Senna laxatives side effects

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Constipation may not be a subject for polite conversation, but it’s a condition that bothers many of us on occasion.

The Food and Drug Administration (FDA) is warning consumers that some of the over-the-counter (OTC) laxatives they may turn to for relief are potentially dangerous if dosing instructions or warnings on the Drug Facts label are not properly followed or when there are certain coexisting health conditions. In fact, there have been dozens of reports of serious side effects, including 13 deaths, associated with the use of sodium phosphate laxatives.

The label of sodium phosphate laxatives states that they should be used as a single dose taken once a day, and the products should not be used for more than three days. Equally important, consumers who do not have a bowel movement after taking an oral or rectal dose should not take another dose of the product.

In addition, labeling instructs adults and children to ask health care professionals before using these products if they have kidney disease, heart problems or dehydration.

FDA is now warning that adults older than 55 and adults and children with certain health conditions should ask a health care professional before using these products because they may be at increased risk for harmful side effects. These new warnings are not currently in the Drug Facts label and apply to both adults and children.

  • who are taking certain drugs that affect how the kidneys work, such as diuretics or fluid medicines; angiotensin-converting enzyme (ACE) inhibitors used to lower blood pressure; angiotensin receptor blockers (ARBs) used to treat high blood pressure, heart, or kidney failure; and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
  • with inflammation of the colon.

Constipation is marked by infrequent bowel movements or difficulty in passing stools.

Laxatives—taken both orally and rectally—come in different forms, with different ingredients. The sodium phosphate used in some products is in a class of medications called saline laxatives. This class of laxatives helps promote a bowel movement by drawing water into the bowel, which softens the stool and makes it easier to pass.

Laxative products containing sodium phosphates are marketed under the brand name “Fleet” and also as store brands and generic products. All of them are potentially associated with serious side effects, such as dehydration and/or abnormal levels of electrolytes in the blood that can lead to serious complications, such as kidney damage and sometimes death.

Who is Most at Risk?

According to Mona Khurana, M.D., a medical officer in FDA’s Division of Nonprescription Regulation Development and a pediatric nephrologist (a doctor who specializes in children’s kidney diseases), the most serious harm in recent reports occurred after consumers overdosed by taking a single dose that was higher than recommended on the drug label or took more than one dose in a day because they had a poor laxative effect from the first dose.

“The bottom line is that these products are safe for otherwise healthy adults and older children for whom dosing instructions are provided on the Drug Facts label as long as they follow these dosing instructions and don’t take the product more often, or in greater amounts, than the label instructs,” Khurana says.

In recent reviews of harmful side effects reported by consumers and health care professionals, FDA has identified 54 cases of serious side effects associated with the oral or rectal use of OTC sodium phosphate products for the treatment of constipation in adults and children. Thirteen cases were fatal, including one child and 12 adults.

“It is not possible to determine the precise rate of these events as no one knows how many individuals who take these medications may experience side effects,” says Khurana, adding, “Not everybody who develops problems in association with sodium phosphate use reports to the FDA.”

Can these laxatives be used safely in young children?

“Caregivers should not give these products orally to children under age 5 years without first asking a health care professional. Both caregivers and health care professionals should avoid the rectal use of these drug products in children under age 2 years,” Khurana cautions. “These warnings against use in young children are listed on product labeling.”

Warning Signs

Consumers taking these laxatives should watch for warning signs of a bad reaction. For example, a rectal dose that is retained and does not produce a bowel movement may cause dehydration and/or serious changes in blood electrolyte levels. Symptoms of dehydration include dry mouth, thirst, reduced urine output, and lightheadedness, especially with changes in position. If the rectal dose is retained in the body longer than 30 minutes, a health care professional should be contacted right away.

The symptoms of kidney injury include drowsiness, sluggishness, a decreased amount of urine, or swelling of the ankles, feet and legs. If you experience any of these symptoms after using laxatives containing sodium phosphates, you should seek medical attention immediately.

If you have any concerns about using the products, particularly for use with young children, talk to your health care professional first, Khurana says.

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Senna Drug Interactions

A total of 189 drugs are known to interact with senna.

  • 188 moderate drug interactions
  • 1 minor drug interaction

Show all medications in the database that may interact with senna.

Check for interactions

Type in a drug name to check for interactions with senna.

Most frequently checked interactions

View interaction reports for senna and the medicines listed below.

  • Aspirin Low Strength (aspirin)
  • codeine
  • Colace (docusate)
  • Cymbalta (duloxetine)
  • docusate
  • Fish Oil (omega-3 polyunsaturated fatty acids)
  • green tea
  • lactulose
  • Lantus (insulin glargine)
  • Lasix (furosemide)
  • Linzess (linaclotide)
  • Lipitor (atorvastatin)
  • Lyrica (pregabalin)
  • Milk of Magnesia (magnesium hydroxide)
  • MiraLAX (polyethylene glycol 3350)
  • Norco (acetaminophen / hydrocodone)
  • Paracetamol (acetaminophen)
  • Prilosec (omeprazole)
  • Protonix (pantoprazole)
  • Synthroid (levothyroxine)
  • tramadol
  • trimethoprim
  • Tylenol (acetaminophen)
  • Vitamin B12 (cyanocobalamin)
  • Vitamin C (ascorbic acid)
  • Vitamin D3 (cholecalciferol)
  • warfarin
  • Zofran (ondansetron)

Senna disease interactions

There are 4 disease interactions with senna which include:

  • inflammatory bowel disease
  • intestinal obstruction disorders
  • acute surgical abdomen
  • rectal bleeding

More about senna

  • Side Effects
  • During Pregnancy or Breastfeeding
  • Dosage Information
  • Drug Images
  • Support Group
  • Pricing & Coupons
  • 166 Reviews
  • Drug class: laxatives
  • FDA Alerts (1)

Related treatment guides

  • Constipation
  • Bowel Preparation

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major

Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.

Moderate

Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.

Minor

Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Unknown

No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Why Can’t You Take Senna When Pregnant?

Constipation is common during pregnancy. You may experience infrequent bowel movements or stools that are hard to pass and require straining. This can cause pain and discomfort. According to the American Pregnancy Association, 50 percent of women experience constipation at some point during their pregnancy. Laxatives can be effective, however, stimulant laxatives such as senna may be best avoided. Talk to your doctor before using any laxatives.

Stimulant Laxatives

Senna is a plant with medicinal properties. The leaves are used for constipation. It is considered a stimulant laxative because it irritates your intestinal wall to stimulate bowel movement. Sennosides are the active substances responsible for its laxative effect.

FDA Category B

The U.S. Food and Drug administration assigns categories for drug safety during pregnancy. The FDA has classified senna as category C. This category is for substances that lack well-controlled human studies, but have demonstrated adverse health effects on the fetuses of pregnant animals. According to the FDA, the potential benefits of category C substances may warrant use if you are pregnant, despite potential risks.

Early Delivery

According to the APA, a normal pregnancy should last about 40 weeks. Taking senna while you are pregnant increases your risk of premature labor. Stimulant laxatives may cause uterine contractions, which can cause premature labor. Premature labor does not always result in premature delivery, according to APA. However, early labor can complicate your pregnancy.

Side Effects

Though senna is a plant, it still has the capacity to cause side effects. You may experience abdominal pain, cramping, discomfort and diarrhea. Diarrhea can cause electrolyte imbalance due to excess fluid loss. You may experience increased thirst due to dehydration.

Alternative Laxatives

Laxatives known as bulking agents and stool softeners draw water into your intestines to help soften and bulk your stool so that you can pass it easily. These are gentle on your intestinal tract and do not irritate your intestines. Bulking agents and stool softeners are safer to use if you are pregnant, than stimulant laxatives, according to MayoClinic.com. If you are experiencing constipation, consult your obstetrician in order to decide the best option for you.

Senna for constipation

This leaflet is about the use of Senna for constipation.

This leaflet has been written for parents and carers about how to use this medicine in children. Our information sometimes differs from that provided by the manufacturers, because their information is usually aimed at adult patients. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Name of drug

Senna
Brand names: Manevac®, Senokot®

Why is it important for my child to take this medicine?

When a child is constipated, their stools (poo) are hard and painful to pass. Sometimes a child may try to hold the stool in because of previous pain when going to the toilet . Constipation can also make the child feel quite poorly.

Your doctor will probably prescribe a type of medicine called an osmotic laxative (e.g. lactulose, polyethylene glycol ) to give to your child first. This will soften the stool (poo). Senna is then used to help your child to pass the softened stool.

It is important that your child takes senna regularly, as it may take some time for the constipation to get better.

  • You can find more information about constipation in children and young people produced by NICE (National Institute for Health and Care Excellence).

What is senna available as?

  • Tablets: 7.5 mg
  • Granules: 400 g; these contain sugar
  • Liquid medicine: 7.5 mg in 5 mL

When should I give senna?

Senna is usually given once each day. You can give it either before the evening meal (which should help your child to do a poo in the morning), or in the morning (before breakfast).

Give the medicine at about the same time each day so that this becomes part of your child’s daily routine, which will help you to remember.

How much should I give?

Your doctor will work out the amount of senna (the dose) that is right for your child. The dose will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give senna?

Tablets should be swallowed whole with a glass of water, milk or juice. Your child should not chew the tablet.

Liquid medicine: Measure out the right amount using a medicine spoon or oral syringe. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount.

Granules: Mix the granules into a cold or warm drink. Your child should swallow it all straight away. (The granules will swell when they come into contact with the liquid, so the mixture should be drunk straight away.) If you prefer, you can sprinkle the granules onto a small amount of food (such as yogurt, honey or jam).

Your child should drink a full glass of water afterwards.

When should the medicine start working?

Your child should be able to do a poo 8–12 hours after taking a dose of senna. However, if the constipation is bad, it may be a few days before they do a poo. Continue to give the medicine each day. Your child should not strain to do a poo.

What if my child is sick (vomits)?

  • If your child is sick less than 30 minutes after having a dose of senna, give them the same dose again.
  • If your child is sick more than 30 minutes after having a dose of senna, you do not need to give them another dose. Wait until the next normal dose.

What if I forget to give it?

  • If you normally give it in the morning: Give your child the missed dose when you remember during the day. This should be at least 12 hours before the next normal morning dose is due.
  • If you normally give it in the evening: You do not need to wake your child up to give the missed dose. Give it in the morning before breakfast. This should be at least 12 hours before the next normal evening dose is due.

What if I give too much?

If you give too much senna, your child may get stomach ache or diarrhoea.

If you think you may have given your child too much senna, contact your doctor or local NHS services (111 in England and Scotland; 0845 4647 in Wales). Have the medicine packet with you if you telephone for advice.

Are there any possible side-effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

  • Your child may get stomach cramps. This usually wears off after a few doses. If it is still a problem when your child has been taking senna for a week, contact your doctor.
  • If your child gets diarrhoea, contact your doctor, as they may want to reduce the dose of senna.
  • If your child has bad or watery diarrhoea, or seems tired and weak, contact your doctor.

There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side-effects to a UK safety scheme at http://www.mhra.gov.uk/yellowcard.

Can other medicines be given at the same time as senna?

  • You can give your child medicines that contain paracetamol or ibuprofen, unless your doctor has told you not to.
  • Senna should not be taken with some medicines that you get on prescription. Tell your doctor and pharmacist about any other medicines your child is taking before giving senna.
  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.

Is there anything else I need to know about senna?

Do not give senna without plenty of water. It will not work properly and you risk causing dehydration.

  • Senna belongs to a group of drugs called stimulant laxatives. Before giving senna, it is important to soften your child’s stools. You can do this by increasing the amount of high-fibre foods such as fruit, vegetables, bran and high-fibre cereals that they eat, and encouraging them to drink plenty of water. Or you might have been prescribed an osmotic laxative – another type of laxative that works by softening the stools.
  • Encouraging your child to be active will also help their constipation. Your pharmacist, doctor or health visitor will be able to give you advice and support.
  • Your child may get stomach cramps. This usually wears off after a few doses. If it is still a problem when your child has been taking senna for a week, contact your doctor.
  • If your child has diarrhoea, contact your doctor, as they may want to reduce the dose of senna.
  • If your child has bad or watery diarrhoea, or seems tired and weak, contact your doctor.

General advice about medicines

  • Try to give medicines at about the same times each day, to help you remember.
  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
  • If you think someone else may have taken the medicine by accident, contact your doctor for advice.
  • Make sure that the medicine you have at home has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine?

  • Keep the medicine in a cupboard, away from heat and direct sunlight. It does not need to be kept in the fridge.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container it came in.

Who to contact for more information

Your child’s doctor, pharmacist or nurse will be able to give you more information about senna and about other medicines used to treat constipation.

The problem with clichés isn’t just that they’re lazy, it’s that we tend to forget the original meaning. Dumpster fires have become such a common refrain, I fear a nation of amateur firemen wouldn’t know what to do if their cubicle trashcan lit aflame; drinking the Kool-Aid, when you think about it, doesn’t sound half bad. But of all my oft-used, under-thought clichés, one I never expected to directly confront was “shitting the bed.” Or, in this case, “shitting the leather seat of an airplane in the middle of first class.”

For the first 28 years of my life, I was able to excavate my bowels like clockwork. But somewhere around the time Chipotle started offering a burrito-rewards program, my body began retaliating. Things got … slower. Having only ever referred to constipation as a punch line, I first devoted lucrative amounts of time trying to convince my gynecologist I had stomach cancer. Too young to die, too proud to take Metamucil, I instead turned to the earthbound gaia’s designated cure-all: laxative teas.

While the Kardashians and lesser reality stars have made detox teas like Fit Tee and Bootea the celebrity shill du jour, herbal laxative teas have been kicking around the wellness aisles for far longer, intended primarily for clogged pipes rather than meaningful weight loss. The most common laxative teas contain copious amounts of senna root, which works along the same general principles of toothpaste management: The sennosides irritate your colon just enough to get it contracting again to squeeze the, er, backlog out. Though laxative teas do help you drop a few immediate pounds, the actual “detox” aspects are murky at best; all you’re losing from your small intestine is undigested water and oil — the dreaded “water weight.” The rest of your toxins have been long absorbed before they even reach the small intestine. But, like me, if all you want is to dislodge a bullet, a senna-tea-induced muscle spasm is a fairly safe bet.

My first contender was Smooth Move tea. More than one friend had looked at me in wide-eyed terror as they scream-whispered that Smooth Move was the holy grail of laxative teas. “Do NOT take it before bed if you’re an extremely heavy sleeper,” cautioned one friend. “And even then, wear sweatpants.” Another suggested sleeping in the bathroom entirely because, “it’s just that strong.” A third sent back perhaps the most ominous warning of all: “Smooth Move tea ruined my wedding night. Don’t do it.”

Already unmarriageable to begin with, I brewed a cup of Smooth Move chamomile, boasting a whopping 1,080 milligrams of senna leaf, which promised to “generally a bowel movement in six to twelve hours.” Its woody floral taste was a pleasant surprise and made for an easy drink, even if it did little to decrease my trepidation. I settled into bed, making sure no blankets would impede a mad dash to the bathroom.

I needn’t have worried. Twelve hours in, little had occurred. There were no ruined sweatpants or sheets; my toilet bowl still gleamed. I was still constipated.

Undeterred, I moved on to a mint-scented “gentle laxative” the following night that promised to help me Get Regular. While it had only 1,010 milligrams of senna, it did boast over 1,100 milligrams of herbs my mother often overloads in Indian food — coriander root, star anise, cinnamon bark — Asia’s purest diuretic. Once again, the wait was for naught; the following morning’s results were even less offensive than the night prior, and the dull ache in my lower abs (fine, upper vag) was still present.

A utilitarian third box promised the no-nonsense toughness that my earlier two teas had largely sidestepped. Touting an “ancient Chinese-American recipe” from California, it assured me that both my physical and mental well-being would be significantly enhanced by its faux-mystical healing properties. This time, I went all in, ordering not one but two extra-spicy dishes of rogan josh from the local Indian place. I set up camp in the bathroom. I refused to give into the shining pink beacon of Pepto-Bismol on my bathroom counter. And, once again, another day, another drought.

While the rational explanation might be that it was stomach cancer after all, I persevered, deciding that if one bag was mildly effective, all three types of tea combined must be triply effective. As for the pesky issue of having to drink 24 ounces of water before bed? No problem; I just steeped all three bags in one cup. Somehow I had no idea that tea gets stronger the longer you leave it in water, so I recklessly steeped them for an unsanctioned 45 minutes.

Finally, after four cups of tea in as many nights, I was rewarded with a colon-emptying so thorough I was sure I’d never need to go to the bathroom again. I texted every holistic friend I had to alert them that I had achieved the Serena Slam of shitting.

How very, very wrong I was.

I used to swallow marbles as a child as a party trick to make people like me. And every time I’d swallow a marble, it would take me anywhere from three to five days to pass the damn thing. I remembered this at 32,000 feet in the air, when I suddenly realized that my recently flushed colon, a day off of its seeming-ceramic victory lap, still had a few things to say. Which is how I found myself en route to New York, seated in first class for the first time ever as a birthday gift to myself, with the dawning realization that the low ceaseless rumble in my seat wasn’t merely the plane’s engine turning over.

When the flight attendant brightly announced after takeoff that “both rear lavatories are out of order!” I knew I was in for a rough ride. While I was able to pull off a few 15-minute occupations of the single stall, someone would invariably knock, forcing me sheepishly back to my assigned seat. During the last 25 minutes of my flight, I found myself in the truly mortifying position of realizing that no matter how tightly I clenched, I was definitely going to shit my pants.

To be clear, the actual pants-shitting was at best a fart with a little something extra. But after age 5, any amount past “I didn’t shit my pants on the airplane today” is too much. With my head held high and my denim-cutoff-clad cheeks clenched tight, I exited that airplane with all the dignity an ancient Chinese-American could muster and power-waddled to the La Guardia bathroom to put on my (actual) big-girl underpants.

You would think that the humiliation of crapping my bikini briefs would put me off laxative teas forever, but after two weeks and untold amounts of fried food, I am still completely Regular — a joy so all-encompassing I’d drink three cups of Smooth Move tea a day to keep it going.

Still, I’ve learned a few things. Most important: Laxative teas are not magic. While they should start kicking in within six to eight hours, if, like me, you ate your body weight in fast food hoping for a get-out-of-jail-free card, it may take a few hours longer to feel relief. Do not double (or triple) up as you lie in wait. Smooth Move tea has become my go-to if I feel slightly bloated; it tends to work the quickest, and most consistently, with only a minimal amount of “will I make it to the bathroom in time” guesswork. Yogi’s Get Regular tea is fine if I’m a little gassy, but isn’t nearly as effective against any real stomach pain. I steer clear of the utilitarian Herbal Laxative Tea unless the situation is particularly untenable, or I’ve eaten Indian food from the taco truck near my apartment, because one strongly brewed cup is enough to keep you sleeping in the bathroom for a day and a half. (As for the weight loss, I did shed a couple of pounds, but only for a day or two.)

Given the lengthy half-life the teas tend to require, they haven’t become part of my daily repertoire just yet. But if I’m properly backed-up, in spitting distance of a pair of sweatpants, and nowhere near an airplane lavatory? There’s a good chance that one — and only one — cup of Smooth Move tea is that night’s digestif.

Senna: Why detox teas containing this ingredient are dangerous

Search #teatox on Instagram and you’ll find more than 700,000 images of lithe-limbed bloggers and influencers praising the benefits of detox teas, which claim to promote weight loss, reduce bloating and cleanse your system in short periods of time.

It’s predominantly an influencer-led industry, with reality stars, fitness icons and even Hollywood celebrities like Demi Lovato flogging tea cleanses to their followers for unknown sums, typically under indicative hashtags such as #ad and #spon.

However, that could all change as the ASA have issued a complaint against an ad for Flat Tummy Tea, as promoted by Geordie Shore star Sophie Kasaei.

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The incriminating post from one week ago has since been deleted, but featured the reality star holding sachets of the tea, crediting it for reducing water weight and subsequently giving her a flat stomach.

The ASA found that Nomad Choice, the company in charge of Flat Tummy Tea, “did not hold scientific data to support their claims that the tea ingredients could help with water weight loss” and therefore found that it had breached rulings.

“There are strict advertising rules surrounding health claims that can or cannot be made be made for food and drink products. These rules apply equally to claims made by influencers on behalf of brands and, in the case of the Instagram post promoting Flat Tummy Tea, they weren’t listed as authorised claims and therefore broke the advertising rules,” a spokesperson for the ASA told The Independent.

The ad, in its incriminating form, has since been banned.

Experts have revealed the dangers of drinking “detox” teas containing senna, which the Flat Tummy Tea’s cleanse tea contains, as it is classified by the NHS as a medication used to treat constipation.

Brands marketing themselves as “all-natural” such as Flat Tummy Tea and SkinnyMint – whose fans include Kylie Jenner – can be misleading because, despite openly containing senna leaves, they are able to advertise themselves this way due to senna being obtained from a plant.

“Detox teas often contain senna, which is a laxative,” explains Dr Chloe Hall, a spokesperson for the British Dietetic Association. “These irritate the stomach lining and can cause cramps and diarrhoea,” she told The Independent.

Senna is listed as an ingredient in Flat Tummy Tea’s cleanse tea. (Flat Tummy Tea)

She added that drinking teas which contain senna could also disrupt the body’s electrolyte balance and subsequently cause heart problems in the long run.

Taking senna can be particularly harmful for those suffering from IBS – who will likely experience stomach cramps and diarrhoea as a result, the NHS website explains.

On SkinnyMint’s website, they claim that 91 per cent of customers felt less bloated after drinking the tea and refer to themselves as a “laxative free blend.”

Whilst senna leaves are listed as an ingredient in their night cleanse tea on the site’s homepage (see below) – it is absent other ingredients lists.

A representative from the company who instant messages potential customers online also revealed that the night cleanse tea contains senna, writing that it has a “laxative effect” along with psyllium husk, which the tea also contains.

“The constipation-relieving effects of senna are attributed to the plant’s sennoside content,” Rhiannon Lambert, leading Harley Street nutritionist, explained.

“Senna works by stimulating your colon to contract more than normal, forcing out essential water and electrolytes along with faecal matter. While this loss of bulk can make you feel and look slimmer short term, it has no impact on fat loss, because calories from food are absorbed in your small intestine long before it gets to the colon. Senna should only be for very short term use but these detox teas suggest long term stints and repetition which is worrying,” she told The Independent.

Instagram posts by the brand claim that drinking the tea could help you look like a Victoria’s Secret model.

“It’s very concerning,” she added. “I say no to working with these kinds of brands every day,” Lambert revealed, who has more than 44,000 followers on Instagram herself.

Nutritionist Steven Grant agrees. “Promoting these teas to have some sort of magical effect on areas such as detox and weight loss without any scientific backing and no details on the dosages used within the teas is shameful in my opinion.”

The teas are often plugged by slim girls who one would assume are not looking to lose weight, with Skinny Mint running their own “influencer program.”

Marketing these brands with triggering words like “skinny” and drinking the teas for their purposefully laxative effect could be considered bulimic adjacent, Grant suggests, who believes that embarking on tea cleanses “could be seen as a form of disorderly eating.”

“I have detox brands reaching out to me at least once or twice a month,” explains Oenone Forbat, who runs fitness Instagram account with 100,000 followers.

“Having slim girls promote them is awful as it insinuates that they think they need to be skinnier,” she told The Independent.

The Independent has contact both Skinny Mint and Flat Tummy Tea for comment.

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