A1-Free vs. Conventional Milk Metabolic Response Study

Postprandial glucose and insulin responses are important indicators of metabolic health, even in individuals without diagnosed metabolic disease. The rate and pattern of nutrient digestion and absorption can influence these responses, and emerging evidence suggests that differences in milk protein composition, specifically the presence or absence of A1 beta-casein, may alter gastrointestinal function and metabolic outcomes.

This study is a randomized, double-blind, crossover trial designed to evaluate the effects of A1-free milk compared to conventional milk on postprandial metabolic responses in healthy adults. Participants will complete four experimental conditions in random order: (1) lactose-containing A1-free milk, (2) lactose-containing conventional milk, (3) lactose-free A1-free milk followed by a delayed lactose challenge, and (4) lactose-free conventional milk followed by a delayed lactose challenge.

The inclusion of both lactose-containing and lactose-free conditions allows for evaluation of two complementary questions. First, direct comparisons between lactose-containing A1-free and conventional milk will assess whether milk protein composition influences postprandial glucose and insulin responses under typical consumption conditions. Second, the lactose-free preload conditions, combined with a standardized delayed lactose challenge, are designed to evaluate whether prior milk consumption modifies subsequent metabolic responses to lactose exposure. This approach provides insight into potential differences in digestive kinetics, including gastric emptying, nutrient delivery, and lactose digestion and absorption.

During each study visit, participants will consume a standardized milk-based intervention following an overnight fast. In the lactose-free conditions, a lactose beverage matched to the amount of lactose typically present in the milk will be administered 60 minutes after milk consumption. Blood samples will be collected at multiple timepoints over a postprandial period to measure glucose and insulin concentrations and characterize response patterns, including early-phase responses and overall exposure.

Secondary and exploratory outcomes include breath hydrogen testing as a non-invasive marker of carbohydrate fermentation and lactose maldigestion, as well as gastrointestinal symptom assessments using validated questionnaires. These measures will be used to provide additional context for interpreting metabolic responses across conditions.

The crossover design allows each participant to serve as their own control, improving statistical power and reducing variability. The findings from this study will help clarify whether differences in milk protein composition influence metabolic responses and whether prior exposure to lactose-free milk alters the body's handling of lactose consumed at a later time.

Inclusion criteria

• Ability/desire to provide informed consent
• Are between 18 and 65 years of age
• Are generally healthy, with no known metabolic or gastrointestinal conditions that would affect digestion or metabolism
• Are willing to consume milk-based beverages and lactose-containing drinks as part of the study
• Are willing to fast overnight (approximately 10-12 hours) prior to study visits and follow study instructions (e.g., diet and activity restrictions)
• Are willing to attend all study visits and complete all study procedures (blood draws, breath tests, urine samples, questionnaires)
• Are able to understand and provide written informed consent in English.

Exclusion criteria

• You have a known allergy to milk or dairy products
• You are currently pregnant, planning to become pregnant, or breastfeeding
• You currently smoke or have used tobacco or nicotine-containing products within the past 3 months
• You have a history of excessive alcohol use within the past 30 days
• You have been diagnosed with diabetes (Type 1 or Type 2), prediabetes, or other metabolic conditions that affect glucose or insulin responses (such as insulin resistance, metabolic syndrome, or polycystic ovary syndrome [PCOS])
• You have a history of gastrointestinal conditions that may affect digestion or absorption (such as inflammatory bowel disease, Crohn's disease, ulcerative colitis, celiac disease, or severe irritable bowel syndrome)
• You have had gastrointestinal surgery that alters normal digestive function (such as bariatric surgery or gastric bypass)
• You have other medical conditions that may affect digestion or interfere with study results (such as Past or present: Organ transplant, chronic pancreatitis, pancreatic insufficiency, symptomatic biliary disease, Celiac disease, chronic constipation, diverticulosis, inflammatory bowel disease (IBD), ulcerative colitis (UC), Crohn's disease (CD), small intestine bacterial overgrowth syndrome (SIBO), gastroparesis, gastro-esophageal reflux disease (GERD), Irritable Bowel Syndrome (IBS) or any other medical condition with symptoms that could confound collection of adverse events.)
• You have used medications or supplements known to affect glucose metabolism, digestion, or gastrointestinal function within the following timeframes prior to enrollment:
• Within 4 weeks: insulin, metformin, GLP-1 receptor agonists, corticosteroids, digestive enzymes, fiber supplements, and all oral or IV antibiotics
• Within 2 weeks: bismuth-containing compounds (e.g., Pepto-Bismol) and proton pump inhibitors or acid suppressors (e.g., omeprazole [Prilosec], lansoprazole [Prevacid], esomeprazole [Nexium], pantoprazole [Protonix], rabeprazole [Aciphex])
• Within 1 week: laxatives and stool softeners (e.g., Miralax, Colace, senna, lactulose, Citrucel, Metamucil, Fibercon), probiotics and prebiotics, gastrointestinal motility agents (e.g., Reglan, Linzess, Amitiza), and antidiarrheal medications (e.g., loperamide [Imodium], Lomotil)
• You have had a recent infection within the past 30 days
• You have been diagnosed with Human Immunodeficiency Virus (HIV), hepatitis B, or hepatitis C
• You are currently undergoing chemotherapy
• Height: ___ Weight: ___ BMI: ___ Weighing <16.5 kg or Body mass index > 35 kg/m2
• You have participated in another clinical trial or used an investigational product within the past 30 days
• You have any other condition that, as determined by the study team, would make participation unsafe or interfere with study results