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The Scoop on Laxatives
A study conducted by The American Cancer Society surveyed 1,064,004 men and women and found that 26% of them reported occasional constipation. (1) Few people realize that, beyond discomfort, occasional constipation significantly increases the risk for colon concerns, (2) poor immunity, fatigue and nutritional deficiencies (see other symptoms in the list below).
Symptoms Associated with Constipation
You are constipated if you eliminate less than once per day.
- Mild Headaches
- Weight Gain
- Joint Discomfort
- Poor Immunity
- Sinus Congestion
- Gas and Bloating
Do Natural Laxatives Work?
In one meta-analysis of over 250 studies, laxative therapies showed no noticeable difference compared to the placebo when measuring long term bowel frequency. In other words, while laxatives of all kinds are prescribed and used as over-the-counter support, little if any evidence exists to confirm their long term effectiveness. (3,4) While they often yield the desired effect at first, over time the body can become tolerant to them and they can stop working.
Natural Laxatives Have Risks!
The harmful side effects of natural or herbal laxatives are rarely mentioned. It is common to think that an herbal laxative like senna tea, a simple mineral like magnesium, or Epsom Salt is harmless. And these are, when used occasionally.
New reports list the risks and dangers of poor digestion, elimination, and nutrient assimilation with some natural laxatives.
Let’s investigate the causes of those concerns, the appropriate support, and the reality that even “natural” laxatives may be dangerous and habit forming when used incorrectly.
What Is the Cause of Poor Digestion?
There are more stress receptors in the gut than there are in the brain.
Ninety-five percent of the serotonin in the body is manufactured and stored in the gut. (11) Other stress receptors like dopamine and norepinephrine (adrenaline) are abundant in the gut, making the gut the first responder for stress. (12) In fact, the gut has its very own nervous system called the Enteric Nervous System (ENS), which is totally independent of the Central Nervous System (CNS).
Many of us can relate to feeling stress, nervousness, and butterflies in the gut. The gut is where we first learn to suck it up as kids, to stuff our emotions in order to deal with adversity and emotional trauma and cope with an unfriendly world.
In Ayurveda, the gut is considered to be the seat of the nervous system. Stress will cause poor digestion long before symptoms of fatigue, mood and other more obvious symptoms are experienced. In my book, Perfect Health for Kids, I wrote a chapter called Colds Start in the Digestive System, where I make the case that poor bowel function is incredibly common with kids and is a major cause of compromised immunity and adult digestive issues. Considering how many kids I see in my practice with poor bowel function, I think it is safe to say that most adult eliminative and digestive issues start early in life when kids are forced to handle overwhelming amounts of emotional stress, and their developing digestive systems take the brunt of it.
Stress impacts the gut wall by compromising blood supply and lymph drainage to the intestinal tract, which dries out the mucus membranes and often results in occasional constipation.
Years of stress and elimination issues can cause the intestinal mucosa to produce reactive mucus as an attempt to soften the stool and improve elimination. Many laxatives mimic this effect, but not without side effects.
Why Are Laxatives Dangerous?
Laxatives typically speed up transit time, which is the time that it takes for food to be eaten and then eliminated. This increases risk of mineral deficiencies due to a phenomenon called “intestinal hurry,” whereby the food moves too quickly through the gut to be properly absorbed. (5) Long term laxative users can have somewhat regular bowel movements, but may become run down and tired due to various mineral and nutritional deficiencies.
Do You Have Intestinal Hurry?
Healthy transit time can vary from 14-24 hours depending on the individual. A less-than-12-hour transit time could indicate malabsorption due to gastrointestinal hurry. Some folks who constitutionally tend toward loose or softer stools may be at risk here as well. Eating beets or corn is usually a good test to measure average transit time. Mark the time you ate them and then inspect your bowels for residue of these foods as a transit time indicator. If it takes less than 12 hours to see them on the other end, then you may be experiencing gastrointestinal hurry and are at risk of some nutritional deficiencies.
Even Natural Laxatives Can Create Intestinal Hurry
Magnesium, senna, caffeine and cascara are common laxatives that cause intestinal hurry and possible malabsorption. Magnesium has been found to cause malabsorption at laxative dosages as low as 250mg per day. (6) Check your transit time with and without your laxative to be sure.
The Common Laxatives
There are five major classifications of laxatives that can all have harmful side effects if used long term.
- Bulking: Psyllium, Bran, Cellulose
- Softening: “Stool Softeners” including Sodium and Calcium Sulfosuccinate
- Stimulant: Senna, Cascara, Caffeine (Coffee, Tea, Chocolate)
- Osmotic: Magnesium, Sodium Salts, Epsom Salt
- Lubricant: Mineral Oil
Stimulant, osmotic and softening laxatives have all been shown to compromise mineral and electrolyte absorption by accumulating water in the gut and slowing absorption. (7, 8)
Stimulants like senna, cascara, and caffeine, and osmotics like magnesium also act as intestinal irritants (9) that aggravate the intestinal mucosa and desensitize the intestinal wall causing constipation, malabsorption and dependency on laxatives with long term use.
*A note on magnesium: As mentioned above, long term use of magnesium at a dose that elicits a laxative effect can cause malabsorption. (6) Magnesium at non-laxative doses can be very helpful as magnesium is a common mineral deficiency.
Daily consumption of coffee and/or caffeinated tea can hide an underlying problem with constipation or sluggish digestion. Though some current studies imply that 1-2 cups per day of coffee can be good for you, more often than not it can irritate the bowels and cause intestinal hurry and thus malabsorption and nutritional deficiencies. If you need your daily cup of coffee or tea to move your bowels, try weaning off of these and follow my treatment protocol below.
Magnesium and other osmotic laxatives and stool softeners work by pulling water into the gut to soften a dry stool. With long term use these can dehydrate the gut wall and cause more intestinal dryness, irritation and reactive mucus production and a form of occasional constipation and malabsorption that is more difficult to treat.
Bulking agents like psyllium act in a similar way. They pull water off the gut wall, which dehydrates and ultimately irritates the bowel. The psyllium expands as it pulls more water off the intestinal wall, which causes the gut to distend. With long term use, the gut becomes dried out, dehydrated and overly bloated. The more distended the gut becomes, the less motile and the more chronic the constipation becomes.
Lubricants like mineral oil leave toxic residues in the mesenteric lymph, intestinal mucosa, liver and spleen while compromising absorption of water and nutrients through the gut wall. (10)
Don’t Be Fooled
I once had a patient who had an extremely bloated belly that distended so large and was tight like a drum. When I asked him how his digestion and elimination were, he said, “Perfect. Once a day. You can set your clock by it.”
I then had to explain to him that is it impossible to have perfect digestion with a belly so distended. The reactive mucus produced by stress was softening and regulating his stool, but compromising assimilation of vital nutrients while congesting and bloating lymphatic vessels around the gut.
Changing Your Diet Isn’t the Cure
Many folks find certain hard-to-digest foods like wheat, dairy, soy, corn, nuts and grains constipating so they stop eating them and think they have healed themselves because the elimination issue disappears. Again – don’t be fooled into thinking that avoiding hard-to-digest foods will fix an underlying digestive problem that might be the real cause of your digestive issues.
The fat soluble environmental toxins and heavy metals in the air we breathe also pollutes the soil and even the organic foods we eat daily. These toxins are very hard to detoxify and we cannot avoid them. A strong digestive system is how the body removes these toxins. Instead of just treating the symptoms by avoiding hard-to-digest foods, treat the cause by teaching your body to naturally become a great detoxifier, by first and foremost making it a great digester.
How to Support the Gut
Now that we know that stress dries out the gut, the first step in developing healthy elimination is to tone the bowel and then lubricate the intestinal villi and gut wall.
1. Triphala (also spelled Trifala) is a classic Ayurvedic formula that consists of three fruits which safely and effectively treat constipation (13):
- Haritaki tones the muscular wall of the gut.
- Amalaki heals the inner wall of the gut and villi.
- Bibhitaki pulls mucus and toxins off the wall of the gut.
I had one patient who claimed to have lost 50 pounds by taking just two capsules after each meal for two years as a post-digestive intestinal sweep. For her, increasing the efficiency of her elimination resulted in weight loss. While this is not always the effect we see in every case, its effectiveness at healing the gut has far-reaching benefits on all the body systems.
Triphala is not a harmful bowel irritating laxative like senna, cascara sagrada and others which are habit forming. Clinically, I find it useful as a bowel sweep for short term eliminative support when traveling and times of stress, and to help reset the lower digestive function.
For Dry Stools and Intestines
For elimination issues where stress causes intestinal dryness, a combination of Triphala and demulcent herbs like licorice and slippery elm can be very effective.
2. Elim I is a Triphala-based formula designed to tone, cleanse, soften, heal and lubricate the gut wall. Elim I is easily weaned off of once normal bowel function is established. The organic ingredients are:
- Slippery Elm Bark
- Licorice Root
- Small amount of Psyllium
How Elim I Works
The slippery elm and licorice are demulcents for the gut wall. When the gut gets stressed and dry it must be soothed with slimy healing demulcent herbs. These demulcents, in combination with Triphala, support the reset of healthy bowel function and the ability to quickly wean off of the herbal formula once elimination is balanced.
To activate this formula I need to bring water to the ingredients in the capsule as quickly as possible after digesting it. I always suggest taking Elim I with a large glass of water, but it wasn’t until I added just a very small amount of psyllium that these demulcent herbs became really active. This small amount of psyllium actually attracts just enough water to the capsule to activate the demulcent herbs and allow them to effectively lubricate the intestinal mucosa and gut.
As I mentioned above, I am not a big fan of psyllium as a bulking agent for regulating the stool. It sucks water off the gut wall and dehydrates the bowel, potentially making the sluggish bowels more chronic. But a very small, non-bulking dose of pysllium used to attract water to and activate the demulcent factors works brilliantly.
In a Nutshell
Developing healthy elimination is not always simple and often requires addressing many factors, including deep underlying emotional issues, chronic stress, and other digestive concerns. It is important to be aware of the risks involved when using even the most natural laxatives. Studies report that they can cause mineral deficiencies and compromised digestion, detoxification and immunity while not really solving this very important problem. In this article, I attempted to solve the most central factor relating to optimal elimination, which is the health of the gut wall.
There are many wonderful natural remedies for mild or occasional constipation, but please remember that chronic constipation is a medical concern and you should speak with your healthcare practitioner about it as soon as possible. This article refers mostly to occasional constipation. In the case of chronic constipation, do not delay medical treatment.
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