NUTRITION HOTLINE: Laxitives

Q: I have been taking laxatives for five years and would like to stop taking them. When I try to stop, I get very constipated and gain a lot of weight. Is there anything I can do to change this?

A: Discontinuing laxatives can be uncomfortable, but it is well worth the effort. Stimulant laxatives do not decrease caloric absorption significantly, as they work in the large intestine, not the small intestine where nutrients are absorbed. Not only are they not effective for weight control, they may also increase the risk of colon cancer and can lead to a cathartic colon (a condition where the nervous function in the colon is damaged and the colon no longer works at all). Hypokalemia (low blood potassium) and other electrolyte imbalances can also result, which can cause death.

Since I am not able to address specific cases in this column, you will need to get precise guidance on your particular situation from your own physician. I can, however, address the overall issue of how laxative abuse is normally managed. One common protocol for stopping laxatives is to either stop all at once, or to taper off by 50 percent every 7–10 days. Most of my clients find tapering to be more tolerable than stopping all at once. Your body will respond with rebound constipation and water retention in your abdomen, fingers, legs, face, and feet.

The constipation can be managed with the use of 1–2 servings of Citrucel fiber supplement per day, while gradually increasing the fiber in your diet to 20 grams/day using whole grains and fruits and vegetables. Docusate sodium (100–300 mg/day) can be used to moisten hard or dry stools, with the goal of having a bowel movement every 1–2 days. Ask your physician to calculate your fluid needs, as increasing fiber without enough fluid can actually make constipation worse. Moderate walking also helps promote gut peristalsis. If needed, Milk of Magnesia can be used several times per week until gut function completely normalizes.

It may take several weeks before the fluid balance in your body and your gut function completely return to normal. Minimizing sodium intake in your diet and elevating your feet may help decrease fluid retention.