The Imodium AD - Opium Connection (How They Stop Diarrhea)

We awkwardly looked into each other’s eyes. Then, down to the floor and then back up. His face was flushing and getting red. On the floor, between us, sat a plastic package marked “Imodium AD.”

Jordan scooped it up and slid it back into his wallet.

He began to explain to me that this was his emergency stash. He had one in the car, in his wallet, at work, and all over the house. Just in case the diarrhea came out of nowhere… and sadly, I understood. That’s what our life was like back when we were sick.

If you’re anything like us, you understand that when the diarrhea strikes – the world stops. Luckily, we live in an age of 24-hour drug stores that stock products like Imodium AD to help in these situations.

There’s no doubt the product has saved lives, but should we think twice about relying on drugs like Imodium AD for diarrhea?

What You Need to Know About Diarrhea

Diarrhea is loose watery stool that is often accompanied by bloating, gas, and cramping. It’s at least a 6 but mostly a 7 on the Bristol Stool Chart. It’s caused by a number of things like:

Food intolerance
Infections
Disease
Medications
And many more…

There are many causes and several can be happening at once which contribute to increased transit time. As mentioned in the causes post above, diarrhea can be simple and extraordinarily complex from a causal standpoint. What is clear is that when the digestive process is sped up there are significant health consequences.

Diarrhea means things are moving too fast and as a result you won’t be absorbing the nutrients from the foods you are eating. Not only that but you’ll be losing electrolytes at a fast pace and disrupting your body’s water balance. Both of these are very important, and if left uncorrected persistent diarrhea can kill you. It is the 2nd leading cause of dying children worldwide.

The real world we live in today doesn’t have time for diarrhea. Between having families, 60+ hour work weeks and extra curricular activities, we don’t have time to be running to the toilet and staying there. We’re stretched pretty thin, which makes most of us naturally reach for a quick fix to make the diarrhea stop.

Opium – The Original Anti-Diarrhea Medication

Imagine for a moment it’s the year 1525, and you were experiencing diarrhea for a few days. And now, feeling fatigued, you walked over to the medicine man asking for advice. He might have given you a small amount of dark liquid with instructions to drink until the diarrhea stops.

What was it?

He just gave you OPIUM!

…which probably also gave you a wicked smile along with a stoppage of the diarrhea, but I digress. One thing that is known is that opium was used for 1000’s of years as an antidiarrheal drug.

You might be surprised to learn that over-the-counter pill Imodium AD actually works to stop diarrhea the same way opium does (minus the high and other addictive effects).

Opium or Imodium?

Both drugs stop diarrhea using the same mechanisms. It’s pretty cool how it works. The cells in your body are covered with these little receptors. You can think of them like locks on a door, and like locks each one has a key. So, each receptor is activated by a particular key.

In your brain and spinal cord, you have a super special group of receptors named µ-opioid receptors (the little µ is pronounced as mu….sounds like mew, like a kitten mewing). These are the receptors that opium and other narcotics effect. The mu-receptors are also located in the gut. According to one study, a lot of the drugs that act on your brain actually act on the gut, too, because “it’s equipped with the largest collection of neurons outside the brain.” This intestinal network of neurons is known as the enteric nervous system.” This is how the gut was nicknamed the second brain by Dr. Michael Gershon.

And this is why opiate drugs like codeine, Vicodin, and hydrocodone list constipation as a side effect and are commonly prescribed with laxatives because they activate the mu-receptors. Now you are starting to understand why opium was used for centuries to treat diarrhea. But we still haven’t gotten to how Imodium works.

What is Imodium and how does it work?

The active ingredient in Imodium AD is loperamide HCL. Loperamide is FDA approved and works by acting on the µ-opioid receptors in the mesenteric plexus of the large intestines. That funky word, mesenteric plexus, is just referring to the neural network of your digestive system (the enteric nervous system that we just learned about). So, you take your Imodium AD and this loperamide HCL ends up connecting with the µ-opioid receptors in your mesenteric plexus, just like opium would. And BAM, no more diarrhea.

See, when loperamide interacts with the µ-opioid receptors in the gut it causes your GI system to slowwww waaayyy doowwnnn (slow motion voice). It’s like a giant factory that just got orders to stop production and it works from top to bottom. Your stomach will stop passing on its contents to the small intestine, all the sphincters in your GI system will tighten up, peristalsis will slow way down so stuff isn’t getting moved through your system as fast, and the result is dramatically slower total transit time.

Finally, due to the slowing of the GI’s motor function, loperamide is also given credit for weakening the secretion of electrolytes and water. Plus, more fluid will be absorbed (making for a more compact poo). All of this works to plug you up, when your digestive tract is moving too quickly.

Is all of this safe?

Loperamide HCL, as mentioned before, is an FDA approved drug. As with many drugs, there are side effects, which are listed by the company as dizziness and drowsiness. But, unlike opium, loperamide has been shown to have a very low concern for abuse and the company claims it is not habit forming. That being said, studies involving loperamide and children have proven it to be lethal. According to one study:

“Serious adverse events, defined as ileus, lethargy, or death, were reported in eight out of 927 children allocated to loperamide. Serious adverse events were not reported in any of the 764 children allocated to placebo. Among the children allocated to loperamide, serious adverse events were reported only among children younger than 3 years.”

And the FDA advises that children under the age of 2 not take Imodium. But does that mean it’s harmless for adults? – a question with an unknown answer. What we do know is that diarrhea alone is possibly fatal, so taking Imodium to prevent death is a good thing. But taking it for chronic diarrhea like Jordan used to is a different story.

Our belief is that long-term reliance on a medication to treat a symptom is not the best approach. No one fully understands ALL the effects of this drug’s usage and we especially have zero data on long-term daily usage. And that’s reason enough for us to not support this habit, especially when there are other alternatives.

The Imodium AD – Opium Connection (How They Stop Diarrhea)

What You Need to Know About Diarrhea

Opium – The Original Anti-Diarrhea Medication

Opium or Imodium?

Other Solutions For Persistent and Chronic Diarrhea

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