Milk coagulation and gastric emptying in women experiencing gastrointestinal symptoms after ingestion of cow's milk

Abstract

BackgroundGastrointestinal symptoms after drinking milk are often attributed to lactose intolerance or cow's milk allergy. However, some individuals without either condition still report gastrointestinal symptoms after drinking milk. This may be caused by gastric emptying (GE) rate or gastric protein coagulation. This study aimed to compare GE rate and protein coagulation after milk consumption between individuals reporting gastrointestinal symptoms and those without symptoms using a novel gastric MRI approach.MethodsThirty women were included in this case–control study, of whom 15 reported gastrointestinal symptoms after drinking milk and 15 were controls. Participants underwent gastric MRI before and up to 90 min after consumption of 250 mL cow's milk. Gastric content volume and image texture of the stomach contents were used to determine GE and changes in the degree of coagulation.Key ResultsGE half‐time did not differ between the groups (gastrointestinal symptom group 66 ± 18 min; control group 61 ± 14 min, p = 0.845). The gastrointestinal symptom group reported symptoms from 30 min onwards and rated pain highest at 90 min. The control group reported no symptoms. Image texture analyses showed a significantly higher percentage of coagulum and lower percentage of liquid in the group in the GI symptom group (MD 11%, 95% CI [3.9, 17], p = 0.003). In vitro data suggests that pH and proteolytic enzyme activity influence the coagulum structure.Conclusions and InferencesGastric milk coagulation and emptied fraction of stomach content may differ between individuals experiencing symptoms after milk consumption, possibly due to differences in pH and proteolytic enzyme activity.

Gastric digestion and changes in serum amino acid concentrations after consumption of casein from cow and goat milk: a randomized crossover trial in healthy men

“…Subsequently, a weighted average texture metric was calculated based on the gastric content volume in each slice such that slices with little stomach content contributed less to the average than those with more stomach content. To quantify the (relative) volume of liquid and semi-solid stomach contents the number of lighter (more liquid), intermediate and darker (semi-solid) voxels was calculated by determining two intensity thresholds with the use of Otsu’s method (Otsu 1979) in Matlab (version R2023a, multitresh function), an approach previously used on in vitro and in vivo MRI images of gastric milk digestion (Mayar, Smeets et al 2023, van Eijnatten, Camps et al 2023, Mayar, de Vries et al 2024). The number of intermediate and darker voxels were summed and interpreted as reflecting voxels in which coagulation took place.…”

Relationships between diet and gut microbiome in an Italian and Dutch cohort: does the dietary protein to fiber ratio play a role?

“…This study involves two cohorts of subjects, one from Italy and one from The Netherlands, who participated in two studies that were conducted at the same time and shared the same criteria (except sex) for the selection of subjects aiming at exploring the physiological mechanisms underpinning cow’s milk digestion by focusing on post-prandial gastro-intestinal responses or gastric emptying, respectively [ 24 , 25 ]. In the present study, the combination of data on diets and gut microbiome collected over the two main studies was performed to increase the sample size and statistical power.…”

“…The trials were registered at www.clinicaltrials.gov (number NCT04205045) and Dutch Trial Register (number NTR7531) for Italian and Dutch cohort, respectively. The two cohorts included healthy, adult subjects, without food allergy/intolerance, and having an omnivorous diet [ 24 , 25 ]. The Italian cohort included males and females whereas the Dutch cohort was of only females.…”

Magnetization Transfer MRI of intragastric milk digestion: a feasibility study in humans

“…A recent study assessed gastric milk coagulation in women experiencing gastro-intestinal (GI) complaints and in a control group after milk consumption by calculating image texture metrics, namely homogeneity, contrast, busyness, and coarseness, for the ܶ ଶ -weighted anatomical images (van Eijnatten et al, 2023). The decrease in homogeneity, and increase in contrast and coarseness, were associated with the coagulation process.…”