Expert: Joanne - 10/23/2006

Question


Hey! I have wrote you before I think the end of September maybe and took your advice and scheduled an appointment with a nutritionist (my appointment is not until Nov. 1st).  Anyways to recap here to help with my question: I am 20 years old and my current weigh is 103 lbs and I’m 5’4.  I fast, exercise, take laxatives, diet pills, and unfortunately have days where I binge.  All of this has had my weight fluctuate big time, I will fast for like 5 days and then binge or just eat normal on like 2 days and gain the weight that I lost and then fast again along with exercising and laxatives (and yes I know laxatives do not help with weight loss, but I use them as a form of punishment) and this cycle is just on going.  I haven’t had a period in six months, my hair is falling out, I seem to have a lot of mood swings, and I just feel out of control.  I have tried several times to stop all of this, but I seem to always fall back into it; its like I get so depressed when I eat and my whole day is ruined.  This is pretty much turned into a bad habit that I just can’t seem to break so I am hoping that by going to the nutritionist this will help.  

Well, I always workout and at least burn anywhere from 600-800 calories at the gym before leaving, but these last three weeks after working out I have noticed that my urine is very dark after I work out like almost brown.  So my first thought was maybe I was dehydrated so I increased my fluid intake and its still like this.  Now I still workout on the days I am fasting so I am not sure if this has anything to do with this or not and I haven’t taken any diet pills in like 4 weeks and I usually forget to take vitamins.  I would think if it was serious though that it would be dark like this all the time?!  

So I have seriously thought about going to the doctor for this and maybe have blood work to make sure I haven’t damaged anything for good -- my biggest concern: is not having my period (which I like for now) but some day I do want kids.  BUT my doctor is extremely busy like to get in for a physical would not be until the end of December, but he does have openings for people that are sick with things that need attention immediately like strip throat or etc.  So I kind of feel really stupid especially not being an anorexic weight going in there for this and telling him everything!  So my question is:  is having dark urine something that is just a common side effect of fasting and exercising or should I really go see my doctor right away?  Considering he is very busy I only want to go if it’s like something that is extremely abnormal.  My other question is; considering I am not an anorexic weight how do I tell him all of this?  I mean I will probably have to tell him something why I want my blood checked and my urine checked and I just don’t know what to say or how to say it.  I mean I guess I am afraid he is going to think I’m crazy because most people going through this are like under weight not my weight.  So I know this is an odd set of questions but I just don’t know what to say if I call to make an appointment or even what to say to him?

Well, on another note I just want to say thanks for taking time to do this.  It’s nice to have a place where I can ask a question and have someone who understands where I am coming from.  I have no one here that would understand where I am coming from or understand my feelings (they would think I was crazy) so it’s relieving to have a place where you know someone that understands and has been through the same or similar thing.  Yet I know this must be very time consuming so I just wanted to say thanks for your time!


Answer
Please, don't worry about this being time-consuming!  I could be doing this, or learning all these 'common-sense health belief models in preventing and treating heart disease'.  Part of the behavioural science part of my course that is terrible!  I know which I would rather be doing! lol

I have tried to do some reading for you about the dark urine, and am struggling to find links that don't point to dehydration (and well you say you have tried to correct that)!  There is info out there that does say that exercise increases urine concentration.  So it could be a mixture of not enough fluid and then the body producing extra urea!

There is something else that I read, don't want to alarm you though, that says that a risk factor of fasting is gallstones.  This creates darker urine as well, but only in severe cases.  You would also have abdominal pain, indigestion, nausea, etc.  which you have not mentioned, so assume that this is most likely not the case or you would have said.

My best advice is to go to your Dr and get the blood work and urinalysis done.

I think that you need to phone, or go to his office to make the appointment and just explain that you have disordered eating patterns.  Tell him that you use laxatives and fast.  You need to be honest.  Explain to him that this is worrying you and ask if there is a chance that he can fit you in soon.  Hopefully he will, but if not and it is scaring you, maybe go to your nearest emergency room and ask if they can check that everything is ok.  If you have no pain or anything like that, it is most likely that it can wait until beginning of December, but it is not worth the stress.  Why not speak to your Dr, see if he can see you soon, if not make the appointment in Dec and if things do happen before then, phone him again, or go to the hospital.

As for talking to your Dr, you just have to be honest with him.  A lot of Drs are well aware that there are many people out there with eating disorders that aren't getting the treatment that they need simply because they don't look ill!

I hope that this has been of some help to you.  Hope that your appointment with your nutritionist goes well.

All the best
Holly