A Basic Physiology Lesson

The two main electrolytes (or ions) that people with EDs need to concern themselves with are potassium (K+) and sodium (Na+). Water is also extremely important, although it is not an ion, it is affected by shifts in sodium balance

Electrolytes do a number of essential functions within the body; they assist in regulating fluid balance, participate in acid-base homeostasis, contribute to enzyme reactions and play an invaluable role in neuromuscular activity. I won't use the technical jargon too much, because I want to make this information as accessible as possible.

With respect to laxatives...there are a number of different types ...the worst being the stimulants like EX-LAX or CORRECTAAL. These pill/chocolate concoctions simply stimulate the nerve endings in the large intestine to react to an artificially induced muscle contraction ... that's all. It doesn't do anything but cause the large intestine to excrete what it absorbs -- which is WATER and other necessary electrolytes. It's the SMALL intestine which absorbs, digests and distributes food products -- the large intestine is in charge of water and ions. In the early stages of laxative abuse, a person might lose what they think is weight, when it is only water and K+ (among other trace elements) that they're losing. In fact, the food has already been absorbed by the small intestine by the time the laxative takes effect. Gradually, the user requires larger doses to maintain the same type of reaction from their system, because the body adapts to this new "induced-excretion". When someone uses laxatives in large quantities OR for a prolonged period of time . . . the body adjusts to the abuse and the stimulation of the large bowel, and it relies on the pills rather than its own natural ability to rid the body of wastes; by this time, it's usually not waste product that's being excreted, either -- it's essential ions which contribute to a number of important functions to the entire body. Symptoms include dehydration, bloating (severe in many cases), fatigue, muscle cramps and/or weakness, lack of coordination and general moodiness (try not having a bowel movement for a week and tell me you feel like smiling . . . !)

Using laxatives will cause permanent damage to the large intestine. Many abusers underestimate this fact because the physical signs of bowel dysfunction may not occur instantly, but it will occur -- and once it does, the experience can be extremely annoying, embarrassing and painful. The average person can and should excrete fecal matter, approximately once a day, if not more. Laxative abusers may experience weeks without having a single episode. If the colon has to compress a week's worth of waste products into one "package", then you can imagine how the process of excretion can rip and tear the rectal tissues from the inside, on its way out . . . causing extreme pain, bleeding and oftentimes, shame. I'm being brazen with my descriptions, I know . . . I intentionally mean to offend, because it IS an offensive thing we do to our bodies and I think it should be described as it is.

Emetic Abuse & Manual Stimulation of the Gag Reflex

Emetics are artificial stimulants which induce vomiting, such as the brand-name product "syrup of Ipecac". Emetics are generally used in emergency situations to evacuate poisonous toxins from the body (which may have been ingested accidently or otherwise). The abuse of emetics and/or the manual stimulation of the gag reflex, cause multiple physiological traumas.

The body is a very smart and efficient organism. Just when you think you've got it "fooled," and you've retained control of your body, it will retaliate with a vengeance in a furious attempt to save you from yourself.

Just as with laxatives, approximately 2/3 of any food ingested has already been absorbed and begun digestion by the small intestine by the time a person throws up. A person may toss up a lot of physical evidence, but the nutritional value of the food may already be absorbed by the body before the act of vomiting has occurred. As the body fights the act of purging, it struggles to keep down whatever food it is given and digests whatever nutrients it can get. Hence, a seasoned vomiter may have the purging action down to a science, but the body will have adapted to this behaviour by speeding up the early stages of digestion -- faster than people who do not throw up. Digestion starts with the saliva and ends in the rectum and the body recruits all of its forces to fight the "enemy" which deprives it of its nourishment, so it speeds up the pre-digestion, salivary response, peptic acid response and jejunal (small intestine) digestion process so that it has something of nutritional value to retain once the person starts her purging routine.

Eventually, with throwing up . . . the acids in the stomach (which can eat through the outer shell of a '76 Buick) wear down the enamel of the teeth, cause ulcers and perforations anywhere from the stomach through to the mouth (oesophagus, trachea, etc.) and wear down the heart muscle from the extreme trauma of intense muscle contraction which results from gagging. The heart suffers with prolonged vomiting. Electrolyte imbalance causes dysrhythmia (alterations in heart rate, stroke volume and beat irregularities), muscle weakness (without the proper ions present, the muscle simply won't function, and the heart is a muscle just as any other) and PAIN (try breathing deeply with a perforated oesophagus . . . ouch!!).

Lastly...I'll briefly describe Na+ and K+ and their importance to the body, with a few practical tips on how to help yourself maintain electrolyte balance the best you can, if you have an ED.

Sodium and water go hand in hand. When one fluctuates, the other is affected in reciprocal fashion; the basic laws of osmosis and turgor pressure from high school science class apply here. Sodium regulates fluid balance within the body, is an electrical stimulator (with K+) to nerve and muscle cells, and is monumental (as is K+) to the proper functioning of the kidneys. Excessive sweating (from prolonged or intense exercise) can cause a pathological state of blood sodium loss, referred to as "hyponatremia". You can correct this imbalance either through preventive or curative means...by modifying the exercise to a less intense regimen (decrease time spent exercising and amount of effort) and by administering direct saline solution to the body, either by mouth or intravenously.

Potassium is essential for maintaining neuromuscular control and precise regulation of skeletal, cardiac and smooth muscle activity. Because there is such a small quantity of cellular K+ maintained in the body, any disruption of its regulation will result in a number of neuromuscular and/or renal (kidney) problems. The kidneys are unable to conserve K+ during periods of acute loss and will continue to excrete it, even in a time of great need. This means that a potassium deficit can develop rather quickly if its intake is inadequate. "Hypokalemia" is the term referring to insufficient potassium concentration in the cells. For the person taking laxatives, potassium loss should be their greatest worry; the liquid stool can rid the body of 75% of its potassium stores, causing potentially permanent damage, since it won't be conserved by the kidney. For those who do study physiology, hypokalemia can also result in an impaired ability to increase blood flow during exercise, so for the person with an ED who uses exercise as her method of purging, the K+ imbalance can lead to decreased blood flow and ischemic injury to muscle cells, resulting in a loss of smooth and skeletal muscle control.

After all has been said and done, what you CAN do, if you are someone who engages in any of the above listed behaviours, is:

• BE AWARE! Know what you're doing to your body and try to understand that what you think is a weight loss device is really depriving you of necessary fluids and ions that help your body functioning -- and I mean BASIC functioning!! (heart beat, muscle movement, coordination, etc)
• KEEP HYDRATED. Drink dilute, aqueous solutions containing electrolytes, simple sugars and carbohydrates (during exercise, or throughout the day) to restore your blood glucose, liver and muscle glycogen levels (simple sugars used up while moving) and to keep you hydrated. Commercial sports drinks are good for this balance, and it's often helpful to dilute these with water to reduce the sodium concentration of the drink. If this idea scares you, then try to drink lots of water, and consume food high in ion content, like banana for K+ or other fruits for their simple sugar and water content.

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