to differences in dietary structure, eating habits, and production techniques, the food categories that cause botulinum toxin poisoning vary from country to country: sausages, ham, and cured meat are more common in Europe, fish products are more common in Japan, and home-made canned food in the United States There are many meat and dairy products, but most of our country is home-made meat products, fermented beans or cereal products
.

 
    So far, there have been no reports of botulinum poisoning caused by beverage contamination at home and abroad
.
The Food Microbiological Risk Assessment Expert Committee (JEMRA) of the Food and Agriculture Organization of the United Nations/World Health Organization (FAO/WHO) has not included "beverage-botulinum" in the list of priority assessment combinations for "food-pathogen"
.
The International Codex Committee on Food Hygiene (CCFH) and other countries in the world have not stipulated the limit requirements for botulinum toxin in beverages
.
Similarly, in China’s National Food Safety Standards for Food Pathogenic Bacteria Limits (GB 29921-2013) promulgated in 2013, the limit requirements for Salmonella and Staphylococcus aureus are set for beverage products.
In view of the growth characteristics of botulinum , There is no limit on Botox
.

 
    (5) Milk-containing beverage products do not have the conditions for botulinum contamination and botulinum toxin formation
.

    Milk-containing beverages refer to beverages made from fresh milk or dairy products (fermented or unfermented) as the main raw material and processed through processes such as blending, homogenization, filling, and sterilization, including formulated milk-containing beverages and fermented beverages.
Milk beverages, lactic acid bacteria beverages
.
The critical pH value for the germination and growth of botulinum spores is 4.
5, that is, botulinum spores cannot germinate and grow when the pH is below 4.
5
.
However, milk-containing beverages are mostly acidic foods (pH<4.
5), so there is generally no risk of botulinum and botulinum toxin contamination
.
In addition, milk-containing beverages must be sterilized during the production process, so in theory, commercially qualified milk beverage products will not contain botulinum toxin
.

 
    3.
Expert advice
    (1) Internet platforms such as WeChat and Fetion have become the main ways for many consumers to obtain and disseminate information
.
Relevant departments should strengthen the management of online food safety issues in response to these new media, and severely crack down on fabricating false information, so as to avoid panic among consumers and affect the healthy development of the industry
.

 
    (2) Food producers and operators should pay attention to the safety inspection of raw materials and the control of the storage environment, and pay attention to the temperature control of the production environment and processing
.
Avoid botulinum toxins and its toxins from contaminating raw materials, and avoid introducing botulinum toxins into food due to insufficient sterilization temperature and endangering consumers' health
.

 
    (3) Consumers should pay attention to the correct preparation, purchase and storage of food
.
When buying, you should correctly identify the label of packaged food, including the main raw materials, storage conditions, shelf life, eating method, etc.
; pay special attention to the packaging after opening, it is not suitable for long-term preservation; consumers who love homemade meat and legumes must be serious Choose good ingredients, use clean water, clean containers, pay attention to personal hygiene and environmental hygiene, make small amounts, and eat for a short time
.

 
    (4) Relevant departments should strengthen the publicity, education and popularization of food safety knowledge, improve consumers' awareness of food quality and safety issues, and enhance consumers' ability to self-identify relevant information
.

 
Experts in this issue:
Liu Xiumei, vice chairman of the Chinese Society for Food Science and Technology, technical consultant and researcher of the National Food Safety Risk Assessment Center
Yuan Xiaomei, deputy director of the National Food Quality Supervision and Inspection Center, professor-level senior engineer
Chen Wei, School of Food Science and Technology, Jiangnan University Director and Professor
Cui Shenghui, Deputy Director and Researcher of the Biological Testing Room of the Institute of Food and Cosmetics Control, China Academy of Food and Drug Control.

 
Main references:
1.
ICMSF, Microorganisms in Foods 5: Characteristics of Microbial pathogens, 1996
2.
ICMSF, Microorganisms in Foods 8: Use of Data for Assessing Process Control and Product Acceptance, 2011
3.
FAO/WHO Microbiological Risk Assessment Expert Committee (JEMRA) Series Reports, 2002-2011
4.
Codex related documents (omitted)
5.
Li Fan, Liu Jingxing, etc.
General Higher Education "Eleventh Five-Year Plan" National Planning Textbook Medical Microbiology (Seventh Edition) [M].
Beijing: People's Medical Publishing House, 2008.

6.
Carl A.
Batt, Mary Lou Tortorello.
Encyclopedia of Food Microbiology second edition [M].
London: Academic Press, Elsevier, 2014.

7.
Koepke R, Sobel J, Arnon SS.
Global occurrence of infant botulism, 1976-2006.
Pediatrics.
2008 Jul;122(1):e73-82.

8.
Brook I.
Infant botulism.
J Perinatol.
2007 Mar;27(3 ): 175-80.