Doctors - Bah!!!!

[Guest guest]

Well folks, just got home from another doctor appointment. He's going to be handling the T P workup - sent me for more blood tests from alphafetelprotein to CBC. The girls at the lab always shake in their boots when they see me, my veins are so bad. This time they needed to take about 10 vials - it took two of them to do it, one to find the vein & one to change the tubes. Fun. Dr Idiot is setting up an ultrasound & will call me with the date. The G I will call me when he has the results in, then we go on for more testing - heart, kidleys etc. Naturally my diabetes complicates things. Now we sit & wait. SuZie

Next time I'm coming back as a cat

[Guest guest]

Gail, I just wish they'd all get on the same page. My family doc said to take 150 ml of Lactulose/day, then I saw Dr Idiot who said too much & said take 5 or 6 tablespoons/daily(1 tbsp = 5 ml) So I'm splitting the difference & taking 90 ml/day. Am I the only one who finds it strange to be taking a laxative for my brain? I saw the G I & he gave me a prescription for some cholesterol powder that you mix in juice. My cholesterol is fine thank you, it's for the itchies???? Go figure. Why do my doctors keep giving me stuff off label? or at the very bottom of the label??? They're gonna drive me nuts!! I go to pick up the script & the pharmacist wants to talk to me cause it's the first time I've had this med so she starts telling me how to take it etc - like I can't read the label - then

she tells me that it can cause constipation. GREAT - then I'll have to up the lactulose !!! DOCTORS AAAAAARRRRRRGGGGGGHHHHHH, I'd better make an appointment with the pshrink before I start trying to buy a gun & go through the hospital taking target practice. SuZiegail <gaila@...> wrote: They have been getting you to sit and wait for years. Can't they get a little more original and really shock you and just get thing

done. Gail

Next time I'm coming back as a cat

[Guest guest]

They have been getting you to sit and wait for years.

Can't they get a little more original and really shock you and just get thing done.

Gail

-----Original Message-----From: Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of suzieSent: April 21, 2006 1:34 PMHepatitis Cfordummies Subject: Doctors - Bah!!!!

Well folks, just got home from another doctor appointment. He's going to be handling the T P workup - sent me for more blood tests from alphafetelprotein to CBC. The girls at the lab always shake in their boots when they see me, my veins are so bad. This time they needed to take about 10 vials - it took two of them to do it, one to find the vein & one to change the tubes. Fun.

Dr Idiot is setting up an ultrasound & will call me with the date. The G I will call me when he has the results in, then we go on for more testing - heart, kidleys etc. Naturally my diabetes complicates things. Now we sit & wait.

SuZie

Next time I'm coming back as a cat

[Guest guest]

Waiting sucks, but I'm so glad you are doing what you need to do to stick around, sweetness. Conniesuzie <suzieandsandy@...> wrote: Well folks, just got home from another doctor appointment. He's going to be handling the T P workup - sent me for more blood tests from alphafetelprotein to CBC. The girls at the lab always shake in their boots when they see me, my veins are so bad. This time they needed to take about 10 vials - it took two of them to do it, one to find the vein

& one to change the tubes. Fun. Dr Idiot is setting up an ultrasound & will call me with the date. The G I will call me when he has the results in, then we go on for more testing - heart, kidleys etc. Naturally my diabetes complicates things. Now we sit & wait. SuZie Next time I'm coming back as a cat The light at the end of the tunnel may be you

[Guest guest]

Ditto what mamma Gail said...Hugs, Pat

RE: Doctors - Bah!!!!

We are all happy to hear Suzies news.This group has special people in it and I personally want to keep you all around forever.

Gail

-----Original Message-----From: Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of connie mcclainSent: April 24, 2006 9:25 AMHepatitis CSupportGroupForDummies Subject: Re: Doctors - Bah!!!!Waiting sucks, but I'm so glad you are doing what you need to do to stick around, sweetness. Conniesuzie <suzieandsandy@...> wrote:

Well folks, just got home from another doctor appointment. He's going to be handling the T P workup - sent me for more blood tests from alphafetelprotein to CBC. The girls at the lab always shake in their boots when they see me, my veins are so bad. This time they needed to take about 10 vials - it took two of them to do it, one to find the vein & one to change the tubes. Fun.

Dr Idiot is setting up an ultrasound & will call me with the date. The G I will call me when he has the results in, then we go on for more testing - heart, kidleys etc. Naturally my diabetes complicates things. Now we sit & wait.

SuZie

Next time I'm coming back as a cat

The light at the end of the tunnel may be you

[Guest guest]

I am on the powder stuff for cholesteral and it doesn't contipate me,on the contrary I go more.So wait and see cause a drug will act different with everyone.

Gail

-----Original Message-----From: Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of suzieSent: April 23, 2006 6:08 PMHepatitis CSupportGroupForDummies Subject: RE: Doctors - Bah!!!!

Gail, I just wish they'd all get on the same page. My family doc said to take 150 ml of Lactulose/day, then I saw Dr Idiot who said too much & said take 5 or 6 tablespoons/daily(1 tbsp = 5 ml) So I'm splitting the difference & taking 90 ml/day. Am I the only one who finds it strange to be taking a laxative for my brain?

I saw the G I & he gave me a prescription for some cholesterol powder that you mix in juice. My cholesterol is fine thank you, it's for the itchies???? Go figure. Why do my doctors keep giving me stuff off label? or at the very bottom of the label??? They're gonna drive me nuts!! I go to pick up the script & the pharmacist wants to talk to me cause it's the first time I've had this med so she starts telling me how to take it etc - like I can't read the label - then she tells me that it can cause constipation. GREAT - then I'll have to up the lactulose !!!

DOCTORS AAAAAARRRRRRGGGGGGHHHHHH, I'd better make an appointment with the pshrink before I start trying to buy a gun & go through the hospital taking target practice.

SuZiegail <gaila@...> wrote:

They have been getting you to sit and wait for years.

Can't they get a little more original and really shock you and just get thing done.

Gail

Next time I'm coming back as a cat

[Guest guest]

We are all happy to hear Suzies news.This group has special people in it and I personally want to keep you all around forever.

Gail

-----Original Message-----From: Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of connie mcclainSent: April 24, 2006 9:25 AMHepatitis CSupportGroupForDummies Subject: Re: Doctors - Bah!!!!Waiting sucks, but I'm so glad you are doing what you need to do to stick around, sweetness. Conniesuzie <suzieandsandy@...> wrote:

Well folks, just got home from another doctor appointment. He's going to be handling the T P workup - sent me for more blood tests from alphafetelprotein to CBC. The girls at the lab always shake in their boots when they see me, my veins are so bad. This time they needed to take about 10 vials - it took two of them to do it, one to find the vein & one to change the tubes. Fun.

Dr Idiot is setting up an ultrasound & will call me with the date. The G I will call me when he has the results in, then we go on for more testing - heart, kidleys etc. Naturally my diabetes complicates things. Now we sit & wait.

SuZie

Next time I'm coming back as a cat

The light at the end of the tunnel may be you

[Guest guest]

Hi SuZie. Deliman here. Is this your first TP? I'm cleared for take off. They said a liver can stay "fresh" for about a hrs.. Are you like ...ready?? Is there a donor available? God Bless you.... The anesthesiologist normally sticks the drug catheter in my neck, at my request, Some get offended when I do this, ( I guess that don't like from a rookie) so it takes a couple of pokes first then kinda' begrudgingly do what you knew was right all along. It's SOOOooomuch easier and I tend not to "mess it up when turning over or performing post op tricks. I used to be a jugular (pun intended!!) My MELD is 10, which I understand means a 'fairly healthy Liver". What is you MELD??When I walk into Vladimir the Impaler's office, they all say uh-oh..here's

hard stick, It generally takes 8-10 pokes before i slap the S(^ & $ outta' someone and say give me the needle.!! Not really ..It's all good... Mine are not only hard to find but (I'm sure like yours...) roll when the needle starts to stick. We are both in the "Holding Pattern.. Did you know the song by Cross (If you get caught between the moon and New York City, was actually about being stuck in a holding pattern?I think they pass out free booze and he wrote the song, made famous for the theme from Arthur, about a mixed up kazillionaire man/child. I doubt if this makes you feel any better but maybe you'll laugh a little. Due to the Ammonia and water retention in general, I have developed man breastsss, SMALL. but there). My doc said it was no problem and normal and I told him he didn't understand..

I really like breastsss and if my man breastssss got any lager, I would have no reason to ever leave the the house and co-mingle. HAHAHAHA! One more "funny" thing happened today. There was a commercial on the boob tube (did I say that??) JEEZ... about the new leaner easier cheaper SS Medicare Plan and that Aetna could help do all my paperwork and I could order 3 mos. supply at a time on some. I already know that that once your accepted by MEDICARE (FEDS) you stop getting MEDICARE..in Texas, and don't get any drugs help or food...if you fit a category. I'm single and rich according to them, therefore I have to wait. The Atnea rep said that was and incorrect. crazy and I had Had ( and still do) the book and read if for him word for word, on a conference call with the Social Security Rep. My source is the most recent

publication about Medicare.One must enroll three months before the two year wait is up. Anyone can call 1-800-MEDICARE or www.medicare.gov for a package of rules----- Even though full retirement age is no longer 65 you should sign up 43 mos before age 65.. Social Security Disability Benefits, Pub.No. 05-10029 ICN456000 page 12 ........... You will get Medicare coverage automatically after you have received disability benefits for two years. I asked the Rep at SOC. SEC Office ( still om conference with Attna) why a 2 yr wait? She said it was the law. I said OK...but not what is it ...WHY is it??.. She said she was only reading the information she had. I asked how can I change this ridiculous rule??... Call your Congress person. I told her I believed the only people

that benefited from this is the government, and the (Third Party) paper pushers Doctors don't like it,, patients need the drugs NOW! Not in 2 years!! Pharmacies don't like it, (Sales will plummet) Pharmacists will feel the after effect from lost sales..(No Jobs) The one I feel the worst for, (beside the patient) is the part time Highschooler that rings up orders and is forced by the government to tell MR. MRS> Ms. 123 America St...." I know we have always been able supply this life sustaining drug to you, but now we ca not, until your two years are up. She has (this may be a little) dramatic) the GRIM REAPER. She is giving the , s', the s. AND the DELIMAN's death sentence. In two years I will probably be dead ( hell..in 2 month's), I need to stay alive and healthy as possible until a Donor liver becomes

available. One more thing...Trust me, the Government jeep's stats just as any business does...they see the truth in the figures tht probablt 65% (guess..I have no idea what % would be accurate) and thet see that even WITH drugs,,, some of us (65%... I dunno.)) die off even taking the billions os dollars of fre drugs... If anyone is still reading, and can tell me different, I can't help but believe out Government is trading our lives for bugeting purposes. Who else benefits from this. If I am so far off base, and you all are thinking,, Man, the Paranoia has really hit him hard this time, or whatever...PLEASE humor me and tell me why in the heck we should wait 2 yrs for drugs needed desparately now, and we have hade our backgrounds checked and claered all the requirements for the money, but not the medicines?? I'm DEAD serious,,(pun

intended.) Thank you, GOOD LUCK suZie!! Deliman gail <gaila@...> wrote: We are all happy to hear Suzies news.This group has special people in it and I personally want to keep you all around forever. Gail -----Original Message-----From: Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of connie

mcclainSent: April 24, 2006 9:25 AMHepatitis CSupportGroupForDummies Subject: Re: Doctors - Bah!!!!Waiting sucks, but I'm so glad you are doing what you need to do to stick around, sweetness. Conniesuzie <suzieandsandy@...> wrote: Well folks, just got home from another doctor appointment. He's going to be handling the T P workup - sent me for more blood tests from alphafetelprotein

to CBC. The girls at the lab always shake in their boots when they see me, my veins are so bad. This time they needed to take about 10 vials - it took two of them to do it, one to find the vein & one to change the tubes. Fun. Dr Idiot is setting up an ultrasound & will call me with the date. The G I will call me when he has the results in, then we go on for more testing - heart, kidleys etc. Naturally my diabetes complicates things. Now we sit & wait. SuZie Next time I'm coming back as a cat The light at the end of the tunnel may be you

Messenger with Voice. PC-to-Phone calls for ridiculously low rates.

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Hi all. I wasn't asked but I'll answer. My docs said to take as much Lactose (or enclose) to BM minimum 5 times daily. I must a weird-oh, but I like the stuff. (function and taste). My surgical team said"you cannot OD of Lactulose/Enulose.or...as I call it sometimes... Look out-your loose...or your end is loose. hehehe! I believe her. Just adjust as needed,. but go (BM) minimum 5 times daily.If there is nothing else I can depend on in this world...I will have Lactulose to re dtire ny faith thata medicine is actually doing it's job. As I understand, it's not so the the benefit ofa laxitive we are trying to achieve, but more of a constrant :Niagra Falls, strong flow...24/7 I gettired of hearing this but H20 is REALL important.. Now..... the why are taking

laxactive for our brains, issue? Think it out.... haha!! I figure it MUST be cause they figure my brain is full of T^ & ^.. haha!! Del gail <gaila@...> wrote: I am on the powder stuff for cholesteral and it doesn't contipate me,on the contrary I go more.So wait and see cause a drug will act different with everyone. Gail -----Original Message-----From:

Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of suzieSent: April 23, 2006 6:08 PMHepatitis CSupportGroupForDummies Subject: RE: Doctors - Bah!!!! Gail, I just wish they'd all get on the same page. My family doc said to take 150 ml of Lactulose/day, then I saw Dr Idiot who said too much & said take 5 or 6 tablespoons/daily(1 tbsp = 5 ml) So I'm splitting the difference & taking 90 ml/day. Am I the only one who finds it strange to be taking a laxative for my brain? I saw the G I & he gave me a prescription for some cholesterol powder that you mix in juice. My cholesterol is fine thank you, it's for the

itchies???? Go figure. Why do my doctors keep giving me stuff off label? or at the very bottom of the label??? They're gonna drive me nuts!! I go to pick up the script & the pharmacist wants to talk to me cause it's the first time I've had this med so she starts telling me how to take it etc - like I can't read the label - then she tells me that it can cause constipation. GREAT - then I'll have to up the lactulose !!! DOCTORS AAAAAARRRRRRGGGGGGHHHHHH, I'd better make an appointment with the pshrink before I start trying to buy a gun & go through the hospital taking target practice. SuZiegail <gaila@...> wrote: They have been getting you to sit and wait for years. Can't they get a little more original and really shock you and just get thing done. Gail Next time I'm coming back as a cat

Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Messenger with Voice.

[Guest guest]

Del Compton <go_deliman@...> wrote: Hi SuZie. Deliman here. Is this your first TP? I'm cleared for take off. They said a liver can stay "fresh" for about a hrs.. Hi Del, I haven't even decided if I'm going to go the transplant route. It's just the t p assessment that I'm going to do, mainly to find out exactly where I stand HCV & liver-wise. Are you like ...ready?? Is there a donor available? God Bless you.... Like I said, I haven't made up my mind whether or not I'm going to try for a transplant. If I do, the nearest t p centre is about 1,000 miles away - there might be one

closer (Winnipeg - approx 8 hour drive) but that's a different province. The anesthesiologist normally sticks the drug catheter in my neck, at my request, Some get offended when I do this, ( I guess that don't like from a rookie) so it takes a couple of pokes first then kinda' begrudgingly do what you knew was right all along. I tell them where to go & they all know me so they do what I say. They know from experience that I've got maybe two veins in my right hand they can use & usually ask me which one we got last time. Due to the Ammonia and water retention in general, I have developed man breastsss, SMALL. but there). My doc said it was no problem and normal and I told him he didn't understand.. I really like breastsss and if my man breastssss got any lager, I would have no reason to ever leave the the

house and co-mingle. HAHAHAHA! Don't worry 'til you need a bra, then you'll find out what life is like for those of us without a y chromosome. I already know that that once your accepted by MEDICARE (FEDS) you stop getting MEDICARE..in Texas, and don't get any drugs help or food...if you fit a category. You will get Medicare coverage automatically after you have received disability benefits for two years. Del sweetie, I'm Canadian. Disability has covered my drugs since I was approved, they also cover teeth, glasses, orthotics, dentures etc etc. Before I got Disability I was on Welfare (they call it Workfare now) they covered drugs, glasses & emergency dental care. I pay $2 a prescription.

Some drugs aren't covered unless your doctor fills out a "special use" form or a "Section 8" form ( no, it's not to get out of the army - Canada remember) Doctors don't like it,, patients need the drugs NOW! Not in 2 years!! Pharmacies don't like it, (Sales will plummet) Pharmacists will feel the after effect from lost sales..(No Jobs) ..PLEASE humor me and tell me why in the heck we should wait 2 yrs for drugs needed desperately now, and we have Had our backgrounds checked and cleared all the requirements for the money, but not the medicines?? Don't ask me, I don't live in the Land of the Fee. I'm DEAD serious,,(pun intended.) Thank you, GOOD LUCK Suzie!! Suzie & SpYke Deliman

Next time I'm coming back as a cat

[Guest guest]

Del Compton <go_deliman@...> wrote: Hi all. I wasn't asked but I'll answer. My docs said to take as much Lactose (or enclose) to BM minimum 5 times daily. Mine said the same thing but they can't decide how much would work best between all three of them. I must a weird-oh, but I like the stuff. You said it, not me. Now..... the why are taking laxactive for our brains, issue? Figured that one out - old shit for brains. Think it out.... haha!! I figure it MUST be

cause they figure my brain is full of T^ & ^.. haha!! Del Glad you're back, SuZiegail <gaila@...> wrote: I am on the powder stuff for cholesteral and it doesn't contipate me,on the contrary I go more.So wait and see cause a drug will act different with everyone. Gail -----Original

Message-----From: Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of suzieSent: April 23, 2006 6:08 PMHepatitis CSupportGroupForDummies Subject: RE: Doctors - Bah!!!! Gail, I just wish they'd all get on the same page. My family doc said to take 150 ml of Lactulose/day, then I saw Dr Idiot who said too much & said take 5 or 6 tablespoons/daily(1 tbsp = 5 ml) So I'm splitting the difference & taking 90 ml/day. Am I the only one who finds it strange to be taking a laxative for my brain? I saw the G I & he gave me a prescription for some cholesterol powder that you mix in juice. My cholesterol is fine thank you, it's for

the itchies???? Go figure. Why do my doctors keep giving me stuff off label? or at the very bottom of the label??? They're gonna drive me nuts!! I go to pick up the script & the pharmacist wants to talk to me cause it's the first time I've had this med so she starts telling me how to take it etc - like I can't read the label - then she tells me that it can cause constipation. GREAT - then I'll have to up the lactulose !!! DOCTORS AAAAAARRRRRRGGGGGGHHHHHH, I'd better make an appointment with the pshrink before I start trying to buy a gun & go through the hospital taking target practice. SuZiegail <gaila@...> wrote:

They have been getting you to sit and wait for years. Can't they get a little more original and really shock you and just get thing done. Gail Next time I'm coming back as a cat Blab-away for as little as 1¢/min. Make PC-to-Phone

Calls using Messenger with Voice.

Next time I'm coming back as a cat

[Guest guest]

Hi suZie. "THEY".. I'm assuming, are the doctor's that can't figure out how much you should "GO" I've been told at least 5 timer. per day. I even got so technical with my Boweling for Dollars that II would actually wait intil 12:01 AM to start the the day. Obviously, I didn't have enough shit to do... haha!! ..so I drank more!!! Now I'm not so popular with friends, but I certainly have alot of shit to do!!! It's easy....start off with 3 tablespoons morning, again at noon, and again at night...(trust me...you'll figure it out!! ) I just "chug it" out of the bottle, but I have no table manners and did the same with Mr. s. Try it on Pancakes!!!!! Isn't yours Maple Flavored...Man I'm gettin the hungreeee's now!!! Remember when all we HAD TO DO was shit and pay taxes?? Delsuzie <suzieandsandy@...> wrote: Del Compton <go_deliman@...> wrote: Hi all. I wasn't asked but I'll answer. My docs said to take as much Lactose (or enclose) to BM minimum 5 times daily. Mine said the same thing but they can't decide how much would work best between all three of them. I must a weird-oh, but I like the stuff. You said it, not me. Now..... the why are taking laxactive for our brains,

issue? Figured that one out - old shit for brains. Think it out.... haha!! I figure it MUST be cause they figure my brain is full of T^ & ^.. haha!! Del Glad you're back, SuZiegail <gaila@...> wrote: I am on the powder stuff for cholesteral and it doesn't contipate me,on the contrary I go more.So wait and see cause a drug will act different with everyone. Gail -----Original Message-----From: Hepatitis CSupportGroupForDummies [mailto:Hepatitis CSupportGroupForDummies ]On Behalf Of suzieSent: April 23, 2006 6:08 PMHepatitis CSupportGroupForDummies Subject: RE: Doctors - Bah!!!! Gail, I just wish they'd all get on the same page. My family doc said to take 150 ml of Lactulose/day, then I saw Dr Idiot who said too much & said take 5 or 6 tablespoons/daily(1 tbsp = 5 ml) So I'm splitting the difference & taking 90 ml/day. Am I the only one who finds it strange to be taking a laxative for my brain? I saw the G I & he gave me a prescription for some cholesterol powder that you mix in juice. My cholesterol is fine thank you, it's for the itchies???? Go figure. Why do my doctors keep giving me stuff off label? or at the very bottom of the label??? They're gonna drive me nuts!! I go to pick up the script & the pharmacist wants to talk to me cause it's the first time I've had this med so she starts telling me how to take it etc - like I can't read the label - then she tells me that it can cause constipation. GREAT - then I'll have to up the lactulose !!! DOCTORS AAAAAARRRRRRGGGGGGHHHHHH, I'd better make an appointment with the pshrink before I start trying to buy a gun & go through the hospital taking target practice. SuZiegail <gaila@...> wrote: They have been getting you to sit and wait for years. Can't they get a little more original and really shock you and just get thing done. Gail Next time I'm coming back as a cat Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using Messenger with Voice. Next time I'm coming back as a cat

Messenger with Voice. Make PC-to-Phone Calls to the US (and 30+ countries) for 2¢/min or less.

[Guest guest]

Listen it is prescribed cause it help lower your ammonia levels.. Not just to keep you on the can.. Boo

Lactulose!

TRADE NAMES

Duphalac (Solvay), Chronulac (Aventis), Constilac (Alra), Cephulac (Aventis), Generlac (Morton Grove), Constulose (Alpharma), Enulose (Alpharma), Cholac (Alra), Kristalose (Bertek).

DESCRIPTION

Lactulose is a semisynthetic disaccharide comprised of the sugars D-galactose and D-fructose. It is not found naturally. The sugars are joined by a beta glycosidic linkage making it resistant to hydrolysis by human digestive enzymes. There is no disaccharidase in the microvillus membrane of small intestine enterocytes that can hydrolyze lactulose; nor is the disaccharide absorbed from the small intestine. Lactulose is, however, fermented by a limited number of colonic bacteria. This can lead to changes in the colonic ecosystem in favor of some bacteria, such as lactobacilli and bifidobacteria, which may confer some health benefits.

Lactulose is used in the treatment of constipation and hepatic encephalopathy. The efficacy of lactulose in these conditions is based on its fermentation in the colon by certain bacteria and the increase of the biomass of these bacteria in the colon. The products of fermentation are mainly organic acids, such as lactic acid and small-chain fatty acids, which, by exerting a local osmotic effect in the colon, result in increased fecal bulk and stimulation of peristalsis. The higher doses used for hepatic encephalopathy lower the colonic pH, and ammonia, in the form of ammonium ions, is used by the bacteria for amino acid and protein synthesis. This lowers the serum ammonia levels and improves mental function.

The stimulation of the growth of bacteria, such as bifidobacteria, may have other health benefits, such as protection against cancer of the colon. Lactulose is referred to as a bifidogenic factor. Substances such as lactulose that promote the growth of beneficial bacteria in the colon are called prebiotics. Prebiotics are typically nondigestible oligosaccharides. In addition to its uses in treatment of hepatic encephalopathy and constipation, lactulose is used in Japan in functional foods and as a nutritional supplement. These uses of lactulose are being explored in the United States, as well.

Lactulose is a solid substance that is very soluble in water and has a sweet taste. It is sweeter than lactose but not as sweet as fructose. Lactulose is also known as 4-O-beta-D-galactopyranosyl-D-fructofuranose. Its molecular formula is C12H22O11, and its molecular weight is 342.30 daltons. The structural formula is:

Lactulose

ACTIONS AND PHARMACOLOGY

ACTIONS

Therapeutically, lactulose has laxative and ammonia-detoxifying actions.

Supplemental lactulose may have antitumor, antimicrobial, hypolipidemic and hypoglycemic actions in some. It may also help improve mineral absorption and balance, and may have antiosteoporotic activity.

MECHANISM OF ACTION

The possible antitumor activity of lactulose might be accounted for, in part, by the possible antitumor action of butyrate. Butyrate, along with other short-chain fatty acids, is produced by bacterial fermentation of lactulose in the colon. Some studies suggest that butyrate may induce growth arrest and cell differentiation and may also upregulate apoptosis, three activities that could be significant for possible antitumor activity. Lactulose may also aid in increasing the concentrations of calcium and magnesium in the colon. High concentrations of these cations in the colon may help control the rate of cell turnover. High concentrations of calcium in the colon may also lead to the formation of insoluble bile or salts of fatty acids. This might reduce the potential damaging effects of bile or fatty acids on colonocytes.

Lactulose may promote the growth of favorable bacterial populations, such as bifidobacteria, in the colon. Bifidobacteria may inhibit the growth of pathogenic bacteria, such as Clostridium perfringens and diarrheogenic Escherichia coli.

Lactulose may aid in lowering serum triglycerides in some. The mechanism of this possible effect is unclear. Decreased hepatocyte de novo synthesis of triglycerides is one hypothetical possibility. Lactulose may also lower total cholesterol and LDL-cholesterol levels in some. Again, the mechanism of this possible effect is unclear. Propionate, a product of lactulose fermentation in the colon, may inhibit HMG-CoA reductase, the rate-limiting step in cholesterol synthesis.

The possible effects of lactulose on blood glucose may be explained in a few ways. Lactulose may delay gastric emptying and/or shorten small-intestinal tract transit time. This may be via the short-chain fatty acids produced from lactulose in the colon. Short-chain fatty acids may be involved in the so-called "ileocolonic brake," which refers to the inhibition of gastric emptying by nutrients reaching the ileo-colonic junction. Short-chain fatty acids may also stimulate contractions of the ileum and shorten ileal emptying. In addition, propionate may inhibit gluconeogenesis by its metabolic conversion to methylmalonyl-CoA and succinyl-CoA. These metabolites could inhibit pyruvate carboxylase. Propionate may also reduce plasma levels of free fatty acids. High levels of free fatty acids lower glucose utilization and induce insulin resistance. Finally, propionate may enhance glycolysis via depletion of citrate in hepatocytes. Citrate is an allosteric inhibitor of phosphofructokinase.

Lactulose may bind/sequester such minerals as calcium and magnesium in the small intestine. The short-chain fatty acids formed from the bacterial fermentation of lactulose may facilitate the colonic absorption of calcium and, possibly, also magnesium ions. This could be beneficial in preventing osteoporosis and osteopenia.

PHARMACOKINETICS

Following ingestion, lactulose reaches the colon with very little digestion or absorption taking place in the stomach or small intestine. Lactulose is fermented by bifidobacteria, lactobacilli and some other bacteria in the colon to produce the short-chain fatty acids acetate, propionate and butyrate; the gases hydrogen, hydrogen sulfide, carbon dioxide and methane; and lactate, pyruvate, succinate and formate. Acetate, propionate and butyrate that are not metabolized in colonocyes are absorbed from the colon and transported via the portal circulation to the liver. These short-chain fatty acids are extensively metabolized in hepatocytes. Acetate, propionate and butyrate that are not metabolized in hepatocytes are transported by the circulation to various tissues, where they undergo further metabolism. Butyrate is an important respiratory fuel for the colonocytes. Lactulose is completely metabolized in the colon, and no lactulose is excreted in the feces.

Those with ileostomies may have a microbial flora colonizing their ileums. In those cases, lactulose could be fermented by some of the bacteria in a fashion similar to their fermentation in the colon.

INDICATIONS AND USAGE

Lactulose is used to treat constipation and hepatic encephalopathy. Preliminary research suggests that it might protect against a number of intestinal pathogens, that it might be helpful in the treatment of some inflammatory bowel diseases and that it could help prevent colorectal cancers. There is additional preliminary evidence suggesting that it could be of benefit in osteoporosis, diabetes mellitus and renal failure.

RESEARCH SUMMARY

Lactulose has proved effective in the treatment of some with chronic constipation, helping to restore normal peristalsis and defecation rhythm, softening stools and diminishing pain and other symptoms of dyspeptic disorders.

Lactulose is used with good results in some with compensated liver disease; lactulose has been shown in various studies to increase protein tolerance and help prevent hepatic encephalopathy.

Lactulose has helped protect against Salmonella infection and has shown activity against a number of other intestinal pathogens. It has reduced the incidence of bacterial translocation from the gut to mesenteric lymph nodes in rats with obstructive jaundice. It has also prevented bacterial translocation in animal models of surgical trauma. Other experiments suggest that lactulose might be helpful in idiopathic, as well as infectious inflammatory bowel diseases.

Lactulose has suppressed experimentally induced colonic aberrant crypt foci in rats and has helped protect colonic mucosa against a known colon carcinogen.

There is some early but promising clinical work. In one controlled study, patients who had undergone endoscopic removal of colorectal polyps were given antioxidant vitamins or lactulose to see if these substances could reduce the recurrence rate of adenomatous polyps. Over the course of this five-year study, polyps recurred in 5.7% of those taking the vitamins (A, C and E) and in 14.7% of those taking lactulose, compared with a recurrence rate of 35.9% in untreated controls. There were 209 subjects in the study.

Lactulose has also been shown to significantly stimulate calcium absorption in postmenopausal women, though the research has not yet been done to see whether it slows the rate of bone loss in aging subjects. There is, in addition, preliminary research suggesting that lactulose might improve glucose tolerance and have other effects on carbohydrate metabolism that could be of benefit in those with diabetes mellitus.

Finally, there is the suggestion in other preliminary research that lactulose might be helpful in the treatment of chronic renal failure. Lactulose has been shown to promote fecal excretion of water, sodium, potassium, amonium, urea, creatine and hydronium ions.

CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS

CONTRAINDICATIONS

Some lactulose preparations contain galactose. Therefore, lactulose is contraindicated in those who require a low galactose diet. Lactulose is also contraindicated in those who are hypersensitive to any component of a lactulose-containing preparation.

PRECAUTIONS

In the United States, lactulose is a prescription drug. Its use requires medical supervision. Its use as a dietary supplement is considered experimental.

Those who develop gastrointestinal symptoms (flatus, bloating, diarrhea) with the use of dietary fiber should exercise caution in the use of lactulose.

Those with lactose intolerance should exercise caution in the use of lactulose.

One of the metabolites of lactulose is hydrogen gas. Hypothetically, this represents a potential hazard for those using lactulose who may be required to undergo electrocautery procedures during proctoscopy or colonoscopy. Accumulation of hydrogen gas in significant amounts in the presence of an electric spark may result in an explosion. Therefore, those undergoing these procedures should stop lactulose intake at least a week before the procedure.

Pregnant women and nursing mothers should avoid lactulose.

ADVERSE REACTIONS

Laxative doses are typically 20 to 40 grams daily. Doses up to 10 grams daily are usually well tolerated. Some may be more sensitive to the possible gastrointestinal side effects of lactulose. The adverse reactions are mainly gastrointestinal and include flatus and abdominal cramps. Doses of greater than 13 grams daily can cause diarrhea. Also, nausea and vomiting have been reported following the higher doses. Some find the taste of lactulose to be disagreeable.

INTERACTIONS

DRUGS

Concomitant use of nonabsorbable antacids with lactulose may inhibit the desired lactulose-induced drop in colonic pH which might affect laxative activity and activity in the treatment of hepatic encephalopathy.

NUTRITIONAL SUPPLEMENTS

The concomitant use of such probiotics as Bifidobacterium longum and lactulose may enhance the possible health benefits of lactulose.

Lactulose may enhance the colonic absorption of calcium and magnesium supplements if used concomitantly.

FOODS

Lactulose may enhance the colonic absorption of calcium and magnesium in foods.

OVERDOSAGE

There have been no reports of overdosage.

DOSAGE AND ADMINISTRATION

Lactulose is available in some functional foods and nutritional supplements in Japan. Its use in the U.S. for supplemental purposes is still experimental. Supplemental doses used in Japan are about 2 to 5 grams daily. Doses higher than 10 grams daily are likely to cause gastrointestinal side effects (flatus, abdominal cramping, diarrhea). Doses of 10 to 20 grams daily and up to 40 grams daily are used to treat constipation. Doses from 60 to 120 grams daily are used to treat hepatic encephalopathy. Pharmaceutical lactulose is available in solutions and in the form of a crystalline powder. Lactulose is a prescription drug in the U.S. for pharmaceutical uses.

HOW SUPPLIED

Powder — 10 g/packet

Solution — 10 g/15 ml

Syrup — 10 g/15 ml

LITERATURE

Bianchi G, Ronchi M, Marchesini G. Effects of lactulose on carbohydrate metabolism and diabetes mellitus. Scand J Gastroenterol Suppl. 1997; 222:62-64.

Challa A, Rao JR, Chawan CB, Shackelford L. Bifidobacterium longum and lactulose suppress azoxymethane-induced colonic aberrant crypt foci in rats. Carcinogenesis. 1997; 18:517-521.

Clausen MR, Mortensen PB. Lactulose, disaccharides and colonic flora. Clinical consequences. Drugs. 1997; 53:930-942.

Gardiner KR, Erwin PJ, NH, et al. Lactulose as an antiendotoxin in experimental colitis. Br J Surg. 1995; 82:469-472.

Horsmans Y, Solbreux PM, Daenens C, et al. Lactulose improves psychomotor testing in cirrhotic patients with subclinical encephalopathy. Aliment Pharmacol Ther. 1997; 11:165-170.

Huchzermeyer H, Schumann C. Lactulose -- a multifaceted substance. Z Gastroenterol. 1997; 35:945-955.

Ozcelik MF, Eroglu C, Pekmezci S, et al. The role of lactulose in the prevention of bacterial translocation in surgical trauma. Acta Chir Belg. 1996; 96:44-48.

Physicians' Desk Reference. 54th ed. Montvale, NJ: Medical Economics Company; 2000.

Ponz de Leon M, Roncucci L. Chemoprevention of colorectal tumors: role of lactulose and of other agents. Scan J Gastroenterol Suppl. 1997; 222:72-75.

Rowland IR, Bearne CA, Fischer R, Pool-Zobel BL. The effect of lactulose on DNA damage induced by DMH in the colon of human flora-associated rats. Nutr Cancer. 1996; 26:37-47.

Salminen S, Salminen E. Lactulose, lactic acid bacteria, intestinal microecology and mucosal protection. Scand J Gastroenterol Suppl. 1997; 222:45-48.

Teuri U, Vapaatalo H, Korpela R. Fructooligosaccharides and lactulose cause more symptoms in lactose maldigesters and subjects with pseudohypolactasia than in control lactose digesters. Am J Clin Nutr. 1999; 69:973-979.

Van den Heuvel EG, Muijs T, Van Dokkum W, Schaafsma G. Lactulose stimulates calcium absorption in postmenopausal women. J Bone Miner Res. 1999; 14:1211-1216.

[Guest guest]

Thank You, BOO!! The following is meant as humorous commentary concerning a serious medical condition. Thank You!!! I didn't understand until I saw the structural formula.. I must have shit fer brains!! ha ha. I know it's partially for controlling ammonia sweetie, I am not only a connoisseur, but change brands depending on what is being served that evening...or morning...or noon.. Lactulose "69 has been found to cause a certain disdain from guests.... (and hosts as

well, mind you)... It does not achieve a complementary sprinkling of flavor and fullness that you will find in a.... say...2005 Enulose. Instead... it seems the conductor has created an overbearing cacophonis sound that it is irritating to all...especially if it is from the valley region. I prefer post "69 domestics (with exception to an "88) and allow them to breath as needed. An "05 Enulose, when served at room temperature, (however,,,becoming hard to find)... will compliment almost any cuisine when allowed to breath properly, but one must always be aware of the slow legs that often accompany the delightful bouquet. This 'unawareness' has been known to leave a foul odor surrounding an otherwise perfect

evening. The Porcelain Trotting Connoisseur Kathy Brunow <kathy-boo@...> wrote: Listen it is

prescribed cause it help lower your ammonia levels.. Not just to keep you on the can.. Boo Lactulose! TRADE NAMES Duphalac (Solvay), Chronulac (Aventis), Constilac (Alra), Cephulac (Aventis), Generlac (Morton Grove), Constulose (Alpharma), Enulose (Alpharma), Cholac (Alra), Kristalose (Bertek). DESCRIPTION Lactulose is a semisynthetic disaccharide comprised of the sugars D-galactose and D-fructose. It is not found naturally. The sugars are joined by a beta glycosidic linkage making it resistant to hydrolysis by human digestive enzymes. There is no disaccharidase in the microvillus membrane of small intestine enterocytes that can hydrolyze lactulose; nor is the disaccharide absorbed from the small intestine. Lactulose is, however, fermented by a limited number of colonic bacteria.

This can lead to changes in the colonic ecosystem in favor of some bacteria, such as lactobacilli and bifidobacteria, which may confer some health benefits. Lactulose is used in the treatment of constipation and hepatic encephalopathy. The efficacy of lactulose in these conditions is based on its fermentation in the colon by certain bacteria and the increase of the biomass of these bacteria in the colon. The products of fermentation are mainly organic acids, such as lactic acid and small-chain fatty acids, which, by exerting a local osmotic effect in the colon, result in increased fecal bulk and stimulation of peristalsis. The higher doses used for hepatic encephalopathy lower the colonic pH, and ammonia, in the form of ammonium ions, is used by the bacteria for amino acid and protein synthesis. This lowers the serum ammonia levels and improves mental function. The stimulation of the growth of bacteria, such as bifidobacteria, may have other health

benefits, such as protection against cancer of the colon. Lactulose is referred to as a bifidogenic factor. Substances such as lactulose that promote the growth of beneficial bacteria in the colon are called prebiotics. Prebiotics are typically nondigestible oligosaccharides. In addition to its uses in treatment of hepatic encephalopathy and constipation, lactulose is used in Japan in functional foods and as a nutritional supplement. These uses of lactulose are being explored in the United States, as well. Lactulose is a solid substance that is very soluble in water and has a sweet taste. It is sweeter than lactose but not as sweet as fructose. Lactulose is also known as 4-O-beta-D-galactopyranosyl-D-fructofuranose. Its molecular formula is C12H22O11, and its molecular weight is 342.30 daltons. The structural formula is: Lactulose ACTIONS AND PHARMACOLOGY ACTIONS Therapeutically, lactulose has laxative and ammonia-detoxifying actions. Supplemental lactulose may have antitumor, antimicrobial, hypolipidemic and hypoglycemic actions in some. It may also help improve mineral absorption and balance, and may have antiosteoporotic activity. MECHANISM OF ACTION The possible antitumor activity of lactulose might be accounted for, in part, by the possible antitumor action of butyrate. Butyrate, along with other short-chain fatty acids, is produced by bacterial fermentation of lactulose in the colon. Some studies suggest that butyrate may induce growth arrest and cell differentiation and may also upregulate apoptosis, three activities that could be significant for possible antitumor activity.

Lactulose may also aid in increasing the concentrations of calcium and magnesium in the colon. High concentrations of these cations in the colon may help control the rate of cell turnover. High concentrations of calcium in the colon may also lead to the formation of insoluble bile or salts of fatty acids. This might reduce the potential damaging effects of bile or fatty acids on colonocytes. Lactulose may promote the growth of favorable bacterial populations, such as bifidobacteria, in the colon. Bifidobacteria may inhibit the growth of pathogenic bacteria, such as Clostridium perfringens and diarrheogenic Escherichia coli. Lactulose may aid in lowering serum triglycerides in some. The mechanism of this possible effect is unclear. Decreased hepatocyte de novo synthesis of triglycerides is one hypothetical possibility. Lactulose may also lower total cholesterol and LDL-cholesterol levels in some. Again, the mechanism of this

possible effect is unclear. Propionate, a product of lactulose fermentation in the colon, may inhibit HMG-CoA reductase, the rate-limiting step in cholesterol synthesis. The possible effects of lactulose on blood glucose may be explained in a few ways. Lactulose may delay gastric emptying and/or shorten small-intestinal tract transit time. This may be via the short-chain fatty acids produced from lactulose in the colon. Short-chain fatty acids may be involved in the so-called "ileocolonic brake," which refers to the inhibition of gastric emptying by nutrients reaching the ileo-colonic junction. Short-chain fatty acids may also stimulate contractions of the ileum and shorten ileal emptying. In addition, propionate may inhibit gluconeogenesis by its metabolic conversion to methylmalonyl-CoA and succinyl-CoA. These metabolites could inhibit pyruvate carboxylase. Propionate may also reduce plasma levels of free fatty acids. High levels of free fatty acids lower

glucose utilization and induce insulin resistance. Finally, propionate may enhance glycolysis via depletion of citrate in hepatocytes. Citrate is an allosteric inhibitor of phosphofructokinase. Lactulose may bind/sequester such minerals as calcium and magnesium in the small intestine. The short-chain fatty acids formed from the bacterial fermentation of lactulose may facilitate the colonic absorption of calcium and, possibly, also magnesium ions. This could be beneficial in preventing osteoporosis and osteopenia. PHARMACOKINETICS Following ingestion, lactulose reaches the colon with very little digestion or absorption taking place in the stomach or small intestine. Lactulose is fermented by bifidobacteria, lactobacilli and some other bacteria in the colon to produce the short-chain fatty acids acetate, propionate and butyrate; the gases hydrogen, hydrogen sulfide, carbon dioxide and methane; and lactate, pyruvate, succinate and formate.

Acetate, propionate and butyrate that are not metabolized in colonocyes are absorbed from the colon and transported via the portal circulation to the liver. These short-chain fatty acids are extensively metabolized in hepatocytes. Acetate, propionate and butyrate that are not metabolized in hepatocytes are transported by the circulation to various tissues, where they undergo further metabolism. Butyrate is an important respiratory fuel for the colonocytes. Lactulose is completely metabolized in the colon, and no lactulose is excreted in the feces. Those with ileostomies may have a microbial flora colonizing their ileums. In those cases, lactulose could be fermented by some of the bacteria in a fashion similar to their fermentation in the colon. INDICATIONS AND USAGE Lactulose is used to treat constipation and hepatic encephalopathy. Preliminary research suggests that it might protect against a number of intestinal pathogens, that it might

be helpful in the treatment of some inflammatory bowel diseases and that it could help prevent colorectal cancers. There is additional preliminary evidence suggesting that it could be of benefit in osteoporosis, diabetes mellitus and renal failure. RESEARCH SUMMARY Lactulose has proved effective in the treatment of some with chronic constipation, helping to restore normal peristalsis and defecation rhythm, softening stools and diminishing pain and other symptoms of dyspeptic disorders. Lactulose is used with good results in some with compensated liver disease; lactulose has been shown in various studies to increase protein tolerance and help prevent hepatic encephalopathy. Lactulose has helped protect against Salmonella infection and has shown activity against a number of other intestinal pathogens. It has reduced the incidence of bacterial translocation from the gut to mesenteric lymph nodes in rats with obstructive

jaundice. It has also prevented bacterial translocation in animal models of surgical trauma. Other experiments suggest that lactulose might be helpful in idiopathic, as well as infectious inflammatory bowel diseases. Lactulose has suppressed experimentally induced colonic aberrant crypt foci in rats and has helped protect colonic mucosa against a known colon carcinogen. There is some early but promising clinical work. In one controlled study, patients who had undergone endoscopic removal of colorectal polyps were given antioxidant vitamins or lactulose to see if these substances could reduce the recurrence rate of adenomatous polyps. Over the course of this five-year study, polyps recurred in 5.7% of those taking the vitamins (A, C and E) and in 14.7% of those taking lactulose, compared with a recurrence rate of 35.9% in untreated controls. There were 209 subjects in the study. Lactulose has also been shown to significantly stimulate

calcium absorption in postmenopausal women, though the research has not yet been done to see whether it slows the rate of bone loss in aging subjects. There is, in addition, preliminary research suggesting that lactulose might improve glucose tolerance and have other effects on carbohydrate metabolism that could be of benefit in those with diabetes mellitus. Finally, there is the suggestion in other preliminary research that lactulose might be helpful in the treatment of chronic renal failure. Lactulose has been shown to promote fecal excretion of water, sodium, potassium, amonium, urea, creatine and hydronium ions. CONTRAINDICATIONS, PRECAUTIONS, ADVERSE REACTIONS CONTRAINDICATIONS Some lactulose preparations contain galactose. Therefore, lactulose is contraindicated in those who require a low galactose diet. Lactulose is also contraindicated in those who are hypersensitive to any component of a lactulose-containing

preparation. PRECAUTIONS In the United States, lactulose is a prescription drug. Its use requires medical supervision. Its use as a dietary supplement is considered experimental. Those who develop gastrointestinal symptoms (flatus, bloating, diarrhea) with the use of dietary fiber should exercise caution in the use of lactulose. Those with lactose intolerance should exercise caution in the use of lactulose. One of the metabolites of lactulose is hydrogen gas. Hypothetically, this represents a potential hazard for those using lactulose who may be required to undergo electrocautery procedures during proctoscopy or colonoscopy. Accumulation of hydrogen gas in significant amounts in the presence of an electric spark may result in an explosion. Therefore, those undergoing these procedures should stop lactulose intake at least a week before the procedure. Pregnant women and nursing mothers should avoid

lactulose. ADVERSE REACTIONS Laxative doses are typically 20 to 40 grams daily. Doses up to 10 grams daily are usually well tolerated. Some may be more sensitive to the possible gastrointestinal side effects of lactulose. The adverse reactions are mainly gastrointestinal and include flatus and abdominal cramps. Doses of greater than 13 grams daily can cause diarrhea. Also, nausea and vomiting have been reported following the higher doses. Some find the taste of lactulose to be disagreeable. INTERACTIONS DRUGS Concomitant use of nonabsorbable antacids with lactulose may inhibit the desired lactulose-induced drop in colonic pH which might affect laxative activity and activity in the treatment of hepatic encephalopathy. NUTRITIONAL SUPPLEMENTS The concomitant use of such probiotics as Bifidobacterium longum and lactulose may enhance the possible health benefits of lactulose. Lactulose may enhance the colonic absorption of calcium and magnesium supplements if used concomitantly. FOODS Lactulose may enhance the colonic absorption of calcium and magnesium in foods. OVERDOSAGE There have been no reports of overdosage. DOSAGE AND ADMINISTRATION Lactulose is available in some functional foods and nutritional supplements in Japan. Its use in the U.S. for supplemental purposes is still experimental. Supplemental doses used in Japan are about 2 to 5 grams daily. Doses higher than 10 grams daily are likely to cause gastrointestinal side effects (flatus, abdominal cramping, diarrhea). Doses of 10 to 20 grams daily and up to 40 grams daily are used to treat constipation. Doses from 60 to 120 grams daily are used to treat hepatic encephalopathy. Pharmaceutical lactulose is available in solutions and in the form of a crystalline powder. Lactulose is a prescription drug in the U.S. for

pharmaceutical uses. HOW SUPPLIED Powder — 10 g/packet Solution — 10 g/15 ml Syrup — 10 g/15 ml LITERATURE Bianchi G, Ronchi M, Marchesini G. Effects of lactulose on carbohydrate metabolism and diabetes mellitus. Scand J Gastroenterol Suppl. 1997; 222:62-64. Challa A, Rao JR, Chawan CB, Shackelford L. Bifidobacterium longum and lactulose suppress azoxymethane-induced colonic aberrant crypt foci in rats. Carcinogenesis. 1997; 18:517-521. Clausen MR, Mortensen PB. Lactulose, disaccharides and colonic flora. Clinical consequences. Drugs. 1997; 53:930-942. Gardiner KR, Erwin PJ, NH, et al. Lactulose as an antiendotoxin in experimental colitis. Br J Surg. 1995; 82:469-472. Horsmans Y, Solbreux PM, Daenens C, et al. Lactulose improves psychomotor testing in cirrhotic patients with subclinical

encephalopathy. Aliment Pharmacol Ther. 1997; 11:165-170. Huchzermeyer H, Schumann C. Lactulose -- a multifaceted substance. Z Gastroenterol. 1997; 35:945-955. Ozcelik MF, Eroglu C, Pekmezci S, et al. The role of lactulose in the prevention of bacterial translocation in surgical trauma. Acta Chir Belg. 1996; 96:44-48. Physicians' Desk Reference. 54th ed. Montvale, NJ: Medical Economics Company; 2000. Ponz de Leon M, Roncucci L. Chemoprevention of colorectal tumors: role of lactulose and of other agents. Scan J Gastroenterol Suppl. 1997; 222:72-75. Rowland IR, Bearne CA, Fischer R, Pool-Zobel BL. The effect of lactulose on DNA damage induced by DMH in the colon of human flora-associated rats. Nutr Cancer. 1996; 26:37-47. Salminen S, Salminen E. Lactulose, lactic acid bacteria, intestinal microecology and mucosal protection. Scand J Gastroenterol

Suppl. 1997; 222:45-48. Teuri U, Vapaatalo H, Korpela R. Fructooligosaccharides and lactulose cause more symptoms in lactose maldigesters and subjects with pseudohypolactasia than in control lactose digesters. Am J Clin Nutr. 1999; 69:973-979. Van den Heuvel EG, Muijs T, Van Dokkum W, Schaafsma G. Lactulose stimulates calcium absorption in postmenopausal women. J Bone Miner Res. 1999; 14:1211-1216.

Talk is cheap. Use Messenger to make PC-to-Phone calls. Great rates starting at 1¢/min.

[Guest guest]

You seriously think your Doctor prescribed it for constipation guy..No it is for your ammonia levels.. Which must be though the roof..I too had to take the stuff for two years.. 35cc X 3 daily honey boy. So take it and no complaints ok..Kathy Boo who is so tired of potty humor...

-- RE: Doctors - Bah!!!!

Thank You, BOO!!

The following is meant as humorous commentary concerning a serious medical condition.

Thank You!!!

I didn't understand until I saw the structural formula.. I must have shit fer brains!! ha ha.

I know it's partially for controlling ammonia sweetie, I am not only a connoisseur, but change brands depending on what is being served that evening...or morning...or noon..

Lactulose "69 has been found to cause a certain disdain from guests.... (and hosts as well, mind you)... It does not achieve a complementary sprinkling of flavor and fullness that you will find in a.... say...2005 Enulose.

Instead... it seems the conductor has created an overbearing cacophonis sound that it is irritating to all...especially if it is from the valley region.

I prefer post "69 domestics (with exception to an "88) and allow them to breath as needed. An "05 Enulose, when served at room temperature, (however,,,becoming hard to find)... will compliment almost any cuisine when allowed to breath properly, but one must always be aware of the slow legs that often accompany the delightful bouquet. This 'unawareness' has been known to leave a foul odor surrounding an otherwise perfect evening.

The Porcelain Trotting Connoisseur