The Lactulose Dilema

[Lucenzo01]

Hi Peatarians, I have a doubt. Ray Peat has said clearly that the less gut flora you have, the better you will be.

So I started reading and found some really interesting thing that doesn't fit in this paradigm. The thing is Lactulose: it's a non-absorbable sugar, meaning that only bacteria will feed it. So, it's a prebiotic, but a special one: it only feeds the gram-positive bacteria. The interesting part of the storie starts here:

"Lactulose is a non-absorbable sugar used in the treatment of constipation and hepatic encephalopathy."

How is it possible that something that is bad for you can treat you of hepatic encephalopathy?

And the way that it treats hepatic encephalopathy is LOWERING AMMONIA. Here we go:

"Lactulose is useful in treating hyperammonemia (high blood ammonia), which can lead to hepatic encephalopathy. Lactulose helps trap the ammonia (NH3) in the colon and bind to it.[15] It does this by using gut flora to acidify the colon, transforming the freely diffusible ammonia into ammonium (NH+
4) which can no longer diffuse back into the blood.[16] It is also useful for preventing hyperammonemia caused as a side effect of administration of valproic acid."

So, basically Lactulosa feed the gram-positive bacteria and they resolve the ammonia problem. And we have here, my friends, it's a fact: the type of bacteria we have in our bodies can influence a lot of metabolic process.

What do you think about it? Has anybody experienced with Laculose?

 

[lvysaur]

Peat has said something along the lines of "lactose feeds gram positive bacteria anyway", when questioned about people who cannot digest lactose. I think it was in a KMUD herb doctors interview.

Lactulose is fructose-galactose, while normal lactose is glucose-galactose. Lactulose is indigestible, and lactose is indigestible for many people. Perhaps a galactose bond is harder to hydrolyze for some reason?

Very interesting stuff here: Lactulose - Wikipedia

It is a disaccharide (double-sugar) formed from one molecule each of the simple sugars (monosaccharides) fructose and galactose. Lactulose is not normally present in raw milk but is a product of heat-processes:[23] the greater the heat, the greater amount of this substance (from 3.5 mg/L in low temperature pasteurized milk to 744 mg/L in in-container sterilized milk).[24]

This explains why UHT causes problems, while unhomo normal milk doesn't. It also explains why cooked milk tastes "sweet"; the glucose isomerizes to fructose.

 

[Lucenzo01]

I have bee taking lactulose with lowering-serotonin agents. Will report in a few days if I feel any difference.

 

[Marg]

Both my husband and I have used the lactulose as a laxative, and it works fast and well with no griping pains. If it doesn't cause any gut flora disruption, I would take it again as it is gentle on the system. It has a very heavy sugary sweet, thick consistancy and you can mix it with juice.

We now use cascara for the benefits that Ray has written about.

 

[Broken man]

I have bee taking lactulose with lowering-serotonin agents. Will report in a few days if I feel any difference.

What about lactulose? Did it help?

 

[Lucenzo01]

What about lactulose? Did it help?

No, it didn't. Nothing works anymore.

 

[aguilaroja]

... basically Lactulosa feed the gram-positive bacteria and they resolve the ammonia problem....it's a fact: the type of bacteria we have in our bodies can influence a lot of metabolic process.
...Has anybody experienced with Laculose?

Lactulose is viewed as an "osmotic" laxative. Its action is described as bringing water into the bowel, increasing stool softness and elimination.

Certainly, lactulose is also a synthetic sugar, altering gut microbes. Lactulose has been routinely used to treat hepatic encephalopathy for several decades. Lowering excess ammonia is a good thing. But it remains not fully clear how effective lactulose is and how it works if it is effective. The argument about colon acidification (Patil & Silk, 1987) may not be primary.

Polyethylene glycol [PEG], a different osmotic laxative, has been shown in a couple of trials to be more effective than lactulose.
Randomized controlled trial of polyethylene glycol versus lactulose for the treatment of overt hepatic encephalopathy. - PubMed - NCBI
"Both lactulose and PEG were safe and effective in the treatment of HE [hepatic encephalopathy]. PEG significantly decreased the time needed for resolution of HE and significantly shortened the hospital stay."

It could be that the bulk action of increased water transit through the bowel is enough to speed discharge of ammonia. It could also be water passages beneficially alters gut flora in the high ammonia/encephalopathic state.
Persisting changes of intestinal microbiota after bowel lavage and colonoscopy. - PubMed - NCBI
"...in normal individuals, a high-volume polyethylene glycol bowel cleansing preparation has a long-lasting effect on the gut microbiota composition and homeostasis, in particular, with a decrease in the Lactobacillaceae abundance,..."

Osmotic fluid flow is a limited view of biological water. But lactulose and PEG clearly make elimination more watery and increase bowel transit speed in many situations. Dr. Peat has a wider view of intestinal function in metabolism, described for instance here:
Cascara, energy, cancer and the FDA's laxative abuse.

 

[Funnywhensunny]

Low-Dose Lactulose as a Prebiotic for Improved Gut Health and Enhanced Mineral Absorption

Although medium and high doses of lactulose are used routinely for the treatment of constipation and hepatic encephalopathy, respectively, a wealth of evidence demonstrates that, at low doses, lactulose can also be used as a prebiotic to stimulate the growth of health-promoting bacteria in the...

www.frontiersin.org