Laxative Tasting

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Dear Editor:

A good time was had by all at the annual San Diego Hospice laxative tasting. Attending the event were 10 palliative medicine fellows and one internal medicine resident. All had the opportunity to imbibe 10 liquid refreshments designed to relax, soften, and move … stools. Each laxative was given a score between 0 and 10, mimicking the pain scale but substituting palatability (Table 1). Zero was the least offensive and 10 the most. Although the customary tasting protocol of sipping and spitting was not observed, some gagging and retching did occur.

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Table 1.

Laxative Tasting Data

	Participants' rating
Drug name	0–3 a	4–6 a	7–10 a	Mean score	Range of scores
1. Docusate liquid	0	2	9	8–9	5–10
2. Senna liquid	4	6	1	4.4	1–8
3. Magnesium citrate	6	4	1	3.1	0–7
4. Sodium phosphate	0	1	10	7.9	4–10
5. Lactulose liquid	6	3	2	4	1–8
6. Sorbitol	4	6	1	4.1	1–9
7. Polyethylene glycol (PEG)	9	1	1	1.9	0–8
8. Milk of magnesia	3	5	3	5.1	0–10
9. Tasteless castor oil	1	6	4	5.8	3–9
10. Yakima Paste b	9	0	0	0.55	0–2

a

Key: 0–3 = most palatable, 4–6 = less palatable, 7–10 = disgusting; ^btwo participants did not rate.

The gold medal went to Yakima paste with a mean score of 0.55. For those not familiar with it, Yakima paste is a mixture of raisins, prunes, senna leaves, figs, and lemon juice (Table 2). Polyethylene glycol snagged the silver at 1.9 and the bronze medal went to magnesium citrate at 3.1, described by one fellow as “citrusy, bubbly, not so bad,” Of the 10 laxatives tasted, the least popular was docusate, mean 8.9, thought by most to have “bitter” notes. Next in line was sodium phosphate, described by one taster as “absolutely disgusting.”

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Table 2.

Yakima Fruit Paste ^a

Ingredients:

4 ounces senna tea leaves

1 pound prunes

1 pound pitted raisins

1 pound figs

1 cup brown sugar

1 cup lemon juice

Preparation Method:

1. Prepare tea using about 2½ cups boiled water added to tea; steep for 5 minutes.

2. Strain tea to remove tea leaves and add only 2 cups tea to a large pot, and then add fruit.

3. Boil fruit and tea for 5 minutes.

4. Remove from heat and add sugar and lemon juice. Allow to cool.

5. Use hand mixer or food processor to blend fruit mixture into a smooth paste.

6. Place in plastic container and place in freezer. (The paste will not freeze, but will keep indefinitely in the freezer without spoiling.)

7. Spoon out what you require each day.

Recommended Usage:

Consume 1 to 2 tablespoons each day.

Eat with a spoon, if desired.

Spread on toast, bread, crackers, or bagels.

Add hot water and make a drink.

a

Currently used at San Diego Hospice; alternate formulations available online.

The tasting was held in part to help the fellows and residents understand why adherence with prescribed medical treatments might be an issue for our patients who suffer from constipation. Constipation occurs in at least 50% of palliative care and hospice patients. Untreated, severe constipation may lead to complications including bowel obstruction, pudendal nerve damage, fecal incontinence, and rectal prolapse. ¹

The results of the tasting will guide us to consider different choices to prevent and treat constipation. For example, using pills instead of liquids when feasible. Or using Yakima paste and avoiding liquid docusate and sodium phosphate. Even the most palatable laxatives might feel burdensome as larger quantities are needed to alleviate symptoms.

We urge all our colleagues to pull out their crystal stemware and host their own laxative tasting, and to challenge the pharmaceutical industry to create more patient-friendly remedies to treat this important symptom.

The atmosphere at the laxative tasting was convivial with much laughter and bonding until approximately 3 p.m. when the event ended abruptly … there was a rush for the bathrooms! (No adverse effects reported.)

Imagine quaffing these fine vintages two or three times every day! Yummm!!!