Lactulose: a prebiotic, laxative and detoxifying agent

Pranami, Dhiren; Sharma, Ramandeep; Pathak, Hardik

doi:10.1007/s40267-017-0384-z

Cited by 19 publications

(19 citation statements)

References 23 publications

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“…Lactulose, a product of heat-treated lactose, has been utilized in the food, medical, and pharmaceutical industries for decades due to its beneficial interactions with gut microbes, laxation-promoting effects, and its activity as a detoxifying agent [ 34 ]. Industrial production of lactulose is performed by the isomerization of lactose in alkaline media, which results in the exchange of the glucose unit for a fructose, retaining the same β(1–4) glycosidic linkage to galactose [ 35 ].…”

Section: Prebioticsmentioning

confidence: 99%

Prebiotics, Bone and Mineral Metabolism

2017

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Increasing interest in functional foods has driven discovery in the area of bioactive compounds. Prebiotics are non-digestible carbohydrate compounds that, when consumed, elicit health benefits and aid in the prevention and treatment of chronic diseases. While prebiotics have been shown to improve a number of chronic, inflammatory conditions, growing evidence exists for prebiotic effects on calcium metabolism and bone health. These novel dietary fibers have been shown to increase calcium absorption in the lower intestines of both preclinical and human models. Rodent models have also been imperative for understanding prebiotic effects on bone mineral density and measures of skeletal strength. Although fewer data are available for humans, bone-related prebiotic effects exist across the lifecycle, suggesting benefits for attainment of peak bone mass during adolescence and minimized bone resorption among postmenopausal women. These effects are thought to occur through prebiotic–microbe interactions in the large intestine. Current prebiotic mechanisms for improved mineral absorption and skeletal health include alterations in gut microbiota composition, production of short-chain fatty acids, altered intestinal pH, biomarker modification, and immune system regulation. While the majority of available data support improved mineral bioavailability, emerging evidence suggests alternate microbial roles and the presence of an intricate gut–bone signaling axis. Overall, the current scientific literature supports prebiotic consumption as a cost-effective and sustainable approach for improved skeletal health and/or fracture prevention. The goal of this review is to discuss both foundational and recent research in the area of prebiotics, mineral metabolism, and bone health.

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Section: Prebioticsmentioning

confidence: 99%

Prebiotics, Bone and Mineral Metabolism

2017

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“…Lactulose is an artificial disaccharide composed of galactose and fructose, and is produced via isomerization of lactose ( Figure 1 ) ( 1 ). Although first described by Montgomery and Hudson in 1929 ( 2 ), lactulose gained clinical interest only in 1957, when Petuely discovered that growth of fecal bacteria from the genus Bifidobacterium increased following administration of lactulose to infants ( 3 , 4 ).…”

Section: Introduction To Lactulosementioning

confidence: 99%

“…In current clinical practice, lactulose is indicated as a laxative for the symptomatic treatment of constipation in children and adults and as a detoxifying agent for the treatment of hepatic encephalopathy (HE) in adults ( Table 1 and Figure 2 ) ( 7 ). Although chiefly used for medicinal purposes at medium and high doses for the treatment of constipation and HE, respectively, low-dose lactulose can also be used as a prebiotic to stimulate the growth of health-promoting bacteria in the gastrointestinal (GI) tract, or gut ( 1 , 11 ). Prebiotics such as lactulose are substrates that are selectively utilized by host microorganisms and that confer a health benefit ( 12 ).…”

Section: Introduction To Lactulosementioning

confidence: 99%

“…The treatment effects of lactulose arise from its effects on the gut, namely alteration of colonic microbiota and formation of favorable metabolites (e.g., SCFAs) ( Figure 2 ) ( 4 ). The human small intestine lacks the enzyme necessary to split the disaccharide lactulose into its component monosaccharides; lactulose, therefore, reaches the large intestine largely intact ( 1 ). Once in the colon, lactulose is selectively metabolized by resident colonic microbiota ( 11 ), producing SCFAs, intestinal gas (hydrogen, carbon dioxide, and methane) and resulting in increased bacterial mass ( 1 , 11 , 34 , 35 ).…”

Section: Introduction To Lactulosementioning

confidence: 99%

“…The human small intestine lacks the enzyme necessary to split the disaccharide lactulose into its component monosaccharides; lactulose, therefore, reaches the large intestine largely intact ( 1 ). Once in the colon, lactulose is selectively metabolized by resident colonic microbiota ( 11 ), producing SCFAs, intestinal gas (hydrogen, carbon dioxide, and methane) and resulting in increased bacterial mass ( 1 , 11 , 34 , 35 ). The ratio of SCFAs produced will be determined by the composition of the host microbiota, as well as the type and quantity of fermentable substrate, pH of the gut, and factors that influence SCFA absorption from the intestine ( 36 ).…”

Section: Introduction To Lactulosementioning

confidence: 99%

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Low-Dose Lactulose as a Prebiotic for Improved Gut Health and Enhanced Mineral Absorption

2021

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Although medium and high doses of lactulose are used routinely for the treatment of constipation and hepatic encephalopathy, respectively, a wealth of evidence demonstrates that, at low doses, lactulose can also be used as a prebiotic to stimulate the growth of health-promoting bacteria in the gastrointestinal tract. Indeed, multiple preclinical and clinical studies have shown that low doses of lactulose enhance the proliferation of health-promoting gut bacteria (e.g., Bifidobacterium and Lactobacillus spp.) and increase the production of beneficial metabolites [e.g., short-chain fatty acids (SCFAs)], while inhibiting the growth of potentially pathogenic bacteria (e.g., certain clostridia). SCFAs produced upon microbial fermentation of lactulose, the most abundant of which is acetate, are likely to contribute to immune regulation, which is important not only within the gut itself, but also systemically and for bone health. Low-dose lactulose has also been shown to enhance the absorption of minerals such as calcium and magnesium from the gut, an effect which may have important implications for bone health. This review provides an overview of the preclinical and clinical evidence published to date showing that low-dose lactulose stimulates the growth of health-promoting gut bacteria, inhibits the growth of pathogenic bacteria, increases the production of beneficial metabolites, improves mineral absorption, and has good overall tolerability. Implications of these data for the use of lactulose as a prebiotic are also discussed.

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