Green Banana and Pectin Improve Small Intestinal Permeability and Reduce Fluid Loss in Bangladeshi Children with Persistent Diarrhea

To evaluate the effects of green banana and pectin (nondigestible, dietary sources of colonic short-chain fatty acids [SCFA]) on intestinal permeability, 57 boys (5–12 months) with persistent diarrhea (≥14 days) were given a week's treatment with a rice-based diet containing either cooked green banana (n=19), pectin (n=17), or rice diet alone (n=21). Intestinal permeability was assessed before and after treatment by giving a lactulose–mannitol (LM) drink and measuring urinary recovery after 5 hr. Treatment with banana significantly (P<0.05) reduced lactulose recovery, increased mannitol recovery, and decreased the LM ratio, indicating improvement of permeability. Pectin produced similar results. Permeability changes were associated with a 50% reduction in stool weights which correlated strongly (green banana, r2 = 0.84, pectin, r2 = 0.86) with the LM ratio. Green banana-derived and SCFA-mediated stimulation of colonic as well as small bowel absorption is responsible for their antidiarrheal effects. The antidiarrheal effects of green banana and pectin are mediated by improvement of small intestinal permeability in addition to their known colonotrophic effects.