Skim Milk Gets a Move On

Wilke, Allan J.
January 2011
Alternative Medicine Alert;Jan2011, Vol. 14 Issue 1, p10
THESE INVESTIGATORS FROM TURKEY HYPOTHESIZED THAT fat-free milk could improve constipation and that the hormones motilin and ghrelin are involved. Ghrelin, a "hunger" hormone produced in the stomach and pancreas, stimulates appetite. It has several other effects on the gastrointestinal (GI) tract, but for this study, its enhancement of motility was the effect of interest. Motilin is secreted in the small intestines and stimulates gastric motility and small intestinal peristalsis. Thirty (30) constipated patients and 19 controls were recruited. All subjects underwent double-contrast barium enemas. Exclusion criteria included pre-existing GI pathology (cancer, lactose intolerance, ulcerative colitis, Crohn's disease, malabsorption syndrome, among others), and other disease or conditions associated with constipation (diabetes, thyroid disease, pregnancy, obesity, and tobacco use). The constipated subjects were classified by the Constipation Severity Instrument (CSI), a validated tool for accessing constipated patients, into three groups, mild, moderate, and severe, with 10 subjects in each group. The CSI for the mild group averaged 17.8, for the moderate group 20.2, and for the severe group 26.7. The controls were divided into two groups with CSIs of 10 and 9. All groups were evenly divided between men and women with average body mass indices around 26 kg/m². The groups were well matched, except that the constipated patients ate fewer legumes, whole grains, and fresh fruits and vegetables. Milk consumption among the constipated patients was limited to 1-2 glasses of whole milk per week. None of them consumed fat-free milk. Blood samples for electrolytes, lipids, ghrelin, and motilin were obtained at baseline and then after 3 days of fat-free milk consumption. All subjects were given a standard diet (45% carbohydrates, 35% fat, and 20% protein). The subjects in control group 1 (CG1) drank 400 mL of fat-free milk a day; those in control group 2 (CG2) drank the same amount of whole milk. The mild, moderate, and severe constipation cases received 400, 600, and 800 mL of fat-flee milk, respectively, a day for 3 days. CG1, which drank fat-free milk, saw an increase in ghrelin levels and a 3-point drop in CSI, while those subjects in CG2, who drank whole milk, saw a decrease in ghrelin and a 1-point drop in CSI. Motilin levels did not change significantly in CG1, but fell in CG2. Similar results were seen in the constipated groups, which all drank fat-free milk. In the mild group, the CSI fell 4 points, 12 points in the moderate group, and 17 points in the severe group. In fact, the post-fat-free milk CSIs in the moderate and severe groups were equal to the control groups. Ghrelin levels rose in all constipated groups. In contrast to CG 1, however, motilin levels also rose. Samples of the whole and fat-free milk were analyzed for chemical content. The only significant differences were the amount of iron (twice as much in whole milk than in fat-free milk) and the amount of ghrelin (more in fat-free milk than in whole milk). Motilin concentrations were equivalent.


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