Eating Disorder Awareness Week: How Does Laxative Abuse Impact The Gut?

23 February 5 min read

Research has shown that as many as half of those with an eating disorder have misused laxatives. Discover how laxative abuse adversely impacts your gut health, including the microbiome.

Laxative abuse and eating disorders

Laxative abuse occurs when someone frequently uses prescription or over-the-counter medications to “feel thin” or “empty”, purge unwanted calories or lose weight. Laxative abuse is particularly common in those with eating disorders, including bulimia nervosa, binge-eating disorder and anorexia.

The condition is extremely dangerous and can cause numerous health complications, including organ failure, prolapse and in severe cases, death. Currently, laxative sales are not regulated in the UK, despite wide-scale abuse. In light of this, there has been discussion about implementing stricter legislation prompted mainly by warnings from the medical community.

There has also been a rise in those abusing slimming teas or “teatox” programs, some of which contain strong natural laxatives and diuretics, a crisis not helped by paid celebrity endorsements on Instagram and Facebook in recent years.

☝DID YOU KNOW?☝ Evidence suggests that more than half of those with eating disorders have misused laxatives.

Myth: laxatives are effective for weight control

Contrary to popular belief, laxatives are not effective for weight control. In reality, the small intestine has absorbed most nutrients by the time they act on the colon. Because of this, laxative-induced bowel movements mainly cause a loss of water, minerals, electrolytes, and indigestible fibre, not fat or calories.

Most of the “weight loss” observed from laxative abuse is just a reduction in water weight and will return as soon as the person rehydrates.

Those who refuse to hydrate risk organ failure and death, so laxative abuse is neither a sustainable nor effective weight-loss method. If any laxative product claims otherwise, they are lying.

☝DID YOU KNOW?☝ Beneficial bacteria in our gut ferment ingestible fibre to produce short-chain fatty acids. These can strengthen the gut lining and reduce low-grade inflammation. Laxatives artificially flush the large intestine, washing away both good gut bacteria and their food

Short term health consequences

In the short term, laxative abuse can cause dehydration, resulting in blurry vision, fainting, tremors and, in severe cases, death. Worse still, diarrhoea can deplete your body of essential electrolytes and minerals, including potassium, sodium, magnesium and phosphorus.

These molecules are essential to the proper functioning of your nerves and muscles. Additionally, chronic diarrhoea triggered by laxatives can deplete your beneficial gut bacteria, resulting in dysbiosis and a host of gastrointestinal issues. In short, laxatives should only be used in the short term for those with constipation and in these cases, under medical supervision.

☝IMPORTANT☝ If you have a history of disordered eating, consult your GP before using any OTC laxative for the treatment of constipation.

Long term health consequences

Laxative abuse often results in laxative dependency, whereby you require increasingly higher doses to stimulate bowel movements. Over time, this can result in a “lazy gut”, a condition where the intestines cannot evacuate waste properly due to weakened muscle and nerve responses.

In the long-term, laxative abuse and dependency can also lead to internal organ failure, colon tearing, anal prolapse and irritable bowel syndrome. Chronic laxative abuse may also increase your risk of developing colon cancer.

An eating disorder therapist lists the myriad dangers of laxative abuse

How does laxative abuse affect the gut microbiome?

A key marker of microbiome health is diversity, whilst dysbiosis, meaning an imbalance, is associated with a range of disorders, including colon cancer, low-grade inflammation and even depression. If you think of the microbiome like a football team, it pays to have players with different skills who can complement each other’s abilities in a game.

Similarly, the microbiome is composed of beneficial bacteria, commensal bacteria (neutral), and even pathogenic bacteria, though these are kept in check in small numbers.

Like a football team suffers when certain players are absent, our inner microbial system is compromised when key bacteria are reduced or lost. Though the research isn’t comprehensive, existing studies suggest that laxative abuse can deplete beneficial and commensal gut bacteria, likely to our detriment.

A study published in the journal Cell investigated the effects of diarrhoea on the microbiome in humanised-mice models. Before you ask, these are not mice that can walk and talk, but rodents with transplanted human microbiomes in their colon.

A short video explaining the human gut microbiome

The researchers found that mild diarrhoea induced both short-term and long-term changes in the gut microbiome alongside temporary disruption to the gut wall.

Amazingly, the commensal bacteria Muribaculaceae, usually highly abundant in mammalian microbes, was shown to undergo extinction unless reintroduced. What’s more, up to 75% of bacterial taxa were shown to be significantly altered in diversity compared to the original baseline.

The mucus barrier was compromised during the study and became more permeable, though it recovered after the diarrhoea had passed. Parallel to this increased permeability, the mice experienced an increased immune response.

It is well known that increased intestinal permeability can lead to low-grade chronic inflammation, a condition associated with inflammatory bowel disease, among other diseases.

No recovery period can occur in those abusing laxatives, particularly those with laxative dependence. As such, long-term laxative abuse likely causes intestinal permeability and inflammation.

☝TIP☝ Discover the diversity and balance of your gut bacteria with the Atlas Microbiome Test.

Slimming teas: are they laxatives in disguise?

In recent years, “slimming teas” and “diet teas” have risen to popularity, largely due to their promotion by celebrities and influencers alike on social media.

Worryingly, many products marketed as “detox”, “diet”, “skinny”, or “flat-tummy” tea contains substances with diuretic and laxative effects and, if used daily, can lead to dehydration, organ failure and gastrointestinal issues.

Due to the normalisation of these products, it has become increasingly common for those with eating disorders to abuse slimming teas, so common in fact that the NHS has urged Instagram and Facebook to ban “irresponsible and unsafe” celebrity adverts for diet pills and teas on their platform.

These products often cleverly avoid the word laxative, hiding behind terms like “cleanse” and “detox” instead. But make no mistake: slimming teas with laxatives in them can cause the same health risks as over-the-counter pills.

Moreover, some laxative-laced teas market themselves as “natural” due to herbal ingredients, something many take to be synonymous with safe. In reality, herbal ingredients such as senna and cascara can have a powerful laxative effect, so “natural” is no guarantee of safety. Likewise, both dandelion and burdock roots are natural diuretics, meaning they encourage the body to expel water and sodium.

Besides posing serious health risks, there is no evidence that these products are effective weight loss tools. As for those that contain laxatives, these simply reduce your water weight temporarily whilst simultaneously depleting your gut flora and electrolytes.

Help and support

If you or a loved one is abusing laxatives, reach out to a GP or a registered eating disorder therapist. Laxative abuse is a dangerous condition that can cause severe short and long term health complications, but help is available!

Overcoming laxative abuse will involve working with a team of health professionals who can guide you through the recovery process. Below is a list of organisations aiming to increase the awareness and prevention of eating disorders in the UK.

Key Points

It is thought that over half of those with eating disorders have misused laxatives at some point.
Laxative abuse is extremely dangerous and can result in organ damage, prolapse, dehydration and even death.
Laxatives are not an effective or sustainable weight loss tool. Whilst they may temporarily reduce weight, this is simply water weight which will return as soon as you hydrate.
Currently, there are very few restrictions on purchasing laxatives, though medical professionals are urging legislators to implement stricter rules.
Just because a product is marketed as “natural” doesn't mean that it’s safe; herbal ingredients such as senna have a powerful laxative effect and pose the same risks that OTC laxatives do when abused.

☝️DISCLAIMER☝This article is for informational purposes only. It is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment.