Goats’ Milk & Cows’ Milk Hypersensitivity | St Helen’s Farm


Goats’ Milk & Cows’ Milk Hypersensitivity – An Overview


Helen Bond, Consultant Dietitian to St Helen’s Farm


Introduction Despite the numerous health benefits that cows’ milk can offer,1


an increasing number of people are seeking alternatives due to a


true,or perceived cows’milk allergy or intolerance.The provision of suitable replacements along with appropriate nutritional advice from a health professional is therefore of utmost importance, to reduce any risk of nutritional deficiencies.This article focuses on cows’ milk hypersensitivity and why goats’ milk can provide a valuable dietary solution for many that cannot tolerate cows’ milk.


Allergy versus Intolerance Cows’ milk hypersensitivity is one of the most common adverse food reactions in the UK.2, 3


According to the


European Academy for Allergy and Clinical Immunology (EAACI) and the World Health Organisation (WHO) cows’ milk allergy (CMA)4


is an abnormal immunological


reaction to cows’ milk protein that is especially common amongst babies and young children, affecting between 2 to 6% per cent of UK infants. In general, CMA is usually a temporary condition with around nine out of ten children losing their sensitivity by the age of five years.5, 6, 7


True CMA in adults is rare, affecting just 0.1- 0.5% adults,5 yet, the prevalence of self diagnosed CMA


has been reported up to ten times higher than the clinically proven incidence, meaning that many people are unnecessarily excluding a major food group from the diet.5, 7 Part of the problem can be attributed to the fact


that the dividing lines between CMA and cows’ milk intolerance are not always clear, and while consumers use the terms interchangeably, they are separate conditions and require separate methods of diagnosis, with different strategies for management and treatment (see Figure 1).


Goats’ milk: a practical solution


to cows’ milk free diets Although goats’ milk is unsuitable for infants under 12 months of age10


closest to cows’ milk than other milk alternatives12 and as a cows’ milk substitute for


those with severe hypersensitivity to cows’ milk. For some people, goats’ milk, the natural alternative to cows’ milk is a solution.11


Goats’ milk is nutritionally and


yet many people who perceive that they can’t drink cows’ milk can drink goats’ milk without any problems. With its mild and smooth taste, goats’ milk is the


milk of choice in most of the world and has been an integral part of the developing world’s diet for centuries. Yet the UK consumer has only recently appreciated goats’ milk for its nutrition qualities and purported health benefits.


Table One: Nutritional Comparison of Goats’ Milk and Cows’ Milk15


Per 100g


Protein (g) Fat (g)


Lactose Vitamin D (µg)


Goats’ Milk (whole)


3.1 3.5


4.4g


Calcium (mg) 100 Riboflavin (mg) 0.13 0.11


Cows’ Milk (whole)


3.2 3.9


4.8g 115 0.17 0.03


Cows’ Milk Intolerance


Non-allergic cows’ milk hypersensitivity e.g. lactose intolerance


• The immune system is not involved • The reaction time is around 0.5-2 hours • Deficiency in the digestive enzyme lactase • Symptoms include: nausea, stomach cramps, bloating, fatigue, loud bowel sounds, diarrhoea, flatulence


• Diagnostic test –blood glucose test, hydrogen breath test, stool acidity testclinical history, elimination diet /lactose challenge.


References: 1. Garrow JS, James WPT, Ralph A (2000). Human Nutrition and Dietetics. 10th Edition. Churchill Livingstone. 2. Taylor SL, Hefle SL (2001). Food Allergies and other food sensitivities. Food Technology; 55: 68-83. 3. Buttriss J (2002). Adverse reactions to food. The Report of the British Nutrition Foundation Task Force. British Nutrition Foundation: 2-10. 4. Johansson SG, et al (2004). Revised nomenclature Review Committee of the World Allergy Organisation, October 2003. J Allergy Clin Immunol.; 113: 832-836. 5. Crittenden RG, Bennett (2006). Cow’s milk allergy: A complex disorder. Journal of the American College of Nutrition; 24(6): 582-591. 6. Sackeyfio A, et al (2011). Diagnosis and assessment of food allergy in children and young people: summary of NICE guidance. BMJ; 342: d747. 7. Ventner C, Arshad SH (2011). Epidemiology of Food Allergy. Paediatr Clin North Am.; 58: 327-349. 8. Skypala I, Venter C, Meyer R (2012). Food Allergy and Intolerances. The British Dietetic Association Fact Sheet. 9. The Royal College of Paediatrics and Child Health (2011). Care Pathways for Food Allergy. Accessed online: http://www.rcpch.ac.uk/allergy/foodallergy [serial online] (June 24, 2011). 10. Buttriss J (2002). Adverse reactions to food. The Report of the British Nutrition Foundation Task Force. British Nutrition Foundation. 11. One Poll, Milk Matters UK Survey, 27th January – 1st February 2012. 12. Tomotake H, at al (2006). Comparison between Holstein cow’s milk and Japanese-Saanen goat’s milk in fatty acid composition, lipid digestibility and protein profile. Biosci Biotechnol Biochem.; 70: 2771-2774. 13. Harden CJ, Hepburn NJ (2011). ‘The benefit of consuming goats’ milk’. The Centre for Food Innovation Sheffield Hallam University. 14. Bellioni- Businco B, et al (1999). Allergenicity of goat’s milk in children with cow’s milk allergy. J Allergy Clin Immunol.; 103: 1191-1194. 15. McCance and Widdowson’s The Composition of Foods. Fifth Edition. (1991) Royal Society of Chemistry. Ministry of Agriculture, Fisheries and Food.


Reviewing the evidence When evaluating the use of using goats’ milk as a credible replacement to cows’ milk, it is important to sift through the evidence. Much of this work has been already been undertaken by the Centre for Food Innovation, at Sheffield Hallam University with its 2011 report entitled ‘The benefit of consuming goats’ milk’.13 The report draws on studies that show the


disparities in the fat (smaller fat globules), protein (aplha-s1casein is largely absent and goats’ milk contains A2 beta-casein rather than allergenic A1) and sugar (up to 10% less lactose content) composition of goats’ milk could go some way in explaining why many people who can’t drink cows’ milk can tolerate goats’ milk without any problems.13, 14 Table One compares the nutrient content of goats’ milk with whole cows’ milk,15 it is evident that


goats’ milk provides similar amounts of protein, calcium, and a range of other essential vitamins and minerals as cows’ milk.


Summary Although further studies are needed to examine the hypoallergenic and therapeutic significance of goats’ milk, it is reasonable to surmise from the research to date and convincing anecdotal evidence, that goats’ milk is a nutrient-rich food, which offers many unique qualities for human nutrition.


Figure 1: Types of Cows’ Milk Allergy and Intolerance8, 9


Cow’s Milk Hypersensitivity


Covers all adverse reactions to cows’ milk. Includes cows’ milk allergy and cows’ milk intolerance.


Cows’ Milk Allergy A. IgE medicated cows’ milk allergy •


Rapid and potentially serious reaction to a cows’ milk < 1 hour


• So called ‘immediate hypersensitivity’ • This reaction involves IgE antibodies, which are produced by the immune system and give positive results with blood and skin tests


•


Symptoms include hives, swollen lips, tongue or face, diarrhoea, vomiting, breathlessness, anaphylaxis.


B. Non - IgE medicated cows’ milk allergy (also defined as cows’ milk protein intolerance)


• The reaction is delayed > 1 hour to days • So called a ‘delayed hypersensitivity’ • The immune system is involved but not IgE antibodies


•


Symptoms include vomiting, bloating, stomach cramps, diarrhoea, constipation and eczema.


• Diagnostic test – clinical history, elimination diet /milk challenge.


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