Lactitol has been widely studied as an alternative to lactulose as well as other harsh laxatives. There have been more than 15 studies assessing Lactitol’s potential as a digestive aid. In the majority of these studies the subjects were adults and elderly, while there is also some clear evidence for Lactitol as a digestive aid in children.

3.1 Lactitol laxative mechanism of action

Lactitol has two main mechanisms of action in constipated patients:

• It is minimally absorbed in the small intestine and thus reaches the large intestine where it is broken down into short chain fatty acids (lactic, acetic, propionic and butyric acid etc.) by bacterial degradation. This lowers colonic pH and stimulates peristalsis (the rippling and wave-like motion that contract and relax the bowel muscles).
• Degradation to short chain fatty acids (SCFA) also increases the osmotic pressure in the intestinal lumen. A dosedependent acceleration of colonic transit results from an increase in faecal volume due to intraluminal water retention and enhanced intestinal peristalsis. (Schiller, 2001).

n addition, since Lactitol is a source of carbohydrate and energy for saccharolytic bacteria, their presence as biomass can be expected in the intestine. This could result in an increased bowel filling volume and further stimulation of the bowel function.

[Table 1: Studies reporting Lactitol as a laxative in adult population]

[Table 2: Studies using Lactitol as a laxative in children]

4.1 Lactitol vs. lactulose: Same efficacy with fewer side effects

When Lactitol was used in studies as a direct comparison to lactulose, bowel movements per week increased in 1 out of 2 studies (Doffoel et al., 1990; Table 3). In another study conducted by Hammer and Ravelli (Hammer and Ravelli, 1992; Figure 7), although there was no significant difference between Lactitol and lactulose and bowel movement per week, 63% of the subjects on the lactulose treatment reported adverse effects, as opposed to 30% of the subjects receiving Lactitol. It must be pointed out that the subjects on Lactitol treatment were on a lower dosage than the subjects receiving lactulose after the first three days of the study (10 g vs. 13.4 g/day respectively).

Dr. Amit Maydeo from the Institute of Advanced Endoscopy in Mumbai, India, carried out a metanalysis of six clinical trials comparing Lactitol vs lactulose. These studies included 349 adult patients with a mean age of 19 to 85 years of age and 81 children ranging from 8 months to 16 years of age. The duration period for these trials was ranging between 3 days to 4 weeks. (Maydeo et al., 2010)

As a conclusion of the metanalysis a comparable efficacy was attributed to Lactitol vs. lactulose. In addition, the individuals that took part in the clinical trials, reported greater tolerability of Lactitol when it came to unnecessary adverse effects while Lactitol was also widely accepted as the preferred laxative over lactulose. This, together with Lactitol’s excellent palatability profile over lactulose gave Lactitol a superior image through this metanalysis (Figure 8).

4.2 Lactitol overall superior results compared to paraffin

In a study looking at 110 patients who had undergone anal surgery, subjects were either provided Lactitol (n=55) (20 g/day), or paraffin (n=55) (15 g twice a day, so 30 g/day) for 7 days. It was observed that Lactitol was overall superior to the results of paraffin on the number of bowel movements per day and efficacy of evacuation right after surgery. The effective dose for patients receiving Lactitol was also lower (16 g/day) than that of paraffin (i.e Cope et al., 1996; Table 3).

[Table 3: Compilation table of studies using Lactitol vs other laxatives]

4.3 Lactitol as an alternative to harsh laxatives in elderly

Idiopathic constipation is an issue for many adults and they will go to different lengths to relieve the symptoms, even if it is with the use of harsh laxatives. Such individuals may also invoke a cycle of laxative abuse. Vanderdonckt and Ravelli (Vanderdonckt and Ravelli, 1993) in a six week study with 10 subjects suffering from chronic idiopathic constipation, offered Lactitol as an alternative to harsh laxatives for weeks 3-6. The first two weeks were used to evaluate the subjects without any intervention, simply documenting the subjects’ harsh laxative use vs. the number of bowel movements per week. In particular, Lactitol treatment increased the mean number of bowel movements to 2.83 per week from 2.00.

Because of the nature of these patients (i.e. their chronic laxative use) the dose that the subjects were given per day was four sachets of Lactitol, with each sachet containing 10 g Lactitol. Therefore, 40 g of Lactitol was provided to the patients for consumption with breakfast and this was open to adjustment by the subjects depending on their experience with the newly introduced laxative.

After one week of Lactitol consumption (40 g/day) individual adjustments were performed as follows: 3 patients continued their initial dose of four sachets/day (40 g/day), 4 patients reduced to three sachets/day after one (2 patients), two (1 patient) and three weeks (1 patient) and another patient reduced the dosage to two sachets (20 g/day) after the first week. Two patients reduced the dose immediately to three sachets and reverted back once the abdominal effects had disappeared.

Overall, the patients preferred the use of Lactitol as an alternative to other harsh cathartics which they had been using for years.

Lactitol is taken orally and can be ingested by people of all age groups without any concerns regarding their health. The dosages specified herein are meant to act as a guideline only and will need to be adjusted to meet individual requirements of the patient depending on severity and development of the constipation. Lactitol dosage in children should always be decided by a clinical professional or a trained physician.

*To be determined by a health professional