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
Most people, be they children or adults, who are diagnosed as cow's milk allergic or intolerant have already been drinking cow's milk for some time so there could be many reasons why they can no longer tolerate it. For example:

• They could have developed a genuine, IgE mediated immune response (allergy) to one or several of the proteins in cow's milk. This can be relatively accurately diagnosed, especially in small children, by a skin prick or blood test. It is thought that no more than 5% of the general population suffers from IgE allergy.

• These people could be either temporarily or permanently deficient in the enzyme lactase that enables them to digest the lactose sugar in cow's (and all other animals’) milk. A permanent deficiency is rare; a temporary deficiency as a result of a gastrointestinal upset that has washed all the lactase out of the gut is quite common. Undiagnosed or recently diagnosed coeliacs may also have temporary lactase deficiency.

• They could be suffering from a wide range of digestive problems that result in a sensitivity to cow's milk and other foods. Digestive problems could also have resulted in a ‘leaky' gut wall allowing partially digested proteins to leak through the gut wall into the blood stream and cause a range of allergic reactions

• They could be suffering from any one of a number of other, often digestive, conditions (Crohn's disease, ulcerative colitis, etc) in which the cow's milk proteins irritate or damage the gut causing discomfort or hampering digestion and nutrition uptake.

But whatever the cause, the question they have to ask is whether changing to an alternative animal milk will solve the problem.

Lactase deficiency
If you are suffering from either a temporary or permanent lactase deficiency, substituting another animal's milk will not help as lactose is present in all animal milks. Choosing lactose-free options products such as those by Lactofree will probably be suitable for you.

Generalised Intolerance
Although cow's, goat, sheep and buffalo milks are very similar, they are not the same. Moreover, goat, sheep and buffalo milk, although pasteurised, comes from animals which have not been intensively farmed and so have not been treated with growth promoters, hormones and antibiotics over many generations. (It is anecdotally well recognised that some people who cannot tolerate normal ‘shop bought’ cow's milk can tolerate organic or 'green top' milk from the farm gate.)

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.

Other conditions
The slightly different protein and nutrient composition (see below) of goat, sheep and buffalo milk may be tolerated by the digestive systems of those suffering from other gastrointestinal conditions. Providing the milks are not causing further damage to an already damaged gut there is no reason not to use them.

'True’ Allergy
Only a small number of those who find shop bought cow's milk difficult to tolerate are truly allergic (eg suffer an immune system reaction) to the proteins in cow's milk. However, for those who are, the proteins in goat's and sheep’s milk are very similar to those in cow's milk and it is estimated that around 80% of those who are genuinely allergic to cow’s milk may also be so to goat’s or sheep’s milk. However, since being able to tolerate alternative animal milks considerably broadens your dietary options, it is certainly worth trying to see whether you might be one of that lucky 20%.

Nutritional value
Although the proteins in cow's, sheep, goat and buffalo milk (nearly twice as much in sheep’s milk as in the other milks) are similar, other nutrient contents do vary considerably. Listed below are some comparative values (per 100g) from the USDA Nutritional Database.

Calcium:
Cow: 119mg; goat; 134mg; sheep: 193mg; human: 32mg
Potassium:
Cow:152mg; goat: 204mg; sheep: 36mg; human: 51mg
Cholesterol:
Cow: 14mg; goat: 11mg; sheep: 7mg; human: 14mg.

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.

(Haenlein, GFW 1992a. Role of goat meat & milk in human nutrition. Proceedings Vth Intern. Conf. Goats, New Delhi, II (2): 575-580).

Infants

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.

If the infant has already reacted badly to a cow's milk formula.

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.

Where the issue is not feeding an already milk allergic infant, but feeding an 'allergy at risk' infant, current recommendations are based on research that is connected with prevention of sensitisation, not controlling symptoms once sensitised.

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 - info@vitacare.co.uk - 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

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