‘I was taking up to 100 laxatives every day’
Amid calls for restrictions on sales of laxatives, former users tell Victoria Lambert of the true cost of addiction
Eight years ago, when Rhian Lovell’s eating disorder was at its most intense, she was taking 100 laxatives a day. The side-effects were “appalling”, she says – “but I was obsessive. I needed to take that number to justify the small amount of food I allowed myself.”
Neath-based Lovell, 36, who works in the probation service, adds: “I’d open the box and the smell would be disgusting. The taste was, too. But it didn’t matter. You do what you feel you have to do.”
That included buying packets of 60 at a time, varying pharmacies and shops so no one questioned the sheer quantity. Lovell, who has two children –
Reuben, five, and
Morgan, two – with her wife, 37-year-old Leanne, says: “I was reliant on them in my head.”
Dave Chawner, a 29-year-old stand-up comic and radio presenter from London, took large amounts of laxatives daily as part of his anorexia, too. In his case, the abuse led to dangerous side effects, including hypokalemia, when levels of potassium in the body are low, and heart palpitations.
But neither Rhian nor Dave are unusual.
The use of laxatives in eating disorders is well known. According to the Royal College of Psychiatrists (Rcpsych), more than half of patients with eating disorders have misused laxatives at some point in their illness. The drugs are taken either to counter the constipation that anorexia often causes due to low amounts of food, or to purge the stomach of its contents, as sufferers may be horrified by the feeling or even thought of food in their bodies.
And they are easy to obtain. Almost all of those with anorexia buy laxatives over the counter, according to the eating disorder charity Beat. In a 2014 survey of eating disorder sufferers, nearly 100per cent of those who responded had bought laxatives over the counter, and 66.7per cent said they had developed a dependency on them.
Now, the Government has announced that it is considering imposing stricter regulations on the sale of laxatives, tasking the Medicines and Healthcare Products Regulatory Agency (MHRA) to examine measures such as imposing age limits on purchasers – and possibly ending over-the-counter sales.
This proposal has been welcomed by experts. Rebecca Field, head of communications for Beat, says: “We know that laxatives pose severe health risks for people with eating disorders. Patient safety should be an absolute priority, and we welcome the MHRA’S review as an opportunity to ensure that is the case.
“Just as painkillers are regulated to prevent people overusing them and harming their own health, there should be restrictions on the availability of laxatives.”
Dave Chawner did not take laxatives when he first developed anorexia at 17, as what he calls a “subliminal coping method”.
He explains: “The anorexia was a response to my situation: exam pressures, university, the idea of moving away from home. Restricting my eating was something I could control, when everything else was intangible.
“I wasn’t really worried about body shape. Anorexia was more about shrinking away than standing out.”
But by 22, he was taking laxatives daily as part of his condition, and feeling the effects. “I was seeing my GP constantly,” he says, “for complications caused by anorexia, ranging from my thyroid not working properly, which left me feeling ice cold, and broken bones caused by osteopenia as my levels of vitamin D and calcium were depleted.”
It was only when he developed depression that Chawner accepted he needed help. “I realised I had a choice ahead of me: I could carry on and would die, or I could turn my life around.”
Of course, laxatives do serve
‘I realised I had a choice: I could carry on and would die, or I could turn my life around’
a genuine need, says Hertfordshire GP Dr Kevin Barrett, who is chair of the Primary Care Society for Gastroenterology (PCSG). “They are intended for patients who cannot easily open their bowels,” he explains, “and who have symptoms of abdominal discomfort or pain, or bleeding on passing hard stools.”
Not all laxatives work in the same way. There are three main types: those that soften the stool with an osmotic effect, by drawing fluid into the gut and breaking-up hard lumps; stimulant laxatives, which cause the muscles in the gut wall to contract and enhance the body’s natural peristaltic action; and bulk-forming laxatives that increase the volume in the gut and trigger gut-muscle contractions in this way.
For those with eating disorders, the laxative of choice is the powerful stimulant type, warns the Rcpsych – and these are the tablets that Lovell chose to take when she developed an eating disorder at the age of 14.
“Growing up in Birmingham, I went to a high-achieving grammar school,” she says. “I had perfectionist traits and struggled in that environment, turning to control over food as a comfort. My routine was not to eat during the day, then at night I would have a meal with my family. I would then go and make myself sick. I started taking laxatives.”
Teachers identified that she was underweight and Lovell was referred to child psychiatric services. “I tried to engage with it, and we had family therapy, but nothing helped,” she says. At 17, she was admitted to a special eating disorder unit for four months. “It got me to a point where I could go home,” she adds. Lovell went back to school and sat her A-levels before university, where she describes herself as a functioning anorexic: “I was controlling my eating all the time.”
Then a long-term relationship broke up and Lovell began to relapse more seriously. “I was working by this point, and aware that if I didn’t have the occasional boiled sweet, I would pass out. So I ate no more than 200 calories – perhaps a bag of microwaved vegetables – a day, and a few sweets as necessary. I knew the laxatives would cause cramps and urgency, and so I became adept at timing when to take them.”
By 2010, Lovell had met Leanne, and was at her wits’ end. “I couldn’t bear it any more. Either it was going to kill me, or I would have a final shot at recovery.” Knowing she lacked the strength to give up by herself, she went into a special unit in Wiltshire. “I put everything I had into getting better.”
Not everyone who misuses laxatives has anorexia. Fifty-six-year-old Rae Radford, a social media consultant from Kent, recalls living on laxatives and mouthfuls of fruit when she was a model in her early thirties.
“I was 5ft 6in and weighed seven stone,” she recalls. “I don’t remember being hungry, but we ate hardly anything. My breath would be bad, so I would allow myself soft mints. A packet of 12 would last three days.”
The side effects were “nasty”, she recalls. “Dreadful stomach cramps, terrible skin. It was crazy.”
Perhaps ironically, laxatives don’t really work for dieting, although they can have very serious consequences. Dr Lorna Richards, a consultant psychiatrist specialising in eating disorders at the Priory’s Woking Hospital in Surrey, explains: “Laxatives do not cause weight loss, as they act in the large intestine, when nutrients and calories have already been absorbed.
“They do cause loss of water and essential minerals, such as sodium and potassium. This can lead to severe dehydration and electrolyte imbalance, which can be fatal.”
In extreme cases, the dehydration can also cause significant electrolyte disturbances that can lead to fatal cardiac arrhythmias. Longer-term, malabsorption of nutrients and vitamins can lead to osteoporosis, anaemia, increased susceptibility to infection and even scurvy or rickets.
Though the new guidance is a step in the right direction, Rebecca Field would also like to see specific action: “The MHRA should introduce a minimum age of 16 for purchasing laxatives,” she says, “an upper limit on the amount that can be purchased, and ensure that laxatives are only available at pharmacies, not in retail stores.
“Doctors and pharmacists should also be made aware that overuse of laxatives is one of the signs of an eating disorder, so they are able to intervene and ensure sufferers get treatment.”