Fructo Oligosaccharide

Usage

• Fructo-oligosaccharides (FOS) are primarily used as prebiotics. They promote the growth of beneficial bacteria, like Bifidobacteria and Lactobacilli, in the colon. While FOS are also used for constipation, obesity, diabetes, traveler’s diarrhea, and high cholesterol, there is limited scientific evidence to support these uses.
• Pharmacological Classification: Prebiotic, and can be classified as a functional food ingredient.
• Mechanism of Action: FOS are non-digestible carbohydrates that reach the colon intact. In the colon, they are fermented by beneficial gut bacteria, promoting their growth and producing short-chain fatty acids (SCFAs) like acetate, propionate, and butyrate. These SCFAs have several potential health benefits including improved gut health, potential effects on lipid metabolism, and modulation of the immune system.

Alternate Names

• Neosugar, Oligofructose

How It Works

• Pharmacodynamics: FOS primarily exert their effects in the colon. Bacterial fermentation produces SCFAs which lower colonic pH, stimulate the growth of beneficial bacteria, and may have systemic effects such as influencing lipid metabolism and immune responses.
• Pharmacokinetics: FOS are not digested or absorbed in the small intestine. They reach the colon where they undergo fermentation by gut bacteria. Any unfermented FOS are excreted in the feces.
• Mode of Action: FOS act as substrates for specific beneficial bacteria in the colon. They are fermented to produce SCFAs, which contribute to numerous physiological effects.
• Elimination Pathways: Primarily excreted in the feces as unfermented FOS and SCFAs.

Dosage

Standard Dosage

Adults:

• 5-20 grams per day, often divided into two doses. Dosages up to 30 grams have been studied.

Children:

• Limited data available. One study used 4 grams FOS per liter of infant formula or up to 1 gram per kilogram of body weight in infants. In children aged 3-6, 6 g/day has been studied. Starting with a lower dose and gradually increasing may be advisable to minimize gastrointestinal side effects.

Special Cases:

• Elderly Patients – Similar to adult dosing but starting with a lower dose is advised. Monitor for gastrointestinal tolerance.
• Patients with Renal Impairment – No specific dose adjustments are necessary as FOS are not renally cleared.
• Patients with Hepatic Dysfunction – No specific dose adjustments are necessary as FOS are not metabolized in the liver.
• Patients with Comorbid Conditions – Caution is advised in individuals with Irritable Bowel Syndrome (IBS) and Small Intestinal Bacterial Overgrowth (SIBO). Start with low doses and monitor tolerance.

Clinical Use Cases

• Dosage recommendations for clinical settings like intubation, surgical procedures, mechanical ventilation, and ICU use have not been established.

Side Effects

Common Side Effects

• Flatulence, bloating, abdominal discomfort, borborygmi, and diarrhea are common, especially with higher doses.

Rare but Serious Side Effects

• Allergic reactions including rash or other skin manifestations and rarely, anaphylaxis, have been reported.

Contraindications

• Hypersensitivity to FOS or inulin.
• Individuals with hereditary fructose intolerance.

Drug Interactions

• Limited information is available on drug interactions with FOS. Concomitant use of antibiotics might reduce the efficacy of FOS.

Pregnancy and Breastfeeding

• There isn’t enough reliable information to know if FOS are safe to use when pregnant or breast-feeding. Avoid use.

Drug Profile Summary

• Mechanism of Action: Prebiotic; fermented by colonic bacteria to produce SCFAs.
• Side Effects: Flatulence, bloating, abdominal discomfort, diarrhea.
• Contraindications: Hypersensitivity, hereditary fructose intolerance.
• Drug Interactions: Limited information available. Antibiotics may reduce efficacy.
• Pregnancy & Breastfeeding: Insufficient safety information. Avoid use.
• Dosage: Adults: 5-20 grams/day, up to 30 grams/day studied. Children: Limited data.
• Monitoring Parameters: Monitor for gastrointestinal tolerance.

Popular Combinations

• FOS are often combined with probiotics in synbiotic formulations.

Precautions

• Start with a low dose and gradually increase to minimize gastrointestinal side effects.
• Individuals with IBS or SIBO should use FOS with caution.
• Discontinue use and seek medical advice if allergic reactions occur.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Fructo Oligosaccharide?

A: The recommended dosage for adults is 5-20 grams per day, sometimes divided into two doses. Dosages up to 30 grams have been studied. For children, limited data is available. Consulting with a healthcare professional is advisable, especially for children and those with underlying health conditions.

Q2: How should FOS be administered?

A: FOS can be taken as a powder mixed into beverages or food, or as capsules or chewable tablets.

Q3: What are the main side effects of FOS?

A: The most common side effects are gastrointestinal, including flatulence, bloating, abdominal discomfort, and diarrhea. These are usually mild and transient, especially at lower doses.

Q4: Are there any contraindications to FOS use?

A: Individuals with hypersensitivity to FOS or inulin, and those with hereditary fructose intolerance should avoid FOS.

Q5: Can FOS be used during pregnancy or breastfeeding?

A: There isn’t enough reliable information regarding the safety of FOS during pregnancy and breastfeeding. Therefore, it is recommended to avoid its use.

Q6: How do FOS work as a prebiotic?

A: FOS reach the colon undigested where they act as a food source for beneficial gut bacteria, promoting their growth and the production of SCFAs.

Q7: Can FOS help with constipation?

A: While some studies suggest FOS may improve bowel movements and soften stools, more research is needed to confirm its efficacy for constipation.

Q8: What is the difference between FOS and probiotics?

A: FOS are prebiotics, which are non-digestible food ingredients that selectively stimulate the growth or activity of beneficial bacteria in the gut. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.

Q9: Can FOS interact with any medications?

A: Limited information is available on drug interactions. Concurrent use of antibiotics may decrease the effectiveness of FOS. Consult with a healthcare professional if taking other medications.

Q10: What should patients be advised regarding FOS use?

A: Patients should be advised to start with a low dose and increase it gradually to minimize gastrointestinal side effects. They should also be informed about potential side effects, contraindications, and the lack of sufficient safety data for pregnant or breastfeeding women. It’s crucial to encourage open communication with healthcare professionals for any concerns or questions.