5 THINGS YOU NEED TO KNOW ABOUT LAXATIVES

Laxative use is a topic that comes up with our clients a lot. Many of our clients have been taking laxatives for years, as a way to deal with feeling full or to make up for calories from food. In this blog, Shannon (lead Nutrition Counsellor at Ease Nutrition Therapy) provides essential facts about laxatives. She also writes about 5 top things you need to know about taking laxatives. Including the dangers of laxatives, how laxatives are used in bulimia, and common questions we're asked in clinic.

We have a part two of this blog here, all about how to stop taking laxatives. We recommend reading this when you're ready to take action to stop using laxatives.

What are laxatives?

Laxatives are used to treat constipation. But as they often make the body feel emptier as they help make bowel movements easier and faster.

Which is why they became a tool for those struggling with disordered eating. You might be someone who tries to purge food or calories with laxatives. You're not alone if you do.

In fact, a recent survey found that taking laxatives was more common than fasting for quick weight-loss. If you're one of the 52% of woman who've taken laxatives to lose weight; you are truly not alone.

Up to 75% of those experiencing anorexia with a binge-purge subtype or bulimia nervosa abuse laxatives (1).

Laxative abuse sounds pretty scary. But it’s a common reality for many people. ''Laxative abuse'' is the recurring use of laxatives to purge. If you’re prescribed laxatives by a medical professional you aren't abusing laxatives. But, if you’re using them to make up for food or calories, or to lose weight, then you might be abusing them.

If you find yourself reaching for laxatives after a binge it can be easy to become dependent on them. Especially as you can buy them in packs of hundreds. But what do laxatives do to your body? The clients we see at Ease Nutrition Therapy often know that laxatives are causing harm, but they often don’t know the extent.

We have not written this article to shame or blame anyone. In fact, we totally understand why you might be struggling with laxatives. This article is written with compassion: we want to give you the information you need, but we are in no way giving you a telling off. We also want to make it really clear that the tips and information we give in this article are not a substitute for medical, nutritional, or psychological support from a professional.

Firstly, how do laxatives actually work?

If you think of food going into your body, it moves down your throat and into your stomach before moving into the small intestine then large intestine (also known as the colon) before waste is disposed of. Laxatives act in two main ways:

1. They soften the stool so it moves easily through the body

2. They stimulate your colon muscles to move the food down and out of the body

There are four main types of laxatives:

1. Stimulants: stimulate bowel movements, hence the name, via the nervous system

2. Bulk-forming: often fibre supplements, draw water into the stools which helps your bowels push them out.

3. Osmotic: draw water into the colon to create loose stools – these push against the walls of your digestive tract and help bowel movements.

4. Stool softeners: does exactly what the name suggests and softens your stool to ease its movement.

How do people come to use, and abuse, laxatives?

You don't decide to become dependent on laxatives. Usually being a little constipated may lead to taking laxatives for the first time. Or you might experiment with them when you're feeling really full, or trying to lose weight. It might even be a GP that recommends them.

After the first use, people notice how much emptier they feel. They then try and emulate this feeling post-food or post binges. Once or twice leads into a few more times as the body stops bowel movements naturally, or as you lose weight or feel lighter. And before you know it you’re consuming a lot of laxatives on a daily basis.

Some people might take laxatives daily, without binging. Or some people might only take them when they're feeling super full.

I speak with a lot of people who find out about laxatives through pro eating disorder content online. This could be websites, social media, forums, or word of mouth (e.g. in treatment centres). Luckily there are forums for people recovering where they discuss how laxatives have affected their lives, so hopefully content about the reality of laxatives starts to reach those seeking it out.

We want you to know the facts about laxatives.

So, here’s 5 things we think you should know about them.

1. You might experience constipation when taking laxatives, or severe diarrhoea

This might seem like a contradiction. But with long term laxative abuse means that your colon nerves become damaged. This means they no longer stimulate the muscles to move your stool. Which is why you may become constipated as a result. This can be incredibly uncomfortable, and perhaps triggering. Which is why we recommend working with a nutrition counsellor (like our team) who can support you through this.

On the flip side if you use too many laxatives you might experience severe diarrhoea which leads to something called a rectal prolapse. This actually requires surgery to treat.

Both constipation and diarrhoea from laxative abuse can have long term side effects. These need to be monitored by a medical professional.

2. Your electrolytes may become imbalanced

Our bodies are fairly good at keeping an eye on our electrolyte and mineral levels; keeping them at a healthy level so we work as best we can.

Electrolytes are needed for:

• Key for muscle function

• Nerve function

• Heart health

• Blood acidity and pressure regulation

• Hydrate the body

• Help rebuild damage tissue

Laxative abuse has been linked with a higher risk of heart attacks. This might be due to (2):

• Dehydration - leads to the arteries to the heart becoming narrower

• Bacterial overgrowth and inflammation - leads to the arteries becoming blocked

• Laxatives increase serotonin formation - this also causes the arteries to become blocked

It might sound extreme, but we’re messing with our body’s balance of electrolytes so the consequences can be severe. And often these imbalances might be asymptomatic until they get extreme enough to cause some side effects.

Laxatives can cause electrolyte imbalance as potassium and sodium leave the body with water. Electrolyte imbalances also cause dehydration which in turn can lead to headaches, fatigue, stomach pain and feeling sick.

Do any of these symptoms sound familiar to you?

We don’t want to alarm you. These symptoms are also general eating disorders, disordered eating, purging, and restriction side-effects. But if you’re experiencing these and you’re using laxatives regularly to purge, I suggest booking a check up with your GP.

3. You might get what is called "lazy colon"

Cathartic colon is a condition where the colon becomes incapable of moving faecal matter, sometimes called "lazy colon". As you can imagine when waste is not disposed of it builds up and conditions such as irritable bowel syndrome can occur.

Laxative abuse will also remove beneficial bacteria from the colon, which act to help the immune system.

4. Laxatives can be addictive

Laxative use can be addictive, both biologically and psychologically. That means your body might become dependent on them due to constant use. You might become dependent on how they make you feel, or what you think they’re doing to your body.

Every time you use laxatives water leaves the body and so areas such as the stomach might look momentarily flat, you might then be convinced it’s helping you lose weight and become attached to this idea. This will make giving them up very difficult.

5. ‘’Laxatives help you lose weight’’ is a myth

I know you might be using laxatives to purge calories from food. But laxatives hit the colon, meaning they affect your body after your small intestine has absorbed the nutrients from your food. Laxatives have no effect on the calories your body absorbs. They just make you poop faster.

You might love the feeling of being lighter after laxatives. But that lighter feeling is just the quicker movement of poop. It’s not calories being expelled, or fat/weight being lost.

Common questions about laxatives and laxative abuse

We are asked a lot of questions about laxatives. We hope the questions and answers below are helpful, in case you've been wondering them too.

1. Are laxatives as bad as vomiting?

Apart from the specific damage to the areas they target (e.g., throat and dental damage in vomiting and colon damage from laxative abuse), both of these types of purging lead to severe dehydration and electrolyte imbalance. Both are associated with eating disorder incidence and highlight a disordered relationship with food.

Laxatives are easy to obtain, and for many abusing them, can be justified easily to friends and family. In a way that vomiting may be seen by relatives as a clear eating disorder symptom, laxative abuse can be hidden under the guise of an upset stomach or treating constipation.

Let us make it clear: Vomiting and laxative use are just as ‘’serious’’ as one another

Does this mean I should never take laxatives?

Some laxatives are safe to use – for example Miralax, Colace and Milk of Magnesia act to soften stool and are said to be safe for general use. It is more stimulating laxatives that affect nerve function that should be monitored such as Dulcolax, Senna etc.

Using laxatives when medically necessary should always be encouraged but it’s recommended to see your doctor if you need to take laxatives on a regular basis. You might be prescribed a laxative if you’re going for surgery, having a colonoscopy, or after giving birth.