Milk and Meat Products
Goat Milk and Its Use as a Hypo-Allergenic Infant Food
By Dr. H.P. Maree, MBChB
Feb 23, 2003, 8:13pm

First printed in Dairy Goat Journal, May 1978

Dr. Maree presented this paper at an annual meeting of the South African Medical Assn. Vitally interested in dairy goats, Dr. Maree operates a large, modern goat dairy. He milks about 1,000 Saanens in a double-eight side-opening milking parlor with a Boumatic low-line system. All the milk produced on the farm is concentrated down to 50 percent volume by the Danish process and canned with no additives in attractive containers.

The incidence and symptoms of a milk induced allergy in infants are viewed. The physical, chemical and antigenic properties of goat milk and cow milk are analyzed and compared. The value of goat milk as a substitute for infants intolerant to cow milk formula is elucidated by means of more recent work on the subject. The use of goat milk as a hypoallergenic infant food or as a milk substitute in infants allergic or intolerant to cow milk has often been debated over the past decades.

A fair amount of work has been carried out in different countries on the composition, nutritive value and use of goat milk as a substitute in cases of allergy or intolerance to cow milk formula. It is our object to review the older literature, to emphasize newer work done, and to give a brief account of the present available data.

Incidence of Allergy to Cow Milk & Cow Milk Formula

It is estimated that symptoms of allergy to cow milk occur in 3 to 7 percent of infants, but the actual prevalence remains unknown. To clarify the confusing estimates in literature it must be taken into consideration that some disturbances produced by milk or milk formula cannot be attributed to its antigenicity and Fries,1 points out that some of the typical allergic symptoms, for instance gastrointestinal upsets, may be caused by a food by virtue of non-antigenic components, special toxins, physical properties, poor preparation or bacterial contamination. Allergy to cow milk or its derivatives is probably no more frequent than in the past. An apparent increase is partially due to the creation of a greater awareness of the symptomatology of milk allergy. The role of the indiscriminate use of antibiotics by producers of milk may also be a factor and has yet to be evaluated. Jester et al.3 examined 1170 samples of cow milk, land found that 3.5% contained penicillin in concentrations of 0.006 to 1.22 u/ml. In 24 samples other antibiotic agents were also detected. An interesting observation made by Fries and. Lightstone4 is that “There is no evidence so far as the editors are aware, of contamination of penicillin or other antibiotics of goat milk or evaporated milk. Whether the penicillin is destroyed by the heating process incident to evaporation, or whether the goat is less subject to mastitis is worthy of inquiry.”

Symptom of Milk-lnduced Allergy

Sensitivity to cow milk usually becomes apparent in early infancy, often within a few days of the baby being given a formula of cow milk for the first time.1

One or more of the following symptoms may be apparent: Gastrointestinal disturbances like vomiting, colic, loose stools or constipation. On the respiratory side one may find an allergic rhinitis presenting with a blocked. stuffy nose or a runny nose (the frequent "cold"). Otitis media, repeated attacks of bronchitis, bronchopneumonia, wheezing or asthma should also be listed. As far as skin conditions are concerned one may find an urticaria, angioneurotic edema, or an atopic dermatitis. As far as systemic reactions are concerned anaphylactic shock may be found as a rare phenomenon.

General Information on Goat milk

As far as production of goat milk is concerned, it is evident from data published in the F.A.0. Production Yearbook5 that the annual production of goat milk in Europe, the Americas, Asia and Africa, is 8 million tons in comparison with approximately 100 million tons of cow milk.

Goat milk, as such, is used to a limited extent in several countries for feeding infants. Only two countries, however, U.S.A. and South Africa, produce goat milk in evaporated or spraydried form intended for pediatric use. The advantage of spraydried goat milk is its low weight and convenience, for instance during travel, better digestibility and greater safety as far as allergenicity is concerned. The work of Saperstein and Anderson,6 on ordinary infant milk formula indicates that an evaporated product stands less chance of evoking an allergenic reaction than a powdered formula. This is due to the greater amount of heat applied to an evaporated product in the manufacturing process when compared to powdered products. The greater amount of heat means better denaturation and the committee on Nutrition of the American Academy of Pediatricians states that "heat denaturation alters basic protein structure by decreasing its allergenicity." The superiority of an evaporated product over its spraydried counterpart in the above respects applies to all milk formula. A comparison between human, cow and goat milk cait be seen from Table 1.7

Various analyses of goat milk in 10 different countries 8, 18 indicates a wide variation in total solids, fat, protein, lactose and ash content. In Table 2 the highest, lowest and average findings can be seen. In the experience of the authors, apart from a regional factor, a wide seasonal variation in the composition of goat milk can occur. The canned product available in South Africa is, therefore, standardized and an analysis on this product is also included in Table 2. No analysis on the American product is available but it is assumed that it will be more or less the same.

The Protein of Goat Milk

Webb and Johnson19 reported that in general the distribution of the different components of goat milk protein are similar to that of cow milk and that the casein fraction is nearly the same elementary composition as bovine casein. Hofman,20 however, showed by electrophoresis that the distribution of the various components in the casein of cow and goat milks are quite different. The casein in cow milk consists of 55% alpha casein, 30% beta casein and 15% k casein, while that of goat milk contains 19% alpha 1, 21% alpha 2 and 60% beta casein.21

The casein of goat milk has more glycine, less arginine and less sulphur-containing amino acids (particularly methionine) than cow milk.22

The most recent work which contributed immensely to our knowledge of goat milk was done in France by Ribadeau Dumas et al23 on the molecular structure of the polymorphs of the caseins.

It was for the first time possible to demonstrate the molecular structure of bovine milk casein. The molecular structure of goat milk was done immediately afterward and it was proved beyond doubt that goat niilk casein differed widely in basic chemical structure from that of cow milk. The author concluded it now was possible to say that not only the lactalbumin but all the various fractions of protein in goat milk differ from that in cow niilk. This, then, is the likely reason why an infant intolerant to a product from cow milk does so well on goat milk.

The Curd Tension of Goat Milk

The curd tension of goat milk is much lower than that of cow milk. The average values with pepsin - HCl were 36, 52 and 78 for goats, Holstein-Friesian and Jersey milk respectively. This may account for the said better digestibility of goat milk as compared to cow milk.

The Nutritive Value of Goat Milk in Feedng Experiments with Infants

On an equal energy intake, goat milk and cow milk are comparable in promoting growth of human infants.24, 32 Daniel and Stearns25 found a somewhat lower nitrogen retention in five infants receiving goat milk as compared with cow milk. They found no significant difference in the retention of calcium and phosphorous by these infants.

The Immunological Properties of Goat Milk Protein

Most text books on allergy and pediatrics state that goat milk may be used as a substitute for cow milk hypersensitivity. The reason given being the whey proteins of goat milk and. cow milk are thought to be imnunologically distinct. This concept dates back to the carly work of Versell.26

Crawford and Grogan27 with precipitation-in-gel experiments cast doubt the species specificity of the whey proteins of cow and goat milk, and also demonstrated almost identical casein precipitation patterns of both inilks. These authors, therefore, assumed they have demonstrated by means of this diffusion-in-gel method an antigenic relationship between goat and cow milk which makes goat milk unsuitable for a patient with cow milk allergy. Saperstein28 also came to a similar conclusion by means of precipitation and anaphylactic tests using rabbit immune sera against Alpha lactalbumin and Beta lactoglobulin. Later work, however, done by Hanson and Anderson29 questions the value and accuracy of the above methods. A similar relationship between the corresponding proteins in human and bovine milk was demonstrated using the above mcthods, although in practice it was found that infants with a cow milk allergy could tolerate breast milk.

Hanson and Anderson29 quote Augustin who criticized the use of sera from hyperimmunized animals in diffusionin-gel methods to study adergens. The antigenic properties demonstrated in this way may have no bearing upon their allergenicity. The findings of Hanson and Anderson “seem to indicate that antigenic relationships, as revealed by hyperimmune sera from animals in diffusion-in-gel methods, may not be assumed to demonstrate any allergen!city of substances antigenically related to known allergens; for example, for goat milk proteins in a patient with cow milk allergy.”

The Fat of Goat Milk

Goat milk creams much less rapidly and completely by gravity than cow milk. This is due to the much srnaller size of the fat globules30 in goat milk and also due to a lack of fat globule clustering agent31 in goat milk. Goat milk differs from cow milk in that it contains more of the essential fatty acids (linoleic and arachidonic) and it has a greater percentage of medium and shortchain saturated fatty acids. These differences suggest that the fat of goat milk may be more readily digested than that of cow milk.32 Data regarding the fatty acid composition of goat milk fat is compared with those of human and cow milk fat is given in Table 3.

It will be noted that goat milk fat contains more Caproic, Caprylic, Capric and Lauric acid than cow milk fat. The contents of Palmitic and Stearic acids are almost of the samc order and of Oleic acid somewhat less than cow milk.

Minerals

Data regarding the mineral contents of goat milk as compared with those of human and cow milk can be obtained from Table 1. The ash content of goat milk ranges from 0.7 to 0.85 percent. It will be noted that goat milk contains less sodium but more potassium and chlorine than cow milk. Reported concentrations of iron and copper in goat milk vary widely. The concentrations of other trace elements in goat milk are of the order of cow milk except for a lower cobalt and molydenum content.33

Vitamins

The vitamin contcnt of goat milk as compared to those of cow and human milk are also obtainable from Table 1. The vitamin content of goat milk is comparable to that of cow milk except for Vitarnin B6, folic acid and Vitamin B12 which are lower in goat milk. Compared to mothers' milk, goat milk contains the seine amount of folic acid and slightly less B12.

Goat Milk Anemia

This was the designation given to a macrocytic — hyperchromic megaloblastic anemia which was observed in infants fed a diet of goat milk in Europe during the 1920s and 1930s.34, 35 Although the major difference between cow and goat milk in rcspoct to the content of vitwnins was observed to be Vitamin B12 and not folic acid, present day expcriencd indicates that infants with this macrocytic inegaloblastic ancmia respond more readily to therapy With folic acid than to Vitarnin B12. It was suggested by Gasser36 that goat milk anemia be described as a macrocytic hyperchromic megaloblastic infant anemia which responds to folic acid therapy.

Collins,35 in reviewing goat milk anemia came to the conclusion that the majot deficiency in infants with goat milk anemia is probably Colic acid. In view of the known inter-relationship between Vitamin B12 and folic acid, he suggests that the folic acid requirement be increased in infants fed the Vitamin B12 low goat milk diet.

In view of the above, it was suggested by several authors that goat milk be fortified with folic acid when used as an infant feed. Experimental work proved that by adding folic acid the nutritional value of goat milk was elevated to the same level as cow milk.

An interesting observation made by Glansmann37 and confirmed by Freudenberglll was that in all the typical anemias, the goat milk used was obtained from animals that were kept in pens and did not receive any green fodder or foliage whatsoever. Collins35 states that we presently know that green foliage is rich in folic acid and is of the opinion that this might have played a major part in the etiology of reported cases. Another important observation made by Von Klaus Betke and Gantert39 was that afl the reported cases had an infection, were malnourished and dystrophic. These two factors may have played a contributive part in the etiology. In reflection to the problem and after reading the paper of these two authors, we are wondering whether the above mentioned factors were not essential elements in the development of goat milk anemia during the two years, 1975 and 1976, evaporated goat milk was used in over 100,000 infants in South Africa. To our knowledge, not a single case of true goat milk anemia was reported. Could this be attributed to the fact that the goat milk came from a well-nourished herd and were given to infants lacking the above two elements? Since January 1977, folic acid is added to the South African products. Whether this was necessary can be debated.

Clinical Evaluation of Goat Milk

Good practice in infant nutrition requires familiarity with current knowledgc of allergic reactions to foods.32 Among foods which are most likely to upset infants, cow milk ranks at the top.1 Evaporated milk is usually less upsetting than powdered milk and powdered milk less than ordinary doorstep milk.1

If cow milk is suspected as a cause of also be sensitive to soya or become sensitive even to the refined products now available on the market.1 Apart from this, there are many potentially deleterious effects referable to the soybean and it would seem preferable to attempt to maintain nutrition with the use of mammalian-derived milks wherever possible, using the vegetable milks only in those instances where mammalian milk is not tolerated.2

Since heat denaturation renders milk less allergcnic, a fortuitous combination such as evaporated goat milk would seem to be an ideal substitute food for infants allergic to milk.4

Goat milk has been found to be well tolerated by these infants, especially those with gastrointestinal or respiratory symptoms and even those who suffered shock from ingestion of cow milk.40 Infantile eczema only occasionally responds to goat mdk substitution, due to the fact the etiology of infantile eczema is a complex one and ad allergy to cow milk is seldom a major factor in the etiology.40

Compared to cow milk the lower curd tension of goat milk and the different chemical and physical composition of its fat, as already discussed, suggests greater digestability. Apart from milk allergy, goat milk is a valuable aid in the problematic infant intolerant to formula derived from milk.

An interesting observation which needs further investigation: goat milk has been used with great success in cases of post gastroentiritis as well as the initial stage of management of kwashiorkor where gastrointestinal hyper-sensitivity is experienced.

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