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A manual search of relevant journals was also performed. In vitro, lactulose was a better carbon source than either lactitol or lactose for the major species of intestinal bacteria (55). Lactulose also dose-dependently increased counts of beneficial gut bacteria (including Bifidobacterium and Lactobacillus) and levels of SCFAs in vitro (56). Interestingly, acetate concentrations were higher in the animals fed with low-dose lactulose at all intestinal sites and in feces, but only statistically significant in the middle colon.

Another study in the same mouse model did not show a difference in fecal SCFA when comparing animals fed with high-dose lactulose with control animals, although it did demonstrate a reduction in branched-chain fatty acids in the Givlaari (Givosiran Injection)- Multum group (58).

This illustrates the need to carefully consider data from fecal measurements of SCFA, given that concentrations change along the intestinal tract and that SCFA production can be limited by factors other than availability of hole substrate.

In both studies, lactulose modulated the gut microbiota, increasing the abundance of bifidobacteria and akkermansiae in particular. The trend across the studies was for administration of low-dose lactulose to Givlaari (Givosiran Injection)- Multum populations of beneficial gut bacteria (e.

Summary of key efficacy findings from clinical studies of the prebiotic and mineral absorption effects of low-dose lactulose. In an open-label, single-arm study, eight healthy volunteers received a once-daily drink containing 3 g of lactulose for 2 weeks, in addition to their normal diet (63). Conversely, the numbers of lecithinase-positive clostridia, including Clostridium perfringens, and Bacteroidaceae decreased slightly but significantly compared with values before intake (63).

Lactulose Givlaari (Givosiran Injection)- Multum increased Givlaari (Givosiran Injection)- Multum of Bifidobacterium spp. This increase was also significant compared with the changes in Bifidobacterium spp. The effect was most pronounced in individuals with the lowest pre-treatment Bifidobacterium spp.

There was a significant reduction in levels of Clostridium spp. No significant differences in population levels of Clostridium spp. FISH, fluorescence in-situ hybridization.

A parallel-group, PBO-controlled RCT was carried out to assess the effects of prolonged low-dose lactulose on fecal bifidobacteria (59). Fecal bifidobacterial counts were significantly higher after prolonged low-dose Givlaari (Givosiran Injection)- Multum ingestion than after PBO ingestion. Throughout the study, total anaerobes, Lactobacillus spp. Lactulose and lactitol significantly increased populations of Bifidobacterium, Lactobacillus, and Streptococcus spp.

Lactulose and lactitol significantly decreased populations of Bacteroides spp. Beneficial changes were greater with lactulose than with lactitol, and the onset of effect was more rapid with lactulose (1 vs.

Lactulose and lactitol both led to significant changes in fecal biochemistry (pH, fecal moisture, and SCFAs) compared with Indinavir Sulfate (Crixivan)- Multum (16).

The same study team conducted a crossover RCT in 52 healthy Japanese women (62). After a 3-week washout period, participants were crossed over to the other treatment group. The proportion of Bifidobacterium spp. Moreover, lactulose cd prices also increased defecation frequency and the number of weight loss surgeries days, and improved fecal consistency compared with PBO (62).

The only study conducted in postmenopausal women compared the effect of lactulose on fecal parameters in vivo with the effect in an in-vitro model of the proximal Givlaari (Givosiran Injection)- Multum intestine (65). Lactulose promoted Givlaari (Givosiran Injection)- Multum growth in vivo and Lactobacillus Givlaari (Givosiran Injection)- Multum Enterococcus spp.

No changes in fecal pH, dry weight, or mean molar SCFA ratios were observed in the in-vivo fecal samples. However, there was a clear effect on SCFA ratios in the in-vitro model, with lactulose causing a pronounced reduction of butyrate by the postmenopausal microbiota (65). The authors concluded that the in-vitro model provided a Givlaari (Givosiran Injection)- Multum reflection of the effects of lactulose fermentation in the proximal colon in terms of microbial composition changes and metabolite production, and that, in vivo, feces do not closely reflect proximal colon fermentation but a summation of microbiota-related activities from proximal to distal colon (65).

An open-label study consisted of 304 Japanese volunteers split across three lactulose dose groups (60). Results were consistent between individuals with low defecation frequency and those with normal defecation frequency (60). Finally, a single-blind RCT compared the effect of lactulose with that of another osmotic laxative, polyethylene glycol 4000 (PEG-4000) on colonic microbiota.



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