Lactulose supplements

Generality

Lactulose is a semi-synthetic disaccharide, obtained from the association of the sugars D-galactose and D-Lactose.

The particular chemical bond present between its two constituent sugars gives lactulose a natural resistance to the hydrolytic action of digestive enzymes, allowing it to reach the intestinal environment unaltered.
This characteristic constitutes the prerogative of the biological activity of lactulose. In fact, once the colic environment has been reached unaltered, lactulose can perform its functions;

mechanical, useful in the treatment of constipation;
metabolic of prebiotic type, thanks to the fermentation processes supported by Lactobacilli and Bifidobacteria.

Indications

Why is lactulose used? What is it for?

In the supplementary field, lactulose is mainly used for its laxative and prebiotic action.
In the pharmacological field, on the other hand, detoxifying properties are ascribed to lactulose against nitrogenous products, which are particularly valuable in the course of encephalopathies.
Recent studies also attribute to lactulose:

Beneficial activities against intestinal inflammatory diseases;
Beneficial activities against osteoporosis;
Protective activities for diabetes and renal insufficiency;
Antiseptic activity for the intestinal mucosa;
Hypoglycemic and hypolipidemic metabolic activities.

Properties and Effectiveness

What benefit has lactulose shown during the studies?

There are numerous studies and clinical evidence relating to the usefulness of lactulose.

Lactulose and laxative activity

Well characterized from a clinical point of view is the laxative activity of lactulose, which has proved effective even in the case of chronic constipation.
This activity would be attributable to the osmotic effect of lactulose, capable of drawing water into the intestinal lumen, softening the faeces and stimulating peristalsis.
The safety of use of lactulose is such that it can also be used as a remedy in children and geriatric patients.

Lactulose and intestinal health

Upon reaching the undigested intestinal environment, lactulose undergoes metabolic processes by the resident bacterial flora.
The metabolic action of the bacterial flora on lactulose determines the production of short-chain fatty acids, including butyrate, to which are attributed:

Protective properties against colocytes and, more generally, the intestinal mucosa;
Antibacterial activities, very effective for example in countering the nesting and growth of Salmonella, Clostridium perfringens and E. Coli;
Prebiotic activities;
Antitumor activities, and prevention of relapses.

Lactulose and metabolic activities

Through mechanisms not yet fully known, but which would probably bring short-chain fatty acids into play once again, lactulose would seem to inhibit the hepatic synthesis of triglycerides and cholesterol, significantly improving the lipidemic profile, in subjects suffering from metabolic syndrome.

Lactulose and menopause

In a recent clinical trial, the use of lactulose was found to be effective in improving calcium absorption and reducing gradual age-related bone loss in menopausal women.
This activity could be particularly valuable in preventing some pathological consequences associated with menopause, such as osteoporosis.

Lactulose and hepatic encephalopathy

The acidification of the colic content induced by lactulose would also be beneficial in the presence of hepatic encephalopathy, a neurological syndrome due to the accumulation in the circulation of toxic substances, such as ammonia.
Lactulose, hindering the growth of ammonia-producing bacteria (such as ". And coli) in favor of lactobacilli, and acidifying the colic content, could be useful in the treatment of this pathology.
In particular, the reduction of the colonic pH would facilitate on the one hand the conversion of ammonia (NH3) into the much less absorbable ammonium ion (NH4 +), while the increase in peristalsis would accelerate the elimination of the same species.
All this would result in the formation of a negative gradient in a colonic environment, whereby the ammonia present in the capillaries of the colonic mucosa would diffuse into the lumen, with consequent reduction of ammonia (concentration of the substance in the plasma).

Dosage and method of use

How to use lactulose

The suggested doses of lactulose vary considerably depending on the purpose.
For supplementary purposes, lactulose should be taken in concentrations of 2-5 g.
Higher doses, 10 to 40 grams per day, could be used to combat constipation and constipation.
At these dosages, the frequency of side effects is clearly high.
Even higher dosages, therefore of strict medical and pharmacological relevance, could be used in the management of hepatic encephalopathy.

Side effects

Doses greater than 10 g daily could be associated with gastrointestinal disorders, such as diarrhea, flatulence, crampy abdominal pain and poorly formed stools.

Contraindications

When should lactulose not be used?

The use of lactulose is contraindicated in case of hypersensitivity to the active ingredient.
Given the presence of galactose, in many products containing lactulose, the contraindications to use could also extend to those who require a diet low in galactose.

Pharmacological interactions

What drugs or foods can modify the effect of lactulose?

The potential beneficial effects of lactulose on intestinal health could be increased by the simultaneous intake of Bifidobacteria.
The use of lactulose could enhance the absorption of calcium and magnesium, taken both as supplements and through food.
Broad spectrum antibacterial agents and antacids, administered orally at the same time as lactulose, may limit its therapeutic efficacy.

Precautions for use

What do you need to know before taking lactulose?

The use of lactulose during pregnancy and in the subsequent period of breastfeeding, should be carried out, if strictly necessary, under the supervision of your doctor.
Known the metabolic characteristics of lactulose, the use of supplements containing it should take place with particular caution in patients: