Botanical stimulant laxatives all generally contain a class of compounds referred to as anthraquinone glycosides. Once ingested and activated by bacterial metabolism in the human gut, these molecules promote water retention in the stool and stimulate peristalsis in the large intestine (colon).
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powder is the solid residue obtained by evaporating the liquid which
drains from the transversely cut leaves of Cape Aloes (Aloe ferox). The
juice is usually concentrated by boiling and solidifies upon cooling.
It is characteristically dark-brown or greenish-brown. It has a sour
odor; the taste is bitter. Cape Aloes is found primarily on the Cape
Horn of South Africa where it can typically grow 6-10 feet tall. The
best-characterized constituent of the resin is aloin, one of the
compounds in the family of anthraquinone glycosides. Other similar
quinones are also present. It is thought that aloin and similar
derivatives are converted into emodin-derivatives within the
gastrointestinal tract and then these act as purging laxatives (65-68)
Aloes' effect is primarily caused by its influence on the motility of
the colon- an inhibition of stationary and stimulation of propulsive
contractions. This results in an accelerated intestinal passage and,
because of the shortened contraction time, a reduction in liquid
absorption. In addition, stimulation of active chloride secretion
increases the water and electrolyte content in the stool. The
preparations of aloes have been in the U.S. Pharmacopoeia for over 100
years and it has a positive Commission E monograph where it is listed
for short-term constipation.
long-term use and reputation as the most potent natural laxative,
cascara sagrada and senna seem to be more popular because of the
commonly held notion that aloes is more often associated with
side-effects such as cramping and nausea. This however has not been the
case when used in recent decades as a dietary supplement and likely is
attributed to information passed on from the use of preparations nearly
a century ago.
Dosing aloes is different
depending on the individual. The optimum dose is the smallest dosage
necessary to obtain a soft stool that passes without difficulty. For
many individuals this is one 250 mg capsule, although many may need 450
mg or more to obtain this effect. Twenty four hours should be allowed
to pass before the next dose is administered. Aloes should not be used
during pregnancy because of its uterine stimulant potential.
Anthroquinones are known to be secreted in breast milk of nursing
mothers and this may purge the child along with the mother. As with all
stimulant laxatives, aloes should not be used for longer than 2 weeks
for most individuals.
sacred bark by those using it, cascara sagrada describes the small- to
medium-sized tree Rhamnus purshiana or Frangula purshiana. The
primary use for cascara sagrada is as a laxative, and has a long
history of use among Native Americans and Western herbalists. The
German Commission E has a positive therapeutic monograph for laxative
formulas with a dose corresponding to 20-30 mg cascaroside A (or
The dried leaflets and pods of Cassia
senna (or related species), is most often referred to medicinally as
senna. These preparations contain the strong glycosides sennoside A and
B. The laxative preparation for senna has been used in medicinal teas
in Europe, and powdered extracts have become very popular in OTC
medications here in the U.S. The typical dose is 0.6-2 grams
(equivalent to 20-30 mg of sennoside B). Senna also has a positive
Commission E monograph for use in laxative formulations. Similar
activities are found in Rhubarb root preparations (Rheum officinale),
although rhubarb is more commonly used in Asia.
Cautions With Stimulant Laxatives
The use of botanical stimulant laxatives
should be considered only after diet, lifestyle, and bulk laxatives
have proven ineffective, and other causes have been ruled out. Botanical stimulant laxatives are
contraindicated in cases of bowel obstruction, acute intestinal
inflammation, and abdominal pain of unknown origin. They should not
generally be used in children under 12 or in pregnant or nursing women.
and abuse of laxatives is common. According to the Mayo Clinic, potential dangers of laxative overuse include electrolyte
imbalance, diarrhea, and nausea. Electrolyte imbalance, especially potassium deficiency, can lead to muscle
weakness and heart function disorders. This potassium imbalance can be
further exacerbated by the use of thiazide diuretics, corticoadrenal
steroids or high doses of licorice root. Chronic use of anthraquinone
glycosides has been associated with an increased pigmentation of the
intestinal mucosa called pseudomelanosis coli. While this has been
determined to be a benign condition, it is diagnostic for laxative
abuse and often alters the ability to diagnose other colon diseases. While the available evidence is divided on whether chronic
use of stimulant laxatives will result in a condition of a sluggish
colon, all attempts should be made to move to bulk-forming laxatives
and refrain from chronic use of stimulant laxatives.