Food for special medical purposes, intended for the dietary management of drug-resistant epilepsies .

The microbiota controls the metabolism of Tryptophan (TRP) : an altered microbiota has been reported in epileptic patients, caused by a deficiency of TRP. Therefore, restoring a correct microbiota allows not only to increase plasma TRP but also to restore its correct metabolism and its cerebral uptake, in order to promote a correct production of serotonin .

Confirming the role of serotonin, A reduced ability to derive TRP from the diet has been reported in epileptic patients (nutritional vulnerability), which may also depend on its altered metabolism with a greater production of indole catabolites, which perform reinforcing actions on the intestinal membrane. In particular, in epileptic patients a reduction of one third of the speed of synthesis of cerebral serotonin has been estimated compared to controls.

The 1990s saw a reversal of the role of serotonin in epilepsy: erroneously thought to be pro-convulsant, it was revealed to be anti-convulsant.

Since serotonin is synthesized from TRP, an essential amino acid (which comes only from the diet), which competes with other Large Neutral Amino Acids (LNAAs) for both brain uptake and intestinal absorption, dietary strategies aimed at increasing both plasma TRP and its brain uptake are useful.

Oral intake of serum protein alpha-lactalbumin has been shown to increase the plasma TRP/LNAAs ratio, but, in the presence of an altered TRP metabolism, this increase does not automatically correspond to an increase in its cerebral uptake (less than 1% of plasma TRP is available for cerebral uptake) and therefore to an increase in cerebral serotonin synthesis.

Thanks to its specific actions on the digestive system, alpha-lactalbumin has been shown to be capable of both modify the microbiota both of increase the rate of brain serotonin synthesis by up to five times . Alpha-lactalbumin It was also found to be able to increase the neuropeptide Y , which has been defined as a powerful endogenous anticonvulsant .

In addition, nourishing the cells of the digestive system well facilitates their response to alpha-lactalbumin stimulation. The specific nutrients of these cells are short chain fats (Short Chain Fatty Acids, SCFAs) which have an anti-inflammatory action , are able to improve the metabolism of the precursors of tryptophan and serotonin and regulate the functionality of the gut-brain axis at 360 degrees. Butyric acid , one of the most widespread SCFA, contributes to the correct functioning of the intestinal mucosa , positively influences the ecosystem of the gastrointestinal tract and has been shown to have anticonvulsant effects in several experimental models of epilepsy, positively influencing both the frequency of the crises themselves that aspects related to neuropsychiatric disorders .

The patented synergistic association between alpha-lactalbumin and butyric acid has led to the development of Lalbaay , the first food for special medical purposes patented and studied in Italy by reference centers in the field of epilepsy, to provide an effective and useful tool for the dietary management of drug-resistant epilepsies.