Expert: Ginger - 7/11/2010

Question
QUESTION: Hiya,

Im a bit confused as to what to do. Ever since I was younger, Ive been obsessed with weight and being thin, how thin I am compared to other people, how thin other people are. You can understand that im sure as most girls are. Ive just always known been thinner will be better, I enjoy weight loss or at least attempting. Im still a healthy weight. Im 5 foot 7 and weigh 8 stone.

Ive skipped breakfast since I was very young and thats just me. Then when I was about 14 I started skipping lunch. Ive always known though that I eat alot more than what Id like to, so thsi year ive been skipping dinner. when i do eat dinner i'll assess like what im having and choose soup or i weigh out 35g of pasta o rice and i like to leave a certain amount but I know that eating them sort of foods makes me feel fat and bloated and its like failing a diet that i created.

That bit sounds bad but then I used to go the gym everyday but lately Ive had lots of work and thigns on and not been able to go and Ive not been running or anything so although I feel really guilty, it obviously hasnt made me go.

I also tend to eat high in fat foods like chocolate or crisps or cake. I feel reallly really guilty when I do but I seem to eat one of these a day still. So Im still fat and everything, Ive not lost weight really so I cant have anything wrong with me in that sense.

But my house mates approched me and were going to ring my parents unless I agreed to see someone which at the moment I have put off. However I dont know what I want to do. I dont really want to go to see a doctor as I think that as i dont have an eating disorder and Im too fat to be ill or anything, id be time wasting. But then one thing that my housemates dont know is that Ive been taking laxatives for a year now every day and night which I want to stop because I don't want all the problems from them and Im not stupid I know its just water weight but it scares me not to have them.

ANSWER: Hi Sarah,
Thanks for your question! I know exactly how you feel when it comes to the laxatives- I was addicted to them for years and years, and I felt scared not to have them, too. But you know what happened to me? After a while, I wasn't able to digest certain foods, because the laxative abuse had made my intestines "slippery". You might already know that with laxatives, your body builds up a tolerance... at one point I was taking 30 or more pills a day just to have the same effect that 3 pills had for me in the beginning! I was completely dependant on them for normal bowel function, and it was terrible. When I stopped, it was difficult at first, but it didn't take long for things to get right again (and I didn't gain weight like I thought I would). I was lucky, though, that I never needed bowel surgery (common with laxative abuse) or had a heart attack from flushing all the electrolytes out of my body (also common!)! I know it's really scary, but please stop taking the laxatives. It's such a dangerous thing to be doing! If you can cut down on the amount you take and/or the frequency you're taking them, that's a start, and you can work your way backwards from there.

I've heard a lot of girls say what you said- "I don't have an eating disorder, I'm too fat," but this isn't true. You can have an eating disorder at any size. It's your eating patterns and thoughts that make an eating disorder, not your size... and, actually, people with bulimia are often on the heavier side. Also, as you already know, people with anorexia and bulimia don't see themselves they way they really are- they see fat when there's no fat there. Here are the criteria doctors use to diagnose those eating disorders:

Bulimia nervosa:  http://www.psychologynet.org/dsm/bulimia.html
Anorexia nervosa: http://www.psychologynet.org/dsm/anorexia.html

Doctors use the Body Mass Index scale to determine whether someone is underweight, overweight, or a healthy weight. At 5'7 and 8 stone, your BMI is 17.5, which is underweight (a healthy BMI is between 18.5 and 24.9). The fact that you are underweight but still consider yourself "too fat to be ill," along with the fact that you use laxatives, feel guilty about what you eat, weigh your food, skip meals and are obsessed with being thin tells me your roomates are right- you should talk to a doctor and/or counsellor. Just like quitting the laxatives, it's a scary decision to make, but I promise you that you'll be better for it! Please speak to someone before things get too much out of control. You're a beautiful person who deserves to feel happy and free, and you owe it to yourself to get some help!

E-mail me any time.
Good luck,
Ginger

---------- FOLLOW-UP ----------

QUESTION: Hiya ginger,

Thank you so much for your reply. You were very polite and have made me feel a little bit more comfortable with if I do decide that I might need help. All I was wondering is, the effects of laxatives. Is there any way of knowng  I have these effect without going to a doctor? The slippery intestine, what problems does that cause? Does that mean the food that you eat can come out without laxatives? I just wondered if this would be a sign of that would be:
(Im sorry this is a little bit gross) But the other week me and my friends had a chinese and I chose veg chow mein so I had to have more laxatives than normal because Id had dinner and it was a take away (So I don't know if thats the reason why) but when I went to the toilet the next day and even later on the same night the poo was like actual food, like the veg exactly how Id ate it.
I know that sounds really silly, but would that mean that I did have a slippery intestine and if so what does that mean for me?

Answer
Hi Sarah,
It doesn't mean the food you eat can come out without laxatives- it means the exact opposite; that your intestines are damaged, and you're becoming dependant on them. Your intestines are covered with villi, which are almost like little hairs... they grab on to the food and break it down. Abusing laxatives makes the villi erode, so your intestines are "slippery." You'd think that would make the food come out easier, but it doesn't, because it also means your bowels can't function normally, either. Veggies (especially green ones) are some of the hardest things for a body to digest, because they're so high in fibre, and when your villi are damaged, they are often not broken down much at all (this is why you saw your chow mein exactly like it was when it went in). Damaged villi can lead to malabsorption of nutrients, but the calories have already passed through your system (since laxatives don't work in the part of your intestine that absorbs the calories from food. By the time the food gets to where the laxatives work, the calories have already been absorbed by your body). I've known girls who became dependant on laxatives so much that when they eventually did stop them, the poo got impacted in their intestines because their bowels weren't working, and they had to have surgery to remove it! I've read studies (there are some online, if you Google it) that show a link between laxative abuse and colon and liver cancers. Scary stuff.

I really wish I could let you step into my shoes, just for a day! I know exactly how you feel about the laxatives... there were so many times when I'd be with my friends and out to eat, and I'd feel panicky because I'd eaten and didn't have any laxatives. If I had eaten more than what I normally let myself eat, I'd take more laxatives than normal to try and push the food out before it was digested (even though I knew, realistically, this didn't work). It caused me so much stress and turmoil, I can't even explain it. There were times when I'd want to go away somewhere with my friends but couldn't, because I was embarrassed to stay in a hotel room with them because of the laxatives. Now that I've recovered from my eating disorder and no longer using laxatives, life is so much better! I really wish I knew then what I know now- I never, ever would have started with the laxatives.

There is a really great book that I read that made me see things a lot clearer- it's called "Life Without Ed" by Jenni Schaefer. It's actually pretty funny, the way she's written it, but super informative. In the meantime, please, please, please listen to your roommates (who obviously care a lot about you) and speak to a doctor or a counsellor. Write me back if you think I can help. Just don't continue down the path you're going, even if you, yourself, don't think you have an eating disorder. The further you go, the harder it is to come back, and it's not a fun place to be, I promise!

Good luck, Sarah!
Ginger