WO2018175879A1 - Méthodes de traitement d'intolérance au lactose et d'amélioration de la santé gastro-intestinale - Google Patents

Méthodes de traitement d'intolérance au lactose et d'amélioration de la santé gastro-intestinale Download PDF

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Publication number
WO2018175879A1
WO2018175879A1 PCT/US2018/024015 US2018024015W WO2018175879A1 WO 2018175879 A1 WO2018175879 A1 WO 2018175879A1 US 2018024015 W US2018024015 W US 2018024015W WO 2018175879 A1 WO2018175879 A1 WO 2018175879A1
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Prior art keywords
gos
weight
composition
another embodiment
lactose
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PCT/US2018/024015
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English (en)
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Andrew Justin RITTER
Dennis Savaiano
Todd Klaenhammer
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Ritter Pharmaceuticals, Inc.
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Publication of WO2018175879A1 publication Critical patent/WO2018175879A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7004—Monosaccharides having only carbon, hydrogen and oxygen atoms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/702—Oligosaccharides, i.e. having three to five saccharide radicals attached to each other by glycosidic linkages

Definitions

  • Lactose intolerance is the inability to digest significant amounts of lactose, a major natural sugar found in milk and milk products of all mammals. Lactose intolerance is caused by a shortage of the enzyme lactase, which is produced by the cells that line the small intestine and is essential to lactose digestion. Lactase breaks down lactose, a disaccharide, into two simpler forms of sugar called glucose and galactose, which are then transported across the cell membrane and absorbed into the bloodstream.
  • lactase If lactase is not present, or not present in sufficient levels, excess undigested lactose passes through the small intestines into the large intestine where it is fermented by bacteria in the colon ("colonic microbiota,” “gut microbiota,” “intestinal microbiota,” or “commensal gut microbiota”).
  • the fermentation of lactose in the large intestine produces hydrogen and methane which can lead to bloating, gas, and diarrhea.
  • These symptoms are caused by a very low activity of lactase in the intestines and are found in subjects who are lactose intolerant. Not all subjects deficient in lactase have the symptoms commonly associated with lactose intolerance, but those who do are said to have lactose intolerance.
  • Lactose maldigestion with or without the symptoms commonly associated with lactose intolerance, is often defined more specifically as an "increase in blood glucose concentration of ⁇ 1.12 mmol/L or breath hydrogen of >20 ppm after ingestion of 1 g/kg body weight or 50 g lactose" (de Vrese et al., 2001).
  • lactase a body produces generally reaches a maximum immediately after birth and then decreases in the majority of people during the ages of about 3-15.
  • the primary cause is an onset of loss of lactase that is believed to be a permanent condition. This onset can occur at a variable period after the weaning period.
  • the primary cause is also genetically determined.
  • the secondary cause is generally a temporary condition that occurs as a result of another disease or event that damages the lining of the small intestine where lactase is active. This temporary condition can be caused by acute diarrhea, disease, parasitic infection, Cohn's disease, celiac disease, gastrointestinal surgery, or the intake of certain medications.
  • Nutritional supplements currently sold often offer no proven benefit or in some instances, must be ingested prior to eating dairy, where the outcome is dependent on the dose of the supplement and relative to the amount of lactose consumed.
  • use of a nutritional supplement to manage the symptoms associated with lactose intolerance may require large dosages, such as five or more pills per day.
  • prebiotics are non-digestible food ingredients that stimulate the growth or activity of bacteria in the digestive system that are beneficial to the health of the body (Gibson and Roberfroid 1995).
  • prebiotics are carbohydrates such as oligosaccharides, but the definition does not preclude non-carbohydrates.
  • a purified GOS preparation can promote the selective growth of beneficial colonic bacteria, including multiple species and strains of bifidobacteria and lactobacilli.
  • Bifidobacteria carry out non hydrogen-producing lactose fermentation reactions in addition to inhibiting hydrogen producing bacteria, such as Escherichia coli (E. coli). It is this excessive hydrogen production that defines lactose malabsorption and ultimately is responsible for the symptoms associated with lactose intolerance (Ballongue 1993; Gibson 1994, 1995).
  • a recent study indicates that higher purity GOS formulations have a greater potential to selectively promote the growth of beneficial lactobacilli and bifidobacteria (Klaenhammer 2010).
  • a method for assessing efficacy of an oligosaccharide mixture comprises administering to a subject in need thereof an effective amount of a composition comprising one or more indigestible oligosaccharides and less than about 20%, 10%, 5%, 4%, 3% or less, digestible saccharides by weight and measuring a change in at least one, two, three or four abdominal symptoms.
  • the abdominal symptom may be one or more of abdominal pain, abdominal cramping, abdominal bloating, abdominal gas.
  • the change in the at least one, two, three or four abdominal symptoms is measured at least 20-60, and preferably 31, days after a first administration of the composition.
  • the change in the abdominal symptoms may be compared to a change in the abdominal symptoms for a subject receiving a placebo, or following a lactose challenge test (SZA), and may be measured 0.5, 1, 2, 3, 4, or 5 hours after the lactose challenge test (SZA).
  • Figure 1 illustrates the chemical structure of lactulose.
  • Figure 2 illustrates the chemical structure of raffinose.
  • Figure 3 illustrates the chemical structure of stachyose.
  • Figure 4 illustrates the chemical structure of inulin.
  • Figure 5 illustrates a treatment regimen with a 70% GOS composition.
  • Figure 6 illustrates another treatment regimen with a 70% GOS composition.
  • Figure 7 illustrates a treatment regimen with a 90% GOS composition.
  • Figure 8 illustrates another treatment regimen with a 93% GOS composition.
  • Figure 9 illustrates a treatment regimen with a 95% GOS composition.
  • Figure 10 illustrates a non-limiting example of different GOS with a DP of 2, 3, and 4.
  • Figure 11 illustrates an HPLC chromatograph of a sample containing high purity GOS.
  • Figure 12 illustrates Lactobacillus acidophilus NCFM growth on 2% GOSl (95%) or glucose.
  • Figures 13A and 13B illustrate HPLC chromatograms of GOS compositions of the present disclosure before (13A) and after (13B) a purification step.
  • Figure 14 illustrates comparative growth of L. acidophilus, Bifidobacterium lactis, Bifidobacterium, breve, and Bifidobacterium longum on GOSl (95%).
  • Figure 15 illustrates comparative growth of B. longum, Bifidobacterium pseudolongum, Bifidobacterium animalis, and Bifidobacterium adolescentis on glucose and GOS l (95%).
  • Figure 16 illustrates comparative growth of B. pseudolongum NCK20383 on glucose, lactose, GOSl (95%), and GOS2 (90%).
  • Figure 17 illustrates comparative growth of four bifidobacterial strains on glucose, GOSl (95%), GOS2 (90%), and lactose.
  • Figure 18 illustrates growth of 3 Escherichia coli strains in media with no added carbohydrate (control), or 2% added glucose, GOS l (95% GOS), or GOS2 (90% GOS).
  • Figure 19 illustrates a schematic of a high percentage GOS composition manufacturing process.
  • Figure 20 illustrates an HPLC chromatograph of a sample containing GOS 95.
  • Figure 21 illustrates an HPLC chromatograph of a blank sample (PVDF filtered 0.015N H2 S04).
  • Figure 22 illustrates an HPLC chromatograph of a sample containing Lactose.
  • Figure 23 illustrates an HPLC chromatograph of a sample containing a-D- Glucose.
  • Figure 24 illustrates an HPLC chromatograph of a sample containing D-(+)- Galactose.
  • Figure 25 illustrates an overview of a Phase ⁇ proof-of-concept study.
  • Figure 26 illustrates a set of interviewer instructions for a pre-screening interview.
  • Figure 27 illustrate a study introduction script for a pre-screening interview.
  • Figure 28 illustrates a lactose intolerance symptom script/guidelines for a pre- screening interview.
  • Figure 29 illustrates a lactose intolerance life-style script/guidelines for a pre- screening interview.
  • Figure 30 illustrates a Lactose Load Symptom Questionnaire for a pre- screening interview.
  • Figure 31 illustrates a Daily Symptom Diary for use during Placebo Run-in and Treatment studies.
  • Figure 32 illustrates a Daily Symptom and Milk Product Diary for use during the follow-up studies.
  • Figure 33 illustrates a change in the bacterial population in response to treatment with GOS-95.
  • Figure 34 illustrates an overview of method for analyzing the operational taxonomic units (OTUs) of the fecal microbiome.
  • OTUs operational taxonomic units
  • Disclosed herein are methods of treating lactose intolerance in a subject experiencing one or more symptoms of lactose intolerance comprising administering a pharmaceutical composition to the subject, wherein the pharmaceutical composition comprises
  • Galactooligosaccharide In one embodiment, at least about 80% of the total weight of the composition is GOS. In one embodiment, at least about 95% of the total weight of the composition is GOS. In one embodiment, the composition comprises about 0.1 g to 20 g GOS.
  • the composition comprises about 1.5 g to 15 g GOS.
  • the composition is a spray-dried powder, effervescent, dissolved tablet, a powder dissolved in water, a powder spread on food, a syrup, or a liquid.
  • the spray-dried powder, effervescent, dissolved tablet, powder dissolved in water, powder spread on food, syrup, or liquid is provided in a capsule or softgel.
  • the syrup or liquid is provided in a bottle.
  • the syrup or liquid is diluted with water prior to consumption.
  • the composition is provided in a dosing unit.
  • the dosing unit is a capsule, tablet, softgel, effervescent tablet, orodispersible tablet, oral thin or dissolving film, oral spray, bar, gel, powder, or lozenge.
  • the dosing unit is provided in the form of a candy matrix such as a gummy, jelly candy, chewing gum, hard candy, tablet candy, taffy candy, chewy candy, or lollipop.
  • the dosing unit further comprises an enteric coating.
  • the composition further comprises a probiotic.
  • the probiotic comprises Lactobacillus or bifidobacteria. In one embodiment, the composition does not contain a probiotic.
  • the composition is administered each day for a predetermined number of days.
  • the predetermined number of days is 1 to 3 days.
  • the predetermined number of days is 1 to 5 days or 3 to 5 days.
  • the predetermined number of days is 1 day to 1 week or 1 day to one month.
  • the predetermined number of days is one month to three months or one month to six months.
  • the predetermined number of days is one month to one year.
  • the method comprises administering a lower dosage of GOS on the first day of administration than the last day of administration.
  • the subject is administered 0.1 grams to 20 grams of GOS on the first day and a greater amount of GOS on the final day.
  • the subject is administered 1 gram of GOS on the first day and 20 grams of GOS on the final day. In one embodiment, the subject is administered 1 gram of GOS on the first day and 10 grams of GOS on the final day. In one embodiment, the subject is administered 1.5 grams of GOS on the first day and 15 grams of GOS on the final day. In one embodiment, the subject is administered 2 grams of GOS on the first day and 20 grams of GOS on the final day. In one embodiment, the method comprises administering the same dosage of GOS on the first day of administration as the last day of administration. In one embodiment, the method comprises administering the composition once a day. In one embodiment, the method comprises administering the composition twice a day. In one embodiment, the composition is provided without a meal.
  • the composition is provided with a meal.
  • the subject is a human subject.
  • the subject is a pediatric subject.
  • the subject is an adult.
  • the subject is an elderly person.
  • the subject is a post-menopausal woman.
  • the one or more symptoms comprise flatulence, heartburn, upset stomach, nausea, bloating, diarrhea, abdominal pain, cramping, or vomiting.
  • the subject has a nutritional deficiency.
  • the nutritional deficiency is a calcium deficiency.
  • Also disclosed here are methods of preventing lactose intolerance in a subject experiencing one or more symptoms of lactose intolerance comprising administering a pharmaceutical composition to the subject, wherein the pharmaceutical composition comprises GOS.
  • the pharmaceutical composition comprises GOS.
  • at least about 80% of the total weight of the composition is GOS.
  • at least about 95% of the total weight of the composition is GOS.
  • the composition comprises about 0.1 g to 20 g GOS.
  • the composition comprises about 1.5 g to 15 g GOS.
  • the composition is a syrup or liquid.
  • the syrup or liquid is provided in a capsule or softgel.
  • the syrup or liquid is provided in a bottle.
  • the syrup or liquid is diluted with water prior to consumption.
  • the composition is provided in a dosing unit.
  • the dosing unit is a capsule, tablet, softgel, effervescent tablet, oral thin or dissolving film, orodispersible tablet, oral spray, bar, gel, powder, or lozenge.
  • the dosing unit is provided in a candy matrix form such as a gummy, jelly candy, chewing gum, hard candy, tablet candy, taffy candy, chewy candy, or lollipop.
  • the dosing unit further comprises an enteric coating.
  • the composition further comprises a probiotic.
  • the probiotic comprises Lactobacillus or bifidobacteria. In one embodiment, the composition does not contain a probiotic. In one embodiment, the composition is administered each day for a predetermined number of days. In one embodiment, the predetermined number of days is 10 to 40 days. In one embodiment, the predetermined number of days is 35 days. In one embodiment, the predetermined number of days is 30 days. In one embodiment, the predetermined number of days is 14 days. In one embodiment, the method comprises administering a lower dosage of GOS on the first day of administration than the last day of administration. In one embodiment, the subject is administered 0.1 grams to 20 grams of GOS on the first day and a greater amount of GOS on the final day.
  • the subject is administered 1 gram of GOS on the first day and 20 grams of GOS on the final day. In one embodiment, the subject is administered 1 gram of GOS on the first day and 10 grams of GOS on the final day. In one embodiment, the subject is administered 1.5 grams of GOS on the first day and 15 grams of GOS on the final day. In one embodiment, the subject is administered 2 grams of GOS on the first day and at least 15 grams of GOS on the final day. In one embodiment, the subject is administered 3 grams of GOS on the first day and at least 15 grams of GOS on the final day. In one embodiment, the subject is administered 4 grams of GOS on the first day and at least 15 grams of GOS on the final day.
  • the subject is administered 5 grams of GOS on the first day and at least 15 grams of GOS on the final day. In one embodiment, the subject is administered 7.5 grams of GOS on the first day and at least 15 grams of GOS on the final day. In one embodiment, the subject is administered 10 grams of GOS on the first day and at least 15 grams of GOS on the final day. In one embodiment, the subject is administered 12.5 grams of GOS on the first day and at least 15 grams of GOS on the final day. In one embodiment, the subject is administered 15 grams of GOS on the first day and more than 15 grams of GOS on the final day. In one embodiment, the method comprises administering the same dosage of GOS on the first day of administration as the last day of administration.
  • the method comprises administering the composition once a day. In one embodiment, the method comprises administering the composition twice a day. In one embodiment, the composition is provided without a meal. In one embodiment, the composition is provided with a meal. In one embodiment, the subject is a human subject. In one embodiment, the subject is a pediatric subject. In one embodiment, the subject is an adult. In one embodiment, the subject is an elderly person. In one embodiment, the subject is a post- menopausal woman. In one embodiment, the one or more symptoms comprise flatulence, heartburn, upset stomach, nausea, bloating, diarrhea, abdominal pain, cramping, or vomiting. In one embodiment, the subject has a nutritional deficiency. In one embodiment, the nutritional deficiency is a calcium deficiency.
  • HBT hydrogen breath test
  • diagnosing the subject as having or not having lactose intolerance based upon a HBT result comprising: administering a hydrogen breath test (HBT) to the subject; diagnosing the subject as having or not having lactose intolerance based upon a HBT result; and, administering a pharmaceutical composition to the subject diagnosed as having lactose intolerance based upon the HBT result, wherein the pharmaceutical composition comprises GOS.
  • HBT result is an increase in breath hydrogen of greater than about 12 ppm.
  • the HBT result is an increase in breath hydrogen of greater than about 15 ppm.
  • the HBT result is an increase in breath hydrogen of greater than about 20 ppm.
  • Also disclosed here are methods of treating lactose intolerance in a subject experiencing one or more symptoms of lactose intolerance comprising: administering a lactose intolerance diagnostic questionnaire; diagnosing the subject as having or not having lactose intolerance based upon a lactose intolerance diagnostic questionnaire result; and, administering a pharmaceutical composition to the subject diagnosed with lactose intolerance based upon the lactose intolerance diagnostic questionnaire result, wherein the pharmaceutical composition comprises GOS.
  • the lactose intolerance diagnostic questionnaire result is a single symptom rating of moderately severe to severe.
  • the lactose intolerance diagnostic questionnaire result is two or more symptom ratings of moderate or higher.
  • the lactose intolerance diagnostic questionnaire result is a single symptom rating of moderate or higher at two different timepoints.
  • the lactose intolerance diagnostic questionnaire is administered after a lactose or milk challenge.
  • methods of treating lactose intolerance in a subject experiencing one or more symptoms of lactose intolerance comprising: administering a hydrogen breath test (HBT) to the subject; administering a lactose intolerance diagnostic questionnaire to the subject; diagnosing the subject as having or not having lactose intolerance based upon a HBT result and a lactose intolerance diagnostic questionnaire result; and administering a pharmaceutical composition to the subject diagnosed with lactose intolerance based upon the HBT result and the lactose intolerance diagnostic questionnaire result, wherein the pharmaceutical composition comprises GOS.
  • HBT hydrogen breath test
  • the HBT result is an increase in breath hydrogen of greater than 12 ppm. In one embodiment, the HBT result is an increase in breath hydrogen of greater than 15 ppm. In one embodiment, the HBT result is an increase in breath hydrogen of greater than 20 ppm. In one embodiment, the lactose intolerance diagnostic questionnaire result is a single symptom rating of moderately severe to severe. In one embodiment, the lactose intolerance diagnostic questionnaire result is two or more symptom ratings of moderate or higher. In one embodiment, the lactose intolerance diagnostic questionnaire result is a single symptom rating of moderate or higher at two different timepoints. In some embodiments, at least about 80% of the total weight of the composition is GOS.
  • the composition comprises about 0.1 g to 20 g GOS. In some embodiments, the composition comprises about 1.5 g to 15 g GOS. In some embodiments, the composition is a syrup or liquid. In some embodiments, the syrup or liquid is provided in a capsule or softgel. In some embodiments, the syrup or liquid is provided in a bottle. In some embodiments, the syrup or liquid is diluted with water prior to consumption. In some embodiments, the composition is provided in a dosing unit.
  • the dosing unit is a capsule, tablet, softgel, effervescent tablet, oral thin or dissolving film, powder, orodispersible tablet, oral spray, bar, gel, or lozenge.
  • the dosing unit further comprises an enteric coating.
  • the composition further comprises a probiotic.
  • the probiotic comprises Lactobacillus or bifidobacteria.
  • the composition does not contain a probiotic.
  • the composition is administered each day for a predetermined number of days. In one embodiment, the predetermined number of days is 1, 2, or 3 days. In one embodiment, the predetermined number of days is 1, 2, 3, 4, 5, 6, or 7 days.
  • the predetermined number of days is 1 day to 1 week or 1 day to one month. In one embodiment, the predetermined number of days is one month to three months or one month to six months. In one embodiment, the predetermined number of days is one month to one year. In some embodiments, the method comprises administering a lower dosage of GOS on the first day of administration than the last day of administration. In some embodiments, the subject is administered 1.5 grams of GOS on the first day and 15 grams of GOS on the final day. In some embodiments, the method comprises administering the same dosage of GOS on the first day of administration as the last day of administration. In some embodiments, the method comprises administering the composition once a day. In some embodiments, the method comprises administering the composition twice a day.
  • the composition is provided without a meal. In some embodiments, the composition is provided with a meal. In some embodiments, the subject is a human subject. In some embodiments, the subject is a pediatric subject. In some embodiments, the subject is an adult. In some embodiments, the subject is an elderly person. In some embodiments, the subject is a post-menopausal woman. In some embodiments, the one or more symptoms comprise flatulence, heartburn, upset stomach, nausea, bloating, diarrhea, abdominal pain, cramping, or vomiting. In some embodiments, the subject has a nutritional deficiency. In some embodiments, the nutritional deficiency is a calcium deficiency.
  • HBT hydrogen breath test
  • the method of treatment further comprising administering a lactose intolerance diagnostic questionnaire to the subject and diagnosing the subject as having or not having lactose intolerance based upon the HBT result and a lactose intolerance diagnostic questionnaire result.
  • Also disclosed herein are methods of treating a subject with a calcium deficiency wherein the subject is experiencing one or more symptoms of lactose intolerance comprising: administering a lactose intolerance diagnostic questionnaire; diagnosing the subject as having or not having lactose intolerance based upon a lactose intolerance diagnostic questionnaire result; and, administering a pharmaceutical composition to the subject diagnosed with lactose intolerance based upon the lactose intolerance diagnostic questionnaire results, wherein the pharmaceutical composition comprises GOS.
  • the HBT result is an increase in breath hydrogen of greater than 12 ppm. In one embodiment, the HBT result is an increase in breath hydrogen of greater than 15 ppm.
  • the HBT result is an increase in breath hydrogen of greater than 20 ppm.
  • the lactose intolerance diagnostic questionnaire result is a single symptom rating of moderately severe to severe. In one embodiment, the lactose intolerance diagnostic questionnaire result is two or more symptom ratings of moderate or higher. In one embodiment, the lactose intolerance diagnostic questionnaire result is a single symptom rating of moderate or higher at two different timepoints. In one embodiment, the lactose intolerance diagnostic questionnaire is administered after a lactose or milk challenge. In some embodiments, the subject has bone loss, osteoporosis, hypertension, weak bone density and/or cardiac arrhythmias. In some embodiments, at least about 80% of the total weight of the composition is GOS.
  • the composition comprises about 0.1 g to 20 g GOS. In some embodiments, the composition comprises about 1.5 g to 15 g GOS. In some embodiments, the composition is a syrup or liquid. In some embodiments, the syrup or liquid is provided in a capsule or softgel. In some embodiments, the syrup or liquid is provided in a bottle. In some embodiments, the syrup or liquid is diluted with water prior to consumption. In some embodiments, the composition is provided in a dosing unit.
  • the dosing unit is a capsule, tablet, softgel, effervescent tablet, oral thin or dissolving film, orodispersible tablet, oral spray, or lozenge.
  • the dosing unit further comprises an enteric coating.
  • the composition further comprises a probiotic.
  • the probiotic comprises Lactobacillus or bifidobacteria.
  • the composition does not contain a probiotic.
  • the composition is administered each day for a predetermined number of days. In some embodiments, the predetermined number of days is 10 to 40 days. In some embodiments, the predetermined number of days is 35 days. In some embodiments, the predetermined number of days is 30 days.
  • the predetermined number of days is 14 days.
  • the method comprises administering a lower dosage of GOS on the first day of administration than the last day of administration.
  • the subject is administered 1.5 grams of GOS on the first day and 15 grams of GOS on the final day.
  • the method comprises administering the same dosage of GOS on the first day of administration as the last day of administration.
  • the method comprises administering the composition once a day.
  • the method comprises administering the composition twice a day.
  • the composition is provided without a meal.
  • the composition is provided with a meal.
  • the subject is a human subject. In some embodiments, the subject is a pediatric subject.
  • the subject is an adult. In some embodiments, the subject is an elderly person. In some embodiments, the subject is a post-menopausal woman. In some embodiments, the one or more symptoms comprise flatulence, heartburn, upset stomach, nausea, bloating, diarrhea, abdominal pain, cramping, or vomiting.
  • pharmaceutically acceptable oral dosage forms of GOS comprising one or more dosing units, each of the dosing units comprising 0.1 to 2 g of a GOS composition wherein the GOS composition is a liquid encapsulated in a gelatin capsule.
  • GOS comprising one or more dosing units, each of the dosing units comprising 0.1 to 2 g of a GOS composition wherein the GOS composition is a viscous syrup or liquid encapsulated in a gelatin capsule.
  • the gelatin capsule is size 000, 00, 0, 1, 2, 3, 4, or 5.
  • the GOS composition comprises at least about 80% GOS by weight.
  • the GOS composition comprises at least about 95% GOS by weight.
  • the gelatin capsule further comprises an enteric coating.
  • GOS composition further comprises a probiotic.
  • the probiotic comprises Lactobacillus or bifidobacteria.
  • the GOS composition does not contain a probiotic.
  • GI gastrointestinal
  • Symptoms of lactose intolerance include gas, heartburn, stomach upset, bloating, flatulence, diarrhea, abdominal pain, cramping, nausea, or vomiting. Minor digestive problems related to the GI also include occasional bloating, diarrhea, constipation, gas, heartburn, or stomach upset.
  • the methods and compositions described herein are useful for reducing or eliminating one or more of these symptoms, for example through colonic adaptation. Fructose and sorbitol malabsorption are also common when lactose malabsorption is present.
  • the methods and compositions described herein can also be useful for reducing or eliminating malabsorption of saccharides or carbohydrates such as lactose, fructose, or sorbitol.
  • Improvements in gastrointestinal health may involve preventing, treating, or reducing or eliminating one or more symptoms of a gastrointestinal disorder, the methods comprising administering to the subject a pharmaceutical composition comprising: a. an effective amount of a galactooligosaccharides (GOS) composition to prevent, treat, or reduce or eliminate the one or more symptoms of the gastrointestinal disorder; and b.
  • a pharmaceutical composition comprising: a. an effective amount of a galactooligosaccharides (GOS) composition to prevent, treat, or reduce or eliminate the one or more symptoms of the gastrointestinal disorder; and b.
  • GOS galactooligosaccharides
  • the gastrointestinal disorder is constipation, diarrhea, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), small intestine bacterial overgrowth (SIBO), hemorrhoids, indigestion or non-ulcer dyspepsia, anal fissures, perianal abscesses, anal fistula, diverticulosis or diverticulitis, colitis, infectious colitis, ulcerative colitis, Crohn's disease, ischemic colitis, radiation colitis, pseudomembranous colitis, C.
  • IBS irritable bowel syndrome
  • IBD inflammatory bowel disease
  • SIBO small intestine bacterial overgrowth
  • the subject experiences a reduction in at least one of the one or more symptoms of the gastrointestinal disorder following treatment.
  • the reduction in the at least one of the one or more symptoms of the gastrointestinal disorder following treatment is about a 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, or 100% decrease in a subject reported severity of the at least one of the one or more symptoms of the gastrointestinal disorder.
  • the reduction in at least one of the one or more symptoms of the gastrointestinal disorder persists for at least about a day, a week, a month, 3 months, 6 months, 9 months, or a year after treatment.
  • the GOS composition comprises from about 50% to about 100% GOS by dry weight. In some embodiments, the GOS composition comprises about 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% of the GOS by dry weight. In some embodiments, the GOS composition comprises disaccharides, trisaccharides, tetrasaccharides, and pentasaccharides.
  • the GOS composition comprises at least 80% disaccharides, trisaccharides, tetrasaccharides, and pentasaccharides by dry weight. In some embodiments, the GOS composition comprises from about 0.1 % to about 5% disaccharides by dry weight, from about 30% to about 75% trisaccharides by dry weight, from about 15% to about 45% tetrasaccharides by dry weight, and from about 1 % to about 20% pentasaccharides by dry weight.
  • the GOS composition comprises from about 1 % to about 2% disaccharides by dry weight, from about 50% to about 60% trisaccharides by dry weight, about 25% to about 35% tetrasaccharides by dry weight, and about 5% to about 15% pentasaccharides by dry weight.
  • the pharmaceutical composition comprises less than 10% digestible saccharides by dry weight. In some embodiments, the pharmaceutical composition comprises less than 5%, 4%, 3%, 2%, or 1 % digestible saccharides by dry weight.
  • the one or more excipients comprise one or more antiadherents, binders, coatings, disintegrants, fillers, flavours, colours, lubricants, glidants, sorbents, preservatives, sweeteners, or a combination thereof.
  • the one or more excipients comprise acacia, alginate, alginic acid, aluminum acetate, benzyl alcohol, butyl paraben, butylated hydroxy toluene, calcium carbonate, calcium disodium edta, calcium hydrogen phosphate dihydrate, dibasic calcium phosphate, tribasic calcium phosphate, calcium stearate, candelilla wax, carboxymethylcellulose calcium, carnuba wax, castor oil hydrogenated, cellulose, cetylpyridine chloride, citric acid, colloidal silicone dioxide, copolyvidone, croscarmellose sodium, crospovidone, cysteine HC1, dimethicone, disodium hydrogen phosphate, erythrosine sodium, ethyl cellulose, gelatin, glycerin, glyceryl behenate, glyceryl monooleate, glyceryl monostearate, glycine, hpmc pthalate, hydroxy
  • the one or more excipients comprise silicified microcrystalline cellulose.
  • the pharmaceutical composition comprises from about 10% to about 75% of the one or more excipients by dry weight.
  • the one or more excipients is silicified microcrystalline cellulose and wherein the pharmaceutical composition comprises from about 10% to about 75% of the silicified microcrystalline cellulose by dry weight.
  • the one or more excipients is silicified microcrystalline cellulose and wherein the pharmaceutical composition comprises from about 45% to about 55% of the silicified microcrystalline cellulose by dry weight.
  • the pharmaceutical composition is in a dosage form that is a liquid, gel, cream, powder, tablet, capsule, gel capsule, effervescent tablet, or lozenge. In some embodiments, the pharmaceutical composition is in a dosage form that is a powder and wherein the powder is packaged in a sachet. In some embodiments, the effective amount of the GOS composition is from about 1 g to about 25 g. In some embodiments, the pharmaceutical composition is administered one, two, or three times a day. In some embodiments, the pharmaceutical composition is administered twice a day. In some embodiments, the pharmaceutical composition is administered each day for a predetermined number of days. In some embodiments, the predetermined number of days is from 1 day to about 60 days.
  • the administering is based on a body mass measurement of the subject.
  • the body mass measurement is used to place the subject in a treatment category.
  • the body mass measurement is used to place the subject in a treatment category, wherein the treatment category comprises subjects weighing less than or equal to about 150 Lbs, subjects weighing from about 151 to 200 Lbs, or subjects weighing greater than about 200 Lbs.
  • an amount of the pharmaceutical composition administered to the subject is based upon the body mass measurement of the subject. In some embodiments, the amount of the pharmaceutical composition is from about 1 g to about 50 g per day for subjects in a first treatment category.
  • the amount of the pharmaceutical composition is about 1 g to about 20 g per day higher for subjects in a second treatment category than for subjects in the first treatment category and wherein the second treatment category comprises heavier subjects than the first treatment category. In some embodiments, the amount of the pharmaceutical composition is about 1 g to about 20 g per day higher for subjects in a third treatment category than for subjects in the second treatment category and wherein the third treatment category comprises heavier subjects than the second treatment category. In some embodiments, a number of dosing units the subject is administered per day is based upon the body mass measurement of the subject. In some embodiments, the number of dosing units is from about 1 to about 30 per day for subjects in a first treatment.
  • the gastrointestinal disorder is constipation, diarrhea, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), small intestine bacterial overgrowth (SIBO), hemorrhoids, indigestion or non-ulcer dyspepsia, anal fissures, perianal abscesses, anal fistula, diverticulosis or diverticulitis, colitis, infectious colitis, ulcerative colitis, Crohn's disease, ischemic colitis, radiation colitis, pseudomembranous colitis, C.
  • IBS irritable bowel syndrome
  • IBD inflammatory bowel disease
  • SIBO small intestine bacterial overgrowth
  • the subject experiences a reduction in at least one of the one or more symptoms of the gastrointestinal disorder following treatment.
  • the reduction in at least one of the one or more symptoms of the gastrointestinal disorder is about a 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, or 100% decrease in a subject reported severity of the at least one of the one or more symptoms of the gastrointestinal disorder.
  • the reduction in at least one of the one or more symptoms of the gastrointestinal disorder persists for at least about a day, a week, a month, 3 months, 6 months, 9 months, or a year after treatment.
  • the gastrointestinal disorder is SIBO, IBS, IBD, metabolic syndrome, or diabetes.
  • the prebiotic composition comprises one or more non-digestible oligosaccharides.
  • the one or more non-digestible oligosaccharides comprise galactooligosaccharides (GOS), lactulose, raffinose, stachyose, inulin, fructooligosaccharides (FOS), or a combination thereof.
  • the prebiotic composition comprises from about 50% to about 100% of the one or more non-digestible oligosaccharides by dry weight. In some embodiments, the prebiotic composition comprises about 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% of the one or more non-digestible oligosaccharides by dry weight. In some embodiments, the prebiotic composition is a galactooligosaccharides (GOS) composition.
  • GOS galactooligosaccharides
  • the GOS composition comprises monosaccharides (GOS1), disaccharides (GOS2), trisaccharides (GOS3), tetrasaccharides (GOS4), pentasaccharides (GOS5), and/or hexasaccharides (GOS6), and combinations thereof.
  • the GOS composition comprises at least 80% disaccharides, trisaccharides, tetrasaccharides, and pentasaccharides by dry weight.
  • the GOS composition comprises from about 0.1% to about 5% disaccharides by dry weight, from about 30% to about 75% trisaccharides by dry weight, from about 15% to about 45% tetrasaccharides by dry weight, and from about 1% to about 20% pentasaccharides by dry weight. In some embodiments, the GOS composition comprises from about 1% to about 2% disaccharides by dry weight, from about 50% to about 60% trisaccharides by dry weight, about 25% to about 35% tetrasaccharides by dry weight, and about 5% to about 15% pentasaccharides by dry weight. In some embodiments, the GOS composition comprises from about 50% to about 100% GOS by dry weight.
  • the GOS composition comprises about 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% GOS by dry weight.
  • the pharmaceutical composition comprises less than 10% digestible saccharides by dry weight.
  • the pharmaceutical composition comprises less than 5%, 4%, 3%, 2%, or 1% digestible saccharides by dry weight.
  • the one or more excipients comprise one or more antiadherents, binders, coatings, disintegrants, fillers, flavours, colours, lubricants, glidants, sorbents, preservatives, sweeteners, or a combination thereof.
  • the one or more excipients comprise acacia, alginate, alginic acid, aluminum acetate, benzyl alcohol, butyl paraben, butylated hydroxy toluene, calcium carbonate, calcium disodium edta, calcium hydrogen phosphate dihydrate, dibasic calcium phosphate, tribasic calcium phosphate, calcium stearate, candelilla wax, carboxymethylcellulose calcium, carnuba wax, castor oil hydrogenated, cellulose, cetylpyridine chloride, citric acid, colloidal silicone dioxide, copolyvidone, croscarmellose sodium, crospovidone, cysteine HC1, dimethicone, disodium hydrogen phosphate, erythrosine sodium, ethyl cellulose, gelatin, glycerin, glyceryl behenate, glyceryl monooleate, glyceryl monostearate, glycine, hpmc pthalate, hydroxy
  • the one or more excipients comprise silicified microcrystalline cellulose.
  • the pharmaceutical composition comprises from about 10% to about 75% of the one or more excipients by dry weight.
  • the one or more excipients is silicified microcrystalline cellulose and wherein the pharmaceutical composition comprises from about 10% to about 75% of the silicified microcrystalline cellulose by dry weight.
  • the one or more excipients is silicified microcrystalline cellulose and wherein the pharmaceutical composition comprises from about 45% to about 55% of the silicified microcrystalline cellulose by dry weight.
  • the pharmaceutical composition is in a dosage form that is a liquid, gel, cream, powder, tablet, capsule, gel capsule, effervescent tablet, or lozenge. In some embodiments, the pharmaceutical composition is in a dosage form that is a powder and wherein the powder is packaged in a sachet. In some embodiments, the sachet contains from about 1 g to about 25 g of the prebiotic composition. In some embodiments, the effective amount of the prebiotic composition is from about 1 g to about 25 g. In some embodiments, the pharmaceutical composition is administered one, two, or three times a day. In some embodiments, the pharmaceutical composition is administered twice a day. In some embodiments, the pharmaceutical composition is administered each day for a predetermined number of days.
  • the predetermined number of days is from 1 day to about 60 days.
  • the pharmaceutical composition is a powder and wherein the powder is mixed with a liquid prior to administering to the subject.
  • the liquid is a non- dairy liquid.
  • the administering is based on a body mass measurement of the subject.
  • the body mass measurement is used to place the subject in a treatment category.
  • the body mass measurement is used to place the subject in a treatment category, wherein the treatment category comprises subjects weighing less than or equal to about 150 Lbs, subjects weighing from about 151 to 200 Lbs, or subjects weighing greater than about 200 Lbs.
  • an amount of the pharmaceutical composition administered to the subject is based upon the body mass measurement of the subject. In some embodiments, the amount of the pharmaceutical composition is from about 1 g to about 50 g per day for subjects in a first treatment category. In some embodiments, the amount of the pharmaceutical composition is about 1 g to about 20 g per day higher for subjects in a second treatment category than for subjects in the first treatment category and wherein the second treatment category comprises heavier subjects than the first treatment category. In some embodiments, the amount of the pharmaceutical composition is about 1 g to about 20 g per day higher for subjects in a third treatment category than for subjects in the second treatment category and wherein the third treatment category comprises heavier subjects than the second treatment category.
  • a number of dosing units the subject is administered per day is based upon the body mass measurement of the subject. In some embodiments, the number of dosing units is from about 1 to about 30 per day for subjects in a first treatment category. In some embodiments, the number of dosing units is about 1 to about 10 higher per day for subjects in a second treatment category than for subjects in the first treatment category and wherein the second treatment category comprises heavier subjects than the first treatment category. In some embodiments, the number of dosing units is about 1 to about 10 higher per day for subjects in a third treatment category than for subjects in the second treatment category and wherein the third treatment category comprises heavier subjects than the second treatment category.
  • a number of days the subject is treated is based upon the body mass measurement of the subject. In some embodiments, the number of days is from about 1 day to about 60 days for subjects in a first treatment category. In some embodiments, the number of days is from about 1 day to about 30 days longer for subjects in a second treatment category than for subjects in the first treatment category and wherein the second treatment category comprises heavier subjects than the first treatment category. In some embodiments, the number of days is from about 1 day to about 30 days longer for subjects in a third treatment category than for subjects in the second treatment category and wherein the third treatment category comprises heavier subjects than the second treatment category. In some embodiments, the first treatment category comprises subjects weighing less than or equal to about 150 Lbs.
  • the first treatment category comprises subjects weighing less than or equal to about 150 Lbs and wherein the second treatment category comprises subjects weighing from about 150 Lbs to about 200 Lbs. In some embodiments, the first treatment category comprises subjects weighing less than or equal to about 150 Lbs, wherein the second treatment category comprises subjects weighing from about 150 Lbs to about 200 Lbs, and wherein the third treatment category comprises subjects weighing greater than about 200 Lbs. In some embodiments, a treatment regimen comprises administering a higher amount of the pharmaceutical composition at the end of the treatment regimen than at the beginning of the treatment regimen.
  • a treatment regimen comprises administering a higher amount of the pharmaceutical composition at the end of the treatment regimen than at the beginning of the treatment regimen and wherein a rate at which the amount of the pharmaceutical composition administered to the subject per day increases is based upon the body mass measurement. In some embodiments, the rate at which the amount of the pharmaceutical composition administered to the subject per day increases is higher for subjects in a second treatment category than for subjects in a first treatment category, wherein the second treatment category comprises heavier subjects than the first treatment category.
  • the pharmaceutical composition further comprises one or more probiotics. In some embodiments, the pharmaceutical composition does not comprise a probiotic. In some embodiments, the one or more excipients do not comprise lactose, glucose, or galactose.
  • the reduction or elimination of symptoms persists after treatment of a condition has concluded.
  • the described methods need not be used on a continuous basis but rather can be utilized for a discrete time period and then discontinued.
  • reduction or elimination of symptoms can be temporary, and after an amount of time has passed, treatment can be administered when symptoms reappear to maintain the effects of the methods described herein.
  • the methods described can be administered on a regular basis for reducing symptoms of lactose intolerance and for improving overall gastrointestinal (GI) health.
  • GI overall gastrointestinal
  • compositions and methods comprising a prebiotic composition are provided that are useful for treatment of lactose intolerance, reduction of symptoms of lactose intolerance, and for improving overall gastrointestinal (GI) health.
  • a prebiotic composition is a pharmaceutical composition.
  • a prebiotic composition comprises one or more saccharides (herein, interchangeably also referred to as carbohydrates or sugars) which are non-digestible by a human digestive system.
  • a prebiotic composition consists essentially of a saccharide which is non-digestible by a human digestive system.
  • the one or more saccharides are oligosaccharides wherein the degree of polymerization (DP) is from 2 to 20.
  • the degree of polymerization can be 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20.
  • the one or more saccharides are a polysaccharide wherein the degree of polymerization is greater than 10.
  • the saccharide comprises a mixture of non-digestible oligosaccharides or polysaccharides.
  • a prebiotic composition comprises one or more digestible saccharides and one or more non- digestible oligosaccharides or polysaccharides.
  • the saccharide is an oligosaccharide, such as a disaccharide, a trisaccharide, a tetrasaccharide, a pentasaccharide, a hexasaccharide, a heptasaccharide, an octasaccharide, a nanasaccharide, or a decasaccharide.
  • oligosaccharide such as a disaccharide, a trisaccharide, a tetrasaccharide, a pentasaccharide, a hexasaccharide, a heptasaccharide, an octasaccharide, a nanasaccharide, or a decasaccharide.
  • Saccharides that are not digestible by humans include, but are not limited to, transgalactooligosaccharides, galacto-oligosaccharides, lactulose, raffinose, stachyose, lactosucrose, fructo-oligosaccharides, isomalto-oligosaccharides, xylo-oligosaccharides, paratinose oligosaccharides, difructose anhydride ⁇ , sorbitol, maltitol, lactitol, reduced paratinose, cellulose, ⁇ -glucose, ⁇ -galactose, ⁇ -fructose, verbascose, galactinol, and ⁇ -glucan, guar gum, pectin, high sodium alginate, and lambda carrageenan.
  • a prebiotic composition comprises a saccharide that is inulin, fructo-oligosaccharide (FOS), lactulose, galacto-oligosaccharide (GOS), raffinose, or stachyose.
  • the saccharide is an oligosaccharide that is non-digestible by a human digestive system, contains at least one beta-glycosidic (e.g., beta galactosidic or beta glucosidic) bond, and would induce lactose digestion when fed to a subject in need thereof.
  • the subject in need thereof is a human.
  • the saccharide is an oligosaccharide that is non-digestible by a human digestive system and contains at least one beta-glycosidic (e.g., beta galactosidic or beta glucosidic) bond that can be digested by a bacterium.
  • the bacterium is a probiotic.
  • the saccharide is an oligosaccharide that is non-digestible by a human digestive system and contains at least one alpha-glycosidic bond.
  • the bacterium is a lactobacilli or a bifidobacteria.
  • the saccharide is GOS.
  • the saccharide is an oligosaccharide that is non- digestible by a human digestive system, contains at least one alpha-glycosidic (e.g., alpha galactosidic or alpha glucosidic) bond, and would induce lactose digestion when fed to a subject in need thereof.
  • the subject in need thereof is a human.
  • the saccharide is an oligosaccharide that is non-digestible by a human digestive system and contains at least one alpha-glycosidic (e.g., alpha galactosidic or alpha glucosidic) bond that can be metabolized by a bacterium.
  • the bacterium is a probiotic.
  • the bacterium is a lactobacilli or a bifidobacteria.
  • the saccharide is GOS.
  • a prebiotic composition comprises at least one non- digestible saccharide and optionally contains one or more digestible saccharides or oligosaccharides.
  • Digestible saccharides are those which are digestible by a human digestive system.
  • the one or more digestible saccharide is lactose, galactose, or glucose.
  • a prebiotic composition does not contain lactose.
  • a prebiotic composition does not contain any probiotic bacteria.
  • a prebiotic composition contains at least one strain of probiotic bacteria.
  • a prebiotic composition contains an oligosaccharide that increases ⁇ -galactosidase activity in the large intestine. In one embodiment, a prebiotic composition contains an oligosaccharide that increases the amount of probiotic activity in the large intestine.
  • Prebiotics are non-digestible substances that when consumed provide a beneficial physiological effect on the host by selectively stimulating the favorable growth or activity of a limited number of indigenous bacteria (Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995 Jun;125(6):1401-12.).
  • a prebiotic is generally a saccharide that is non-digestible or essentially non-digestible by a human and acts to encourage the growth of probiotic bacteria in the gut, increase adhesion of probiotic bacteria in the gut, displace pathogens, or provide a fermentable dose of carbohydrate to probiotic bacteria (symbiotic) or selected commensal bacteria and increase the levels of those microbial populations (notably lactobacilli and bifidobacteria) in the gastrointestinal tract.
  • a prebiotic can be a saccharide that is non-digestible by the human host and can act as a non-digestible fiber in the diet.
  • Suitable prebiotics can include one or more of a carbohydrate, carbohydrate monomer, carbohydrate oligomer, or carbohydrate polymer.
  • the prebiotics are non-non-digestible saccharides, which include non-non-digestible monosaccharides, non- digestible oligosaccharides, or non-non-digestible polysaccharides.
  • the sugar units of an oligosaccharide or polysaccharide can be linked in a single straight chain or can be a chain with one or more side branches. The length of the oligosaccharide or polysaccharide can vary from source to source. In one embodiment, small amounts of glucose can also be contained in the chain.
  • the prebiotic composition can be partially hydrolyzed or contain individual sugar moieties that are components of the primary oligosaccharide.
  • a prebiotic composition described herein consists essentially of one or more non-digestible saccharides. In another embodiment, a prebiotic composition consists essentially of one or more non-digestible oligosaccharides. In one embodiment, the non-digestible oligosaccharides are GOS. In other embodiments, a composition described herein consists essentially of non-digestible GOS and does not contain a probiotic microbe, or microbes.
  • a prebiotic composition allows the colonic microbiota, comprising microorganisms known to increase the ability of a subject to tolerate fermentable carbohydrates, to be regularly maintained or replenished through consumption of the prebiotic composition.
  • adaptation of the intestinal and colonic microbiota increases the intestine and colon's capacity to use lactose without producing gas.
  • Adaptive changes in microbiota of the gastrointestinal tract can be useful for the reduction of bloating, diarrhea, gastric distention, pain, or flatulence from the consumption of dairy products and other lactose containing compositions.
  • tolerance of a human subject to dairy products in general, can be improved through regular consumption of a prebiotic composition.
  • Prebiotics can promote colonic bacteria that slow fermentation.
  • FOS neosugar, or inulin promotes the growth of acid-forming bacteria in the colon such as bacteria belonging to the genera Lactobacillus or Bifidobacterium.
  • Lactobacillus acidophilus and Bifido bacterium bifidus can play a role in reducing the number of pathogenic bacteria in the colon.
  • Additional properties, such as the effect of prebiotics on colonic pH and stool bulking provide for their classification as dietary fibers.
  • prebiotics can improve the bioavailability of essential minerals. As a fiber, prebiotics are thought to slow digestion.
  • GI gastrointestinal
  • Other polymers such as various galactans and carbohydrate based gums, such as psyllium, guar, carrageen, gellan, and konjac, are also known to improve gastrointestinal (GI) health.
  • the carbohydrate lactulose can also improve GI health.
  • a prebiotic composition comprises one or more of GOS, lactulose, raffinose, stachyose, lactosucrose, FOS (i.e. oligofructose or oligofructan), inulin, isomalto-oligosaccharide, xylo-oligosaccharide, paratinose oligosaccharide, transgalactosylated oligosaccharides (i.e. transgalacto-oligosaccharides), transgalactosylate disaccharides, soybean oligosaccharides (i.e.
  • soyoligosaccharides soyoligosaccharides
  • gentiooligosaccharides gentiooligosaccharides
  • glucooligosaccharides pecticoligosaccharides
  • palatinose polycondensates difructose anhydride ⁇ , sorbitol, maltitol, lactitol, polyols, polydextrose, reduced paratinose, cellulose, ⁇ -glucose, ⁇ -galactose, ⁇ -fructose, verbascose, galactinol, and ⁇ -glucan, guar gum, pectin, high, sodium alginate, and lambda carrageenan, or mixtures thereof.
  • a prebiotic composition comprises a mixture of one or more non-digestible oligosaccharides, non-digestible polysaccharides, free monosaccharides, non-digestible saccharides, starch, or non-starch polysaccharides.
  • a prebiotic component of a prebiotic composition is a GOS composition.
  • a prebiotic composition is a pharmaceutical composition.
  • a pharmaceutical composition is a GOS composition.
  • a prebiotic composition reduces or eliminates one or more symptoms associated with lactose intolerance or with lactose digestive problems, including but not limited to cramps, flatulence, stomach pain, vomiting, bloating, diarrhea, nausea, gastric distention and intestinal pain, in a subject in need thereof.
  • the subject is a patient.
  • the subject is a human.
  • the subject is a non-human animal.
  • percent by weight means the percentage of the component' s weight in comparison to the total dry weight of the composition.
  • Oligosaccharides are generally considered to have a reducing end and a non- reducing end, whether or not the saccharide at the reducing end is in fact a reducing sugar. In accordance with accepted nomenclature, most oligosaccharides are depicted herein with the non- reducing end on the left and the reducing end on the right.
  • oligosaccharides described herein are described with the name or abbreviation for the non-reducing saccharide (e.g., Gal or D-Gal), preceded or followed by the configuration of the glycosidic bond (a or ⁇ ), the ring bond, the ring position of the reducing saccharide involved in the bond, and then the name or abbreviation of the reducing saccharide (e.g., Glc or D-Glc).
  • the linkage e.g., glycosidic linkage, galactosidic linkage, glucosidic linkage
  • Each saccharide is in the cyclic form (i.e.
  • lactose is a dissaccharide composed of cyclic forms of galactose and glucose joined by a beta (1-4) linkage where the acetal oxygen bridge is in the beta orientation.
  • Lactose exists as alpha- and beta-lactose (see structures below), ⁇ -lactose can be expressed as ⁇ - D-galactopyranosyl-(l-4) -D-glucopyranose, -D-Gal-(1-4 -D-Glc or as Gal (l-4)-Glc.
  • a- lactose can be expressed as -D-galactopyranosyl-(l-4) a-D-glucopyranose, -D-Gal-(l-4)- a-D- Glc or as Gal (l-4)-Glc.
  • Both FOS and GOS are non-digestible saccharides, ⁇ glycosidic linkages of saccharides, such as those found in, but not limited to, FOS and GOS, make these prebiotics mainly non-digestible and unabsorbable in the stomach and small intestine (see below).
  • a- linked GOS (a-GOS) is not hydrolyzed by human salivary amylase, but can be used by Bifidobacterium bifidum and Clostridium butyricum (Yamashita A. et al. (2004) J. Appl. Glycosci. 51 : 115-122).
  • FOS and GOS can pass through the small intestine and into the large intestine (colon) mostly intact, except where probiotic and commensal microbes are able to metabolize the oligosaccharides.
  • GOS also known as galacto-oligosaccharides, galactooligosaccharides, trans- oligosaccharide (TOS), irans-galacto-oligosaccharide (TGOS), and trans- galactooligosaccharide
  • TOS trans- oligosaccharide
  • TGOS irans-galacto-oligosaccharide
  • trans- galactooligosaccharide are oligomers or polymers of galactose molecules ending mainly with a glucose or sometimes ending with a galactose molecule and have varying degree of polymerization (generally the DP is between 2-20) and type of linkages.
  • GOS comprises galactose and glucose molecules.
  • GOS comprises only galactose molecules.
  • GOS are galactose-containing oligosaccharides of the form of [ -D-Gal-(l-6)] n - -D-Gal-(l-4)-D-Glc wherein n is 2-20.
  • Gal is a galactopyranose unit and Glc (or Glu) is a glucopyranose unit.
  • a prebiotic composition comprises a GOS-related compound.
  • a GOS-related compound can have the following properties: a) a "lactose" moiety; e.g., GOS with a gal-glu moiety and any polymerization value or type of linkage; or b) be stimulatory to "lactose fermenting" microbes in the human GI tract; for example, raffinose (gal- fru-glu) is a "related" GOS compound that is stimulatory to both lactobacilli and bifidobacteria.
  • a prebiotic composition comprises GOS with a low degree of polymerization.
  • a prebiotic composition comprising GOS with a low degree of polymerization increases growth of probiotic and select commensal bacteria to a greater extent than an equivalent amount of a prebiotic composition comprising GOS with a high degree of polymerization.
  • a prebiotic composition comprising a high percentage of GOS with a low degree of polymerization increases growth of probiotic and beneficial commensal bacteria to a greater extent than an equivalent amount of a prebiotic composition comprising a low percentage of GOS with a low degree of polymerization.
  • a prebiotic composition comprises GOS with a degree of polymerization less than 20, such as less than 10, less than 9, less than 8, less than 7, less than 6, less than 5, less than 4, or less than 3.
  • a prebiotic composition comprising GOS with a low degree of polymerization increases growth of probiotic and/or beneficial commensal microbes in the GI tract of a subject. 2.
  • GOS is found in human and bovine maternal milk. GOS can be produced from lactose syrup using the transgalactosylase activity of the enzyme ⁇ -galactosidase (Crittenden, (1999) Probiotics: A Critical Review. Tannock, G. (ed) Horizon Scientific Press, Wymondham, pp. 141-156).
  • ⁇ -D-galactosidase is known to catalyze not only the hydrolysis of the ⁇ -D-galactoside linkage of lactose to give D-glucose and D-galactose but also to carry out transgalactosylation reactions where the D-galactosyl group of a ⁇ -D-galactoside is transferred onto a hydroxylated acceptor.
  • a ⁇ -D-galactoside such as lactose or another carbohydrate is present, it is possible to obtain new glycoside linkages between the D-galactose unit and the acceptor.
  • the starting galactoside such as lactose can also be present in a GOS mixture following the transgalactosylation reactions.
  • GOS comprises one or more saccharides that have been produced from a glycoside and the transgalactosylation reaction of a ⁇ -galactosidase.
  • GOS includes saccharides such as transgalactosylated oligosaccharides (i.e. transgalacto-oligosaccharides) or transgalactosylate disaccharides.
  • the DP of the formed oligosaccharide can vary, typically from 2-20, depending on the enzyme source.
  • a GOS composition is a blend of one more saccharides with a DP range of 2-6 (i.e. di- through hexasaccharides). In another embodiment, a GOS composition is a blend of one or more saccharides with a DP range of 2-8 (i.e. di- through octasaccharides). In another embodiment, a GOS composition is a blend of one or more saccharides with a DP range of greater than 8. In yet another embodiment, a GOS composition is a blend of one or more saccharides with a DP range of 9-15. In another embodiment, a GOS composition is a blend of one or more saccharides with a DP of 1, a DP range of 2-6, a DP range of 6-8, and DP range of greater than 8.
  • Linkages between the individual sugar units found in GOS include ⁇ -(1-6), ⁇ - (1-4), ⁇ -(1-3) and ⁇ -(1-2) linkages. ⁇ -(1-3) linkages are less common than ⁇ -(1-6) or ⁇ -(1-4) linkages.
  • GOS comprises a number of ⁇ -(1-6) linked or ⁇ -(1-4) galactopyranosyl units linked to a terminal glucopyranosyl residue through an a-(l-4) glycosidic bond.
  • GOS comprises a number of ⁇ -(1-6) linked or ⁇ -(1-4) galactopyranosyl units linked to a terminal glucopyranosyl residue through a ⁇ -(1-4) glycosidic bond.
  • GOS formed by transgalactosylation comprise ⁇ -D- galactopyranosyl-(l-3) linkages.
  • GOS are branched saccharides. Branched oligosaccharides can be formed as an artifact of the transgalactosylation reaction.
  • GOS are linear saccharides. Non-limiting GOS examples include the following shown below:
  • the source of the ⁇ -galactosidase can determine the GOS end products from transgalactosylation reactions.
  • ⁇ -galactosidase from Streptococcus thermophilus can produce a collection of transgalactosylated disaccharides including Gai (1-6) Glc, Gai (1- 3) Glc, Gal (1-2) Glc, and Gal (1-6) Gal (Matsumoto et al., (1992), Chapter 5: Galactooligosaccharides, in Japanese Technology Reviews, ed. by Karbe, I., Gordon and Breach, NY, pp. 90-160).
  • Transgalactosylated oligosaccharides can be produced using ⁇ - galactosidase from Aspergillus oryzae (Tanaka et al, (1983) Bifidobacteria Microflora, 2, 17- 24), and consists of tri-, tetra-, penta- and hexa-GOS.
  • GOS are prepared using ⁇ -galactosidase from A.
  • a strain of Bifidobacterium bifidum produces a galactosidase activity that converts lactose to a GOS mixture comprising the disaccharide Gal a (1-6) Gal, at least one trisaccharide selected from Gal ⁇ (l-6)-Gal ⁇ (l-4)-Glc and Gal ⁇ (l-3)-Gal ⁇ (l-4)-Glc, the tetrasaccharide Gal ⁇ (1- 6)-Gal ⁇ (l-6)-Gal ⁇ (l-4)-Glc and the pentasaccharide Gal ⁇ (l-6)-Gal ⁇ (l-6)-Gal ⁇ (l-6)-Gal ⁇ (l-4)-Glc.
  • a GOS composition is a mixture of 10 to 45% w/v of the disaccharide, 10 to 45% w/v of the trisaccharide, 10 to 45% w/v of the tetrasaccharide and 10 to 45% w/v of the pentasaccharide.
  • a GOS composition is a mixture of oligosaccharides comprising 20-28 % by weight of ⁇ (1-3) linkages, 20-25 % by weight of ⁇ (1-4) linkages, and 45-55 % by weight of ⁇ (1-6) linkages.
  • a GOS composition is a mixture of oligosaccharides comprising 26 % by weight of ⁇ (1-3) linkages, 23 % by weight of ⁇ (1-4) linkages, and 51 % by weight of ⁇ (1-6) linkages.
  • Alpha-GOS are oligosaccharides having an alpha-galactopyranosyl group.
  • Alpha-GOS comprises at least one alpha glycosidic linkage between the saccharide units.
  • Alpha-GOS are generally represented by a-(Gal) n (n usually represents an integer of 2 to 10) or a-(Gal) n Glc (n usually represents an integer of 1 to 9). Examples include a mixture of a-galactosylglucose, a-galactobiose, a- galactotriose, a-galactotetraose, and higher oligosaccharides. Additional non-limiting examples include melibiose, manninootriose, raffinose, stachyose, and the like, which can be produced from beat, soybean oligosaccharide, and the like.
  • alpha-GOS products are also useful for the compositions described herein. Synthesis of alpha-GOS with an enzyme is conducted utilizing the dehydration condensation reaction of a-galactosidase with the use of galactose, galactose-containing substance, or glucose as a substrate.
  • the galactose-containing substance includes hydrolysates of galactose-containing substances, for example, a mixture of galactose and glucose obtained by allowing beta-galactosidase to act on lactose, and the like.
  • Glucose can be mixed separately with galactose and be used as a substrate with a-galactosidase (see e.g., WO 02/18614). Methods of preparing alpha-GOS have been described (see e.g., EP1514551 and EP2027863).
  • a GOS composition comprises a mixture of saccharides that are alpha-GOS and saccharides that are produced by transgalactosylation using ⁇ - galactosidase.
  • GOS comprises alpha-GOS.
  • alpha-GOS comprises a-(Gal)2 from 10% to 100% by weight.
  • GOS comprises only saccharides that are produced by transgalactosylation using ⁇ -galactosidase.
  • a GOS composition can comprise GOS with alpha linkages and beta linkages.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20 % by weight of di-saccharides, 1-20 % by weight tri-saccharides, 1-20 % by weight tetra-saccharide, and 1-20 % by weight penta-saccharides.
  • a GOS composition is a mixture of oligosaccharides consisting essentially of 1-20 % by weight of di-saccharides, 1-20 % by weight tri-saccharides, 1-20 % by weight tetra-saccharide, and 1-20 % by weight penta-saccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20 % by weight of saccharides with DP of 1-3, 1-20 % by weight of saccharides with DP of 4-6, 1-20 % by weight of saccharides with DP of 7-9, and 1-20 % by weight of saccharides with DP of 10-12, 1-20 % by weight of saccharides with DP of 13-15.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight of di-saccharidesdisaccharides, 55-75% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight tri-saccharides, 1-20% by weight tetra- saccharidepentasaccharides, and 1-20% by weight penta-saccharideshexasaccharides.
  • a GOS composition is a mixture of oligosaccharides consisting essentially of 1- 20% by weight of di-saccharidesdisaccharides, 55-65% by weight trisaccharides, 25-50% by weight tetrasaccharides, 1-20% by weight tri-saccharides, 1-20% by weight tetra- saccharidepentasaccharides, and 1-20% by weight penta- saccharideshexasaccharides.trisaccharidespentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight of saccharides with DP of 1-3, 1-20% by weight of saccharides with DP of 4-6, 1-20% by weight of saccharides with DP of 7-9, and 1-20% by weight of saccharides with DP of 10-12, 1-20% by weight of saccharides with DP of 13-15.
  • a GOS composition is a 1 : 1 : 1 : 1 : 1 ratio of saccharides with a DP of 2:3:4:5:6.
  • a GOS composition is a 1:2:3:2: 1 : 1 ratio of saccharides with a DP of 1 :2:3:4:5:6.
  • a GOS composition is a (12 to 13):(4 to 5): 1 ratio of saccharides with a DP of 3:4:5.
  • a GOS composition is a 12.3: 4.8: 1 ratio of saccharides with a DP of 3:4:5.
  • a GOS composition is a (8-10):(10-15):(4-6):(l-3) ratio of saccharides with a DP of 2:3:4:5.
  • a GOS composition is a mixture of oligosaccharides comprising 50-55 % by weight of di-saccharides, 20-30 % by weight tri-saccharides, 10-20 % by weight tetra-saccharide, and 1-10 % by weight penta-saccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 52 % by weight of di-saccharides, 26 % by weight tri-saccharides, 14 % by weight tetra-saccharide, and 5 % by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 45-55 % by weight tri-saccharides, 15-25 % by weight tetra-saccharides, 1-10 % by weight penta-saccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 49.3 % by weight tri-saccharides, 19 % by weight tetra-saccharides, 4 % by weight penta-saccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 2-5 % by weight of a mixture of tri- to hexa-saccharides, 25-35 % by weight Gai (1-6) Glc, 5-15 % by weight Gal (1-3) Glc, 5-15 % by weight Gal (1-2) Glc, 25-30 % by weight Gai (1-6) Gal, and 1-5% by weight Gai (1-3) Gal, and optionally further contains one or more digestible saccharides or oligosaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 3.9 % by weight of a mixture of tri- to hexa- saccharides, 32.6 % by weight Gal (1-6) Glc, 7.6 % by weight Gal (1-3) Glc, 9.4 % by weight Gal (1-2) Glc, 27.2 % by weight Gal (1-6) Gal, and 2.5% Gal (1-3) Gal, and optionally further contains one or more digestible saccharides or oligosaccharides.
  • Digestible saccharides or oligosaccharides are carbohydrates that can be digested by the human digestive system, and include but are not limited to lactose, galactose, or glucose.
  • digestible saccharides found in a GOS composition comprise lactose, galactose, or glucose.
  • a GOS composition is a mixture of non-digestible oligosaccharides and lactose, glucose or galactose.
  • a GOS composition is composed of 62 % by weight oligosaccharides and 38% digestible saccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% disaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20% by weight disaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-5%, 1-10%, 1-15%, 1-20%, 5- 10%, 10-15%, 15-20% by weight disaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising at least 55% trisaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55%, 56%, 57%, 58%, 59%, 60%, 61%, 62%, 63%, 64%, 65%, 70%, or 75% by weight trisaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60%, 55-61%, 55-62%, 55-63%, 55-64%, 55-65%, 55-70%, 55-75%, 60-65%, 65-70%, 70-75% by weight trisaccharides.
  • a GOS composition is a mixture comprising at least 25% tetrasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 25%, 26%, 27%, 28%, 29%, 30%, 31%, 32%, 33%, 34%, 35%, 40%, 45%, or 50% by weight tetrasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 25-30%, 25-31%, 25-32%, 25-33%, 25-34%, 25-35%, 25-40%, 25- 45%, 25-50%, 30-35%, 35-40%, 40-45%, 45-50% by weight tetrasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-5%, 1-10%, 1-15%, 1-20%, 5-10%, 10-15%, 15-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-5%, 1-10%, 1-15%, 1-20%, 5-10%, 10-15%, 15-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-35% by weight tetrasaccharides. In another embodiment, a GOS composition is a mixture of oligosaccharides comprising 55-65% by weight trisaccharides, 25-35% by weight tetrasaccharides. In another embodiment, a GOS composition is a mixture of oligosaccharides comprising 55-70% by weight trisaccharides, 25-35% by weight tetrasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-75% by weight trisaccharides, 25-35% by weight tetrasaccharides. In another embodiment, a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-30% by weight tetrasaccharides. In another embodiment, a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-40% by weight tetrasaccharides. In another embodiment, a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-45% by weight tetrasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-50% by weight tetrasaccharides. In another embodiment, a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides. In another embodiment, a GOS composition is a mixture of oligosaccharides comprising 55-65% by weight trisaccharides, 25- 30% by weight tetrasaccharides, 1-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-70% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-75% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-40% by weight tetrasaccharides, 1-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-45% by weight tetrasaccharides, 1-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-50% by weight tetrasaccharides, 1-20% by weight pentasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-65% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-70% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-75% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-40% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-45% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 55-60% by weight trisaccharides, 25-50% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-60% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1- 20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55- 70% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55- 75% by weight trisaccharides, 25-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55- 60% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55- 60% by weight trisaccharides, 25-40% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55- 60% by weight trisaccharides, 25-45% by weight tetrasaccharides, 1-20% by weight pentasaccharides, 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55- 60% by weight trisaccharides, 25-50% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-5% by weight disaccharides, 55-65% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55-65% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1- 20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 10-15% by weight disaccharides, 55-65% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 15-20% by weight disaccharides, 55- 65% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55- 57.5% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 57.5%- 60% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 60%- 62.5% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 62.5%- 65% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 65%- 67.5% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 67.5%- 70% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 70%- 72.5% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 72.5%- 75% by weight trisaccharides, 25-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25-27.5% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 27.5%-30% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 30%-32.5% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 30%-32.5% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 32.5%-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 1-5% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 10-15% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 15-20% by weight pentasaccharides, and 1-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 5-10% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 10-15% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-20% by weight disaccharides, 55-65% by weight trisaccharides, 25%-35% by weight tetrasaccharides, 1-20% by weight pentasaccharides, and 15-20% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 1-5% by weight disaccharides, 55-60% by weight trisaccharides, 25%-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55-60% by weight trisaccharides, 25%-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55-57.5% by weight trisaccharides, 25%-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 57.5-60% by weight trisaccharides, 25%-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 60-62.5% by weight trisaccharides, 25%-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 62.5%-65% by weight trisaccharides, 25%-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55%-60% by weight trisaccharides, 25%-27.5% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55%-60% by weight trisaccharides, 27.5-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55%-60% by weight trisaccharides, 30-32.5% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55-60% by weight trisaccharides, 32.5-35% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55%-60% by weight trisaccharides, 25-30% by weight tetrasaccharides, 5-7.5% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55%-60% by weight trisaccharides, 25-30% by weight tetrasaccharides, 7.5-10% by weight pentasaccharides, and 1-5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55%-60% by weight trisaccharides, 25-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 1-2.5% by weight hexasaccharides.
  • a GOS composition is a mixture of oligosaccharides comprising 5-10% by weight disaccharides, 55%-60% by weight trisaccharides, 25-30% by weight tetrasaccharides, 5-10% by weight pentasaccharides, and 2.5-5% by weight hexasaccharides.
  • a GOS composition comprises a mixture of oligosaccharides, wherein the composition has a saccharimetric measurement at least about 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, or 100 degrees Brix.
  • a GOS composition comprises a mixture of oligosaccharides, wherein the composition has a saccharimetric measurement of between about 50-100, 50-80, 60-80, or 70-80 degrees Brix.
  • a GOS composition has a saccharimetric measurement of between about 72 and 78 degrees Brix.
  • a GOS composition can comprise greater than about 93% GOS and have a saccharimetric degree of 75 degrees Brix.
  • a GOS composition can comprise greater than about 93% GOS, less than about 5% digestible saccharides (such as lactose, glucose, and galactose), and have a saccharimetric degree of 75+ degrees Brix.
  • a GOS composition can comprise greater than about 93% GOS, less than about 5% digestible saccharides, less than about lOppm heavy metals, less than 0.1% sulphated ash, and have a saccharimetric measurement of 75 degrees Brix.
  • a GOS composition can comprise greater than about 95% GOS and have a saccharimetric degree of 75 degrees Brix.
  • a GOS composition can comprise greater than about 95% GOS, less than about 5% digestible saccharides (such as lactose, glucose, and galactose), and have a saccharimetric degree of 75+ degrees Brix.
  • a GOS composition can comprise greater than about 95% GOS, less than about 5% digestible saccharides, less than about lOppm heavy metals, less than 0.1% sulphated ash, and have a saccharimetric measurement of 75 degrees Brix.
  • a GOS composition can comprise greater than about 96% GOS and have a saccharimetric degree of 75 degrees Brix.
  • a GOS composition can comprise greater than about 96% GOS, less than about 5% digestible saccharides (such as lactose, glucose, and galactose), and have a saccharimetric degree of 75+ degrees Brix.
  • a GOS composition can comprise greater than about 96% GOS, less than about 5% digestible saccharides, less than about lOppm heavy metals, less than 0.1% sulphated ash, and have a saccharimetric measurement of 75 degrees Brix.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises 1-100% by weight GOS.
  • the percentage by weight of GOS refers to the weight of GOS relative to the total dry weight of the GOS composition.
  • compositions containing GOS may be referred to as GOS [Number], where [Number] refers to the percent by weight of GOS relative to the total dry weight of the GOS composition within the actual composition contains between 90 to 100 % of the claimed amount.
  • GOS 60 refers to a composition that contains between 54% and 66% GOS by weight relative to the total dry weight of the composition.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 1% by weight GOS.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 5% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 10% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 20% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 30% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 40% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 50% by weight GOS.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 60% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 70% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises 72.3% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 80% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 85% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 90% by weight GOS.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 91% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 92% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 93% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 94% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 95% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 96% by weight GOS.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 96.8% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 97% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 98% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 99% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 100% by weight GOS. In another embodiment, a prebiotic composition comprises a GOS composition wherein the GOS composition comprises between 0.1% and 100% GOS.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%, 29%, 30%, 31%, 32%, 33%, 34%, 35%, 36%, 37%, 38%, 39%, 40%, 41%, 42%, 43%, 44%, 45%, 46%, 47%, 48%, 49%, 50%, 51%, 52%, 53%, 54%, 55%, 56%, 57%, 58%, 59%, 60%, 61%, 62%, 63%, 64%, 65%, 66%, 67%, 68%, 69%, 70%, 71%, 72%, 73%, 74%, 75%, 76%, 77%, 78%, 79% 80%, 81%
  • a prebiotic composition or pharmaceutical composition comprises a GOS composition, wherein the GOS composition comprises about 90%, 90.1%, 90.2%, 90.3%, 90.4%, 90.5%, 90.6%, 90.7%, 90.8%, 90.9%, 91%, 91.1%, 91.2%, 91.3%, 91.4%, 91.5%, 91.6%, 91.7%, 91.8%, 91.9%, 92%, 92.1%, 92.2%, 92.3%, 92.4%, 92.5%, 92.6%, 92.7%, 92.8%, 92.9%, 93 %, 93.1%, 93.2%, 93.3%, 93.4%, 93.5%, 93.6%, 93.7%, 93.8%, 93.9%, 94%, 94.1%, 94.2%, 94.3%, 94.4%, 94.5%, 94.6%, 94.7%, 93.8%, 93.9%
  • GOS 97.2%, 97.3%, 97.4%, 97.5%, 97.6%, 97.7%, 97.8%, 97.9%, 98%, 98.1%, 98.2%, 98.3%, 98.4%, 98.5%, 98.6%, 98.7%, 98.8%, 98.9%, 99%, 99.1%, 99.2%, 99.3%, 99.4%, 99.5%, 99.6%, 99.7%, 99.8%, 99.9%, 100% by weight GOS.
  • the percentage by weight of GOS refers to the weight of GOS relative to the total dry weight of the prebiotic or GOS composition.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 1-90%, about 10-90%, about 20- 90%, about 30-90%, about 40-90%, about 40-80%, about 40-70%, about 40-60%, about 40- 50%, about 50-90%, about 50-80%, about 50-70%, about 50-60%, about 60-90%, about 60- 80%, about 60-70%, about 70-90%, about 70-80%, about 70-90%, about 70-80%, about 80- 90%, about 90-96%, about 93-96%, about 93-95%, about 94-98%, about 93-99%, or about 90- 100% by weight GOS.
  • the percentage by weight of GOS refers to the weight of GOS relative to the total dry weight of the prebiotic or GOS composition.
  • a prebiotic composition comprises 0.01-20 g of a GOS composition, such as about 0.01, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16, 16.5, 17, 17.5, 18, 18.5, 19, 19.5, or about 20 g of GOS composition.
  • a prebiotic composition comprises about 0.1 -2g of a GOS composition.
  • a prebiotic product can comprise GOS for improving gut health by promoting the growth of bifidobacteria in the gut.
  • high purity GOS compositions (about or greater than 85% GOS by weight, e.g. GOS 95) selectively increases intestinal populations of beneficial bacteria or enteric colonization of lactose metabolizing bacteria, such as bifidobacteria and lactobacilli, without increasing the growth of harmful bacteria or without a similar and proportionate increase in many undesirable microbes., such as Escherichia coli (E. coli). This can be in contrast to compositions with lower percentage by weight GOS.
  • contaminating simple carbohydrates may have been sufficient to stimulate the growth of E. coli strains to levels equal to free glucose.
  • higher purity GOS formulations can have a greater potential to selectively promote the growth of beneficial lactobacilli and bifidobacteria.
  • Increased colonization of lactose metabolizing colonic bacteria, such as beneficial, lactose-fermenting lactobacilli and bifidobacteria has been associated with increased ⁇ -galactosidase activity and GOS utilization, thereby increasing the fermentation of lactose into galactose, glucose and short chain fatty acids.
  • a high purity GOS composition reduces lactose-derived gas production and mitigates the symptoms of lactose intolerance.
  • metabolism of a GOS composition by lactobacilli and bifidobacteria yields organic acids and other agents that inhibit enteric pathogens.
  • a GOS composition provides a selective advantage for organisms in the gut that can use them.
  • a GOS composition acts as anti- adhesives for bacteria in the gut.
  • a mixture of oligosaccharides is useful for the preparation of a medicament for preventing the adhesion of pathogens or toxins produced by pathogens to the gut wall.
  • the beneficial effect of high purity GOS compositions on the bacterial flora is with acute administration ( ⁇ 30 days).
  • the dose of GOS (-95%) is titrated from a starting dose as low as 1.5 g/day to a final dose of 12 g/day (6 g BID) at the end of either a 15-day or 30-day treatment period.
  • the dose of GOS (-95%) is equivalent to 200 mg/kg/day for a 60 kg adult.
  • a composition that comprises a suitable amount of a prebiotic composition that is effective for promoting the growth of probiotics such that fermentation in the gut is slowed or gastrointestinal health is improved.
  • prebiotics can be administered in an amount per serving from about lmg to about 20g, or about lmg to about 15g, or about lmg to about lOg, or about lmg to about 5g, or about 2mg to about lOOOmg, or about 2mg to about 500mg, or about 2mg to about 200mg, or about 2mg to about lOOmg, or about 2mg to about 50mg, or about 2mg to about 20mg, or about 5mg to about lOmg, or about 5, 6, 7, 7.5, 8, 9, or lOmg or about 0.25g to about 1.7g.
  • a prebiotic in another embodiment can be administered in an amount per serving of about lg, about 2g, about 3g, about 4g, about 5g, about 6g, about 7g, about 8g, about 9g, about lOg, about 1 lg, about 12g, about 13g, about 14g, about 15g, about 16g, about 17g, about 18g, about 19g, or about 20g.
  • the prebiotic used can be from about O.lg to about 15g, or about O.lg to about lg, or about O.lg to about 0.5g or about O.lg to about 2g, or about 0.5g to about lg, or about 0.2g to about lg, or about lg to about 5g, or about lg to about 15g per serving.
  • the smallest effective amount of prebiotic is used.
  • the prebiotic can be about 0.5% to about 100% by weight of a prebiotic composition.
  • a prebiotic composition e.g., GOS
  • GOS a prebiotic composition
  • a prebiotic composition can be administered in a dose from about 1 mg to about 25 g, or about 1 mg to about 5 g, or about 1 mg to about 1000 mg, or about 1 mg to about 500 mg, or about 1 mg to about 200 mg, or about 1 mg to about 100 mg, or about 1 mg to about 50 mg, or about 2 mg to about 20 mg, or about 5 mg to about 10 mg, or about 5, 6, 7, 7.5, 8, 9, or 10 mg.
  • a prebiotic composition is used in a dose of about 7.5 mg.
  • the dose of a prebiotic composition administered to a subject can be increased from about 1 g to about 10 g over time.
  • an initial dose of a prebiotic composition can be 1-3 grams. This dose can be increased over time (e.g., days or a week) so that the final dose is about 10 g of GOS.
  • a high percentage GOS composition e.g., GOS 95
  • a lower percentage GOS composition e.g., GOS 60
  • a high percentage GOS composition is a purified form of the food ingredient ⁇ -linked galacto-oligosaccharide.
  • the GOS has a molecular weight of 342.29 + (162.15) n -i,, and an empirical formula of C n 6H 22+ ( n- i)ioO 6+n5.
  • the GOS has one or more of the following physical characteristics: clear or pale yellow syrup, sweet taste, freely soluble in water, slightly soluble in alcohols, insoluble in ether and chlorinated solvents, and a density >1.30 gram/mL.
  • a GOS composition is an odorless, colorless to pale yellow, viscous liquid or syrup.
  • a GOS syrup is filled directly into high density polyethylene (HDPE) bottles containing one dose per bottle, without additional ingredients.
  • a GOS composition has the specification as shown in Table 1.
  • a GOS syrup is stable when filled into HDPE bottles fitted with the cap.
  • capped bottles containing low and high dose GOS compositions have a stability at 25°C/60% RH and 40°C/75%RH for at least six months.
  • a lower percentage GOS composition is purified to a pharmaceutical grade by the elimination of residual glucose, lactose and galactose by the organisms used in making bread (Saccharomyces cerevisiae) and yogurt (Streptococcus thermophilis) to yield a high percentage GOS composition. Further processing can include ultrafiltration, nanofiltration, decolorization, deionization, and concentration to yield high percentage GOS compositions. High percentage GOS compositions can contain the same galacto oligosaccharides as low percentage GOS compositions.
  • the lower purity GOS composition is non-digestible fibers derived from lactose.
  • the purity of a high percentage GOS composition is assessed by high performance liquid chromatography (HPLC) analysis.
  • Table 2 contains a product specification for a high purity GOS composition (GOS 95), illustrating the criteria used to evaluate purity of a GOS composition such as GOS 95.
  • Table 3 contains release criteria for a GOS composition having >95% purity (GOS 95).
  • Table 4 contains data from a certificate of analysis of a 96.8 % GOS composition, illustrating other components that can be in a prebiotic composition comprising a GOS composition.
  • a prebiotic comprises a GOS composition meeting the release criteria given in Table 3. In some embodiments, a prebiotic comprises a GOS composition meeting the acceptance criteria given in Table 5. In other embodiments, a prebiotic comprises a GOS composition as described in Table 6. TABLE 5. ACCEPTANCE CRITERIA FOR GOS 95.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 70% by weight GOS, about 3% by weight moisture, about 30% by weight other saccharides, about 0.1% by weight ash, about 1 ppm heavy metal (e.g., Pb), and about 1 ppm arsenic (AS2O3).
  • GOS composition comprises about 70% by weight GOS, about 3% by weight moisture, about 30% by weight other saccharides, about 0.1% by weight ash, about 1 ppm heavy metal (e.g., Pb), and about 1 ppm arsenic (AS2O3).
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 70- 75% by weight GOS, about 1-3% by weight moisture, about 20% by weight lactose, less than 1 % by weight glucose, less than 1 % by weight galactose, about 0.1% by weight ash, about 1 ppm heavy metal (e.g., Pb), and about 1 ppm arsenic (AS2O3).
  • GOS composition comprises about 70- 75% by weight GOS, about 1-3% by weight moisture, about 20% by weight lactose, less than 1 % by weight glucose, less than 1 % by weight galactose, about 0.1% by weight ash, about 1 ppm heavy metal (e.g., Pb), and about 1 ppm arsenic (AS2O3).
  • a GOS composition comprises GOS and one or more of water or digestible saccharides.
  • a GOS composition comprises less than about lOppm of a heavy metal (such as arsenic or lead), including but not limited to less than about 10, 9, 8, 7, 6, 5, 4, 3, 2, or lppm of a heavy metal.
  • a GOS composition comprises less than about 0.10% sulphated ash, including but not limited to less than about 0.9, 0.8, 0.7, 0.6, 0.5, 0.4, 0.3, 0.2, or 0.1% sulphated ash.
  • a GOS composition can comprise greater than about 90% GOS, less than about 5% digestible saccharides, less than about lOppm of heavy metals, and less than about 0.10% sulphated ash. In another embodiment, a GOS composition comprises less than about 5000 ppm ethanol and less than about 3000 ppm methanol. In another embodiment, a GOS composition comprises a bacterial count of less than about 100 cfu/g, and a mold count of less than about 10 cfu/g. In another embodiment, a GOS composition comprises a bacterial count of less than 1 CFU/g, including Escherichia coli and Salmonella species.
  • a GOS composition comprises about 1-90%, about 10- 90%, about 20-90%, about 30-90%, about 40-90%, about 40-80%, about 40-70%, about 40- 60%, about 40-50%, about 50-90%, about 50-80%, about 50-70%, about 50-60%, about 60- 90%, about 60-80%, about 60-70%, about 70-90%, about 70-80%, about 70-90%, about 70- 80%, about 80-90%, about 92-100%, about 93-99%, about 94-98%, about 92-96%, about 93- 96%, or about 93-95% by weight GOS and less than about 10 ppm heavy metals and less than about 0.10% sulphated ash.
  • Standard analytical methods can be used to determine the amount of the various components in the prebiotic or GOS composition, such as but not limited to HPLC, colorimetry (e.g., sodium sulfide colorimetry), or spectrophotometry (e.g., atomic absorption spectrophotometry) .
  • the absorbance of a GOS composition at about A 42 o can be from about 0.3 AU to about 0.6 AU.
  • the pH of a GOS composition can be from about 3 to about 7.
  • the conductance of a GOS composition can be less than about 100 ⁇ 8/ ⁇ .
  • a GOS composition can comprise about 1-5% digestible saccharides, such as lactose, glucose or galactose. In another embodiment, a GOS composition can comprise about 0.001 to about 1% glucose or about 0.01 to about 0.1% glucose. In another embodiment, a GOS composition can comprise about 0.1% galactose to about 2% galactose. In another embodiment, the density of a GOS composition can be about 1200 to about 1500 g/mL.
  • a GOS composition comprises about 1-90%, about 1- 80%, about 1-70%, about 1-60%, about 1-50%, about 1-40%, about 40-90%, about 40-80%, about 40-70%, about 40-60%, about 40-50%, about 50-90%, about 50-80%, about 50-70%, about 50-60%, about 60-90%, about 60-80%, about 60-70%, about 70-90%, about 70-80%, about 70-90%, about 70-80%, about 80-90%, about 90-96%, about 93-96%, about 93-95%, about 94-98%, about 93-99%, or about 92-100% by weight GOS and no digestible saccharides.
  • a prebiotic composition comprises a GOS composition wherein the GOS composition comprises about 1-90%, about 1-80%, about 1-70%, about 1-60%, about 1- 50%, about 1-40%, about 40-90%, about 40-80%, about 40-70%, about 40-60%, about 40-50%, about 50-90%, about 50-80%, about 50-70%, about 50-60%, about 60-90%, about 60-80%, about 60-70%, about 70-90%, about 70-80%, about 70-90%, about 70-80%, about 80-90%, about 92-100%, about 93-99%, about 94-98%, about 92-96%, about 93-96%, or about 93-95% by weight GOS and less than about 6% (such as about 5, 4, 3, 2, or 1%) digestible saccharides.
  • the GOS composition comprises about 1-90%, about 1-80%, about 1-70%, about 1-60%, about 1- 50%, about 1-40%, about 40-90%, about 40-80%, about 40-70%, about 40-60%, about 40-50%,
  • a GOS composition comprises about 70% GOS and about 20% digestible saccharides. In another embodiment a GOS composition comprises about 70- 75% GOS and about 5-30% digestible saccharides.
  • a GOS composition comprises about 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, or 95% by weight GOS and about 1-10% by weight digestible saccharides. In one embodiment these digestible saccharides are byproducts of the GOS synthesis process.
  • a GOS composition comprises about 92% GOS. In another embodiment a GOS composition comprises about 92% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 92% GOS and about 8% digestible saccharides. In another embodiment a GOS composition comprises about 92% GOS and no digestible saccharides. In another embodiment a GOS composition comprises about 92% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 92% GOS and about 1-8% digestible saccharides. In another embodiment a GOS composition comprises about 92% by weight GOS and about 8% by weight digestible saccharides. In another embodiment a GOS composition comprises about 92% by weight GOS and about 5% by weight digestible saccharides.
  • a GOS composition comprises about 93% GOS. In another embodiment a GOS composition comprises about 93% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 93% GOS and about 7% digestible saccharides. In another embodiment a GOS composition comprises about 93% GOS and no lactose. In another embodiment a GOS composition comprises about 93% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 93% GOS and about 1-7% digestible saccharides. In another embodiment a GOS composition comprises about 93% by weight GOS and about 1-7% by weight digestible saccharides. In another embodiment a GOS composition comprises about 93% by weight GOS and about 7% by weight digestible saccharides. In another embodiment a GOS composition comprises about 93% by weight GOS and about 7% by weight digestible saccharides. In another embodiment a GOS composition comprises about 93% by weight GOS and about 5% by weight digestible saccharides.
  • a GOS composition comprises about 94% GOS. In another embodiment a GOS composition comprises about 94% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 94% GOS and about 6% digestible saccharides. In another embodiment a GOS composition comprises about 94% GOS and no lactose. In another embodiment a GOS composition comprises about 94% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 94% GOS and about 1-6% digestible saccharides. In another embodiment a GOS composition comprises about 94% by weight GOS and about 5% by weight digestible saccharides.
  • a GOS composition comprises about 95% GOS. In another embodiment a GOS composition comprises about 95% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 95% by weight GOS and about 5% by weight digestible saccharides. In another embodiment a GOS composition comprises about 95% GOS and no lactose. In another embodiment a GOS composition comprises about 95% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 95% GOS and about 1-5% digestible saccharides. In another embodiment a GOS composition comprises about 95% by weight GOS and about 1-5% by weight digestible saccharides, such as digestible saccharides.
  • a GOS composition comprises about 96% GOS. In another embodiment a GOS composition comprises about 96% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 96% by weight GOS and about 4% by weight digestible saccharides. In another embodiment a GOS composition comprises about 96% GOS and no lactose. In another embodiment a GOS composition comprises about 96% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 96% GOS and about 1-4% digestible saccharides. In another embodiment a GOS composition comprises about 96% by weight GOS and about 1-4% by weight digestible saccharides.
  • a GOS composition comprises about 97% GOS. In another embodiment a GOS composition comprises about 97% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 97% GOS and about 3% digestible saccharides. In another embodiment a GOS composition comprises about 97% GOS and no lactose. In another embodiment a GOS composition comprises about 97% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 97% GOS and about 1-3% digestible saccharides. In another embodiment a GOS composition comprises about 97% by weight GOS and about 1-3% by weight digestible saccharides.
  • a GOS composition comprises about 97% by weight GOS and about 3% by weight digestible saccharides. [0134] In one embodiment a GOS composition comprises about 98% GOS. In another embodiment a GOS composition comprises about 98% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 98% by weight GOS and about 2% by weight digestible saccharides. In another embodiment a GOS composition comprises about 98% GOS and no lactose. In another embodiment a GOS composition comprises about 98% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 98% GOS and about 0.1-2% digestible saccharides.
  • a GOS composition comprises about 99% GOS. In another embodiment a GOS composition comprises about 99% GOS and digestible saccharides. In another embodiment a GOS composition comprises about 99% GOS and lactose, glucose, galactose or a combination thereof. In another embodiment a GOS composition comprises about 99% by weight GOS and about 1% by weight digestible saccharides. In another embodiment a GOS composition comprises about 99% GOS and no lactose. In another embodiment a GOS composition comprises about 99% GOS and no lactose, glucose, or galactose. In another embodiment a GOS composition comprises about 99% GOS and about 0.1-1% digestible saccharides.
  • a GOS composition comprises about 100% GOS.
  • a GOS composition comprises about 1%, about 2%, about 3%, about 4%, about 5%, about 6%, about 7%, about 8%, about 9%, about 10%, about 15%, or about 20% by weight of digestible saccharides.
  • a GOS composition comprises about 99.9%, 99.5%, 99%, 98.5%, 98%, 97.5%, 97%, 96.5%, 96%, 95.5%, 95%, 94.5%, 94%, 93.5%, 93%, 92.5%, 92%, 91.5%, 91%, 90.5%, 90%, 80%, 75%, 70%, 65%, 60%, 55%, 50%, 45%, 40%, 35%, 30%, 25%, 20%, 15%, 10%, 5%, or 1% by weight GOS and one or more digestible saccharides.
  • a prebiotic composition comprises GOS.
  • a prebiotic composition comprising GOS is a pharmaceutical composition.
  • a prebiotic composition consists essentially of GOS.
  • a prebiotic composition consists essentially of GOS and is prepared or administered without any lactose.
  • a prebiotic composition consists essentially of GOS and comprises one or more digestible saccharides such as lactose, galactose, or glucose. These digestible saccharides can be present in trace amounts (e.g., less than 5% by weight of the composition) and can be byproducts of the synthesis of the GOS.
  • a prebiotic composition comprising GOS comprises about 70% GOS and about 30% digestible saccharides by weight.
  • 8g of a prebiotic composition comprising GOS can comprise 5.6g of GOS, 1.6g lactose, and 0.8g of other digestible saccharides.
  • a prebiotic composition comprising GOS, and optionally digestible carbohydrates, are used in a method to stimulate lactose fermenting commensal microbes of the human gastrointestinal tract in an adaptation process designed to alleviate lactose intolerance symptoms.
  • gradual feeding of a prebiotic composition comprising GOS, at increasing doses over a defined time frame can adapt the lactose fermenting commensal microbes to efficiently metabolize lactose in lactose-intolerant individuals. In one embodiment this adaptation is permanent.
  • a prebiotic composition comprises an effective amount of GOS and optionally another non-digestible saccharide. In one embodiment a prebiotic composition increases Beta-galactosidase activity of species of the Lactobacillus and/or Bifidobacterium species. In another embodiment a prebiotic composition comprises an effective amount of GOS or another non-digestible saccharide to increase the lactase activity of intestinal bacteria (e.g., Lactobacilllus and/or Bifidobacterium) which breaks down the lactose that is not digested by a lactose intolerant human.
  • intestinal bacteria e.g., Lactobacilllus and/or Bifidobacterium
  • a method of treatment is provided for the use of GOS and optionally another non-digestible saccharide to increase Beta-galactosidase activity of lactobacilli or bifidobacteria.
  • a method of treatment is provided for the use of GOS and optionally another non-digestible saccharide to increase the lactase activity of intestinal bacteria (e.g., lactobacilli or bifidobacteria).
  • a method of treatment is provided for the use of GOS and optionally another non-digestible saccharide to prevent, treat, or reduce a symptom of lactose intolerance in a human.
  • a symptom of lactose intolerance in a human is treated, prevented, or reduced by administration of a composition comprising GOS and optionally another non-digestible saccharide.
  • a prebiotic composition comprises between 80-99.9% GOS and no lactose. In another embodiment, a prebiotic composition comprises between 80- 99.9% GOS and 20%-0.1% digestible saccharides. In another embodiment, a prebiotic composition comprises between 80-99.9% GOS, between 0.1-20% digestible saccharides, and between 0.1-20% non-digestible saccharides other than GOS.
  • a prebiotic composition comprising GOS comprises about 90% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.2g of GOS.
  • a prebiotic composition comprises about 90% GOS and about 5% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.2g of GOS and about 0.4g of digestible saccharides.
  • a prebiotic composition comprises about 90% GOS, about 5% digestible saccharide, and about 2% non-digestible saccharides other than GOS.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.2g of GOS, about 0.4g digestible saccharide, and about 0.16g of other non-digestible saccharides.
  • a prebiotic composition comprising GOS comprises about 91% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.28g of GOS.
  • a prebiotic composition comprises about 91% GOS and about 5% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.28g of GOS and about 0.4g of digestible saccharides.
  • a prebiotic composition comprises about 91% GOS, about 5% digestible saccharides, and about 2% non-digestible saccharides other than GOS.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.28g of GOS, about 0.4g of digestible saccharides, and about 0.16g of other non-digestible saccharides.
  • a prebiotic composition comprising GOS comprises about 92% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.36g of GOS.
  • a prebiotic composition comprises about 92% GOS and about 5% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.36g of GOS and about 0.4g of digestible saccharides.
  • a prebiotic composition comprises about 92% GOS, about 5% digestible saccharides, and about 2% non-digestible saccharides other than GOS.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.36g of GOS, about 0.4g of digestible saccharides, and about 0.16g of other non-digestible.
  • a prebiotic composition comprises about 93% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.44g of GOS.
  • a prebiotic composition comprises about 93% GOS and about 5% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.44g of GOS and about 0.4g of digestible saccharides.
  • a prebiotic composition comprises about 93% GOS, about 5% digestible saccharides, and about 2% non-digestible saccharides other than GOS.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.44g of GOS, about 0.4g of digestible saccharides, and about 0.16g of other non-digestible.
  • a prebiotic composition comprises about 94% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.52g of GOS.
  • a prebiotic composition comprises about 94% GOS and about 5% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.52g of GOS and about 0.4g of digestible saccharides.
  • a prebiotic composition comprises about 94% GOS, about 5% digestible saccharides, and about 1% non-digestible saccharides other than GOS.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.52g of GOS, about 0.4g of digestible saccharides, and about 0.08g of other non-digestible saccharides.
  • a prebiotic composition comprises about 95% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.6g of GOS.
  • a prebiotic composition comprises about 95% GOS and about 5% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.6g of GOS and about 0.4g of digestible saccharides.
  • a prebiotic composition comprises about 96% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.68g of GOS.
  • a prebiotic composition comprising about 96% GOS comprises about 4% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.68g of GOS and about 0.32g of digestible saccharides.
  • a prebiotic composition comprises about 97% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.76g of GOS.
  • a prebiotic composition comprising about 97% GOS comprises about 3% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.76g of GOS and about 0.24g of digestible saccharides.
  • a prebiotic composition comprises about 98% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.84g of GOS.
  • a prebiotic composition comprising about 96% GOS comprises about 2% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.84g of GOS and about 0.16g of digestible saccharides.
  • a prebiotic composition comprises about 99% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 7.92g of GOS.
  • a prebiotic composition comprising about 99% GOS comprises about 1% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 7.92g of GOS and about 0.08g of digestible saccharides.
  • a prebiotic composition comprises about 100% GOS and no lactose.
  • 8g of a prebiotic composition comprising GOS can comprise about 8.0g of GOS.
  • a prebiotic composition comprising about 99.9% GOS comprises less than about 1% digestible saccharides.
  • 8g of a prebiotic composition comprising GOS can comprise 8.0g of GOS and about O.lg of digestible saccharides.
  • a GOS composition reduces or eliminates one or more symptoms associated with lactose intolerance or with lactose digestive problems, including but not limited to cramps, flatulence, stomach pain, vomiting, bloating, diarrhea, nausea, gastric distention and intestinal pain, in a subject in need thereof.
  • the subject is a patient.
  • the subject is a human.
  • the subject is a non-human animal.
  • FOS are chain oligomers or polymers of the sugar fructose that are found in a variety of foods.
  • the sugar units can be linked in a single straight chain or can be a chain with side branches. In many cases small amounts of glucose are also contained in the chain.
  • the length of the fructose chains can vary from source to source.
  • FOS are primarily polyfructans with a degree of polymerization (DP) generally ranging from 2 to 20 (oligofructose) or greater than 20 (inulin).
  • the D-fructose moieties in FOS are joined by ⁇ -(2-1) linkages and the oligomers or polymers are terminated with a D-glucose molecule linked to fructose by an a- (1-2) bond.
  • a prebiotic composition comprises a FOS composition, wherein the FOS composition comprises about 1% or more of the composition by weight, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% FOS.
  • the FOS composition comprises about 0.5% or more of FOS in the FOS composition by weight, such as about 0.5%, 1%, 5%, 10%, 15%, 20%, 25%, 30%, or 35% FOS.
  • the prebiotic or FOS composition comprises 0.01-20 g of FOS, such as about 0.01, 0.03, 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 g of FOS.
  • the prebiotic or FOS composition comprises FOS and water and one or more digestible saccharides.
  • a prebiotic composition comprises less than about lOppm of a heavy metal (such as arsenic or lead), including but not limited to less than about 10, 9, 8, 7, 6, 5, 4, 3, 2, or lppm of a heavy metal.
  • a prebiotic composition comprises a mixture of FOS and GOS.
  • about 90 % by weight of the prebiotic component is GOS and about 10 % by weight of the prebiotic component is FOS.
  • about 50 % by weight of the prebiotic component is GOS and about 50 % by weight of the prebiotic component is FOS.
  • 1-90 % by weight of the prebiotic component is GOS and 10-60 % by weight of the prebiotic component is FOS.
  • the prebiotic component of a prebiotic composition is 90-100% by weight GOS.
  • Inulin is an example of a longer chained compound that is considered to be a FOS.
  • the shorter (lower molecular weight) compounds tend to have a sweet taste.
  • the size and complexity of the FOS molecules gives it desirable characteristics.
  • the simple sugars fructose and glucose are quickly absorbed into the body by the intestines, FOS for the most part is non-digestible and therefore acts as a fiber in the diet. This is because humans do not have the enzymes to break down the FOS as it travels down the digestive tract. When the FOS reaches the large intestine and the colon, the bacteria that are found there start to break down the FOS. These bacteria have the enzymes needed to break down FOS.
  • Some Bifidobacterium and Lactobacillus species have been reported to use FOS. It is believed that foods that promote the growth of bifidobacteria are beneficial for gastrointestinal health.
  • a prebiotic composition comprises inulin, wherein the inulin comprises 1% or more of the composition by weight, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% inulin.
  • a prebiotic composition comprises 1-20 g of inulin, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 g of inulin.
  • a prebiotic composition comprises inulin, water, or one or more digestible saccharides.
  • a prebiotic composition comprises less than about lOppm of a heavy metal (such as arsenic or lead), including but not limited to less than about 10, 9, 8, 7, 6, 5, 4, 3, 2, or lppm of a heavy metal.
  • a heavy metal such as arsenic or lead
  • Lactulose is a disaccharide that is formed from one molecule of fructose and galactose. It can be produced by isomerization of lactose.
  • a prebiotic composition comprises lactulose (4-0- -D-Galactopyranosyl- -D-fructofuranose), wherein lactulose comprises about 1% or more of the composition by weight, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80
  • a prebiotic composition comprises 1-20 g of lactulose, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 g of lactulose.
  • a prebiotic composition comprises lactulose, water, or one or more digestible saccharides.
  • the composition comprises less than about lOppm of a heavy metal (such as arsenic or lead), including but not limited to less than about 10, 9, 8, 7, 6, 5, 4, 3, 2, or Ippm of a heavy metal.
  • Raffinose (melitose, melitriose, gossypose, a-D-galactosylsucrose) is a trisaccharide composed of galactose, fructose, and glucose.
  • the enzyme a-galactosidase which is not found in the human digestive tract, can hydrolyze raffinose.
  • raffinose passes through the stomach and upper intestine and is digested by bacteria that do contain a- galactosidase in the lower intestine.
  • a prebiotic composition comprises raffinose, wherein the raffinose comprises 1% or more of the composition by weight, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% raffinose.
  • a prebiotic composition comprises 1-20 g of raffinose, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 g of raffinose.
  • a prebiotic composition comprises raffinose or one or more digestible saccharides.
  • a prebiotic composition comprises less than about lOppm of a heavy metal (such as arsenic or lead), including but not limited to less than about 10, 9, 8, 7, 6, 5, 4, 3, 2, or Ippm of a heavy metal.
  • a heavy metal such as arsenic or lead
  • Stachyose is a tetrasaccharide that consists of two a-D-galactose units, one a- D-glucose unit, and one ⁇ -D-fructose unit. It is linked as gal(al ⁇ 6) gal(al ⁇ 6)glc(al ⁇ 2 )fru. Stachyose is not completely digestible by humans.
  • a prebiotic composition comprises stachyose, wherein the stachyose comprises 1% or more of the composition by weight, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% stachyose.
  • a prebiotic composition comprises 1-20 g of stachyose, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 g of stachyose.
  • a prebiotic composition comprises stachyose, water, or one or more digestible saccharides.
  • a prebiotic composition comprises less than about lOppm of a heavy metal (such as arsenic), including but not limited to less than about 10, 9, 8, 7, 6, 5, 4, 3, 2, or lppm of a heavy metal.
  • a prebiotic composition comprises GOS and inulin.
  • the ratio of GOS:inulin is about 99: 1, about 95: 1, about 90: 1, about 85: 1, about 80: 1, about 75: 1, about 70: 1, about 65: 1, about 60: 1, about 55: 1, about 50: 1, about 45: 1, about 40: 1, about 35: 1, about 30: 1, about 25: 1, about 20: 1, about 15: 1, about 10: 1, about 9: 1, about 8: 1, about 22:3, about 7: 1, about 6: 1, about 5: 1, about 4: 1, about 3: 1, about 2: 1, or about 1: 1.
  • a prebiotic composition comprising GOS and inulin comprises between 0.4 g to 20 g GOS and inulin.
  • a prebiotic composition comprising GOS and inulin can contain about 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2, 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 3, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 3.7, 3.8, 3.9, 4, 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8, 4.9, 5, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 6, 6.1, 6.2, 6.3, 6.4, 6.5, 6.6, 6.7, 6.8, 6.9, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16, 16.5, 17, 17.5, 18, 18.5, 19, 19.5, or 20 g GOS and inulin.
  • Probiotics typically refer to beneficial live microorganisms, e.g., bacteria, found in the gastrointestinal tract and, when administered in adequate amounts, confer a health benefit on the host (or subject in need thereof). Reports indicate that probiotic microbes favorably alter the intestinal microbiota balance, inhibit the growth of harmful bacteria, promote good digestion, modulate immune functions, and increase resistance to both viral and bacterial infections. Probiotics are also reported to produce angiotensin-converting enzyme (ACE) inhibitory peptides, a key clinical target for blood pressure control.
  • ACE angiotensin-converting enzyme
  • GRAS Bacterial cultures that are generally recognized as safe (GRAS) or known commensal or probiotic microbes could be used to assist in the reduction or elimination of lactose intolerance-like symptoms or improving overall GI health, for example through colonic adaptation, are applicable in the methods and compositions described herein.
  • probiotics include, but are not limited to, those that acidify the colon such as those from the genera Lactobacillus or Bifidobacterium, which are thought to maintain a healthy balance of intestinal microbiota by producing organic acids (lactic & acetic acids), hydrogen peroxide, and bacteriocins which are documents to inhibit enteric pathogens.
  • Bacteriocins are small antimicrobial peptides which can kill both closely-related bacteria, or exhibit a broader spectrum of activity (e.g., nisin) which includes most Gram-positive pathogens (e.g., Listeria, Staphylococcus, and Clostridium species).
  • Non-exclusive examples of probiotic bacteria that can be used in the methods and compositions described herein include L. acidophilus, a probiotic microbe which is an important member of the microbiota of the GI tract and has been used extensively and successfully as a probiotic cultures in dietary supplements, foods, and dairy products. These beneficial bacteria have been reported to modulate immune function, inhibit carcinogenesis, facilitate metabolism of cholesterol, and assist in digestion. Numerous reports over many Lactobacillus species are reported to promote a healthy microbiota, reduce putrefaction, and reduce endotoxemia. Other Lactobacillus bacteria which can be employed include, but are not limited to, L. crispatus, L. casei, L. rhamnosus, L. reuteri, L.
  • probiotic bacteria suitable for the compositions include Bifidobacterium lactis, B. animalis, B. bifidum, B. longum, B. adolescentis, and B. infantis.
  • Yeasts such as Saccharomyces boulardii, are also suitable as probiotics and may act to restore the intestinal microbiota. Mixtures of one or more species or strains of bacteria can be used.
  • yogurt is a product which already contains bacteria species, such as Lactobacillus bulgaricus and Streptococcus thermophilus , which are used for fermentation. Yogurt can be supplemented with prebiotics and additional bacterial species that are considered probiotic cultures.
  • strains of probiotic bacteria that can be used in the methods and compositions described herein include, for example, Bacillus coagulans GBI-30, 6086; Bifidobacterium animalis subsp. lactis BB-12; Bifidobacterium breve Yakult; Bifidobacterium infantis 35624; Bifidobacterium animalis subsp.
  • lactis HN019 (DR10); Bifidobacterium longum BB536; Escherichia coli M-17; Escherichia coli Nissle 1917; Lactobacillus acidophilus DDS-1 ; Lactobacillus acidophilus LA-5; Lactobacillus acidophilus NCFM; Lactobacillus casei DN114-001 (Lactobacillus casei Immunitas(s)/Defensis); Lactobacillus casei CRL431 ; Lactobacillus casei F19; Lactobacillus paracasei Stl l (or NCC2461); Lactobacillus johnsonii Lai (Lactobacillus LCI, Lactobacillus johnsonii NCC533); Lactococcus lactis L1A; Lactobacillus plantarum 299V; Lactobacillus reuteri ATTC 55730 (Lactobacillus reuteri SD2112); Lactobacillus
  • a composition comprises a prebiotic and probiotic.
  • a prebiotic composition comprises or consists essentially of GOS.
  • a prebiotic composition is administered with increasing doses of probiotics during the period of treatment.
  • a prebiotic composition is administered with constant doses (dose amounts that do not change) of probiotics during the period of treatment.
  • a prebiotic composition is administered with both increasing doses of probiotics for a portion of the treatment and a constant dose of probiotics during another portion of the treatment period.
  • probiotic bacteria such as L. acidophilus
  • probiotic bacteria are given prior to beginning treatment with a prebiotic.
  • probiotic bacteria such as L. acidophilus
  • probiotic bacteria are given in conjunction with treatment with a prebiotic (e.g., comprising or consisting essentially of GOS), for part or all of the treatment with the prebiotic.
  • a prebiotic e.g., comprising or consisting essentially of GOS
  • some or all doses of a prebiotic are accompanied by a dose of bacteria, e.g., live cultured bacteria, e.g., L. acidophilus.
  • bacteria e.g., L.
  • acidophilus are given initially with a prebiotic (e.g., comprising or consisting essentially of GOS), but then use of the bacteria is discontinued.
  • a prebiotic e.g., comprising or consisting essentially of GOS
  • the initial one, two, three, four, five, six, seven, eight, nine, ten, or more than ten days of treatment with a prebiotic (e.g., comprising or consisting essentially of GOS) further comprises doses of bacteria, with the use of bacteria discontinued after that time.
  • bacteria e.g., bacteria in yogurt
  • bacteria by themselves can be given for the first two days of treatment; then the administration of bacteria is discontinued.
  • probiotic bacteria either alone or in combination with other substances or treatments are used after the treatment with a prebiotic (comprising or consisting essentially of GOS) is terminated.
  • the bacteria can be taken for any suitable period after the termination of treatment with prebiotic and can be taken daily or at regular or irregular intervals. Doses can be as described below.
  • probiotics are given as live cultured bacteria.
  • the dose can be about O.OOlmg to about lmg, or about 0.5mg to about 5mg, or about lmg to about lOOOmg, or about 2 mg to about 200mg, or about 2 mg to about lOOmg, or about 2 mg to about 50mg, or about 4 mg to about 25mg, or about 5 mg to about 20mg, or about 10 mg to about 15mg, or about 50mg to about 200mg, or about 200mg to about lOOOmg, or about 10, 11, 12, 12.5, 13, 14, or 15mg per serving.
  • L. acidophilus is used in a dose of about 12.5mg per serving.
  • the probiotic bacteria can also be about 0.5% w/w to about 20% w/w of the final composition.
  • the dose of probiotics can be given in combination with one or more prebiotics.
  • Another common way of specifying the amount of probiotics is as a colony forming unit (cfu).
  • a cfu is an individual cell which is able to clone itself into an entire colony of identical cells.
  • one or more strains of probiotic bacteria are ingested in an amount of about 1 x 10 6 to about 1 x 10 9 cfu's, or about 1 x 10 6 cfu's to about 1 x 10 9 cfu's, or about 10 x 10 6 cfu's to about 0.5 x 10 9 cfu's, or about 113 x 10 5 cfu's to about 113 x 10 6 cfu's, or about 240 x 10 5 cfu's to about 240 x 10 6 cfu's, or about 0.3 x 10 9 cfu's per serving.
  • a typical serving size for a dairy product such as fluid milk is about 240g.
  • a serving size is about 245g, or about 240g to about 245g, or about 227 to about 300g.
  • the dairy product is yogurt.
  • Yogurt can have a serving size of about 4 oz, or about 6 oz, or about 8 oz, or about 4 oz to 10 oz, or about half cup, or about 1 cup, or about 113g, or about 170g, or about 227g, or about 245g or about 277g, or about lOOg to about 350g.
  • probiotic bacteria are given as live cultured bacteria, e.g., in combination with a prebiotic (e.g., comprising or consisting essentially of GOS) and, optionally, other substances.
  • the dose can be about 1 mg to about 1000 mg, or about 2 mg to about 200 mg, or about 2 mg to about 100 mg, or about 2 mg to about 50 mg, or about 4 mg to about 25 mg, or about 5 mg to about 20 mg, or about 10 mg to about 15 mg, or about 10, 11, 12, 12.5, 13, 14, or 15 mg of probiotic bacteria.
  • L. acidophilus is used in a dose of about 12.5 mg.
  • an initial dose of a prebiotic can be about 0.6 g to 1.0 g, e.g., 0.8 g, given in combination with about 10-15 mg, e.g., about 12.5 mg, of L. acidophilus.
  • the dose of a prebiotic can be increased incrementally by about 0.6 g to 1.0 g, e.g., 0.8 g, and the accompanying dose of L. acidophilus can be increased by about 10-15 mg, e.g., about 12.5 mg, of L. acidophilus.
  • a prebiotic composition for the treatment of the symptoms of lactose intolerance comprises inulin, FOS, lactulose, GOS, raffinose, stachyose, or a combination thereof.
  • a prebiotic composition comprises or consists essentially of GOS.
  • a prebiotic composition comprises GOS and one or more digestible saccharides.
  • Digestible saccharides are saccharides that are digestible by humans and include, but are not limited to lactose, glucose, and galactose.
  • a prebiotic composition comprises GOS and less than 20% of one or more digestible saccharides.
  • a prebiotic composition comprises GOS and less than 10% of one or more digestible saccharides. In one embodiment a prebiotic composition comprises GOS and less than 5% of one or more digestible saccharides. In another embodiment a prebiotic composition contains less than 5% lactose. In another embodiment a prebiotic composition contains less than 4% lactose. In another embodiment a prebiotic composition contains less than 3% lactose. In another embodiment a prebiotic composition contains less than 2% lactose. In another embodiment a prebiotic composition contains less than 1% lactose. In another embodiment a prebiotic composition contains less than 0.5% lactose. In another embodiment a prebiotic composition contains less than 0.4% lactose.
  • a prebiotic composition contains less than 0.3% lactose. In another embodiment a prebiotic composition contains less than 0.2% lactose. In another embodiment a prebiotic composition contains less than 0.1% lactose. In another embodiment a prebiotic composition contains less than 0.05% lactose. In another embodiment a prebiotic composition contains less than 0.01% lactose. In another embodiment a prebiotic composition contains less than 0.005% lactose. In one embodiment a prebiotic composition comprises GOS and essentially no lactose. In one embodiment a prebiotic composition does not contain any lactose. In another embodiment a prebiotic composition contains GOS and at least one probiotic bacteria strain. In another embodiment a prebiotic composition comprises GOS and optionally one or more of lactose, at least one probiotic bacteria strain, or a buffer. Additional ingredients include ingredients to improve handling, preservatives, antioxidants, flavorings and the like.
  • a prebiotic composition comprises GOS or a probiotic.
  • a prebiotic composition is in the form of a powder, tablet, capsule, oral thin or dissolving film, orodispersible tablet, effervescent tablet, oral spray, or liquid.
  • a prebiotic composition can be administered with a dairy product and is in the form of milk or other common dairy product such as a yogurt, shake, smoothie, cheese, and the like.
  • a prebiotic composition comprises less than 100% by weight of GOS
  • the remaining ingredients can be any suitable ingredients intended for the consumption of the subject in need thereof, e.g., human, including, but not limited to, other prebiotics (e.g., FOS), a buffer, one or more digestible saccharides, ingredients intended to inhibit clumping and increase pourability, such as silicone dioxide and microcrystalline cellulose, or similar ingredients as are well-known in the art.
  • Remaining ingredients can also include ingredients to improve handling, preservatives, antioxidants, flavorings, and the like.
  • One or more buffers can also be administered in methods and compositions described herein. Any buffer suitable for consumption by the subject being treated, e.g., human, are useful for the compositions herein.
  • the buffer neutralizes stomach acidity which can, e.g., allow live bacteria to reach the gut.
  • Buffers include citrates, phosphates, and the like.
  • One embodiment utilizes a buffer with a calcium counterion, such as Calcium Phosphate Tribasic.
  • the calcium can serve to restore the calcium that many lactose intolerant subjects are missing in their diet.
  • a recent study demonstrated the ability of calcium phosphate to protect Lactobacillus acidophilus from bile. Calcium phosphate can help neutralize stomach acidity.
  • a buffer such as calcium phosphate is given prior to beginning treatment with a prebiotic composition (such as a composition comprising or consisting essentially of GOS), optionally in conjunction with administration of bacteria.
  • a buffer such as calcium phosphate is given in conjunction with treatment with a prebiotic composition (e.g., a composition comprising or consisting essentially of GOS), for part or all of the treatment with lactose.
  • some or all doses of a prebiotic composition are accompanied by a dose of a buffer such as calcium phosphate.
  • a buffer such as calcium phosphate is given initially with a prebiotic composition (such as a composition comprising or consisting essentially of GOS), but then its use is discontinued.
  • a prebiotic composition such as a composition comprising or consisting essentially of GOS
  • the initial one, two, three, four, five, six, seven, eight, nine, ten, or more than ten days of treatment with a prebiotic composition can include doses of a buffer such as calcium phosphate, with the use of the buffer discontinued after that time.
  • a buffer such as calcium phosphate can be given for the first two days of treatment, and then the administration of buffer is discontinued.
  • a buffer such as calcium phosphate either alone or in combination with other substances or treatments is used after the treatment with a prebiotic composition is terminated.
  • a buffer such as calcium phosphate can be taken for any suitable period after the termination of treatment with lactose, and can be taken daily or at regular or irregular intervals. Doses can be as described below.
  • a buffer can be used in a dose from about 2 mg to about 2000 mg, or about 4 mg to about 400 mg, or about 4 mg to about 200 mg, or about 4 mg to about 100 mg, or about 8 mg to about 50 mg, or about 10 mg to about 40 mg, or about 20 mg to about 30 mg, or about 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, or 30 mg.
  • a prebiotic composition further comprises an amount of a buffer from 1-50 mg, such as about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, or 50 mg.
  • buffer is used in a dose of about 25 mg.
  • calcium phosphate is used in a dose of about 25 mg.
  • the dose can be given in combination with a prebiotic composition (e.g., a composition comprising or consisting essentially of GOS).
  • a prebiotic composition e.g., a composition comprising or consisting essentially of GOS.
  • the dose of buffer increases as well.
  • an initial dose of a prebiotic composition can be about 0.6 g to 1.0 g, e.g., 0.8 g, given in combination with about 20-30 mg, e.g., about 25 mg, of buffer, e.g., calcium phosphate.
  • the dose of a prebiotic composition can be increased incrementally by about 0.6 g to 1.0 g, e.g., 0.8 g, and the accompanying dose of buffer, e.g., calcium phosphate, can be increased by about 20- 30 mg, e.g., about 25 mg, of buffer, e.g., calcium phosphate.
  • C Compositions comprising GOS and at least one probiotic bacteria strain
  • a prebiotic composition comprises GOS and at least one probiotic bacteria strain.
  • the GOS can comprise more than 1% of the weight of the composition while the at least one probiotic bacteria strain will typically comprise less than about 10%, 5%, 4%, 3%, or 2% by weight of the compositions (herein all percentages are weight percent unless otherwise indicated).
  • the GOS can be present at about 1-99.75% by weight and the at least one probiotic bacteria strain at about 0.25-2 % by weight, or the GOS can be present at about 89-96% by weight and the bacteria at about 1.2-3.7% by weight.
  • GOS are present at about 92% by weight and at least one probiotic bacteria strain, (e.g., L.
  • GOS are present at about 92% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacterium lactis), is present at about 1.5% by weight.
  • GOS are present at about 93% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacterium lactis), is present at about 1.5% by weight.
  • GOS are present at about 94% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacterium lactis), is present at about 1.5% by weight.
  • GOS are present at about 95% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacterium lactis), is present at about 1.5% by weight.
  • GOS are present at about 96% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacterium lactis), is present at about 1.5% by weight.
  • GOS are present at about 97% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacterium lactis), is present at about 1.5% by weight.
  • GOS are present at about 98% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacteriium lactis), is present at about 1.5% by weight. In another embodiment, GOS are present at about 98.5% by weight and at least one probiotic bacteria strain, (e.g., L. acidophilus or Bifidobacterium lactis), is present at about 1.5% by weight.
  • probiotic bacteria strain e.g., L. acidophilus or Bifidobacteriium lactis
  • the remaining ingredients can be any suitable ingredients intended for consumption by the subject in need thereof, e.g., human, including, but not limited to, other prebiotics (e.g., FOS), one or more buffers, digestible saccharides ingredients intended to inhibit clumping and increase pourability, such as silicone dioxide and microcrystalline cellulose, or similar ingredients as are well-known in the art.
  • Remaining ingredients can also include ingredients to improve handling, preservatives, antioxidants, flavorings and the like.
  • Compositions comprising GOS and a buffer
  • a prebiotic composition comprises GOS and a buffer (e.g., calcium phosphate tribasic).
  • GOS can be present at about 1-100% by weight and the buffer at about 0.50-4% by weight, or GOS can be present at about 1-96% by weight and the buffer at about 1 to about 3.75% by weight.
  • GOS are present at about 1% by weight and buffer is present at about 3% by weight.
  • GOS are present at about 5% by weight and buffer is present at about 3% by weight.
  • GOS are present at about 10% by weight and buffer is present at about 3% by weight.
  • GOS are present at about 15% by weight and buffer is present at about 15% by weight.
  • GOS are present at about 20% by weight and buffer is present at about 3% by weight. In one embodiment, GOS are present at about 25% by weight and buffer is present at about 3% by weight. In one embodiment, GOS are present at about 30% by weight and buffer is present at about 3% by weight. In one embodiment, GOS are present at about 35% by weight and buffer is present at about 3% by weight. In one embodiment, GOS are present at about 40% by weight and buffer is present at about 3% by weight. In one embodiment, GOS are present at about 50% by weight and buffer is present at about 3% by weight. In one embodiment, GOS are present at about 60% by weight and buffer is present at about 3% by weight.
  • GOS are present at about 70% by weight and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 90% by weight and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 92% by weight and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 93% by weight and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 94% by weight and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 95% by weight and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 96% by weight and buffer is present at about 3% by weight.
  • GOS are present at about 97% by weight and buffer is present at about 2% by weight. In another embodiment, GOS are present at about 98% by weight and buffer is present at about 1% by weight. In another embodiment, GOS are present at about 99% by weight and buffer is present at about 1 % by weight. In another embodiment, GOS are present at about 100% by weight and buffer is present at less than about 1% by weight.
  • the remaining ingredients can be any suitable ingredients intended for consumption by the subject (e.g., a human) including, but not limited to, probiotics (e.g., beneficial bacteria) or other prebiotics (e.g., FOS), but also including ingredients intended to inhibit clumping and increase pourability, such as silicone dioxide and microcrystalline cellulose, or similar ingredients as are well-known in the art.
  • Remaining ingredients can also include ingredients to improve handling, preservatives, antioxidants, flavorings and the like.
  • compositions comprising a digestible saccharide, a probiotic bacteria, and GOS
  • a prebiotic composition comprises a digestible saccharide, a probiotic bacteria (e.g., L. acidophilus or Bifidobacterium), and GOS.
  • a probiotic bacteria e.g., L. acidophilus or Bifidobacterium
  • GOS e.g., lactose
  • lactose can be present at about 1-20% by weight, bacteria at about 0.25-2.10% by weight, and GOS at about 1-98.75% by weight.
  • lactose can be present at about 5-20% by weight, bacteria at about 0.91-1.95% by weight, and GOS at about 1 to about 96% by weight.
  • lactose is present at about 20% by weight, bacteria at about 1.5% by weight, and GOS are present at about 1% by weight.
  • lactose is present at about 20% by weight, bacteria at about 1.5% by weight, and GOS are present at about 50% by weight. In another embodiment, lactose is present at about 20% by weight, bacteria at about 1.5% by weight, and GOS are present at about 60% by weight. In another embodiment, lactose is present at about 20% by weight, bacteria at about 1.5% by weight, and GOS are present at about 70% by weight. In another embodiment, lactose is present at about 5% by weight, bacteria at about 1.5% by weight, and GOS are present at about 90% by weight. In another embodiment, lactose is present at about 5% by weight, bacteria at about 1.5% by weight, and GOS are present at about 92% by weight.
  • lactose is present at about 5% by weight, bacteria at about 1.5% by weight, and GOS are present at about 93% by weight. In another embodiment, lactose is present at about 5% by weight, bacteria at about 1% by weight, and GOS are present at about 94% by weight. In another embodiment, lactose is present at about 4.5% by weight, bacteria at about 1.5% by weight, and GOS are present at about 94% by weight. In another embodiment, lactose is present at about 4.5% by weight, bacteria at about 0.5% by weight, and GOS are present at about 95% by weight. In another embodiment, lactose is present at about 3.5% by weight, bacteria at about 0.5% by weight, and GOS are present at about 96% by weight.
  • lactose is present at about 2.5% by weight, bacteria at about 0.5% by weight, and GOS are present at about 97% by weight. In another embodiment, lactose is present at about 1.5% by weight, bacteria at about 0.5% by weight, and GOS are present at about 98% by weight. In another embodiment, lactose is present at about 0.5% by weight, bacteria at about 0.5% by weight, and GOS are present at about 99% by weight.
  • the remaining ingredients can be any suitable ingredients intended for consumption by the subject, e.g., a human, including, but not limited to a buffer, digestible saccharides (e.g., lactose, glucose, or galactose), ingredients intended to inhibit clumping and increase pourability, such as silicone dioxide and microcrystalline cellulose, or similar ingredients as are well-known in the art.
  • Remaining ingredients can also include ingredients to improve handling, preservatives, antioxidants, flavorings and the like.
  • compositions comprising GOS, a probiotic bacteria, and buffer
  • a prebiotic composition comprises GOS, a probiotic bacteria strain, and buffer.
  • GOS can be present at about 1-100% by weight, a probiotic bacteria strain at about 0.25-2% by weight, and the buffer at about 0.50-4% by weight.
  • GOS can be present at about 1-95% by weight, a probiotic bacteria strain at about 0.91-1.95% by weight, and the buffer at about 1.2 - 3.75% by weight.
  • GOS are present at about 1% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight.
  • GOS are present at about 5% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 10% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 15% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 20% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 25% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight.
  • GOS are present at about 30% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 35% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 40% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 50% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 60% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight.
  • GOS are present at about 70% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 90% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 92% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 93% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight.
  • GOS are present at about 94% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 95% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 3% by weight. In another embodiment, GOS are present at about 96% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 2% by weight. In another embodiment, GOS are present at about 97% by weight, a probiotic bacteria strain at about 1.5% by weight, and buffer is present at about 1.5% by weight.
  • GOS are present at about 99% by weight, a probiotic bacteria strain at about 0.5% by weight, and buffer is present at about 0.5% by weight. In another embodiment, GOS are present at about 100% by weight, a probiotic bacteria strain at less than about 0.5% by weight, and buffer is present at less than about 0.5% by weight.
  • the remaining ingredients can be any suitable ingredients intended for the consumption of a subject (e.g., human) including, but not limited to, other prebiotics (e.g., FOS), digestible saccharides (e.g., lactose, glucose or galactose), ingredients intended to inhibit clumping and increase pourability, such as silicone dioxide and microcrystalline cellulose, or similar ingredients as are well-known in the art.
  • Remaining ingredients can also include ingredients to improve handling, preservatives, antioxidants, flavorings and the like.
  • compositions comprising a digestible saccharide, GOS, and a buffer
  • a prebiotic composition comprises a digestible saccharide, GOS, and a buffer.
  • lactose can be present at about 1-20% by weight, GOS at about 1 -100% by weight, and the buffer at about 0.50-4% by weight, or the lactose can be present at about 5-20% by weight, GOS at about 1 - 96% by weight, and the buffer at about 1.2 - 3.75% by weight.
  • lactose is present at about 20% by weight, GOS at about 1% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 5% by weight, GOS at about 1% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 20% by weight, GOS at about 10% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 15% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 20% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 25% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 30% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 20% by weight, GOS at about 35% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 40% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 50% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 60% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, GOS at about 70% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 5% by weight, GOS at about 90% by weight, and buffer is present at about 3% by weight. In another embodiment, lactose is present at about 5% by weight, GOS at about 92% by weight, and buffer is present at about 3% by weight. In another embodiment, lactose is present at about 4% by weight, GOS at about 93% by weight, and buffer is present at about 3% by weight. In another embodiment, lactose is present at about 3% by weight, GOS at about 94% by weight, and buffer is present at about 3% by weight. In another embodiment, lactose is present at about 2% by weight, GOS at about 95% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 1% by weight, GOS at about 96% by weight, and buffer is present at about 3% by weight.
  • the remaining ingredients can be any suitable ingredients intended for consumption by a subject (e.g., human) including, but not limited to, bacteria, ingredients intended to inhibit clumping and increase pourability, such as silicone dioxide and microcrystalline cellulose, or similar ingredients as are well-known in the art.
  • Remaining ingredients can also include ingredients to improve handling, preservatives, antioxidants, flavorings and the like.
  • compositions comprising a digestible saccharide, bacteria, GOS, and a buffer
  • a prebiotic composition comprises a digestible saccharide, bacteria, GOS, and buffer.
  • lactose can be present at about 1-20% by weight, bacteria at about 0.25 - 2.10% by weight, GOS at about 1 -100% by weight, and the buffer at about 0.50-4% by weight, or the lactose can be present at about 5-20% by weight, bacteria at about 0.91 - 1.95% by weight, GOS at about 70 -95% by weight, and the buffer at about 1.2 - 3.75% by weight.
  • lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 1% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 10% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 15% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 20% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 25% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 30% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 35% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 40% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 50% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 60% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 20% by weight, bacteria at about 1.47% by weight, GOS at about 70% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 5% by weight, bacteria at about 1.47% by weight, GOS at about 90% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 3% by weight, bacteria at about 1.47% by weight, GOS at about 92% by weight, and buffer is present at about 3% by weight.
  • lactose is present at about 2% by weight, bacteria at about 1.47% by weight, GOS at about 93% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 1% by weight, bacteria at about 1.47% by weight, GOS at about 94% by weight, and buffer is present at about 3% by weight. In one embodiment, lactose is present at about 0.5% by weight, bacteria at about 1.47% by weight, GOS at about 95% by weight, and buffer is present at about 3% by weight.
  • the remaining ingredients can be any suitable ingredients intended for consumption by a subject, e.g., human, including, but not limited to, ingredients intended to inhibit clumping and increase pourability, such as silicone dioxide and microcrystalline cellulose, or similar ingredients as are well-known in the art.
  • Remaining ingredients can also include ingredients to improve handling, preservatives, antioxidants, flavorings and the like.
  • a prebiotic composition in powdered form can include flavorings such that when mixed in a liquid (e.g., water), the powder can flavor the liquid with various flavors such as grape, strawberry, lime, lemon, chocolate, and the like.
  • the compositions include microcrystalline cellulose or silicone dioxide.
  • Preservatives can include, for example, benzoic acid, alcohols, for example, ethyl alcohol, and hydroxybenzoates.
  • Antioxidants can include, for example, butylated hydroxyanisole (BHA), butylated hydroxytolulene (BHT), tocopherols (e.g., Vitamin E), and ascorbic acid (Vitamin C).
  • compositions described herein include any suitable form, including liquid or powder.
  • Powdered compositions can be as pure powder, or can be in the form of capsules, tablets, or the like. Powder can be packaged in bulk (e.g., in a container containing sufficient prebiotic or other substances for a subject to follow for an entire course of treatment with increasing doses of prebiotic, or a portion of a course of treatment), or as individual packets (e.g., packets containing a single dose of prebiotic plus other components, or packets containing the dose of prebiotic and other components needed for a particular day of a prebiotic treatment regimen).
  • the powder can be in any suitable container, such as a packet, sachet, canister, ampoule, ramekin, or bottle.
  • the container can also include one or more scoops or similar serving devices of a size or sizes appropriate to measure and serve one or more doses of prebiotic and, optionally, other ingredients included in the powder.
  • Liquid compositions contain prebiotic and, optionally, other ingredients, in a suitable liquid, e.g., water or buffer.
  • Liquid compositions can be provided in bulk (e.g., in a container containing sufficient prebiotic or other substances for one subject in need thereof to follow an entire course of treatment with increasing doses of prebiotic, or a portion of a course of treatment), or as individual containers, such as cans, bottles, soft packs, and the like (e.g., containers containing a single dose of prebiotic plus other components in suitable liquid, or containers containing the dose of prebiotic and other components needed for a particular day of a prebiotic treatment regimen).
  • the container can also include one or more measuring cups or similar serving devices of a size or sizes appropriate to measure and serve one or more doses of prebiotic and, optionally, other ingredients included in the liquid.
  • compositions described herein comprise one or more excipients.
  • the one or more excipients comprise one or more antiadherents, one or more binders, one or more coatings, one or more disintegrants, one or more fillers, one or more flavours, one or more colours, one or more lubricants, one or more glidants, one or more sorbents, one or more preservatives, one or more sweeteners, or a combination thereof.
  • the antiadherent is magnesium stearate.
  • the one or more binders are cellulose, microcrystalline cellulose, hydroxypropyl cellulose, xylitol, sorbitol, maltitiol, geleatin, polyvinylpyrrolidone, polyethylene glycol, methyl cellulose, hydroxypropyl methylcellulose, or a combination thereof.
  • the one or more coatings are a hydroxypropyl methylcellulose film, shellac, corn protein zein, gelatin, methyl acrylate- methacrylic acid copolymers, cellulose acetate succinate, hydroxy propyl methyl cellulose phthalate, hydroxy propyl methyl cellulose acetate succinate, polyvinyl acetate phthalate, methyl methacrylate-methacrylic acid copolymers, sodium alginate, stearic acid, or a combination thereof.
  • the one or more disintegrants are crosslinked polyvinylpyrrolidone (crospovidone), crosslinked sodium carboxymethyl cellulose (croscarmellose sodium), sodium starch glycolate, or a combination thereof.
  • the one or more fillers are calcium carbonate, magnesium stearate, dibasic calcium phosphate, cellulose, vegetable oil, vegetable fat, or a combination thereof.
  • the one or more flavours are mint, cherry, anise, peach, apricot, liquorice, raspberry, vanilla, or a combination thereof.
  • the one or more lubricants are talc, silica, vegetable stearin, magnesium stearate, stearic acid, or a combination thereof.
  • the one or more glidants are fumed silica, talc, magnesium carbonate, or a combination thereof.
  • the one or more sorbents are fatty acids, waxes, shellac, plastics, plant fibers, or a combination thereof.
  • the one or more preservatives are vitamin A, vitamin E, vitamin C, retinyl palmitate, selenium, cysteine, methionine, citric acid, sodium citrate, methyl paraben, propyl paraben, or a combination thereof.
  • the one or more sweeteners are stevia, sparame, sucralose, neotame, acesulfame potassium, saccharin or a combination thereof.
  • compositions formulated for oral delivery to a subject in need thereof are methods and compositions formulated for oral delivery to a subject in need thereof.
  • a composition is formulated to deliver a composition comprising a prebiotic to a subject in need thereof.
  • a pharmaceutical composition is formulated to deliver a composition comprising a prebiotic to a subject in need thereof.
  • a composition is formulated to deliver a composition comprising prebiotic and a probiotic to a subject in need thereof.
  • a composition is administered in solid, semi-solid, micro- emulsion, gel, or liquid form.
  • dosage forms include tablet forms disclosed in US Patent Nos. 3048526, 3108046, 4786505, 4919939, and 4950484; gel forms disclosed in US Patent Nos. 4904479, 6482435, 6572871, and 5013726; capsule forms disclosed in US Patent Nos. 4800083, 4532126, 4935243, and 6258380; or liquid forms disclosed in US patent Nos. 4625494, 4478822, and 5610184; each of which is incorporated herein by reference in its entirety.
  • compositions that can be used orally include tablets, push-fit capsules made of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol. Tablets can be made by compression or molding, optionally with one or more accessory ingredients.
  • Compressed tablets can be prepared by compressing in a suitable machine the active ingredient in a free- flowing form such as a powder or granules, optionally mixed with binders (e.g., povidone, gelatin, hydroxypropylmethyl cellulose), inert diluents, preservative, antioxidant, disintegrant (e.g., sodium starch glycolate, cross-linked povidone, cross-linked sodium carboxymethyl cellulose) or lubricating, surface active or dispersing agents.
  • binders e.g., povidone, gelatin, hydroxypropylmethyl cellulose
  • inert diluents preservative, antioxidant
  • disintegrant e.g., sodium starch glycolate, cross-linked povidone, cross-linked sodium carboxymethyl cellulose
  • Molded tablets can be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.
  • the tablets can optionally be coated or scored and can be formulated so as to provide slow or controlled release of the active ingredient therein. Tablets can optionally be provided with an enteric coating, to provide release in parts of the gut (e.g., colon, lower intestine) other than the stomach. All formulations for oral administration can be in dosages suitable for such administration.
  • the push-fit capsules can contain the active ingredients in admixture with filler such as lactose, binders such as starches, and/or lubricants such as talc or magnesium stearate and, optionally, stabilizers.
  • the active compounds prebiotics or probiotics
  • suitable liquids such as fatty oils, liquid paraffin, or liquid polyethylene glycols.
  • Dragee cores are provided with suitable coatings.
  • suitable coatings can be used, which can optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, or titanium dioxide, lacquer solutions, and suitable organic solvents or solvent mixtures.
  • Dyestuffs or pigments can be added to the tablets or Dragee coatings for identification or to characterize different combinations of active compound doses.
  • Formulations for oral use can also be presented as hard gelatin capsules wherein the active ingredient is mixed with an inert solid diluent, for example, calcium carbonate, calcium phosphate or kaolin, or as soft gelatin capsules wherein the active ingredient is mixed with water soluble carrier such as polyethylene glycol or an oil medium, for example peanut oil, liquid paraffin, or olive oil.
  • an inert solid diluent for example, calcium carbonate, calcium phosphate or kaolin
  • water soluble carrier such as polyethylene glycol or an oil medium, for example peanut oil, liquid paraffin, or olive oil.
  • Oral liquid preparations can be in the form of, for example, aqueous or oily suspensions, solutions, emulsions syrups or elixirs, or can be presented as a dry product for reconstitution with water or other suitable vehicle before use.
  • Such liquid preparations can contain conventional additives, such as suspending agents, for example sorbitol, methyl cellulose, glucose syrup, gelatin, hydroxyethyl cellulose, carboxymethyl cellulose, aluminum stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate, acacia; nonaqueous vehicles (which can include edible oils), for example almond oil, oily esters such as glycerine, propylene glycol, or ethyl alcohol; preservatives, for example methyl or propyl p-hydoxybenzoate or sorbic acid, and, if desired, conventional flavoring or coloring agents.
  • suspending agents for example sorbitol, methyl cellulose, glucose syrup, gelatin, hydroxyethyl cellulose, carboxymethyl cellulose, aluminum stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate, aca
  • a provided prebiotic composition includes a softgel formulation.
  • a softgel can contain a gelatin based shell that surrounds a liquid fill.
  • the shell can be made of gelatin, plasticiser (e.g., glycerin and/or sorbitol), modifier, water, color, antioxidant, or flavor.
  • the shell can be made with starch or carrageenan.
  • the outer layer can be enteric coated.
  • a softgel formulation can include a water or oil soluble fill solution, or suspension of a composition, for example, a prebiotic composition, covered by a layer of gelatin.
  • An enteric coating can control the location of where a prebiotic composition is absorbed in the digestive system.
  • an enteric coating can be designed such that a prebiotic composition does not dissolve in the stomach but rather travels to the small intestine, where it dissolves.
  • An enteric coating can be stable at low pH (such as in the stomach) and can dissolve at higher pH (for example, in the small intestine).
  • Material that can be used in enteric coatings includes, for example, alginic acid, cellulose acetate phthalate, plastics, waxes, shellac, and fatty acids (e.g., stearic acid, palmitic acid). Enteric coatings are described, for example, in US Patent Nos.
  • the enteric coating can be an aqueous enteric coating.
  • examples of polymers that can be used in enteric coatings include, for example, shellac (trade name EmCoat 120 N, Marcoat 125); cellulose acetate phthalate (trade name aquacoat CPD®, SepifilmTM LP, Klucel®, Aquacoat® ECD, and Metolose®); polyvinylacetate phthalate (trade name Sureteric®); and methacrylic acid (trade name Eudragit®).
  • an enteric coated prebiotic composition is administered to a subject.
  • an enteric coated probiotic composition is administered to a subject.
  • an enteric coated probiotic and prebiotic composition is administered to a subject.
  • probiotic bacteria can be administered to a subject using an enteric coating.
  • the stomach has an acidic environment that can kill probiotics.
  • An enteric coating can protect probiotics as they pass through the stomach and small intestine.
  • Enteric coatings can be used to (1) prevent the gastric juice from reacting with or destroying the active substance, (2) prevent dilution of the active substance before it reaches the intestine, (3) ensure that the active substance is not released until after the preparation has passed the stomach, and (4) prevent live bacteria contained in the preparation from being killed because of the low pH- value in the stomach.
  • Enteric coatings can also be used for avoiding irritation of or damage to the mucous membrane of the stomach caused by substances contained in the oral preparation, and for counteracting or preventing formation or release of substances having an unpleasant odor or taste in the stomach. Finally, such coatings can be used for preventing nausea or vomiting on intake of oral preparations.
  • a prebiotic composition is provided as a tablet, capsule, or caplet with an enteric coating.
  • the enteric coating is designed to hold the tablet, capsule, or caplet together when in the stomach.
  • the enteric coating is designed to hold together in acid conditions of the stomach and break down in non-acid conditions and therefore release the drug in the intestines.
  • Softgel delivery systems can also incorporate phospholipids or polymers or natural gums to entrap a composition, for example, a prebiotic composition, in the gelatin layer with an outer coating to give desired delayed/control release effects, such as an enteric coating.
  • a composition for example, a prebiotic composition
  • an outer coating to give desired delayed/control release effects, such as an enteric coating.
  • Formulations of softgel fills can be at pH 2.5-7.5.
  • a softgel formulation can be sealed tightly in an automatic manner.
  • a softgel formulation can easily be swallowed, allow for product identification using colors and several shapes, allow uniformity, precision and accuracy between dosages, be safe against adulteration, provide good availability and rapid absorption, and offer protection against contamination, light and oxidation. Furthermore, softgel formulations can avoid unpleasant flavors due to content encapsulation.
  • a composition comprising a softgel formulation can be in any of number of different sizes, including, for example, round, oblong, oval, tube, droplet, or suppositories.
  • a composition in a dosage form which comprises an effective amount of prebiotic and one or more release controlling excipients as described herein.
  • Suitable modified release dosage vehicles include, but are not limited to, hydrophilic or hydrophobic matrix devices, water-soluble separating layer coatings, enteric coatings, osmotic devices, multi-particulate devices, and combinations thereof.
  • the dosage form is a tablet, caplet, capsule or lollipop.
  • the dosage form is a liquid, oral suspension, oral solution, or oral syrup.
  • the dosage form is a gel capsule, soft gelatin capsule, or hard gelatin capsule.
  • the dosage form is a gelatin capsule having a size indicated in Table 7.
  • compositions comprising a prebiotic is provided in effervescent dosage forms.
  • the compositions can also comprise non-release controlling excipients.
  • a composition comprising a prebiotic is provided in a dosage form that has at least one component that can facilitate release of the prebiotic.
  • the dosage form can be capable of giving a discontinuous release of the compound in the form of at least two consecutive pulses separated in time from 0.1 up to 24 hours.
  • the compositions can comprise one or more release controlling and non-release controlling excipients, such as those excipients suitable for a disruptable semi-permeable membrane and as swellable substances.
  • compositions comprising a prebiotic is provided in an enteric coated dosage form.
  • the composition can also comprise non-release controlling excipients.
  • composition comprising a prebiotic is provided in a dosage form for oral administration to a subject in need thereof, which comprises one or more pharmaceutically acceptable excipients or carriers, enclosed in an intermediate reactive layer comprising a gastric juice-resistant polymeric layered material partially neutralized with alkali and having cation exchange capacity and a gastric juice-resistant outer layer.
  • compositions comprising a prebiotic are provided in the form of enteric-coated granules, for oral administration.
  • the compositions can further comprise cellulose, disodium hydrogen phosphate, hydroxypropyl cellulose, hypromellose, lactose, mannitol, and sodium lauryl sulfate.
  • compositions comprising a prebiotic are provided in the form of enteric-coated pellets, for oral administration.
  • the compositions can further comprise glyceryl monostearate 40-50, hydroxypropyl cellulose, hypromellose, magnesium stearate, methacrylic acid copolymer type C, polysorbate 80, sugar spheres, talc, and triethyl citrate.
  • compositions comprising a prebiotic are provided in the form of enteric-coated granules, for oral administration.
  • the compositions can further comprise carnauba wax, crospovidone, diacetylated monoglycerides, ethylcellulose, hydroxypropyl cellulose, hypromellose phthalate, magnesium stearate, mannitol, sodium hydroxide, sodium stearyl fumarate, talc, titanium dioxide, and yellow ferric oxide.
  • composition comprising a prebiotic can further comprise calcium stearate, crospovidone, hydroxypropyl methylcellulose, iron oxide, mannitol, methacrylic acid copolymer, polysorbate 80, povidone, propylene glycol, sodium carbonate, sodium lauryl sulfate, titanium dioxide, and triethyl citrate.
  • compositions provided herein can be in unit-dosage forms or multiple- dosage forms.
  • Unit-dosage forms refer to physically discrete units suitable for administration to human or non-human animal subject in need thereof and packaged individually. Each unit-dose can contain a predetermined quantity of an active ingredient(s) sufficient to produce the desired therapeutic effect, in association with other pharmaceutical carriers or excipients. Examples of unit-dosage forms include, but are not limited to, ampoules, syringes, and individually packaged tablets and capsules. Unit-dosage forms can be administered in fractions or multiples thereof.
  • a multiple-dosage form is a plurality of identical unit-dosage forms packaged in a single container, which can be administered in segregated unit-dosage form.
  • multiple-dosage forms include, but are not limited to, vials, bottles of tablets or capsules, or bottles of pints or gallons.
  • the multiple dosage forms comprise different pharmaceutically active agents.
  • a multiple dosage form can be provided which comprises a first dosage element comprising a composition comprising a prebiotic and a second dosage element comprising lactose or a probiotic, which can be in a modified release form.
  • a pair of dosage elements can make a single unit dosage.
  • a kit comprising multiple unit dosages, wherein each unit comprises a first dosage element comprising a composition comprising a prebiotic and a second dosage element comprising probiotic, lactose or both, which can be in a modified release form.
  • the kit further comprises a set of instructions.
  • compositions can be formulated in various dosage forms for oral administration.
  • the compositions can also be formulated as a modified release dosage form, including immediate-, delayed-, extended-, prolonged-, sustained-, pulsatile-, controlled-, extended, accelerated-, fast-, targeted-, programmed-release, and gastric retention dosage forms.
  • These dosage forms can be prepared according to known methods and techniques (see, Remington: The Science and Practice of Pharmacy, supra; Modified-Release Drug Deliver Technology, Rathbone et al., Eds., Drugs and the Pharmaceutical Science, Marcel Dekker, Inc.: New York, N.Y., 2002; Vol. 126, which is herein incorporated by reference in its entirety).
  • the compositions are in one or more dosage forms.
  • a composition can be administered in a solid or liquid form.
  • solid dosage forms include but are not limited to discrete units in capsules or tablets, as a powder or granule, or present in a tablet conventionally formed by compression molding.
  • Such compressed tablets can be prepared by compressing in a suitable machine the three or more agents and a pharmaceutically acceptable carrier.
  • the molded tablets can be optionally coated or scored, having indicia inscribed thereon and can be so formulated as to cause immediate, substantially immediate, slow, controlled or extended release of a composition comprising a prebiotic.
  • dosage forms as disclosed herein can comprise acceptable carriers or salts known in the art, such as those described in the Handbook of Pharmaceutical Excipients, American Pharmaceutical Association (1986), incorporated by reference herein in its entirety.
  • an effective amount of a composition comprising a prebiotic is mixed with a pharmaceutical excipient to form a solid preformulation composition comprising a homogeneous mixture of compounds described herein.
  • a pharmaceutical excipient to form a solid preformulation composition comprising a homogeneous mixture of compounds described herein.
  • homogeneous it is meant that the agents are dispersed evenly throughout the composition so that the composition can be subdivided into unit dosage forms such as tablets, caplets, or capsules.
  • This solid preformulation composition can then be subdivided into unit dosage forms of the type described above comprising from, for example, about 1 g to about 20 mg of a prebiotic composition.
  • a prebiotic composition can be formulated, in the case of caplets, capsules or tablets, to be swallowed whole, for example with water.
  • the prebiotic composition does not comprise excipients and/or preservatives.
  • compositions described herein can be in liquid form.
  • the liquid formulations can comprise, for example, an agent in water-in-solution and/or suspension form; and a vehicle comprising polyethoxylated castor oil, alcohol, and/or a polyoxyethylated sorbitan mono-oleate with or without flavoring.
  • Each dosage form comprises an effective amount of an active agent and can optionally comprise pharmaceutically inert agents, such as conventional excipients, vehicles, fillers, binders, disintegrants, pH adjusting substances, buffer, solvents, solubilizing agents, sweeteners, coloring agents, and any other inactive agents that can be included in pharmaceutical dosage forms for oral administration. Examples of such vehicles and additives can be found in Remington's Pharmaceutical Sciences, 17th edition (1985).
  • the dosage forms described herein can be manufactured using processes that are well known to those of skill in the art.
  • an effective amount of a prebiotic can be dispersed uniformly in one or more excipients, for example, using high shear granulation, low shear granulation, fluid bed granulation, or by blending for direct compression.
  • Excipients include diluents, binders, disintegrants, dispersants, lubricants, glidants, stabilizers, surfactants and colorants.
  • Diluents, also termed "fillers,” can be used to increase the bulk of a tablet so that a practical size is provided for compression.
  • Non- limiting examples of diluents include lactose, cellulose, microcrystalline cellulose, mannitol, dry starch, hydrolyzed starches, powdered sugar, talc, sodium chloride, silicon dioxide, titanium oxide, dicalcium phosphate dihydrate, calcium sulfate, calcium carbonate, alumina and kaolin. Binders can impart cohesive qualities to a tablet formulation and can be used to help a tablet remain intact after compression.
  • Non-limiting examples of suitable binders include starch (including corn starch and pregelatinized starch), gelatin, sugars (e.g., glucose, dextrose, sucrose, lactose and sorbitol), celluloses, polyethylene glycol, waxes, natural and synthetic gums, e.g., acacia, tragacanth, sodium alginate, and synthetic polymers such as polymethacrylates and polyvinylpyrrolidone.
  • Lubricants can also facilitate tablet manufacture; non-limiting examples thereof include magnesium stearate, calcium stearate, stearic acid, glyceryl behenate, and polyethylene glycol.
  • Disintegrants can facilitate tablet disintegration after administration, and non-limiting examples thereof include starches, alginic acid, crosslinked polymers such as, e.g., crosslinked polyvinylpyrrolidone, croscarmellose sodium, potassium or sodium starch glycolate, clays, celluloses, starches, gums and the like.
  • suitable glidants include silicon dioxide, talc, and the like.
  • Stabilizers can inhibit or retard drug decomposition reactions, including oxidative reactions.
  • Surfactants can also include and can be anionic, cationic, amphoteric or nonionic.
  • the tablets can also comprise nontoxic auxiliary substances such as pH buffering agents, preservatives, e.g., antioxidants, wetting or emulsifying agents, solubilizing agents, coating agents, flavoring agents, and the like.
  • preservatives e.g., antioxidants, wetting or emulsifying agents, solubilizing agents, coating agents, flavoring agents, and the like.
  • the prebiotic composition does not comprise excipients and/or preservatives.
  • a softgel formulation is made with a gelatin mass for the outer shell, and a composition including one or more substances, for example prebiotics and/or probiotics, for the capsule fill can be prepared.
  • a gelatin mass gelatin powder can be mixed with water and glycerin, heated, and stirred under vacuum.
  • Additives, for example, flavors or colors, can be added to molten gelatin using a turbine mixer and transferred to mobile vessels.
  • the gelatin mass can be kept in a steam-jacketed storage vessel at a constant temperature.
  • the encapsulation process can begin when the molten gel is pumped to a machine and two thin ribbons of gel are formed on either side of machine. These ribbons can then pass over a series of rollers and over a set of die that determine the size and shapes of capsules.
  • a fill composition for example a prebiotic and/or probiotic fill composition, can be fed to a positive displacement pump, which can dose the fill and inject it between two gelatin ribbons prior to sealing them together through the application of heat and pressure.
  • the capsules can pass through a conveyer into tumble dryers where a portion of the water can be removed.
  • the capsules can then be placed on, for example, trays, which can be stacked and transferred into drying rooms. In the drying rooms, dry air can be forced over capsules to remove any excess moisture.
  • Immediate-release formulations of an effective amount of a prebiotic composition can comprise one or more combinations of excipients that allow for a rapid release of a pharmaceutically active agent (such as from 1 minute to 1 hour after administration).
  • an excipient can be microcrystalline cellulose, sodium carboxymethyl cellulose, sodium starch glycolate, corn starch, colloidal silica, Sodium Laurel Sulphate, Magnesium Stearate, Prosolve SMCC (HD90), croscarmellose Sodium, Crospovidone NF, Avicel PH200, and combinations of such excipients.
  • the prebiotic composition does not comprise excipients and/or preservatives.
  • Controlled-release formulations (also referred to as sustained release (SR), extended-release (ER, XR, or XL), time-release or timed-release, controlled-release (CR), or continuous-release) refer to the release of a prebiotic composition from a dosage form at a particular desired point in time after the dosage form is administered to a subject.
  • Controlled- release formulations can include one or more excipients, including but not limited to microcrystalline cellulose, sodium carboxymethyl cellulose, sodium starch glycolate, corn starch, colloidal silica, Sodium Laurel Sulphate, Magnesium Stearate, Prosolve SMCC (HD90), croscarmellose Sodium, Crospovidone NF, or Avicel PH200.
  • controlled-release includes sustained but otherwise complete release.
  • a sudden and total release in the large intestine at a desired and appointed time or a release in the intestines such as through the use of an enteric coating are both considered controlled-release.
  • Controlled-release can occur at a predetermined time or in a predetermined place within the digestive tract. It is not meant to include a passive, uncontrolled process as in swallowing a normal tablet. Examples include, but are not limited to, those described in U.S. Patent Nos.
  • the prebiotic composition does not comprise excipients and/or preservatives.
  • a controlled release dosage form begins its release and continues that release over an extended period of time. Release can occur beginning almost immediately or can be sustained. Release can be constant, can increase or decrease over time, can be pulsed, can be continuous or intermittent, and the like. Generally, however, the release of at least one pharmaceutically active agent from a controlled-release dosage form will exceed the amount of time of release of the drug taken as a normal, passive release tablet. Thus, for example, while all of at least one pharmaceutically active agent of an uncoated aspirin tablet should be released within, for example, four hours, a controlled-release dosage form could release a smaller amount of aspirin over a period of six hours, 12 hours, or even longer. Controlled-release in accordance with the compositions and methods described herein generally means that the release occurs for a period of six hours or more, such as 12 hours or more.
  • a controlled release dosage refers to the release of an agent, from a composition or dosage form in which the agent is released according to a desired profile over an extended period of time.
  • controlled-release results in dissolution of an agent within 20-720 minutes after entering the stomach.
  • controlled-release occurs when there is dissolution of an agent within 20-720 minutes after being swallowed.
  • controlled-release occurs when there is dissolution of an agent within 20-720 minutes after entering the intestine.
  • controlled-release results in substantially complete dissolution after at least 1 hour following administration.
  • controlled-release results in substantially complete dissolution after at least 1 hour following oral administration.
  • controlled-release compositions allow delivery of an agent to a subject in need thereof over an extended period of time according to a predetermined profile.
  • Such release rates can provide therapeutically effective levels of agent for an extended period of time and thereby provide a longer period of pharmacologic or diagnostic response as compared with conventional rapid release dosage forms.
  • Such longer periods of response provide for many inherent benefits that are not achieved with immediate-release dosages.
  • controlled-release refers to wherein all or less than all of the total amount of a dosage form, made according to methods and compositions described herein, delivers an active agent over a period of time greater than 1 hour.
  • controlled-release refers to delayed release of an agent, from a composition or dosage form in which the agent is released according to a desired profile in which the release occurs after a period of time.
  • the compositions described herein can be administered at a substantially lower daily dosage level than immediate- release forms.
  • the controlled-release layer is capable of releasing about 30 to about 40% of the one or more active agents (e.g., prebiotic or probiotic) contained therein in the stomach of a subject in need thereof in about 5 to about 10 minutes following oral administration.
  • the controlled-release layer is capable of releasing about 90% of the one or more active agents (e.g., prebiotic or probiotic) is released in about 40 minutes after oral administration.
  • the controlled-release layer comprises one or more excipients, including but not limited to silicified microcrystalline cellulose (e.g., HD90), croscarmellose sodium (AC-Di-Sol), hydroxyl methyl propyl cellulose, magnesium stearate, or stearic acid.
  • a controlled release formulation weighs between about 100 mg to 3 g.
  • the prebiotic composition does not comprise excipients and/or preservatives.
  • compositions suitable for administration of the compounds provided herein include all such carriers known to those skilled in the art to be suitable for the particular mode of administration.
  • the compositions can one or more components that do not impair the desired action, or with components that supplement the desired action, or have another action.
  • an effective amount of the prebiotic is formulated in an immediate release form.
  • the immediate-release form can be included in an amount that is effective to shorten the time to its maximum concentration in the blood.
  • certain immediate-release pharmaceutical preparations are taught in United States Patent Publication US 2005/014771 OA 1 entitled, "Powder Compaction and Enrobing," which is incorporated herein in its entirety by reference.
  • the dosage forms described herein can also take the form of pharmaceutical particles manufactured by a variety of methods, including but not limited to high-pressure homogenization, wet or dry ball milling, or small particle precipitation (nano spray).
  • Other methods to make a suitable powder formulation are the preparation of a solution of active ingredients and excipients, followed by precipitation, filtration, and pulverization, or followed by removal of the solvent by freeze-drying, followed by pulverization of the powder to the desired particle size.
  • the dosage form can be an effervescent dosage form.
  • Effervescent means that the dosage form, when mixed with liquid, including water and saliva, evolves a gas.
  • Some effervescent agents (or effervescent couple) evolve gas by means of a chemical reaction which takes place upon exposure of the effervescent disintegration agent to water or to saliva in the mouth. This reaction can be the result of the reaction of a soluble acid source and an alkali monocarbonate or carbonate source. The reaction of these two general compounds produces carbon dioxide gas upon contact with water or saliva.
  • An effervescent couple (or the individual acid and base separately) can be coated with a solvent protective or enteric coating to prevent premature reaction.
  • the acid sources can be any which are safe for human consumption and can generally include food acids, acid and hydrite antacids such as, for example: citric, tartaric, amalic, fumeric, adipic, and succinics.
  • Carbonate sources include dry solid carbonate and bicarbonate salt such as, preferably, sodium bicarbonate, sodium carbonate, potassium bicarbonate and potassium carbonate, magnesium carbonate and the like. Reactants which evolve oxygen or other gasses and which are safe for human consumption are also included. In one embodiment citric acid and sodium bicarbonate are used.
  • the dosage form can be in a candy form (e.g., matrix), such as a lollipop or lozenge.
  • a candy form e.g., matrix
  • an effective amount of a prebiotic is dispersed within a candy matrix.
  • the candy matrix comprises one or more sugars (such as dextrose or sucrose).
  • the candy matrix is a sugar-free matrix.
  • Conventional sweeteners such as sucrose can be utilized, or sugar alcohols suitable for use with diabetic patients, such as sorbitol or mannitol can be employed.
  • Other sweeteners, such as the aspartames can also be easily incorporated into a composition in accordance with compositions described herein.
  • the candy base can be very soft and fast dissolving, or can be hard and slower dissolving.
  • Candies with a gelatin base such as gummy candies, may be both soft and slow dissolving.
  • Dosage forms in a candy matrix may have particular appeal to pediatric or adolescent subjects.
  • Certain candy matrix forms such as gummy or jelly candy forms may also facilitate ingestion by individuals suffering from conditions that may inhibit swallowing of tablet, capsule, or pill dosage forms.
  • Various forms will have advantages in different situations.
  • a candy mass composition comprising an effective amount of the prebiotic can be orally administered to a subject in need thereof so that an effective amount of the prebiotic will be released into the subject's mouth as the candy mass dissolves and is swallowed.
  • a subject in need thereof includes a human adult or child.
  • a candy mass is prepared that comprises one or more layers which can comprise different amounts or rates of dissolution of the prebiotic.
  • a multilayer candy mass (such as a lollipop) comprises an outer layer with a concentration of the prebiotic differing from that of one or more inner layers.
  • the choices of matrix and the concentration of the drug in the matrix can be important factors with respect to the rate of drug uptake.
  • a matrix that dissolves quickly can deliver drug into the subject's mouth for absorption more quickly than a matrix that is slow to dissolve.
  • a candy matrix that contains the prebiotic in a high concentration can release more of the prebiotic in a given period of time than a candy having a low concentration.
  • a candy matrix such as one disclosed in US Patent No. 4671953 or US Application Publication No.2004/0213828 (which are herein incorporated by reference in their entirety) is used to deliver the prebiotic.
  • the dosage forms described herein can also take the form of pharmaceutical particles manufactured by a variety of methods, including but not limited to high-pressure homogenization, wet or dry ball milling, or small particle precipitation (e.g., nGimat's NanoSpray).
  • Other methods useful to make a suitable powder formulation are the preparation of a solution of active ingredients and excipients, followed by precipitation, filtration, and pulverization, or followed by removal of the solvent by freeze-drying, followed by pulverization of the powder to the desired particle size.
  • the pharmaceutical particles have a final size of 3-1000 ⁇ , such as at most 3, 4, 5, 6, 7, 8, 9,10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, 1000 ⁇ .
  • the pharmaceutical particles have a final size of 10-500 ⁇ .
  • the pharmaceutical particles have a final size of 50-600 ⁇ .
  • the pharmaceutical particles have a final size of 100-800 ⁇ .
  • an oral dosage form (such as a powder, tablet, , oral thin or dissolving film, or capsule) comprising a prebiotic composition comprising about 0.7 g of GOS, about 0.2 g of lactose, about 0.01 g of glucose, about 0.01 g of galactose, about 0.1-0.2 g of a binder, about 0.1-0.2 g of a dispersant, about 0.1-0.2 g of a solubilizer, wherein the GOS are composed of about 1-25 % disaccharides, about 1-25 % trisaccharides, about 1-25 % tetrasaccharides, and about 1-25 % pentasaccharides.
  • an oral dosage form comprising a prebiotic composition comprising about 0.7 g of GOS, about 0.2 g of lactose, about 0.01 g of glucose, about 0.01 g of galactose, about 0.1-0.2 g of a binder, about 0.1- 0.2 g of a dispersant, about 0.1-0.2 g of a solubilizer, wherein the GOS are composed of about 1- 25% disaccharides, about 55-65% trisaccharides, about 25-35% tetrasaccharides, about 1-25% pentasaccharides, about 1-25% hexasaccharides, or combinations thereof.
  • the oral dosage form can be in the form of a powder, oral thin or dissolving film, capsule, or tablet. Suitable amounts of binders, dispersants, and solubilizers are known in the art for preparation of oral tablets or capsules.
  • An oral thin or dissolving film suitable for use in delivering a prebiotic composition may be formulated as described in U.S. Pat. No. 6,177,096, which is herein incorporated by reference in its entirety.
  • Oral thin or dissolving films may be suitable for providing additional features in addition to delivery of GOS compositions, such as for freshening breath.
  • an oral dosage form (such as a powder, tablet, oral thin or dissolving film, or capsule) comprising a prebiotic composition comprising about 1-99.9% by weight of GOS, about 0.5-20% by weight of lactose, about 0.1-2% by weight of glucose, about 0.1-2% by weight of galactose, about 0.05-2% by weight of a binder, about 0.05-2% by weight of a dispersant, about 0.05-2% by weight of a solubilizer, wherein the GOS are composed of about 1%, 2.5% 5%, 7.5%, 10%, 12.5%, 15%, 17.5%, 20%, 22.5%, 25%, 1- 5%, 5-10%, 10-15%, 15-20%, 20-25%, or 1-25% by weight disaccharides, about 1-25, 55%, 60%, 65%, 70%, 75%, or 55-75% by weight trisaccharides, about 1-25%, 20%, 22.5%, 25%, 27.5%, 30%, 32.5%, 35%, 37.
  • an oral dosage form (such as a powder, tablet, , oral thin or dissolving film, or capsule) comprising a prebiotic composition comprising about 1, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 99.5, 100% by weight of GOS, about 0, 5, 10, 15, or 20% by weight of lactose, about 0.1, 0.5, 1, or 2% by weight of glucose, about 0.1, 0.5, 1, or 2% by weight of galactose, about 0.05, 0.1, 0.5, 1, or 2% by weight of a binder, about 0.05, 0.1, 0.5, 1, or 2% by weight of a dispersant, about 0.05, 0.1, 0.5, 1, or 2% by weight of a solubilizer, wherein the GOS are composed of about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, or 25% by weight disaccharides, about 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, or
  • an oral dosage form comprising a prebiotic composition
  • the oral dosage form is a syrup.
  • the syrup can comprise about 1%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, or 85% solid.
  • the syrup can comprise about 15%, 20%, 25%, 30%, 35%, 40%, 45%, or 50% liquid, for example, water.
  • the solid can comprise a prebiotic composition.
  • the solid can be, for example, about 1-96%, 10-96%, 20-96%, 30-96%, 40-96%, 50-96%, 60-96%, 70-96%, 80- 96%, or 90-96% prebiotic composition.
  • the solid can be, for example, about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, or 96% prebiotic composition.
  • a prebiotic composition comprises GOS.
  • a prebiotic composition comprises GOS and another prebiotic.
  • a prebiotic composition comprises GOS and inulin or GOS and FOS.
  • an oral spray form comprising a prebiotic composition comprising about 0.7 g of GOS, about 0.2 g of lactose, about 0.01 g of glucose, about 0.01 g of galactose, about 0.1-0.2 g of a binder, about 0.1-0.2 g of a dispersant, about 0.1-0.2 g of a solubilizer, wherein the GOS are composed of about 1-25% disaccharides, about 55-65% trisaccharides, about 25-35% tetrasaccharides, about 1-25% pentasaccharides, about 1-25% hexasaccharides, or combinations thereof.
  • an oral spray form comprising a prebiotic composition comprising about 1-99.9% by weight of GOS, about 0.5-20% by weight of lactose, about 0.1-2% by weight of glucose, about 0.1-2% by weight of galactose, about 0.05-2% by weight of a binder, about 0.05-2% by weight of a dispersant, about 0.05-2% by weight of a solubilizer, wherein the GOS are composed of about 1-25% by weight disaccharides, about 55- 65% by weight trisaccharides, about 25-35% by weight tetrasaccharides, about 1-25% by weight pentasaccharides, about 1-25% by weight hexasaccharides, or combinations thereof.
  • an oral spray form comprising a prebiotic composition comprising about 1, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 99.5, 100% by weight of GOS, about 0, 5, 10, 15, or 20% by weight of lactose, about 0.1, 0.5, 1, or 2% by weight of glucose, about 0.1, 0.5, 1, or 2% by weight of galactose, about 0.05, 0.1, 0.5, 1, or 2% by weight of a binder, about 0.05, 0.1, 0.5, 1, or 2% by weight of a dispersant, about 0.05, 0.1, 0.5, 1, or 2% by weight of a solubilizer, wherein the GOS are composed of about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, or 25% by weight disaccharides, about 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, or 65% by weight trisaccharides, about 25, 26, 27, 28, 29, 30, 31, 32, 33,
  • a bar form comprising a prebiotic composition comprising about 1, 10, 20, 30, 40, 50, 60, 70, 80, 90, 95, 99.5, 100% by weight of GOS, about 0.1, 0.5, 1, or 2% by weight of glucose, about 0.1, 0.5, 1, or 2% by weight of galactose, about 0.05, 0.1, 0.5, 1, or 2% by weight of a binder, about 0.05, 0.1, 0.5, 1, or 2% by weight of a dispersant, about 0.05, 0.1, 0.5, 1, or 2% by weight of a solubilizer, wherein the GOS are composed of about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, or 25% by weight disaccharides, about 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, or 65% by weight trisaccharides, about 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, or 35% by weight tetrasaccharides, about 1, 10, 20, 30, 40,
  • the softgel capsule is about 0.25 mL, 0.5 mL, 1.0 mL, 1.25 mL, 1.5 mL, 1.75 mL, or 2.0 mL.
  • a softgel capsule comprises about 0.1 g to 2.0 g of prebiotic composition.
  • a softgel capsule comprises about 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, or 2.0 g of a prebiotic composition.
  • the prebiotic composition comprises GOS.
  • the prebiotic composition consists essentially of GOS.
  • a softgel capsule comprises GOS and inulin or FOS.
  • the prebiotic composition will be delivered in a gelatin capsule containing an amount of GOS within the ranges listed in Table 8.
  • the number of pills taken per day will be within the ranges listed in Table 8.
  • a prebiotic composition that does not contain a preservative. In another embodiment, a prebiotic composition is provided that does not contain an antioxidant. In another embodiment, a prebiotic composition is provided that does not contain a preservative or an antioxidant. In one embodiment a prebiotic composition comprising GOS does not contain a preservative or an antioxidant.
  • a prebiotic composition is formulated as a viscous fluid.
  • a prebiotic composition is formulated such that its water content is low enough that it does not support microbial growth.
  • a prebiotic composition is formulated as a viscous fluid without a preservative in a gel capsule.
  • a prebiotic composition comprising GOS is a viscous fluid.
  • a prebiotic composition comprises a high percentage of GOS that does not support microbial growth.
  • the prebiotic composition comprises GOS and inulin or FOS.
  • an oral dosage form comprising a prebiotic composition, wherein the oral dosage form is a softgel.
  • the softgel comprises a syrup.
  • the syrup comprises a prebiotic composition.
  • the prebiotic composition comprises GOS.
  • the prebiotic composition comprises more than 80% GOS.
  • the prebiotic composition comprises between 80-99.9% GOS.
  • the prebiotic composition comprises more than 80% GOS.
  • the prebiotic composition comprises about 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 99.9% GOS.
  • a GOS composition is formulated for delivery in a soft gel capsule.
  • a GOS composition formulated for delivery in a soft gel capsule is a high percentage GOS composition, such as a 90-100% GOS composition (e.g., 90, 91, 92, 93,
  • a GOS composition formulated for delivery in a soft gel capsule comprises about 95% GOS. In another embodiment a GOS composition formulated for delivery in a soft gel capsule comprises about
  • the GOS composition is formulated such that its water content is low enough that it does not support microbial growth.
  • the GOS composition is formulated as a viscous fluid without a preservative in a gel capsule.
  • the GOS composition is formulated as a viscous fluid without an antioxidant in a gel capsule.
  • the soft gel capsule comprises about 0.1-2 g of a GOS composition.
  • a prebiotic composition can be formulated as described, in US Patent No. 6,750,331, which is herein incorporated by reference in its entirety.
  • a prebiotic composition can be formulated to comprise an oligosaccharide, a foaming component, a water-insoluble dietary fiber, or a neutralizing component.
  • a prebiotic composition can be in the form of a chewable tablet.
  • a prebiotic composition may be provided in the form of an orodispersible tablet or orally disintegrating tablet (ODT). Orodispersible tablets are designed to rapidly dissolve after first contact with saliva, thus eliminating the need to chew a tablet, swallow a tablet intact, or take the tablet with liquids.
  • ODT forms of a prebiotic composition may be specifically applicable to pediatric and geriatric patients and to individuals with conditions related to impaired swallowing. The quick solubility of an ODT tablet also reduces the risk of choking or suffocation during oral administration.
  • a foaming component can be at least one member selected from the group consisting of sodium hydrogencarbonate, sodium carbonate, and calcium carbonate.
  • a neutralizing component can be at least one member selected from the group consisting of citric acid, L-tartaric acid, fumaric acid, L-ascorbic acid, DL-malic acid, acetic acid, lactic acid, and anhydrous citric acid.
  • a water-insoluble dietary fiber can be at least one member selected from the group consisting of crystalline cellulose, wheat bran, oat bran, cone fiber, soy fiber, and beet fiber.
  • the formulation can contain a sucrose fatty acid ester, powder sugar, fruit juice powder, and/or flavoring material.
  • Formulations of the compositions described herein can include additive components selected from various known additives.
  • additives include, for example, saccharides (excluding oligosaccharides), sugar alcohols, sweeteners and like excipients, binders, disintegrators, lubricants, thickeners, surfactants, electrolytes, flavorings, coloring agents, pH modifiers, fluidity improvers, and the like.
  • additives include wheat starch, potato starch, corn starch, dextrin and like starches; sucrose, glucose, fructose, maltose, xylose, lactose and like saccharides (excluding oligosaccharides); sorbitol, mannitol, maltitol, xylitol and like sugar alcohols; calcium phosphate, calcium sulfate and like excipients; starch, saccharides, gelatine, gum arabic, dextrin, methyl cellulose, polyvinylpyrrolidone, polyvinyl alcohol, hydroxypropylcellulose, xanthan gum, pectin, gum tragacanth, casein, alginic acid and like binders and thickeners; leucine, isoleucine, L-valine, sugar esters, hardened oils, stearic acid, magnesium stearate, talc, macrogols and like lubricants; CMC, CMC-N
  • a GOS composition is a chewable oral dosage formulation.
  • the chewable formulation can comprises between about 1- 99.9% GOS.
  • a GOS composition comprises about 80% GOS, about 5% L- ascorbic acid, about 2% anhydrous citric acid, about 3% sodium hydrogencarbonate, about 3% calcium carbonate, about 2% sucrose fatty acid, about 3% fruit juice powder, and about 2% potassium carbonate.
  • a GOS composition comprises about 85% GOS, about 5% L-ascorbic acid, about 3% sodium hydrogencarbonate, about 2% sodium carbonate, about 2% sucrose fatty acid ester, about 2% fruit juice powder, and about 1% potassium carbonate.
  • a GOS composition comprises about 90% GOS, about 2% L-ascorbic acid, about 1% anhydrous citric acid, about 2% sodium hydrogencarbonate, about 2% sodium carbonate, about 2% sucrose fatty acid ester, and about 1% potassium carbonate.
  • a GOS composition comprises about 95% GOS, about 2% L-ascorbic acid, about 1% sodium hydrogencarbonate, and about 2% fruit juice powder.
  • a GOS composition comprises about 95% GOS and about 5% of L-ascorbic acid, anhydrous citric acid, sodium hydrogencarbonate, calcium carbonate, sucrose fatty acid, fruit juice powder, or potassium carbonate.
  • a GOS composition comprises about 95% GOS and about 5% of L-ascorbic acid, anhydrous citric acid, sodium hydrogencarbonate, calcium carbonate, sucrose fatty acid, fruit juice powder, and potassium carbonate.
  • the present disclosure provides methods and prebiotic compositions useful for the reduction of symptoms of lactose intolerance and for improving overall gastrointestinal (GI) health.
  • Symptoms of lactose intolerance include gas, bloating, diarrhea, abdominal pain, cramping, and vomiting. Minor digestive problems related to the GI also include occasional bloating, diarrhea, constipation, gas, heartburn, or stomach upset.
  • the methods and compositions described herein can be useful for reducing or eliminating one or more of these symptoms, for example through colonic adaptation. These compositions are expected to modify the colonic microbiota, which may result in an increased tolerance to lactose and other fermentable carbohydrates.
  • compositions can allow the colonic microbiota, comprising microorganisms known to increase the ability of an individual to tolerate fermentable carbohydrates, to be regularly replenished through consumption of the compositions.
  • Adaptation of the intestinal and colonic microbiota improve the composition of the intestinal microbiota, and the capacity for consumption of foods comprising lactose can be increased.
  • an individual's tolerance to dairy in general can be improved through regular consumption of a prebiotic composition.
  • This change in colonic microbiota is useful for the reduction of bloating, diarrhea, gastric distention and pain, and/or flatulence from the consumption of dairy products or other foods comprising lactose.
  • a method of treating lactose intolerance is disclosed.
  • a method of treating at least one symptom of lactose intolerance is disclosed.
  • lactose intolerance results from a decrease in lactase production as a subject ages. Secondary lactose intolerance can result when a subject's small intestine decreases lactase production after an illness, surgery, or injury to the small intestine. Secondary lactose intolerance can occur as a result of Crohn's disease, celiac disease, or gastroenteritis. This type of lactose intolerance can be temporary or permanent.
  • a third type of lactose intolerance is congenital lactose intolerance, in which a subject is born with lactose intolerance.
  • Lactose intolerance can be tested either indirectly or directly.
  • Indirect testing methods include, but are not limited to: a hydrogen breath test, a stool acidity test, a blood glucose test, or milk challenge test.
  • the breath is measured to determine the amount of hydrogen produced after consuming a measured amount of lactose, typically 15g.
  • the lactose is administered by drinking a lactose mixture, and the subject exhales into a vacuum-sealed collection tube at three one hour time intervals.
  • a high level of hydrogen in the breath indicates an improper digestion of lactose.
  • a stool test the stool is tested to determine the amount of acid.
  • Lactose maldigestion is often defined more specifically as an "increase in blood glucose concentration of ⁇ 1.12 mmol/L or breath hydrogen of >20ppm after ingestion of lg/kg body weight or 50g lactose" (de Vrese et al., 2001).
  • the direct method measures lactase activity in a mucosal biopsy specimen.
  • the stool acidity test is typically used to test lactose intolerance in infants and young children.
  • the hydrogen breath test is typically not recommended for young children since dehydration can occur due to diarrhea after ingestion of the lactose-containing drink.
  • Effectiveness of treatment can be measured in a number of ways. Conventional measurements, such as those described, can be used before and after treatment. Alternatively, or in addition, the amount of lactose-containing product that can be administered before the onset of one or more symptoms can be measured or evaluated before and after treatment. Thus, for example, treatment can be considered fully or partially effective if, after treatment, less hydrogen is produced on average in a subject after challenge with a food comprising lactose (such as a dairy product).
  • the Hydrogen Breath Test is utilized to determine facilitation of lactose metabolism by GOS containing compositions (e.g. GOS 95), thereby resulting in less hydrogen production following lactose challenge as compared to baseline levels.
  • GOS composition is a high percentage composition, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% by weight).
  • the HBT test involves administering 25 mg of lactose and determining the amount of hydrogen in the breath at periodic intervals, usually for four to eight hours (Bhatnagar and Aggarwal 2007).
  • fecal bacteria levels are assessed for bacterial DNA samples to assess bacterial adaptation.
  • treatment with GOS compositions e.g. GOS 95
  • GOS compositions is expected to provide relief fromone or more lactose intolerance symptoms beyond the treatment phase.
  • the GOS composition is a high percentage composition, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% by weight).
  • a subject cannot precisely test the amount of hydrogen or use a blood glucose test to measure effectiveness. Instead, a subject can subjectively determine the quantity of lactose-containing products they can consume, and the types and degree of symptoms experienced after such consumption.
  • "Partial" elimination of symptoms of lactose intolerance includes a subjective or measurable increase in the amount of lactose that can be consumed before the onset of symptoms.
  • “Substantial” elimination of symptoms of lactose intolerance encompasses an effect where at least about twice the amount of lactose or a lactose containing food can be consumed after treatment before the onset of symptoms as could have been consumed before treatment.
  • “Complete” or “substantially complete” elimination of symptoms of lactose intolerance indicates that normal amounts of lactose can be consumed after treatment (i.e., the amount of lactose in a typical diet for the area or culture in which the subject normally lives) without symptoms, or with only the rare occurrence of symptoms.
  • a subject in need thereof can consume one half cup (4 oz.; about 120 mL) of milk with no, or minimal, symptoms of lactose intolerance.
  • consumption of 1 or more cups (about 240 mL) of milk causes symptoms of lactose intolerance, such as gas or diarrhea, to occur.
  • a subject can find that 1 and one -half cups (about 360 mL) of milk can be consumed in a single administration without causing any symptoms of lactose intolerance. The subject would experience the substantial elimination of the symptoms of lactose intolerance.
  • a subject can find that after treatment with a composition and/or dosing regimen disclosed a normal diet for their geographical or cultural region can be consumed with no, or rare, symptoms of lactose intolerance.
  • effectiveness can be measured by a percentage decrease in one or more symptoms of lactose intolerance.
  • the severity of a predetermined symptom, or set of symptoms is measured before and after treatment, e.g., using pre and post Likert scale.
  • Exemplary symptoms include gas, bloating, diarrhea, cramping, abdominal pain, and vomiting. Any one or more than one, of the symptoms can be measured.
  • a subject can be asked to rate one or more symptoms on a scale of increasing severity from 1 to 5.
  • a set of symptoms is rated, and the ratings are added; for example, gas, bloating, diarrhea, abdominal pain, abdominal distension, vomiting, nausea, or cramping can be rated.
  • a percentage change in one or more symptoms of lactose intolerance can be calculated based on a subject's ratings before and after treatment with a composition or method disclosed herein.
  • the composition is a prebiotic composition.
  • the prebiotic composition comprises GOS.
  • symptoms of lactose intolerance can be considered to be reduced by the a subject's reported decrease in one or more specific symptoms after challenge with a food comprising lactose (e.g., if there is a 50% decrease in symptoms, then symptoms of lactose intolerance are reduced by 50%).
  • a milk challenge test is used to determine if a subject is lactose intolerant.
  • a subject fasts overnight, and then the person drinks a glass of milk in the morning. After drinking the milk, nothing else is eaten or drunk for three to five hours. If a subject experiences one or more symptoms of lactose intolerance within several hours after consuming the milk then the subject is lactose intolerant.
  • a lactose intolerance diagnostic device is used to determine if a subject is lactose intolerant.
  • a diagnostic device is a lactose intolerance diagnostic questionnaire wherein a subject rates the severity of exemplary symptoms of lactose intolerance.
  • the symptoms are rated on a scale of 0 to 5, wherein 0 indicates no symptoms, 1 indicates slight symptoms, 2 indicates mild symptoms, 3 indicates moderate symptoms, 4 indicates moderately severe symptoms, and 5 indicates severe symptoms.
  • the symptoms include abdominal pain/cramps, bloating, flatulence, diarrhea and/or nausea/upset stomach.
  • a questionnaire can be filled out after a lactose challenge.
  • a questionnaire can be filled out after a milk challenge. In another embodiment, a questionnaire can be filled out without a challenge.
  • a single score of 4 or 5 indicates a subject has lactose intolerance. In another embodiment, two or more scores of 3 or greater indicates a subject has lactose intolerance. In another embodiment, a score of 3 or greater for a single symptom at two different timepoints indicates a subject has lactose intolerance. In another embodiment, a change in the average scores over time is used to evaluate the effectiveness of a treatment regimen.
  • a subject is directly tested for lactose intolerance by biopsying the intestinal lining and measuring lactase levels in the lining.
  • Lactose intolerance can also be psychologically induced. There are also many different variations of lactose intolerance depending on the subject. For example, some subjects cannot consume cheese, melted cheese, plain milk, or warm dairy containing products like milk in coffee without experiencing one or more symptoms of lactose intolerance. In another embodiment a subject cannot consume any dairy products without experiencing one or more symptoms of lactose intolerance. In some embodiment a lactose intolerant subject is limited to consuming special "lactose free" foods that have been manufactured to be free of lactose.
  • lactose free foods are: MOCHA MIX® ice cream, TOFUTTI® ice cream and ice cream sandwiches, LACTAID® brand milk, FORMAGGTM cheese, TOFUTTI® “Better than Cream Cheese", and margarine.
  • a subject consumes a lactase tablet to help digest the lactose in milk or a milk product.
  • Each lactase tablet typically hydrolyzes up to 99% of the ingested lactose within 24 hours and is designed to be ingested with the lactose containing food.
  • Other possible techniques for dealing with lactose maldigestion are to use microgranules containing bioactive compounds or microorganisms (see, e.g., U.S. Patent No. 5,952,021, which is herein incorporated by reference in its entirety).
  • the use of an active lactase composition for treatment of lactase deficiency is described in U.S. Patent No. 3,718,739, which is herein incorporated by reference in its entirety.
  • Digestive AdvantageTM Lactose Intolerance Therapy which includes probiotics and digestive enzymes, can also be used for dietary management of lactose maldigestion.
  • a prebiotic composition is used in a method by administering increasing doses of the composition to a subject who is suffering from lactose intolerance, experiencing symptoms of lactose intolerance, or is in need of improving overall gastrointestinal (GI) health.
  • the subject experiences a reduction or elimination of one or more symptoms of lactose intolerance or an improvement in overall gastrointestinal health after administration of the prebiotic composition.
  • the prebiotic composition comprises GOS.
  • a GOS composition can optionally comprise digestible saccharides.
  • a GOS composition is administered in about equal doses over a period of time to a subject with lactose intolerance or symptoms of lactose intolerance, or to a subject in need of improved gastrointestinal health. In one embodiment a GOS composition is administered in increasing doses, for a period of time, to a subject with lactose intolerance or symptoms of lactose intolerance, or to a subject in need of improved gastrointestinal health. In one embodiment a GOS composition is provided in any form suitable for oral consumption, such as by a liquid, tablet, capsule, or powdered form. In one embodiment a subject is treated with just a GOS composition, without supplementation with a probiotic.
  • other substances can be administered in combination with a GOS composition.
  • lactose is simultaneously administered with a GOS composition.
  • lactose is administered before a GOS composition (e.g., before a regimen of increasing doses of a GOS composition begins, or before a dose of a GOS composition during such a regimen).
  • a digestible saccharide is administered after a dose of GOS composition (e.g., after a regimen of increasing doses of GOS compositions begins, or after a dose of GOS compositions during such a regimen).
  • a digestible saccharide can be administered simultaneously with, before, or after the administration of the GOS composition or any combination thereof.
  • a GOS composition is supplemented with one or more other non-digestible saccharides, such as inulin, FOS, lactulose, raffinose, stachyose, or a combination thereof.
  • the GOS composition is supplemented with one or more strains of probiotic bacteria.
  • the GOS composition is supplemented with one or more digestible saccharides, salts, or buffers, e.g., phosphates.
  • a GOS composition is administered in combination with lactase, or with a product containing pre-digested lactose. In another embodiment a GOS composition is administered in an increasing dose, in combination with lactase or with a product containing pre-digested lactose. In another embodiment a GOS composition is administered in an about equal doses over time, in combination with lactase or with a product containing pre- digested lactose.
  • colonic bacteria adapt readily to undigested carbohydrates, such as high purity GOS compositions (e.g. GOS 95), resulting in dramatically improved lactose tolerance.
  • GOS composition is a high percentage composition, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% by weight).
  • GOS promotes the selective growth of beneficial lactose-metabolizing colonic bacteria (multiple species and strains of bifidobacteria and lactobacilli). Bifidobacteria carry out non-hydrogen-producing lactose fermentation reactions in addition to inhibiting hydrogen-producing bacteria, such as E. coli.
  • administration of a composition comprising an indigestible oligosaccharide results in an alteration of colonic bacteria.
  • the colonic bacteria can be from the colonic microbiome.
  • the alteration of the colonic bacteria comprises altering one or more operational taxonomic units (OTUs).
  • OTUs operational taxonomic units
  • administration of an indigestible oligosaccharide composition promotes an increase in the representation of beneficial colonic bacteria.
  • the beneficial bacteria can comprise Lactobacillus species, Faecalibacterium species, Roseburia species, Bifidobacterium species, Coprococcus bacterial species, Dorea bacterial species, or a combination thereof.
  • administration of an indigestible oligosaccharide composition promotes a reduction in gas producing members of the colonic microbiome.
  • the gas producing bacteria can comprise one more Clostridium species or E. coli.
  • administration of an indigestible oligosaccharide promotes an alteration in the fecal or colonic microbiome such that beneficial lactose metabolizing colonic bacteria have increased representation while gas producing bacteria have decreased representation.
  • the indigestible oligosaccharide comprises a GOS.
  • administration of a GOS composition entails dietary adaptation to GOS.
  • the microbiome of the colon is altered by treatment with a GOS composition that comprises GOS and less than 20% digestible saccharides by weight.
  • administration of an indigestible oligosaccharide composition results in an alteration of colonic bacteria for at least 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years after the termination of GOS treatment.
  • administration of an indigestible oligosaccharide composition results in an alteration of one or more OTUs from the colonic microbiome for at least 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years after the termination of GOS treatment.
  • administration of a GOS composition results in an alteration of colonic bacteria for at least 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years after the termination of GOS treatment.
  • administering results in an alteration of one or more OTUs from the colonic microbiome for at least 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years after the termination of GOS treatment.
  • the alteration of the colonic microbiome is determined by conducting a genetic analysis.
  • the genetic analysis comprises performing a terminal restriction fragment length polymorphism analysis on nucleic acid isolated from a sample obtained from the colon.
  • the genetic analysis comprises performing a sequencing reaction on nucleic acid isolated from a sample obtained from the colon.
  • the sample obtained from the colon can be a fecal or stool sample.
  • the nucleic acid can be DNA, RNA, or a combination thereof.
  • the sequencing reaction can comprise pyrosequencing.
  • the sequencing reaction can comprise 16S rRNA sequencing.
  • the sequencing reaction can comprise 16S rRNA pyrosequencing.
  • one or more symptoms of lactose intolerance in a subject exhibiting symptoms of lactose intolerance are decreased or eliminated by administering to the subject a GOS composition for a period of time.
  • the administration comprises increasing the amounts of a GOS composition administered to a subject over time.
  • the administration comprises administering about equal amounts of a GOS composition to a subject over time.
  • a symptom of lactose intolerance remains partially, substantially, or completely eliminated or decreased in severity in a subject for at least about 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years after the termination of treatment.
  • a symptom of lactose intolerance remains partially, substantially, or completely eliminated or decreased in severity in a subject for more than 5 years.
  • a symptom of lactose intolerance is permanently eliminated or decreased in severity in a subject after the termination of treatment.
  • the methods herein decrease symptoms of lactose intolerance in a subject exhibiting symptoms of lactose intolerance by administering to the subject increasing amounts of a GOS composition for a period of time, wherein symptoms of lactose intolerance are substantially eliminated for at least about one month after treatment is terminated.
  • one or more symptoms of poor gastrointestinal health in a subject exhibiting symptoms of poor gastrointestinal health are decreased or eliminated by administering to the subject a composition comprising an indigestible oligosaccharide for a period of time that alters the microbiome of the colon.
  • the indigestible oligosaccharide comprises GOS.
  • the one or more symptoms of poor gastrointestinal health can comprise abdominal pain, bloating, flatulence (gas), diarrhea (loose stools), abdominal cramping, gurgling (bowel sounds), nausea (upset stomach), heartburn, or a combination thereof.
  • the alteration of the colonic micorbiome as a result of administration of a GOS composition causes a symptom of poor gastrointestinal health to remain partially, substantially, or completely eliminated or decreased in severity in a subject for at least about 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years after the termination of treatment.
  • a symptom of poor gastrointestinal health remains partially, substantially, or completely eliminated or decreased in severity in a subject for more than 5 years.
  • a symptom of poor gastrointestinal health is permanently eliminated or decreased in severity in a subject after the termination of treatment.
  • the methods herein decrease symptoms of poor gastrointestinal health in a subject exhibiting symptoms of poor gastrointestinal health by administering to the subject increasing amounts of a GOS composition for a period of time, wherein symptoms of poor gastrointestinal health are substantially eliminated for at least about one month after treatment is terminated.
  • the subject exhibiting one or more symptoms of poor gastrointestinal health has lactose intolerance, Crohn's disease, irritable bowel syndrome, traveler's diarrhea or a combination thereof.
  • one or more symptoms of lactose intolerance in a subject exhibiting symptoms of lactose intolerance are decreased or eliminated by administering to the subject a composition comprising an indigestible oligosaccharide for a period of time that alters the microbiome of the colon.
  • the indigestible oligosaccharide comprises GOS.
  • the one or more symptoms of lactose intolerance can comprise abdominal pain, bloating, flatulence (gas), diarrhea (loose stools), abdominal cramping, gurgling (bowel sounds), nausea (upset stomach), heartburn, or a combination thereof.
  • the alteration of the colonic micorbiome as a result of administration of a GOS composition causes a symptom of lactose intolerance to remain partially, substantially, or completely eliminated or decreased in severity in a subject for at least about 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years after the termination of treatment.
  • a symptom of lactose intolerance remains partially, substantially, or completely eliminated or decreased in severity in a subject for more than 5 years.
  • a symptom of lactose intolerance is permanently eliminated or decreased in severity in a subject after the termination of treatment.
  • the methods herein decrease symptoms of lactose intolerance in a subject exhibiting symptoms of lactose intolerance by administering to the subject increasing amounts of a GOS composition for a period of time, wherein symptoms of lactose intolerance are substantially eliminated for at least about one month after treatment is terminated.
  • a symptom of lactose intolerance in a subject exhibiting symptoms of lactose intolerance is decreased or eliminated by administering to the subject increasing amounts of a prebiotic composition for a period of time, wherein the symptoms of lactose intolerance, measured as described herein, are decreased by an average of about 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, or about 100% when compared to symptoms prior to the administration of a prebiotic composition.
  • An "average" decrease is a decrease as measured in a group of subjects exhibiting symptoms of lactose intolerance, such as more than about 2, 3, 4, 5, 10, 20, or 30 subjects.
  • the decrease in or elimination of a symptom of lactose intolerance persists for at least about 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, 6 months, 9 months, one year, 18 months, two years, three years, four years, or five years.
  • a symptom of lactose intolerance remains partially, substantially, or completely eliminated or decreased in severity in a subject for more than 5 years after the termination of treatment.
  • the decrease or elimination of a symptom is permanent.
  • the present disclosure provides for a method of decreasing symptoms of lactose intolerance in a subject exhibiting symptoms of lactose intolerance by administering to the subject increasing amounts of a prebiotic composition for a period of time, wherein one or more symptoms of lactose intolerance, measured as described herein, are decreased by an average of at least about 20% and remain decreased by at least about 20% for at least about one month after treatment is terminated.
  • the methods herein decrease symptoms of lactose intolerance in a subject exhibiting symptoms of lactose intolerance by administering to the subject increasing amounts of a prebiotic composition for a period of time, wherein one or more symptoms of lactose intolerance, measured as described herein, are decreased by an average of about least about 50% and remain decreased by at least about 50% for at least about one month after treatment is terminated.
  • the methods herein decrease symptoms of lactose intolerance in a subject exhibiting symptoms of lactose intolerance by administering to the subject increasing amounts of a prebiotic composition for a period of time, wherein one or more symptoms of lactose intolerance, measured as described herein, are decreased by an average of about least about 75% and remain decreased by at least about 75% for at least about one month after treatment is terminated.
  • the total duration of treatment of lactose intolerance can be from about one week to about 12 weeks, or about four weeks to about ten weeks, or about four weeks to about eight weeks, or about six weeks.
  • the subject is started on a program of taking increasing amounts of a prebiotic composition described herein (such as a composition comprising or consisting essentially of GOS), optionally along with ingestion of lactose containing food products.
  • a prebiotic composition can also be administered in combination with another substance (such as a probiotic), as described herein.
  • the total duration of treatment is about 5 days to about 35 days.
  • the total duration of treatment is about 7 days to about 90 days, or about 7 days to about 60 days, or about 14 days to about 50 days, or about 14 days to about 40 days, or about 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, or 60 days.
  • the total duration of treatment is about 30 days.
  • the total duration of treatment is about 34 days.
  • the total duration of treatment is about 36 days.
  • the total duration of treatment is about 38 days.
  • the total duration of treatment is about 42 days.
  • the total duration of treatment is about 60 days.
  • the total duration of treatment is about 90 days.
  • the total duration of treatment is based on a subject's response to the treatment. For example, an individual can experience a reduction in lactose intolerance symptoms after 14 days of treatment with a prebiotic composition. In another example an individual can experience a reduction in lactose intolerance symptoms after 30 days of treatment with a prebiotic composition.
  • the duration of treatment is determined by an individual subject's response to a prebiotic composition and the onset of relief from one or more lactose intolerance symptoms.
  • the treatment is continuous.
  • the duration of the treatment is based on a subject's symptoms of lactose intolerance.
  • a subject can experience symptoms at a given dose of a prebiotic composition (e.g., a composition comprising or consisting essentially of GOS), and can require that the subject stay at that dose, or a lower dose, until symptoms subside.
  • the duration of the treatment is not determined at the outset, but continues until the maximum dose of a prebiotic composition (such as a composition comprising or consisting essentially of GOS), is achieved per day, or until the desired level of lactose tolerance is achieved.
  • the maximum amount of prebiotic composition (e.g., a composition comprising or consisting essentially of GOS), administered per day is between 0.4 g and 20 g, such as about 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16, 16.5, 17, 17.5, 18, 18.5, 19, 19.5, or 20 g per day.
  • a dose can be about 0.4 g to 6 g.
  • a subject can be given one dose for a period of time during a treatment regimen and a second dose during a second period of time during the treatment regimen.
  • a subject can be administered one dose of prebiotic composition for a one or two week period and a second dose for a subsequent one or two week period.
  • the prebiotic composition comprises GOS.
  • an increasing dosage of a prebiotic composition can be achieved by increasing the number of doses per day of the composition administered, increasing the amount of a prebiotic composition administered per dose, or both. In one embodiment, both strategies are used.
  • a prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • the first dose of a prebiotic composition can be administered at a constant dose while the second dose can be administered in increasing doses, for a pre-determined number of days.
  • the prebiotic composition comprises GOS.
  • the dose can be administered to a subject at a frequency of once per day, twice per day, or three times per day.
  • the number of days of administration can last for a period of about 1 to 90 days, such as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, or 90 days.
  • 1 to 90 days such as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40,
  • a prebiotic composition can be administered twice per day.
  • the first dose of the prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • the prebiotic composition can be administered an average of about once per day, twice per day, three, four, five, six, or more than six timer per day, or any combination thereof.
  • the prebiotic composition can be administered for a period of about 1 to 90 days, such as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, or 90 days.
  • days such as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42,
  • the prebiotic composition is administered at the same dosage level at each administration.
  • a prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • GOS a prebiotic composition
  • the prebiotic composition can be administered for a period of about 1 to 90 days, such as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, or 90 days.
  • days such as 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42,
  • a subject who has completed a treatment regimen consumes dairy products at least once every 4-5 days in order to maintain the reduction in symptoms of lactose intolerance.
  • a subject self-administers a prebiotic composition (e.g., a composition comprising or consisting essentially of GOS).
  • a prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • the prebiotic composition is supplied or recommended by a health professional, e.g., a dietician, nutritionist, nurse, physician, or other qualified health professional.
  • the prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • a prebiotic composition is labeled as a medical food.
  • a subject in need thereof can repeat courses of treatment with a prebiotic composition.
  • the course of treatment can be repeated when symptoms of lactose intolerance reappear or increase to an undesirable level.
  • the course of treatment can be repeated at regular or predetermined intervals.
  • treatment can be repeated after about one month, two months, three months, four months, six months, eight months, ten months, one year, 18 months, two years, three years, four years, five years, or more than five years, or any combination thereof (e.g., treatment can be repeated after one year, then every two to five years thereafter).
  • the treatment can be repeated in the same form (e.g., duration, dosage, timing of dosage, additional substances, etc.) as used in the first treatment or it can be modified.
  • treatment duration can be shortened or lengthened, dosage can be increased more quickly or slowly or a higher or lower starting dose of a prebiotic composition
  • a different prebiotic composition such as a composition comprising inulin, FOS, lactulose, raffinose, stachyose or combinations thereof
  • an initial dose of a prebiotic composition is administered to a subject in need thereof as part of a dosing regimen with incremental increases in the dosage of the prebiotic composition over time.
  • the incremental increases in a prebiotic composition dosage can be any suitable dose size.
  • the starting dose of a prebiotic composition is about 0.05 g to 4.0 g, or about 0.1 g to about 3 g, or about 0.2 g to about 3.0 g, or about 0.2 g to about 2 g, or about 0.4 g to about 1.6 g, or about 0.4 g to about 1.4 g, or about 0.6 g to about 1.2 g, or about 0.6 g to about 1.0 g, or about 0.7 g to about 0.9 g, or about 0.8 g.
  • the starting dose of a prebiotic composition is about 0.2 g to about 4.7 g, about 0.5 g to about 8.0 g, or about 0.4 g to about 6.8 g.
  • the incremental increase in prebiotic or GOS composition dosage can vary, or each increase can be the same, or any combination thereof.
  • an amount of a prebiotic composition administered to a subject in need thereof can be increased incrementally by about 0.05 g to 4.0 g, or about 0.1 g to about 3 g, or about 0.2 g to about 3.0 g, or about 0.2 g to about 2 g, or about 0.4 g to about 1.6 g, or about 0.4 g to about 1.4 g, or about 0.6 g to about 1.2 g, or about 0.6 g to about 1.0 g, or about 0.7 g to about 0.9 g, or about 0.8 g.
  • an amount of a prebiotic composition administered to a subject in need thereof can be increased incrementally by about 0.5 g, about 0.29 g, about 0.30 g, or about 0.42 g, about 0.43 g. In another embodiment, an amount of a prebiotic composition administered to a subject in need thereof can be increased incrementally by 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, or 1 g per dose.
  • the maximum dose reached in treatment can be any suitable dose size, depending on the subject being treated and the outcome desired.
  • the maximum dose of a prebiotic composition administered in a single dose can be about 1 g to about 2 g, about 3 g to about 4 g, about 5 g to about 6 g, about 6 g to about 60 g, or about 12 g to about 48 g, or about 14g to about 36 g, or about 16g to about 36 g, or about 18g to about 34 g, or about 20 g to about 32 g, or about 22 g to about 30 g, or about 23 g to about 29 g, or about 24 g to about 28 g, or about 25 to about 27 g, or about 25.5 g to about 26.5 g, or about 25.5 g, 25.6 g, or 25.7 g per dose. In one embodiment the maximum dose of prebiotic composition administered is about 12 g per dose.
  • an initial dose of prebiotic composition is about 0.4 g, and the dose is increased by 0.4 g over time, for example, daily, until a maximum dose of 20 g to 25 g of a prebiotic composition is reached.
  • the initial dose of a prebiotic composition is about 0.5 g, and the dose is increased by 0.5 g over time, for example, daily, until a maximum of 8.0 g to 15 g of prebiotic composition per day is reached.
  • the doses of a high purity GOS composition are gradually increased over 35 days beginning with 1.5 gm/day and increasing to 15 gm/day (7.5 gm twice daily).
  • the GOS composition is a high percentage composition, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% by weight).
  • a prebiotic composition can be administered in any suitable form, such as a powder, capsules, tablets, a powder that can be dissolved in a liquid prior to consumption, or in liquid form, (e.g., GOS pre-dissolved in a liquid). Any grade or form of prebiotics that is suitable for consumption by the subject being treated, e.g., by a human, can be used.
  • a prebiotic composition comprising GOS can be distributed in a syrup form.
  • a GOS syrup can be diluted with water prior to ingestion.
  • a GOS syrup can be administered with a meal.
  • a GOS composition is administered to a subject in one or more capsules.
  • the one or more capsules are 000, 00 or 0 size capsules.
  • the subject is administered the one or more capsules at least twice a day.
  • the subject is administered the one or more capsules for two or more days.
  • the subject is administered more capsules on the last day than on the first day.
  • the subject is administered the same number of capsules on the last day as on the first day.
  • Additional substances can be given in conjunction with a prebiotic composition or GOS composition. These substances can enhance the action of the increasing doses of prebiotic by, e.g., encouraging the growth of bacteria in the gut that alleviate symptoms of lactose intolerance, increasing adhesion of probiotic or beneficial commensal bacteria, or allowing doses of probiotic bacteria to more readily pass through the stomach without being destroyed. These substances can be given prior to treatment with prebiotic, during treatment with prebiotic, after treatment with prebiotic, or any combination thereof. If administered during prebiotic treatment, they can be administered with the dose of prebiotic being given, or before or after the dose of prebiotic, or any combination thereof.
  • substances are provided for use in conjunction with a prebiotic composition include a probiotic microbe(s), lactase or other lactose digestive enzymes, or buffers (such as phosphates).
  • a prebiotic composition is administered in conjunction with live bacteria.
  • a prebiotic composition is administered in conjunction with lactase or other lactose digestive enzymes.
  • a prebiotic composition is administered in conjunction with a buffer (e.g., phosphates).
  • a prebiotic composition e.g., GOS
  • a prebiotic composition comprises trace amounts of digestible saccharides, such as lactose, glucose or galactose.
  • the trace amounts of digestible saccharides make up 5% by weight (such as 4%, 3%, 2%, 1%, 0.5%, or 0.1%) or less of the prebiotic composition.
  • the trace amounts of digestible saccharides make up about 20% by weight (such as about 20%, 19%, 18%, 17%, 16%, 15%, 14%, 13%, 12%, 11%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, or 0.1%) or less of the prebiotic composition.
  • a high purity GOS composition (e.g., GOS 95) is used.
  • the dose of GOS 95 is from 1.5 g to 12 g/day (6 g BID).
  • the GOS composition is a high percentage composition, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% GOS by weight).
  • the dose of a high purity GOS composition is administered for 15 days or 30 days.
  • a high percentage GOS composition is administered at escalating dosages for 15 or 30 days.
  • a therapeutic dose of a high purity GOS composition is based on human exposure-response relationship and pharmacokinetics.
  • the starting dose for a high percentage GOS composition has a low potential for undesirable GI adverse effects.
  • a dosing regimen for a high purity GOS composition results in a steady-state exposure of the gut to GOS facilitating optimal gut microflora re-population.
  • the doses of GOS are gradually increased over 30 days or at a more rapid rate over 15 days beginning with 1.5 g - 3 g/day and increasing to 12 g/day (6 g BID); doses are in liquid form and are mixed with water and taken as directed by the dosing scheme.
  • GOS is administered for about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59 or 60 days.
  • GOS is administered for about 15 days.
  • GOS is administered for 30 days.
  • GOS is administered for 35 days.
  • GOS is administered for about 1-60 days about 1-30 days, about 5-25 days, about 10-20 days, or about 12 to 18 days.
  • the prebiotic comprises GOS.
  • the percent of GOS in the prebiotic composition can be about 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% GOS.
  • the percent of GOS in the prebiotic composition can be about 90-100%, about 95- 100%, about 96-100%, about 97-100%, about 98-100%, or about 99 to 100%.
  • the prebiotic composition comprises at least about 95% GOS.
  • the prebiotic composition comprises at least about 96% GOS.
  • the prebiotic composition comprises at least about 96.8% GOS.
  • the prebiotic composition is GOS 95.
  • the number of days the doses of prebiotic composition comprising GOS can be gradually increased can be about 2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100 days.
  • the number of days the doses of prebiotic composition can be gradually increased can be about 2-30 days, about 2-38 days, about 10-20 days, about 20-100 days, about 20-50 days, about 20-40 days, or about 20-30 days.
  • the number of days the doses of prebiotic composition can be increased at can be about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, or 19 days, or about 1-20 days, about 1-15 days, or about 10-20 days.
  • the beginning dose of prebiotic composition can about 1.5 g/day to 3 g/day, about 0.1 g/day to 20 g/day, about 0.1 g/day to 15 g/day, or about 0.1 g/day to 10 g/day.
  • the beginning dose of prebiotic composition can be about 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, orlO g/day.
  • the dose of prebiotic composition can be increased to about 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 13, 13.5, 14, 14.5, 15, 15.5, 16, 16.5, 17, 17.5, 18, 18.5, 19, 19.5, 20, 20.5, 21, 21.5, 22, 22.5, 23, 23.5, or 24 g/day.
  • the dose of prebiotic can be increased to about 2-24, 5-20, 7-18, or 10-15 g/day.
  • the prebiotic composition can be administered once a day, twice a day, three times a day, four times a day, five times a day, or six times a day.
  • the prebiotic composition comprising GOS is GOS 95. Examples of GOS 95 dosages are shown in Table 9.
  • the subject to whom the prebiotic composition can be administered can include, for example, a human, for example, a preterm newborn, a full term newborn, an infant up to one year of age, young children (e.g., 1 yr to 12 yrs), teenagers, (e.g., 13-19 yrs), adults (e.g., 20-64 yrs), pregnant women, and elderly adults (65 yrs and older).
  • a human for example, a preterm newborn, a full term newborn, an infant up to one year of age, young children (e.g., 1 yr to 12 yrs), teenagers, (e.g., 13-19 yrs), adults (e.g., 20-64 yrs), pregnant women, and elderly adults (65 yrs and older).
  • the age of the subject can be about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, or 110 years.
  • the prebiotic composition is comprises a high percentgate of GOS, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% GOS by weight). In one embodiment, the prebiotic composition is GOS 95.
  • the subject to whom the prebiotic composition can be administered can be a pediatric subject aged birth up to the 16 th birthday.
  • the pediatric subject can be from any of the recognized pediatric age categories.
  • the subject can be a neonate, aged 0-1 months; an infant, aged 1 month to 2 years; a child, aged 2 to 12 years; or an adolescent, aged 12 to 16 years.
  • the pediatric subject is administered a liquid formulation of the prebiotic composition, for example a GOS composition.
  • the pediatric subject is administered a GOS composition in a capsule or tablet.
  • the prebiotic composition is comprises a high percentgate of GOS, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% GOS by weight).
  • the dose of the GOS composition (e.g. GOS 95)is gradually increased over 15 days or at a slower rate over 30 days beginning with 1.5 - 3 g/day and increasing to 12 g/day (6g BID) to reach the corresponding level of lactose per day in approximately 24 ounces of milk.
  • This level of 24 ounces of milk was chosen to develop tolerance to a total of three servings of dairy per day, the recommended level in the US Dietary Guidelines to meet calcium and other nutrient needs.
  • subjects who are lactose intolerant and treated with GOS 95 develop tolerance.
  • developing tolerance is from gradually increasing the dose of GOS 95.
  • the prebiotic composition is comprises a high percentgate of GOS, such as about 90% or greater (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% GOS).
  • a high perecentage GOS composition e.g.
  • GOS 95 is administered over a 35 day period to improve lactose metabolism via the adaptation of intestinal bacterial metabolism in subjects who are lactose intolerant.
  • the dose of the high perecentage GOS composition can be gradually increased over 35 days, beginning with 1.5 g/day and increasing to 15 g/day (7.5g/dose, twice per day).
  • the dose of the high perecentage GOS composition can be 1.5g/day for days 1-5, 3 g/day for days 6-10, 6 g/day for days 11-15, 7.5 g/day (a 1.5 g dose and a 6.0 g dose) for days 16-20, 9 g/day (a 3.0 g dose and a 6.0 g dose) for days 21-25, 12 g/day (two 6.0 g doses) for days 26-30, and 15 g/day (two 7.5 g doses) for days 31-35.
  • an improvement in lactose tolerance would be expected to last for at least 30 days after cessation of treatment.
  • the high perecentage GOS composition comprises about 90% or more GOS (e.g., about 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% GOS).
  • a subject undergoes a booster program after completion of the primary treatment program, which comprises administering a prebiotic composition comprising GOS to a subject.
  • the length of a booster program can be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 days, or more.
  • the dose of the prebiotic composition comprising GOS e.g.
  • GOS 95, etc.) administered during the booster program can be about 0.5 g, 1 g, 1.5 g, 2 g, 2.5 g, 3 g, 3.5 g, 4 g, 4.5 g, 5 g, 5.5 g, 6 g, 6.5 g, 7 g, 7.5 g, 8 g, 8.5 g, 9 g, 9.5 g, 10 g, 10.5 g, 11 g, 11.5 g, 12 g, 12.5 g, 13 g, 13.5 g, 14 g, 14.5 g, 15 g, or more.
  • the same dose of the prebiotic composition comprising GOS e.g. GOS 95.
  • the same dose of the prebiotic composition comprising GOS is administered each day of a booster program.
  • a larger dose of the prebiotic composition comprising GOS is administered on the final day of a booster program than is administered on the first day.
  • the length of a booster program can be 10 days.
  • about 3 g of the prebiotic composition comprising GOS is administered on days 1 - 5 of a booster program and about 6 g of the prebiotic composition comprising GOS (e.g. GOS 95) is administered on days 6 - 10 of a booster program.
  • the prebiotic composition comprising GOS is administered in a dosing unit, for example a gelatin capsule.
  • the number of gelatin capsules administered each day of a booster program can be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, or more.
  • a prebiotic composition can be administered 1, 2, 3, 4, 5 or more times a day during a booster program.
  • a prebiotic composition e.g. a GOS composition
  • the prebiotic composition comprising GOS e.g. GOS 95
  • the prebiotic composition comprising GOS is administered once per day for days 1 - 5 of a booster program and twice per day for days 6 - 10 of a booster program.
  • a subject has a psychological aversion to the consumption of dairy products.
  • the subject's psychological aversion is caused by the experience of one or more symptoms of lactose intolerance when the subject consumes a dairy product.
  • a subject has a psychological aversion to a dairy product because the subject is aware the dairy product contains lactose.
  • a subject has a psychological aversion to a dairy product because the subject is aware the dairy product contains lactose, and the subject previously personally experienced one or more symptoms of lactose intolerance when the subject consumed the dairy product.
  • a subject has a psychological aversion to a dairy product because the subject is aware the dairy product contains lactose, and the subject is aware that a genetically related person previously experienced one or more symptoms of lactose intolerance when the genetically related person consumed the dairy product.
  • a method of treating psychological aversion of a subject to intake of dairy products comprising administering a prebiotic composition to said subject.
  • the prebiotic composition comprises, consists essentially of, or consists of GOS.
  • the prebiotic composition comprises a high perecentage of GOS.
  • the prebiotic composition comprises, consists essentially of, or consists of GOS and one or more probiotics.
  • a subject does not have a psychological aversion to ingesting or consuming a prebiotic composition.
  • a subject does not have a psychological aversion to ingesting or consuming GOS.
  • a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising, consisting essentially of, or consisting of a prebiotic composition to modulate the psychological aversion to dairy products.
  • a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising, consisting essentially of, or consisting of GOS to modulate the psychological aversion to dairy products.
  • a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising, consisting essentially of, or consisting of GOS and a probiotic to modulate the psychological aversion to dairy products.
  • the modulation is a decrease in psychological aversion of the subject to dairy products.
  • the modulation of the psychological aversion can result in an increase in consumption of dairy products by the subject. In another embodiment, modulation of the psychological aversion can result in increased blood calcium levels or bone density in the subject.
  • the subject is a preterm newborn, a full term newborn, an infant up to one year of age, a young child (e.g., 1 yr to 12 yrs), a teenager, (e.g., 13-19 yrs), an adult (e.g., 20-64 yrs), an elderly adult (65 yrs and older), a pregnant women, a man or a woman.
  • the subject is at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 1060, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116,
  • the subject is an elderly adult. In another embodiment, the subject has osteoporosis. In another embodiment, the subject has low bone density. In another embodiment, the subject is an elderly adult who has osteoporosis. In another embodiment, the subject is a woman over the age of about 30, 40, 50, 60, 70, 80, 90, 100, 110, or 120 years old. In another embodiment, the woman is a postmenopausal woman. In another embodiment a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising GOS, which modulates the subject's aversion to psychological aversion to dairy products.
  • GOS GOS
  • a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising GOS, which reduces the subject's aversion to psychological aversion to dairy products.
  • a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising GOS, which inhibits the subject's aversion to psychological aversion to dairy products.
  • an a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising GOS, which modulates the subject's aversion to psychological aversion to dairy products by decreasing one or more symptom's of lactose intolerance.
  • an a subject with a psychological aversion to dairy products is administered a therapeutic composition comprising GOS, which modulates the subject's aversion to psychological aversion to dairy products by decreasing one or more symptom's of lactose intolerance and leading to increased consumption of dairy products by the subject.
  • GOS glycosylcholine
  • increased consumption of dairy products by the subject results in increased calcium consumption by the subject.
  • increased consumption of dairy products by the subject results increases the bone density of the subject.
  • a subject that has one or more symptoms of lactose intolerance and/or a psychological aversion to dairy products restricts his or her diet, which can result in a nutrition shortage and/or disease.
  • Milk and other lactose containing dairy products are a source of nutrients in the American diet, including protein, calcium, riboflavin, vitamin A, and vitamin D.
  • Studies have linked a sufficient daily intake of calcium and vitamin D with reduced incidence of type 2 diabetes. Intake recommendations for calcium are provided in the Dietary Reference Intakes (DRIs) which were developed by the Food and Nutrition Board at the Institute of Medicine for the National Academys.
  • DRIs Dietary Reference Intakes
  • hypocalcaemia is the presence of low serum calcium levels in the blood. Long term hypocalcaemia can result in bone loss, osteoporosis, hypertension, and/or weak bone density. Other symptoms of hypocalcaemia include petechia; oral, perioral, and acral parasthesias; carpopedal and generalized tetany; largent tetany; hyperactive tendon reflexes; laryngospasm; and cardiac arrhythmias.
  • Petechiae are small red or purple spots on the body caused by a minor hemorrhage (i.e. broken capillary blood vessels. Paresthesias are a tingling sensation, often in the mouth, lips and extremities of the hands and feet. Tetany is the involuntary contraction of muscles, which can be caused by the inability of muscle fibers to depolarize due to low calcium levels in the blood. Laryngospasms are particularly dangerous form of tetany where the contraction of laryngeal cords can result in a partial blockage of the breathing canal.
  • Cardiac arrhythmia which is caused by abnormal electrical activity in the heart, encompasses any abnormal heart beat pattern. The heart beat may be too fast, too slow, or irregularly timed. Long QT syndrome is an arrhythmia that can be acquired due to hypocalcaemia.
  • a subject that restricts his or her intake of dairy products because of lactose intolerance or psychological aversion to dairy products is administered a therapeutic composition comprising, consisting essentially of, or consisting of a prebiotic composition to modulate the restriction of dairy products.
  • a subject that restricts his or her intake of dairy products because of lactose intolerance or psychological aversion to dairy products is administered a therapeutic composition comprising, consisting essentially of, or consisting of a GOS to modulate the restriction of dairy products.
  • a subject that restricts his or her intake of dairy products because of lactose intolerance or psychological aversion to dairy products is administered a therapeutic composition comprising, consisting essentially of, or consisting of a GOS and one or more probiotics to modulate restriction of dairy products.
  • the modulation comprises an increase in consumption of dairy products.
  • the subject is a preterm newborn, a full term newborn, an infant up to one year of age, a young child (e.g., 1 yr to 12 yrs), a teenager, (e.g., 13-19 yrs), an adult (e.g., 20-64 yrs), an elderly adult (65 yrs and older) a pregnant women, a man or a woman.
  • a young child e.g., 1 yr to 12 yrs
  • a teenager e.g., 13-19 yrs
  • an adult e.g., 20-64 yrs
  • an elderly adult e.g., 65 yrs and older
  • the subject is at least 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105, 1060, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116,
  • the subject is an elderly adult. In another embodiment, the subject has osteoporosis. In another embodiment, the subject has low bone density. In another embodiment, the subject is an elderly adult who has osteoporosis. In another embodiment, the subject is a woman over the age of about 30, 40, 50, 60, 70, 80, 90, 100, 110, or 120 years old. In another embodiment, the woman is a postmenopausal woman. In another embodiment, the subject is a woman with osteoporosis over the age of about 30, 40, 50, 60, 70, 80, 90, 100, 110, or 120 years old. In another embodiment, the woman is postmenopausal.
  • Osteoporosis is a condition in which the bone mineral density (BMD) is reduced in a subject.
  • Bone density can be determined using, e.g., dual energy X-ray absorptiometry (DXA or DEXA), ultrasound, quantitative computerized tomography (CT) scanning, or single-photon absorptiometry.
  • DXA or DEXA dual energy X-ray absorptiometry
  • CT quantitative computerized tomography
  • Bones in a subject with osteoporosis can become brittle; mild stresses, such as coughing, or falls, can result in a bone fracture. A man or a woman can have osteoporosis.
  • a person with low bone density or osteoporosis comprises a postmenopausal woman with at least one risk factor for osteoporosis, a woman older than 65 years old, a man over 70 years old, a man between the age of 50 to 70 who has at least one osteoporosis risk factor, a woman who experienced early menopause, a postmenopausal woman who has recently stopped taking hormone therapy, a person older than 50 with a history of a broken bone, or a person who takes medications, such as prednisone, aromatase inhibitors, or anti-seizure drugs, that are associated with osteoporosis (see, e.g., www.mayoclinic.com/health/osteoporosis/DS00128).
  • Risk factors for osteoporosis can include, e.g., low calcium intake, tobacco use, eating disorders (e.g., anorexia nervosa or bulimia), sedentary lifestyle (e.g., lack of walking, running, jumping, dancing, and weightlifting), excessive alcohol consumption, long-term use of corticosteroid medications (e.g., prednisone, cortisone, prednisolone and dexamethasone), long-term use of aromatase inhibitors, selective serotonin reuptake inhibitors (SSRIs), methotrexate, some anti-seizure medications, proton- pump inhibitors, or aluminum containing antacids.
  • corticosteroid medications e.g., prednisone, cortisone, prednisolone and dexamethasone
  • aromatase inhibitors e.g., prednisone, cortisone, prednisolone and dex
  • Some medications have been associated with an increased risk of osteoporosis, including, e.g., barbiturates, L-thyroxine over-replacement, depot preogesterone, gonadotropin-releasing hormone agonist, anticoagulants (e.g., warfarin), thiazolidinediones (e.g., rosiglitazone, inhibitors of PPARy), and chronic lithium therapy.
  • barbiturates e.g., barbiturates, L-thyroxine over-replacement, depot preogesterone, gonadotropin-releasing hormone agonist, anticoagulants (e.g., warfarin), thiazolidinediones (e.g., rosiglitazone, inhibitors of PPARy), and chronic lithium therapy.
  • a hypogonadal state e.g., Kallmann syndrome, Klinefelter syndrome, Turner syndrome, anorexia nervosa, andropause, hyperprolactinemia, hypothalamic amenorrhea, bilateral oophorectomy (surgical removal of the ovaries), premature ovarian failure, or testosterone deficiency (e.g., andropause or after surgical removal of the testes) can cause secondary osteoporosis.
  • a hypogonadal state e.g., Kallmann syndrome, Klinefelter syndrome, Turner syndrome, anorexia nervosa, andropause
  • hyperprolactinemia e.g., hypothalamic amenorrhea
  • bilateral oophorectomy surgical removal of the ovaries
  • premature ovarian failure e.g., andropause or after surgical removal of the testes
  • testosterone deficiency e.g., andropause or after surgical removal of the testes
  • Endocrine disorders that can induce bone loss include, e.g., acromegaly, adrenal insufficiency, Cushing's syndrome, diabetes mellitus type 1 and 2, hyperparathyroidism, hypothyroidism, and thyrotoxicosis. Reversible bone loss can also occur during lactation and pregnancy.
  • Nutritional and gastrointestinal disorders that can predispose a subject to osteoporosis include, e.g., coeliac disease, Crohn's disease, lactose intolerance, severe liver disease (e.g., primary biliary cirrhosis), and surgery (e.g., after gastrectomy, intestinal bypass surgery, or bowel resection).
  • a subject with an adequate calcium intake can develop osteoporosis due to the inability to absorb calcium and/or vitamin D.
  • rheumatologic disorders e.g., rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, and polyarticular juvenile idiopathic arthritis are at increased risk of osteoporosis, e.g., as part of their disease or because of other risk factors (e.g., corticosteroid therapy).
  • Systemic diseases such as amyloidosis and sarcoidosis can also lead to osteoporosis. Renal insufficiency can lead to osteodystrophy.
  • Hematologic disorders linked to osteoporosis can include, e.g., hemophilia, lymphoma, leukemia, mastocytosis, multiple myeloma, other monoclonal gammopathies, sickle-cell disease and thalassemia.
  • Inherited disorders linked to osteoporosis include, e.g., Ehlers-Danlos syndrome, epidermolysis bullosa, Gaucher's disease, glycogen storage diseases, hemochromatosis, hypophosphatasia, homocystinuria, osteogenesis imperfecta, Marfan syndrome, Menkes' syndrome, and porphyria, [0319]
  • a subject with scoliosis can have a higher risk of osteoporosis.
  • Bone loss can be a feature of complex regional pain syndrome. Accelerated bone loss can be found in subjects with Parkinson's disease and chronic obstructive pulmonary disease.
  • a person that has one or more symptoms of lactose intolerance and/or a psychological aversion to dairy products and who has low bone density, osteoporosis, a sign or symptom of osteoporosis, or a risk factor for osteoporosis is administered a therapeutic composition comprising, consisting essentially of, or consisting of a prebiotic composition to modulate restriction of dairy products.
  • a person that has one or more symptoms of lactose intolerance and/or a psychological aversion to dairy products and who has low bone density, osteoporosis, a sign or symptom of osteoporosis, or a risk factor for osteoporosis is administered a therapeutic composition comprising, consisting essentially of, or consisting of a GOS to modulate restriction of dairy products.
  • a person that has one or more symptoms of lactose intolerance and/or a psychological aversion to dairy products and who has low bone density, osteoporosis, a sign or symptom of osteoporosis, or a risk factor for osteoporosis is administered a therapeutic composition comprising, consisting essentially of, or consisting of a GOS and a probiotic to modulate the restriction of dairy products.
  • the modulation of restriction of dairy products comprises an increase in dairy product consumption.
  • Medications that can help slow bone loss and/or maintain bone mass include, for example, antiresorptive agents (e.g., bisphosphonates (e.g., alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel) and zoledronic acid (Reclast), estrogen analogs, selective estrogen receptor modulators (SERMS) (e.g., raloxifene (Evista)), and calcitonin).
  • Medications that can help slow bone loss and/or maintain bone mass include, for example, bone anabolic agents, e.g., teriparatide (Forteo), calcium salts, and sodium fluoride.
  • Medications that can help slow bone loss and/or maintain bone mass include, for example, RANKL inhibitors (e.g., denosumab), strontium ranelate, calcium, and vitamin D.
  • Hormone therapy, exercise, and physical therapy can be used to help slow bone loss and maintain bone mass.
  • a person with lactose intolerance and who has low bone density, osteoporosis, a sign or symptom of osteoporosis, or a risk factor for osteoporosis can be administered a therapeutic composition comprising, consisting essentially of, or consisting of a prebiotic composition to modulate restriction of dairy products, and one more or medications to slow bone loss and/or maintain bone mass comprising an antiresorptive agent or bone anabolic agent.
  • the prebiotic composition comprises GOS.
  • the prebiotic composition comprises GOS and further comprises a probiotic.
  • a person with lactose intolerance and who has low bone density, osteoporosis, a sign or symptom of osteoporosis, or a risk factor for osteoporosis is administered a therapeutic composition comprising, consisting essentially of, or consisting of a prebiotic composition to modulate restriction of dairy products, and can undergo hormone therapy, exercise, or physical therapy to slow bone loss and/or maintain bone mass.
  • the prebiotic composition comprises GOS.
  • the prebiotic composition comprises GOS and further comprises a probiotic.
  • a person with lactose intolerance and who has low bone density, osteoporosis, a sign or symptom of osteoporosis, or a risk factor for osteoporosis is administered a therapeutic composition comprising, consisting essentially of, or consisting of a prebiotic composition to modulate restriction of dairy products, and can undergo hormone therapy, exercise, or physical therapy and/or be administered one or more medications to slow bone loss and/or maintain bone mass.
  • the prebiotic composition comprises GOS.
  • the prebiotic composition comprises GOS and further comprises a probiotic.
  • LQT Long QT syndrome
  • TDP torsade de pointes
  • Treatment for LQT involves two options: arrhythmia prevention and arrhythmia termination.
  • Beta blockers decreases the risk of stress induced arrhythmias and are a common treatment for LQT.
  • Implantable cardioverter-defibrillators ICD can be used in conjunction with blocker treatment as a method of terminating arrhythmias when they occur.
  • a person with lactose intolerance and who has long QT syndrome is administered a therapeutic composition comprising, consisting essentially of, or consisting of a prebiotic composition to modulate restriction of dairy products and can be treated by beta blockers to prevent episodes of arrhythmia and/or implanted with an ICD to terminate or decrease the duration of TDP episodes.
  • treatment with a prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • a probiotic composition optionally in conjunction with a probiotic composition, one or more digestible saccharides, a buffer, or a combination thereof
  • Any suitable treatment for the reduction of symptoms of lactose intolerance can be used, e.g., the use of lactase.
  • lactase is administered before, during, or after treatment with a prebiotic composition, or any combination thereof.
  • lactase is administered after prebiotic treatment is terminated. The lactase is used on an as-needed basis.
  • a subject to be treated for one or more symptoms of lactose intolerance is a human.
  • the human subject is a preterm newborn, a full term newborn, an infant up to one year of age, a young child (e.g., 1 yr to 12 yrs), a teenager, (e.g., 13-19 yrs), an adult (e.g., 20-64 yrs), a pregnant women, an elderly adult (65 yrs and older), a male or a female.
  • a subject experiencing one or more symptoms of lactose intolerance is diagnosed with a lactose intolerance diagnostic device or test prior to or concurrently with the beginning of a treatment regimen.
  • a test for lactose intolerance is a hydrogen breath test. In the hydrogen breath test, the breath is measured to determine the amount of hydrogen produced after consuming a measured amount of lactose.
  • the amount of lactose consumed can be about 1 g, 2 g, 3 g, 4 g, 5 g, 6 g, 7 g, 8 g, 9 g, 10 g, 11 g, 12 g, 13 g, 14 g, 15 g, 16 g, 17 g, 18 g, 19 g, 20 g, 21 g, 22 g, 23 g, 24 g, 25 g, 26 g, 27 g, 28 g, 29 g, 30 g, 31 g, 32 g, 33 g, 34 g, 35 g, 36 g, 37 g, 38 g, 39 g, 40 g, or more. In one embodiment, the amount of lactose consumed is about 15g.
  • the lactose is administered by drinking a lactose mixture, and the subject exhales into a vacuum- sealed collection tube at three one hour time intervals.
  • a high level of hydrogen in the breath indicates an improper digestion of lactose.
  • an increase in hydrogen breath of 12 ppm can indicate a subject has lactose intolerance. In another embodiment, an increase in hydrogen breath of 15 ppm can indicate a subject has lactose intolerance. In one embodiment, an increase in hydrogen breath of greater than 20 ppm indicates a subject has lactose intolerance. In another embodiment, a lactose intolerance diagnostic device is a lactose intolerance diagnostic questionnaire wherein a subject rates the severity of exemplary symptoms of lactose intolerance. In one embodiment, the symptoms are rated on a scale of 0 to 5, wherein 0 indicates no symptoms, 1 indicates slight symptoms, 2 indicates mild symptoms, 3 indicates moderate symptoms, 4 indicates moderately severe symptoms, and 5 indicates severe symptoms.
  • the symptoms include abdominal pain/cramps, bloating, flatulence, diarrhea and/or nausea/upset stomach.
  • a questionnaire can be filled out after a lactose challenge.
  • a questionnaire can be filled out after a milk challenge.
  • a questionnaire can be filled out without a challenge.
  • a single score of 4 or 5 indicates a subject has lactose intolerance.
  • two or more scores of 3 or greater indicates a subject has lactose intolerance.
  • a score of 3 or greater for a single symptom at two different timepoints indicates a subject has lactose intolerance.
  • a change in the average scores over time is used to evaluate the effectiveness of a treatment regimen.
  • a lactose intolerance diagnostic questionnaire is given in conjuction with a hydrogen breath test or lactose challenge with, for example, about 1 g, 2 g, 3 g, 4 g, 5 g, 6 g, 7 g, 8 g, 9 g, 10 g, 11 g, 12 g, 13 g, 14 g, 15 g, 16 g, 17 g, 18 g, 19 g, 20 g, 21 g, 22 g, 23 g, 24 g, 25 g, 26 g, 27 g, 28 g, 29 g, 30 g, 31 g, 32 g, 33 g, 34 g, 35 g, 36 g, 37 g, 38 g, 39 g, 40 g, or more of lactose consumed.
  • a lactose intolerance diagnostic questionnaire is given in conjuction with a hydrogen breath test or lac
  • a treatment regimens lasts, for about 1-20 days, about 1- 25 days, about 1-30 days, about 1-35 days, about 1-40 days, about 1-45 days, about 1-50 days, about 5-30 days, about 5-35 days, about 5-40 days, about 5-45 days, about 5-50 days, about 5-55 days, about 5-60 days, or about 5-90 days.
  • a treatment regimen lasts exactly or about 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, or 90 days.
  • the amount of each dose in a treatment regimen is constant.
  • a constant dose of prebiotics can be administered each day to a subject for the duration of the treatment regimens described above.
  • the dosing regimen is a constant 0.1-20 g of prebiotic per day.
  • the dosing regimen can be an escalating regimen, for example, 2 g of prebiotic on day 1 and 20 g of prebiotic on day 14 or day 20.
  • the dose escalates by about 0.1 g, 0.2 g, 0.3 g, 0.4 g , 0.5 g, 0.6 g, 0.7 g, 0.8 g, 0.9g, l.Og, l.lg, 1.2 g, 1.3 g, 1.4 g, 1.5 g, 1.6 g, 1.7 g, 1.8 g, 1.9 g, 2.0 g, 2.1 g, 2.2 g, 2.3 g, 2.4 g, 2.5 g, 2.6 g, 2.7 g, 2.8 g, 2.9 g, 3.0 g, 3.1 g, 3.2 g, 3.3 g, 3.4 g, 3.5 g, 3.6 g, 3.7 g, 3.8 g, 3.9 g, 4.0 g, 4.1 g, 4.2 g, 4.3 g, 4.4 g, 4.5 g, 4.6 g, 4.7 g, 4.8 g, 4.9 g, or
  • the dosing regimen can include between 0.1 and 20 g of prebiotic per day.
  • the regimen can also include escalating the number of doses per day, for example, 1 dose per day, 2 doses per day, 3 doses per day, 4 doses per day, 5 doses per day, 6 doses per day, 7 doses per day, 8 doses per day, 9 doses per day, or 10 doses per day.
  • 1 dose per day is administered on day 1, 2 doses per day on day 10, and 3 doses per day on day 14 or day 20 of a treatment regimen.
  • the treatment occurs in phases.
  • One phase utilizes a single administration of a prebiotic composition per day, generally though not necessarily with food, e.g., dinner.
  • the dose of a prebiotic composition increases over time.
  • the dose of a prebiotic composition can increase each day.
  • Another phase generally following the first phase, utilizes two administrations of a prebiotic composition per day, again, generally with food, e.g., with breakfast and dinner. Again, during this phase the dose of a composition comprising a prebiotic increases over time, e.g., increasing each day.
  • the treatment includes one phase in which a composition comprising a prebiotic composition is administered once per day in conjunction with a probiotic (e.g., live bacteria). This phase, if used, is generally the first phase of the method.
  • a probiotic microbe(s) is administered during some or all of the entire period of treatment.
  • a probiotic is included in a prebiotic-containing product that is administered to a subject.
  • no dairy products are consumed.
  • a final phase of the protocol can involve the gradual reintroduction of dairy into the diet, either with or without the continuing use of the prebiotic composition used in the first phases of treatment. Finally, treatment is concluded and no further ingestion of a prebiotic composition is required.
  • the dosing regimen comprises five phases.
  • the first phase comprises administration of a prebiotic composition for two days, optionally with a probiotic.
  • a prebiotic composition is taken with food once a day (e.g., breakfast, lunch, or dinner) for a period of about 10 to 30 days, or about 14 to 24 days, or about 16 to 20 days, or about 18 days.
  • a prebiotic composition is taken twice a day with food (e.g., both breakfast and dinner) for another period of about 6 to 18 days, or about 8 to 16 days, or about 10 to 14 days, or about 12 days.
  • a prebiotic composition is administered with both dinner and breakfast, along with the addition of a lactose containing product (e.g., a dairy product).
  • dairy products are not administered during the first phases, e.g., the first about 30-34 days of the regimen.
  • This total period e.g., of approximately 38 days, can constitute the full period in which a prebiotic composition is administered, but more importantly administered essentially in these time periods.
  • the regimen optionally includes a fifth phase: the actual ingestion of dairy products every few days to maintain and build up tolerance to lactose, but without the administration of a prebiotic composition (to test the establishment of lactose tolerance). If lactose tolerance is not established, the regimen can be repeated.
  • the first period of time through the first, roughly 18 days, the amount of a prebiotic composition administered at dinner time increases regularly each day.
  • a prebiotic composition is administered regularly each day in combination with a breakfast meal.
  • a lactose containing food item such as milk, also is regularly increased for those 4 days.
  • a first dose of a prebiotic composition is administered in increasing amounts for a 6-week period.
  • probiotic bacteria comprising one or more strains of bacteria (e.g., in a food containing product also having a live culture bacteria) is administered with the prebiotic composition.
  • a food item containing live cultured bacteria is yogurt.
  • a second dose of a prebiotic composition (such as a composition comprising or consisting essentially of GOS) is administered, typically at breakfast time.
  • a prebiotic composition and a probiotic composition are administered to a subject in need thereof.
  • a subject in the first day of the regimen, a subject ingests 8 ounces (about 226.4 g) or less of a probiotic composition along with 1 tablespoon (about 14.8 mL) of a prebiotic composition, at the dinner meal.
  • a subject in need thereof will ingest 8 ounces (about 226.4 g) or less of a probiotic composition on the first day, along with 1 tablespoon (about 14.8 mL) of a prebiotic composition with dinner.
  • the amount of the yogurt ingested is reduced by half to 4 ounces (about 113.2 g) or less of a probiotic composition, although the administration of the a prebiotic composition remains the same.
  • administration of the probiotic composition is stopped, but administration of a prebiotic composition remains at 1 tablespoon (about 14.8 mL).
  • the amount of a prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • the amount of a prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • both 1 tablespoon (about 14.8 mL) of a prebiotic composition (such as a composition comprising or consisting essentially of GOS) is ingested in the morning, with breakfast, and 16 tablespoons (about 237 mL) of a prebiotic composition (e.g., a composition comprising or consisting essentially of GOS) are ingested with dinner.
  • a prebiotic composition e.g., a composition comprising or consisting essentially of GOS
  • the morning dose increases daily at a rate of a tablespoon (about 14.8 mL) per day.
  • the subject in need thereof is ingesting 32 tablespoons (about 474 mL) of a prebiotic composition (such as a composition comprising or consisting essentially of GOS).
  • a prebiotic composition such as a composition comprising or consisting essentially of GOS
  • a dairy product such as milk (without prebiotic composition) is ingested, with 9 ounces (about 255 g) of milk in the morning and an additional 9 ounces (about 255 g) in the evening.
  • the milk amounts are increased incrementally at a rate of an ounce (about 28.3 g) per day, such that, by day 38, the subject is ingesting 12 ounces (about 340 g) of milk with breakfast and an additional 12 ounces (about 340 g) of milk at dinner.
  • cheese is substituted for milk.
  • the number of days in which a prebiotic or probiotic composition is administered can vary, and the quantity of the dosages can similarly be modified according to the needs of a particular subject and the symptoms of the subject. Even though there can be variations in both the time period and the dosage rates, the concept of increasing the dosages of a prebiotic composition for specific time periods is maintained and encompassed by the methods herein.
  • a subject in need thereof can ingest more than 5 tablespoons (about 74 mL) of a prebiotic composition by day 7.
  • the amount of a prebiotic composition ingested by day 7 can be increased to 6 tablespoons (about 89 mL) on day 8. Determination of whether or not the subject is capable of increasing the dosage or the time period depends on whether or not the subject encounters any adverse affects.
  • the same alterations can be made in the time intervals between the administration of a prebiotic composition and a lactose containing food item.
  • the subject in need thereof could potentially alter the amount of a prebiotic composition every 12 hours. In like manner, that time period could vary to 36 or even 48 hours.
  • a prebiotic composition is administered in a powder formulation of a prebiotic composition (e.g., a composition comprising or consisting essentially of GOS), the latter of which can be mixed with water and administered much in the same manner as a soft drink.
  • a prebiotic composition is incorporated in one or more capsules, capsules, or gels, as indicated.
  • a prebiotic composition is supplied in a liquid formulation for oral administration.
  • a subject in need thereof is treated with a regimen using a powdered prebiotic composition using a dosing schedule as set forth in Figures 5, 6, or 7.
  • 70% GOS refers to a GOS composition comprising 70% by weight GOS, about 20% by weight lactose, and 10 % by weight digestible saccharides.
  • a prebiotic composition contains a GOS composition (starting at 0.5 g and increased to 8.00 g over 34 days) with 0 % by weight additional lactose.
  • the amount of 70% GOS composition administered can be about 0.5 g, 1 g, 1.5 g, 2 g, 2.5 g, 3 g, 3.5 g, 4 g, 4.5 g, 5 g, 5.5 g, 6 g, 6.5 g, 7 g, 7.5 g, or 8.0 g.
  • a prebiotic composition contains a 70% GOS composition (starting at 0.29 g and increased to 4.69 g over 34 days) with additional lactose (starting at 0.33 g and increased to 5.3 g over 34 days).
  • the amount of 70% GOS composition administered can be about 0.29 g, 0.59 g, 0.88 g, 1.17 g, 1.46 g, 1.76 g, 2.05 g, 2.34 g, 2.64 g, 2.93 g, 3.22 g, 3.52 g, 3.81 g, 4.10 g, 4.39 g, or 4.69 g.
  • the 90% GOS are a GOS composition comprising 90% by weight GOS and 10 % by weight digestible saccharides.
  • a prebiotic composition contains a GOS composition (starting at 0.42 g and increased to 6.74 g over 34 days) with 0 % by weight additional lactose.
  • the amount of 90% GOS composition administered can be about 0.42 g, 0.84 g, 1.26 g, 1.68 g, 2.11 g, 2.53 g, 2.95 g, 3.37 g, 3.79 g, 4.21 g, 4.63 g, 5.05 g, 5.47 g, 5.89 g, 6.32 g, or 6.74 g.
  • the 93% GOS composition is a GOS composition comprising 90% by weight GOS (starting at 0.42 g and increased to 6.74 g over 34 days).
  • the amount of 93% GOS composition administered can be about 0.42 g, 0.84 g, 1.26 g, 1.68 g, 2.11 g, 2.53 g, 2.95 g, 3.37 g, 3.79 g, 4.21 g, 4.63 g, 5.05 g, 5.47 g, 5.89 g, 6.32 g, or 6.74 g.
  • the 95% GOS composition is a GOS composition comprising 95% by weight GOS.
  • the amount of 95% GOS composition administered can be about 0.42 g, 0.84 g, 1.26 g, 1.68 g, 2.11 g, 2.53 g, 2.95 g, 3.37 g, 3.79 g, 4.21 g, 4.63 g, 5.05 g, 5.47 g, 5.89 g, 6.32 g, or 6.74 g.
  • a prebiotic composition contains a GOS composition (starting at a certain amount and increasing to a maximum amount over 34 days) with additional lactose (starting at a certain amount and increasing to a maximum amount over 34 days).
  • a capsule containing GOS composition powder is administered to a subject in need thereof.
  • the subject in need thereof has completed the protocol and can now enjoy dairy products pain-free.
  • no future protocol, supplements, or medication is needed for these subjects in need thereof to consume dairy products.
  • the protocol is re-administered as needed.
  • a prebiotic composition is administered in a 16 day program.
  • Examples of 16 day programs are shown in Tables 8, 9, and 10. Milk can be provided to the subject after completion of the 16 day program.
  • PM dose AM dose (g PM dose AM dose (g of GOS) of GOS) (g of GOS) (g of GOS) (g of GOS)
  • a prebiotic composition is administered during a 30 or 34 day treatment program.
  • 30 and 34 day treatment programs are shown in Tables 11, 12, and 13. Milk is provided after the treatment program.
  • PM dose AM dose (g PM dose AM dose (g of GOS) of GOS) (g of GOS) (g of GOS) (g of GOS)
  • dosages of a prebiotic are administered to a subject in gelatin caps "00", which can hold between 0.546 - 1.092 g (e.g., of powder); gelatin caps "0", which can hold between 0.408-0.816 g (e.g., of powder), and gelatin caps "#1", which can hold between 0.300 and 0.600 g (e.g. of powder).
  • approximately 3 g of prebiotic composition is administered to a subject in three gelatin cap 00 pills.
  • approximately 1.5 g of prebiotic composition is administered two gelatin caps "00” or two gelatin caps "0.”
  • a prebiotic composition is measured using a scoop.
  • Variations in the doses and timing in which the prebiotic compositions are administered can result in an effective treatment for increasing tolerance for lactose containing product.
  • the presented doses may be tested on subjects in need thereof.
  • the weight of the subject might be a consideration.
  • a subject weighing 50 pounds (about 22.5 kg) is administered a lower dosage of a prebiotic composition than an adult.
  • the timing of administration of a prebiotic composition to a pediatric subject can be different (e.g., once per day for 4 weeks) or the duration of administration can be shorter or longer than the duration of administration to an adult.
  • the duration of administration of a prebiotic composition to a pediatric subject is shorter than the duration of administration to an adult.
  • the duration of administration of a prebiotic composition to a pediatric subject is longer than the duration of administration to an adult.
  • the amount of a prebiotic composition administered to a subject can be proportionally adjusted based on the subject's weight.
  • the doses are disclosed as being administered with breakfast and dinner, alternatively the order of the doses can be switched, or can be administered at other times of the day with meals such as lunch or snacks (or conceivably with no meals).
  • the program can also be reduced into a shortened or lengthened program.
  • a program of administration of a prebiotic composition to a subject in need thereof can be an abbreviated 1 week program or it can be lengthened up to a 10 week program.
  • kits for the treatment of the symptoms of lactose intolerance include a prebiotic composition in suitable packaging for use by a subject in need thereof in the treatment of one or more symptoms of lactose intolerance. Any of the compositions described herein can be packaged in the form of a kit.
  • a kit can contain an amount of a prebiotic composition and, optionally, other ingredients as described herein, sufficient for an entire course of treatment, or for a portion of a course of treatment.
  • a kit includes sufficient prebiotic composition for the first, second, third, fourth, fifth, and sixth weeks of treatment, or additional weeks of treatment if used, or any combination thereof.
  • Doses of a prebiotic composition can be individually packaged, or the prebiotic composition can be provided in bulk, or combinations thereof.
  • the individually packaged prebiotic composition is provided as a tablet, caplet, capsule or container of powder.
  • the prebiotic composition is provided in a controlled release formulation.
  • the prebiotic composition is provided as a formulation with an enteric coating.
  • a kit provides, in suitable packaging, individual doses of a prebiotic composition that correspond to dosing points in a treatment regimen, wherein the doses are packaged in one or more packages intended for use in the treatment of symptoms of lactose intolerance.
  • a kit can contain doses of a prebiotic composition, as described herein, for a treatment program, where the prebiotic composition is taken in increasing doses, so that individual packets of a prebiotic composition are increasing in amount of a prebiotic composition contained in the packet, from lower doses intended for use at the start of the program to higher doses as the program progresses.
  • doses are provided for later points in the program, two or more doses per day can be provided, each in its individual packet.
  • Each packet can be labeled to indicate the day and time of day that it is intended to be taken, or the packaging containing the packets can be so labeled, or both.
  • a "packet,” as used in this context, is any individual container that contains a prebiotic composition, whether the prebiotic composition is in solid or liquid form, and includes a packet that contains powder, tablets, or pills, or a packet that contains a liquid.
  • kits containing a course of treatment for a gastrointestinal disorder comprising: a. a kit box comprising a lid; b. a plurality of sachets, each of the sachets containing a single dose of a pharmaceutical composition comprising a galactooligosaccharides (GOS) composition, wherein the pharmaceutical composition is a powder, and wherein the plurality of sachets are contained within the kit box; c. a label on a front side of the kit box; and d. instructions for use.
  • each of the plurality of sachets comprises: a. a seal; b. a front label (4240); c.
  • the sachet comprises the notch, wherein the notch is located on a side edge of the sachet. In some embodiments, the sachet comprises the notch, wherein the notch is located on a top edge of the sachet. In some embodiments, the plurality of sachets is from 10 to 100 sachets. In some embodiments, each of the plurality of sachets comprises from about 2 g to about 50 g of the pharmaceutical composition.
  • the pharmaceutical composition further comprises one or more excipients. In some embodiments, the pharmaceutical composition comprises from about 10% to about 50% of the one or more excipients by dry weight. In some embodiments, the prebiotic composition does not comprise excipients and/or preservatives.
  • the GOS composition comprises disaccharides, trisaccharides, tetrasaccharides, and pentasaccharides. In some embodiments, the GOS composition comprises from about 0.1% to about 5% disaccharides, from about 30% to about 75% trisaccharides, from about 15% to about 45% tetrasaccharides, and from about 1% to about 20% pentasaccharides.
  • the GOS composition comprises from about 1% to about 2% disaccharides, from about 50% to about 60% trisaccharides, about 25% to about 35% tetrasaccharides, and about 5% to about 15% pentasaccharides.
  • the pharmaceutical composition comprises less than 5% digestible saccharides.
  • the gastrointestinal disorder is lactose intolerance, constipation, diarrhea, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), small intestine bacterial overgrowth (SIBO), hemorrhoids, indigestion or non-ulcer dyspepsia, anal fissures, perianal abscesses, anal fistula, diverticulosis or diverticulitis, colitis, infectious colitis, ulcerative colitis, Crohn's disease, ischemic colitis, radiation colitis, pseudomembranous colitis, C.
  • IBS irritable bowel syndrome
  • IBD inflammatory bowel disease
  • SIBO small intestine bacterial overgrowth
  • hemorrhoids indigestion or non-ulcer dyspepsia
  • anal fissures perianal abscesses
  • anal fistula diverticulosis or diverticulitis
  • colitis infectious colitis
  • ulcerative colitis Crohn's disease
  • the gastrointestinal disorder is lactose intolerance.
  • kits containing a course of treatment for a gastrointestinal disorder comprising: a. a container containing a pharmaceutical composition comprising a GOS composition, wherein the pharmaceutical composition is a powder, the container comprising: i. a threaded opening, and ii. a label on a side-wall of the container; b. a lid that can be screwed onto the threaded opening of the container; c. a scoop or measuring cup; and d. instructions for use.
  • the container further comprises tabs forming a v- shaped opening in the threaded opening.
  • the container is cylindrical in shape.
  • the container comprises four substantially rectangular side- walls that taper to a rounded neck.
  • the gastrointestinal disorder is lactose intolerance, constipation, diarrhea, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), small intestine bacterial overgrowth (SIBO), hemorrhoids, indigestion or non-ulcer dyspepsia, anal fissures, perianal abscesses, anal fistula, diverticulosis or diverticulitis, colitis, infectious colitis, ulcerative colitis, Crohn's disease, ischemic colitis, radiation colitis, pseudomembranous colitis, C.
  • the gastrointestinal disorder is lactose intolerance.
  • kits containing a course of treatment for a gastrointestinal disorder comprising: a. a container comprising: i. a threaded opening or a child-safe lock opening, and ii. a label on a side-wall of the container; b. a lid compatible with the threaded opening or the child-safe lock opening; c. a plurality of tablets, each of the tablets being a dosage unit of a pharmaceutical composition comprising a GOS composition; d. instructions for use.
  • the container is cylindrical in shape.
  • the container comprises four substantially rectangular side-walls that taper to a rounded neck.
  • each of the plurality of tablets comprises from about 0.14 g to about 2 g of the pharmaceutical composition.
  • the pharmaceutical composition further comprises one or more excipients.
  • the pharmaceutical composition comprises from about 10% to about 50% of the one or more excipients by dry weight.
  • the GOS composition comprises disaccharides, trisaccharides, tetrasaccharides, and pentasaccharides.
  • the GOS composition comprises from about 0.1% to about 5% disaccharides, from about 30% to about 75% trisaccharides, from about 15% to about 45% tetrasaccharides, and from about 1% to about 20% pentasaccharides.
  • the GOS composition comprises from about 1% to about 2% disaccharides, from about 50% to about 60% trisaccharides, about 25% to about 35% tetrasaccharides, and about 5% to about 15% pentasaccharides.
  • the pharmaceutical composition comprises less than 5% digestible saccharides.
  • the gastrointestinal disorder is lactose intolerance, constipation, diarrhea, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), small intestine bacterial overgrowth (SIBO), hemorrhoids, indigestion or non-ulcer dyspepsia, anal fissures, perianal abscesses, anal fistula, diverticulosis or diverticulitis, colitis, infectious colitis, ulcerative colitis, Crohn's disease, ischemic colitis, radiation colitis, pseudomembranous colitis, C.
  • IBS irritable bowel syndrome
  • IBD inflammatory bowel disease
  • SIBO small intestine bacterial overgrowth
  • hemorrhoids indigestion or non-ulcer dyspepsia
  • anal fissures perianal abscesses
  • anal fistula diverticulosis or diverticulitis
  • colitis infectious colitis
  • ulcerative colitis Crohn's disease
  • the gastrointestinal disorder is lactose intolerance.
  • kits containing a course of treatment for a gastrointestinal disorder comprising: a. a container comprising: i. a threaded opening or a child-safe lock opening, and ii. a label on a side-wall of the container; b. a lid compatible with the threaded opening or the child-safe lock opening; c. a plurality of capsules, each of the capsules being a dosage unit of a pharmaceutical composition comprising a GOS composition; d. instructions for use.
  • the container is cylindrical in shape.
  • the container comprises four substantially rectangular side-walls that taper to a rounded neck.
  • each of the plurality of tablets comprises from about 0.14 g to about 2 g of the pharmaceutical composition.
  • the pharmaceutical composition further comprises one or more excipients.
  • the pharmaceutical composition comprises from about 10% to about 50% of the one or more excipients by dry weight.
  • the GOS composition comprises disaccharides, trisaccharides, tetrasaccharides, and pentasaccharides.
  • the GOS composition comprises from about 0.1% to about 5% disaccharides, from about 30% to about 75% trisaccharides, from about 15% to about 45% tetrasaccharides, and from about 1% to about 20% pentasaccharides.
  • the GOS composition comprises from about 1% to about 2% disaccharides, from about 50% to about 60% trisaccharides, about 25% to about 35% tetrasaccharides, and about 5% to about 15% pentasaccharides.
  • the pharmaceutical composition comprises less than 5% digestible saccharides.
  • the gastrointestinal disorder is lactose intolerance, constipation, diarrhea, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), small intestine bacterial overgrowth (SIBO), hemorrhoids, indigestion or non-ulcer dyspepsia, anal fissures, perianal abscesses, anal fistula, diverticulosis or diverticulitis, colitis, infectious colitis, ulcerative colitis, Crohn's disease, ischemic colitis, radiation colitis, pseudomembranous colitis, C.
  • IBS irritable bowel syndrome
  • IBD inflammatory bowel disease
  • SIBO small intestine bacterial overgrowth
  • hemorrhoids indigestion or non-ulcer dyspepsia
  • anal fissures perianal abscesses
  • anal fistula diverticulosis or diverticulitis
  • colitis infectious colitis
  • ulcerative colitis Crohn's disease
  • the prebiotic composition can be provided in bulk in a single container, or in two, three, four, five, or more than five containers (e.g., where each container contains enough of a prebiotic composition for a particular week of a treatment program).
  • the bulk containers can be suitably packaged together to provide sufficient prebiotic composition for all or a portion of a treatment protocol.
  • the container or containers can be labeled with a label indicating information useful to the subject in need thereof performing the treatment protocol, such as dosing schedules.
  • kits of the present disclosure include a powder or liquid containing all the ingredients intended to be used in a course of treatment or a portion of a course of treatment, e.g., a prebiotic composition and optionally a probiotic, FOS, or a buffer.
  • a prebiotic composition is packaged in one package or set of packages, and additional components, such as bacteria, FOS, or buffer, are packaged separately from the prebiotic composition.
  • Kits can further include written materials, such as instructions, expected results, testimonials, explanations, warnings, clinical data, information for health professionals, and the like.
  • the kits contain a label or other information indicating that the kit is only for use under the direction of a health professional, such as a dietician, nutritionist, nurse, physician, or other appropriate health professional.
  • the kits contain or include information, such as a label, designating the material within as a medical food.
  • the present disclosure provides for a kit that includes a container of powder, where the powder includes a prebiotic composition, and optionally FOS, bacteria, or buffer, and a label on the container that indicates proper dosage and schedule of use for the powder.
  • the container can further include scoops or other measuring or serving devices.
  • the present disclosure provides for a kit that includes a container of liquid, where the liquid includes a prebiotic composition and additionally FOS, bacteria, or buffer, and a label on the container that indicates proper dosage and schedule of use for the liquid.
  • the container can further include measuring or serving devices.
  • EXAMPLE 1 CLINICAL STUDY [0359] The primary objective of this study is to assess the efficacy of 2 RP-G28 dosing regimens on symptoms related to lactose intolerance relative to placebo after 30 days of treatment.
  • the study may be designed as a phase 2b/3, multicenter, randomized, double- blind, placebo-controlled, parallel-group study to determine the efficacy, safety, and tolerability of 2 dosing regimens of RP G28 in subjects with moderate to severe lactose intolerance. Subjects may be enrolled at up to 30 investigative sites in the United States. There are 3 distinct phases to this study: a 7 day screening phase, a 30-day treatment phase, and a 30-day, off-study drug, post-treatment phase. The phases of the study are outlined in Figure 1.
  • the current Protocol G28-003 study is designed to assess 2 dosing regimens of RP-G28 for efficacy and tolerability in order to determine the most efficacious and safe dose to be further studied in the phase 3 program.
  • a 5-hour Solution Z Assessment SZA
  • SZA Solution Z Assessment
  • HBT hydrogen breath test
  • the primary objective of this study is to assess efficacy of RP-G28 compared to the placebo on reduction of abdominal symptoms post-lactose challenge (SZA) after 30 days of treatment (Day 31).
  • the primary efficacy endpoint is abdominal symptom response at Day 31.
  • a response is based on change from baseline (Day -7, visit 1) to end of treatment period at Day 31 (visit 5), calculated from the combined average of four maximum symptom scores taken over 0.5, 1, 2, 3, 4, 5, and 6 hours for each abdominal symptom (abdominal pain, abdominal cramping, abdominal bloating, and abdominal gas) after a lactose challenge test (SZA).
  • a response is defined as a 1, 2, 3, 4, or 5 points, or greater, decrease from baseline or a composite score of zero at Day 31.
  • a change of at least 3 points, of at least 4 points, of at least 5 points, or greater, as reported by a patient is considered meaningful.
  • the change of at least 3 points, of at least 4 points, or of at least 5 points, or greater may be either for a single symptom or for a composite of 2, 3, or 4 symptoms. Even more preferably, a change of at least 4 points or greater is considered meaningful.
  • the change of at least 4 points, or greater may be either for a single symptom or for a composite of 2, 3, or 4 symptoms.
  • Exploratory objectives include assessments of bowel movement; LI patient global impression and assessment standards, and HBT. Exploratory endpoints may be assessed between baseline (Day -7, visit 1) and end-of-treatment phase (Day 31, visit 5), between baseline and 30 days post-treatment phase (Day 61, visit 8), and between end-of-treatment phase and 30 days post treatment phase, when possible. Determination of treatment effect in fecal bacterial shift, noted in the protocol, may be assessed separately.
  • Exploratory endpoints may include:
  • PAARI Adequate Relief Item
  • PASI Satisfaction Item
  • AEs adverse events
  • An AE is defined as any undesired medical occurrence in a patient or clinical investigation patient receiving a pharmaceutical product and which does not necessarily have a causal relationship with this treatment.
  • An AE can therefore be any unfavorable sign and unintended sign (including an abnormal laboratory finding), symptom, or disease temporarily associated with the use of a study drug, whether or not related to the study drug.
  • Adverse events may be graded for severity using the following categories. Missing grade may be assigned a grade of 3 (severe) in tabulations.
  • Grade 2 Interferes to some extent with subject's usual function
  • Relationship to study drug may be assessed by the principal investigator using the following categories. Missing relatedness may be assigned to "related" in tabulations.
  • Probable There is a reasonable causal relationship between the investigational product and the AE. The event responds to de-challenge. Rechallenge not required; • Definite: There is a reasonable causal relationship between the investigational product and the AE, when the event responds to withdrawal of the investigational product (de-challenge), and recurs with rechallenge by administration of the investigational product.
  • a treatment-emergent AE is any AE that begins or increases in severity after the initial dose of study drug.
  • SAR serious adverse drug reaction
  • the Sponsor typically assesses whether the event is unexpected or expected based on the clinical information known about the investigational product (eg, noted in the Investigator's Brochure). This determination may be made prior to database lock and unblinding.
  • Subject's age is defined as its integer value in years at enrollment. Baseline:
  • baseline is the last assessment taken prior to the first study drug administration (Day -7; hours 0-5).
  • Enrollment date is the same as the randomization date at visit 2 and is designated Day 1.
  • Randomization date is the day the subject is assigned a randomization number on study Day 1.
  • a subject who has a decrease of 4 or more points from baseline in their composite score or achieves a composite score of zero at the time point of interest is defined as having responded.
  • a subject who has a decrease of 1, 2, or 3 points from baseline in their composite score or achieves a composite score of zero at the time point of interest may also be defined as having responded.
  • a composite score is derived by taking the maximum score reported during hours 0.5 to 5 of the SZA for each abdominal symptom (abdominal pain, abdominal cramping, abdominal bloating, and abdominal gas) and averaging them.
  • the number of subjects who are randomized, receive study drug, and complete the study may be summarized.
  • the number of subjects included in the safety, mITT, and PP analysis sets may be included in the table.
  • Attendance at each visit, including missed visits, discontinuations, lost to follow up, and percentage accountability may be summarized.
  • a list of subjects who withdraw early may be provided.
  • the reason and timing of the withdrawal may be recorded.
  • the reason any subject is excluded from an analysis set may be provided.
  • significant known protocol deviations may be noted for individual subjects; a summary table may also be provided.
  • Age, race, ethnicity, sex, height, weight, and body mass index may be summarized by treatment arm for all subjects receiving study drug, using descriptive statistics.
  • Abdominal symptom responder status at Day 31 may be analyzed by a Cochran-Mantel-Haenszel (CMH) test comparing pooled high dose and low dose vs placebo.
  • CMH Cochran-Mantel-Haenszel
  • Stratification may be by the baseline composite score arranged into quartiles.
  • the comparison between the pooled high- and low-dose arms versus placebo may be tested.
  • all analyses of primary and secondary endpoints may be repeated using the PP population.
  • Quantitative exploratory endpoints based on maximum scores or counts may be analyzed using analysis of covariance (ANCOVA) models with treatment group (3 levels) as a factor and the baseline value of the corresponding parameter as a covariate.
  • ANCOVA covariance
  • contrasts between the pooled active groups and placebo, and between each active group and placebo may be tested.
  • Binary endpoints may be analyzed using CMH tests.
  • a subject who provides no data at the time point of interest is defined to be a nonresponder.
  • stool form Type 6 or Type 7 a subject with missing data (subject did not attend visit) may be assumed to have stool form Type 6 or Type 7 present.
  • Sensitivity analyses conducted in the mITT population may include the following approaches to handle subjects who do not provide data (subject did not attend visit) at the end-of-treatment phase assessment:

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Abstract

La présente invention concerne des méthodes d'utilisation de douleur abdominale, de crampe abdominale, de ballonnement abdominal et de gaz abdominal, et leurs combinaisons, pour l'évaluation de l'efficacité de mélanges d'oligosaccharides pour traiter une intolérance au lactose et pour améliorer la santé gastro-intestinale.
PCT/US2018/024015 2017-03-24 2018-03-23 Méthodes de traitement d'intolérance au lactose et d'amélioration de la santé gastro-intestinale WO2018175879A1 (fr)

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US11690817B2 (en) 2017-11-22 2023-07-04 Axcess Global Sciences, Llc Non-racemic beta-hydroxybutyrate compounds and compositions enriched with the R-enantiomer and methods of use
US11786499B2 (en) 2017-11-22 2023-10-17 Axcess Global Sciences, Llc Ketone body esters of S-beta-hydroxybutyrate and/or S-1,3-butanediol for modifying metabolic function
US11944598B2 (en) 2017-12-19 2024-04-02 Axcess Global Sciences, Llc Compositions containing s-beta-hydroxybutyrate or non-racemic mixtures enriched with the s-enatiomer
US11793778B2 (en) 2018-04-18 2023-10-24 Axcess Global Sciences, Llc Compositions and methods for keto stacking with beta-hydroxybutyrate and acetoacetate
US11806324B2 (en) 2018-04-18 2023-11-07 Axcess Global Sciences, Llc Beta-hydroxybutyric acid compositions and methods for oral delivery of ketone bodies
EP3969008A4 (fr) * 2019-05-15 2023-01-18 Axcess Global Sciences, LLC Compositions autobiotiques et procédé pour favoriser un microbiome intestinal sain
US11950616B2 (en) 2019-06-21 2024-04-09 Axcess Global Sciences, Llc Non-vasoconstricting energy-promoting compositions containing ketone bodies
US11969430B1 (en) 2023-03-10 2024-04-30 Axcess Global Sciences, Llc Compositions containing paraxanthine and beta-hydroxybutyrate or precursor for increasing neurological and physiological performance

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