Related Terms

• Beta-galactosidase, beta-galactosidase, Bi2muno®, Bi2muno®, Bi2tos®, Bi2tos®, bifidogenic, Bimuno®, Bitos®, Elix'or®, galacto-oligosaccharide, galactosyl lactose, oligogalactose, oligogalactosyl lactose, prebiotic, probiotic, synbiotic, transgalacto-oligosaccharides (TOS), transgalactooligosaccharides, Vivinal®GOS.

• Note: The galactooligosaccharides designed for human use are marketed by Clasado, Inc. (UK) under the brand name Bi2muno®, while Bi2tos® is designed for animal use.

Background

• Galactooligosaccharides (GOS) are short chains of variable length made up of the sugars galactose and glucose. While GOS are poorly digested by human enzymes, there are gut bacteria that are able to break down GOS. GOS thus serve as an energy source for beneficial bacteria that live in the human intestine. GOS are considered prebiotics, which are defined as food compounds that are indigestible by humans but are digestible by intestinal bacteria. Other indigestible oligosaccharides with prebiotic effects include fiber gums, fructooligosaccharides (FOS), inulins, isomalto-oligosaccharides, lactilol, lactosucrose, lactulose, pyrodextrins, soy oligosaccharides, and xylooligosaccharides.

• Prebiotics differ from probiotics. Probiotics are bacteria (such as Lactobacillus and Bifidobacterium) often taken as supplements to promote the establishment of beneficial gut bacteria.

• GOS have numerous purported beneficial effects. GOS are believed to mimic the oligosaccharides found naturally in human breast milk and may contribute to the known health benefits of breastfeeding. Infant formulas in Europe have been supplemented with GOS since 2001, and numerous studies support the safety and prebiotic effects of GOS supplementation in infants.

• Results of other studies suggest that GOS may have beneficial effects for the immune system, in treating constipation, in preventing atopic dermatitis, and in maintaining bone density. Although there is preliminary evidence supporting these potential benefits, more studies are needed.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Cancer, colorectal cancer, Crohn's disease, diarrhea, digestion, gastroenteritis (stomach flu), inflammatory bowel disease, irritable bowel syndrome, osteoporosis, pouchitis, ulcerative colitis.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

• To prevent bone loss, 10-20 grams of galactooligosaccharides (GOS) has been taken by mouth daily for nine days.

• For constipation, 260 grams of yogurt containing 12 grams of GOS, 12 grams of prunes, and six grams of linseed has been taken by mouth daily for three weeks, except for the first three days, during which 130 grams of yogurt was ingested. Yogurt supplemented with nine grams of GOS (Elix'or, BWP, Holland) has been taken by mouth twice daily for two weeks.

• For immunomodulation, three grams of prebiotics (90% GOS and 10% fructooligosaccharides [FOS]) has been taken by mouth three times daily by pregnant women from gestation week 25 until delivery.

• For blood lipid lowering, 15 grams of GOS has been taken daily for 21 days.

Children (under 18 years old)

• The European Commission's Scientific Committee on Food determined that up to eight grams of galactooligosaccharides (GOS) per liter is safe for consumption by older infants.

• For prevention of allergic disorders, newborn infants have taken by mouth 0.8 grams of GOS in sugar syrup along with a probiotic capsule once daily for the first six months of life.

• For prevention of atopic dermatitis, newborn infants have received by mouth 0.8 grams of GOS in sugar syrup along with a probiotic capsule once daily or in combination with fructooligosaccharides (FOS) (0.8 grams total in 100 milliliters of formula, or eight grams per liter) for the first six months of life. A prebiotic formula containing polydextrose (PDX), GOS, and lactulose (LOS) at four grams and eight grams per liter has also been taken by mouth.

• For infant growth and development, two prebiotic blends, PG4 (Enfamil LIPIL with an iron formula supplemented with a PDX and GOS blend, in a 50:50 ratio) and PGL8 (Enfamil LIPIL with an iron formula supplemented with PDX, GOS, and LOS) have been taken by mouth beginning at 14 days of age and continuing until 120 days of age.

• For the immune system, formula containing 0.6 grams of GOS and FOS per 100 milliliters has been taken by infants for 32 weeks, starting from birth.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

• Avoid with known allergy or hypersensitivity to lactose. Commercial preparations of GOS (Bi2muno®) may contain up to 25% lactose in liquid form and up to 30% lactose in powder form.

Side Effects and Warnings

• Oligosaccharides are generally considered to be safe when consumed as part of normal diet. The side effects of galactooligosaccharides (GOS) intake are mild laxative effects and gas. Symptoms may be more severe if consumed by sensitive individuals or if large quantities are consumed.

• In Europe, formulas containing up to eight grams of GOS per liter are considered safe for infants, and a prebiotic mixture of 10% long-chain inulin and 90% GOS has been added to infant formulas since 2001. In several studies, a lack of adverse effects was observed.

• When taken in dry form without sufficient liquid, GOS may cause choking.

• In one infant study, a combination prebiotic formula containing polydextrose (PDX), galactooligosaccharides, and lactulose (LOS) was associated with an increased incidence of eczema at a concentration of four grams per liter but not at eight grams per liter. The clinical relevance of this is unclear.

• Bloating, gas, and increased stool frequency may occur when large quantities of GOS are consumed. Indigestible carbohydrates such as GOS may produce more severe gastrointestinal symptoms in the lactose intolerant or other sensitive individuals. Significantly looser stools, vomiting, and diarrhea were also associated with combination prebiotics containing GOS. When used in the low doses found in infant formula, GOS are seldom associated with significant adverse effects. Side effects observed in infants receiving GOS supplementation that did not appear to be directly related to GOS intake were increased gas, abdominal discomfort, and vomiting.

• In one study that tested the efficacy of a synbiotic preparation (probiotic + prebiotic GOS) in preventing infantile allergic disease, adverse effects (that did not appear to be treatment related) included excessive crying. Another study found increased irritability and fussiness in infants receiving polydextrose (PDX), galactooligosaccharides, and lactulose (LOS).

• Use cautiously in individuals who have immune disorders, as galactooligosaccharides may have immunomodulatory effects.

• Use cautiously with agents that interfere with calcium absorption (e.g., alcohol, anticonvulsants, caffeine, cholestyramine, fluoroquinolone antibiotics, inositol hexaphosphate (phytic acid), loop diuretics (including furosemide, bumetanide, ethacrynic acid, and torsemide), stimulant laxatives (cascara, senna, and bisacodyl), Orlistat (Xenical®), and sotalol), as they may negate effects of galactooligosaccharides on calcium uptake.

• Avoid with known allergy, hypersensitivity, or intolerance to lactose, as commercial preparations of GOS (Bi2muno®) may contain up to 25% lactose in liquid form and up to 30% lactose in powder form. Large amounts of indigestible carbohydrates (such as lactose, lactulose, or fructooligosaccharides [FOS]) may produce more severe gastrointestinal symptoms.

• GOS are possibly safe when consumed during pregnancy or breastfeeding in recommended amounts. There is a lack of sufficient scientific information concerning GOS during pregnancy and breastfeeding.

Pregnancy and Breastfeeding

• Galactooligosaccharides (GOS) are possibly safe when consumed during pregnancy or breastfeeding in recommended amounts. There is a lack of sufficient scientific information concerning GOS during pregnancy and breastfeeding.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

• Galactooligosaccharides (GOS) may interact with alcohol, caffeine, calcium salts, drugs that weaken the immune system, laxatives, and mineral oil.

Interactions with Herbs and Dietary Supplements

• Galactooligosaccharides (GOS) may interact with alcohol, caffeine, calcium, foods containing calcium, foods containing phytic acid, foods containing prebiotics, foods containing probiotics, foods containing vitamin D, herbs and supplements that weaken the immune system, laxatives, mineral oil, phytic acid, probiotics, and vitamin D.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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2. Bakker-Zierikzee AM, Tol EA, Kroes H, et al. Faecal SIgA secretion in infants fed on pre- or probiotic infant formula. Pediatr Allergy Immunol 2006;17(2):134-140. View Abstract

3. Depeint F, Tzortzis G, Vulevic J, et al. Prebiotic evaluation of a novel galactooligosaccharide mixture produced by the enzymatic activity of Bifidobacterium bifidum NCIMB 41171, in healthy humans: a randomized, double-blind, crossover, placebo-controlled intervention study. Am J Clin Nutr 2008;87(3):785-791. View Abstract

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11. Teuri U, Korpela R. Galacto-oligosaccharides relieve constipation in elderly people. Ann Nutr Metab 1998;42(6):319-327. View Abstract

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15. Ziegler E, Vanderhoof JA, Petschow B, et al. Term infants fed formula supplemented with selected blends of prebiotics grow normally and have soft stools similar to those reported for breast-fed infants. J Pediatr Gastroenterol Nutr 2007;44(3):359-364. View Abstract