Influence of Lactitol and Psyllium on Bowel Function in Constipated Indian Volunteers: A Randomized, Controlled Trial

Abstract

Psyllium and lactitol have been reported to increase fecal volume, moisture content and bowel movement frequency (BMF). However, the benefits of their combined use on constipation has not been examined. The aim of this study was to evaluate the effects of a 4-week intervention with lactitol and/or psyllium on bowel function in constipated volunteers. Adults (N = 172) who were diagnosed with functional constipation per Rome III criteria were randomized to four treatment groups: 10 g lactitol, 3.5 g psyllium, a combination of 10 g lactitol and 3.5 g psyllium, or placebo. The primary endpoint was change in BMF from Day 0 to 28 as compared to placebo. Secondary endpoints were assessed by inventories, including stool consistency, patient assessment of constipation symptoms and quality of life, relief of constipation, 24-h food recall, physical activity, product satisfaction and adverse events (AE). BMF increased by 3.0 BMs with lactitol, by 2.9 with psyllium, and by 3.1 with the combination, but was not different from placebo (3.7 BMs). Other clinical endpoints were similar between treatments. No serious AEs were reported. In conclusion, this study showed a similar effect on relief of constipation in all treatment groups. The treatments that were administered to the volunteers were well tolerated.

The Renaissance of Plant Mucilage in Health Promotion and Industrial Applications: A Review

“…It has been proven that polysaccharides derived from these plants reduce cholesterol and blood glucose, have anti-inflammatory and antioxidant activities, and are anticarcinogenic. They are also a good source of dietary fiber [135,136]. Based on the antiallergic and antimicrobial properties of mucilage from P. ovata, a mouthwash containing polysaccharides and vinegar was developed.…”

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“…It is in powder form that should be mixed with a beverage once a day. It has been demonstrated to increase fecal volume, moisture content, and bowel movement frequency (Cheng et al 2019 ). Its most common AE are upper respiratory infections, gassiness, diarrhea, and increased creatinine phosphokinase levels.…”

Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review

“…Psyllium was also associated with improved stool consistency at various time points. In the third placebo-controlled trial, which also included lactitol and psyllium + lactitol as comparators, there were no significant differences between any of the 4 groups in terms of stool frequency (primary endpoint), stool consistency, QoL, or patient-assessed symptoms in subjects with self-reported constipation (<3 BMs/week) ( 54 ). In other comparative trials, lactulose ( 55 ), mango ( 45 ), and prunes ( 44 ) significantly outperformed psyllium in stool frequency and consistency.…”

“…The data are most robust for psyllium. However, it is worth noting that the highest graded placebo-controlled psyllium study ( 54 ) revealed no significant benefit over placebo and head-to-head trials revealed that psyllium is less effective than comparator agents (e.g., PEG, lactulose, and fruits). Psyllium: Level II Evidence, Grade B Recommendation Polydextrose: Level I Evidence, Grade I (Insufficient) Recommendation Inulin: Level I Evidence, Grade I (Insufficient) Recommendation Mixed Fiber: Level II Evidence, Grade B Recommendation …”

“…The data are most robust for psyllium. However, it is worth noting that the highest graded placebo-controlled psyllium study (54) revealed no significant benefit over placebo and head-to-head trials revealed that psyllium is less effective than comparator agents (e.g., PEG, lactulose, and fruits). Table 7 summarizes studies evaluating miscellaneous patient groups and therapeutic agents.…”