Millions of Americans experience chronic constipation. But laxatives might not be the answer. Here’s why.
The United States is a constipated nation.
Constipation complaints account for more than 2.5 million doctors’ visits every year — and those are just the people who seek treatment. Doctors suspect that many others struggle with slow transit time (close to one in three Americans, by some estimates) but that most folks are too sheepish to seek help. Following the money, however, helps fill in the blanks: Americans spend hundreds of millions of dollars every year on laxatives.
Interestingly, humans have fretted about the dangers of slow transit time since the beginning of recorded health literature. An Egyptian papyrus from the 16th century BC warns that constipation is the root of all disease, arguing that decomposing food in the colon releases material that poisons the body.
Today, that ancient hypothesis still holds up. Most of the toxins, heavy metals, and drugs we encounter every day are directed quickly to the colon — to take the very next train out of the body. If that train is running late, though, those toxins can get reabsorbed and cause more health problems than they might have in the first place.
Laxatives, however, may not be the answer. We tend to think of laxatives as a benign source of relief, offering fast results with very few side effects. But laxatives have a downside — and given the amount we’re consuming, it’s worth taking a closer look at these over-the-counter remedies.
The Trouble With Laxatives
Laxatives work in one of four ways: by stimulating the lining of the intestines to push stool through the system faster; by drawing water into the colon to soften the stool; by introducing a lubricant, like mineral oil, to create a type of internal water slide for stool; or by bulking up the stool with fiber so the colon is stimulated naturally to push it through the system quickly. But overuse of laxatives can lead to several problems:
Laxative dependency. Chronic laxative use can make the colon forget how to do its regularly scheduled job. “Laxatives can interfere with the enteric nervous system,” says Thomas Sult, MD, a functional-medicine practitioner in New London, Minn. The enteric nervous system is the part of the autonomic nervous system that governs gastrointestinal function.
Colon damage. Research has found that long-term use of stimulant laxatives, like over-the-counter Correctol and Dulcolax, can cause muscle and nerve injury in the large intestine. Chronic, sustained use of stimulant laxatives also correlates with the development of a condition called melanosis coli, in which the cells of the colon wall become damaged and die. This cell death can take place in the course of just a few months of laxative use. And it isn’t just triggered by synthetic stimulant laxatives. Sult notes that natural laxatives, like aloe vera and senna, can cause the same negative cellular changes.
GI problems. Osmotic laxatives, like milk of magnesia and magnesium citrate, draw water into the colon to soften the stool. Though this can make stool easier to pass, it can also cause more gastrointestinal issues like bloating and diarrhea. And because these medications pull fluid from the rest of the body, they can lead to dehydration and electrolyte imbalances.
Vitamin and mineral deficiencies. When taken for longer than a week, lubricant laxatives like mineral oil can affect how the body absorbs vitamins, minerals, and other medications.
Possible neurological problems in children. Miralax, a common over-the-counter osmotic laxative, is currently under FDA review following reports that the drug has caused neuropsychiatric problems in children. Ongoingresearch, as well as significant anecdotal evidence, has linked the polyethylene glycol in Miralax to side effects like aggression, paranoia, anxiety, and depression. “There are reports of Miralax and neurotoxicity,” Sult confirms. “If you ask someone at a major hospital or clinic if Miralax causes neurotoxicity, they’ll say, ‘No, that’s ridiculous.’” But if you look around, you can see case reports. It stems from the glycol.”
How to Stay Regular
So how do you keep the trains running on time? Here are the top tips for preventing constipation.
Fill up on fiber. The NIH defines constipation as having three or fewer bowel movements a week or straining to pass hard, small stool at least 25 percent of the time. One of the key reversal strategies is to eat more whole-food sources of fiber, which are even better than fiber supplements because of the accompanying phytonutrients. Think legumes, broccoli, Brussels sprouts, peas, artichokes, blackberries, raspberries, and avocados. Ground flaxseed is another great source of fiber. You can add a tablespoon to smoothies or low-glycemic baked goods.
Supplement as necessary. Though it’s best to increase your fiber intake with fiber-rich whole foods, there are times when fiber-rich supplements can be a fine addition to your medicine cabinet: while traveling, when circadian disruption can trigger slow transit time; after a major surgery or injury, when a course of necessary painkillers might lead to sluggish bowels; or just after pregnancy, when shifts in the internal geography can slow things down.
Stay hydrated. Drink at least half your body weight in fluid ounces of clean, filtered water every day.
Cut out constipating foods. Dairy is a known trigger for constipation. But it’s just one of a handful of foods that can be linked to slow transit time (as well as symptoms like fatigue, brain fog, bloating, and joint pain). Doing an elimination diet can help identify if food is playing a role in chronic constipation. “The elimination diet is the gold standard for detecting food sensitivities,” says Sult. For children who resist doing a full elimination diet, simply cutting out dairy might improve transit time.
Embrace fermented foods. Friendly ferments like sauerkraut, kimchi, kombucha, coconut yogurt, and kvass can really help keep things moving. A bonus? You don’t need much. Think of fermented foods as condiments — a teaspoon of sauerkraut on a salad or a shot of kvass can be all it takes to regulate your internal transit time.
Slow down. Today’s digestive-distress epidemic is fueled by stress, and now, more than ever, we live stressed and isolated lives, says Sult. We’re always moving from one task to the next and eating on the run. “Think about sitting down to dinner, having a social meal,” says Sult. How you eat calms the enteric nervous system — and that can be as instrumental in keeping you regular as what you eat.