CAMEL MILK AS A COMPLEMENTARY AND ALTERNATIVE MEDICINE

Camel milk has always been a major traditional staple in the nutrition of the pastoral nomadic people. The milk is consumed either fresh, or soured for longer preservation. Camel milk has been employed as a medicine for centuries by pastoral nomadic people because of its richness in vitamins, minerals, and iron; and contains anti-bodies and immunological potency, mainly for infants. Camel milk is also a good substitute for human milk. It is low in cholesterol, sugar and protein, and contains a high concentration of insulin. Camel milk is used as an antioxidant, and tumor growth depressant; to treat prostate, breast cancer, and other cancers including leukemia, and can be used to alleviate the side effects of chemotherapy and radiation. The main argument in this paper is that people in Asia and Africa use camel milk as a complementary and alternative medicine, mainly for cancer, in addition to it being a source of food and drink.Methods: The data for this paper are derived from a broader study of complementary and Alternative Medicine in the Middle East and North Africa that took place over the course of two decades. Unstructured interviews and observation of participants were carried out in the informants' homes (men and women), as well as in the homes of healers (men and women) of different ages (twenty to eighty years old), and from a variety of groups (urban, peasant and Bedouin): camel breeders, pastoral communities, healers, patients, and veterinarians. All the material was recorded in field logs. All interviews were conducted in Arabic. Background: Health care systems are based upon the dyadic core, consisting of a healer and a patient. In western society, this can be a family physician, cardiologist, oncologist, or a psychiatrist. In traditional society, the healer can be a shaman, herbalist, bonesetter, or a medium. In traditional society, the state may introduce a western medical system; in such a situation, an array of medical systems or a pattern of medical pluralism will coexist. From this perspective, the medical system of a society consists of the totality of medical subsystems that coexist in a cooperative relationship with one another (1). The camel has been mentioned in the Quran among the animals as a superior creature and miraculous creation by Allah “Do they not look at the Camels, how they are made?” (2), and its milk is mentioned in the Quran as producing sufficient milk for everyone that in Paradise there are “rivers of milk the taste of which never changes” (3). It is also part of Islamic oral tradition (4). Pastoral nomadic Bedouin tribes in the Middle East and North Africa rear camels. Almost all the pastoral Bedouins' food is obtained from grain, mostly wheat and barley, which is grown in areas that are mostly in the joint possession of each tribe. Some of their food is obtained from herd animals, mostly sheep and goats, with some cattle and camels. To find enough natural pastureland for the herds, part of the tribe moves through the desert, sometimes over considerable distances. The primary staple in the pastoral Bedouin nutrition, among other resources, is camel meat and milk (5, 6, 7, 8, 9, 10). In fact, parallel to Arabs breeding their camels for greater milk production, ancient Arabian camel nomads were breeding themselves via consanguineous marriage and virtual consanguineous marriage to ensure that genetically their kin would continue to survive on milk in the waterless desert” (11). Camel milk is not boiled before it is drunk. It is considered especially nutritious. Milk was the primary source of nourishment for the entire Rwala (12) family. One female camel can produce between one to seven liters of milk a day. The better the pasture, the more milk given. Fertile female camels produce milk for twelve months. The freshly obtained milk has a salty taste because the camels are fond of grazing on salty vegetation. The milk is either drunk immediately or any remaining milk is poured into a leather bag (sheepskin or goatskin). The Rwala do not churn camel's milk. If they have too much, they boil it and from the curds make small cheeses which are eaten either dry or stewed with bread (13). The milk is used either fresh (termed halib), or soured for longer preservation (called laban). The latter is made by pouring the fresh milk into a leather bag for the purpose, where the requisite inoculants for controlled souring are maintained. Some plants on which camels graze tend to scent or flavor their milk. Camel milk is low in separable fat, but a form of butter called jbab, is sometimes made from it, as well as a cheese called igt produced by extending the souring process (13, 14). Camel breeds in Arabia ranging from coarse baggage-carrying types to high milk-yielding breeds and fine-featured breeds. Camel milk may also be mixed with well water that is too saline for human consumption, to make a mixture (shanin)) in which the salts are diluted to drinkable level (14). The Bedouin consume both camel meat and milk as a basic source of nutrition for the family. Camel milk contains a higher level of vitamin C, protein, and mineral content than either cow or goat milk (15). Milk, also, replaces to a great extent the water Bedouin would otherwise need to quench their thirst. Some Bedouin slaughter a she-camel's calf so that their children can live off the mother's milk, and if the she-camel doesn't spontaneously yield sufficient milk, they bring her the calf of another she-camel so that the nursing calf will stimulate increased milk flow (16). Sometimes three to four she-camels are gathered together with one calf to increase their flow of milk. When the calf is not slaughter, they reserve part of the milk for the calf, leaving one side of the udder to it and milking the other side to provide milk for their own children (17). Camel milk contains vitamins B2, B12, and C; linoleic acid, lactose, and extracts of aromatic plants that camels graze on such as rosemary and hyssop; these extracts act as are stimulant on the liver, as a hepatic (18). The composition of the milk and its attributes, however, hinge on the camel's age, quality, and the nature of the food it consumes (including availability of pasture) and availability of water - the best quality being the milk of young camel's during the first 40 days after birth of their calf. The composition of pasture plants impact on their medicinal effects (18, 19). Camel milk production has become a booming business in Middle Eastern countries. Camel milk is drunk throughout Arabia, and it is extremely nourishing and low in fat content (20). Recently, the European Union has also allowed import of camel milk from African and Asian countries into the EU. Among the Bedouin in the Negev (21) it is customary for the midwife to hide the umbilical cord under the supporting pole of the tent (wasit al-bayt ) (22) or in the tent lining (btanit al-bayt) to symbolize the baby's ongoing loyalty to his family. One old informant (a woman, related to the author) revealed that she hung her son's umbilical cord on the neck of a she-camel (naqa) to symbolize his connection to camels; indeed, when he grew up he loved tending camels and was even nicknamed “father of the she-camels” (abu al-niaq) (23). International Journal of Scientific Research 435 Volume-7 | Issue-1 | January-2018 ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 93.98 Treatments: Camel milk has been employed as medicine for centuries by nomadic people because its richness in vitamins, minerals and iron (24). It is commonly used to treat hepatitis, autoimmune diseases, osteoporosis, tuberculosis, asthma, flu, hypertension, and diabetes. Camel's milk contains anti-bodies and immunological potency, mainly for infants. It is prescribed for asthma, diabetes, tuberculosis, liver inflammation, digestive ailments, cancer, smallpox, wounds, dental diseases, lung diseases, and ascites, and as an antidote for toxins. Milk is believed to strengthen teeth, bones, and the sexual organs, especially of old men. It is used to treat anemia, tuberculosis, senility, acne, leukemia, and impotency (18), and is also used as an aphrodisiac (25). Camel milk is used to treat hepatitis, autoimmune diseases, osteoporosis, tuberculosis, asthma, flu, hypertension, and diabetes (26). Camel milk cures hepatitis B; the special fat in camel milk soothes the liver (27). Camel milk has numerous uses in treating illnesses. It is a purgative, and should be consumed in moderation by persons not used to it (20). It is used to treat the digestive system: for spasms, as an antiseptic digestive (due to its antihelminthic, antiparasitic, antibacterial, antifungal, antiviral, antimicrobial properties), for helicobacter pylloripyllori, gastritis, peptic ulcers, and stomachaches (17). It is prescribed due to its anti-microbial factors and for viral infections (28), and as an alternative source of nutrition for children who are allergic to cow milk (29). Camel milk is also prescribed to treat viral and bacterial pathogens (30). Camel milk contains lysozyme, an enzyme with bactericidal activity which also stimulates a rise in antibodies (31). It is prescribed for chronic pulmonary tuberculosis (32). To treat stomach ulcers/colic, the patient drinks camel milk in one of the following mixtures: a quarter of a teaspoon of myrrh mixed in a cup of camel's milk or half a spoonful of pulverized leaves from the mastic tree (lentisk) in a cup of camel's milk; a teaspoon of the juice of carob pods mixed in a cup of camel's milk (33). Camel milk is employed to treat constipation and stomachache/abdominal pain (33). It is also taken as an anti-acid for hyperacidity to treat heartburn/ excess gastric juices (33). It is prescribed to alleviate liver pain and treat a prolapsed liver (liver displacement) (33); and also, to treat cardiovascular system, nervous system, and respiratory system disorders, as well as insomnia, and allergies. Camel milk is used to treat disorders in liver, kidneys, gall bladder and spleen (34). It is prescribed in cases of rheumatism, leg and joint pains; the patient may also wear a bracelet (swar) made of camel's wool (wabar), and drink camel milk (35). It acts as a laxative on people unaccustomed to drinking it; to treats reoccurring acute and chronic health problems including asthma, anemia, jaundice, and spleen problems (36). Camel's milk is prescribed to treat breast cancer and antitumor (37, 38). The lactoferrin in camel milk also has medicinal values: antibacterial, antiviral properties, as well as inhibiting tumor growth. It inhibits the occurrence and development of cancer of the skin, breast, colon, and stomach; it is used to treat Type 1 and Type 2 diabetics as well as gestational diabetes (39, 40, 41). Camel milk can alleviate the side effects of chemotherapy and radiation, making the treatment more effective and tolerable for the patient (42). It is used to treat diabetes, allergies, cancer, arthritis, tuberculosis, autism, liver disease, and more (24). A series of metabolic and autoimmune diseases have been successfully treated with camel milk (43), it is common practice to give camel milk to children as a nutritious diet that strengthens their bodies and immune system. Camel milk has been showed to improve the behavior of children on the autistic spectrum (44, 45). Blisters from burns are treated by applying goat, sheep, or camel milk to the affected area several times a day (33). To induce enhanced lactation, when the mother cannot breastfeed due to lack of milk, she and her baby drink the milk of she-camels mixed with water (33). Camel milk is used as a remedy for snakebites, and scorpion and spider bites. The dervish gives the victim camel milk and olive oil to drink (33, 13). Bedouin used to take pustules (bathr, pl. buthur) from patient with smallpox during recovery, mix them with camel milk, and give the milk to others to drink, to immunize them against smallpox (33, 46). The high mineral content (sodium, potassium, zinc, copper and magnesium) as well as a high vitamin C found in camel milk may act as antioxidant thereby removing free radicals (47). Camel milk is employed to treat diarrhea, tuberculosis, cancer, and liver cirrhosis (48). It is used to treat dropsy, jaundice, problems of the spleen, tuberculosis (49, 50). Camel milk treats diabetes and reduces the risk of diabetic complications (51). It is used to treat diabetes: treat Type 1 diabetes mellitus (52, 53), increases insulin level in patients with Type 2 Diabetes Mellitus (54), Type 1 diabetes (55, 56), treat diarrhea (57), and epidemic diseases (58), and Crohn's disease (59). It has anti-diabetic, and anti-cancer properties (60, 61). It treats peptic ulcers (62), enhancing the immune system's defense mechanism. Recent studies also indicate that magnesium significantly enhances the body's antioxidant defenses, and is effective against alcohol-induced oxidative stress, disturbance of liver function, and elevated cholesterol, mainly when administrated with selenium (which has antioxidant properties and may help protect cells from damage) (63). Peptidoglycan in camel milk has the ability to inhibit cancer metastasis (64). Camel milk is very useful in the treatment of HIV and AIDS (65, 66). It is used to treat gastritis, stomach discomfort, HIV, tuberculosis, fever, urinary problems, hepatitis, jaundice, the common cold, diarrhea, nausea, diabetics, rickets, asthma, and anemia (67). Ibn-Sina (68) found camel milk has therapeutic effects in spleen, kidney, liver, cancer, and children diseases. Camel milk has an anti-aging effect-filling in and smoothing fine skin wrinkles (69). Anti-tumor properties of camel milk are due to strong antimicrobial and anti-oxidative activities that help reduce liver inflammation (70). Camel milk has been used therapeutically against certain types of cancer, diabetes, colitis, autism and Crohn's disease (71). Camel milk contains protective proteins, including the immunoglobulins necessary for activating the immune system, and contains nutritional benefits for brain development (72). Camel's milk has been shown to trigger apoptosis (controlled cell death) in human breast cancer and liver cancer cells via epigenetic mechanisms; and has been applied to treat multiple sclerosis, psoriasis, Lupus, allergies- asthma (64, 70, 73). In Sudan and the Arab world, camel milk together with garden rocket or arugula (Eruca sativa) are used traditionally to improve impaired liver functions. Camel milk is used in Kazakhstan as an adjunct to chemotherapy for some cancers of the digestive tract (74). Camel milk composition: Camel milk is low in cholesterol, sugar, and protein but high in minerals (sodium, potassium, iron, copper, zinc, and magnesium), vitamins A, B2, C and E, and contains a high concentration of insulin (75, 76). It was found that Fe and Zn occur in greater quantities in camel's milk than in cow's and goat's milk. Camel's milk contains insulin-like protein with its Zn (77). It also contains fat with a relatively large amount of polyunsaturated fatty acids and linoleic acids, which are essential for human nutrition (78). The composition of camel milk is closer to human milk and of high nutritional value and therapeutic effects (38, 48, 79). Camel milk has a high biological value compared to other ruminants' milk due to its higher levels of antimicrobial factors such as lysozyme, lactoferrin, lactoperoxidase, immunoglobulin G, and secretory immunoglobulin (28, 80). The lactoperoxidase has anti- tumor activity (38), the Peptydoglycon recognition protein (PGRP) impacts positively on breast cancer by controlling metastasis (37). Camel milk has the IgA and IgG that have proved effective against several viral and bacterial pathogens (30). Consumption of camel milk is well tolerated by children who are lactose-intolerant and therefore allergic to cow milk (29). It is used to treat viral and bacterial infections (28), and chronic pulmonary tuberculosis (32). Camel milk can be classified as a food with high nutritive and therapeutic applications, and is known for high protein, casein, potassium and vitamin C content. This milk can be the sole dietary source for a human (or for a camel for that matter) for a long period providing the minimum balance of nutrition (81). Caseins constitute 75-80 percent of the proteins in camel milk, and the increase of free radical scavenging activity by camel milk proteins and casein after their hydrolysis suggest that anti-oxidative peptides are being released and these peptides are mainly generated from the caseins rather than from the whey proteins (82). Camel milk proteins can be divided into two groups: caseins and whey proteins. The amount and type of amino acids in camel milk are high - except for lysine, glycine, threonine, and valine. The most important proteins in camel milk are whey proteins that contain albumin, lactoferrin, immunoglobulins, and so forth; it contains fats, lactose, vitamins, and minerals that treat diarrhea, tuberculosis, cancer, diabetes, and liver cirrhosis (48). 436 International Journal of Scientific Research Volume-7 | Issue-1 | January-2018 ISSN No 2277 - 8179 | IF : 4.176 | IC Value : 93.98 It is claimed that the value of camel's milk is to be found in the high concentrations of volatile acids, especially, linoleum acid and polyunsaturated acids, which are essential for human nutrition (52). There was a 30-35 percent reduction in daily doses of insulin in patients with Type 1 diabetes who received raw camel's milk, demonstrating that camel milk possesses insulin-like actions that decrease the requirement of exogenous insulin in Type 1 diabetes patients (55, 56). Camel milk is used to treat diarrhea (57), and epidemic diseases (58). Camel milk helps regulate cellular sugar in the absence of endogenous insulin and in presence of exogenous oral insulin. It is assumed that micelles in camel's milk may protect the insulin present in the milk from coagulation by acidity or from digestion by pepsin in the stomach, thus allowing it to be absorbed in the micelles or to be released again to be absorbed by insulin receptors in the small intestine (52). Insulin is one of the camel milk proteins; this milk passes the human stomach into the intestines. Therefore, insulin is not destroyed and is absorbed into the bloodstream where it reduces blood sugar (83). Since camel's milk contain high levels of vitamins C, A, B2, E and very rich in potassium, iron, magnesium and other trace elements, these vitamins and polyunsaturated elements are antioxidants, thereby removing free radicals and useful in preventing tissues injury including β-cells in the pancreas. High concentrations of antioxidants and removal of fat from the body may make the insulin receptors more responsive to available insulin (52, 84). Moisture and protein levels are higher in camel milk compared to cow milk. The comparatively low percentages of total solids and fat in camel milk carry definite positive benefits for drinking camel milk over cow milk. Post-partum changes in gross chemical composition of camel milk showed an increase in fat, while protein decreases 27 days after parturition (85). In late phase of lactation, the ash, fat and total solids were significantly higher than in the early phase of lactation. The fat is present in fixed amount in milk and its percentage changes according to the water content (which varies according to the animal's water consumption); hence, a fall in water content will increase the fat percentage while an increase in water will decrease it. In the desert, high water content with low fat percentage is a definite advantage. The higher ash contents during late lactation suggest that camel milk can provide a satisfactory level of minerals (86, 87). Differences in macro-minerals levels might be due to breed variances or different environmental conditions such as feed and soil. Different breeds of camels have different capacities to deposit minerals in their milk (88). There was a concentration of Fe, Zn and Cu in Indian dromedary camels (85). The values of trace minerals Fe, Zn, and Cu were significantly higher in camel milk, compared to bovine milk (87). The role of Zn in the development and maintenance of a well-functioning immune system has been well-established (89). The levels of vitamin A, E and B1 were reported to be low in camel milk compared to cow milk (90). The vitamin C content in camel milk is two to three-fold higher compared to cow milk. The levels of vitamin A, E and B1 were higher in camel colostrum than mature camel milk. The camel milk contains higher concentration of lactoferrin and lysozyme than bovine milk. However, the vitamin C content remains higher in mature camel milk. The low pH due to the vitamin C content stabilizes the milk and it can be kept for relatively longer periods. Milk enzymes play an important role in maintaining milk quality. The availability of a relatively higher amount of vitamin C in raw camel milk is relevant from a nutritional standpoint, since vitamin C is a powerful anti- oxidant. Camel milk can be an alternative source of vitamin C under harsh environmental conditions in the arid and semi-arid areas (i.e. where vitamin C from fresh vegetables are scarce) (87). In addition, camel milk contains fatty acids: butyric, caproic, caprylic, capric, lauric, myristic, myristoleic, palmitic, palmitoleic, stearic, oleic, linoleic, and arachidic acids (85,91). A peptidoglycan recognition protein has been detected in camel milk. This enzyme has broad antimicrobial activity and has the ability to control cancer metastasis (64). Consumption of total whey proteins in the diet has been associated with retardation of chemically induced cancers in several animal models (87). Camel milk contains vitamins; B1, B2, niacin and C, amino and fatty acid compositions, and antimicrobial factors namely lysozyme (LZ), lactoferrin (LF) and immunoglobulins (Igs). Results indicate that camel milk contained higher fat, protein (especially casein), ash, Ca, Mg, P, K, Na, Fe, and Cu, lactose and Zn (92), contains protective proteins high levels of vitamin C, A, B2 and E is very rich in magnesium and zinc (93). These vitamins are antioxidants that seem to be useful in reducing the oxidative stress caused by toxic agent (94, 95). The rearing conditions of the camel significantly affect the proximate composition and the mineral components of the milk. The milk normally has a sweet and sharp taste, but sometimes can also have a salty taste due to the type of plants eaten in the desert by the camels. There is a high concentration of mineral elements per biomass of plants that grow in the arid areas; the minerals are subsequently taken up by the grazing animals and bio-concentrated in their tissues, including milk. High mineral contents and vitamin C, make camel milk a good source of this vitamin for desert populations where fruit and vegetables are lacking (65, 66). Also, camel milk might be helpful in the treatment of HIV and AIDS cases. Camel milk is a good substitute for human milk, as it does not contain β-lacto globulin. It is rich in healthy vitamins and minerals, especially B vitamins, and vitamin C, calcium, phosphorus, sodium, potassium, chloride, iodine, magnesium, and small amounts of iron. The main mineral compounds of milk are calcium and phosphorus, which are important elements for bone growth and proper development of newborns. The high bio- availability of these minerals enhances in a unique manner the nutritional value of camel milk (96). Camel milk has a positive impact for children with severe food allergies. Parents of such children were instructed not to heat the milk, since pasteurization would destroy the immunoglobulins and other protective proteins, mainly bacterial enzymes (97). It is claimed that the proteins of camel milk are critical components for preventing and curing food allergies because camel milk contains no beta-lactoglobulin (98) and it contains a different beta-casein (99)- the two components in cow milk that are responsible for allergies. Another relevant fact is that the components of camel milk include immunoglobulins similar to those in mothers' milk, which reduce children's allergic reactions and strengthen their future response to foods (97). Camel milk could play an important role in reduction of oxidative stress by increase in antioxidant enzymes and non-enzymatic antioxidant molecule levels, and it has been showed to improve autistic behavior in children (44, 100). Camel milk has an anti-aging effect due to the presence of α-hydroxyl acids which are known to fill out and smooth and skin wrinkles. Alpha-hydroxyl acids help to shed the outer horny layer of dead cells on the skin (epidermis) by helping to break down sugars used to hold skin cells together. This promotes the emergence of new cells, which are more elastic and clear. Alpha-hydroxyl acids helps to eliminate wrinkles and age spots and relieve dryness as they make the outer layer of the skin thinner and support the lower layer of the dermis by making it thicker. In addition, liposome occurring in camel milk is applicable as a potential cosmetic ingredient to improve anti-aging effects (69). Korashy et al., (70) investigated the molecular mechanisms that govern the effect of camel milk on human cancer cells; their study clearly demonstrates that camel milk induces apoptosis in human hepatoma (HepG2) and human breast (MCF7) cancer cells through apoptotic- and oxidative-stress- mediated mechanisms. Habib et al. (101) examined the functional properties of camel milk lactoferrin, the main iron binding protein of the milk which showed a 56 percent reduction of cancer growth. Average milk yield of camel per day ranges between 3.5 (under desert conditions) to 40 liters (under intensive management). The best quality of young camel's milk is during the first 40 days after birth of their calf. This great variation in camel milk production may be attributed to the high genetic variation between individuals, breed, feeding and management conditions, type of work, milking frequency, and age of animal, frequency of lactation, lactation number and stage of lactation (70, 71, 72, 73). Conclusion: Camel milk has always been a major traditional staple in the nutrition of pastoral nomadic peoples in Asia and Africa, in addition to being a source of food and drink. Camel milk is also a good substitute for human milk. The milk is consumed either fresh, or soured for longer preservation. Camel milk is low in cholesterol, sugar and protein, but high in minerals and other trace elements, vitamins A, B2, C and E, and contains a high concentration of insulin. Camel milk has been employed as a complementary and alternative medicine for centuries by pastoral nomadic peoples because of its richness in vitamins, minerals and iron; and it contains anti-bodies and immunological potency. It has anti-aging effect, filling in and smoothing skin wrinkles. It is used as an antioxidant, and tumor growth depressant; to treat prostate, breast cancer, and other cancers including leukemia and can be used to alleviate the side effects of chemotherapy and radiation. It is also useful in the treatment of HIV and AIDS cases.It is used by pastoral nomadic peoples to treat diabetes, allergies arthritic, tuberculosis, liver disease, digestive system disorders, and dental diseases; and diseases of the cardiovascular, nervous and respiratory systems. Acknowledgements My thanks to the Research Centre for Anthropology and Health/ Department of Life Sciences, University of Coimbra, Portugal, for their kindly hospitality and assistance during the academic year 2016- 2017. In addition, I thank Prof. Ana Luisa Santos for her help, advice and generous hospitality. Finally, my deepest gratitude goes to my students and colleagues at the University of Coimbra; and to the pastoral nomadic and semi-nomadic communities, to their healers and people, without whose help and hospitality, cooperation, and willingness to share their knowledge and experiences with me this research could not have been conducted. However, I am solely responsible for any factual errors or omissions that might remain.