Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose?

Abstract

Twelve healthy volunteers were studied for two test periods, at the beginning of which they ingested a diarrheogenic load (60 g) of lactulose in 350 mL water with 10 g polyethylene glycol 4000 (PEG); the two periods were separated by a lactulose feeding period of 8 d, during which a nondiarrheogenic load (20 g) of lactulose was taken twice daily. The transit time and flow rates of water and lactulose in the distal ileum of four subjects were not different before and after the lactulose feeding period. In the other eight subjects, stool weight and frequency, fecal pH, and fecal outputs of carbohydrates and osmotic moieties after the ingestion of 60 g lactulose dropped significantly (P < 0.05) after the lactulose feeding period, whereas the orofecal transit time and fecal concentrations of beta-galactosidase and lactic acid increased (P < 0.05). We conclude that changes in colonic function induced by prolonged exposure to a nondiarrheogenic amount of lactulose mitigate the severity of the diarrhea because of the larger dose of lactulose.

Use of pigs as a potential model for research into dietary modulation of the human gut microbiota

“…By prefeeding the prebiotic inulin, diarrhoea caused by the application of lactulose could be relieved (131) . These findings are in agreement with observations of Flourie et al (133) , who showed that primarily offering adult human subjects a low dose of lactulose increases fermentation and moderates diarrhoea during a period following a high dose of lactulose consumption. It appears that pre-feeding represents a form of adaption of the colonic microbiota, since a dose of indigestible carbohydrate that can be completely fermented might increase the overall capacity for fermentation, partly by inducing the production of bacterial glucosidases (133) .…”

A digestive tolerance study of maltitol after occasional and regular consumption in healthy humans

“…Digestive tolerance of maltitol A Ruskone-Fourmestraux et al Prolonged ingestion of slowly absorbed sugars, such as lactose and lactulose, results in changes in the metabolic activity of the colonic flora, especially a fall in breath excretion of H 2 , which increases its ability to ferment the sugar (Florent et al, 1985;Flourié et al, 1993;Launiala, 1968;Perman et al, 1981). As a result, there is efficient fermentation of the chronically ingested unabsorbed sugar, and thus a reduction in its diarrhoeogenic effect (Rambaud & Flourié, 1994).…”

“…The capacity to ferment unabsorbable sugars, such as lactose and lactulose, and to reduce their laxative effects can, however, be increased by regular ingestion of these sugars, which results in changes in the metabolic activity of the colonic flora, especially a reduced excretion of hydrogen in the breath (H 2 ) (Florent et al, 1985;Flourié et al, 1993;Launiala, 1968;Perman et al, 1981).…”

Gastrointestinal responses following acute and medium term intake of retrograded resistant maltodextrins, classified as type 3 resistant starch

“…Colonic bacterial glucosidases are known to be substrate inducible (Macfarlane et al, 1988) and increased fermentation in the colon may decrease or even suppress diarrhoea by removing the osmotic effect of malabsorbed carbohydrates (Rambaud and Flourié, 1994) as well as stimulation of colonic sodium and water transport by short-chain-fatty acids resulting from the fermentation process. Reduction in diarrhoea following chronic ingestion of lactulose in lactose maldigesters has also been observed (Flourié et al, 1993) and a significant reduction in breath hydrogen excretion, diarrhoea and flatus has been reported following consumption of lactose after adaptive feeding periods (Johnson et al, 1993;Hertzler and Savaiano, 1996).…”