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Lactulose ingestion increases faecal bifidobacterial counts: A randomised double-blind study in healthy humans

European Journal of Clinical Nutrition volume 58, pages 462–466 (2004)Cite this article

Abstract

Objective: Faecal bifidobacteria and lactobacilli, perceived as exerting health-promoting properties, may be increased by ingestion of high-dose lactulose in humans. The effects of low and well-tolerated doses of lactulose are not well known. The aim of the study was to assess the effects of prolonged low-dose lactulose administration on faecal bifidobacteria and selected metabolic indexes potentially involved in colonic carcinogenesis.

Subjects and methods: In all, 16 healthy volunteers were included in this controlled, randomised, double-blind, parallel group trial. Participants ingested lactulose or placebo (sucrose) at a dose of 5 g b.i.d. for 6 weeks. Stools were regularly collected at baseline (d0), and after 3 (d21) and 6 (d42) weeks of sugar ingestion. Tolerance was evaluated using a daily chart.

Results: Faecal bifidobacterial counts were higher in lactulose than in sucrose group (P=0.03). Lactulose ingestion led to a significant increase in faecal bifidobacteria counts from d0 to d21 and d42 ((m±s.e.m.) 8.25±0.53, 8.96±0.40 and 9.54±0.28 log colony-forming units/g wet wt (CFU/g), respectively (P=0.048)). Placebo ingestion did not lead to any faecal bifidobacterial count change. Total anaerobes, Lactobacillus and pH were not significantly changed throughout the study in the two groups. Neither faecal bile acids nor neutral sterols were modified by lactulose. Excess flatus was more common in the lactulose group (P=0.03), but was very mild. Bloating and borborygmi did not differ between both the groups.

Conclusions: A measure of 10 g lactulose/day increases faecal bifidobacterial counts, and lactulose fulfils the criteria requested to be considered as a prebiotic.

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References

  • Andrieux C, Gadelle D, Leprince C & Sacquet E (1989): Effects of some poorly digestible carbohydrates on bile acid bacterial transformations in the rat. Br. J. Nutr. 62, 103–119.

    Article  CAS  Google Scholar 

  • Ballongue J, Schumann C & Quignon P (1997): Effects of lactulose and lactitol on colonic microflora and enzymatic activity. Scand. J. Gastroenterol. Suppl. 222, 41–44.

    Article  CAS  Google Scholar 

  • Beerens H (1991): Detection of bifidobacteria by using propionic acid as a selective agent. Appl. Environ. Microbiol. 57, 2418–2419.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Berge Henegouwen GP, van der Werf SD & Ruben AT (1987): Effect of long term lactulose ingestion on secondary bile salt metabolism in man: potential protective effect of lactulose in colonic carcinogenesis. Gut 28, 675–680.

    Article  Google Scholar 

  • Bouhnik Y, Pochart P, Marteau P, Arlet G, Goderel I & Rambaud JC (1992): Fecal recovery in humans of viable Bifidobacterium sp ingested in fermented milk. Gastroenterology 102, 875–878.

    Article  CAS  Google Scholar 

  • Buddington RK, Williams CH, Chen SC & Witherly SA (1996): Dietary supplement of neosugar alters the fecal flora and decreases activities of some reductive enzymes in human subjects. Am. J. Clin. Nutr. 63, 709–716.

    Article  CAS  Google Scholar 

  • Challa A, Rao DR, Chawan CB & Shackelford L (1997): Bifidobacterium longum and lactulose suppress azoxymethane-induced colonic aberrant crypt foci in rats. Carcinogenesis 18, 517–521.

    Article  CAS  Google Scholar 

  • Gibson GR, Roberfroid MB (1995): Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J. Nutr. 125, 1401–1412.

    Article  CAS  Google Scholar 

  • Hennigan TW, Sian M, Matthews J & Allen-Mersh TG (1995): Protective role of lactulose in intestinal carcinogenesis. Surg. Oncol. 4, 31–34.

    Article  CAS  Google Scholar 

  • Hoffmann K, Bircher J (1969): Changes in the bacterial population of the intestine following lactulose administration. Schweiz. Med. Wochenschr. 99, 608–609.

    CAS  PubMed  Google Scholar 

  • Nagengast FM, Hectors MP, Buys WA & van Tongeren JH (1988): Inhibition of secondary bile acid formation in the large intestine by lactulose in healthy subjects of two different age groups. Eur. J. Clin. Invest. 18, 56–61.

    Article  CAS  Google Scholar 

  • Nair PP (1988): Role of bile acids and neutral sterols in carcinogenesis. Am. J. Clin. Nutr. 48, 768–774.

    Article  CAS  Google Scholar 

  • Owen RW (1997): Faecal steroids and colorectal carcinogenesis. Scand. J. Gastroenterol. Suppl. 222, 76–82.

    Article  CAS  Google Scholar 

  • Riggio O, Varriale M, Testore GP, Di Rosa R, Di Rosa E, Merli M, Romiti A, Candiani C & Capocaccia L (1990): Effect of lactitol and lactulose administration on the fecal flora in cirrhotic patients. J. Clin. Gastroenterol. 12, 433–436.

    Article  CAS  Google Scholar 

  • Salminen S, Salminen E (1997): Lactulose, lactic acid bacteria, intestinal microecology and mucosal protection. Scand. J. Gastroenterol. Suppl. 222, 45–48.

    Article  CAS  Google Scholar 

  • Singh J, Rivenson A, Tomita M, Shimamura S, Ishibashi N & Reddy BS (1997): Bifidobacterium longum, a lactic acid-producing intestinal bacterium inhibits colon cancer and modulates the intermediate biomarkers of colon carcinogenesis. Carcinogenesis 18, 833–841.

    Article  CAS  Google Scholar 

  • Terada A, Hara H, Kataoka M & Mitsuoka T (1992): Effect of lactulose on composition and metabolic activity of the human fecal flora. Microb. Ecol. Health Dis. 5, 43–50.

    Article  Google Scholar 

  • Tuohy KM, Ziemer CJ, Klinder A, Knöbel Y, Pool-Zobel BL & Gibson GR (2002): A human volunteer study to determine the prebiotic effects of lactulose powder on human colonic microbiota. Microb. Ecol. Health Dis. 14, 165–173.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Service de Gastroentérologie et d’Assistance Nutritive, Hôpital Lariboisière, Paris, France

    Y Bouhnik, A Attar & F A Joly

  2. Laboratoire de Physiologie et Nutrition, associé à l’INRA, Orsay, France

    M Riottot

  3. Laboratoires Solvay Pharma, Suresnes, France

    F Dyard

  4. Service de Gastroentérologie, Centre Hospitalier Lyon Sud, France

    B Flourié

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  1. Y Bouhnik
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Contributions

Guarantor: Y Bouhnik.

Contributors: YB carried out the data checking and was responsible for writing the manuscript. AA carried out data analysis and assisted in the preparation of the manuscript. JFA was involved in the data checking and in assisting manuscript preparation. RM was responsible for neutral sterol and bile acids analysis. FD and BF participated for the design of the study and in writing the manuscript.

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Correspondence to Y Bouhnik.

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Bouhnik, Y., Attar, A., Joly, F. et al. Lactulose ingestion increases faecal bifidobacterial counts: A randomised double-blind study in healthy humans. Eur J Clin Nutr 58, 462–466 (2004). https://doi.org/10.1038/sj.ejcn.1601829

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