Bifiteral®

Introduction

Bifiteral® is the trade name of a laxative based on the active ingredient lactulose. (100 ml Bifiteral® contains approx. 67g lactulose.)

It is used for constipation (constipation) when it cannot be relieved naturally. Bifiteral® is classified in the group of osmotically acting laxatives (water-drawing laxatives). This includes the subgroup of saline laxatives (Epsom salt, Glauber’s salt), synthetic sugars (lactulose) and polyethylene glycols (macrogol).

The lactulose contained in Bifiteral® is a disaccharide (disaccharide) consisting of the sugars galactose and fructose. It cannot be absorbed by the intestine, i.e. it cannot be transferred into the blood. Consequently, the lactulose remains in the intestine, which means that more water remains in the intestine.

The reason for this is that Bifiteral® is osmotically effective. The term osmosis refers to a biochemical process that occurs at various points in the body. If a semi-permeable membrane (a membrane permeable only to water) separates two liquid containers from each other and a higher concentrated solution is present on one side of the membrane (more particles of one substance per quantity of liquid), then water will flow from the lower concentrated side through the membrane to the higher concentrated side, so that in the end an equally concentrated solution is present on both sides.

This process also takes place in the intestine. This is where the various nutrients (sugars, proteins, fats) are normally absorbed (absorbed via the intestinal wall). However, since the lactulose from the Bifiteral® cannot be absorbed, a more highly concentrated solution of lactulose is formed inside the intestine.

According to the principle of osmosis (see above), water from our body will now flow through the membrane (in this case the intestinal wall) into the intestine to reduce the lactulose concentration (because: more water to the same number of lactulose particles means a lower concentration). Because there is more water in the intestine, the stool becomes softer and can be excreted more easily. Another mechanism is that part of the lactulose from the Bifiteral® in the intestine is split into acetic acid and lactic acid by the natural intestinal flora (bacteria that live in the intestine).

This causes the pH value in the intestine to drop. The pH value describes how acidic a liquid is (the more acidic a solution is, the more positively charged hydrogen atoms (H+) are present in it, the lower the pH value). When it becomes more acidic in the intestine, it is stimulated to move more (intestinal motility increases).

This increased movement will push the stool more towards the bowel outlet (anus) and facilitate bowel movement. The bacteria in the intestine produce ammonia in their metabolism. Ammonia is also an end product or breakdown product of proteins in our body.

It can no longer be used and is excreted in the stool and urine. When it accumulates (accumulates) in large quantities, it is toxic to the body and causes damage to the brain and lungs, among other things. When the pH decreases in the intestine due to the cleavage of lactulose from the Bifiteral® and more H+ ions are present, these combine with ammonia to form NH4+(ammonium ions). The important thing about this is that, unlike ammonia, the ammonium ions cannot be absorbed in the intestine. This in turn means that the administration of Bifiteral® can help to reduce high ammonia levels, as the ammonium ions produced do not enter our circulation but are excreted with the stool.