Diuretics - Usage Trends

Usage Trends

The 2004 edition of The Pill Book and the 2005 edition of the Nursing Spectrum Drug Handbook list the loop diuretic furosemide (Lasix) among the top ten most commonly prescribed drugs in the United States. Not far behind were the thiazide diuretic hydrochlorothiazide and the potassium-sparing diuretic triamterene, both of which landed in the top twenty.

Cheap but Effective Prescription Drugs

Lawrence K. Altman reported in the New York Times that "traditional water pills, or diuretics, are superior to newer, more expensive drugs in lowering high blood pressure and preventing its serious and often fatal complications." In 2002, a New Jersey-based study was conducted involving more than 42,000 men and women of varied ethnic backgrounds age fifty-five and older. The results showed that diuretics were found more effective in lowering the participants' blood pressure than the trendier—and extremely costly—new classes of blood pressure drugs. In follow-up reports published in 2005, researchers suggested that thiazide diuretics, in particular, are also helpful in preventing heart attacks and strokes.

In addition, several sources, including the 2003 Rotterdam Study, have shown that thiazide diuretics "may reduce bone loss by reducing the amount of calcium excreted in the urine," reported Eric Nagourney in the New York Times. Thiazide diuretics seem to protect the elderly against hip fractures, a common and potentially life-threatening ailment among older people. "The benefit was most pronounced in people over eighty," noted Nagourney.

Abusing Diuretics to Lose Weight

Although diuretics have legitimate uses, some people abuse the drugs. The most widespread abuses of diuretics appear among: 1) individuals suffering from eating disorders; and 2) athletes attempting to keep their weight down for sporting competitions.

According to the National Institute of Mental Health (NIMH), up to 3.7 percent of females suffer from anorexia, and up to 4.2 percent of females suffer from bulimia at some point in their lives. Anorexia involves self-starvation in an effort to keep off weight. Bulimia involves a cycle of bingeing and purging, meaning people eat massive amounts of food in a single sitting and then attempt to rid themselves of the huge caloric intake before it can be digested. Bulimics purge the food through self-induced vomiting, laxative use, and diuretics.

Males generally develop eating disorders less frequently than females. However, as of 2005, the percentage of males with eating disorders was on the rise. In addition, the National Eating Disorders Association (NEDA) reported that patients with either anorexia or bulimia frequently "develop the other eating disorder" within five to fifteen years of developing the first. In other words, a person with anorexia may end up with bulimia and a person with bulimia may end up with anorexia. This shift in disorders, according to NEDA president Doug Bunnell, helps "remind clinicians, patients, and families that these disorders are complicated."

Blood Pressure Facts

The following statistics were cited in reports on a study of diuretics funded by the National Heart, Lung and Blood Institute, the National Institute on Aging, and the Robert Wood Johnson Foundation.

  • High blood pressure affects about 50 million people in the United States, and the risk increases with age.
  • Half of all Americans over the age of sixty have high blood pressure.
  • One-third of Americans over the age of sixty have both high blood pressure and diabetes, a serious disorder affecting the level of sugars in the blood.

The Sports Connection

Diuretic use and eating disorders in sports and professional athletics are growing concerns both in the United States and abroad. Jockeys, swimmers, and gymnasts, for instance, compete under conditions where "smaller" is considered "better." Weight loss among these and other athletes may be encouraged by coaches. Female athletes, in particular, often develop eating disorders and unhealthy weight-loss practices, including diuretic abuse. This puts them at a higher risk for osteoporosis and interrupting their menstrual cycle.

Many sporting organizations test athletes for diuretic use. Some athletes use diuretics to lose weight or cover up steroid use. In 2003 Australian cricket player Shane Warne received a one-year suspension after testing positive for a banned diu
Many sporting organizations test athletes for diuretic use. Some athletes use diuretics to lose weight or cover up steroid use. In 2003 Australian cricket player Shane Warne received a one-year suspension after testing positive for a banned diuretic. AP/Wide World Photos.

Sports such as weightlifting, wrestling, and boxing require regular weigh-ins. Diuretics are sometimes used by athletes to lose weight quickly in order to compete in lower-weight classes. The pressure to keep their weight down may extend beyond the use of diuretics, leading to starvation diets and attempts to sweat off pounds in rubber suits or saunas. These and other unsafe practices can put athletes at risk for severe dehydrationAn abnormally low amount of fluid in the body., seizures, and even death.

Diuretics in the sports world have another documented use. Called "masking," it is when diuretics are used to speed the elimination of banned performance-enhancing substances from the body. This practice increases the users' chances of passing mandatory drug tests. Athletes using steroids, for instance, might attempt to rid their bodies of trace amounts of the banned drug by taking diuretics.

Many sports organizations have added diuretics and other masking agents to their list of banned substances. For example, the National Football League Players Association (NFLPA) mentions diuretic use in its steroid policy. The organization notes that "masking agents or diuretics used to hide [the presence of steroids and other performance-enhancing substances]" are considered "Prohibited Substances." Steroids, masking agents, diuretics, and other banned substances "have no legitimate place in professional football."