Uncovering Lactitol: More Than Just a Sweetener

Toilet paper roll on a wall.
  • Lactitol is a sugar alcohol that’s both an artificial sweetener and a drug used to treat certain health conditions.
  • Doctors may prescribe lactitol to treat conditions like chronic idiopathic constipation, hemorrhoids, or hepatic encephalopathy.
  • Lactitol has been approved by the United States Food and Drug Administration (FDA) for use in nonpregnant adults only.
  • Lactitol may not be suitable for some people, including those with intestinal obstructions, galactosemia, or a history of abusing laxatives.

If you’re one of approximately 141.18 million Americans using sugar substitutes, you may be interested in lactitol and its health benefits.

Lactitol is a unique sugar alternative that can be used to treat constipation, diabetes, and other health conditions.

Keep reading to discover why this drug is effective, how it works, who should use it, and its potential benefits and side effects.

What is Lactitol?

Lactitol is a sugar alcohol synthesized from lactose and can be used as an artificial sweetener and laxative. It’s only about 40% as sweet as common sugar (sucrose), yet it tastes similar.

This makes it a viable substitute in many foods and beverages where sugar is traditionally used. At only two calories per gram, it carries half the calories of regular sugar.

Since the digestive system doesn’t fully absorb lactitol, it contributes less to overall calorie intake.

This allows you to enjoy its sweet flavor with a reduced risk of weight gain compared to regular sugar consumption.

Can lactitol cause tooth decay?

Lactitol is beneficial for dental health as it resists breakdown by mouth bacteria, unlike regular sugar.

These bacteria typically convert regular sugar into acid, causing tooth enamel erosion and decay.

However, lactitol doesn't produce such harmful acids, thus protecting your teeth from decay. This makes it a great sugar alternative for both oral health and calorie control.

What are the Medical Uses of Lactitol?

Lactitol is not only a low-calorie sweetener that can be purchased at the grocery store; it also has medicinal properties and can be used for:

Constipation treatment

In medicine, lactitol is primarily used to treat constipation in adults, particularly in the case of chronic idiopathic constipation — constipation without a known medical cause.

Lactitol functions as an osmotic laxative, utilizing its osmotic effect to create a hyperosmotic environment in the gut. This process draws water into the intestine.

This process facilitates smoother passage of stool through the digestive system.

Osmotic laxatives like lactitol, and sometimes stimulant laxatives, are often considered a first-line therapy for treating constipation.

Marketed under the brand name Pizensy®, lactitol has been approved by the FDA for the treatment of chronic idiopathic constipation and is available in powder form.

Oral lactitol powder can be purchased in either single-dose sachets or multi-dose bottles, providing flexibility and convenience.

However, it's important to note that the safety of lactitol for children has not yet been established, and its FDA approval is currently limited to nonpregnant adults.

Hepatic encephalopathy management

Hepatic encephalopathy is a disorder caused by liver failure.

Under normal circumstances, the liver plays a crucial role in detoxifying the body by converting ammonia — a byproduct of bodily processes and gut bacteria — into a less harmful substance called urea.

This conversion is vital, as ammonia is toxic, particularly to the brain.

In liver failure, the impaired detoxification process leads to an accumulation of ammonia, because gut bacteria convert urea back into ammonia, which is then reabsorbed by the body.

High ammonia levels can significantly impair brain function, highlighting the liver's role in neurological health and the need to manage ammonia levels in patients with liver failure.

Lactitol accelerates the movement of substances such as urea through the gut, reducing ammonia reabsorption.

Additionally, it creates a more acidic environment in the gut, which aids in lowering ammonia production and overall levels, thus helping to decrease the risk of brain dysfunction associated with liver failure.

Diabetes management

Lactitol is a beneficial alternative to table sugar for people with diabetes due to its sweet taste and unique absorption properties.

Unlike regular sugar, lactitol is poorly absorbed by the gut, leading to a decreased impact on blood sugar levels.

This attribute makes it a safer option for diabetics who need to manage their blood glucose meticulously.

The reduced spike in blood sugar from lactitol aids in maintaining stable blood sugar levels. This is crucial for the daily management of diabetes, where fluctuating glucose levels can have significant health effects.

However, it's essential for those with diabetes to approach dietary changes, including the use of lactitol, with caution and under the guidance of a healthcare professional.

Hemorrhoid or anal fissure treatment

Osmotic laxatives such as lactitol can be used as an additional treatment when someone has hemorrhoids or fissures.

Lactitol softens the stool by drawing water into it, which ultimately facilitates bowel movements.

Since hemorrhoids and anal fissures are often a result of constipation, addressing constipation is crucial for both the relief of current symptoms and the prevention of future occurrences.

By improving stool consistency and regularity, lactitol not only provides symptomatic relief, but also plays a key role in the overall management and prevention of these conditions.

How Should I Use Lactitol?

When using lactitol, always adhere to the specified dosage and directions for safe usage and effective results.

The standard recommended dose is 20 grams daily, ideally taken with meals for optimal effectiveness. However, this dosage may be reduced if you experience overly loose stools.

How to prepare lactitol

Mix 10–20 grams of lactitol powder with water or another beverage of your choice, such as juice or tea.

Lactitol should be used once daily and other medications should not be taken within 2 hours of its use.

This is because lactitol accelerates the passage of substances through the gut, which could impact the absorption of other medications if they’re taken too closely together.

When should I take a lower dose of lactitol?

The lower 10-gram dose is recommended if your stool becomes too loose.

In cases of persistently loose stools, it's advisable to stop using lactitol and consult a healthcare provider for further guidance before continuing the medication.

What are the Side Effects of Lactitol?

Most of the side effects of lactitol are due to the body’s inability to digest it. Lactitol reaches the gut where certain bacteria in the colon can digest it.

The bacteria ferment the lactitol, causing it to become more active and draw water into the gut. This can enhance its laxative effects and cause stomach pain and other side effects. Here are some common side effects of lactitol:

  • Diarrhea

  • Flatulence

  • Abdominal pain

  • Abdominal distension (swelling or protruding of the abdomen)

  • Increased blood pressure

  • Upper respiratory tract infections

Key Point: Lactitol Side Effects vs. Lactose Intolerance

The side effects listed above are similar to those experienced by people with lactose intolerance.

Much like the mechanism of lactitol, individuals with lactose intolerance are unable to completely digest and absorb lactose. This leads to lactose attracting water into the intestine, resulting in a watery stool.

Additionally, bacteria in the colon ferment the undigested lactose, leading to gas production (resulting in flatulence), drawing additional water into the intestine, and causing diarrhea and bloating.

Interactions: What Should I Not Be Taking with Lactitol?

When using lactitol, avoid taking other oral medications simultaneously, as they may not be absorbed properly.

It's advisable to wait at least 2 hours before and after taking lactitol to use other medications.

You should also exercise caution with other laxatives, as their combined use with lactitol could lead to severe diarrhea and gastrointestinal issues. Always consult a healthcare professional before using lactitol alongside any other medications, including different laxatives.

Who Should Not Be Using Lactitol?

Lactitol may not be suitable for certain individuals. If you’re using lactitol as a sugar substitute and experience digestive issues or laxative effects, it’s best to explore other sugar alternatives.

If your doctor has prescribed lactitol and you experience adverse effects, contact them as soon as possible.

Individuals who may want to avoid using lactitol include:

  • People with undiagnosed constipation: Those who have not been evaluated by a doctor to determine the cause of their constipation

  • Those with intestinal obstructions: This includes impacted stools, tumors, nonfood objects that were swallowed or inserted rectally, adhesions (scars), or hernias. Constipation caused by something physically blocking the intestine cannot be treated with laxatives alone, as the passage is completely blocked

  • Individuals with diarrhea

  • People who have galactosemia (a genetic disorder where the body can’t process a component of lactitol called galactose)

  • Those who have had a previous allergic reaction to lactitol

  • People with a history of abusing laxatives, for example, those with bulimia nervosa

Lactitol in Pregnancy and Breastfeeding

Because lactitol is not well-digested or absorbed into the blood, it shouldn’t pose a risk to a developing fetus in pregnancy. Additionally, animal studies haven’t shown evidence of harm to developing fetuses.

However, keep in mind that there are no directions for use during pregnancy and the FDA hasn’t established a pregnancy category for this medication yet. Pregnant women should always consult their healthcare provider before taking medication and weigh up the potential risks and benefits of using lactitol during pregnancy.

What are Some Lactitol Alternatives?

It’s important to note that this medication is not the only treatment for constipation — there are many other options available.

Lifestyle modification is important for managing chronic idiopathic constipation.

Increasing fluid and fiber intake should be discussed with your doctor as a possible treatment before or in conjunction with medication.

Here are some osmotic laxatives your doctor may prescribe instead of lactitol:

  • Lactulose (Duphalac®)

  • Sorbitol (Numoisyn®)

  • Polyethylene glycol/PEG (Gavilax®, Glycolax®, Miralax®)

Stimulant laxatives

These laxatives are also considered by some healthcare providers as a first-line drug treatment for chronic idiopathic constipation.

They work by stimulating the nerves inside the intestine to increase the water content of stool and also increase the rate of peristalsis (involuntary contractions that move food or waste along the gastrointestinal tract).

This allows for faster movement of stool through the digestive system. Some of these medications are available in herbal tea preparations.

Some stimulant laxatives your doctor may prescribe include:

  • Senna (Innerclean®, Senexon®, Senokot®, Swiss Kriss®, Fletcher’s Castoria®, X-Rep®)

  • Bisacodyl (Dulcolax®, Magic Bullet®, Correctol®)

  • Cascara (Nature’s Remedy®)

Where Can I Learn More About Lactitol and Similar Medications?

Have you been struggling with constipation or one of the other conditions mentioned in this article and think lactitol may help? Visit LifeMD to speak to a licensed medical professional.

A team of healthcare professionals can help diagnose and treat your condition to provide fast relief and prevent long-term health complications. Book your appointment today to get started.

Harmony Vance, APRN

Harmony is a family nurse practitioner and has been caring for patients for over 20 years through various roles in the medical field. She graduated in 2018 with a Master's Degree and a focus on family care.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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