What is Lactulose?
Lactulose is a synthetic sugar that is not digested by the human body. It is made up of the natural sugars galactose and fructose bonded together. When consumed, lactulose slowly moves through the digestive tract where it is fermented by gut bacteria in the large intestine. The fermentation process produces organic acids like lactate, formate and acetate which help to soften stool and promote more frequent bowel movements.
Composition and Production
While Lactulose is not found naturally in food, it closely resembles the disaccharide lactose which is present in dairy products. However, lactulose contains a beta linkage between the galactose and fructose units instead of an alpha linkage like in lactose. This small difference allows lactulose to pass through the small intestine without being broken down by digestive enzymes. It is produced industrially by the isomerization of lactose in an acidic solution. The manufacturing process yields a mixture containing 60-70% lactulose along with some unreacted lactose.
Mechanism of Action
When consumed, lactulose is not absorbed in the small intestine due its molecular structure. It moves through to the colon where it acts as a prebiotic, feeding beneficial gut bacteria. The bacteria ferment lactulose leading to the production of organic acids and gas. This lowers the pH of the colon contents, inhibiting the growth of pathogenic ammonia-producing bacteria. It also draws water into the colon by osmosis, which softens stool. The increased intestinal motility helps encourage more frequent bowel movements, alleviating constipation.
Uses and Benefits of Lactulose
Treatment of Constipation
As Lactulose promotes softer stool and bowel regularity, it is very effective at treating occasional constipation. For chronic idiopathic constipation not responding to fiber and lifestyle changes, lactulose can help regulate bowel movements. It works within 1-2 days for most people when taken as directed.
Hepatic Encephalopathy Prevention
In people with liver damage or disease, excess ammonia produced in the colon travels through the blood to the brain. This can cause hepatic encephalopathy, a type of brain dysfunction. Lactulose helps prevent this condition by lowering colonic ammonia levels through bacterial fermentation. It is one of the standard first-line treatments for both acute and maintenance therapy of hepatic encephalopathy.
Other Uses
Some other conditions lactulose may help with include diverticulitis, irritable bowel syndrome with constipation, and prevention of portosystemic encephalopathy in people with portal hypertension awaiting liver transplant. It is also used prior to diagnostic procedures like barium enema to provide proper bowel cleansing.
Dosage and Safety
Lactulose comes as a syrup containing 3.1-3.7 grams of lactulose per teaspoon. The standard starting dose for constipation is 15-30 ml once or twice daily until relief occurs. For hepatic encephalopathy, the dose is typically 30-60 ml 3-4 times daily but it varies per individual. Side effects may include abdominal bloating, cramping and flatulence due to gas production in the colon. Lactulose is generally well tolerated and safe for long-term use when taken as prescribed.
Lactulose is a prebiotic treatment that works by bacterial fermentation in the colon. It promotes bowel regularity through stool softening and increased intestinal motility, proving effective for both constipation and hepatic encephalopathy. With correct dosage and use as directed by a physician, lactulose offers a gentle and low-risk option for several gastrointestinal conditions. It remains one of the safest and most economical treatment choices available.
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