Thu, 24 Apr 97 08:34:59

From: Helen Young <hyoungatoxfam.org.uk>

Subject: Use of camels milk to make HEM

We are seeking advice or comment on the use of camels milk as the basis for high energy milk for therapeutic feeding.

In Wajir, North Kenya, supplies of DSM have been reduced because of the rains disrupting transport. Camel+s milk is however available. The Dept of Medicine and Therapeutics, University of Aberdeen has found out the composition of camel+s milk, but two sources have given two different compositions! Thanks very much Geraldine McNeill for finding this information for us.

We erred on the side of caution and took the second estimate, which had the higher protein content, and based a formula for HEM on that, diluting the camels milk to obtain roughly the same proportion of protein as HEM and then increasing the energy content by adding oil and sugar. The formula for both HEM based on DSM, oil and sugar, and also camels milk, oil and sugar are given below.

ANY COMMENTS OR ADVICE ARE WELCOME.

1. High Energy Milk (1L) *

2. High Energy Milk (1L)

Camel High Energy Milk

* This recipe for high energy milk follows the WHO specification for F100 therapeutic milk given in the recent WHO Guidelines Treatment of Severe Malnutrition.

Ideally the composition should be improved by the addition of a mineral pre-mix, which supplies potassium, magnesium and other essential minerals. During the initial phase of treatment (on admission) dilute high energy milk should be given at the rate of 3 parts HEM to 1 part water.

Date: Thu, 24 Apr 1997 21:12:49 +0200

From: Rita Bhatia <BHATIAatunhcr.ch>

Subject: Use of camels milk to make HEM -Reply

Very Interesting. How about VItamin C Content of Camel Milk. Scurvy and Horn of Africa///

From INFOODSatcrop.cri.nz

Date: Fri, 25 Apr 1997 12:28:00 +1300

Subject: Use of camels milk to make HEM (fwd) -Reply

>>> mmd319 24/Apr/1997 11:51pm >>>

Dear Barbara,

On another list (ngonut) which aims to assist those organising and running nutrition programs in the third world, the message below was posted.

Could anyone on the INFOODS list reconcile the differences in the composition of camel's milk that we have so that we can formulate a diet for the treatment of severely malnourished refugees. It would also be very helpful in formulation of these diets to know the other constituents of camel's milk so that we can determine if the mineral/vitamin mix that we normally add to recipies based upon cows milk are appropriate for those based upon camel's milk.

Thank-you.

Responses can be sent to either myself, Helen Young, or posted on the infoods

list, where I can pick them up.

Subject: milk and vitamin C

Date: Fri, 25 Apr 1997 11:29:57 +0100 (BST)

From: "Michael H.N. Golden" <m.goldenatabdn.ac.uk>

Rhita Bhatia raises a very important point about the vitamin C content of milk. I know that Helen Young (Oxfam) last year investigated an outbreak of scurvy in the mountains of western China. She made the observation that their yak herds had been decimated and wanted to know the vitamin C content of yak milk. We could not find this information in the Chinese or Mongolian food composition tables. Colin Mills was arranging to have it measured from Animals in London Zoo!

There are repeated outbreaks of scurvy in Northern Uganda, Southern Sudan and the Horn. Have we overlooked an important source of vitamin C for these people in Camel's milk? What is the contribution of milk, in pastoralists, to vitamin C status? What happens to the vitamin C in DSM on storage?

Best wishes,

Prof. Michael H.N.Golden

From: Zita weiseprinzozatwho.ch

Date: Fri, 25 Apr 97 14:56:17 +0100

Subject: camel's milk and vitamin C

I will try to address some of Mike's queries regarding vitamin C and camel's milk. Camel's milk contains approximately 6 mg of vitamin C per 100 g, which is about 3x the amount in cow's milk (Source: Knoess KH. The Camel: A meat and milk animal. FAO World Animal Review, No. 22 (1977).

Pastoralists in Somalia traditionally sour and store camel's milk in opaque containers, a process which preserves the vitamin C ( Source: Magan et al. An outbreak of scurvy in Somali refugee camps. Disasters 7.2.83).

They traditionally consume up to 4 litres of camel's milk per day, which provides more than adequate quantities of vitamin C. Somali refugees who are unable to purchase sufficient amounts of camel's milk are at risk of developing scurvy. A rapid transition of diet from an animal-based source of this vitamin to one from vegetables is demanded which does not always occur easily.

Dr Micheal Toole (source from UNHCR) mentioned how in Somalia in 1982 a community health worker observed recovery from scurvy in one young patient who was taken to the bush by his father to drink large quantities of camel's milk.

In 1982 camel's milk was provided to the refugees in some camps but was discontinued due to the high cost of camel's milk, particularly at times when scurvy was at the peak.

Vitamin C is very unstable and most of the vitamin C is lost in the production of DSM.

Loss of vitamin C in the drying of milk is about the same as that lost during pasteurization which is 75% of the value in raw milk. In 1988 the RHU Somalia recommended the fortification of DSM with vitamin C. A study to look at the losses of vitamin C during storage of fortified DSM and the losses of the vitamin during the preparation of food has not been looked at.

Best wishes.

Fri, 25 Apr 1997 16:46:42 +0100 (BST)

Subject: milk and scurvey

From: "Michael H.N. Golden" <m.goldenatabdn.ac.uk>

Zita's comments on Camel's milk vit C (6mg/100g) are very interesting. Although the recommended intakes of vitamin C are well above this level - in a crisis the data of the classical studies conducted by Hans Krebs (a noted nutritionist) are germaine (Bartley W, Krebs HA, O'Brien JRP "Vitamin C requirements of human Adults" London: MRC special report series # 280, 1953 - see also Hodges et al "experimental scurvy in man" AJCN 22,535-548, 1969 and Jacob RA et al Ann NY acad Sci 498;333-346, 1987).

Those that receive about 1mg/d for 2-3 months developed mild scurvy. Those that receive 10mg/d had no signs. Those that had 10mg/d for 23 weeks and then 3.2-4.5mg/d for 28 wks showed no signs however and intake of 5 mg per day may not be sufficient to prevent gum lesions Physical signs of scurvy dissapeared with 10mg/d in Kreb's study.

I have argued elsewhere that we should be striving for HEALTH in refugees/malnourished and not just the absence of clinical deficiency and that the requirements in a hostile enviroment are likely to be higher; nevertheless, it seems that as little as 100ml of camel's milk will have an important effect in ameliorating the worst effects of vitamin C deficiency in a crisis.

The point about DSM (a relatively poor source of vitamin c to start with) which is stored for long times in a tropical environment is important. Many places are still using DSM/sugar/oil mixes without vitamin/mineral supplements for severely malnourished children. These children have already depleated levels of vitamin C, and must be a grave risk of superimposed scurvy during recovery.

DSM/sugar/oil mixes by themselves are not appropriate diets for severely malnourished children and must have an appropriate mineral/vitamin mix added to them.

Best wishes, -- Prof. Michael H.N.Golden