Diuretic Abuse: A Warning Sign of Bigger Problems

By Hugh C. McBride

On Dec. 2, the National Football League suspended six players for the final four games of the 2008 season for violating the league’s policy against the use of performance-enhancing substances. Though most cases of athletes and performance enhancers involve substances such as steroids, human growth hormone, or erythropoietin (EPO), the recent suspensions resulted from the use of a drug that is more commonly associated with extreme weight loss and eating disorders: diuretics.

Given the “bigger is better” mindset that permeates professional football, it would appear counterproductive for players to abuse substances designed to make them smaller. But multiple press reports indicated that diuretics are on the NFL’s banned substance list because the substances can be used as “masking agents” to hide evidence of steroid use from the prying eyes of drug-testing personnel.

In addition to causing a few public relations headaches for six players and their teams, the appearance of diuretics in the headlines of the nation’s sports pages should also serve as a reminder that the use of these drugs may indicate another, more serious problem, and that even effective medications can cause significant damage when used for illicit purposes.

About the Drugs

When used as directed by an experienced health care provider, diuretics can be beneficial in the treatment of a wide range of conditions, including hypertension (high blood pressure), glaucoma, and edema (the abnormal accumulation of subcutaneous fluids). The drugs have also been prescribed to patients who are suffering from diabetes and osteoporosis, or who are at heightened risk of experiencing congestive heart failure.

According to information on the Mayo Clinic’s website, diuretics (also sometimes referred to as “water pills”) work by causing the kidneys to excrete higher amounts of sodium in urine. “The sodium, in turn, takes water with it from your blood,” the site reports. “That decreases the amount of fluid flowing through your blood vessels, which reduces pressure on the walls of your arteries.”

Side effects of diuretic use can include increased urination, dehydration, potassium or sodium imbalances, weakness, and impotence.

Diuretic Abuse

Unfortunately, because of diuretics’ effects on urination and hydration, some individuals who hope to lose large amounts of weight in a short period of time, or who are struggling with a purge-related eating disorder choose to abuse the drugs.

In cases of extreme weight loss, diuretics can give the illusion of success by causing the body to rid itself of excess water. In reality, though, the dieter will either quickly regain the weight once he rehydrates, or will risk damaging his kidneys, liver, and heart by continuing to use the drugs. (When not properly monitored by a health care professional, people who use diuretics risk depleting themselves of vital fluids and electrolytes, which can lead to organ damage.)

Individuals with eating disorders such as bulimia nervosa or binge eating disorder may abuse diuretics as a way to purge themselves after eating. As is the case with self-induced vomiting or the misuse of laxatives, repeatedly using diuretics for their purgative effects can have a negative impact on one’s health, including organ damage, organ failure, and even death.

Warning Signs & Treatment Options

Diuretic medications come in both prescription and over-the-counter forms. Though the prescription versions are more potent, significant damage can result from misuse of the OTC ones – marketed under brand names such as Diurex, XPel, and H2O Lean – which anyone (even minors) can purchase from their local drugstore or via an online pharmacy.

In addition to the physical damage that the abuse of these medications can cause, their use may also signal the presence of an emotional disorder or other mental health condition. Parents who become aware that their child is using diuretics or water pills without a medically appropriate reason should evaluate whether their teen might be afflicted with an eating disorder, or be suffering from an unhealthy body image.