If you’ve ever struggled with constipation, you know how painful it can be. And with 15-20% (over 42 million people) in the United States struggling with it, you’re not alone.
I have personally done battle in the past with constipation, and it’s part of why I’m so passionate as a coach, about gut health and proper elimination.
Chronic constipation can be painful, even life limiting. It’s why so many people turn to OTC “quick fix” remedies. The discomfort is often intolerable.
When it comes to the options available to you in drugstores, one popular option is “herbal” laxatives. Most people see herbal laxatives and think that because it’s an herb, it’s safe, non habit forming, “natural”, and won’t have side effects.
When I was in my 20s, herbal laxatives were my go-to for constipation. Like most, I suppose I felt that if they were “herbal” it somehow meant they weren’t harmful in any way. I never paused to ask myself if using herbal laxatives was dangerous. In hindsight I should have, and in this blog I wanted to dive into the research on herbal laxatives to answer the question: are they dangerous?
Let’s first be clear: constipation is a serious issue. Often not viewed as a concern in conventional gastroenterology or mainstream medicine, constipation - if chronic- can have serious health consequences.
If you’re not regularly eliminating the waste of your body you’ll start recirculating it, which can cause inflammation, hormonal imbalance, and an increased risk of serious medical issues such as hemorrhoids, toxic megacolon and possibly colon cancer.
For more on the dangers of chronic constipation check out my blog here.
Constipation is a serious issue but what’s MOST important isnt to force a bowel movement but rather to identify and address why your body struggles to eliminate regularly in the first place.
I understand constipation is painful so to alleviate discomfort and get yourself pooping again as quickly as possible, you’ll likely need to begin a short-term supplemental intervention while simultaneously working at the root cause.
The question is… where do you start? What are your options? And most importantly, what is “safe?”
OTC Remedies for Constipation
Every year millions of prescriptions are written for medications to relieve constipation. This, of course, doesn’t account for the untold numbers who decided to self-medicate with over-the-counter laxatives versus going to the doctor.
And I don’t blame them. Conventional medicine is well known for not taking constipation seriously. Discussing your bowel struggles with a stranger can be embarrassing enough, and it’s made worse when their only solution is to tell you to take Miralax or Metamucil.
It’s why laxatives are a 600 million dollar a year market.
In addition to herbal laxatives there are also other remedies like enemas,teas, and non-stimulatory vitamin laxatives.
Unfortunately, many people are marketed into opting for herbal laxatives because of the terms “herbal” and “natural.” These terms create the belief that they’re safer or better for dealing with constipation than other ideas.
Sadly, this isn’t the case.
Just because anyone can walk into the store and purchase vitamins or supplements without a prescription, or order them online with the swipe of a finger, doesn’t mean using supplements should be taken lightly.
Many herbal supplements can have negative effects based on bio individuality, interactions with other supplements or medications, or droending on dosage and frequency of use.
Anything you put into your body should be taken seriously.
The Truth About Herbal Laxatives
Herbal laxative use is prevalent. Over the last few decades it’s widespread use has caught the eye of the research communities and is becoming a topic of interest.
Although the literature hasn’t cemented any truths (yet), the safety of herbal laxative use is up for debate.
Several studies have looked into links between herbal laxatives and colon cancer and the jury is still out. Other studies are even finding that certain compounds in herbal laxatives have genotoxic effects (meaning they damage DNA code).
Still, other research indicates the effects are minor and/or cannot be considered a cause of herbal laxative use.
But before I dive deeper into the studies I want be clear on exactly what herbal laxatives are.
What are in herbal laxatives?
If you go to the store and pick up a product that contains an herbal laxative it will likely include one or more of the following compounds:
Aloe latex
Cascara
Frangula
Rheum (Rhubarb)
Senna
All of these are herbal stimulant laxatives, frequently found in teas, pills and liquids.
How Do Herbal Laxatives Work?
These herbs contain compounds known as anthranoids. There are several types of anthranoids and each herbal laxative has a different type or combination of them.
Anthranoids act on the colon as stimulant laxatives by inducing intestinal peristalsis.
Though it isn’t precisely known, it is believed that colonic gut flora aids in metabolizing compounds into usable form. These active compounds then stimulate peristalsis, interact with nerve fibers in the colon, and disrupt electrolyte levels, which affects water reabsorption in the colon.
Stimulant laxatives can physically irritate the colon causing contractions that can sometimes be very painful. This increases the rate at which food passes through your colon and can affect nutrient and water reabsorption.
But this is also how they stimulate elimination and therefore, alleviate constipation.
Are Herbal Laxatives Dangerous?
Look, there’s no doubt that constipation should be relieved and that going on a regular basis is better than not going. But in the case of herbal laxatives the research is still ongoing and there are some real concerns for you to be aware of.
There are four ways that herbal laxatives can be dangerous:
Melanosis coli and possible increased cancer risk
Electrolyte imbalance
Physical dependence
Psychological dependence
Let’s dive deeper into each of these areas so you’ll fully understand the risks of these products. Starting with the scariest: cancer risk.
Herbal Laxatives = Melanosis Coli = Cancer?!?
Certain studies suggest anthranoids have carcinogenic and mutagenic effects. Scientists have seen that these compounds cause melanosis coli – which really just means the cells in your colon turn a dark color. This is a potentially big deal because it’s been thought that melanosis coli could be a precursor to troubles like colon cancer.
However this has not been proven. At least not right now. Earlier claims of melanosis coli-cancer connection are being refuted.
Some studies are now reporting that there’s actually no significant risk from herbal laxative use in regards to cancer, even going so far as to say that the coloring of colon cells from anthranoid use is not related to colon cancer.
However, anthranoids have been shown to induce apoptosis in high dosages. Apoptosis is when a cell explodes itself (a.k.a. cell kamikaze).
Apoptosis is a natural mechanism the body has for protection. If a cell is damaged, and it recognizes this, it has the ability to commit suicide for the betterment of the group. But inducing apoptosis through herbal laxative use is cause for concern as that study shows senna usage resulted in altered colonic crypt lengths.
How can something that is killing cells in your colon be ok?
In my opinion it can’t be. And although herbal laxatives have not been conclusively linked to cancer, it is concerning enough to me that I would not be willing to risk it.
You’re Not Just Losing Poop in That Toilet
If you have used herbal laxatives, I’m guessing you have experienced their ability to “clean you out.” Well, it turns out that it’s not just waste that you are dumping into the toilet.
When you have these kind of stimulated bowel movements you also lose sodium, potassium, and a bunch of water. In other words, you lose a bunch of electrolytes into the toilet as well. It has been reported that individuals who overuse herbal laxatives - particularly cascara which is, in my opinion, the most harsh of the herbal laxatives- display hypokalemia (a severe depletion of potassium), dehydration, and acidification of their system.
Consumption of certain herbal laxatives while taking other drugs can increase the risk of hypokalemia – a double whammy.
Chronic overuse of laxatives can also cause raised levels of aldosterone, impaired kidney function, muscle weakness, thirst, and edema.
And in rare cases herbal laxatives have been linked to bloody diarrhea, vomiting and even death.
All laxatives that cause a good clean out will affect electrolyte levels. I couldn’t find any comparison studies of laxatives. However, the studies above focus specifically on herbal laxatives, which is worth noting.
You Can Become Physically Dependent Upon Herbal Laxatives
Physically, you can become dependent on laxatives for bowel movements, especially if used chronically.
The irritation caused by herbal laxatives can create what I call a lazy GI tract and if used harshly enough and frequently enough can actually destroy parts of your colon.
In some cases, mucosal lining was altered to the point where the natural folds that make up the inside of the intestine turned smooth.
Basically, the colon can lose its shape, form, and elasticity.
This can make it really hard to stop taking laxatives once you’ve started. Your colon actually doesn’t function the way it is naturally designed to when chronically using herbal laxatives.
This is a serious issue for those who want to stop using them at some point and fix the root issue of their constipation.
The process of trying to retrain and repair the colon takes time and can be embarrassing and painful, which may cause many to just start back on the laxatives.
Getting Addicted to Stimulated Bowel Movements
While physical changes in the colon sounds scary, I think an underrated source of concern is the psychological dependence.
Competing in frequent figure shows had caused me to struggle incessantly with constipation. When it got bad enough, and I was so uncomfortable I could hardly stand it, it was the only thing I could think about; I wanted to poop and I wanted to go now.
And when I would find something that worked- a food, a routine, a supplement, I was instantly hooked. But in the long-run this sets up a very serious problem of addiction to routines and pills.
Our brains have an amazing ability to create new habits through what’s called neuroplasticity.
In simple terms, neurons that fire together wire together and those connections become deeper over time. Which in this context means that if you take herbal laxatives over and over, to get rid of pain and poop, your brain begins to wire together that you forever need those laxatives.
Over time, it’s easy to start believing it’s the only thing that will make you have a bowel movement.
Now, it’s true this habit pattern can also form in relation to other things such as coffee or exercising (both of which are other ways people try to stimulate bowel movements). So, this is not just an issue with herbal laxatives, but combined with the other three risk factors I think they’re an even worse choice for those who are constipated.
What are Safer Alternatives For Constipation?
Herbal laxatives can be “acceptable” for short term use (1-2 weeks) but in my opinion, based on my personal experience, the research and their addictive nature, are best avoided altogether.
In my opinion, there are many other safer ways, as well as more natural, to relieve constipation.
Please, don’t ever forget that constipation- while not “okay”- is entirely solvable. It’s not permenant. Most importantly, it is a symptom of a bigger issue, and your body’s way of communicating to you that something os wrong.
If you want to get rid of constipation, once and for all, then the best thing you can do is:
Investigate the root cause. A healthy bowel produces a healthy bowel movement. There’s a reason you’re constipated. Your body is speaking to you. Listen!
Work with someone who can help you discover how to support the body naturally. By “naturally” I mean by primarily helping you make the necessary dietary shifts and implement proper lifestyle intervention. Strategic supplementation can help as a short term means of symptom alleviation, but ultimately the goal should be to address the root cause.
I am proud to say that one of my passions- and greatest successes- as a coach, is helping clients live life free of chronic constipation. I have successfully overcome my own, and I am confident I can help you overcome yours.
Book a free 15 minute coaching call here!