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. 2017 Sep 15;8(5):739-748.
doi: 10.3945/an.116.013953. Print 2017 Sep.

Systematic Review of the Gastrointestinal Effects of A1 Compared with A2 β-Casein

Simon Brooke-Taylor  1 , Karen Dwyer  2 , Keith Woodford  3 , Natalya Kost  4
Affiliations

Systematic Review of the Gastrointestinal Effects of A1 Compared with A2 β-Casein

Simon Brooke-Taylor et al. Adv Nutr. .

Abstract

This is the first systematic review, to our knowledge, of published studies investigating the gastrointestinal effects of A1-type bovine β-casein (A1) compared with A2-type bovine β-casein (A2). The review is relevant to nutrition practice given the increasing availability and promotion in a range of countries of dairy products free of A1 for both infant and adult nutrition. In vitro and in vivo studies (all species) were included. In vivo studies were limited to oral consumption. Inclusion criteria encompassed all English-language primary research studies, but not reviews, involving milk, fresh-milk products, β-casein, and β-casomorphins published through 12 April 2017. Studies involving cheese and fermented milk products were excluded. Only studies with a specific gastrointestinal focus were included. However, inclusion was not delimited by specific gastrointestinal outcome nor by a specific mechanism. Inclusion criteria were satisfied by 39 studies. In vivo consumption of A1 relative to A2 delays intestinal transit in rodents via an opioid-mediated mechanism. Rodent models also link consumption of A1 to the initiation of inflammatory response markers plus enhanced Toll-like receptor expression relative to both A2 and nonmilk controls. Although most rodent responses are confirmed as opioid-mediated, there is evidence that dipeptidyl peptidase 4 stimulation in the jejunum of rodents is via a nonopioid mechanism. In humans, there is evidence from a limited number of studies that A1 consumption is also associated with delayed intestinal transit (1 clinical study) and looser stool consistency (2 clinical studies). In addition, digestive discomfort is correlated with inflammatory markers in humans for A1 but not A2. Further research is required in humans to investigate the digestive function effects of A1 relative to A2 in different populations and dietary settings.

Keywords: gastrointestinal tract; humans; in vitro; in vivo; inflammation; milk; β-casein; β-casomorphin.

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Conflict of interest statement

Author disclosures: NK, no conflicts of interest. SB-T previously consulted for the a2 Milk Company (Australia) Pty. Ltd. as an independent scientific adviser on food-labeling compliance matters, including undertaking a systematic review to meet Australia New Zealand food regulatory requirements related to health claims on food products. KD received an honorarium from the A2 Corporation to attend a meeting and grant support for an independent project. KW consulted for the A2 Corporation as an independent scientific adviser. This is a free access article, distributed under terms (http://www.nutrition.org/publications/guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

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