Twenty-six percent of people reported constipation in one study by the American Cancer Society that surveyed 1,064,004 men and women(1). Few people realize that constipation significantly increases the risk for colon cancer(2), poor immunity, fatigue and deficiencies.
Do Natural Laxatives Work?
In one meta analysis of over 250 studies, laxative therapies showed no noticeable difference than 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).
Natural Laxatives are Dangerous!
The harmful and dangerous 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, or even a daily cup of coffee or tea is harmless.
New reports list the risks and dangers of poor digestion.
Let’s investigate the cause of poor digestion, constipation, appropriate treatments and the risk that even “natural laxatives” may be dangerous and habit forming.
What Is the Cause of Poor Digestion?
There are actually more stress receptors in the gut than there are in the brain.
95% of the serotonin in the body is manufactured and stored in the gut(5). Other stress receptors like dopamine and nor epinephrine (adrenaline) are also abundant in the gut making the gut the first responder for stress(5). The gut has it’s very own nervous system called the Enteric Nervous System (ENS) which is totally independent of the Central Nervous System (CNS). When the ENS (your gut) feels stress, it manufactures stress fighting hormones, then stores these hormones and delivers the appropriate stress response to the heart, brain, CNS and any other system that needs to respond. The message the gut delivers is the one that controls your state of mind.
I am sure this does not come as a surprise since it’s common to feel stress, nervousness, anxiety and butterflies in the gut. Yup, the gut is where we first learn to suck it up as kids, deal with adversity and emotional trauma and cope with an unfriendly world.
In Ayurvedic Medicine the gut is the seat of the nervous system. Stress will cause poor digestion way before symptoms of fatigue, anxiety, depression and others 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 in their guts.
Stress impacts the gut wall and compromises blood supply and lymph drainage to the intestinal tract which dries out the mucus membranes and often results in constipation.
Years of stress and constipation cause the intestinal mucosa to produce reactive mucus as an attempt to soften the stool and improve elimination – but this only provides temporary symptomatic relief. Many laxatives mimic this effect, but with dangerous 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 “gastrointestinal hurry” where the food moves too quickly through the gut to be properly absorbed(7). Chronic laxative users can have somewhat regular bowel movements but can be chronically run down and tired due to various mineral and nutritional deficiencies.
Do You Have Gastrointestinal Hurry?
Normal transit time can vary from 14-24 hours depending on the individual. Less than a 12 hour transit time could indicate malabsorption due to gastrointestinal hurry. Some folks with naturally loose or softer stools may be at risk here as well. Eating beets or corn are usually good markers to measure the 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 then you are experiencing gastrointestinal hurry and are at risk of chronic nutritional deficiencies.
Even Natural Laxatives Can Create Gastrointestinal Hurry
Magnesium, senna, caffeine and cascara are common laxatives that cause gastrointestinal hurry and malabsorption. Magnesium has been found to cause malabsorption at dosages as low as 250mg per day(8). Check your transit time with and without your laxative to be sure.
The Common Laxatives
There are five major classifications of laxatives that all have harmful side effects if used long term. They are:
- Bulking: psyllium, bran, cellulose.
- Softening: “Stool Softeners” 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 due to accumulating water in the gut and slowing absorption(9,10).
Stimulants like senna, cascara, and caffeine and osmotics like magnesium also act as intestinal irritants(11) that aggravate the intestinal mucosa and desensitize the intestinal may cause constipation, malabsorption and dependency on laxatives.
Coffee and black tea can hide an underlying problem with constipation or sluggish digestion. Though some current studies imply that 1-2 cups of coffee are good for you, it can irritate the bowels and cause gastrointestinal hurry and thus malabsorption and nutritional deficiencies. If you need your daily cup of coffee or tea to move your bowels then 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 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(12).
Don’t Be Fooled
I once had a patient who had an extremely bloated belly that distended so large it was tight like a drum. I asked him how his digestion and elimination were and 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 constipation disappears. Again – don’t be fooled that avoiding hard to digest foods fixes an underlying digestive problem.
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 detoxifies itself. Don’t just treat the symptoms by avoiding hard to digest foods – treat the digestion.
How to Support the Gut
As stress dries out the gut, the first step in treating constipation is to tonify the bowel and then lubricate the intestinal villi and gut wall.*
Triphala is a classic Ayurvedic formula that consists of three fruits that safely and effectively treat constipation(13):
- Haritaki tones the intestinal muscle
- Amalaki nourishes the inner wall of the gut and villi.
- Bibhitaki pulls mucus and toxins off the wall of the gut.
I had one patient who lost 50 pounds by taking just two capsules after each meal for two years as a post digestive intestinal sweep.With more efficient elimination she lost weight but that is not the effect we expect to see or see regularly.* 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 healing of the gut, eliminative support when traveling and times of stress.
For Stubborn Elimination
For severe chronic constipation Triphala alone is not potent enough. Stress causes significant intestinal dryness which is best treated with a combination of Triphala and demulcent herbs like licorice and slippery elm.
Treating constipation is not always simple and often requires addressing many factors, including deep underlying emotional issues and chronic stress. 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.