Tagged Laxatives

Attention, Teenagers: Nobody Really Looks Like That

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Credit Anna Parini

The universal truth of puberty and adolescence is body change, and relatively rapid body change. Teenagers have to cope with all kinds of comparisons, with their peers, with the childhood bodies they leave behind, and with the altered images used in advertising and in the self-advertising on social media.

It may be that the rapid way the body changes during these years can help adolescents believe in other kinds of change, including the false promises that various products can significantly modify their size and shape. A study published last month in the journal Pediatrics looked at two kinds of risky behavior that are increasingly common over adolescence: the use of laxatives for weight loss and the use of muscle-building products.

It used data from an ongoing study of more than 13,000 American children, the Growing Up Today Study (GUTS). The participants’ mothers took part in the Nurses’ Health Study II, and the children were recruited in 1996, when they were 9 to 14 years old, and surveyed about a variety of topics as they grew up.

By age 23 to 25, 10.5 percent of the women in this large sample reported using laxatives in the past year to lose weight; the practice increased over adolescence in the girls, but was virtually absent among the boys. Conversely, by young adulthood, about 12 percent of the men reported use of a muscle-building product in the past year, and again, this increased during adolescence.

So a lot of young women are taking laxatives to try to become very thin, and a lot of young men are using products to help them bulk up and become more muscular. The researchers were interested in how these practices were associated with traditional ideas of masculinity and femininity. They found that, regardless of sexual orientation, kids who described themselves as more gender conforming were more likely to use laxatives (the girls) or muscle-building products (the boys).

“The link is the perception that they are going to alter your weight, shape, appearance,” said Rachel Rodgers, a counseling psychology researcher who studies body image and eating concerns and is an associate professor of applied psychology at Northeastern University.

“The representations of ideal appearance in society are very restrictive and very unrealistic both for men and for women,” she said. “They portray bodies that are unattainable by healthy means.”

Jerel Calzo, a developmental psychologist who is an assistant professor at Harvard Medical School, and the lead author on the study, said that one important aspect of this research was the way it highlighted the vulnerability of those who identify with traditional gender ideals.

“Usually in research we tend to focus on youth who are nonconforming, who we might focus on as more at risk for negative health outcomes, depression, who might be ostracized or victimized,” he said. But there are risks as well for those who are trying to measure up to what they see as the conventional standard.

The GUTS participants were asked to describe themselves as children in terms of the games they liked and the movie and TV characters they imitated, and this was used to score them as more or less “gender conforming.”

The early patterns of gender conformity were significant, Dr. Calzo said, because they were linked to behaviors that lasted through adolescence and into young adulthood. “Laxative use increases with age, muscle-building product use increases with age,” he said. “There is a need for early intervention.”

Chronic use of laxatives can affect the motility of the bowel so that it can be hard to do without them, and overdoses can alter the body’s balance of electrolytes, to a really dangerous extent.

“There’s a lot of shame and guilt for laxative abuse,” said Sara Forman, an adolescent medicine specialist who is the director of the outpatient eating disorders program at Boston Children’s Hospital. And many products marketed as cleanses or herbal teas are not labeled as laxatives, though they contain strong laxative ingredients.

The muscle-building products in the study included steroids, creatine and several others. The risks of steroids are well known, from hormonal imbalances and shrinking testicles to acne and aggression. With other commercial muscle-building products, the risks may have more to do with the lack of regulation, Dr. Calzo said. The products can contain banned substances or analogues of banned substances, like the amphetamine analogue found in popular diet and workout supplements last year.

And of course, the muscle-building products won’t reshape you into the photoshopped model any more than the laxatives will.

As Dr. Calzo says, we need to worry about the vulnerabilities of children who are growing up with issues of gender identity and sexuality. But don’t assume that more “mainstream” or “conforming” kids have it easy when it comes to body image. Parents can help by keeping the lines of communication open and starting these conversations when children are young. We should be talking about the images that our children see, about how real people look and how images are altered.

And that conversation should extend to social media as well; in a review by Dr. Rodgers, increased social media use was correlated with body image worries. “Teenagers are looking at their friends on social media and seeing photos that have been modified and viewing them as something real.”

The other message for parents is about helping to model healthy eating, family meals, realistic moderation around eating and exercising, and to refrain from any kind of negative comments or teasing about a child’s body. “Research has shown people who have more body satisfaction actually take care of themselves better, which suggests that the approach of making them feel bad is actually not helpful,” Dr. Rodgers said.

Every adolescent, across gender, gender identity, gender conformity, and sexuality, lives with a changing body and the need to navigate body image and identity. There are a lot of unrealistic images out there to measure yourself against, and a lot of false promises about how you might get there.

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Simple Remedies for Constipation

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Credit Paul Rogers

Chronic constipation is an all-too-common problem rarely discussed in polite company and only reluctantly mentioned to doctors during checkups. Although it accounts for eight million doctor visits annually, only “a minority of those with constipation seek medical attention,” Dr. Arnold Wald, a leading expert on the problem, reports.

Yet this hesitance can perpetuate mistaken beliefs about its consequences, causes and treatment, and often results in failure to get effective relief. Most of the time, relatively simple treatments prove adequate. Even more complex cases, like those that involve a disorder of muscle action in the pelvis, usually respond well to currently available remedies.

Chronic constipation can accompany a long list of medical problems – mechanical ones like a stricture or tumor; neurological disorders like Parkinson’s disease or multiple sclerosis; or metabolic conditions like severe low thyroid or low blood levels of magnesium.

Constipation can also be a side effect of medications, especially opiates like Percocet and OxyContin, as well as some antidepressants, anticonvulsants and antihistamines.

As someone who has dealt with constipation, with varying degrees of success, for most of my life, I had more than an academic interest in learning more about it. Hence this column, prompted by a friend’s excruciatingly painful problem that seemed to emerge from nowhere and by a new review of studies on the topic published in JAMA by Dr. Wald, a gastroenterologist at the University of Wisconsin School of Medicine and Public Health.

Many strongly held beliefs about constipation are not based on medical evidence, Dr. Wald and his colleagues have noted.

One of the oldest yet most persistent of these unsubstantiated notions is that failure to empty one’s bowels each and every day can result in so-called autointoxication – the absorption of poisonous substances produced from partially digested food and food byproducts in the intestines. Through the years, autointoxication has been erroneously blamed for a host of ailments, including high blood pressure, arthritis, atherosclerosis, gall bladder disease, various cancers and skin disorders.

Autointoxication is often cited as a reason for the common but mistaken belief that a daily bowel movement is essential to good health. But there’s no evidence that food that sits in the intestine leads to the buildup of toxins. The medically accepted definition of constipation is “fewer than three bowel movements a week, or hard, dry and small bowel movements that are painful or difficult to pass,” often resulting in abdominal pain or bloating.

Unfortunately, as a college freshman, I met those criteria. An astute physician provided advice that has helped to minimize the problem ever since. She gave me a list of “constipating” foods to avoid – white rice and other refined grains, unripe bananas, tea, cheese and chocolate – and even more important, foods to eat regularly: beans, whole grain cereals (especially bran) and breads, vegetables, fruits (especially dried fruits) and nuts. Eating more of these and other high-fiber foods can be very effective in curbing constipation. And she recommended drinking a full glass of water before bed to help soften the stool and another after awakening to stimulate my bowel.

Following this advice I’ve never had to rely on laxatives, although those medications are associated as well with myths and misconceptions that are important to dispel. One mistaken belief Dr. Wald and others have cited is that long-term use of stimulatory laxatives like senna and bisacodyl (Senokot and Dulcolax, respectively) can impair normal function of the colon and cause dependency on the medication.

While it is true that using stimulatory laxatives for many years at more than a dozen times the suggested dosage can damage the colon’s nerves and muscles, Dr. Wald and others say that properly designed studies of these laxatives have shown no harm to the colon when they are taken in recommended amounts.

Yet many doctors still warn – inappropriately, Dr. Wald says — against taking stimulatory laxatives for more than a few days. Indeed, the website FamilyDoctor.org states, “When these laxatives are taken for a long time, the bowel can lose its muscle tone and ‘forget’ how to push the stool out on its own.” Best to forget this outdated idea as long as you stick to the recommended dose if you must take these products.

Short of potent laxatives, other milder remedies often prove helpful. One is exercise, the more vigorously done the better. Another is to establish a regular bathroom time and respond promptly to the urge to defecate. I am among many who have found that a large cup of hot coffee in the morning is often a very effective stimulus.

However, as my ability to prevent constipation has diminished with age, I’ve added two other over-the-counter aids: a daily soluble fiber supplement of psyllium dissolved in juice or water (other fiber products like methyl cellulose, calcium polycarbophil and wheat dextrin can also be effective) and a twice-daily dose of a stool softener, both of which can safely be used indefinitely.

However good dietary fiber normally is for maintaining a healthy gut, it can be harmful when the cause of constipation is muscle weakness or a nerve problem, Dr. Wald said. Such patients often do better by eating less fiber and instead taking a secretory drug like lubiprostone (Amitiza) or linaclotide (Linzess) that adds water to the colon and softens the stool.

Sometimes, too, standard remedies for chronic constipation are ineffective. None worked for my friend, a New Yorker who suddenly developed an extremely painful problem at age 73 that was finally diagnosed as a failure of her pelvic floor muscles to relax when they are supposed to and allow the stool to pass through. Instead of relaxing, the muscles around the rectum contract. “It is a learned unconscious act that can be unlearned,” Dr. Wald explained.

Despite the usual remedies of diet, exercise and a costly prescription-only stool softener, the problem has recurred every eight days or so, she said. She is now being treated with deep breathing exercises 10 times a day and abdominal massage above the colon twice a day, and has begun biofeedback to “retrain” the muscles that are responsible for normal colorectal action. Dr. Wald said that biofeedback training, when done properly, is effective in about 80 percent of cases.

My friend’s experience underscores the importance of consulting an expert when constipation persists and fails to respond adequately to self-help measures of diet, exercise and over-the-counter remedies.

st dosing oneself prematurely with widely touted substances like resveratrol, the antioxidant found in red grapes and wine, or growth hormone.

Consumers must exercise caution, he warned, because “there’s an entire industry out there trying to market the products we’re testing before they are adequately evaluated.”

He also emphasized that taking a drug found to ward off age-related ills is not a license to abandon a healthy lifestyle. Doing so “could completely negate the benefit of a compound that slows aging,” he said.

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