DEAR DR. DONOHUE: This question is one I cannot ask my family physician. I take about 15 laxatives a day – all at once – and have been doing so for about two years. I feel I am really doing myself harm, but I can’t seem to wean myself from them. Your thoughts are appreciated. – A.B.

ANSWER: You’re going to need your family doctor’s input in getting you over the laxative habit. The doctor isn’t going to recoil in disgust or swoon on hearing this. He or she has heard the same story many times. The dangers of laxatives have been overstated in the past, but taking 15 a day is a bit much for anyone’s colon. There are four general classes of laxatives. I don’t know which you’re taking, so I’ll spend a moment on each.

Osmotic laxatives pull water into undigested food. MiraLax, Cephulac, Enulose and milk of magnesia belong in this class. They have few side effects. If your stools are loose and voluminous, you can lose minerals like potassium.

Bulking laxatives attract water into the food residue too. Metamucil, Citrucel and psyllium are such laxatives. So is fiber. And fiber can safely replace the 15 laxative pills you take. As you decrease the number of your laxative pills, increase the amount of fiber you eat. Do this slowly; too much fiber gives you gas and bloating. Drink more fluid than you usually do. Fruits, vegetables and whole grains are fiber sources. We’re supposed to get around 25 grams a day. An apple with skin has 4.7 grams; a carrot, 4 grams; 1 ounce of All-Bran cereal, 14 grams; 6 prunes, 8 grams; a cup of baked beans, 9 grams. If all 15 of your pills are bulking agents, you’re not in deep trouble at all.

Stool softeners act like soap to promote the mixing of food and fluids. They keep stools moist and soft. Colace is an example. Stool softeners don’t get people into dire straits.

Stimulant laxatives irritate the colon wall and cause it to contract more forcefully. If taken in large amounts, they have the potential to disturb colon action, but the colon can return to normal when a person eventually gets off them. Senokot and Cascara are stimulant laxatives.

Do tell your doctor, who can work with you to get you over your laxative habit.

DEAR DR. DONOHUE: You had a laxative recipe in the paper. It included bran. Do you mean the bran flakes cereal? If not, where do you get it? – Anon.

ANSWER: Bran is the outer coat of grains, the stuff removed during refining. It’s a wonderful fiber source. You can buy bran (wheat bran) in health-food stores.

The recipe calls for 2 cups bran, 2 cups applesauce and 1 cup of prune juice. Refrigerate the mixture and take 2 or 3 tablespoons once or twice daily as needed. You can add anything your heart desires – nuts, raisins, fruit, whatever.

DEAR DR. DONOHUE: Please give me some information on the pancreas. I am 81 years old, and I have a cyst on my pancreas. Doctors are waiting to see if it grows. Is a cyst on the pancreas always cancer? Can they remove it? – I.K.

ANSWER: A pancreatic cyst is rarely cancer.

Some people are born with one or more pancreatic cysts. They arise because of faulty development of pancreatic ducts – the drainage pipes through which pancreatic digestive enzymes are carried into the digestive tract.

Cysts also form after pancreatic inflammation. They don’t become cancer. People with the genetic illness polycystic kidney disease often form pancreatic cysts – those are not cancer either.

A small number of pancreatic cancers arise in special kinds of cysts that, on scans, have irregular nodules on their walls, fibrous partitions in their interiors and some solid masses inside them. If there is doubt about a cyst, fluid can be drawn from it and examined for cancer cells.

DEAR DR. DONOHUE: I disagree with your answer to the person who asked why he gained weight after starting insulin. About 95 percent of people who start insulin do gain weight. I work as a diabetes care manager, and part of the discussion during an insulin-start appointment is that weight gain occurs unless calories taken in via food are matched by calories burned each day. Your answer to that patient was too short to help him understand what he’s up against. – S.D.

ANSWER: Weight gain definitely does occur when a person begins insulin treatment or begins to take some oral diabetes medicines.

In an untreated diabetic, blood sugar cannot get into body cells. Much is eliminated in the urine. Those sugar calories leave the body. That’s a reason why diabetics urinate so frequently and in such great volumes. And it’s also the reason why an untreated diabetic has such a great appetite without gaining weight. After insulin is begun, sugar is able to enter cells; as a result, the body retains calories, and weight increases.

There is another reason why this happens. Upon starting insulin treatment, the body’s metabolic rate decreases somewhat, so fewer calories are burned and more are stored.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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