CONCERNING HEALTH TRENDS ON TikTok 

Part 1: Laxatives

Many of us – if not all – have heard dancers complain about digestive issues, haven’t we? And almost like a reflex, there’s this thought of ’Oh, probably it’s been the food. Maybe they’re allergic, or intolerant. So many people these days are intolerant to food…’. And many dancers start cutting out foods – often with no positive result. And then some. 

Rarely is it thought about how these digestive issues could be treated. Until TikTok made it a health trend. I actually had thought this one would not affect the dance world so much, but a recent poll on Instagram, plus an increasing number of dancers in clinical settings, report the use of laxatives. Argh! 

What are laxatives or what do they do? In plain medical language: Using laxatives is just another form of purging. Probably hardly anyone would think of laxatives as ’purging’, but we use it in medicine as the effect on the body is pretty much the same. WHAT? There are so many videos on TikTok promoting laxatives as a low-budget weight loss option – and completely blocking out what is actually happening in the body. Yes, sure – you will lose weight (just not the weight you wanted to lose); and a lot more. And the latter one is not being communicated on TikTok. 

So, c’mon, Stephanie, what is it with laxatives? So many dancers struggle with their digestion, being plagued by constipation or other uncomfortable symptoms like bloating. If laxatives can help, surely they must be good?

Main causes for digestive issues in dancers

A significant body of scientific evidence has found low energy availability, or restrictive dieting overall, to be a main factor for constipation in dancers. Yes, not kidding! If your gut isn’t getting enough to fill its system and do its job, how do we expect it to produce the output we’re waiting for? It’s not happening. But what do dancers often think? ’Wow, I’ve been fueling so well with healthy meals and snacks, my body is turning against me, why am I getting punished with constipation? Something must be wrong.’ It is more likely that those meals and snacks haven’t met your energy needs – and nothing else is ’wrong’. Laxatives aren’t sorting anything that’s going on in the digestive system, they’re simply adding to the problem – no matter how much relief a dancer might feel being able to produce a bowel movement on demand. (Hypermobility and gastrointestinal issues are considered a little later in this blog post). Here are the facts: 

Underfueling causes digestive problems such as constipation

Not getting enough energy makes the body face a difficult decision: Heartbeat, breathing, thinking – and moving! – need to be prioritized, definitely NOT digestion. Side note: As moving is included in the priority list, too many people tend to not understand that it doesn’t mean someone is ’okay’ or ’fine’ just because they can still move (=dance). The only reason the body prioritizes movement is that – long ago – it meant moving from one place to another would increase chances that food could be found to end the restriction/underfueling; and that is exactly how the body reacts today still although our environment has changed to food being available 24/7. Diet and fitness culture are experts at making us believe that essential functions like our heartbeat do not require energy – when they absolutely do (Watch this – it’s excellent!). So, instead of stopping our heartbeat, our bodies stop our digestion (esp. in the large intestine, the colon) when ’there’s not enough energy in the tank’. Let’s be honest, it is smart; and definitely a sign that our body is not working against us, but for us, by keeping us alive (maybe not kicking, but alive). 

But why is the digestive tract affected? Not fueling sufficiently for one’s daily needs causes the body to break down muscle tissue, including gastrointestinal muscles, i.e.the muscles that are normally responsible for moving the food through the guts. We all know too well that we lose muscle (skeletal muscle) tissue when we are injured and can’t move e.g. an arm, a leg, or a foot. And just as much as that impairs daily activities, so does a loss of muscle tissue in our guts, most often resulting in constipation. 

Below is an Instagram post that never gets old: The effects of sufficient versus insufficient (=underfueling) on body and mind. 

And why can’t laxatives sort that problem? 

Well, the obvious being that laxatives do not provide energy. Energy that would be required otherwise to get the digestive system back to good function. There’s a belief that laxatives can cause a person to consume fewer calories – but that would only happen in extreme abuse (and it#s unlikely you’d be able to still dance at such doses, you’re more likely to spend your entire days and nights in the bathroom). As they work mostly in the colon (= late stages of digestion), the absorption of nutrients has taken place much earlier. What laxatives do though is dehydrate. Human body weight is comprised of about 50% of water, and part of that is what gets ’lost’ – mistakenly believed to be ’fat loss˚. Using laxatives when not indicated almost always causes nausea and cramps, and can also be the cause of severe health conditions like pancreatitis or kidney stones. There’s an ongoing debate that chronic (=long-term) laxative abuse may damage the muscles of the colon so much that a life without these ’helpers’ may no longer be possible (when someone has to rely on laxatives as part of a damaged gut, the use of laxatives is then called ’constipation management’, but please be aware that this is a real medical complication that accompanies someone for the rest of their life, and is certainly not what they set out for when they started taking laxatives). 

Other side effects of laxatives include diarrhoea. Most people get worried when they have diarrhoea, knowing that it can cause electrolyte imbalances (which then in turn can cause severe side effects), but that electrolytes get lost when taking laxatives, this somehow gets blocked out. Electrolytes include calcium, chloride, potassium, magnesium and sodium. They regulate a multitude of body functions – think of them as the catalysts to any chemical reaction (=metabolism) in the body. An imbalance of electrolytes can cause heart rhythm changes, weakness, confusion or even seizures.

The way most OTC  laxatives work is by drawing more water into the colon. That water will be what makes you dehydrated (and that in turn adds to electrolyte imbalances). There are other laxatives that stimulate the muscles of the digestive tract to contract rhythmically (thereby producing bowel movements), but these usually are – they definitely should be – prescribed by a healthcare professional. 

Clinical inside scoop

I’ve had GPs prescribe laxatives in dosages that should be called ’laxative abuse’ to young patients that either had severely disordered eating or even a clinical eating disorder (and definitely were underfueled), thereby enabling the young person to no longer think rationally about the true cause of constipation (even worse, being reassured they’re fine except for the constipation), the body’s actual needs (most often: more food), and that way, laxatives can easily become part of a vicious cycle of restricting (potentially paired with bingeing), and over-exercising. 

Hypermobility and gastrointestinal issues

Hypermobile individuals may ‘naturally’ experience a floppy, or weaker colon due to their condition. Yet any dietary management should not be laxatives in the first place, but a diet that is suitable for their individual needs – often a diet that is lower in fibre to help the food pass through the digestive system more easily (absolutely contrary to someone without hypermobility and constipation that is not due to DE/E: they would get the advice to increase their fibre intake; whereas non-hypermobile individuals with DE/ED would also be recommended a low fibre diet). Reducing the fibre content of a diet does not dehydrate, does not cause nausea or cramps, does not cause an inflammation of the pancreas or kidney stones,  and does not cause electrolyte imbalances.

If you then pair symptomatic hypermobility with disordered eating (DE) or an eating disorder (ED) where (additional) muscle breakdown of the gastrointestinal system has happened due to restrictive food intake, you somehow got the recipe for disaster, right? Both DE/ED as well as GI-symptoms associated with hypermobility should be checked by a dietitian/nutritionist first and foremost. And TikTok is not the place to get that checked; nor is Instagram ( or any social media, for that matter). The only safe way to do that is in a clinical setting with your dietitian/nutritionist/doctor. 

If you come across this trend, please remember, it’s not a trend. It’s harmful. Dislike. Report.

 

Selected references:

Bashir A, Sizar O (2024). Laxatives. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. PMID: 30725931

Roerig JL, Steffen KJ, Mitchell JE, Zinker C (2010). Laxative abuse: epidemiology, diagnosis and management. Drugs. 70(12):1487-503. doi: 10.2165/11898640-000000000-00000

Keay N, AusDancersOverseas, Francis G (2020). Indicators and correlates of low energy availability in male and female dancers. BMJ Open Sport Exerc Med 6(1):e000906. doi: 10.1136/bmjsem-2020-000906.eCollection 2020