Cow's Milk Protein sensitivity and Buffalo Milk

Jamie asked me, what is perhaps the most interesting question I have ever been asked. 

“Do u know of any cross reaction between breast milk protein, cow milk protein and buffalo milk protein.”

As it turns out she has a client who is traveling to a country where drinking buffalo milk is rather common and the client has a nursing infant who is sensitive to cow’s milk proteins.  She wanted to know if buffalo milk would be the same.  I have never in my life considered buffalo milk and so it took some digging.  I was interested to discover that in general buffalo’s milk has a lower risk of causing problems through breast milk than does cow’s milk and that Indian buffalo bred for dairy production are better than wild-type buffalo (Sodhi et al., 2012).  I was also turned on to a new interest, and that is the study and diagnosis of Cow’s Milk Protein Allergy (CMPA) and Cow’s Milk Protein Insensitivity (CMPI).  It would appear that “lactose intolerance” is frequently over diagnosed when in fact the real problem is A1 β-casein intolerance.  Who knew?  Now I do, and I will share this with you.

In a rather complicated and technical paper on the specific components of milks commonly found in India, Islam and colleagues analyzed the chemical make-up of Buffalo, Holstein hybrids, Red Chittigong cattle (RCC) and “indigenous cattle” that are commonly found in India.  They found that Buffalo milk and that of the RCC was nutritionally better than Holstein cow’s milk (HC).  When compared to HC, buffalo and RCC are higher in fat and protein and lower in A1 β-casein (Islam et al, 2014).  So to answer the question, the breastfed infant is likely to be fine if his mother drinks buffalo milk while outside the U.S.  But that wasn’t enough for me.  I, like you, had never herd {VBG} of A1 β-casein, so I had to look it up and figure out why it mattered. 

As it turns out there are two primary milk protein in mammalian milk, particularly among dairy animals.  They are A1 β-casein and A2 β-casein.  A1 β-casein (A1 from now on please) is the primary source of irritation in non-human milk intolerance and it is predominantly found in European cattle breads (Holstein and other “black and white” cows).  A2 β-casein (A2) is not known to cause milk intolerance (Pal, 2015).  A2 comes from Asian, African, and American cattle breeds that are brown i.e. Jersey cows and other “southern breeds” (Snowville Creamery, 2016).  That may be enough for many of you out there but if you are really interested, I will carry on.

So, A1 has a very interesting effect on the human gut.  Upon entry to the GI system A1 proteins activate BCM-7 (the real bad guy) and that protein stimulates the opioid receptors in the gut (Pal, 2015).  That’s right, I said opioid receptors. Some of you are wondering how milk can be a narcotic (it isn’t).  The opioid receptors in the brain are responsible for decreasing pain, but those found in intestine simply slow down the passage of chyme through the GI tract.  When things slow down in the gut those contents begin to irritate the lining for the intestine and you get constipation, bloating, pain, and diarrhea.  Does sound familiar to any of my “lactose intolerant” friends out there?  In infants it will also frequently cause vomiting and bloody stool.  Any lactation consultant worth her salt will tell you to remove all forms of dairy from your diet for at least 2-3 weeks to allow the baby’s GI system to heal.  If symptoms go away you know what it is and how to treat it (don’t go back to dairy).  But after reading this I hope that you will consider trying to find A2 milk and give that a try since it just might work. 

Another thing I found while researching this article was cow’s milk protein allergy (CMPA) which is far more serious than insensitivity.  It is an actual allergic reaction to cow’s milk protein (A1 and/or A2).  It usually starts with a rash in the first month of life (or the first month of formula feeding) but can also present with GI illness, and even respiratory problems leading to anaphylaxis.  In the western world 2-3% of infants will be allergic to cow’s milk protein for the first three years of life.  Oddly enough, babies tend to grow out of this allergy and 85-90% of them will be allergy free by age 3 (Host & Halken, 2014).  What was maddening for me as a lactation consultant was that while researching for this post I found several articles on the diagnosis and treatment of CMPA the authors never once recommended putting the baby on breast milk to treat or prevent the allergy.  In their excellent article “Cow’s milk Allergy: Where have we come from and where are we going” Host and Halken offer several possible treatments for CMPA.  First they offer changing to extremely hydrolyzed formula (eHF) but admit that it is rather biter and unpalatable making it difficult for an infant to tolerate and rather expensive making it hard for the parents to tolerate (2014).  Then they offer exposure therapy through an new treatment modality known as OIT (oral immunotherapy) in which they offer the infant small but ever increasing doses of the allergen over a period of time gradually making the infant immune to the allergenic effects, but they again concede that it is risky and that “a subset of patients have developed significant side-effects.”  Further they suggest that the results are transient and will fade when you stop exposing the infant to the allergen.  Finally, they recommend injectable IgE therapy with omalizumab (try saying that five times fast) (Host & Halken, 2014).  I shudder to think of the poor infant having routine injections of any medication but particularly one that will attempt to suppress the immune system at such a young age.  Why, we are left to wonder, does the author not suggest switching to human breast milk rather than doing all of this to the poor infant?  But that is a topic for another day. 

So there you have it.  If you have a baby who is sensitive to cow’s milk he is most likely sensitive to A1 β-casein and not lactose intolerant.  The primary treatment for cow’s milk protein sensitivity and cow’s milk protein allergy is the same, remove the cow’s milk from the baby’s diet.  Either remove it from the mother’s diet, effectively removing it from the breast milk (not well studied I have to admit) or if he is on artificial milk supplements (AKA Formula) then take him off the formula in favor of either breast milk or eHF (yuck!).  Finally, if you happen to have a supply of buffalo milk, give it a try, you might be happy with the results. 

References:  

Host, A. and Halken, S. (2014) Cow’s Milk Allergy: Where have we come from and where are we going? Endocrine, Metabolic, and Immune Disorders – Drug Targets.  14, 2-8.

Islam, M.A., Alam, M.K., Islam, M.N., Khan, M.A.S., Ekeberg, D., Rukke E.O., Begarud, G.E. (2014) Principal milk components in Buffalo, Holstein Cross, Indigenous Cattle and Red Chittagong Cattle from Bangladesh.  Asian Australas Journal of Animal Science V27, 6: 886-897. http://dx.doi.org/10.5713/ajas.2013.13586

Snowville Creamery (2016) About A1 and A2 beta-casein in cow’s milk.  Retrieved 18 Feb 2016: http://www.snowvillecreamery.com/a1-and-a2-beta-casein-in-cow-milk.html

Sodhi, M., Mukesh, M., Kataria, R.S., Mishra, B.P., Joshii, B.K. (2012) Milk proteins and human health: A1/A2 milk hypothesis. Indian J Endocrinology and Metabolism.  Sep-Oct; 16(5): 856.  doi: 10.4103/2230-8210.100685

Pal, S, Woodford, K., Kukuljan, S., Ho, S. (2015) Milk Intolerance, beta-casein and lactose. Nutrients, 7:7285-7297.  doi:10.3390/nu7095339