Skip to main content
SpringerLink
Log in

Comparison of Diarrhea Induced by Ingestion of Fructooligosaccharide Idolax and Disaccharide Lactulose (Role of Osmolarity Versus Fermentation of Malabsorbed Carbohydrate)

  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Whether carbohydrate malabsorption causesdiarrhea probably depends on the balance between theosmotic force of the carbohydrate and the compensatorycapacity of the colon to dispose of the carbohydrate by bacterial fermentation. The present studyevaluated the specific role of the osmolarity bycomparing the severity of diarrhea after ingestion oftwo nonabsorbable carbohydrates, thefructooligosaccharide Idolax and the disaccharide lactulose. Bothcarbohydrates are readily fermented by the colonic florabut differ in osmolarity, the osmotic force being twiceas high for lactulose as for Idolax. Twelve subjects were given increasing doses (0, 20, 40, 80, 160g/d) of Idolax and lactulose in a crossover design.Every dose level was administered for three days withintervals of one week. Stools were collected on the third day to determine 24-hr volume,concentrations of short-chain fatty acids, L- andD-lactate, residues of Idolax or lactulose, sodium,potassium, pH, osmolarity, and in vitro productions oforganic acids. Measured by short-chain fatty acid andlactate formation in a fecal incubation system, thefermentation of Idolax and lactulose was identical andvery rapid compared with a range of referencecarbohydrates. A laxative effect of both Idolax and lactulosewas demonstrated. The increment in fecal volume as afunction of the dose administered was twice as high forlactulose (slope of the regression line = 7.3, r = 0.64, P < 10-5) as for Idolax(slope = 3.7, r = 0.51, P < 10-3), i.e.,isosmolar doses of lactulose and Idolax had the sameeffect on fecal volume. The variation in fecal volumewas substantial (lactulose 80 g/day: 110-1360 g/day; Idolax 160g/day: 130-1440 g/day). High responders had earlier andlarger fecal excretions of the saccharide compared withlow-responders. Fecal volume in carbohydrate-induced diarrhea is proportional to the osmotic forceof the malabsorbed saccharide, even though all or themajority of the saccharide is degraded by colonicbacteria. The capacity to modify the diarrhea varies considerably from person to person and isassociated with colonic saccharide disposal, whereas thevariation in response to isosmolar amounts of differentsaccharides is small within the sameindividual.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Cummings JH, Macfarlane GT: The control and consequence s of bacte rial fermentation in the human colon. J Appl Bacte riol 70:443-459, 1991

    Google Scholar 

  2. McNeil NI, Cummings JH, James WPT: Short chain fatty acid absorption by the human large intestine. Gut 19:819-822, 1978

    Google Scholar 

  3. McNeil NI, Cummings JH, Jame s WPT: Re ctal absorption of short chain fatty acids in the absence of chloride. Gut 20:400 - 403, 1979

    Google Scholar 

  4. Ruppin H, Bar-Meir S, Soerge l KH, Wood CM, Schmitt MG Jr: Absorption of short-chain fatty acids by the colon. Gastroente rology 78:1500-1507, 1980

    Google Scholar 

  5. Florent C, Flourié B, Leblond A, Rautureau M, Be rnier JJ, Rambaud JC: Influence of chronic lactulose ingestion on the colonic me tabolism of lactulose in man (an in vivostudy). J Clin Invest 75:608-613, 1985

    Google Scholar 

  6. Hove H, Mortensen PB: Colonic lactate metabolism and Dlactate acidosis. Dig Dis Sci 40:320-330, 1995

    Google Scholar 

  7. Bustos D, Pons S, Pe rnas JC, Gonzalez H, Caldarini MI, Ogawa K, de Paula JA: Fecal lactate and short bowel syndrome. Dig Dis Sci 39:2315- 2319, 1994

    Google Scholar 

  8. Saunde rs DR, Wiggins HS: Conservation of mannitol, lactulose, and raffinose by the human colon. Am J Physiol 241:G397- G402, 1981

    Google Scholar 

  9. Argenzio RA, Moon HW, Keme ny LJ, Whipp SC: Colonic compensation in transmissible gastroenteritis of swine. Gastroente rology 86:1501- 1509, 1984

    Google Scholar 

  10. Hamme r HF, Santa Ana CA, Schiller LR, Fordtran JS: Studies of osmotic diarrhea induced in normal subjects by ingestion of polyethylene glycol and lactulose. J Clin Invest 84:1056-1062, 1989

    Google Scholar 

  11. Holtug K, Clausen MR, Hove H, Christiansen J, Mortensen PB: The colon in carbohydrate malabsorption: Short-chain fatty acids, pH, and osmotic diarrhoea. Scand J Gastroente rol 27:545- 552, 1992

    Google Scholar 

  12. Dahlqvist A, Gryboski JD: Inability of the human smallintestinal lactase to hydrolyze lactulose. Biochim Biophys Acta 110:635- 636, 1965

    Google Scholar 

  13. Carulli N, Salvioli GF, Manenti F: Absorption of lactulose in man. Digestion 6:139-145, 1972

    Google Scholar 

  14. Molis C, Flourié B, Ouarne F, Gailing MF, Lartigue S, Guibert A, Bornet F, Galmiche JP: Dige stion, excre tion, and ene rgy value of fructooligosaccharide s in healthy humans. Am J Clin Nutr 64:324-328, 1996

    Google Scholar 

  15. Roberfroid M: Dietary fiber, inulin, and oligofructose: A re view comparing their physiological e ffects. Crit Rev Food Sci Nutr 33:103-148, 1993

    Google Scholar 

  16. Chauve A, Devroe de G, Bastin E: Intraluminal pressure s during perfusion of the human colon in situ. Gastroenterology 70:336-340, 1976

    Google Scholar 

  17. Mortensen PB, Hove H, Clausen MR, Holtug K: Ferme ntation to short-chain fatty acids and lactate in human faecal batch cultures. Intra-and inter-individual variations ve rsus variations caused by change s in fermented saccharide s. Scand J Gastroente rol 26:1285–1294, 1991

    Google Scholar 

  18. Zijlstra JB, Beukema J, Wolthers BG, Byrne BM, Groen A, Danke rt J: Pre treatme nt me thods prior to gas chromatographic analysis of volatile fatty acids from faecal samples. Clin Chim Acta 78:243-250, 1997

    Google Scholar 

  19. Gutmann I, Wahle feld AW: Lactate determination with lactate dehydrogenase and NAD. InMethods of Enzymatic Analysis. HU Be rgme ye r (ed). New York, Academic Press, 1974, pp 1464-1468

    Google Scholar 

  20. Weije rs HA, van de Kame r JH, Dicke WK, Ijsseling J: Diarrhoea cause d by deficiency of sugar splitting enzyme s. Acta Paediatr 50:55-71, 1961

    Google Scholar 

  21. Haemmerli UP, Kistler H, Ammann R, Marthale r T, Semenza G, Auricchio S, Prader A: Acquired milk intolerance in the adult cause d by lactose malabsorption due to a sele ctive deficiency of intestinal lactase activity. Am J Med 38:7-30, 1965

    Google Scholar 

  22. Bustos Fe rnández L, Gonzalez E, Marzi A, de Paolo MIL: Fe cal acidorrhea. N Engl J Med 284:295-298, 1971

    Google Scholar 

  23. Christopher NL, Bayle ss TM: Role of the small bowel and colon in lactose-induced diarrhe a. Gastroenterology 60:845- 852, 1971

    Google Scholar 

  24. Read NW, Kre js GJ, Read MG, Santa Ana CA, Morawski SG, Fordtran JS: Chronic diarrhea of unknown origin. Gastroenterology 78:264-271, 1980

    Google Scholar 

  25. Wang X, Gibson GR: Effects of the in vitrofermentation of oligofructose and inulin by bacteria growing in the human large intestine. J Appl Bacte riol 75:373-380, 1993

    Google Scholar 

  26. Stone-Dorshow T, Levitt MD: Gaseous response to ingestion of a poorly absorbed fructo-oligosaccharide swee tener. Am J Clin Nutr 46:61-65, 1987

    Google Scholar 

  27. Birche r J, Müller J, Gugge nheim P, Haemme rli UP: Treatment of chronic portal-systemic encephalopathy with lactulose. Lance t 1:890-893, 1966

    Google Scholar 

  28. Perman JA, Modler S, Olson AC: Role of pH in production of hydrogen from carbohydrate s by colonic bacte rial flora. Studies in vivoand in vitro .J Clin Inve st 67:643-650, 1981

    Google Scholar 

  29. Mortensen PB, Holtug K, Bonné n H, Clausen MR: The degradation of amino acids, proteins, and blood to short-chain fatty acids in colon is prevented by lactulose. Gastroenterology 98:353-360, 1990

    Google Scholar 

  30. Cummings JH, Pomare EW, Branch WJ, Naylor CPE, Mac-Farlane GT: Short chain fatty acids in human large intestine, portal, hepatic and venous blood. Gut 28:1221-1227, 1987

    Google Scholar 

  31. Mortensen PB, Andersen JR, Arffmann S, Krag E: Short-chain fatty acids and the irritable bowel syndrome: The effect of wheat bran. Scand J Gastroente rol 22:185-192, 1987

    Google Scholar 

  32. Lewis SJ, He aton KW: Increasing butyrate concentration in the distal colon by accele rating intestinal transit. Gut 41:245-251, 1997

    Google Scholar 

  33. Launiala K: The mechanism of diarrhoea in congenital disaccharide malabsorption. Acta Pœdiatr Scand 57:425-432, 1968

    Google Scholar 

  34. Bond JH, Levitt MD: Quantitative measurement of lactose absorption. Gastroente rology 70:1058-1062, 1976

    Google Scholar 

  35. Flourié B, Brie t F, Florent C, Pe llier P, Maurel M, Rambaud JC: Can diarrhea induced by lactulose be reduced by prolonged ingestion of lactulose? Am J Clin Nutr 58:369-375, 1993

    Google Scholar 

  36. Phillips SF, Giller J: The contribution of the colon to e lectrolyte and water conse rvation in man. J Lab Clin Med 81:733- 746, 1973

    Google Scholar 

  37. Debongnie JC, Phillips SF: Capacity of the human colon to absorb fluid. Gastroenterology 74:698-703, 1978

    Google Scholar 

Download references

Authors
  1. Mette Rye Clausen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jimmy Jorgensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Per Brobech Mortensen
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clausen, M.R., Jorgensen, J. & Mortensen, P.B. Comparison of Diarrhea Induced by Ingestion of Fructooligosaccharide Idolax and Disaccharide Lactulose (Role of Osmolarity Versus Fermentation of Malabsorbed Carbohydrate). Dig Dis Sci 43, 2696–2707 (1998). https://doi.org/10.1023/A:1026659512786

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1026659512786

Search

Navigation