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Drugs and Health Products

Inulin

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This monograph is intended to serve as a guide to industry for the preparation of Product Licence Applications (PLAs) and labels for natural health product market authorization. It is not intended to be a comprehensive review of the medicinal ingredient.

Notes
  • Text in parentheses is additional optional information which can be included on the PLA and product label at the applicant's discretion.
  • The solidus (/) indicates that the terms and/or the statements are synonymous. Either term or statement may be selected by the applicant.

Date

October 4, 2013

Proper name(s)

Inulin (CFIA 2012; IOM 2005)

Common name(s)

Inulin (CFIA 2012; IOM 2005)

Source material(s)

  • Cichorium intybus L. - root (Chicory) (CFIA 2012; USDA 2012; IOM 2005; McGuffin et al. 2000)
  • Helianthus tuberosus L. - tuber (Jerusalem artichoke) (CFIA 2012; USDA 2010)

Route(s) of administration

Oral

Dosage form(s)

  • The acceptable pharmaceutical dosage forms include, but are not limited to capsules, chewables (e.g. gummies, tablets), liquids, powders, strips or tablets.
  • This monograph is not intended to include foods or food-like dosage forms such as bars, chewing gums or beverages.

Use(s) or Purpose(s)

Statement(s) to the effect of:
  • Source of fiber for the maintenance of good health (CFIA 2012; FCC 8; IOM 2005).
  • Helps support and maintain a healthy digestive system (CFIA 2012; FCC 8; IOM 2005).
  • Helps stimulate the growth of healthy bacteria (such as bifidobateria) in the intestine/gut (Marteau et al. 2011; Roberfroid 2007a; Menne et al. 2000; Gibson et al. 1995).
  • Prebiotic (Marteau et al. 2011; Roberfroid 2007a,b; Menne et al. 2000; Gibson et al. 1995).
  • Helps provide gentle relief of constipation and/or irregularity (Marteau et al. 2011; IOM 2005; Kleessen et al. 1997).

Dose(s)

Statement(s) to the effect of:

Subpopulation(s)

Adults (≥ 18 years)

Quantity(ies)

Source of fiber, healthy digestive system, constipation/irregularity
2-15 g, per day (Kolida and Gibson 2007; IOM 2005; Menne et al. 2000; Coussement 1999).

Prebiotic, healthy bacteria 5-15 g, per day (Kolida and Gibson 2007; Menne et al. 2000; Coussement 1999).

Directions for use

Products providing ≥ 5 g inulin per dose
  • Take with 250 ml of water (Pray 2006)
  • Take two hours before or after taking other medications or natural health products since the absorption of these products may be delayed (Pray 2006).

Duration of use

No statement required.

Risk information

Statement(s) to the effect of:

Caution(s) and warning(s)

Products providing ≥ 5 g inulin per dose
If you have diabetes, consult a health care practitioner prior to use (Pray 2006).

Products for constipation/irregularity
  • If symptoms worsen or if laxative effect does not occur within seven days, consult a health care practitioner (Pray 2006).
  • If you are taking medications which inhibit peristaltic movement, consult a health care practitioner prior to use (e.g. opioids, loperamide) (Pray 2006).
  • If you have symptoms such as abdominal pain, nausea, vomiting or fever, consult a health care practitioner prior to use (Pray 2006).
  • If you are experiencing a sudden change in bowel habits that has persisted for more than 2 weeks, undiagnosed rectal bleeding, or have failed to defecate following the use of a laxative product, consult a health care practitioner prior to use (Pray 2006).

Contraindication(s)

No statement required.

Known adverse reaction(s)

All products
Hypersensitivity has been known to occur (Brinker 2010; Hendler and Rorvik 2008; Franck et al. 2005; Gay-Crosier et al. 2000).

Products providing ≥ 5 g per day
May cause mild gastro-intestinal discomfort (such as gas, bloating, cramps) (Marteau et al. 2011; Kolida and Gibson 2007; Menne et al. 2000; Coussement 1999; Klessen et al. 1997).

Non-medicinal ingredients

Must be chosen from the current NNHPD Natural Health Products Ingredients Database (NHPID) and must meet the limitations outlined in the database.

Storage conditions

Statement(s) to the effect of:

Store in well-closed containers at room temperature (USP 35).

Specifications

  • The finished product specifications must be established in accordance with the requirements described in the NNHPD Quality of Natural Health Products Guide.
  • The medicinal ingredient must comply with the requirements outlined in the Natural Health Products Ingredients Database (NHPID). In addition, the medicinal ingredient may comply with the specifications outlined in the Inulin monograph published in the United States Pharmacopeia (USP 35).

References cited

  • Brinker F. Herb Contraindications and Drug Interactions, 3rd edition. Sandy (OR): Eclectic Medical Publications; 2001.
  • CFIA 2012: Canadian Food Inspection Agency, Next link will take you to another Web site Guide to Food Labelling and Advertising, Chapter 6: The Elements Within the Nutrition Facts Table Section 6.8.1 Dietary Fibre. [Date modified 2012 September 24; Accessed 2013 April 16].
  • Coussement PAA 1999. Inulin and Oligofructose: safe intakes and legal status. The Journal of Nutrition 1999;129:1412S-1417S.
  • FCC 8: Food Chemicals Codex. Eighth edition. Rockville (MD): The United States Pharmacopeial Convention; 2012.
  • Franck P, Moneret-Vautrin DA, Morisset M, Kanny G, Mégret-Gabeaux ML, Olivier JL. Anaphylactic reaction to inulin : first identification of specific IgEs to an inulin protein compound. International Archives of Allergy and Immunology 2005;136:155-158.
  • Gay-Crosier F, Schreiber G, Huaser C. Anaphylaxis from inulin in vegetables and processed food. The New England Journal of Medicine 2000;342(18):1372.
  • Gibson GR, Beatty ER, Wang X, Cummings JH. Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin. Gastroenterology 1995;108(4):975-82.
  • Hendler SS, Rorvik DM, editors. Physician Desk References (PDR) for Nutritional Supplements, 2nd edition. Montvale (NJ): Thomson Reuters, 2008.
  • IOM 2005: Institute of Medicine of the National Academies. Next link will take you to another Web site Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Food and Nutrition Board. [Access 2013 August 20].
  • Kleessen B, Sykura B, Zunft H-J, Blaut M. Effects of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons. American Journal of Clinical Nutrition 1997;65(5):1397-1402.
  • Kolida S, Gibson GR. 2007. Prebiotic capacity of inulin-type fructans. The Journal of Nutrition 2007;137:2503S-2506S.
  • Marteau P, Jacobs H, Cazaubiel M, Signoret C, Prevel J-M, Housez B. Effects of chicory inulin in constipated elderly people: a double-blind controlled trial. International of Food Sciences and Nutrition 2011;62(2):164-170.
  • McGuffin M, Kartesz JT, Leung AY, Tucker AO, editors. Herbs of Commerce, 2nd edition. Silver Spring (MD): American Herbal Products Association; 2000.
  • Menne E, Guggenbuhl, Roberfroid M. Fn-type chicory inulin hydrolysate has a prebiotic effect in humans. Journal of Nutrition 2000;130:1197-1199.
  • Pray WS. Non-Prescription Product Therapeutics, 2nd edition. New York (NY): Lippincott Williams & Wilkins; 2006.
  • Ramnani P, Gaudier E, Bingham M, van Bruggen P, Tuohy KM, Gibson GR. Prebiotic effect of fruit and vegetable shots containing Jerusalem artichoke inulin: a human intervention study. British Journal of Nutrition 2010;104(2):233-240.
  • Roberfroid MB. Inulin-type fructans: functional food ingredients. The Journal of Nutrition 2007a;137:2493S-2502S.
  • Roberfroid M. Prebiotics: The Concept Revisited. The Journal of Nutrition 2007b;137:830S-837S.
  • USDA 2012: United States Department of Agriculture, Agricultural Research Service, National Genetic Resources Program. Next link will take you to another Web site Germplasm Resources Information Network (GRIN). [Internet].National Germplasm Resources Laboratory, Beltsville (MD). [Cichorium intybus L. Last updated 2012 June 21; Accessed 2013 April 2].
  • USP 35: United States Pharmacopeia and the National Formulary (USP 35 - NF 30). Rockville (MD): The United States Pharmacopeial Convention; 2012.

References reviewed

  • BHC 1992: Bradley PR, editor. British Herbal Compendium Volume 1: A Handbook of Scientific Information on Widely Used Plant Drugs—Companion to Volume 1 of the British Herbal Pharmaocopeia. Bournemouth (GB): British Herbal Medicine Association; 1992.
  • Brighenti F, Casiraghi MC, Canzi E, Ferrari A. Effect of consumption of a ready-to-eat breakfast cereal containing inulin on the intestinal milieu and blood lipids in healthy male volunteers. European Journal of Clinical Nutrition 1999;53(9):726-33.
  • Causey JL, Feirtag JM, Gallaher DD, Tungland BC, Slavin JL. Effects of dietary inulin on serum lipids, blood glucose and the gastrointestinal environment in hypercholesterolemic men. Nutrition Research 2000;20:191-201.
  • Den Hond E, Geypens B, Ghoos Y. Effect of high performance chicory inulin on constipation. Nutrition Research 2000;20(5):731-736.
  • ESCOP 2003: E/S/C/O/P Monographs: The Scientific Foundation for Herbal Medicinal Products. 2nd edition. Exeter (GB): ESCOP, the European Scientific Cooperative on Phytotherapy in collaboration with Georg Thieme Verlag and Thieme; 2003.
  • Kim SH, Lee DH, Meyer D, Supplementation of infant formula with native inulin has a prebiotic effect in formula-fed babies. Asia Pacific Journal of Clinical Nutrition 2007;16(1):172-177.
  • Pourghassem GB, Dehghan P, Aliasgharzadeh A, Asghari J-AM. Effects of high performance inulin supplementation on glycemic control and antioxidant status in women with type 2 diabetes. Diabetes Metabolism Journal 2013;37(2):140-148.
  • Rao AV. Dose-Response effects of inulin and oligofructose on intestinal bifidogenesis effects. Journal of Nutrition 1999;129:1442S-1445S.
  • Roberfroid MB, Van Loo JAE, Gibson GR. The bifidogenic nature of chicory inulin and its hydrolysis products journal of nutrition 1998;128:11-19.
  • Szajewska H, Wizman Z, Abu-Zekry M, Kekez A, Braegger C, Kolacek S, Micetic-Turk D, Ruszczynski M, Vukavic T. Inulin and fructo-oligosaccharides for the prevention of antibiotic-associated diarrhea in children: report by the ESPHGAN working group on probiotics and prebiotics. Journal of Pediatric Gastroenterology and Nutrition 2012;54(6):828-829.
  • Van Dokkum W, Wezendonk B, Srikumar TS, van den Heuvel EGHM. Effect of nondigestible oligosaccharides on large-bowel functions, blood lipid concentrations and glucose absorption in young healthy male subjects. European Journal of Clinical Nutrition 1999;53(1):1-7.
  • Yap WKW, Mohamed S, Jamal MH, Meyer D, Manap YA. Changes in infant faecal characteristics and microbiota by inulin supplementation. Journal of Clinical Biochemistry Nutrition 2008;43:159-166.
  • WHO 1999: World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 1. Geneva (CH): World Health Organization; 1999.