I get it: you’re suffering with constipation, and you just want to get it all cleared out. You may be gassy, crampy, bloated, lethargic, and you know that one great bowel movement is going to fix all that. It’s been days…maybe even a week. Your head wants it, your gut wants it, and nearly every other television commercial informs you that the country at large wants it.

You need to poop! Why not just buy one of the laxatives so ubiquitously advertised and be done with it? What could possibly be wrong taking such a widely sold and widely used over the counter (OTC) substance?

Um…lots. Let’s take a step back and remind ourselves of the paradigm shift necessary to see things from a Functional Health standpoint.

1. The longest line usually leads to the wrong conclusion. As Mom always warned, “If all your friends jump off a cliff, will you?”
2. Normal is not the same as optimal.
3. The “pill for an ill” mentality is killing us.
4. Understanding “why” must come first before “how” or “what.” Cause before symptom.

Now that we have reminded ourselves of those tenets, let us proceed to our discussion of laxatives. Before we get to “why” let’s talk about the four basic types of laxatives:

1. Bulk-forming laxatives, for example, methylcellulose (Citrucel) and psyllium hydrophilic mucilloid (Metamucil)
2. Osmotic-type laxatives such as GoLYTELY, GlycoLax, milk of magnesia and MiraLax
3. Stimulant laxatives are the fastest-acting, such as aloe (whole), cascara sagrada (Nature’s Remedy), senna compounds (Ex-Lax, Senokot), bisacodyl (Dulcolax, Correctol), and castor oil
4. Saline enemas such as Fleet Phospho-Soda.

1. Bulk-forming laxatives. There is a place for adding bulk to your routine. In fact, this is a component of several short term IB Solutions protocols. However, it’s about the ingredients: we do not use petroleum products, cellulose, artificial colors, preservatives or dyes. You must read labels to get and stay healthy. And, these short-termed protocols are used for targeted outcomes under supervision. Aside from these targeted usages, the bulk you do need in your daily routine should come from your food: soluble and insoluble fiber, which will both increase bowel transit time, and provide the structure upon which probiotics thrive (prebiotics).

2. Osmotic laxatives operate to draw water from the rest of your body into your intestines, leading to evacuation. First of all, most patients I see are already dehydrated, not coming even close to drinking half their body weight in ounces of pure water every day. You can diagnose this yourself via several easy self-tests: increased thirst (ironically, often one of the last signs), dry mouth, tired or sleepy, decreased urine output, dark yellow urine (should be clear or close to clear at least once per day), headache, dry skin, dizziness, few or no tears. This is especially notable in senior citizens, as often the sensation of thirst decreases with age, and in the general population of seniors, most are already on one or more prescriptions, which necessitate more water to process. Here as well, the negative effect of ingredients comes into play. One brand of “milk of magnesia,” a common and widely accepted OTC laxative choice, includes two kinds of grains (anhydrous acid derived from corn; and cellulose, probably derived from corn husks), which many of my patients have genetically tested sensitive to; artificial dyes (D&C red); artificial flavor; artificial sweetener (sorbitol); table sugar (sucrose); and the true nail in the coffin: magnesium hydroxide, which neutralizes stomach acid (hydrochloric acid, or HCL), which decreases digestion, which leads to constipation!

3. Stimulant laxatives are powerful, making them attractive to sufferers…as well as to bulimics (note: laxatives do not inhibit caloric absorption from food). As they blaze their way through your digestive tract, they leach vital nutrients, upset electrolyte balance, create dangerous dependency and can cause huge downstream negative effects, including organ failure.

Two of the most common leading ingredients in OTC stimulant-type laxatives are cascara sagrada and senna. I have already discussed synthetic ingredients, but these two deserve special attention because they are “natural.” Cascara sagrada (“sacred bark”) has been used for centuries. Native Americans used it for relief of constipation. However, that does not make it a health food, nor make it safe. In fact, it has been linked with creating severe dehydration, colon damage, permanent dependency on laxatives, and even gentoxic events that can lead to cancer. It has noted adverse drug interactions, especially with heart medication and diuretics. It can lead to electrolyte imbalance, purging your body of the vital building blocks of salt: potassium, sodium, calcium. The end product of that can be organ failure. It is definitely contraindicated for people with irritable bowel syndrome (IBS) and irritable bowel disorder (IBD), such as Crohn’s and ulcerative colitis.

Senna comes from a plant, too: Casia senna. Its active components, senna glycoside and sennosides, draw water from other parts of your body into your intestines, leading to evacuation. Again, it creates bowel dependency, can lead to electrolyte imbalance, organ damage (particularly liver), and is contraindicated for those with hemorrhoids, IBD and heart disease.

“But I bought it at a health food store!” Or, “it’s just tea!”

*Time for a quick reminder here of a core IB Solutions principle: just because you can buy it at a health food store does not make it a health food for you, now or ever. For example, some people are allergic to echinacea. Even though it’s a great substance that comes from the natural world, it is bad for them. Forever. Some people are “sensitive” to echinacea, so it’s bad for them now, but might be okay for them in the future after they have healed their gut. This is why part of the IB Solutions Method is to test for these things.

4. Enemas. Types of these also have a place in several true healing protocols. For example, certain protocols within the IB Solutions Method call for coffee enemas. But this is a world away from OTC laxative enemas. As a laxative, an enema works in two ways: to stimulate the emptying of the bowels by inserting an amount of fluid, and by stimulating the bowels to empty by the absorption of whatever the fluid contains. Here as well, to resist banging the same gong, it is about ingredients, duration of use and appropriateness of use. Application of anything enema style is going to result in absorption of said substance. Therefore, one must use caution using something that contains disodium EDTA (a common preservative distilled from ethylenediamine, formaldehyde and sodium cyanide), and benzalkonium chloride (a flammable topical antiseptic), for starters. Also, overused as a laxative, enemas can incite dependency and upset electrolyte balance which can lead to extremely serious consequences.

What is the IB Solutions answer to constipation? “Why” drives the how and what of our answer. I refuse to join a medical model that throws a pill at an ill, gaining only symptomatic relief, if even that. And if it doesn’t work — or results in an adverse side effect? Another pill??? “Normal” these days means multiple prescriptions, a medicine chest full of over the counter “remedies,” and TV self-diagnosis. But normal is not optimal. “Optimal” means emptying your bowels with regularity, vitality, and no poly-pharmacy. Get out of that long line that accepts the inevitability of OTC fixes to an illness you should not have. I treat the person, not the symptom.

First why: what is causing the constipation? Small intestine overgrowth of bacteria (SIBO)? Parasitic infestation? Pathogenic gut bacteria, or lack of healthy diverse gut bacteria? Food allergies/sensitivities? Lifestyle choices (such as lack of exercise — did you know that gentle yoga poses address constipation, as does walking)? Drug interaction? Drug-induced nutritional deficiency? Dehydration? Lack of proper fiber? The IB Solutions Method tests for all of these, essentially going big early in our process in order to narrow our focus in the treatment phase.

Then, how and what: once we figure out why, then we can determine what to do and how to do it. This is always a personal approach, unique to each patient, not a cookie cutter answer. No one-size-fits-all “Detox! Purge! Take this! Take that!” Sometimes a priority schedule must be established be cause there are several factors, to deal with, and trying to address them all will not only be ineffective, it could be dangerous. We have great success in restoring true regularity, many times for people who have suffered for years. You are not a single simple symptom, and your recovery will probably not require a single simple solution. That is the IB Solutions Method, and you deserve it.

Dr. Wade Binley, DC CFMP

Dr. Wade Binley, DC CFMP

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