|The Goat's Milk Question|
Goat, sheep and buffalo milk, yogurt, butter and cheese are becoming more and more easily available and make gastronomically very acceptable alternatives to cow's milk. But are they really a ‘medically’ acceptable alternative - and, of more concern to many of our readers, what about allergic or intolerant babies? Frances Dale checks out the facts - and talks to the experts.
Toddlers, Children and Adults
But whatever the cause, the question they have to ask is whether changing to an alternative animal milk will solve the problem.
It is quite common for those suffering from a generalised intolerance to cow's milk to be able to tolerate other animal milks perfectly well. Because doing gives so much more flexibility to the diet, it is certainly worth a try.
Goat milk is also higher than cow's in Vitamins A & C,
phosphorus and niacin, although lower in folic acid so should be
supplemented with green leafy vegetables. Goat’s milk fat also
has a much higher concentration of medium chain fatty acids (caproic,
caprylic, capric, lauric, myristic) than cow’s milk fat and
is lower in stearic and oleic acids. A considerable literature exists
documenting the beneficial effects of those medium chain fatty acids
in a number of disorders and diseases (malabsorption syndromes, chyluria,
steatorrhea, hyperlipoproteinemia, intestinal resection, coronary
bypass, premature infant feeding, childhood epilepsy, cystic fibrosis,
gallstones). Medium chain fatty acids have been shown to lower serum
cholesterol and dissolve gallstones.
The problem for infants is both different and more complex
For a start, no ‘raw’ animal milk will provide an infant with the nutrition that it requires, so whatever the milk used as the base it will need to be fortified to become a nutritionally acceptable alternative to breast milk. As of now nutritionally complete formula feeds are available based on goat's milk but not on sheep's or buffalo's milk.
There are also two different questions to be asked:
1. Will infants who have already been fed, and reacted badly to, cow's milk formulae also react to goat’s milk formulae?
2. If an infant comes from an allergic background but has not yet come into contact with (and therefore had a opportunity to react to) cow’s milk, is it more likely to be sensitised to cow’s milk by being fed a goat’s milk formula or an hydrolysed cow’s milk formula in which the proteins have been partially or totally broken down? (There are as yet no hydrolysed goat’s milk formulas so that option does not exist.)
Foods Matter was recently asked these very questions by a reader and consulted amongst the allergy community as to what advice to give.
There was general agreement that, if breast feeding was not, or was no longer, an option it was worth trying a goat’s milk formula. But if the infant was suffering from a ‘true allergy’ (diagnosed by a skinprick or blood test) there would only be a 20% chance of the infant tolerating the goat milk.
However if the reaction was a more generalised intolerance (not diagnosable by a skin prick or blood test) that resulted in, primarily, digestive symptoms, the chances of the infant being able to tolerate a goat’ milk formula increased dramatically - up to 50% according to Dr Rodney Ford, a New Zealand professor of paediatrics who has worked extensively with children with food sensitivity. If the infant comes from an atopic background but has not yet been sensitised to cow's milk.
The experts we consulted were primarily concerned with infants who were likely to suffer from a ‘true’ (and therefore potentially life threatening) allergy to cow's milk rather than a generalised intolerance.
The general consensus was that the proteins in the two milks were so similar that there would be a high risk of sensitisation. As a result the majority opted for a hydrolysed formula in which the proteins had been broken down so as to be no longer recognisable by the immune system of the majority of infants. However, as Dr Janice Joneja points out these formulae are extremely expensive. They have also been highly processed, so may not appeal to parents wishing to feed their babies as ‘'naturally' as possible, Moreover, they taste pretty horrible so may be rejected by more gastronomically discriminating infants!
Below is a selection of the advice proffered.
From: Dr Michael Radcliffe,
Clinical Research Fellow University of Southampton, and Dr Michael
Tettenborn, paediatric allergist.
This research shows that goat’s milk formula is far more sensitising to the at-risk-child, and far more likely to lead to cow’s milk problems than a hydrolysate.
We both favour Nutramigen (extensively hydrolysed) first; and if not accepted, then Pregestemil (extensively hydrolysed) or failing that Nan HA or Pepti-Junior (both partially hydrolysed).
However, the extensively hydrolysed milks need to be prescribed.
Incidentally, you should be aware that an infant may be allergy prone, but not necessarily prone to cow’s milk allergy. We do not inherit specific allergies, only the tendency to be allergic.
From: Janice M. Joneja, PhD, RD
Neither cow's milk-based nor goat's milk- based formulae are ideal for an allergic baby as cow's milk and goat's milk proteins are very similar in their allergenic potential and either could lead to allergic sensitisation.
However, if the baby is doing well on a nutritionally complete goat's milk formula there is no reason for it not to continue.
From an allergy point of view the extensively hydrolysed casein formulae are by far the best. However, if a baby is taking a goat’s milk formula and has not shown any signs of allergy there is no reason to switch to these (they are very expensive) unless and until until it does, at which time an extensively hydrolysed casein formula should be substituted.
From: Dr Jonathan Hourihane, senior lecturer Welcome Trust Research Facility, Southampton
Current expert opinion is not to advocate goat’s milk formula for cow’s milk allergy as most babies react to it, although this is not always the case.
However I think that any child with a milk issue should be referred to an allergist for review of this issue and the other allergic problems that may follow
From: Dr Harry Morrow-Brown, MD FRCP
Generally speaking only a small minority of milk allergics can tolerate goat’s milk because the proteins in all mammalian milks are so similar. However, if a baby who cannot tolerate cow’s milk formula can tolerate goat’s formula there would seem to be no reason not to use it.
From: David Freed MD, British Society for Ecological Medicine
If it is too late to re-institute exclusive breastfeeding, I have no objection to a baby receiving a goat’s milk formula that has been adjusted to reflect 'humanised' values, as cow-based formulae are.
Having said that, goat’s milk is no less likely to evoke allergy in a genetically-susceptible infant than cow’s milk. The two milks are antigenically somewhat different from each other, but equally allergenic. On the other hand goat is in general no worse than cow, so given the background I think it quite reasonable for this mother to use an appropriate goat’s formula and that indeed is what I would advise. My own daughter had the same dilemma when nursing one of our grandsons, and I gave her the same advice.
By far the best, albeit least practical, approach in these days of HIV phobia, is for the baby to be wet-nursed, or for mother to obtain samples of human milk from her friends and feed it by bottle.
Vitacare - 020 7722 4300 - firstname.lastname@example.org - make a goat’s infant formula and a follow-on milk, both of which ‘'have been adjusted to reflect humanised values', to quote Dr Freed.
First published 2005; updated 2010