Laxatives: Risks And Realities

Laxatives are medicines that treat constipation by softening stools or stimulating bowel movements. They are generally considered safe for occasional use, but they can cause problems when misused or overused, including chronic constipation and dehydration. While laxatives can be purchased over the counter, it is important to use them sparingly and only as directed to prevent side effects such as bloating, gas, and stomach cramps. They should not be used for weight loss, as this can be dangerous and lead to dehydration, electrolyte imbalance, and other serious health issues. Instead, a healthy diet, regular exercise, and adequate fluid intake are recommended to prevent constipation.

Laxatives for weight loss

Laxatives are medications used to treat constipation by stimulating bowel movements or loosening stool to ease its passage. They are not intended for weight loss and can be dangerous if used for this purpose.

How laxatives work

There are five types of laxatives, and they act on your intestines in different ways:

• Bulk-forming laxatives: These add soluble fiber to your stool, which breaks down easily in water and becomes a gel, helping your colon hold onto water. This softens the stool and makes it easier to pass.
• Stool softeners: These help mix water into the stool, making it softer and easier to pass.
• Lubricant laxatives: These coat the stool and make it slippery, allowing it to pass out easily.
• Stimulant laxatives: These make the muscles in your intestines squeeze, moving the stool along. They can be harsh on the body and cause cramping.
• Osmotic laxatives: These pull water from the body into the bowel, helping it hold onto water and softening the stool to pass more easily.

Why laxatives don't work for weight loss

The temporary weight loss that may be experienced from taking laxatives is due to water loss, not fat loss. Laxatives do not reduce body fat or promote long-term weight loss. Even at high doses, stimulant laxatives have only a "modest effect" on calorie absorption.

The dangers of using laxatives for weight loss

Using laxatives for weight loss can lead to serious side effects, including:

• Dehydration: Laxatives cause water loss, which can lead to dehydration and associated symptoms such as headaches, reduced urine output, increased thirst, fatigue, dry skin, and dizziness. Dehydration can also cause more serious complications, including heart problems and kidney failure.
• Electrolyte imbalance: Laxatives can cause an electrolyte imbalance, leading to symptoms such as thirst, headaches, heart palpitations, fatigue, weakness, and muscle aches. In severe cases, an electrolyte imbalance can be life-threatening.
• Constipation and diarrhea: Prolonged use of laxatives can cause loss of bowel muscle tone, leading to constipation and/or diarrhea.
• Damage to intestines: Overuse of laxatives can damage the intestines and increase the risk of colon cancer.
• Interference with medications: Laxatives can interfere with the effectiveness of prescription medications.
• Eating disorders: People who use laxatives for weight loss are more likely to develop an eating disorder.

Safe weight loss strategies

Instead of using laxatives, safe and effective ways to lose weight include:

• Regular exercise
• Eating more fruits and vegetables
• Reducing portion sizes
• Eating a high-protein breakfast
• Decreasing intake of added sugars
• Eating a nutritious, balanced diet

Laxatives and dehydration

Laxatives are intended to be used medicinally to treat constipation. However, some people misuse them in an attempt to lose weight. This is dangerous and can cause dehydration, among other health issues.

Laxatives work by softening stools, making them easier to pass, or by stimulating the lower intestine to push out the stool. They do not prevent the body from absorbing calories, and they can create dependency and worsen constipation if overused.

Laxatives deplete the body of water, and the resulting dehydration can lead to tremors, fainting, weakness, blurred vision, and even organ damage and death in severe cases. The body compensates for dehydration by retaining water, which can cause bloating.

Dehydration is also observed when saline laxatives are used for constipation treatment if fluid replacement is not maintained, which can affect the treatment's efficacy.

Laxative abuse can also cause electrolyte imbalances, as they are lost at abnormally high rates in diarrhoea. Electrolytes such as sodium, potassium, and chloride are essential for the proper functioning of nerves and muscles, including the heart. Electrolyte imbalances can lead to tremors, vomiting, urinary tract infections, kidney failure, muscle spasms, and heart attacks.

To avoid dehydration and other health risks associated with laxative use, it is important to use them as directed by a doctor and not for weight loss.

Laxatives and eating disorders

Laxatives are a valuable tool for treating constipation, but they can also be misused by people with eating disorders. People with eating disorders may use laxatives to eliminate unwanted calories, lose weight, "feel thin", or "feel empty". However, this is based on the misconception that laxatives can rush out food and calories before they are absorbed by the body. In reality, by the time a laxative acts on the large intestine, most foods and calories have already been absorbed by the small intestine. Therefore, the weight lost through laxative misuse is mostly water weight, which returns as soon as the person rehydrates.

Laxative misuse can lead to a variety of health complications and even life-threatening conditions. It can cause dehydration, which can lead to tremors, weakness, blurry vision, fainting, kidney damage, and in extreme cases, death. It can also disturb the balance of electrolytes and minerals such as sodium, potassium, magnesium, and phosphorus, which are necessary for the proper functioning of nerves and muscles, including those of the colon and heart. Overuse of laxatives can lead to laxative dependency, where the colon stops reacting to usual doses and larger amounts are needed to produce bowel movements. This can result in internal organ damage, including a stretched or "lazy" colon, colon infection, irritable bowel syndrome, and, rarely, liver damage. Chronic laxative misuse may also increase the risk of colon cancer.

Treating laxative misuse requires working with a team of health professionals with expertise in treating eating disorders, including a physician, psychiatrist, psychotherapist, and dietician. Support from close friends and family can also be helpful. It is important to seek help if you or someone you know is struggling with an eating disorder or laxative misuse.

Laxatives and prescription medications

Laxatives are medicines for constipation. They are typically recommended by doctors only if you are experiencing problems passing stool and have already tried increasing your fibre intake, exercising regularly, and drinking more water.

There are five types of laxatives, each acting on your intestines in different ways:

• Bulk-forming laxatives add soluble fibre to your stool, which breaks down easily in water and becomes a gel, helping your colon hold onto water.
• Stool softeners mix water in with the stool, softening it enough to pass.
• Lubricant laxatives coat your stool and make it slippery, allowing it to pass out easily.
• Stimulant laxatives make the muscles in your intestines squeeze and move the stool along. However, they can be harsh on your body and cause cramping.
• Osmotic laxatives pull water from the rest of your body into your bowel and help it retain water, thus softening your stool and aiding its passage.

Laxatives should not be used for weight loss, as this can be dangerous and cause dehydration, electrolyte imbalance, constipation, damage to the intestines, and interference with prescription medications.

If you are experiencing constipation, over-the-counter (OTC) laxatives are usually the first course of action. However, if these do not provide relief, your healthcare provider may recommend a prescription laxative. OTC laxatives are meant for very short-term use, and overusing them could worsen constipation and lead to serious medical problems. They can even be addictive.

Prescription laxatives are typically used for treating chronic constipation with no known cause, constipation related to a condition (such as irritable bowel syndrome), and opioid-induced constipation. They are not meant for rapid relief of occasional constipation but rather to maintain regularity when constipation is a persistent issue.

Several types of prescription laxatives are available, including:

• Osmotic laxatives, such as polyethylene glycol (PEG) 3350 (brand names: Miralax, GlycoLax, Healthylax, and Smooth LAX) and sorbitol, which draw water into the bowel to soften the stool.
• Prokinetic agents, such as Motegrity (prucalopride), cause the gastrointestinal tract to contract and push materials through.
• Secretagogues, including Amitiza (lubiprostone) and Linzess (linaclotide), pull water into the bowel to soften the stool but through a different mechanism than osmotic laxatives.
• Opioid antagonists like Relistor (methylnaltrexone), Movantik (naloxegol), and Symproic (naldemedine) are used to relieve constipation caused by opioid medications.

Laxatives and chronic constipation

Laxatives are medicines for constipation. They are usually recommended by doctors only if you have problems passing stool and after you have tried other methods such as eating more fibre, exercising regularly, and drinking more water.

There are five types of laxatives:

• Bulk-forming laxatives: These add soluble fibre to your stool, which breaks down easily in water and becomes a gel, helping your colon hold onto water. This softens your stool and makes it easier to pass.
• Stool softeners: These help mix water in with the stool, making it soft enough to pass.
• Lubricant laxatives: These coat your stool and make it slippery so that it can pass out easily.
• Stimulant laxatives: These make the muscles in your intestines squeeze and move the stool along. However, they can be harsh on your body and cause cramping.
• Osmotic laxatives: These pull water from your body into your bowel and help it hold onto water, softening your stool and aiding its passage.

While laxatives can be effective in treating constipation, they should be used sparingly and with caution. Misuse or overuse of laxatives can lead to problems, including chronic constipation. It is important to remember that laxatives are not a substitute for a healthy diet and lifestyle. A diet rich in fresh fruits, vegetables, and whole grains, regular exercise, and adequate fluid intake (at least eight 8-ounce cups of water or other fluids like tea and soup) can help prevent constipation in most people.

If you are experiencing chronic constipation, it is important to consult your doctor. They can evaluate your medical history, perform a physical exam and lab tests, and determine the exact cause and appropriate treatment for your condition. Chronic constipation may be a warning sign of a more serious underlying issue, such as colon cancer, diabetes, or hypothyroidism.

Frequently asked questions