Feast or Famine

By Jewel Payne

The seductive allure of the adrenaline-like drug methamphetamine overtook Lori, a 24-year-old Lakota Sioux, instantaneously. Its energy-providing, weight-losing effects made it glamorously attractive for the unemployed single mother of four. Methamphetamine is the preferred drug-of-choice among female drug users. It is the most widespread amphetamine illegally made and abused today. While the 190 lb., 5’5" inactive Native American woman tried the stimulant for several reasons, the outcome of the addiction turned out to be more than she had originally bargained for.

A Dangerous Deal with the Devil

"I needed the energy to perform the daily tasks I was taking on by playing the role of both parents . . . and when I discovered the influence it had on my productivity, I was hooked."

Lori is not alone, especially in her living environment. The Fort Peck Indian Reservation has a high drug abuse rate, and unemployment can reach as high as 80% during the cold seasons of the northeastern region of Montana. Living within a culture where physical activity is not considered a priority, it is not surprising that obesity is an acceptable characteristic in her community. Even among the dominant culture of the United States, physical activity is often ignored as 55% of adults, approximately 100 million, are overweight or obese. Compared to 1996, where one-third of the U.S. population was overweight, it is apparent how our society is "super-sizing" because of the lack of exercise.

Historically, the image of Lori's tribe’s identity has always been portrayed with a warrior-like appearance having a persevering attitude able to withstand the trials of time. The Plains tribes, indigenous to the North American continent, took pride in their appearance and maintained it through their daily physical activities. Today, however, over half the tribe is overweight, and health problems such as diabetes, hypertension, cardiovascular disease, and cancer are rampant epidemics among even the younger generation.

While the prevention and treatment of malnutrition was a major health issue until the mid to late 1970s, the opposite, obesity, is plaguing the Indians of North America today as a major health threat. With the introduction of government commodities in the early 1880s Native Americans experienced a different eating style. Up until then, the scarcity of food on the reservation limited the availability of nutrients, thus impacting the nutrition of the Native Americans. Even when a small amount of food was available, it was considered a blessing from the Creator, and Indian people savored the gift. This spiritual viewpoint toward food caused Indian people to accept the abundance of commodity rations while disregarding "moderation," a key factor in healthy eating.

Many blame the adoption of a "Westernized diet" with increased carbohydrate and fat consumption and the influence of a couch-potato lifestyle for the extra weight gain. Still others claim this weight problem is caused by the "Thrifty gene" syndrome, which predisposes future generations to becoming overweight. Regardless of the reasoning for developing obesity, Lori made a devastating decision to take Methamphetamine as opposed to eating less.

The Deadly Attempt to Conform with Society

Lori lives in a world where identity coincides with a country's perpetuated perception that "image is everything." She reads beauty magazines just like any typical young adult who wishes to improve her appearance. The only difference that separates her from any other 24-year-old American female is that she can't afford the luxuries offered behind the cover of the magazines. Poverty was just one factor in her vulnerability toward the drug. The other was her misconception that meth would somehow promote social acceptance through its effect on her weight loss. Most Americans hold unfavorable attitudes toward overweight people, and Lori wanted to overcome her unpleasant appearance. Lori, like millions of other Americans, felt that there was a simple solution to her weight problem, some type of a miracle drug. But Lori turned to the use of an illegal one.

"I thought 'if I could just have more energy to find a job and take care of my family then I could live just like any other American citizen' and from there considered [Methamphetamine use] okay. I also knew of former meth users who had lost a lot of weight fast and I was hoping for the same effect."

The need to "fit it" was her initial consideration for taking the drug. Consciously justifiable under her circumstances, she started purchasing the drug for the deceptive energy it provided. However, the deadly attempt to conform with society had turned into a life-altering addiction.

Three weeks into her minimum wage, fast-food career, she had used over half of her profit from her labor to fulfill drug demands. Methamphetamine had diminished her craving for food and had allowed Lori to lose unwanted weight gained from childbearing. In addition to Lori's loss of appetite, she also stopped sleeping. Methamphetamine causes a stimulation of purposeful movement, and Lori's extra time was spent doing repetitive movements through locomotor activity. The increase in physical activity caused by lack of sleep led to her rapid weight loss.

The Destruction of an Escalating Disease

Despite her original reasons for attempting the drug, Lori was now driven by the psychological and physical dependence she had developed for the addictive stimulant. Studies show that when meth is administered to rats they will aggressively choose more meth as opposed to food, water, sex, or other natural drives. The rats eventually die of starvation in the process of giving themselves methamphetamine even though food is available. The drug preference clearly indicates the psychological and physical dependency developed through the drug addiction.

"Once I experienced how easy I could avoid eating and seen how much weight I was losing, I became addicted. I couldn't stop myself from the weight loss. It felt so nice to lose all those pounds and I kept looking forward to that body I had been waiting for."

Used to treat obesity in the 1950s and 60s, methamphetamine is commonly abused among dieters across America. The drug falls into the class of stimulants and causes an increase in heart rate, blood pressure, and dilation of the bronchioles (breathing airways in the lungs). Because of its ability to suppress the appetite and accelerate the metabolism, frequent users and dieters may lose anywhere from 20 to 30 lbs in a short amount of time.

It wasn't until Lori realized she was spending more money on meth than on food for her family that she understood her addiction. Even then, her dependency on the stimulant was so overpowering that she disregarded her own health and continued to use the drug. The immediate "rush" Lori experienced was an overwhelming, pleasurable feeling. Although the influence on mood is the most consistently reported positive effect, it is short-lived and the crash is exactly opposite of the high. To avoid experiencing the crash, Lori would continue using meth every 2 hours for 3 to 6 days around the clock. While the initial effect of the drug may last for up to 24 hours, the body’s tolerance decreases the high to only 8 hours with repeated exposure. The impaired tolerance of the body creates a dangerous risk of drug overdose.

As Lori developed a tolerance for the drug, other diseases stepped in. Depression, severe paranoia, and insomnia replaced her initial euphoria. Amphetamine psychosis often develops among heavy users and they acquire an aversion to food so great that they have to be pushed to eat. Users even have to force themselves to drink liquefied food and take vitamins because they can't swallow. A dry mouth often experienced by users makes swallowing food very difficult. The "cottonmouth" is caused by dehydration from the profuse sweating of the paranoid users.

"I can remember not eating for days and then finally thinking to myself that if I don’t eat something I am going to make myself sick, so I would drink Slimfast in the morning, drink a glass of it for lunch, but had no sensible meal for supper [laughs]. It was the only thing I could really get down myself. [Pauses] You know, it is the first time in all my life when I found the Slimfast diet to actually work . . . in addition to meth, of course."

Lori began to develop eating disorders. It first started with anorexia nervosa because she stopped eating during her "speeding days," and then her disorder expanded into binge eating as the drug wore off, and Lori found herself famished.

Methamphetamine acts on control centers in the lateral hypothalamus, depressing the digestive system and interfering with the two neurotransmitters: norepinephrine and dopamine. Methamphetamine causes the release of sugar and fat into the blood stream because of its stimulation on the sympathetic nervous system and also causes relaxation of smooth muscles of the gastrointestinal tract because of its deactivation on the parasympathetic nervous system.

Malnutrition quickly develops in long-term heavy users like Lori as they starve their bodies and begin using their body stores for energy. This malnutrition changes the body’s regular metabolism cycle as food restriction causes the metabolism to adapt to a lower energy level. As a result of energy deprivation, Lori experienced a breakdown of muscle tissue, also known as rhabdomyolysis, to compensate for inadequate fuel sources.

The muscle breakdown created a burden for her kidneys to filter the excess protein in the blood. Lori's bizarre eating habits also damaged her liver. The liver converts fat into energy for the body to use during times of initial drug use. During extended fasting while Lori was "geeking," her liver worked overtime removing dangerous by-products from muscle and tissue breakdown as her body searched for protein stores.

When the users go "off" methamphetamine, their appetite rebounds as their body discovers it has been literally feeding off itself and wasting tissue. Feelings of fatigue and depression are also experienced as the drug wears off, leaving the user feeling lethargic. Food became a medicine for Lori during these difficult times, and she would stuff herself to help elevate her mood to counteract the withdrawal effects. Individuals with eating disorders often use food as a drug: either as a medication to cover up insecurity problems or as an artificial form of comfort or escape. Lori needed food to satisfy her feelings of hopelessness and despair during the times when the drug was not available.

The withdrawal effects are opposite of the drug-induced state and last for several weeks after the user goes "off". Withdrawal involves symptoms like severe drug cravings, loss of energy, depression, excessive sleep, and an increased appetite.

"My body would hurt physically . . . my heart would pound, it was hard to breathe, I had constant headaches and my body just completely ached. I can recall breaking into repeated cold sweats going through my withdrawals. It was like my body was my own enemy because I couldn't even regulate my own body temperature. I would hear ringing in my ears and probably couldn't hear a pin drop if I tried to. What was the worst were my eating habits I developed because I would always feel sick to my stomach. So, to help alleviate the pain I would eat. . . and if I couldn't get anything down I would throw up crystal meth and blood because of my empty stomach."

Meth users report dry heaving, fainting, or even passing out with exhaustion from withdrawal symptoms. Physicians regard methamphetamines to be "the worst possible drug since it can burn people out almost instantly." The withdrawal symptoms are strong because of the meth addiction and are more intense and longer lasting than cocaine. The after effects of meth, caused by the severe crash, continue to damage the user after drug use has stopped. Vitamin deficiencies, dehydration, decreased circulation, and depressed immunity may lead to skin disorders, ulcers, and respiratory diseases due to the lowered resistance to illnesses. Morbidity and mortality rates run high from methamphetamine abuse resulting in toxicity and malnutrition, which slowly progress into kidney failure and cardiovascular collapse.

For Lori, a ravaging cycle of continual weight-loss and weight-gain occurred during her drug abuse. This "yo-yo" dieting is even more dangerous than merely being overweight itself. The drastic weight loss and immediate weight gain overwhelm the organs of the body and create stress for normal bodily functions. Consequentially, Lori noticed a lack of her menstruation, also known as amenorrhea, a dangerous infertility problem of women who place too much stress on their bodies--usually a problem for female athletes, females with eating disorders, overweight or obese women, and those undernourished.

The Ghastly Reflection in the Mirror

Luckily, Lori sought professional help from the Indian Health Service facility after she decided she had seen enough destruction of her body. The glamour she had attained was not the result she had initially sought. Poor nutrition caused Lori's teeth to discolor, become brittle and chip off. Lori needed sufficient calcium levels for normal muscle contraction, and consequently, her muscles robbed the calcium from her teeth. Her cheeks sank in and her ribs stuck out underneath her once voluptuous, but now flattened breasts, due to the excessive weight loss. After looking into the mirror at the unrecognizable pale face peering back and staring in shock at the protruding bones covering her malnourished body, Lori made a life-changing decision to drop her meth habit.

The Quest for the Good Red Road

Treatment for drug abusers like Lori entail a three-part process.

· Detoxification, getting rid of the drugs accumulated in dangerous levels in the body, is the first step.

· Pharmacology, substituting less harmful drugs for methamphetamine to help the user taper off from the addiction, is the second step.

· Psychotherapy, going to a counselor on a regular basis to prevent drug relapse, is the third step.

Counseling was even more crucial for Lori because she developed depression connected to her eating disorders. Sixty-three percent of all patients with eating disorders have serious depression, which sometimes results in attempted suicide. Because Lori is a traditional Lakota Sioux, she needed a psychotherapy treatment program that would integrate Lakota values, beliefs, and principles.

Meeting with a nutritionist regarding the damage of the Methamphetamine abuse also played a vital role in Lori’s treatment plan. Following a healthy diet is not only inexpensive, but it is also a great tool for treatment and prevention of diseases such as diabetes, cardiovascular disease, malnutrition, infant mortality, hypertension and kidney disease. While pharmacology is useful in the prevention of drug relapse during treatment, it is very expensive and causes unpleasant side-effects in the patients. A safer, less expensive treatment to reduce drug craving is for the nutritionist to recommend a diet and/or supplements which will synthesize the neurotransmitters depleted by chronic methamphetamine use. Implementing nutrition requires the replenishment of amino acids needed in the re-synthesis of norepinephrine and dopamine.

According to the Indian Health Service Laboratory technician Lori's blood and urine samples had abnormal readings due to her malnutrition. These included a reduced number of red blood cells, also known as anemia, and low levels of the minerals calcium, magnesium, potassium, and phosphate. Lori faced another risk from her long-term anorexia nervosa. This risk involved developing bone diseases such as Osteopenia and osteoporosis from lack of the mineral calcium. These bone diseases could develop since Lori’s bone mineral density was still being jeopardized even when she regained her weight and menstrual cycle after overcoming her eating disorder. Intervention for the health of Lori’s bones was crucial during this time of her life since bone mineral peak occurs during adolescence and early adulthood. With Lori’s habitual drug abuse, her bone mineral loss and lack of mineral peak could have resulted in compromised bone mineral density.

Furthermore, a more serious risk Lori placed on herself through her muscle deterioration was an electrolyte imbalance. The muscle breakdown caused potassium to be released from normal contracting muscle cells, thus resulting in an increase in the diameter of Lori's blood vessels and arteries, primarily her arteries. When Lori's blood vessels increased in size, her blood pressure dropped. This difference in size could be compared to the difference in size between a garden hose and a fireman's hose. When the same amount of water is forced through each hose, the larger hose will experience the less pressure, comparable to Lori's blood pressure from the increased vessel size. The decrease in blood pressure is especially dangerous to meth users as failure of the essential electrolyte, potassium, may lead to inadequate blood flow to the muscles, more specifically cardiac muscle.

Lori went to a diet counselor who advised her to increase her total energy intake (everything eaten), her macronutrient intake (her protein, carbohydrate and fat intake), and her micronutrient intake (her vitamins and minerals specific for bone health). Lori initially wrote down a 24-hr diet record and thereafter at 6 and 12 months to report her progress. To change her diet, Lori began to take calcium supplements in the form of Tums and participated in heavy resistance training and high-impact exercise such as weight lifting to rebuild her bone mineral density.

Although supplementing her diet with whole foods is the best method for increasing her micronutrient intake, the Tums provided an effective method to deliver sufficient calcium for Lori’s demand. Lori had problems adding dairy products and calcium-rich foods into her diet since she continued to have digestive problems and a dry mouth. The well-balanced, nutritious diet recommended by her nutritionist included adequate vitamins, minerals, protein, carbohydrates, and fat according to the Recommended Dietary Allowances (RDAs). Because of Lori’s strong motivation and willingness to change, she overcame problems of body image, drug-induced dietary restriction, poor vitamin and mineral intake, drug withdrawals, eating for emotional suppression, lack of self-worth, and severe depression.

Lori’s story is based on actual experiences of real meth users. She is a fictional character used to illustrate the complications of meth abuse. Young females across America are experiencing the addiction and destruction of Methamphetamine just as Lori had. The physiological destruction described in the story is factual in accordance with medical research and study results of meth users. While the tragic stories of Methamphetamine abusers all share the same principle of how easy it is to be sucked into drug abuse, not all of them share the same successful ending as Lori.

Glossary

Amenorrhea- the absence or stopping of the menstrual periods. It is normal for the periods to be absent before puberty, during pregnancy and milk secretion, and after the end of the reproductive period. In primary amenorrhea the menstrual periods fail to appear at puberty, often because of a congenital defect. In secondary amenorrhea the menstrual periods stop after establishment at puberty, for a great variety of reasons, including disorders of the hypothalamus, deficiency of ovarian hormone, pituitary or thyroid gland deficiency, diabetes, mental disturbance, depression, anorexia nervosa, change of surroundings, excessive exercise, and removal of the womb or ovaries.

Amphetamine- n. A sympathomimetic drug that has a marked stimulant action on the central nervous system. It alleviates fatigue and produces a feeling of mental alertness and well being. The drug has been used in the treatment of narcolepsy, mild depressive neuroses, and obesity, but the chief indication is for the treatment of hyperkinetic syndrome in children. It is administered by mouth; side effects include insomnia and restlessness. Tolerance to amphetamine develops rapidly, and prolonged use may lead to dependence.

Anemia-a decrease in hemoglobin in the blood to levels below the normal range which may be caused by a decrease in red cell production, an increase in red cell destruction, or a loss of blood.

Anorectic- n. Causing a lack of appetite, as an anorexiant drug.

Anorexia nervosa- a psychological illness, most common in female adolescents, in which the patients starve themselves or use other techniques, such as vomiting or taking laxatives, to induce weight loss. A false perception of their bodies as fat and/or a phobia of becoming fat motivate them. The result is severe loss of weight, usually amenorrhea, and sometimes-even death from starvation. The cause of the illness is complicated; problems within the family and rejection of adult sexuality are often factors involved. Patients must be persuaded to eat enough to maintain a normal body weight and their emotional disturbance is usually treated by psychotherapy.

Dopamine- n. A catecholamine derived from dopa that is an intermediate in the synthesis of norepinephrine. It is found in high concentrations in the adrenal medulla and is also in the brain in the caudate nucleus where it may function as a neurotransmitter.

Electrolyte- an element or compound that , when melted or dissolved in water or another solvent, dissociates into ions and is able to conduct an electric current. Electrolytes differ in their concentrations in blood plasma, interstitial fluid, and cell fluid and affect the movement of substances between those compartments. Proper quantities of principal electrolytes and balance among them are critical to normal metabolism and function. For example, calcium (Ca++) is necessary for relaxation of skeletal muscle and contraction of cardiac muscle; potassium (K+) is required for contraction of skeletal muscle and relaxation of cardiac muscle. Sodium (Na+) is essential in maintaining fluid balance. Certain diseases, conditions, and medications may lead to a deficiency of one or more electrolytes and to an imbalance among them; for example, certain diuretics and a low-sodium diet prescribed in hypertension may cause hypokalemic shock as a result of a loss of potassium. Diarrhea may cause a loss of many electrolytes, leading to hypovolemia and shock, especially in infants. Careful and regular monitoring of electrolytes and intravenous replacement of fluid and electrolytes are aspects of acute care in many illnesses.

Hypothalamus- n. The region of the forebrain in the floor of the third ventricle, linked with the thalamus above and the pituitary gland below. It contains several important centers controlling body temperature, thirst, hunger, and eating, water balance, and sexual function. It is also closely connected with emotional activity and sleep and functions as a center for the integration of hormonal and autonomic nervous activity through its control of pituitary secretions.

Nutritionist-n. a professional who has completed academic degree of BS, MS, EdD, or PhD in foods and nutrition.

Norepinephrine (noradrenaline)- an adrenergic hormone made in the adrenal medulla that acts to increase blood pressure by vasoconstriction but does not affect cardiac output.

Obesity- an abnormal increase in the proportion of fat cells, mainly in the viscera and subcutaneous tissues of the body.

Osteopenia- A condition of subnormally mineralized bone, usually the result of a failure of the rate of bone matrix synthesis to compensate for the rate of bone lysis.

Osteoporosis- n. Loss of bony tissue, resulting in bones that are brittle and liable to fracture. Infection, injury, and synovitis can cause localized osteoporosis of adjacent bone. Generalized osteoporosis is common in the elderly, and in women often follows the menopause. It is also a feature of Cushing’s disease and prolonged steroid therapy. The condition may be prevented by estrogen therapy during and after the menopause (this use of estrogens is controversial), by increased calcium, vitamine D and flouride intakes, and by exercise.

Parasympathetic nervous system- the part of the nervous system that regulates involuntary function, including the activity of the cardiac muscle, smooth muscles, and glands. Slows heart rate, increases intestinal peristalsis and gland activity, and relaxes sphincters.

Recommended Dietary Allowances (RDAs)- levels of daily intake of essential nutrients judged by the Food and Nutrition Board of the National Research Council to be adequate to meet the known nutrient needs of practically all healthy people.

Rhabdomyolysis- n. a paroxysmal potentially fatal disease of skeletal muscle characterized by the presence of myoglobin, a respiratory pigment of muscle tissue, in the urine. It is also associated with acute renal failure in heatstroke.

Sympathetic nervous system- the part of the nervous system that regulates involuntary function, including the activity of the cardiac muscle, smooth muscles, and glands. Accelerates heart rate, constricts blood vessels, and raises blood pressure.

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