By Dr. Mercola
Americans spend more than $700 million a year on over-the-counter (OTC) laxatives to treat constipation.1
However, you must use extreme caution when using such products, as they can have unintended consequences that make your bowel function worse or, as the US Food and Drug Administration (FDA) recently warned,2 may even be deadly.
If you struggle with constipation, you can often find relief by making some simple changes to your diet and lifestyle… drugs, including laxatives, should only be used as an absolute last resort -- if at all.
FDA Warning: 13 Deaths Linked to OTC Laxatives
The FDA released the warning following 13 deaths (12 adults and one child) that occurred after use of OTC saline laxatives (including brand name Fleet and others). The products contain the active ingredient sodium phosphate, which draws water into your bowel to help soften your stool, allowing it to pass easier.
However, if too much is taken, the laxatives can lead to dehydration and abnormal levels of electrolytes in your blood, which can cause kidney damage, heart problems, and death. According to the FDA:
"…using more than one dose in 24 hours of over-the-counter (OTC) sodium phosphate drugs to treat constipation can cause rare but serious harm to the kidneys and heart, and even death. OTC sodium phosphate drug products include oral solutions taken by mouth and enemas used rectally.
FDA has become aware of reports of severe dehydration and changes in the levels of serum electrolytes from taking more than the recommended dose of OTC sodium phosphate products, resulting in serious adverse effects on organs, such as the kidneys and heart, and in some cases resulting in death. These serum electrolytes include calcium, sodium, and phosphate."
More Than 50 Reports of Serious Adverse Reactions to Saline Laxatives
In all, the FDA has received 54 reports of side effects linked to the saline laxatives, with overdoses occurring by taking a single dose that was higher than recommended, or taking more than one dose in one day (presumably after the first dose didn't work).
It's thought that the actual number of people experiencing side effects from these products could be much higher, as many do not report their symptoms to the FDA. According to the FDA, the following groups are at higher risk of serious complications from the use of saline laxatives:
- Young children (FDA warns that children 2 and under should not be given the rectal form of these products and those 5 and under should only use the oral forms under the direction of a health care professional, and even then with extreme caution)
- People aged 55 and older
- People with kidney disease, bowel obstruction, or inflammation of the bowel
- People taking medications that affect kidney function, including diuretics or water pills; angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) used to treat high blood pressure; and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen
Your Body Can Also Become Dependent on Laxatives
Another crucial reason why laxatives are NOT a good option is that your body may become dependent on them. This is especially true with stimulant laxatives (such as brand name Exlax), which work by increasing the contraction of muscles in your intestines. This risk also applies to senna or cassia laxatives, which are frequently marketed as "natural."
These laxatives may decrease your colon's ability to contract and over time may damage your large intestine's nerves, muscles, and other tissues. The cumulative lifetime use of commercial laxatives has even been associated with increased risk of colon cancer.3
For these reasons, and because constipation is usually easy to remedy naturally, laxatives should be avoided at all cost and used only as a last resort. If you absolutely must use a laxative, make sure it is used for only a very short period of time.
What Causes Constipation?
The reason there's such a large market for OTC laxatives is because constipation is such a prevalent condition in the US. It's estimated that up to 19 percent of Americans struggle with constipation, although it becomes even more common with increasing age, and women often get constipated more often than men.4
Constipation is defined as passing hard, dry stools that you have to strain to move, and it's typically accompanied by decreased frequency of defecation. Straining is not normal, nor is experiencing feelings of incomplete elimination, bloating, crampiness, or sluggishness after going number two. If you're over the age of 65, your risk of becoming constipated increases significantly.
Regular bowel movements are extremely important for your health because, without them, toxins accumulate and are recirculated in your bloodstream. If elimination is not regular and complete, the wastes will dry and become cemented to the walls of your colon.
Chronic, untreated constipation can lead to fecal impaction,5 which can be a serious medical condition. Constipation has also been shown to increase your risk of colon cancer and has been implicated in diverticulosis and appendicitis.
Some of the common causes of constipation include laxative abuse, hypothyroidism, irritable bowel syndrome (IBS), and ignoring the urge to go. If you consistently ignore the urge to have a bowel movement – for instance, to avoid using a public toilet – eventually you may stop feeling the urge. While conventional medicine typically defines constipation as fewer than two or three bowel movements a week, you should really be having one bowel movement a day, and preferably two or three. So if you are having less than one bowel movement per day, you should take steps to increase them.
The Number One Step to Remedy Constipation? Eat More Vegetables (i.e. Fiber)
If you're constipated, you should tweak your diet so that it includes whole foods, particularly fresh, organic vegetables and fruits that provide good nutrients and fiber; most of your fiber should come from vegetables, not grains. Grains actually contain anti-nutrients that may damage your health. Ironically, since we're often told that whole grains are one of the best sources of fiber for our health, the high-fiber bran portion of grain – a key part that makes it a whole grain -- actually contains many of the anti-nutrients.
Also, grains contain sticky, pasty proteins known as prolamines (which include gluten in wheat), which largely cancel out any benefit you think you are getting from the relatively "higher fiber" they contain versus processed grains.
Assuming your gut is generally healthy, I believe most people need upwards of 32 grams of fiber a day. Most Americans get nowhere near this amount. If your diet could use more fiber, resist the urge to fortify it with whole grains. Instead, focus on eating more vegetables, nuts, and seeds. The following whole foods, for example, contain high levels of soluble and insoluble fiber
Chia seeds Berries Vegetables such as broccoli and Brussels sprouts Root vegetables and tubers, including onions and sweet potatoes Almonds Psyllium seed husk, flax, and chia seeds Green beans Cauliflower Beans Peas
Fermented Foods Will Also Help Support Healthful Bowel Movements
The human digestive system is not designed to break down fiber. Instead, it ends up undigested in your bowel, where the majority of your gut flora resides. If your gut flora is healthy, i.e. dominated by beneficial, probiotic species, then these microbes will feed on the fiber and proliferate.
However, if your gut is filled with pathogenic bacteria and/or yeast and fungi, fiber may actually make your symptoms worse, as it is a non-specific growth factor for intestinal bacteria, and does not discriminate between pathogenic and beneficial bacteria. So, if your bowel is predominantly dominated by pathogenic microbes, pathogenic microbes will feed on fiber and proliferate, making whatever health problems you have worse.
So while increasing fiber from vegetables is important if you're constipated, so, too, is making sure you're introducing that fiber to a healthy gut environment. The key to doing this is to reduce your intake of excess sugar while adding naturally fermented foods into your diet, such as (non-pasteurized) sauerkraut, pickles, and kefir (if you tolerate dairy). You can also add a probiotic supplement if you suspect you're not getting enough beneficial bacteria from your diet alone. Probiotics have, in fact, even been shown to help relieve constipation among one particularly constipation-prone population – pregnant women.6
Additional Tips for Remedying Constipation Naturally
Constipation can be extremely uncomfortable, even painful, but it's also one of the easiest conditions to resolve without the use of potentially deadly drugs like laxatives. If you were to take one supplement for constipation, magnesium would win hands down. In fact many popular constipation remedies, like milk of magnesia, consist of magnesium. Since most people are deficient in this important mineral that would be a good choice.
Also if you are taking calcium, stop that, as calcium will constipate you. Interestingly, narcotic analgesics like codeine and hydrocodone also have similar effects.
Mechanical therapies like squatting are another phenomenal choice. There are even devices that will allow you to assume a squatting position while you are seeking to have a bowel movement. This prevents constipation in four ways:
- Gravity does most of the work. The weight of your torso presses against your thighs and naturally compresses your colon. Gentle pressure from your diaphragm supplements the force of gravity.
- The ileocecal valve, between your colon and small intestine, is properly sealed, allowing your colon to be fully pressurized. The pressure creates a natural laxative effect. In the sitting position, the IC valve is unsupported and tends to leak, making it difficult to generate the required pressure.
- Squatting relaxes your puborectalis muscle, which normally chokes the rectum to maintain continence.
- Squatting lifts your sigmoid colon to unlock the "kink" at the entrance to the rectum. This kink also helps prevent incontinence by taking some of the pressure off your puborectalis muscle.
In addition to modifying your diet as described above, other effective constipation relief and prevention strategies include:
- Remove all sources of gluten from your diet (the most common sources are wheat, barley, rye, spelt, and other grains)
- Avoid artificial sweeteners, excess sugar (especially fructose), chemical additives, MSG, excessive amounts of caffeine, and processed foods as they are all detrimental to your gastrointestinal (and immune) function
- Make sure you stay well hydrated with fresh, pure water
- Get plenty of exercise daily
- Avoid antidepressants, antacids (like calcium), blood pressure medications, and iron supplements, as they may also contribute to constipation
- Address emotional challenges, such as avoidance of public restrooms, with tools like EFT