Epsom salts is a hyperosmotic saline type laxative which acts within in a regulation time of 1-6 hours, however this figure is also reported to be 3 to 12 hours or even longer up to 24 hours. I assume it is dependant upon the transit time through the small intestines. It contracts the gallbladder, relaxes the sphincter of Oddi, and increases gastric, intestinal and pancreatic secretion and, very importantly, production of cholecystokinin. Magnesium Sulfate (Magnesium Suphate; MgSO4) consists of 9.7% Magnesium bound to Sulphur . Magnesium Sulphate is not absorbed into the body but attracts Water in the Colon and acts as a Laxative. They are used for rapid emptying of the lower intestine and bowel. They are not used for long-term or repeated correction of constipation. With smaller doses than those used for the laxative effect, some saline laxatives are used as antacids. The information that follows applies only to their use as laxatives.

Cholecystokinin is a hormone that describes itself; 'cholecysto' means gallbladder and 'kinin' movement. The most potent stimulus for release of cholecystokinin is the presence of fat in the duodenum. The hormone acts on the pancreas to stimulate the secretion of digestive enzymes. Cholecystokinin also causes the increased production of hepatic bile, stimulates the contraction of the gallbladder and the relaxation of the Sphincter of Oddi, resulting in the delivery of bile into the duodenum

The Sphincter of Oddi is a muscular valve that controls the flow of bile into the duodenum through a "nipple" called the ampulla of Vater or papilla of Vater. A sphincter is a circular muscle which is normally constricted (closed) and which relaxes to allow the passage of substances.

 

Diagram of the Sphincter of Oddi

Hyperosmotic saline type laxatives pull salt (saline) solution into the intestines from the blood. Hyper (high) and osmotic (pertaining to osmosis). Osmosis is a term used in biology to describe the movement across a special membrane. If one side of such a membrane has a high concentration of a solution and the other side a low concentration then water will move through the membrane from the high to the low concentration side. No energy is needed in the process. This is how plants distribute water from the roots. The name given to this type of membrane is semipermeable membrane (permeable to the solvent, but not the solute). In general, these they are impermeable to organic solutes with large molecules, while permeable to water and small, uncharged solutes.

In the case of Epsom salts, magnesium is the active solute ingredient and water is the solvent. This excessive fluid then provides a flushing or laxative action within the intestines. There may be a loss of electrolytes as salts are carried across the intestinal membrane in to the gut. Many people can re-hydrate by drinking water but active people require the inclusion of electrolytes added to the water. To re-hydrate take a pinch of baking soda and a pinch sea salt in a pint of water and optionally half a pinch of Lo-Salt if it is available.

Trials of using Epsom salts with and without food have shown that it had the following effects:

Significantly accelerated the transit time from duodenum to the ileum.

Increased faecal fat and weight.

Delayed the reoccurrence of phase III of the MMC migratory motor complex during fasting but not after meal.

Affected antroduodenal during fasting but not after meal ingestion. Antroduodenal describes motility the contractions of the muscles of the stomach and the first part of the small intestine, the duodenum

Postprandial gall-bladder relaxation and postprandial peptide YY release were significantly increased. (Postprandial means after a meal). Pancreatic Peptide YY3-36 is a peptide produced in the small intestine and colon that reduces appetite in response to feeding.

It was concluded that Epsom salts MgSO[4] accelerates intestinal transit both in the fasting and fed state. MgSO[4] activates the ileal brake mechanism only in the fed state, with peptide YY release and inhibition of gall-bladder emptying. The ileal brake describes the transit from small to large intestines. Applying the brake causes the transit time to increase and is a normal response that allows biliary salts to be recovered; the enterohepatic cycle.

This explains why it is so important to consume Epson Salts when the stomach and small intestines are empty and MMC phase is complete, and why it is recommended that no food is consumed for prior to flushing. I would estimate that a minimum of 2 hours are required for a simple meal to trigger an ileocaecal brake response and 4 hours is required for the MMC. Consequently 6 hours should elapse between eating and commencing the flush protocol in order to obtain the maximum benefit.

It is well known that drinking sulphate-containing natural mineral waters causes contraction of the gallbladder, probably induced by the release of cholecystokinin. This had been reported in medical papers since 1943 by Boyden EA, Bergh GS, Layne J A. in a paper called “An analysis of the reaction of the human gall bladder and sphincter of Oddi to magnesium sulphate. Surgery 1943; 13:723-733”. Some people consume sulphur supplements such as cysteine or taurine which are naturally occurring sulphur bearing amino acids, or MSM (methysulfonylmethane) which is an organic sulphur compound. However, the sulphur may not be converted to the properly needed sulphate form. The form of sulphur in the Epsom salts is already a sulphate and readily available to the body. Sodium phosphate and sulphate are cholagogue (increases flow of bile from the gallbladder) purgatives and have traditionally been used in the treatment of gallstones. Health springs are often rich in sulphate. In an experiment people were given sulphate mineral water containing 2800 mg of sulphate (SO 4 2−/L) which was ingested within 5 min. 2800 mg of sulphur can be provided by about 10.5 grams (Just over 1 dessertspoon) of magnesium sulphate. The size of the gallbladder was record using ultrasound. The experiment was repeated several times at different hours of the day for each person. After the intake of the mineral water, the mean gallbladder size decreased significantly, followed by an increase after 60 min. The maximum contraction was in the early morning hours and was 30% greater than the minimal that occurred around midday. The relaxation maximum was 38.5% greater than the minimal and occurred around 9:00. These results show that the resting size of the gallbladder between meals and its reaction to stimuli show a marked circadian variation. A circadian rhythm is a 24-hour day cycle in the physiological processes of living beings. It can be concluded that contraction of the gallbladder is maximal in the early morning and dilatation is stronger in the afternoon about 18.00 hrs. The influence of the circadian cycle on the flush is difficult to analyse and needs to be assessed in relation to all other aspects.

The most convincing argument that supports the benefits of Epson salts as a liver flushing agent is an experiment carried out in 1981 by the Departments of Surgery and Radiology, The University of Texas Medical Branch, Galveston, Texas.

Five volunteers drank a solution of magnesium sulphate (25 g in 100 ml of distilled water) and the contraction of the gallbladder, bile flow and blood levels were monitored at 2, 5, 10, 15, 20,25,30,35,40,50, and 60 minutes. The results show that blood cholecystokinin concentrations were increased significantly in response to oral magnesium sulphate. The base concentrations did not change significantly during the first 15 minutes after ingestion. It then rose significantly and kept rising for 40 minutes when it was 1.75 times the starting value. The volume of the gallbladder before administration of magnesium sulphate was approximately 308 mL. Gallbladder volume did not change in the first 15 minutes; it then decreased as the cholecystokinin concentrations rose. At 25 minutes, the gallbladder size was decreased significantly to 204 mL. Gallbladder contraction was sustained during the remainder of the study, and the smallest gallbladder volume was observed at 50 minutes where it was 109 mL.

Graph showing the contraction of the gallbladder to the oral magnesium sulphate

The magnesium sulphate also induced a significant increase in levels blood gastrin a hormone that stimulates secretion of gastric acid by the stomach which is released by cells in the stomach and duodenum. There was no significant change in blood serum magnesium concentrations from a mean base concentration of 3.1 mg/dl. All the volunteers noted hyperperistalsis (increased intestinal activity) and had increased bowel movements’ an average of 3 hours, from 30 minutes to 24 hours after oral ingestion of magnesium sulphate.

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