Kristin Revere and Dr. Ari Brown focus on the benefits of goat milk formula on the latest episode of Ask the Doulas. Dr. Brown is the chief medical advisor at Kabrita.
Hello, hello! This is Kristin Revere with Ask the Doulas, and I am thrilled to chat with Dr. Ari Brown. Dr. Brown is a pediatrician, best-selling author, and chief medical advisor at Kabrita. She has been in private practice for over 25 years. Her passion to advocate for children and educate families extends beyond the office setting. She is the co-author of the best-selling 411 Parenting book series, including Baby 411: Clear Answers and Smart Advice for Your Baby’s First Year; Expecting 411, and Toddler 411. Dr. Brown has received several professional awards, including the American Academy of Pediatrics Advocacy Award and the Ralph Feigin MD Award for Professional Excellence.
Welcome, Dr. Brown!
Thank you so much for having me!
What an impressive background! I don’t know how you have the time to author three books. I’ve only authored one, and it took me two years!
Well, it’s been a journey. Let’s say I didn’t get much sleep during those years, put it that way.
I can only imagine! I’m excited to learn from you. It is excellent timing in that we’re recording this during National Breastfeeding Awareness Month, but we are going to talk about all types of feeding today. So I’d love to get into a bit more about your background and what led you to focus on feeding topics, especially goat milk formula.
Sure. So I am starting my 30th year of practice. My gosh. And I see a lot of newborns. Over the years, I’ve cared for too many to count, and now those little babies – some of those are parents and bringing their babies to me now!
That’s so lovely! The full circle!
It does. It feels full circle, and it’s really – I have to say, I have the best job in the world because I get to be part of all of these families’ experiences and share in watching their kids grow up. And what a great gig, right? But I think in my experience – and also, by the way, I’m a parent too – I know what keeps parents up at night. And the reality is that we’ve been given this very precious gift, and we don’t want to screw it up. So the stakes feel really high, and we all want to do our best, right? I think what I’ve learned on this journey of walking this road with parents is they feel much more empowered when they’re knowledgeable and also learning that we’re all just trying to do our best and that no one is every going to be the perfect parent, right? So I try to give parents that knowledge base. I feel very passionate about education, which is why I write books and do speaking engagements and do all these crazy things. And I also want them to feel like they don’t need to be a martyr, right, and that they have to be open minded and realize that we’re not going to be able to control all the variables, as much as we would love to do that. And so we want parents to be confident in the way that they feed their baby, and I think that when it comes to breastfeeding particularly, the struggles early on can feel insurmountable, and I don’t think people are prepared for that. So that’s part of the education piece is preparing families for, wow, this may seem like a natural thing, but it doesn’t come naturally for everybody, and everybody has to learn. The baby has to learn. You have to learn. And that takes some practice, and sometimes there’s some challenges. And those challenges are early, right when you’ve delivered a baby and you’re exhausted and your hormones are all over the place. All of those things can conspire to make that journey very early on very difficult. And so teaching families where they can get help and being prepared for that is one of my missions.
And how that led to goat milk based infant formula? Well, the interesting thing is, watching my families over the years, I’ve learned a lot of things from them and what’s important to them. I had families that were basically buying not regulated formula from Europe – basically, being bootlegged. It’s almost like prohibition days, and people were bootlegging this formula with a middle man that was questionable. Like, where are you getting this product? And these families would be saying, well, I’m buying this and I’m getting – and I’m like, why are you doing this? I was actually pretty intrigued by this whole process, which was really kind of consumer driven. People were looking for something better as an alternative that they could feel confident about to feed their babies. So I kind of became goat curious, as an American pediatrician, because we didn’t have that, any goat milk based product, in the American market. I came across Kabrita while they were going through the entire process, which by the way, the only goat milk based infant formula in the US that meets all FDA requirements, and they did this whole process and they did it right. I kind of stumbled upon them back in 2018 as they were going through this process and was really excited that they were doing it right. They were doing the work and doing the research and the clinical trials and getting it published and really demonstrating the efficacy – and we’ll talk more about why I’m excited about goat milk based infant formula, but they brought this product to market through the correct channels where you can actually buy it the way you’re supposed to be able to buy a product in the US, and so that’s why I’m excited about this. It does offer a great option for families if they are combo feeding or if they ultimately formula feed their baby.
That makes complete sense. And of course, we’ve gone through the formula shortage. You mentioned trying to buy European formula, buying formula online and not knowing the source. There was a lot of desperation, not only in being able to find formula, but also afford it.
Right, yeah. I think the infant formula shortage demonstrated that the American formula supply system is kind of messed up. And there had been kind of – not a monopoly but an oligopoly, kind of two major manufacturers. And some of it is because we have a system where we have the WIC program, which is the Woman, Infant, and Children program where government subsidizes infant formula for families, which is fantastic, but because there are these government contracts, it kind of restricts the marketplace, right? And then when we had a problem and we lost basically 40% of our infant formula supply in the US overnight because one manufacturing plant had a problem with a contamination event, it made us realize, wow, we probably need to have more options here in the US. And so I think that has been an eye opener and hopefully an opportunity for us to have more options. That did bring in other infant formulas, and it is a nice reminder that Kabrita, like I said, had been going through this entire regulatory process and meeting all of the hurdles. Some of these other products that have kind of entered the market only have emergency discretion use because of the infant formula shortage, and for them to maintain their supply in the US, they have to go through the same FDA regulatory hurdles, which that has not happened for those products yet. But I am thankful that it’s been a horrible situation, but it’s offered an opportunity to have more options for us and a more stable infant formula supply, hopefully, in the future.
Exactly. So Dr. Brown, I would love for you to explain the difference between goat milk formula and the, say, cow milk based, and the pros and cons of each. And certainly, as families are making choices, it’s good to have all of the information. I know with a lot of my clients, their infant or baby might have skin reactions or some allergies to the milk based formulas.
Sure. So let’s start really simple and talk about what infant formula is. So it’s a chemical formula. That’s why it’s called formula. But as we have evolved, as civilization has evolved, we have created options to approximate and resemble human milk, as much as we can. And so people have tried many different kind of formula bases over the years and then tried to modify it, which is the formula piece, to compare it as much as possible to human milk. And to be clear, there is nothing like human milk. Breastmilk – human milk is made for human babies, right? And it’s living food, and it’s dynamic food. It’s never exactly the same for every person or even on a daily basis, right? So you’re never going to get exact comparison. But when you’re trying to create these infant formulas, historically, what has been the most popular base has been cow milk protein. And I think a lot of people don’t realize it, because that’s what’s so prevalent. When you look at a can of formula, you don’t realize, oh, this is made out of cow milk or this is made out of goat milk. In general, the leader in the marketplace, or at least in the United States for – I will say goat milk based infant formula has been around for decades worldwide. This is not new there. It’s just new in the US. But cow milk has been the prevailing base for infant formula. And most babies tolerate it and do fine with it. And all of the what we call macronutrients and micronutrients – so your macronutrients are your fat and your protein and your carbohydrate, and your micronutrients are your vitamins and minerals, like folic acid and vitamin D and all the other ones. So those ingredients are regulated. So for any product to be sold in the United States – or the EU has their standards, and wouldn’t it be great if we all had one universal standard, but we don’t. The United States has 29 ingredients that have to be regulated and meet those standards to be able to be sold in the US and meet all FDA requirements. All of those ingredients are as close to, again, human milk as possible. And then there are some premium ingredients that some manufacturers will add, and that kind of falls under what we call bioactives. So they’re probiotics or prebiotics. Other things that, again, are present in human milk and then are added to infant formula to try to resemble human milk as much as possible. But the base, again, is kind of the protein, right? So cow milk protein has historically been the most popular base.
Now, there are some babies who cannot tolerate that protein, and there are some babies who are actually allergic to that protein. So for babies who struggle with tolerance issues – you may have a fussy, gassy baby; constipated baby; unhappy baby. And then when you have a baby who has a true allergy, you may seem eczema. The one key thing that we’re looking for as pediatricians is blood in the stool. There is – it’s called a food protein induced proctitis, but what happens is the lining of the gut gets irritated because of this protein allergy, and then the baby may have this – what looks like slimy, mucous, snotty-looking stool, but then when you test it in the lab, there’s actually blood in it. Some babies, you will actually see the blood visibly.
So for those kids, you can’t have them on a cow milk protein based infant formula. You have to use something that’s considered hypoallergenic where the protein has been totally broken down or an elemental formula where it’s just amino acids floating around, like the protein is just amino acids. It’s not even cow milk based. And we have tried other alternatives. In the US, there’s also a soy-based product for some babies and for families who for dietary reasons do not want a cow-based product. So we’ve had kind of these categories of cow milk based infant formula, soy based infant formula, hypoallergenic where the protein is really, really broken down, and then elemental formulas where it’s just amino acids and there’s not even any cow milk.
But these babies that have trouble tolerating the cow milk protein, that’s when people are seeking alternatives because it’s really not fun to have a baby who’s miserable, right? And so that’s where goat milk infant based formula has risen in popularity, but what I always try to tell people is this is not just a niche product for babies who can’t tolerate cow milk protein. It is completely acceptable as first line nutrition. You don’t have to wait until your baby has a problem with cow milk to try goat milk based infant formula, and in fact, that’s now been endorsed by the American Academy of Pediatrics. They put out an endorsement in 2023 regarding that.
But here’s the difference. So why is goat milk protein different than cow milk protein, and why is it more tolerated? So the key is – and this is where we’re getting a little bit granular, a little nitty gritty – but if everyone remembers Little Miss Muffet, sitting on her tuffet, eating her curds and whey – milk proteins are casein, which is the curds, and whey is very liquidy. And casein, when it gets digested in the gut – curds. Kind of like cottage cheese, like those clumps. And so the big difference between goat milk and cow milk, naturally, is that the goat milk protein, that casein protein, is more like human milk, which is why it’s more easily digested. And so it’s got more beta casein and it’s got less alpha S1 casein than cow milk, and it’s got more alpha S2 casein. So it’s a little bit granular, but at the end of the day, the casein makes the curds different. And the goat casein curds are softer and looser, so they’re easier to digest, versus the cow milk curds. And so when you look at the data on these clinical trials of the babies who drink the goat milk based infant formula versus the cow milk based infant formula, it’s more tolerable. You have fewer reports of the gassiness, colicky behavior, constipation, and even there’s some data on sleep where the babies sleep a little bit more comfortably and slightly longer, which for a newborn, I don’t give anyone – I don’t tell anyone their baby is going to sleep, so this is not like the baby is going to sleep through the night. But it does seem that it’s more tolerated. And so that’s really the key difference between those two. Now that Kabrita is out – it came out in January here in the US – I’ve had families who have started cow milk based infant formula, and if the babies are having trouble with it, I’m like, let’s try this! Let’s see how it goes! And I’ve had good success with families. So I can say clinically that I do think I have some happier babies after trying it. I’m very excited about that.
The other piece that’s a little bit different between the cow milk and the goat milk is something called oligosaccharides, and again, this is a little bit granular, but these are prebiotics that are in huge numbers in human milk. Huge, like third leading ingredient in human milk. And goat milk naturally contains five times more oligosaccharides than the cow milk. So that makes a big difference. Also, there’s a diversity in the population. So what it does is it fosters the baby’s microbiome because you need the prebiotics to grow those little germs that help your gut digest. That’s also a reason why goat milk based infant formula has an advantage over the cow milk based because it’s supporting the microbiome and the gut health.
So where can our listeners and doula clients find Kabrita?
Super easy. It’s on Amazon now. You can buy it directly from Kabrita if you go to Kabrita.com. You’ll be able to order it directly online and you can even set a schedule and set it and forget it and it shows up however often you want it to. As far as in stores, there are a variety of supermarkets that are now carrying it nationwide. Whole Foods is now carrying it. And stay tuned because there’s a lot of other places that are coming, probably by the end of the year.
Exciting! I’d love to take a few minutes to chat about your books. I’m sure that our listeners would be interested in ordering the entire series. They’re so helpful!
That was an evolution of families coming in, really seeking information. I’m working on my second generation of parents, right? But I’ve watched this evolution of parents who crave information, and they want more detail and they really want to understand and make science based decisions, right? And as the growth of the internet and opportunities to filter information on that become more and more confusing – it’s overwhelming. You have a vast array of information. You just don’t know if it’s accurate, right? And so as I watched my parents in my practice struggle with wanting to learn more, but I don’t know what I can trust. Can you help me? It exceeded the duration of our well check time, and I was like, how can I really give you more information, what you really need, and how can I be kind of at your bedside when I’m actually not physically there? That was the birth of Baby 411. It was really just all the questions that parents asked. I think people still buy books, which is exciting. As a book author, I’m so glad people still buy books because I think it’s super important to have everything in one place. But in the day – you know, I’ve kind of picked up all the parenting books that were on the bookshelves, and I was like, what is missing here? Because clearly people are reading this stuff, and they still don’t know what they need to know. And so what I realized is that most of them are not written by somebody who lives in Exam Room 1. And that’s what I can honestly say is I spend my days in Exam Room 1, and I’ve made a career of conversations with families. So it’s really that level of detail. And now we have a challenge, because I’m on the tenth edition of Baby 411. We update our books every two years. So I’ll say to my parents, if you have a question that is not in this book, you get added to the next edition.
I love it! Because everything changes, even in two years, with sleep, feeding, all of the things.
Exactly. So we update it. I’m on social media. I’m on TikTok. My daughter, who is an adult now, was like, you need to be on TikTok. That’s where people are who are young parents. And I’m like, oh, okay. So I’m actually on TikTok, but I will say, in between every update on my books, I’m always posting new information, and when there’s something that’s buzzing, I definitely address it so that people will understand, what do I really need to be concerned about? Is this new study important, or is it just hype and the headline and the clickbait? So anyway, I encourage people to follow me there because I really try to keep people abreast of new and changing things and then again, we update the books every two years. So it’s very relevant and timely and evidence-based.
So where can they find your books?
Again, go to Amazon. Our books are sold nationwide where books are sold, so every national bookstore carries them. Amazon, or you can go to Baby411.com and buy it direct.
Beautiful. Dr. Brown, you mentioned TikTok. I’ve seen your videos on Instagram, as well. I’ll have to check out your TikTok. But yeah, they’re very helpful and engaging. Where else can our listeners connect with you? You mentioned your website. Any other social media spaces you are spending time with? Facebook, for example?
You know, it’s interesting. I think that when I post to Instagram, it will go directly to Facebook, and it’s a generational thing. I think you have to be everywhere all at once, I guess. But I will say that I’m probably a little less active on Facebook. But yes, we have our fan page @expecting411 on Facebook, and that is the portal for all three of our books.
Wonderful. Any final tips for our listeners, Dr. Brown?
I think one of the things I like to tell families is to give yourself permission. I think particularly moms, but dads, too. I think that we put our children first, and they are our highest priority. And for good reason, but I think that you need to take a step back sometimes and go, you know what, I am a parent. I’m a spouse. I’m a sibling, a child. You have so many roles and you wear so many hats, and I think at some point, a lot of parents kind of become martyrs. So I always remind people that happy parents make happy babies. So make sure that you take care of yourself. Don’t forget about yourself in this equation, and I think that it makes a much more joyous parent and a much better relationship with your child.
Excellent advice! Thank you so much for sharing your wisdom and we’ll have to chat again soon!
My pleasure! Thank you so much for having me!
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