Expert: Leigh-Anne - 9/2/2004

Question
Hi. I have been bulimic for about 10 years, going through phases where I binge/purge, and phases (months at a time) where I eat relatively normal with no bingeing/purging. I didn't notice any symptoms until the past year or so. My glands are sometimes swollen, and my stomach becomes inflamed. One symptom that has me particularly worried is something I can't find information on. In fact, I don't even know if it's related to bulimia. When I am having "normal" eating days, I stick to about 1200 calories a day, and I work out. Most of the time when I binge, I vomit to get rid of it. Some days, however, I eat more than I normally would, but it's throughout the whole day and not as much as I'd eat during a binge (probably about 2500 calories throughout the day). I don't really try to compensate with laxatives or exercise. But here's what happens: My whole body gets very sore. It feels like my skin hurts, and even the smallest amount of pressure (a light touch of a fingertip) is uncomfortable. My whole body feels bloated, and my hands and feet are noticably swollen. I felt the soreness yesterday, and I used a urine strip to test glucose and ketones in the urine (my grandmother had diabetes, so I had wondered if maybe eating more food than usual was causing high blood sugar, which in turn caused the soreness and swelling). There wasn't any glucose in my urine, but the test did show ketones. I don't know what this means, and I don't know if it could be related to bulimia. I hope you can help me, because I'm very scared. I should also add that I was recently tested for diabetes, and I don't have it, so that is not the cause. Also, it only happens when I leave the food in my system, and NOT when I purge. I hope to hear from you soon. Thank you so much.  

Answer
Excessive ketones in the urine (ketonuria) indicates that the body is not using carbohydrates from food as fuel and is inadequately trying to break down fat as fuel. Ketonuria is a sign that the body is beginning to operate in starvation mode.

The reason your body aches sometimes can also be because your body is not getting enough energy/calories to function properly, so it's starting to feed off of other sources to keep you going (muscles/protein). The pain may likely be caused by not enough blood circulating in the body too. Those tiny capillaries that feed your skin, and other vital organs and body parts are not getting enough oxygen, they are being deprived, so you may be having some tissue ischemia (basically lack of oxygen) or necrosis (death).

Small amounts of ketones in the urine are nothing to get excited about. If you have heard about the recent fad diet, Atkins... this diet puts your body in a state of ketosis. Your body doesn't get the carbohydrates it needs, so it breaks down the fat, protein and muscle of your body. Ketones are amino acids that result when your body breaks down those products. Prolonged ketosis can put strain on your kidneys, and that should be addressed with your physician. However, ketosis can occur for many reasons, including starvation, after prolonged exercise (where your body starts to break down muscle for energy), and others.

I hope this helps clear up some things. If not, please contact me again and I will try to answer more clearly.

Leigh-Anne