Blood Glucose Response After Oral Lactulose Intake in Type 2 Diabetic

Total Page:16

File Type:pdf, Size:1020Kb

Blood Glucose Response After Oral Lactulose Intake in Type 2 Diabetic ISSN 1948-9358 (online) World Journal of Diabetes World J Diabetes 2021 June 15; 12(6): 685-915 Published by Baishideng Publishing Group Inc World Journal of W J D Diabetes Contents Monthly Volume 12 Number 6 June 15, 2021 REVIEW 685 Role of novel biomarkers in diabetic cardiomyopathy Kumric M, Ticinovic Kurir T, Borovac JA, Bozic J 706 Critical review of bone health, fracture risk and management of bone fragility in diabetes mellitus Palui R, Pramanik S, Mondal S, Ray S 730 Mechanisms linking gut microbial metabolites to insulin resistance Jang HR, Lee HY 745 Alzheimer’s disease and type 2 diabetes mellitus: Pathophysiologic and pharmacotherapeutics links Rojas M, Chávez-Castillo M, Bautista J, Ortega Á, Nava M, Salazar J, Díaz-Camargo E, Medina O, Rojas-Quintero J, Bermúdez V MINIREVIEWS 767 Diabetes and inflammatory diseases: An overview from the perspective of Ca2+/3'-5'-cyclic adenosine monophosphate signaling Bergantin LB 780 Effect of COVID-19 on management of type 1 diabetes: Pushing the boundaries of telemedical healthcare Bilic Curcic I, Cigrovski Berkovic M, Kizivat T, Canecki Varzic S, Smolic R, Smolic M 786 Oral glucose tolerance test in diabetes, the old method revisited Kuo FY, Cheng KC, Li Y, Cheng JT 794 Diabetic gastroenteropathy: An underdiagnosed complication Concepción Zavaleta MJ, Gonzáles Yovera JG, Moreno Marreros DM, Rafael Robles LDP, Palomino Taype KR, Soto Gálvez KN, Arriola Torres LF, Coronado Arroyo JC, Concepción Urteaga LA 810 Endothelial impairment evaluation by peripheral arterial tonometry in pediatric endocrinopathies: A narrative review La Valle A, Crocco M, Chiarenza DS, Maghnie M, d'Annunzio G 827 Diabetes and peripheral artery disease: A review Soyoye DO, Abiodun OO, Ikem RT, Kolawole BA, Akintomide AO 839 New perspectives on angiotensin-converting enzyme 2 and its related diseases Liu LP, Zhang XL, Li J 855 Cardiovascular autonomic neuropathy in diabetes: Pathophysiology, clinical assessment and implications Duque A, Mediano MFF, De Lorenzo A, Rodrigues Jr LF WJD https://www.wjgnet.com I June 15, 2021 Volume 12 Issue 6 World Journal of Diabetes Contents Monthly Volume 12 Number 6 June 15, 2021 ORIGINAL ARTICLE Retrospective Cohort Study 868 Estimated impact of introduction of new diagnostic criteria for gestational diabetes mellitus de Wit L, Zijlmans AB, Rademaker D, Naaktgeboren CA, DeVries JH, Franx A, Painter RC, van Rijn BB Observational Study 883 Control of modifiable risk factors and major adverse cardiovascular events in people with peripheral artery disease and diabetes Golledge J, Drovandi A, Rowbotham S, Velu R, Quigley F, Jenkins J Randomized Controlled Trial 893 Blood glucose response after oral lactulose intake in type 2 diabetic individuals Pieber TR, Svehlikova E, Mursic I, Esterl T, Wargenau M, Sartorius T, Pauly L, Schwejda-Guettes S, Neumann A, Faerber V, Stover JF, Gaigg B, Kuchinka-Koch A META-ANALYSIS 908 Coffee consumption and risk of type 2 diabetes mellitus in Asians: A meta-epidemiological study of population-based cohort studies Bae JM WJD https://www.wjgnet.com II June 15, 2021 Volume 12 Issue 6 World Journal of Diabetes Contents Monthly Volume 12 Number 6 June 15, 2021 ABOUT COVER Editorial Board Member of World Journal of Diabetes, Jue Liu, MD, PhD, Associated Professor, Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China. [email protected] AIMS AND SCOPE The primary aim of World Journal of Diabetes (WJD, World J Diabetes) is to provide scholars and readers from various fields of diabetes with a platform to publish high-quality basic and clinical research articles and communicate their research findings online. WJD mainly publishes articles reporting research results and findings obtained in the field of diabetes and covering a wide range of topics including risk factors for diabetes, diabetes complications, experimental diabetes mellitus, type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, diabetic angiopathies, diabetic cardiomyopathies, diabetic coma, diabetic ketoacidosis, diabetic nephropathies, diabetic neuropathies, Donohue syndrome, fetal macrosomia, and prediabetic state. INDEXING/ABSTRACTING The WJD is now abstracted and indexed in Science Citation Index Expanded (SCIE, also known as SciSearch®), Current Contents/Clinical Medicine, Journal Citation Reports/Science Edition, PubMed, and PubMed Central. The 2020 Edition of Journal Citation Reports® cites the 2019 impact factor (IF) for WJD as 3.247; IF without journal self cites: 3.222; Ranking: 70 among 143 journals in endocrinology and metabolism; and Quartile category: Q2. RESPONSIBLE EDITORS FOR THIS ISSUE Production Editor: Yu-Jie Ma; Production Department Director: Xiang Li; Editorial Office Director: Jia-Ping Yan. NAME OF JOURNAL INSTRUCTIONS TO AUTHORS World Journal of Diabetes https://www.wjgnet.com/bpg/gerinfo/204 ISSN GUIDELINES FOR ETHICS DOCUMENTS ISSN 1948-9358 (online) https://www.wjgnet.com/bpg/GerInfo/287 LAUNCH DATE GUIDELINES FOR NON-NATIVE SPEAKERS OF ENGLISH June 15, 2010 https://www.wjgnet.com/bpg/gerinfo/240 FREQUENCY PUBLICATION ETHICS Monthly https://www.wjgnet.com/bpg/GerInfo/288 EDITORS-IN-CHIEF PUBLICATION MISCONDUCT Timothy Koch https://www.wjgnet.com/bpg/gerinfo/208 EDITORIAL BOARD MEMBERS ARTICLE PROCESSING CHARGE https://www.wjgnet.com/1948-9358/editorialboard.htm https://www.wjgnet.com/bpg/gerinfo/242 PUBLICATION DATE STEPS FOR SUBMITTING MANUSCRIPTS June 15, 2021 https://www.wjgnet.com/bpg/GerInfo/239 COPYRIGHT ONLINE SUBMISSION © 2021 Baishideng Publishing Group Inc https://www.f6publishing.com © 2021 Baishideng Publishing Group Inc. All rights reserved. 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA E-mail: [email protected] https://www.wjgnet.com WJD https://www.wjgnet.com III June 15, 2021 Volume 12 Issue 6 World Journal of W J D Diabetes Submit a Manuscript: https://www.f6publishing.com World J Diabetes 2021 June 15; 12(6): 893-907 DOI: 10.4239/wjd.v12.i6.893 ISSN 1948-9358 (online) ORIGINAL ARTICLE Randomized Controlled Trial Blood glucose response after oral lactulose intake in type 2 diabetic individuals Thomas R Pieber, Eva Svehlikova, Ines Mursic, Tamara Esterl, Manfred Wargenau, Tina Sartorius, Lioba Pauly, Susann Schwejda-Guettes, Annalena Neumann, Valentin Faerber, John Friedrich Stover, Barbara Gaigg, Angelika Kuchinka-Koch ORCID number: Thomas R Pieber Thomas R Pieber, Eva Svehlikova, Ines Mursic, Tamara Esterl, Division of Endocrinology and 0000-0003-3554-0405; Eva Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria Svehlikova 0000-0002-9743-2031; Ines Mursic 0000-0003-3836-6529; Manfred Wargenau, Department of Statistic, M.A.R.C.O. GmbH & Co. KG, Institute for Tamara Esterl 0000-0002-2615-680X; Clinical Research and Statistics, Düsseldorf 40211, Germany Manfred Wargenau 0000-0002-0886- 0158; Tina Sartorius 0000-0002-5264- Tina Sartorius, Department of Nutritional CRO, BioTeSys GmbH, Esslingen 73728, Germany 7207; Lioba Pauly 0000-0002-2673- 012X; Susann Schwejda-Guettes Lioba Pauly, Susann Schwejda-Guettes, Department of Medical & Clinical Affairs, Market 0000-0002-6635-6005; Annalena Access & Education Business Unit Enteral Nutrition, Bad Homburg 61352, Germany Neumann 0000-0002-9716-329X; Valentin Faerber 0000-0003-4250- Annalena Neumann, Valentin Faerber, Department of Medical, Clinical & Regulatory Affairs, 3389; John Friedrich Stover 0000- Business Unit Parenteral Nutrition, Keto-Analogues and Standard I.V. Fluids, Fresenius Kabi 0001-9457-0941; Barbara Gaigg 0000- Deutschland GmbH, Bad Homburg 61352, Germany 0002-8549-8877; Angelika Kuchinka- Koch 0000-0003-1874-1571. John Friedrich Stover, Department of Consultancy, Stover-Solutions, Zurich 8006, Switzerland Author contributions: Pieber TR, Barbara Gaigg, Angelika Kuchinka-Koch, Market Unit Lactulose, Fresenius Kabi Austria GmbH, Svehlikova E, Mursic I, and Esterl Linz 4020, Austria T performed the study, data Corresponding author: Valentin Faerber, PhD, Director, Department of Medical, Clinical & collection and interpretation; Stover JF, Pauly L, Schwejda- Regulatory Affairs, Business Unit Parenteral Nutrition, Keto-Analogues and Standard I. V. Guettes S, Kuchinka-Koch A, and Fluids, Fresenius Kabi Deutschland GmbH, Else-Kroener-Straße 1, Bad Homburg 61352, Gaigg B designed and supervised Germany. [email protected] the study; Wargenau M planned and performed the statistical analysis of the data and interpreted Abstract the results; Sartorius T, Neumann BACKGROUND A, and Faerber V wrote the Lactulose is approved for the symptomatic treatment of constipation, a gastrointe- manuscript; all authors reviewed, stinal (GI) complication common in individuals with diabetes. Lactulose products edited, and approved the contain carbohydrate impurities (e.g., lactose, fructose, galactose), which occur manuscript for submission. during the lactulose manufacturing process. These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus (T2DM) using lactulose Supported by Fresenius Kabi for the treatment of mild constipation. A previous study in healthy subjects Deutschland GmbH, Germany. revealed no increase in blood glucose levels after oral lactulose intake. However, it is still unclear whether the intake of lactulose increases blood glucose levels in Institutional review board individuals with diabetes. WJD https://www.wjgnet.com 893 June 15, 2021 Volume 12 Issue 6 Pieber TR et al. Blood glucose after lactulose
Recommended publications
  • The Chemical Isomerization of Lactose to Lactulose by Using Sodium Hydroxide As Batch Reaction
    Pak. J. Chem. 5(3): 24-30, 2016 Full Paper ISSN (Print): 2220-2625 ISSN (Online): 2222-307X DOI: 10.15228/2016.v06.i01-2.p04 The Chemical Isomerization of Lactose to Lactulose by Using Sodium Hydroxide as Batch Reaction *Nahla T. K. Department of Food Sciences, College of Agriculture, University of Baghdad, Iraq E-mail: *[email protected] ABSTRACT Lactulose is a synthetic and non-absorbable disaccharide sugar containing glucose and fructose units. It is used for the treatment of constipation and hepatic encephalopathy. The purpose of this experiment was to synthesized lactulose in the presence of sodium hydroxide as a catalyst. The evaluation of lactulose synthesis was carried out at different concentration of sodium hydroxide (1, 2 and 3M) and the study was also conducted at different temperatures (30, 50, 70, and 90 °C). In addition, the kinetics of lactose isomerization with respect to the time also studied. Finally, it was concluded that the lactulose formation was determined by spectrophotometric method. The lactulose isomerization increased about more than 30.9% at 90 °C in the presence of 1M sodium hydroxide and 20 % lactose concentration. Keywords: Lactose, isomerization, lactulose, sodium hydroxide. 1. INTRODUCTION Lactulose is a synthetic sugar, which is not adsorbed by humans or rodents due to the lack of enzymes which catalyzes the disaccharide sugars. It can be generated by either alkaline isomerization of lactose via the Lobry de Bruyn - Alberda van Ekenstein rearrangement or by enzyme-catalyzed synthesis. Based on the first reaction, different process schemes for the preparation of lactulose have been developed. The enzymatic synthesis of lactulose can be carried out using different pathways with the transgalactosylation reaction being the most promising1.
    [Show full text]
  • Concentration and Distribution of Sialic Acid in Human Milk and Infant Formulas1–3
    Concentration and distribution of sialic acid in human milk and infant formulas1–3 Bing Wang, Janette Brand-Miller, Patricia McVeagh, and Peter Petocz Downloaded from https://academic.oup.com/ajcn/article/74/4/510/4737459 by guest on 23 September 2021 ABSTRACT 2- to 4-fold higher than those of other mammals, including chim- Background: In animal studies, sialic acid supplementation is panzees (4). Sialic acid is thought to play a role in the structural associated with increases of gangliosides in the brain and and functional establishment of synaptic pathways: >40% of improved learning ability. Only limited data are available on the sialic acid in the brain is found in the synaptosomal fraction and sialic acid content of human milk and infant formulas. contributes to the negative charge of the membrane (3). Because Objective: We compared the concentrations of oligosaccharide- most neurotransmitters are positively charged, sialic acid may bound, protein-bound, and free sialic acid in milk from mothers of assist neurotransmission by facilitating the binding of transmit- full-term and preterm infants and in a range of infant formulas. ter molecules to the synaptic membrane. Design: The milk from 20 and 14 mothers of full-term and Morgan and Winick (2) showed that exogenous sialic acid preterm infants (mean gestational age: 31 ± 3 wk), respectively, administered by intraperitoneal injection increased the produc- was collected at 4 stages of lactation (colostrum, transition, 1 mo, tion of ganglioside sialic acid in the brain and improved learning and 3 mo) and compared with 21 different infant formulas. ability in well-nourished and malnourished rat pups.
    [Show full text]
  • Xorox Univerelty Microfilms
    INFORMATION TO USERS This material was producad from a microfilm copy of the original document. While the moit advanced technological meant to photograph and reproduce thii document have been used, the quality it heavily dependent upon the quality of the original submitted. The following explanation of techniques is provided to help ou understand markings or patterns which may appear on this reproduction. 1. The sign or "target" for pages apparently lacking from the document photographed is "Missing Page(s)". If it was possible to ob tain the mining page(s) or section, they are spliced into the film along w ith: adjacent pages, This may have necessitated cutting thru an image and dupli eating adjacent pages to insure you complete continuity. 2. When an image on the film is obliterated with a large round black mark, it is an indication that the photographer suspected that the copy may have moved during exposure and thus cause a blurred image, fou will find a good image of the page in the adjacent frame. 3. When a map, drawing or chart, etc., was part of the material being photographed the photographer followed a definite method in "sectioning” the material. It is customary to begin photoi ig at the upper left hand comer of a large dieet and to continue photoi ig from left to right in equal sections with a small overlap. If necessary, sectioning is continued agein — beginning below the first row and continuing on until complete. 4. The majority of users indicate that the textual content is of greatest value, however, a somewhat higher quality reproduction could be made from "photographs" if essential to the understanding of the dissertation.
    [Show full text]
  • Lactulose Solution, Usp
    LACTULOSE- lactulose solution VistaPharm, Inc ---------- LACTULOSE SOLUTION, USP Rx Only VP2051 04/10 DESCRIPTION Lactulose is a synthetic disaccharide in solution form for oral administration. Each 15 mL of lactulose solution contains: 10 g lactulose (and less than 1.6 g galactose, less than 1.2 g lactose, and 1.2 g of other sugars). Also contains FD&C Yellow No. 6, purified water, USP and wild cherry flavoring. A minimal quantity of sodium hydroxide, NF is used to adjust pH when necessary. The pH range is 2.5 to 6.5. Lactulose is a colonic acidifier which promotes laxation.The chemical name for lactulose is 4-O-β-D- galactopyranosyl-D-fructofuranose. It has the following structural formula: C12H22O11 The molecular weight is 342.30. It is freely soluble in water. CLINICAL PHARMACOLOGY Lactulose is poorly absorbed from the gastrointestinal tract and no enzyme capable of hydrolysis of this disaccharide is present in human gastrointestinal tissue. As a result, oral doses of lactulose reach the colon virtually unchanged. In the colon, lactulose is broken down primarily to lactic acid, and also to small amounts of formic and acetic acids, by the action of colonic bacteria, which results in an increase in osmotic pressure and slight acidification of the colonic contents. This in turn causes an increase in stool water content and softens the stool. Since lactulose does not exert its effect until it reaches the colon, and since transit time through the colon may be slow, 24 to 48 hours may be required to produce the desired bowel movement.
    [Show full text]
  • Protocols for Breath Tests Interpretation Help Standard Dosages and Sampling Intervals for Hydrogen/Methane Breath Tests
    PROTOCOLS FOR BREATH TESTS INTERPRETATION HELP STANDARD DOSAGES AND SAMPLING INTERVALS FOR HYDROGEN/METHANE BREATH TESTS Breath Test Dosage Mixing Sample Intervals LACTOSE, FRUCTOSE OR SUCROSE INTOLERANCE: Lactose Intolerance • Max Dose = 25g Mix dose of Lactose in Collect Baseline, drink SUSPECTED POSITIVE: 8-10 ounces of water. mixed Lactose and collect a • Hydrogen (H ) Production Only: 20 ppm delta increase in Hydrogen from the lowest preceding value in the test. • Patients 55 lbs (24.9kg) or greater = 25g Lactose single breath sample each 2 hour for 3 hours. • Patients less than 55 lbs (24.9kg) = 1g of Lactose for • Methane (CH4) Production Only: 12 ppm delta increase in Methane from the lowest preceding value in the test. (4 Samples Total) each 2.2 lbs (1kg) of patient weight. • Hydrogen/Methane Both Produced: Add both H2 and CH4 values together in each sample. Review for a 15 ppm delta increase from the lowest preceding value. Fructose Intolerance • Max Dose = 25g Mix dose of Fructose in Collect Baseline, drink 8-10 ounces of water. mixed Fructose and collect • Patients 55 lbs (24.9kg) or greater = 25g Fructose a single breath sample each hour for 3 hours. SMALL INTESTINAL BACTERIAL OVERGROWTH (SIBO): • Patients less than 55 lbs (24.9kg) = 1g of Fructose (4 Samples Total) for each 2.2 lbs (1kg) of patient weight. SUSPECTED POSITIVE: Sucrose Intolerance • Max Dose = 50g Mix dose of Sucrose in Collect Baseline, drink OPTION 1: GLUCOSE (DEXTROSE) 8-10 ounces of water. mixed Sucrose and collect • Patients 110 lbs (50kg) or greater = 50g Sucrose • Hydrogen (H ) Production Only: 12 ppm delta increase in a single breath sample 2 every 30 minutes for Hydrogen from the lowest preceding value in the test.
    [Show full text]
  • REVIEW the Role and Potential of Sialic Acid in Human Nutrition
    European Journal of Clinical Nutrition (2003) 57, 1351–1369 & 2003 Nature Publishing Group All rights reserved 0954-3007/03 $25.00 www.nature.com/ejcn REVIEW The role and potential of sialic acid in human nutrition B Wang1* and J Brand-Miller1 1Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, NSW, Australia Sialic acids are a family of nine-carbon acidic monosaccharides that occur naturally at the end of sugar chains attached to the surfaces of cells and soluble proteins. In the human body, the highest concentration of sialic acid (as N-acetylneuraminic acid) occurs in the brain where it participates as an integral part of ganglioside structure in synaptogenesis and neural transmission. Human milk also contains a high concentration of sialic acid attached to the terminal end of free oligosaccharides, but its metabolic fate and biological role are currently unknown. An important question is whether the sialic acid in human milk is a conditional nutrient and confers developmental advantages on breast-fed infants compared to those fed infant formula. In this review, we critically discuss the current state of knowledge of the biology and role of sialic acid in human milk and nervous tissue, and the link between sialic acid, breastfeeding and learning behaviour. European Journal of Clinical Nutrition (2003) 57, 1351–1369. doi:10.1038/sj.ejcn.1601704 Keywords: sialic acid; ganglioside; sialyl-oligosaccharides; human milk; infant formula; breastfeeding Introduction promising new candidate is sialic acid (also known as The rapid growth and development of the newborn infant N-acetylneuraminic acid), a nine-carbon sugar that is a puts exceptional demands on the supply of nutrients.
    [Show full text]
  • LACTULOSE SOLUTION USP - Lactulose Solution Hi-Tech Pharmacal Co., Inc
    LACTULOSE SOLUTION USP - lactulose solution Hi-Tech Pharmacal Co., Inc. DESCRIPTION Lactulose is a synthetic disaccharide in solution form for oral administration. Each 15 mL of lactulose solution contains: 10 g lactulose (and less than 1.6 g galactose, less than 1.2 g lactose, and 1.2 g or less of other sugars). Lactulose solution contains potassium sorbate as an inactive ingredient. Lactulose is a colonic acidifier which promotes laxation. The chemical name for lactulose is 4-O-β-D-galactopyranosyl-D-fructofuranose. It has the following structural formula: The molecular weight is 342.30. It is freely soluble in water. CLINICAL PHARMACOLOGY Lactulose is poorly absorbed from the gastrointestinal tract and no enzyme capable of hydrolysis of this disaccharide is present in human gastrointestinal tissue. As a result, oral doses of lactulose reach the colon virtually unchanged. In the colon, lactulose is broken down primarily to lactic acid, and also to small amounts of formic and acetic acids, by the action of colonic bacteria, which results in an increase in osmotic pressure and slight acidification of the colonic contents. This in turn causes an increase in stool water content and softens the stool. Since lactulose does not exert its effect until it reaches the colon, and since transit time through the colon may be slow, 24 to 48 hours may be required to produce the desired bowel movement. Lactulose given orally to man and experimental animals resulted in only small amounts reaching the blood. Urinary excretion has been determined to be 3% or less and is essentially complete within 24 hours.
    [Show full text]
  • SPC in English
    SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICINAL PRODUCT Lactulose-MIP 650 mg/ml oral solution 2. QUALITATIVE AND QUANTITATIVE COMPOSITION 1 ml of oral solution contains 650 mg of lactulose. For the full list of excipients, see section 6.1 3. PHARMACEUTICAL FORM Oral solution. Clear colourless or yellowish, viscous liquid. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications Constipation, which cannot be influenced sufficiently by high-roughage diet or other general measures, as well as diseases requiring easy defecation. Prevention and treatment of portal systemic encephalopathy. 4.2 Posology and method of administration Posology Lactulose is taken orally. The dosage recommendations given below are meant as guidelines only, and hence are to be adapted to the requirements of the individual patients according to the severity and development of their condition. The quantities indicated can be measured with the accompanying measuring cup. Constipation: Adults and adolescents (14-17 years): The initial dose is 15-30 ml daily, taken either in a single dose (preferably in the morning) or in two divided doses. When the bowel movement begins, the dose should be reduced by half. If no response is seen in 3 days, the dosage may be raised to twice the initial dose. If still no response is observed a doctor should be consulted. If the patient has been treated with laxatives for a greater period of time, these should be discharged gradually. Children, daily dosage: Under 1 year: 5 ml 1-6 years: 10-15 ml 7-14 years 15 ml The dosage should be individually adjusted, producing bowel movements with soft stool.
    [Show full text]
  • Probiotics and Prebiotics in the Elderly J M T Hamilton-Miller
    447 Postgrad Med J: first published as 10.1136/pgmj.2003.015339 on 5 August 2004. Downloaded from REVIEW Probiotics and prebiotics in the elderly J M T Hamilton-Miller ............................................................................................................................... Postgrad Med J 2004;80:447–451. doi: 10.1136/pgmj.2003.015339 Probiotics (usually lactobacilli and bifidobacteria) and probiotics did not become popular until the public embraced the idea of functional foods prebiotics (non-digestible oligosaccharides) have been (‘‘foods that provide physiological benefits or shown to be useful in preventing certain disease conditions reduce the risk of chronic diseases, over and as well as possibly promoting specific aspects of health. In above their basic nutritional value’’) during the last decade of the 20th century. Metchnikoff’s the present review, the evidence from clinical trials for theory that gut flora contribute in some way to benefits from probiotics and prebiotics to elderly aging was supported in the 1950s, by the finding populations is presented and discussed, specifically in that germ-free animals live longer than their conventional counterparts.7 respect of three common conditions found in the elderly. Today, probiotics are familiar to the public as Both probiotics and prebiotics may be helpful in the components of bioyoghurts and dietary malnutrition, particularly in lactose intolerance and calcium supplements, are widely available, and exten- sively purchased. In 1997, Europeans spent the absorption, and in constipation. Probiotics have been equivalent of almost $900 million on probiotic shown clearly to boost immunity in the elderly, but the yoghurts and milks, and this market is growing clinical significance of this remains to be clarified.
    [Show full text]
  • Lactulose, Disaccharides and Colonic Flora Clinical Consequences
    Drugs 1997 Ju n: 53 (6): 930-942 REVIEW ARTICLE 00 12-6667/97/rJ:XJO-O<I3O/S13.00/0 © Ad isInterna tional lim ited . AUrights reserved . Lactulose, Disaccharides and Colonic Flora Clinical Consequences Mette Rye Clausen and PerBrebech Mortensen Department of Medicine CA, Division of Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Contents Summary . 930 1. Dietary Carbohydrate . 931 1.1 Lactulose . 931 2. Colonic Fermentation and Producti on of Short-Chain Fatty Acids (SCFA) 931 2.1 Fermentation of Lactulose . 932 3. Lactulose in the Management of Constipation ........ 933 3.1 Colonic Compensation in Car bohydrate Malabsorption 933 3.2 Fermentation Capac ity Threshold: Individual Variability . 934 3.3 Does Lactulose Exert Its Laxative Effect Through the Osmotic Activity of Unferme nted Carbohydrate? . 935 3.4 Capac ity of the Colon to Absorb Fluid . 936 3.5 Possible Me chanisms of Action of Lactulose in the Treatment of Constipation. 936 4. Lac tulose in the Management of Hepatic Encephalopathy . 937 4.1 Effects of Lac tulose on Ammonia and Nitrogen Metabolism . 937 4.2 Role of Short- and Medium-Chain Fatty Acids in Hepatic Encephalopathy . 938 4.3 Effect of Lactulose on Colon ic SCFA Production in Hepatic Encephalopathy 939 4.4 Possible Mechanisms of Action of Lactulose in the Treatment of Hepatic Encephalopathy 940 5. Conclusions.................................. 940 Summary Lactulose is one of the mos t freq uently utilised age nts in the treatment of constipation and hepatic ence pha lopathy because of its efficacy and good safe ty profile. The key to understanding the possible modes ofaction by which lactulose ac hieves its therapeutic effects in these diso rders lies in certain pharmacological phe nomena: (a) lactulose is a sy nthetic disaccharide that does not occur naturally; (b) there is no disaccharidase on the microvillus membrane of enterocytes in the human small intesti ne that hydrolyses lactulose; and (c) lactulose is not absorbed from the small intestine.
    [Show full text]
  • Hydrogen/Methane Breath Tests
    Green Spring Station Out-Patient Center 2360 W. Joppa Rd. Suite 206, Lutherville, MD 21093 Kerrie Hendren, RN BSN 410-583-2614 HYDROGEN/METHANE BREATH TESTS What is a BREATH TEST? Information for physicians and patients. (H2. Hydrogen and CH4. Methane) Hydrogen and/or Methane gas in the body are produced from intestinal bacteria. Bacteria, normally in the large intestine, produce hydrogen or methane through fermentation of carbohydrates. Substrates containing these carbohydrates, like Lactulose, is given orally to test for small intestinal bacterial presence. Some of the hydrogen or methane produced from the bacterial fermentation causes bloating, abdominal discomfort or diarrhea. The gases are absorbed by the intestinal mucosa and enter the vasculature and transported to the lungs. The gases are then exhaled through normal breathing. These are collected in a bag for immediate analysis. In Small Intestinal Bacterial Overgrowth (SIBO), bacteria exist in the small intestine. Lactulose, when used as the challenge dose, is poorly absorbed in the gastrointestinal tract making it the perfect substrate to test for bacterial overgrowth throughout the length of the small bowel (21 feet). NOTE: If lactose or fructose is given as substrate, bacteria compete with the natural digestive process and metabolize the sugar before it is absorbed and may produce an early rise in breath hydrogen. Dedicated intolerance testing for these sugars are performed separately. In Lactose and Fructose intolerance, the individual has a deficiency in the enzymes needed for its absorption. Normally, it is broken down in the small intestine, absorbed, and very little lactose or fructose reach the large intestine. If it reaches the colon in its raw form, it is metabolized by colonic bacteria producing a large amount of gas which can be measured distally in the breath sample.
    [Show full text]
  • Diet for Those with Symptomatic Small Bowel Bacterial Overgrowth
    Diet for Those with Symptomatic Small Bowel Bacterial Overgrowth What is small bowel bacterial overgrowth (SBBO or SIBO for short)? We all have bacteria in our intestines, but some people have too much. These extra bacteria can cause problems. Good movement of food through the small bowel helps avoid this problem, and so does having normal amounts of stomach acid. So, people with slow bowel motility or who make too little gastric acid are at risk for bacterial overgrowth. What are the symptoms? Symptoms include gas, abdominal pain, distention, bloating, fullness, diarrhea, nausea, and/or pain after eating foods that are high in sugars, like sodas, sweets and desserts, or high in fiber, such as pinto beans, kidney beans, bran cereals, etc. How does what I eat make my symptoms worse? When there are too many bacteria high up in your intestine near your stomach, they get “first dibs” on the food that you eat – instead of you! The bacteria use your food for fuel, and they make gas in the process. This is what makes you uncomfortable. Foods that do not contain carbohydrates or fiber do not usually cause problems. This includes meats (beef, pork, lamb, venison); poultry (chicken, turkey, duck); fish and shellfish; eggs; and butter, oils, and hard cheeses. How to best use this diet: Look over the list of foods below and cut out the foods and drinks you eat a lot of. Start by at least cutting out concentrated sugars and sweets. If you feel a lot better, that may be all you need to do.
    [Show full text]