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Anorexia, Binge Eating Disorder, And Bulimia: My story
I recently read about the misuse of laxatives and other medications to promote weight loss. What should I know about this weight-loss practice?
Eating disorder patients commonly report the use of, and/or abuse of, various medications, herbs, and over-the-counter (OTC) products. Used as weight control or purging agents, many of these products can be harmful when taken in a manner inconsistent with their intended use.
In addition, young people may mix prescription drugs with other drugs of abuse, such as marijuana and alcohol, putting them at risk for drug interactions and overdose. I have detailed some of the most commonly misused products, including prescription and OTC medications, as well as herbs and vitamin supplements.
Laxatives
Laxatives are the most commonly abused substance by people with anorexia; an estimated 50% of anorexia patients report self-induced vomiting or the abuse of laxatives. Indeed, some states in the
Diarrhea that results from laxative use may lead a person to believe that weight loss has occurred, but in reality, any weight loss that may follow the use of laxatives is due to the loss of fluids and valuable electrolytes, not food, from the body.
Furthermore, the abuse of laxatives can result in rebound water retention, leading to the faulty belief that weight gain has occurred, thereby perpetuating the cycle of laxative abuse.
Tolerance for the drug can develop with prolonged usage, which can result in an increase in use of the drug over time. Prolonged use and abuse of laxatives can have serious physical complications, including painful constipation (as a result of colon impairment), cramping, nausea, fainting, weakness, gastrointestinal bleeding, rectal prolapse, edema, electrolyte imbalances, cardiac arrhythmias, permanent colon damage, kidney dysfunction, and, in severe cases, kidney failure or sudden death. Certain laxatives are detectable in urine, blood, or stool samples with a simple test, so parents of children or teens with anorexia can ask their family physician to help determine if laxative abuse is a concern.
Treatment for mild electrolyte fluid imbalance involves athome mineral supplementation, while more severe, persistent cases can be difficult to correct and may require intravenous mineral fluid and mineral replacement in a hospital setting.
The return of normal bowel function may take up to several weeks to resume. Although fluid retention may last for a few days, laxative withdrawal does not cause any permanent weight gain, and any swelling in the abdomen or ankles will likely remit after the body readjusts to normal bowel movements. It is helpful when ceasing the use of laxatives to drink plenty of non-caffeinated fluids, especially water, to increase the daily intake of natural fiber (found in whole grains, fruits, vegetables, and oat bran) and to get regular, non-excessive physical activity, as these measures can promote natural bowel function.
Diuretics
Diuretics are another medication prone to abuse by those with anorexia. Diuretic medications rid the body of excess water by elevating the rate of urine excretion. OTC forms are frequently used by women to reduce water retention associated with the menstrual cycle, and prescription forms are used by patients with high blood pressure, liver cirrhosis, or certain kidney diseases. Unfortunately, in their pursuit of thinness, eating disorder patients may also abuse diuretics. Although fluid loss may give the appearance of weight loss, any actual loss is in the form of valuable fluids that are necessary for proper organ functioning. As with laxative abuse, the misuse of diuretics can have serious health-related consequences.
Prescription Medications
According to the National Institute on Drug Abuse, reports of the misuse of prescription medications have increased significantly in the past decade. Some of these occasions of misuseinvolve inappropriate attempts at weight control. Thyroid medications, asthma medications, and stimulants used to treat attention deficit hyperactivity disorder (ADHD) are examples of medications that may be appropriately prescribed for treatment of a primary medical condition, yet may be misused for weight-loss purposes.
An alarming practice that has gained recent attention involves patients (typically females) with Type I diabetes mellitus. An increasing number of these patients are engaging in an
extremely risky and harmful weight-loss practice known as “diabulimia.” Some patients attempt to purge calories by skipping doses of insulin, which causes the body to urinate out glucose from the body. However, there is a grave risk of serious complications from this behavior, such as blindness, need for limb amputation, kidney failure, coma, and even death. Despite these risks, more young women who desperately need their life-sustaining insulin are skipping their shots. According to the Associated Press, estimates of diabulimia among women with Type I diabetes in the
Diet Pills
The recent boom in the diet industry has yielded many new OTC methods of weight loss, many of which can be misused by those with an eating disorder. OTC diet pills are the second most abused substance by those with anorexia. Some of the popular weight-loss ingredients in diet pills include caffeine and Phenyl-propranolamine, an ingredient which can cause insomnia, mood changes, anxiety, irritability, and, in large doses, psychosis, seizures, cerebrovascular hemorrhage (stroke), and kidney failure. In 2000, the Food and Drug Administration (FDA) issued a health advisory concerning Phenyl-propranolamine after a Yale study suggested it might have been responsible for hundreds of cases of reported strokes. Likewise, Ephedra (or Ephedrine), was banned by the FDA in 2004 due to the increased risk of heart attack. However, these ingredients still find their way into the medicine cabinets of some who pursue extreme weight loss. (Also watch for a product ingredient called Ma Huang, the Chinese herbal equivalent to Ephedra).
Herbal Diet Products
So called “herbal” or “natural” weight-loss products can be just as dangerous as diet pills made from synthetic ingredients, and many can have serious and potentially lethal side effects. Even caffeine, when taken in extremely large doses, may cause chronic insomnia, breathlessness, persistent anxiety, and mild delirium. Here is a list of some herbal agents used for weight loss or as purging agents, along with their potential adverse effects.
Ephedra: a stimulant that may cause nervousness, dizziness, cardiac arrhythmia, stroke, and sudden death.
Yohimbine: an appetite suppressant that may cause anxiety, elevated blood pressure, nausea, insomnia, tachycardia, tremor, and kidney failure. Yohimbine is also marketed in a number of products for body building and “enhanced male performance.”
Chromium Picolinate: an ingredient in weight-loss products that has been reportedly associated with hypoglycemia, dissolving of muscle tissue, and cognitive and personality disturbances.
Cascara: used as a laxative and purging agent. May cause severe vomiting, electrolyte imbalance, and cardiac arrhythmia.
Senna: also a laxative that can cause excessive fluid loss, cramping, and nausea.
Perhaps the most widely reported risk for misuse of an OTC is associated with the emetic Ipecac. Found in many home medicine cabinets, Ipecac is an OTC remedy used by some
parents to prevent poisoning in children from accidental ingestion of a toxic substance. Ipecac has frequently, and tragically, been misused as a purging agent by eating disorder
patients in order to repeatedly induce vomiting. Ipecac is never intended to be used without the express supervision of a physician. Even in small, repeated doses, use of this emetic syrup can be fatal. Patients who use Ipecac to induce vomiting can develop an irreversible cardiac condition called myocardial toxicity, or poisoning of the heart muscle. Symptoms of cardiomyopathy include muscle weakness (often severe enough to prevent a person from walking or lifting their head), seizure, irregular heartbeat, blackouts, and respiratory complications. It can take weeks or even months to recover from Ipecac poisoning. Death can occur from the use of Ipecac, as was reportedly the case with the well-known musician Karen Carpenter; the substance caused severe damage to her heart, eventually leading to cardiac arrest and death. It is essential to inform your physician if you use, or have ever used, this substance as a purging agent. If no damage to the heart muscle has occurred, full recovery is possible.
