Guangdong, China—Using laxatives regularly might increase the risk of dementia, according to a new study finding an association, especially with osmotic “stool softeners.” This report was recently published in the journal Neurology.

“Constipation and laxative use are common among middle-aged and older adults,” stated study author Feng Sha, PhD, of the Shenzhen Institute of Advanced Technology at the Chinese Academy of Sciences in Guangdong, China. “However, regular laxative use may change the microbiome of the gut, possibly affecting nerve signaling from the gut to the brain or increasing the production of intestinal toxins that may affect the brain. Our research found regular use of over-the-counter laxatives was associated with a higher risk of dementia, particularly in people who used multiple laxative types or osmotic laxatives.”

Dr. Sha points out that osmotic and stimulant laxatives are not recommended for regular use, yet some people use them regularly. A third type of laxative is bulk-forming.

“Use of OTC laxatives is common in the general population,” the authors wrote. “The microbiome-gut-brain axis hypothesis suggests use of laxatives is associated with dementia. We aimed to examine the association between regular use of laxatives and incidence of dementia in UK Biobank participants.”

The prospective cohort study included participants aged 40 to 69 years without any history of dementia. For purposes of the research, regular use of laxatives was defined as self-reported use on most days of the week for the last 4 weeks at baseline from 2006 to 2010. The focus was on outcomes including all-cause dementia, Alzheimer’s disease, and vascular dementia, which were all identified from linked hospital admissions or death register up to 2020.

The study ultimately included 502,229 participants with a mean age of 56.5 years (standard deviation = 8.1) at baseline. Most were female (54.4%), and 3.6% reported regular use of laxatives. Sociodemographic characteristics, lifestyle factors, medical conditions, family history, and regular medication use were considered in the analysis.

The results indicates that over a mean follow-up of 9.8 years, 1.3% of participants with regular use of laxatives and 0.4% without regular use developed all-cause dementia. “Multivariable analyses showed that regular use of laxatives was associated with increased risk of all-cause dementia (hazard ratio [HR] 1.51; 95% confidence interval 1.30-1.75) and vascular dementia (HR 1.65; 1.21-2.27), with no significant association observed for Alzheimer’s disease (HR 1.05; 0.79-1.40),” according to study authors. “The risk of both all-cause dementia and vascular dementia increased with the number of regularly used laxative types (P-trend 0.001 and 0.04, respectively).”

The researchers added that among the 5,800 participants who clearly stated they were using just one type of laxative, only those reporting use of osmotic laxatives showed a statistically significantly higher risk of all-cause dementia (HR 1.64; 1.20-2.24) and vascular dementia (HR 1.97; 1.04-3.75).

The number of laxative types used was also linked with the likelihood of dementia. For those using one type of laxative, the risk increased by 28%. There was a 90% increased risk, however, for those taking two or more types of laxatives.

Among those reporting use of one type, only those on osmotic laxatives had an elevated risk, and a 64% increase compared with those who did not use laxatives.

“Finding ways to reduce a person’s risk of dementia by identifying risk factors that can be modified is crucial,” Dr. Sha advised. “More research is needed to further investigate the link our research found between laxatives and dementia. If our findings are confirmed, medical professionals could encourage people to treat constipation by making lifestyle changes such as drinking more water, increasing dietary fiber, and adding more activity into their daily lives.”

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