Sunday, April 6, 2014

The homemade goat milk formula revisited

This is a super technical post, and will be useful only for those who want to come up with a homemade goat milk formula.

First, here is an important point to take note of: Babies allergic to cow milk can ALSO be allergic to goat milk. The incidence of goat milk allergy and its severity relative to cow milk allergy appears to be a subject of some controversy. As previously noted, goat's milk has really low levels of the main culprit implicated in cow milk allergy, A1 casein, although it does have an another allerginic substance, beta-casein. I kind of got cross eyed when I tried to figure out what percentage of children with cow's milk allergy are also allergic to goats milk. One study puts this at 26%. There are also studies that show that infants that are not allergic to cow's milk may be allergic to goat's milk.

However, overall, studies as well as anecdotal evidence suggest that goat milk allergy/intolerance is far less of a problem than cow milk allergy/intolerance. It comes down to how your child responds to it: many children who are miserable with cow's milk fare very well when they go to goat's milk. Also, food allergies are insanely complex: I was struck by one story I read a long time ago on Amazon. This child was having issues when on a cow milk formula, and they switched him/her to goat's milk and  found a huge improvement.  At the same time, they were having him tested for allergies, and testing revealed that he WAS allergic to goat's milk (based on IgE, I think). They then took him off it, but what was surprising to me was that they noted a real improvement in symptoms when he was switched to goat's milk.

I tried to find where I had read this, but was unable to. The point of this is it may be better to see what your child tolerates best, rather than just looking at what the clinical testing reveals. Sometimes, only one clinical parameter (like IgE levels) may not provide the full picture. This point is made by Dr. Sears, who states that clinical studies about goat milk allergenicity really do not appear to correlate with parental observations as to how well it is tolerated.

However, keep your pediatrician in the loop and always proceed with caution when introducing something new: anphylactic shock has been observed in very rare instances in response to a milk allergy, and there has been one documented case of it occurring in response to goat milk. However, I would emphasize that such a situation may be exceedingly rare.

Also, while we spend so much time talking about allergy, keep in mind that true cow milk allergy is low in frequency: maybe only 2% of the population. Even if you suppose this quoted study under-represents this issue and you double this figure, this is still not a very widespread problem.

The majority of the population should do okay with either goat or cow's milk. However, goat milk has some advantages, and moreover, most formula makers have made some really poor choices when coming up with baby formulas (even the organic ones), and hence I would want to go with a homemade formula.

Most of this goat milk formula recipe comes from the one recommended by Joe Stout from Mount Capra. The first thing I did when I was analyzing his formula was to make sure the protein level was okay, because goat milk has about 3 times the amount of protein as human milk, which can mess with a newborn's kidneys.

The biggest issue in coming up with a formula to replicate human milk is that the levels of the various components of human milk can vary, apparently (I have not verified this statement myself). I found one study which stated that human milk contained about 1.1 g protein/100 mL.  Based on my calculations, the amount of protein suggested for use on the Mt. Capra site (1 scoop Myenberg's powder/8 oz) would deliver a little more protein (1.7 g/100 mL).

I communicated this to Joe Stout, who very kindly explained that trying to come up with the "correct" amount to mimic that in human milk is a crapshoot, because the composition of human milk can vary.

Moreover, formula manufacturers have to follow an extremely unclear system (or so I think):
Based off of the regulations in the 1980 Infant Formula Act, the infant formula must contain at least 1.8 grams of protein and no more than 4.5 grams of protein per 100 kcal formula.

The fact that they did not specify this per volume, and did it per 100 kcal of formula,  is rather insane, I think. This system is immensely difficult to follow and allows wide variation, and I decided to go with a slightly different approach.

I tailored everything to mimic what little we know about human milk composition, on a per volume basis, and I used most of the calculations specified in the Mt. Capra formula. The end result may not resemble everybody's milk, but atleast it resembles somebody's milk. The thing to remember is, no matter what minor variations there may be in the protein composition between formulas and even in different human milk sources, babies do just fine generally on all of them, unless you really overshoot or undershoot.

It would be a smart idea to take a formula recipe (this one or the Mt. Capra one), as a starting source and modify it slightly if required, based on your baby's response, growth, and general well being. 

Here is a formula, if one is making it with Myenberg's goat's milk powder. Note that ingredients can be purchased from iHerb or Amazon.com


Notes:

  • For people confused about ounces and mL, 1 oz = 28 mL. 
  • The amount of goat milk powder added is not set in stone:  I was planning to start with 0.7 scoops per 8 oz, but I quickly had to work up to 1 scoop per 8 oz (this delivers 1.7 g protein per 100 mL, which is a bit more than human milk (1.1 g/100 mL) or the Nestle Nan formula (1.53 g protein/100 mL) she was originally on.
  • Note that if you add 1 scoop of Myenberg's, you would have to decrease the amount of lactose to 2.26 tsp per 8 oz. You can slightly adjust the lactose as needed based on your baby's response (for example, if he/she has green frothy poops, they may be getting more lactose than they can handle comfortably: this was the case with Gauri, and I reduced it to 1.75 tsp lactose per 8 oz, and the greenish poop issue went away, and the gassiness also reduced slightly.
  • Alternatives to lactose include turbinado sugar, maple syrup, or organic brown rice syrup. I prefer lactose as it is what is present in human milk, and it helps in the establishment of a healthy normal flora (this is incredibly important). The reason that formula companies use other things (corn solids, maltodextrin etc) is because they are cheaper. When making your own formula, unless your baby shows signs of intolerance, lactose is a good choice.
  • Blackstrap molasses (NOT INCLUDED IN THE FORMULA CARD ABOVE) supplies minerals and B complex vitamins. It made my newborn daughter's poop green, suggesting that she was getting too much iron, so I dropped it like a hot potato. The Mt. Capra formula uses it. It may be more suitable for babies over 3 months of age, I think.
  • I don't like this multivitamin supplement(Country Life baby maxi), honestly. They use cyanocobalamin instead of methyl cobalamin, and have sodium benzoate in combination with vitamin C, which drives me batty as the two can apparently combine to give benzene, a carcinogenic substance. I'm listing it here because I've found no better alternative.
  • The Vitamin D dosage can be tailored to meet your baby's needs (you just need to ensure that the levels are above 30 ng/mL for optimal health)
  • I'll be writing a blogpost on the probiotic (Biogaia Protectis) soon.See here.
  • I added homemade organic ghee as an experiment, and to provide high quality fats. Interestingly, it seemed to increase the frequency of poops per day, from 1 to 2, which was nice, and unexpected side effect. Turns out ghee is used in ayurvedic medicine to treat constipation.
  • Quick tips to make this formula: Use a Pyrex 16-oz measuring cup (this fits in the Phillips Avent sterilizer). Sterilize all bottles, cutlery, whisks, and measuring spoons (I use steel ones). Boil filtered water using an electric kettle (do this many hours before preparation, so it cools enough). Add the ingredients (goat milk powder, lactose or another source of sugar, oils). Add a little warm to hot water, and make a super concentrated solution (you would have to use a spoon or a whisk to dissolve the lumps). Then make it up to 16 oz, and distribute into bottles (I highly recommend the PURA KIKI steel bottles), and store in the fridge till use. I only make little more than one day's worth at a time: I make 40 oz using my 16-oz measuring cup thrice.

9 comments:

  1. Another important factor that you haven't considered at all, is taste. If it has an odd vitamin taste, your baby may not willingly drink the formula. Breast milk is sweet, and some formulas can be somewhat bitter. The surrogate's diet during pregnancy can also influence a baby's willingness to take types of formulas if he/she is picky (though I'm guessing the evidence on that is mainly anecdotal).

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    1. I always figured I'd have to play around with the extras, and maybe end up giving them separately if they make the baby hate the formula. I don't know how well the fish oil (DHA), for example, would go down.

      The core formula (with the milk powder and the lactose and the blackstrap molasses) should be pretty sweet. Most babies tend to be okay with the taste of the goat milk,, so I'm hoping I run into no issues there.

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  2. How do you prepare this? Do you mix a big batch of all the dry ingredients and add the liquids as you go? (Is the molasses a powder?) Can you prepare a lot and freeze it? I'm curious.

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    1. All of this is theoretical since I have not actually prepared this yet, but I was planning to make enough for one day at one go- this should work out to 24-30 oz.

      My plan was to microwave-heat water in one of those big glass pyrex measuring jugs with handles (you get ones with lids), then add goat milk powder and the lactose, molasses, and the oils to the warm water, mix it up, and then distribute it (when warm) into bottles I'd store in the fridge. The molasses I have is a very viscous liquid; I may have to get an electric whisk to mix all of this well. The only issue with this is the coconut oil, which is solid when not warm.

      The additives (the probiotics, vitamin D, DHA, ghee/Vitamin Drops) I'd add to the bottles after I warmed them up, maybe, or maybe I would give them separately.

      All of this is just planning: god knows how much I'd have to tweak it in practice!

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    2. I guess you could prepare and freeze, or make 2 days worth if you get a really big jar.

      Based on this current calculation of how much powder to add, one can of milk powder would last around 10 days.

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    3. Wow. Quite an undertaking. If you're preparing the formula in the hospital, then you will definitely need to be in a suite. The private rooms do not have microwaves if I'm remembering correctly. I'd also be weary of having all these ingredients out in the open since they're strict with "no outside food." You'd have more privacy upstairs in the small kitchen nook the suites have (microwave, fridge, sink.)

      Not to be pessimistic, but do you have a back-up feeding plan?

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  3. This plan was for when I was home. When in the hospital, I was planning to do goat milk powder + lactose only. Best laid plans of mice and men and all: right now my baby is in the NICU only allowed to take saline, and once we shift to feeds, I have to only use the brands supplied by the hospital (autocratic much ?).

    Going with nestles nan while we are here, once we transition to feeds (please god let that be soon!)

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    1. My fingers are crossed her stay is short and you're both settled at home very soon. All will be well. Enjoy your precious girl.

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