Expert: Joanne - 4/4/2008

Question
I've been bulimic for a little past a year now.  Prior, I was always healthy and naturally thin because I was always active in sports.  However, when I first started my first year of college, I gained my "freshmen 15".  Being 5'0, this heavily impacted my appearance and my physical comfort.  Apart from that, some of my family members began making unnecessary comments that eventually led to my eating disorder.  After being caught by my mom for a second time in Nov., she forced me to have my blood examined and it turns out that I have hyperthyroidism and gallstones, with menstrual cycle absence.  At this point, I had reached my lowest of 83lbs. I tried eating again but each time I do, I have stomach discomfort and severe bloating.  Because of this, I am afraid to eat normally and have fallen back to my bulimia patterns, but alot less severe.  I have denied my relapse to my family because I am tired of being judged by them and because of this, I have not told my doctor (my mom does not give me privacy).  I am going to have another exam next month to see if my hyperthyroidism is still prevalent and I am worried.  I am now 90 lbs and most importantly, I really want to recover from my eating disorder because I do not want to live like this for the rest of my life.  Is there a way that I should eat that would prevent my bloating and discomfort?  I think it may be due to the refeeding syndrome and my gallstones.  Currently, I allow myself to keep down foods like fruits and vegetables and small amounts of cereal because they do not irritate my bowel.  Anything else, I have to purge because I am afraid of the bloating and discomfort.  I am afraid to talk to anyone else about my issues because they will threaten to put me in an eating disorder program.  I am determined to recover on my own.

Answer
Amanda

I've been trying to read up a bit on your conditions to see if there is a link, but I'm not sure I've found it!

I have read in one article that sometimes hyperthyroidism can be caused by bulimia, in that the hormones produced by the thyroid are at higher levels than expected for your age and size.  Do you know if you were given a reason for your hyperthyroidism?  Is it something that you are going to have to live with?  Or could it possibly be reversible when your body recovers from the bulimia?  If you have true hyperthyroidism, you need to make sure that you are taking in enough calories on a daily basis as your body is burning more than it should be naturally already, so by not helping to compensate for that, you are putting yourself at risk of serious health complications.

Gallstones?  Did you have any other investigation to make sure that it was gallstones?  The blood tests that showed these up only show up problems with the liver, pancreas or ducts that carry bile.  If this was not investigated further with imaging of some sort, them I would ask for it to be done to make sure that there is nothing else that can be responsible for the abnormal tests.  The stomach discomfort and bloating could be due to the gallstones though, depending on where about the pain actually is, as basically the gallstones obstruct the bile ducts.  I think it is worth asking your Dr about possible treatment options for this.  There are a few things that can be done, and if it is affecting your health in that you are in so much pain, or not eating because of them, then they need to be treated!!!

See you Doctor!!!!  Ask for help with the medical conditions, but most importantly, tell them about the eating disorder!  Explain to your mum that you would rather see the doctor yourself.  If this doesn't work, then when you are with your Dr, ask for a private word!  Most Drs should respect this and ask your mother to leave the room!

Joanne