Are Herbal Laxatives Dangerous? (And What Everyone with Constipation Needs to Know)

by Steven Wright

senna-pods-mortar-and-pestle

We are a constipated nation. If you’ve ever struggled with constipation, like me, you know how painful it can be. And with 15-20% (or over 42 million people) in the United States struggling with it I know I’m not alone.

So, what should constipated people do? If you head to the local drugstore, it’s likely you’ll end up buying a product that contains an herbal laxative.

But have you ever paused to wonder: are these things dangerous?

As someone who used to be constipated I wondered the same thing. And so I decided to dive into the research to see what I could find out about herbal laxatives.

And as always, the story is more complex and contextual than anyone, including myself, would like it to be.

Let’s first be clear: constipation is a serious issue and if you’re not regularly eliminating the waste of your body you’ll start recirculating it. And you’re raising your risk of serious medical issues such as hemorrhoids, toxic megacolon and possibly colon cancer.

What’s important is to begin a short-term intervention to start pooping again, but the question is… where do you start?

What are Constipated People Doing?

In 2004, 5.3 million prescriptions were written for medications to relieve constipation and untold numbers decided to self-medicate with over-the-counter laxatives. And i don’t blame them, it’s much less embarrassing to try to take care of this personal problem yourself.

Unfortunately, it’s a 600 Million dollar a year market. Companies know this too and through widespread marketing campaigns herbal laxatives have become a very common remedy.

But, there are also other remedies like enemas, non-stimulatory vitamin laxatives and foods that can be eaten to help with constipation.

Unfortunately, many people are marketed into buying herbal laxatives because of the terms “herbal” and “natural.” This belief makes them safer or better for dealing with constipation than other ideas.

Sadly, this isn’t the case.

The Truth About Herbal Laxatives

Herbal laxative use is prevalent. It’s widespread use has caught the eye of the research communities over the last few decades and is becoming a hot research topic. 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. Some studies are even finding that certain compounds in herbal laxatives have genotoxic effects (meaning they damage DNA code).

But on the other side researchers are saying the effects are minor and/or cannot be considered a cause of herbal laxative use. But before we dive deeper into the studies let’s talk about what herbal laxatives are.

What are in herbal laxatives?

If you go to the store and pick up a product that uses an herbal laxative it will likely contain one or many of the following compounds:

  • Aloe
  • Cascara
  • Frangula
  • Rheum
  • Senna

All of these are herbal stimulant laxatives. And are found in teas, pills and liquids.

How Do Herbal Laxatives Work?

These herbs contain compounds called 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 get the poop out.

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
  • Physiological 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 is a precursor to troubles like colon cancer.

No, 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). How can something that is killing cells in your colon be ok?

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.

But at this point, it’s very much back and forth. The reality is this whole area of research is new and still developing. And cancer is a complex disease. Drawing the conclusion that herbal laxatives cause cancer is irresponsible and not possible at this point.

But it is concerning enough to me that I’m not 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 like cascara 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. If you want to see a severe case, check out Dr. Oz’s episode on laxative abuse. The irritation caused by herbal laxatives can create a lazy GI tract and 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 supposed 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 physiological dependence. When I was constipated, and it got bad enough, it was the only thing I could think about; I wanted to poop and I wanted to go now.

And when I would figure out routines, or test different aids for pooping, if it worked I was instantly hooked. I’d try the same thing day after day because it always felt so much better to poop than not to.

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 need those laxatives to go. And then, 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 coffee or exercising (both of which are 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?

In my opinion, there are many other safer ways, as well as more natural, to relieve constipation. Not to mention they aren’t being studied as possibly promoting cancer.

That being said, don’t forget that constipation is solvable, that constipation is a symptom of a bigger issue, and it’s a communication from your body that something is wrong.

If you want to actually get rid of constipation, once and for all, then I want you to check out our 2.5-hour Constipation Event.

We covered the best short-term and long-term strategies for improving constipation and, if done correctly, strategies that won’t create the problems we talked about today. Instead, we covered the correct strategies to uncover and correct whatever root causes are “off” inside your body causing the constipation.

We draw on my experiences, our consulting case files and the many hours we’ve spent talking with functional medical doctors about this.

If you struggle with constipation from time to time, or all of the time, please don’t miss this. You can grab your access here:

http://constipationhelp.scdlifestyle.com

In the mean time, make sure to read the article I linked to above about foods that will help with constipation. There are many alternatives for overcoming constipation beyond herbal laxatives.

-Steve

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About the author

Steven Wright Steve Wright is a health engineer and author. In 2009, he reached a breaking point when IBS took over his life and the doctors didn't know how to help. Since then, he has transformed his health and started SCDLifestyle.com to help others naturally heal stomach problems. You can check out his story here and find him on Google+, Facebook or Twitter.

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{ 22 comments… read them below or add one }

Jen September 22, 2014 at 8:41 pm

Hey, I am just wondering by having “aloe” in the list above whether you are talking about Aloe Vera or Cape aloe?

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Steven Wright October 4, 2014 at 7:10 pm

No I wasn’t but those can be laxative in nature as well. They can also be healing for some people. It’s a tricky supplement.

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Billy Bob September 22, 2014 at 8:45 pm

The problem with herbs and their medicinal use by the public, is the public rarely understands them and just goes to the local health food store and buys something because of an internet claim they read OR doesnt by something because of an internet claim they read.

I am a student at the School of Natural Healing working on my nutritional herbalist degree and eventually a master herbalist degree. Dr. John Christopher was and is still probably the most famous herbalist in Americas history. He founded the school I am enrolled in and was the mentor to Dr. Shulze as well as another amazing master herbalist that is changing peoples lives with their herbal products and education of medicinal plant use.

Dr. Christopher knew the human body as well as anyone today and the colon was one of his main interest. He had a formula that is still the most famous of his today. It did include cascara, senna, fennel, ginger and some others. Its been said that is the most important herbal formula he ever made and allowed many many people to heal and reverse their colon cancers, IBS , colitis etc. Of course we all know diet and gut flora are also key in elliminating constipation, so of course people will become addicted to a laxative of any sort if they dont correct the underlying issue.

The lower bowel herbal formula was proven to retrain the colon to work and help the colon to remove the pounds and layers of fecal matter off the colon walls. i have seen the pictures of diverticuli and colon fecal matter that was expelled by using the herbs…many lives have been saved. Until this day that formula is regarded by the master herbalist as the greatest of all. Dr. Christopher claimed it would NOT become dependant IF the diet was improved…but if people continue to eat bread and cheese and too much meat…then of course they will never get to the underlying issue…

My master herbalist mentor has used the herbs for 30 years and said EVERYONE with IBS, colitis etc…that used the gentle formula, never had colon issues again. His formula is a copy of Dr Christophers with a few additions of his own, but they are not harsh and you actually have to take a lot to flush out.

Again its all about knowing what you are taking and the quality of the products. Herbs are for assistance…but diet is king…have to fix the root cause of constipation.

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Steven Wright October 4, 2014 at 7:13 pm

Thanks for the comment “Billy”. I agree herbs can be very powerful therapeutic agents. Saying that the formula above always works and never causes issues is of course a lie but I get that there are products like it and practitioners out there who understand herbs and use them to great affect.

As you mentioned several times, this post was not about damning herbal usage in general but about the over counter abuse that happens.

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R September 23, 2014 at 11:41 am

Thank you for insight on this. My son has been having flat stools for 2 1/2 years. I have always had a thought regarding an herbal supplement I had my son take because he had yeast issues – can’t remember if it was a laxative or cleanse. Seems like sometime around the use of that supplement, he started having flatter stools. We have been to Pediatric GI Dr.’s. He had a barium enema that turned out fine. They would not consider a colonoscopy because of his age. They said flat stools were normal???? Anyway, this makes me question this herbal thing a little more. Is there anything we can do? Thanks again.

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Brent Kovacs September 24, 2014 at 4:06 pm

Hi, thanks for reaching out!

I recommend starting off with the real food suggestions for constipation that Steve described in his post we linked to.

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LeeAnn September 23, 2014 at 12:31 pm

I was wondering what you would recommend as safe for pregnant and postpartum moms. Pretty routinely they are prescribed with a stool softener iof taking
Iron supplements while pregnant, and stool softener a postpartum so they aren’t straining after labor. What would you recommend for moms
In this situation?

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Brent Kovacs September 24, 2014 at 4:11 pm

Hi LeeAnn,

Thanks for reaching out! We suggest working with a skilled functional medicine practitioner, but you can certainly try some of Steve’s suggestions he made in his article 6 Real Food Suggestions…http://scdlifestyle.com/2013/07/real-food-tips-constipation/

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ryn September 24, 2014 at 5:35 pm

i share some of your concerns about the strong -stimulant- laxatives like the ones you listed, but it’s far over-reaching to say they apply to all herbs with a laxative effect. the gentle demulcent herbs like marshmallow, cinnamon, violet leaf, and irish moss can all aid in relieving constipation due to dryness. cholagogue herbs like yellow dock, dandelion root, and burdock can aid in bowel movements through the lubricating effect of bile release. i hope your seminar will cover the appropriate use of these safe herbs, and if not, that you’ll consult with a knowledgable herbalist so that you can learn the material and pass it on to others.

also, it would be good to acknowledge that many people, whether they recognize it or not, depend on a common herbal laxative for bowel movements every day – coffee.

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Steven Wright October 4, 2014 at 7:17 pm

Thanks Ryn! I appreciate the comment. Yes SOO many use Coffee daily.

I tried to make this very specific about the over counter abuse that is happening and I agree that the working with a practitioner who understands herbs is not a bad thing.

I’ll say it again, herbs in general are not bad. But just like anything can be misused and abused.

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billy bob jay September 28, 2014 at 8:03 am

yup…that morning cup of joe is a VERY common laxative people depend on and still eat crap but think they are ‘normal’… but without the joe…no go

cap that off with non organic coffee and boom…lots of added toxins for the liver to deal with

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Corrinne December 10, 2014 at 10:14 pm

Hi Steve,

I’m wondering…is it harmful to drink peppermint tea on a daily basis (no more than 2, 8oz cups)? I’ve been doing this for a few weeks now because it has been so relieving.

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Lori Jo Berg December 12, 2014 at 3:39 pm

Hi Corinne, thank you for reaching out! This should be fine, but listen to your body and make any necessary adjustments as you see fit.

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Lauren February 24, 2015 at 5:43 am

What about using essential oils to relieve constipation? juniper, peppermint, and fennel

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Lori Jo Berg February 24, 2015 at 10:15 am

Hi Lauren, thanks for reaching out! Sure, these could be used in conjunction with dietary and supplements for a comprehensive approach to constipation.

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Margarita Om November 24, 2015 at 6:28 pm

Hello,

5 Years ago doctors found out I have a 4 meters long colon which is curved and twisted many times. However, it is functioning and no surgery is needed. The only thing is that I can’t have a proper bowl movement so the doctors actually prescribed me Cascara Sagrada and Dandelion root, which I have been taking regularly in the past 2-3-4 years. I have tried so many different things but nothing really works… Fiber for me makes me even more constipated and my colon is very large (4m) and needs to be emptied somehow? So what do you suggest if the Herbal Laxatives are so dangerous?

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Mariel Heiss November 25, 2015 at 12:05 pm

Hi Margarita – thanks for commenting!

It sounds like you have a pretty unusual situation. While Steve and Jordan don’t recommend herbal laxatives in most instances, in a case like yours, they would encourage you to work with your doctor to find a solution for your constipation.

You are a perfect example that everyone is unique and special circumstances do exist! If the herbal laxatives start causing problems or stop working for you, then it would be time to start questioning what else you could try (although it sounds like you’ve tried a lot of other things).

Generally we recommend increasing fat intake and Vitamin C and Magnesium supplementation to help with constipation. Hope this helps!

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rogue g July 20, 2016 at 9:03 pm

Yes, if you use Senna Leaves too much, they will make your constipation worse. they are meant to be used in the short term. For me, I use the Dr Max Powers 15 Days Cleanse. I DO NOT TAKE IT FOR 15 DAYS!!! I only take two pills the day i have constipation, and maybe the next day. NO MORE. And then I dont take it for a month, as you dont want you body getting used to it. A bottle lasts me about a year, and for the last year I have barely had any problems.

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Diana V Torres August 23, 2016 at 11:40 am

Heard your entire talk on leaky gut except for ending, how or what do I do now about this?
Diana V. TOrres

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Mariel Heiss August 23, 2016 at 2:39 pm
Lynn September 3, 2016 at 5:43 pm

I have been using Dr. Schulz Formula 1 for many years. I want to say maybe 12 years. I have had great results with it and take one pill with dinner nightly. But this last week has been awful. I started with very narrow straw size poop. Not a lot just a little straw poop. Then two days after after eating a big meal with a salad bar I came home with a sore stomach. After hours in the toilet I had uncontrolled diarrhea. For a week after this awful situation I have been having the feeling to go every few minutes but cannot move my bowels. Nothing comes out except maybe a tiny piece of stool. It is the worst thing ever. Went to the GI Doctor and she told me to take Delcolax as well as Milcolax then after start taking liquid magnesium. She says to continue with the Dr. Schulz after I feel better. She also did my colonoscopy two months ago and although I did have the dark colon she said to continue. I did not want to take the Delcolax because I read on line about people having awful cramps and sweats like they were going to die. I did start the Milcolax today before the annema. Only one small piece of poop came out the rest was all brown water with tiny particals. I have not eaten much since eating that salad bar one week ago and having this going feeling with no poop. Oh yes, I also took some magnesium oxide pills with the Milcolax before the annema. I am lying in bed right now after my warm water annema and I am still feeling the same feeling to go. I am so afraid that all of this was caused by being on Dr. Schulz for so long and not sure how to stop. Any help would be so appreciated.

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Mariel Heiss September 6, 2016 at 4:35 pm

Hi Lynn – I’m sorry to hear what you’re going through! We recommend checking out our program for constipation here: http://constipationhelp.scdlifestyle.com/

I hope this helps and you’re feeling better soon!

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