Archive for the ‘Publications’ Category

Exercise counts most for kids

Saturday, February 18th, 2012

thumbs up on this activity

In a previous post I mentioned former neighbors whose two boys had to run around outside for an hour a day (and they did spend most of that hour literally running), before they got any “screen time.” I thought that was admirable and noted both kids were slender.

Now I found an article in the February 15, 2102 issue of JAMA that confirms the wisdom of the approach my friends took toward this issue. A sextet of authors from the UK, Norway, Sweden and Canada published results for the International Children’s Accelerometry Database Collaborators (ICAD).

First I had to make sure what accelerometry meant in this context. The dictionary definition was only somewhat useful. It obviously refers to a gadget for measuring acceleration, but when I returned to a prior study  of 1,862 British children aged 9 or 10 published in 2009 in the American Journal of Clinical Nutrition, I learned it’s a very expensive and sophisticated gadget. My wife has a step counter that our local hospital seniors’ organization, the Aspen Club, gave her free. The device used in the large-scale research project, sold by a Florida firm, does lots more than just count steps. Among other thing it also monitors how much energy you expend and what your activity intensity has been. Of course the current model I found online costs $1,249, but there is a volume discount.

That earlier study concluded we need to get our youngsters really moving in order to “curb the growing obesity epidemic.”

The current paper offers a more nuanced viewpoint. It has a daunting title: “Moderate to Vigorous Physical Activity and Sedentary Time and Cardiometabolic Risk Factors in Children and Adolescents.”  The study looked at exercise levels and screen time in over 20,000 kids ages 4 to 18. Overall those who got more exercise improved all the risk factors measured: waist size, blood pressure, insulin levels, triglycerides and HDL cholesterol.

thumbs down on this one

Once levels of physical activity were factored in, sedentary time seemed relatively unimportant. But a smaller group, 6413 kids, was followed  for a little over two years and neither screen time nor exercise seemed important in changes in waist size, while kids who, at the start of the various studies, had bigger bellies, also had them later. I’d bet most of those were quite TV-addicted, since the paper warns that activity (or lack of activity actually) is often a clue to snacking and soft drinks.

I may show the short form of this paper to the principal of the nearby grade school I’ve mentioned previously. All those kids, starting in kindergarden, have a one-hour exercise period mostly spent running. I think it’s a school-district-wide program and just confirms what to me is common sense.

Lots of our youngsters are spending their days sitting in front of a screen of some sort instead of playing active games outdoors. Even in the age group followed in the recent article, a quarter of the kids were at least overweight; 7% were already obese. The average time for active play was a half an hour a day and the average for screen time was close to six hours a day.

I doubt we can totally reverse those numbers, but it’s a good idea.

End of Life Care

Wednesday, February 15th, 2012

Hospice care nurses can make you smile

We’ve had a relative and a friend who each had Hospice care, one in another state and one locally. Both their spouses thought that Hospice was wonderful and wondered why they had to wait so long before their loved one was eligible for it. So when the Annals of Internal Medicine for February arrived, I decided to read an article titled “End-of-Life Care Discussions Among Patients with Advanced Cancer” and the section called “In the Clinic” which this month was on Palliative Care.

I knew that Hospice is for patents in their last six months of life. More than three quarters of them have at least one of four diagnoses: congestive heart failure, kidney failure, dementia or chronic obstructive pulmonary disease (emphysema). They have no life-saving avenues left and are normally not in a hospital setting. Some prefer to die at home and some are in long-term care facilities. We have a local organization, Pathways Hospice which supplies care for patents in several Northern Colorado communities; they offer on-call nursing care 24/7, spiritual care, appropriate medical equipment and counseling services. Their care is overseen by physicians trained in Palliative Medicine.

I thought the two overlapped, but didn’t know as much as I wanted to much about Palliative Care itself. It’s now a subspecialty recognized by the American Board of Medical Specialties and its physicians usually work with a team that may include social workers, chaplains, physical therapists and pharmacists. The patents they care for have severe illness and are usually in a hospital setting, although some may be seen in outpatient clinics.

There are no treatment limitations for this group of patients, but for some the article said, “You would not be surprised if the patent died within 12 months.” Other have had recurrent hospital admissions or complex care needs. They may have limited family support or chronic mental illness.

Management of their symptoms: pain, shortness of breath, nausea, agitation and distress, delirium and “failure to thrive” are crucial avenues for the Palliative Care team to address. Those teams have quadrupled in the last ten years.

The link I supplied led me to a directory of hospitals which offer Palliative Care teams. Physicians trained in Palliative Medicine supervise both those teams and Hospice activities.

But it's best to have that talk while you're still able to.

The problem I noted reading the Annals articles was that many patents don’t ask their docs about EOL care and, somewhat surprisingly, many physicians don’t have any discussion with their patients about this crucial area until the very last moment, if that. Frequently people in the final month of their lives finally have that EOL talk; often they’re an inpatient by then and being cared for by someone other than their long-term physician.

My wife and I have discussed what we do and don’t want, but I think it’s time for me to let my primary care physician know what I’ve decided. At present I’m basically healthy, but I’m also about to turn seventy-one and you never know.

 

 

Adults, obese and otherwise

Sunday, February 12th, 2012

PIck well and cut back your waste/waist

In my last post I explained the concept and the math behind the body mass index (BMI) approach to evaluating if your weight was normal or not (your BMI is very  well in synch with the most scientific methods of determining body fat percentages). Now I want to expand on that a bit  with some recent statistics and some thoughts on how we can lose weight if we need to. Unfortunately, some of us have lots of extra pounds we should shed if we want to have our best shot at leading long, healthy lives.

The Feb 1, 2012 issue of JAMA had a number of interesting articles on obesity. I’ve previously mentioned several on childhood and adolescent obesity; today I’d like to zero in on two whose focus is American adults.

Four CDC staffers, led by Katherine Flegal, PhD, published the most recent statistics from a recurring national survey with the daunting acronym NHANES. This national health and nutrition survey (the E stands for examination) started in 1971, but from 1999 on has been released results in two-year cycles. The current article from the National Center for Health Statistics, looking at the 2009-2010 NHANES data had a little good news and lots of bad news.

After 1980, until the turn of the 21st century, the prevalence (scientific term for percentage) of obesity in our population kept zooming up. Now it appears to have leveled off. I guess that’s something we should be happy about, except now over 35% of adults in this country are obese. Men and women have about equally high rates of obesity and men have caught up to women in this regard over the last twelve years. Some subsets, by sex and racial groups, are even more likely to be obese or very obese.

The worst news from this article was that no group–men, women, non-Hispanic whites, Hispanics or non-Hispanic blacks–had a decrease in the prevalence of obesity in this most recent data set.

So which exercise and diet should we try?

getting enough exercise is difficult when your joints hurt

Many adults report “No Leisure-Time Physical activity.” Overall, more of us are exercising, but the data vary from state to state. Those who have arthritis, fifty million in the US, need special attention or are even more likely to get no exercise. The CDC has worked with the Arthritis Foundation to develop ideas for this huge group. Going back to my review of articles on youngsters, I think for the rest of us, we could begin with simple steps, parking at the far end of the parking lot and substituting some walking for part of our screen time as two examples.

Harvard Medical School’s free online HEALTHbeat publication had a review of pros and cons of various diets in its Feb 7, 2012 edition. The bottom line still is if you want to lose weight, you must cut down on your calories. The Mediterranean-style emphasis on fruits and vegetables, unrefined carbohydrates, nuts, seeds and fish may be the most effective in reducing cardiovascular and diabetic risks.

My New Year’s Resolution is to keep my weight under 150 pounds. I have to work at it as I like to eat, but most of the time I’ve stayed away from splurges.

How about you?

 

JAMA

 

 

The very high-priced spread

Saturday, February 4th, 2012

This obese teenager could be headed for trouble

I’ve been concerned about our burgeoning problem of excessive weight, so when the Journal of the American Medical Association for February 1, 2012 arrived, I was intrigued by the variety of articles touching on the subject. Let me start with a disclaimer: I have no clear-cut special competence, no magic bullet for preventing or treating obesity in our children. I do think it’s a major threat to the upcoming generations here and elsewhere in the world. I am also very aware that its opposite numbers, hunger and even starvation, threaten whole populations around the globe.

But my own background, both as a physician and as someone who has successfully fought weight issues (I weighed 218 in 1969 and 148 this morning), has made me concentrate on the American epidemic of eating to excess as a major area of my interest.

The first article dealt with kids and adolescents. A group of CDC researchers reported an update on obesity in American kids, giving data from 199 to 2010. The newest statistics show nearly ten percent of our infants and toddlers are obese and close to 17% of our kids ages two to nineteen. As the kids got older, more boys than girls were obese in this survey with over 4,000 participants.

Then there was an article titled “Weight Loss Stratagies for Adolescents,” based on a Boston Children’s Hospital Conference roughly a year ago. The MD, PhD Harvard Professor of pediatrics who discussed the issue began with the case history of a particular obese girl, a fourteen-year-old who was five foot six and weighed nearly 250 pounds (giving her a body mass index,BMI, of 40). Her adoptive parents were overweight themselves, but had to learn to “back off” in their attempts to control her diet. There is some early data that suggests that parents can help by providing health food choices in the home and facilitating enjoyable physical activity throughout the day (versus a fixed “exercise time).

I had seen an example of that with some former neighbors whose boys, in order to have their one hour of “screen time,” had to be outside playing for several hours at a time. Both youngsters were lean.

One critical point to be made is avoiding focusing on obese kids only. A large Danish study, published in the New England Journal of Medicine in December, 2007,  followed over a quarter million children born in the 1930 to 1976 time period. Denmark established a national civil register of “vital statistics” in 1968 and enrolled everyone in the country, giving them a unique number, ironically termed their CPR number. Although that had nothing to do, I gather, with cardiopulmonary resuscitation, which is what I think CPR means, the study did look at risk factors for coronary heart disease.

When your heart's on fire, it may not be from love

The results are impressive and threatening: every one point increase in BMI across the spectrum was associated with an increased risk of coronary artery disease. A child didn’t have to be fat to be at risk later on. One calculation estimated that a 13-year-old boy weighing 25 pounds more than the average had a one-third increase in the likelihood of having a heart attack before the age of sixty.

It’s time to start helping our kids live leaner and longer, healthier lives.

 

What sweetener do you use: Part 5; Fructose effects

Saturday, January 28th, 2012

A good place to start researching

I basically knew what happens when we ingest glucose, (eating it or drinking it depending on whether it’s in solid or liquid form, e.g frosting versus sweetened tea) : it goes through the liver and heads off to muscle and other body parts where insulin activity is responsible for energy use. But I wanted to compare its effects to those of fructose. First I found an old article (1986 vintage) in the American Journal of Physiology (AJP), hardly a bedside reading item for me these days, but one I used to proofread for as a research fellow. That, once I translated it into English that I could understand, changed my mind a bit.

Glucose does lead to an increase in insulin levels and an increase in carbohydrate breakdown, while lipid (fat) breakdown slows down. The net result is a considerable bump in energy use. ‘So far, so good,’ I thought. But a comparable amount of fructose resulted in a much smaller increase of insulin, yet considerably more carb breakdown and even less fat breakdown. So even more energy was used. That I hadn’t expected, but this study was a one-time experiment with seventeen healthy folk followed for a few hours.

So my next question, and I thought this one was far more important, was what happen longterm?

Let’s look at animal research first. A group from Princeton published an article online in a journal called Pharmacology, Biochemistry and Behavior in February 2010. Tha basic conclusion from these scientists contradicted what I had read elsewhere, but made sense. They concluded all sweetener calories are not equal– after feeding rats standard foods and adding either table sugar-sweetened water or HFCS-sweetened water. Even if the HFCS water was less sweet overall, the rats gained more weight. Long-term feeding experiments showed rats fed HFCS developed many of the signs of the “metabolic syndrome.” weight gain, fat deposition in the belly and abnormal blood levels of trigclycerides.

So fructose was being metabolized to form fat, while glucose was being used as it normally is. That brought their thoughts back to why fructose in HFCS is different from that in table sugar. According to this research group, HFCS contains free, unbound fructose while that found in table sugar is always tied to a glucose molecule. Their concept is that table sugar fructose has to go through an additional chemical process, freeing it from glucose, before it can be used by the body.

So why should we care what makes rats fatter?

But here's our real target

I found a long article in The Journal of Clinical Investigation (JCI), the other research magazine my boss (and I) reviewed potential articles for in 1970 to 1972. Here people who who overweight or obese to begin with were fed either glucose- or fructose-containing liquids for ten weeks.

And the results were similar. Those getting fructose had more belly fat develop. I think translates to more chance of heart disease  and other long term complications.

The evidence is gradually adding up; I think HFCS is something to be avoided. Let’s feed our kids and ourselves more fruits and vegetables and less processed foods.

What sweeteners do you use: Part 3. Fructose & HFCS

Friday, January 20th, 2012

It's time to dissect out the science behind sugars

I knew that sugars are found naturally in milk, fruits, vegetables and honey. MedlinePlus, from the NIH’s National Library of Medicine has a brief discussion of those natural sugars. I also knew that glucose was absorbed in the small intestine and leads to the pancreas putting out insulin. It’s eventually converted to energy, though some may be stored in another form in the liver and muscles until needed.

But before I get to the artificial sweeteners, I needed to read more about fructose, the other half of table sugar.  My first source, a Mayo Clinic article, didn’t make it to be much of a villain, but then I started to put the whole picture together. To start with, table sugar is half glucose and half fructose. The two “simple sugars,” called monosaccharides by chemists, have the same chemical formula with six carbon atoms, twelve hydrogens and six oxygens, but the way those are arranged is quite different. They each supply four Kilocalories per gram or fifteen per teaspoonful (That’s technically correct, but most of us just use the term “calories.”).

If you taste table sugar and call it a “one” in terms of how sweet it is, glucose is about three-fourths as sweet and fructose is nearly one and three-fourths as sweet.  Both are considerably sweeter than lactose, the kind of sugar found in milk. Fructose is also easier to dissolve in water and hangs on to water better; that’s apparently how it can lengthen the shelf life of baked goods.

That’s not why I think high-fructose corn syrup (HFCS) became ever-present in sodas, other sweetened beverages and processed goods. In a blog post I wrote many  months ago, I mentioned that after WWII our government wanted to find a way to use two kinds of war-time chemicals; they eventually became pesticides and fertilizers. Corn turned out to be an extremely efficient plant in turning sunlight to stored energy, so it was subsidized. Eventually that led to “monoculture, huge farms raising nothing but corn.

What's the motive: health or profit?

Like any other industry, the corn producers needed to make a profit and have their stock prices increase. That resulted in HFCS being produced and added to lots and lots of food and beverage items.

So what? A 2208 article in Science Daily gave me a clue. The way our bodies handle fructose is considerably more complex than that of glucose. The two simple sugars are separated from each other in the small bowel and glucose quickly passes through the liver on its way to all the other spots in the body where it can become energy. Fructose, according to scientists, makes the liver work harder and there’s some data pointing toward its triggering the production of fat.

And we don’t just get straight fructose in our diets: HFCS, according to the USDA, is about one fourth water and the rest dissolved sugars. HFCS42  (with 42% fructose) is added to many products, especially processed foods. HFCS55 (with 55% fructose) is added to soft drinks. It’s roughly comparable in sweetness to table sugar; the issue is why do you need to ingest any more sugar?

There’s been more research in this area and I’ll cover that in my next post.

 

 

 

What sweetener do you use? Part 1

Wednesday, January 11th, 2012

real sugar has some calories

I have a confession to make. On the rare occasions when I do use a sweetener, I actually use sugar or occasionally honey.

Now that doesn’t happen very often; I don’t have all that much of a “sweet tooth” and usually add a few Crasins to my unsweetened cereal in the morning and drink a non-coffee called Cafix (now that’s a clever name; I suppose it’s implying “Caffeine Fix”) with a small amount of vanilla soy milk, but no sugar.

On Wednesday, January 4th of this year, The Wall Street Journal had a big spread in their “Personal Journal” section with an eye-catching title, Bracing for the Fake Sugar Rush.” In the article four artificial sweeteners, Truvia, Splenda, Equal and Sweet”n Low’ were compared to sugar. Prices were listed, tastes and aftertastes were compared, the sweetening agents were mentioned and the calories noted (0 for the articial sweeteners and 15 calories per teaspoon for the good old fashioned stuff).

Then I started thinking. I knew that adding 3,500 calories to my food intake theoretically would result in a weight gain of a pound. Since I enjoy math I wanted to figure out how much sugar that is. That translates into 233 and 1/3 teaspoons full or 1.167 kilograms of sugar (about two and a half pounds). So I’d have to eat two and a half pounds of sugar to, in theory, gain a pound of weight?

These three don't; but do they have any risks?

I went back to the article I just mentioned: my real reason for not using artificial sweeteners is two-fold. The WSJ admittedly “unscientific taste test” confirmed one of those; all four of the fake sugars had strange aftertastes according to their samplers: one was “Tab-like,” one was compared to soap water, another termed metallic and the fourth said to leave a taste “like a copper pipe.”

The other is safety; consumers often hear much later of concerns about new chemicals, whether they be sweeteners or medications. The managing director of a “brand-consulting firm” says one worry is “Did they test it on enough rats over a long enough period of time?”

Well, I’ve done basic lab research with rodents (three and a half years in medical school) and I’d really like to be able to say those experiments directly apply to humans, but I can’t be sure that’s a true statement. I did later work with dogs and when my boss (an associate professor at UCLA) was getting ready to present some of our results at an international conference, he came up with a great idea.

“Peter,” he said, “when I show the slides with our data, someone in the back of the room is going to get up and ask if humans react the same way. So let’s replicate our experiment in at least a few people.”

Guess who was the first of those “people?” I was poked and prodded and infused with the same materials as our dogs.

In our case the data was essentially the same and when that inevitable heckler at the back of the room said his piece, my boss replied, “Let’s have the first large slide.”

But how much safety testing has been done with humans for these sweeteners? I’ll try to find out if there are any long-term data on those of us who use non-caloric alternatives to sugar and write about that next.

 

Vindication?: part 2

Sunday, January 8th, 2012

here's a high-protein diet

In my my previous post, I talked about my own dieting program, but mentioned a very recent article in the Journal of the American Medical Association, typically called JAMA. I came across a newspaper article on this research study while reading The Wall Street Journal . Now I want to analyze  the  JAMA article. Let me give you a quick overview and then I’ll tell you what bothers me about the implications.

Three groups of relatively young people (18 to 35) were fed extra calories with varying amounts  of protein while living in a special metabolic unit. They all gained weight, but those fed a low-protein diet gained less. That group increased their total body fat just like the others did, but did not gain “lean body mass” (that’s anything but fat: i.e., bones, organ weight and muscles), while those on a normal protein intake and those eating more protein than usual gained not just fat, but also muscle mass. So calories count more than composition of a diet, but extra calories with too little protein leads to weight gain that’s all fat (90% of those surplus calories formed fat; 10% went into the energy necessary to do so).

Okay, that’s the classic comic version. Let me dissect the study and its conclusions a bit more.

This was a relatively short-term study of what happens when people overeat.  The extra calories the subjects ate were in the form of fat. It was also a small study with only twenty-five subjects who were healthy non-smokers, weren’t allowed alcohol or caffeine and had stable weights to begin with. They varied from quite lean to overweight, but none of them were obese. It was a “single-blind” study, that usually translates to meaning a study in which either the investigator or the participant, but not both of them, is unaware of the nature of the treatment the participant is receiving; in this case only the kitchen staff knew who was in which diet group.

The research was exceedingly well done with careful methods, an inpatient ward for the study subjects, a preliminary period where diets were adjusted to keep their weight constant, and lots of state-of-the art measurements of how much fat and how much muscle each person had before and after the eight-week diet.

So far, so good: eating too much makes you gain weight; lots of that weight is fat. Eating more protein tends to add muscle (I can’t see that their bones got heavier or the basic weight of their organs, though they likely accumulated some fat).

all vegetarian food

All that makes sense to me; now how does that apply to dieting? I think it likely does, but that’s not what this study was designed to show. The question that remains is what should I eat if I want to lose weight? I just found an article in The Telegraph (a London paper I never read otherwise). The title was “Vegetarian low protein diet could be key to long life.”

Unfortunately, the study was done in fruit flies. The lead author said “…similar results have been found in mice.” Thus far a variety of studies in animals imply we can live longer by eating less. I’ll accept that, but for now, until there are large-group human studies, I’m sticking to reasonable amounts of protein and less overall calories.

 

 

Vindication? Part 1

Thursday, January 5th, 2012

One way to get lots of protein

Since the late 1990s when I invented a diet, or perhaps I should say an eating pattern, I’ve relied on one principal concept: Eat Less; Do More. I came upon this simple idea after listening to a group of medical professionals who were discussing which diet they should go on while they were simultaneously consuming huge portions at our hospital cafeteria.

One of them, I recalled, had tried a high-carb, low-protein diet the past year; losing nearly twenty pounds, then regained it all and more in a few months. Now she was going to attempt  to lose twenty-five pounds with a different approach, this one with an emphasis on protein. I had seen weight-loss plans come and go and didn’t believe any of them were the answer, at least not for everyone. I remember coming home and saying to my wife, “Lynn, I’ve invented a new diet”

I explained it was simply, “Never finish anything; No snacks between (meals); Nothing after eight.” I added, “Get lots of exercise.”

I lost the seven pounds I had gained on a two-week vacation and didn’t need my strategy again until early in 2009. Then I weighed 177 one morning, up three pounds from my normal weight since 1991. I attributed that to eating out four times in the prior week. But when I tried on a pair of good suit slacks, I realized the weight hadn’t changed much, but the distribution sure had.

I went back to my eating plan, lost five pounds easily, then coasted a while before resuming the diet. Lynn bought me a digital scale and I weighed myself daily. I also started going to our gym six days a week. Eventually I shed thirty pounds and five inches off my waistline. At 147 pounds I was twenty-five under my usual high school weight. This morning, nearly two years later, I weighed 148.

I allow myself a three-pound zone of weight fluctuation, thinking that would account for fluid shifts and the occasional big splurge. Whenever I exceed 150 pounds I go back on my plan.

Then I read a Wall Street Journal article titled “New Ways Calories Can Add Up to Weight Gain: Study Challenges Idea That Varying Amounts Of Fat, Protein and Carbohydrates Are Key to Weight Loss.” It quoted the Journal of the American Medical Association, AKA: JAMA. I went online and found the JAMA article and an accompanying editorial.

I read both pieces in detail, even finding a wild typo, “…their diets were returned to baseline energy levels and diet compositions (15% from protein, 35% from fat and 60% from carbohydrate).” I called the AMA and suggested they correct the numbers since they added to 110%.

Is a high-carb, low-protein diet safer?

But the basic premise of the study’s data intrigued me. It’s something I’ve believed for years, calories count, as opposed to what form those calories come in. But there’s one extra facet: low-protein diets can be dangerous.

I’ll analyze that in detail in my next post.

 

 

Meth Madness: Part 2

Sunday, January 1st, 2012

Users of both genders and all ages abuse this drug

I want to be perfectly clear: methamphetamine use is a terrible plague in our society.  Although overall numbers are down over the past decade, we’re still talking about a million plus people in the United States, many of whom are young and heterosexual. But, of course, that’s not the only population group with members who abuse the drug; The CDC factsheet on its risk for HIV/AIDS stresses it can contribute to sexual risk behaviors, regardless of the sexual orientation of the user. I spoke recently to a long-term friend who is gay.  I asked him about its use in the gay community and he replied, “Everyone I ever knew about who used meth is dead.”

There’s a brain chemical called dopamine that affects how we experience pleasurable activities. Lab experiments show this highly addictive and illegal drug can lead to considerably greater dopamine being released than either eating or having sex.

A user experiences a high, a “rush” much more intense than from any normal activity. But there’s a problem; it doesn’t last more than eight to 24 hours. And it’s not as intense in succeeding uses. So that leads to a pattern of addiction, the need for not only repeated  drug use, but more and more of the substance.

Chronic, repeated meth exposure, whether by oral ingestion, ‘snorting”, smoking or injection, clearly leads to damage in the brain, the teeth and the skin.

An online review by the  National Institute on Drug Abuse, part of the National Institutes of Health, says imaging studies (e.g., MRIs) done on meth addicts show alterations in parts of the brain involved in motor skills, verbal learning, emotion and memory.

I went back to the PBS special, “How Meth Destroys the Body” and was stuck by the graphic photos of “meth mouth.” A common sign of abuse of this drug is severe tooth decay. The cause is uncertain, but meth does lead to shrinkage of a user’s blood vessels and the mouth requires an adequate blood supply to stay healthy. The addicts often binge on high-sugar foods and drinks; their mouths lack sufficient saliva to maintain optimal healthy oral tissue and, on a high, meth users often grind their teeth and, of course, forget to brush or floss.

Between the tooth decay, the increased physical activity frequently experienced and the failure to eat adequately, meth users lose weight and look older.

the model of meth's structure looks benign; it's not, though!

They also lose interest in any activities other than those related to obtaining and snorting or injecting the drug. Men may become impotent; women may lose their interest in sex.

So why don’t we require simply prescriptions for the cold and allergy pills that contain psudoephedrine, the chemical I mentioned in my last post that is used in the production of methamphetamine? I read an article in the 20 December 2011 edition of the Annals of Internal Medicine which told of the widespread abuse of controlled substances in the United States. It wasn’t describing illegal drugs, just ones that normally do require a doctor’s prescription. Many of these can now be purchased on the Internet.

That series of photos of meth users mouths and “before” and “after” photos of addicts may be one place to start.