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The Role of Nutrition in Recovery Back to Course Index

 

 

Connection Between Nutrition and Drugs

It would seem like a no-brainer that someone with a drug or alcohol problem would be the first to understand how substances they put into their body can affect their mental and physical health – but that isn’t always the case when it comes to healthy food and nutrition.  The foods we eat can affect our mood. Many people enter rehab with little to no knowledge about proper nutrition and how important it is to the treatment and recovery process.

In addition to this lack of knowledge, the food environment we live in is challenging.  It is generally easy to eat foods that are tasty but low in nutrients and high in fat and sugar. Although this is something that affects everyone, this type of food environment has a potentially more profound impact on individuals with substance use disorders.

There is a wealth of research that shows both biological and behavioral similarities between drug addiction and overeating, such as alterations in dopamine expression, cravings, and relapse to highly palatable foods.

Today, thanks to research, there is also no longer a question of whether or not food itself can be addictive. Furthermore, processed foods, especially those that are high in sugar and/or fat, are typically the most addictive.

So how exactly does a food addiction relate to drug use?

Let’s first talk about the relationship between dopamine and drugs. Dopamine, a “reward” hormone, plays a major part in why we choose to do pleasurable things again and again. Dopamine is released in the brain when someone does something fun, tries a portion of new delicious food, or uses drugs.

Drugs actually cause a major surge in dopamine, one that is much more powerful than say, booking a flight for someone’s next vacation or finding a $50 bill on the ground. This surge of dopamine is largely responsible for the intense desire to seek out drugs, even at the expense of social relationships, work duties, and quality of life.

The effect of food on the dopamine response is not that much different.

When someone eats a new food, especially a highly palatable food (like a donut or chips, for example), dopamine is released in the brain, which gives them that rewarding sensation–telling them that what they’re eating is absolutely delicious.

Research shows that repeated exposure to this food may eventually wane the dopamine response, but if there’s a cue associated with the food (i.e., every time they have coffee they need a donut), the cue alone will eventually be enough to make them eat that food because of the pleasure that has been associated with it.

What this means is that our bodies have evolved in a way that we can eat in the absence of hunger. Whether or not you’re hungry, having a cup of coffee means you are going to eat a donut, because you associate the two together, and it was, at one time, extremely pleasurable.

However, that high dopamine response will come back when you’re either eating a portion of different palatable food or if the previous one was restricted and then reintroduced. For example, if an individual goes on a diet and restricts themselves from eating ice cream for two weeks, they are likely to binge the next time they eat it, thanks to a large release of dopamine.

So while drugs are widely available and abused, so are highly palatable and highly processed foods. These foods are often eaten because of the stimulation they provide to the body’s reward system, which is a dangerous pattern that shows up in drug addiction as well.

Taking drugs out of the picture typically leads someone (whether in recovery or not) to seek other sources of stimulation, and more often than not, that stimulation comes from food.

Alcohol and drug abuse take a major toll on the human body. Recovering from alcohol or drug abuse is a gradual process, and nutrition is one of the many issues that require attention. Alcoholism is especially hard to recover from as the detoxification stage is complicated (requiring careful monitoring, medications, and support), and alcohol itself is difficult to avoid in the course of everyday socializing. Food is vital in helping the body rebuild itself and maintain health.

Abusing alcohol and drugs:

  • Leads to less consumption  of food (except with marijuana use)

  • Frequently leads to choosing foods that are less nutritious and/or may cause the skipping of meals

  • Increases the speed at which the body uses up energy

  • Increases the loss of nutrients through vomiting and diarrhea

  • Damages the gut so that it can’t absorb the nutrients in food properly

Food influences the way the brain functions. When the body isn’t producing enough brain chemicals (neurotransmitters) or the chemicals are out of balance, an individual can feel irritable and anxious. They can suffer from food cravings, anxiety, and an inability to sleep. The resulting stress can also affect memory and/or make people paranoid, tired, dissatisfied, or depressed.

How Substance Abuse Disrupts Nutrition

The main side effect of an unhealthy diet is malnutrition, a condition caused by a lack of nutrients. Substance abuse increases the risk of malnutrition because alcohol and other drugs deprive the body of its ability to absorb nutrients. Many people with substance use disorders ignore dietary needs and rely on their drug of choice to relieve physical or emotional discomfort. “When they’re using, they can’t separate hunger cues from other cues.  During recovery, it’s hard to differentiate between malnourishment and withdrawal.  Weight gain or loss is an overarching concern for people in recovery. Some people lose too much weight because of malnourishment. Others gain too much weight because they try to replace drugs with food. Each type of substance also causes unique health problems.

Alcohol

Chronic alcohol consumption deprives the body of an important vitamin called thiamine. Every tissue in the body uses thiamine, including tissues in the brain, heart, liver, and kidneys. Without the vitamin, the tissues can’t function properly.

Low thiamine levels increase the risk of heart disease and heart failure. The brain also suffers. People with thiamine deficiency are more likely to experience dementia and Wernicke-Korsakoff syndrome. The syndrome is associated with incoordination, vision problems, confusion, and memory loss. Chronic alcohol use also increases the risk of metabolic syndrome, which is associated with high blood sugar, high cholesterol, high blood pressure, and too much body fat. Metabolic syndrome increases the risk of diabetes and heart disease.

 

Opioids

Opioids slow the way the body functions, making people who take them feel sleepy. The drugs also slow digestion and metabolism. That means the body isn’t able to efficiently process nutrients from food. The most recognizable side effect of disrupted digestion is constipation. Withdrawal from opioid use can disrupt a meal plan. People often feel nauseated, vomit, and have diarrhea during withdrawal. These symptoms can prevent food and water consumption at a time when the body needs fuel.

 

Stimulants

Dramatic weight loss is the primary concern for people who chronically use stimulants, such as cocaine, methamphetamine, and prescription ADHD medications. Stimulant users are more likely to develop eating disorders, such as anorexia. People who go on cocaine or crystal meth benders may go days without eating or sleeping. When the bender ends, they’re starving and often binge eat. These dramatic consumption habits increase the risk of malnutrition. Additionally, crystal meth users often have problems with oral hygiene. They may be less likely or unable to consume solid foods because of missing teeth or pain while chewing.

 

Nutritional Side Effects of Detox

Many rehab clients gain a lot of weight during detox. As drugs leave the body, appetite increases. Dietitians monitor weight closely because it’s dangerous to gain weight too fast. Eating too much can lead to obesity, diabetes, heart disease, and other problems. However, increased appetite can be beneficial for people who enter recovery with low body weight.

Some people struggle to eat during medical detox. Alcohol and marijuana withdrawal can cause appetite loss. Withdrawal from opioids can cause nausea, diarrhea, and vomiting. Dietitians have to make sure people recovering from these addictions don’t lose too much weight.

Some medications that are used during detox complicate diet plans. Naltrexone (Vivitrol) and disulfiram (Antabuse) can cause nausea and vomiting. Acamprosate (Campral) increases appetite and can make foods taste different. Methadone, buprenorphine (Suboxone), and bupropion (Wellbutrin) can cause constipation and changes in appetite.

 

What And How To Eat During Recovery

During recovery, individuals should eat a diet that will balance the levels of serotonin (a hormone that helps with relaxation) in the brain. This involves eating foods high in carbohydrates, especially the complex carbohydrates found in starchy foods like legumes (e.g., beans, lentils, and peas), root vegetables (e.g., potatoes and carrots), pastas and breads. Eating these foods, in combination with protein in meals, will keep clients at their best.

Deficiencies in B-complex vitamins such as thiamine, folate or folic acid, and B12 are common with alcoholism, and inadequate stores of other B vitamins and vitamin C frequently occur. Chronic alcohol consumption also increases the loss of minerals like zinc, magnesium, and calcium from the body. Iron is an exception to this and is rarely deficient because alcohol damages the stomach lining, thereby increasing iron absorption.

In the first year after someone stops using alcohol or drugs, their nutrition needs are higher than normal. They need to make sure they’re feeding their body good food on a daily basis. Even if they eat a healthy, varied diet while using drugs and alcohol, fewer nutrients are available to satisfy nutritional needs since a lot of those nutrients are being used to detoxify their body.

Malnutrition during alcohol use shows up in several ways. In the short term, they may become very tired and have a weaker immune system—which means that they’re more susceptible to infections. Other symptoms include dental problems, digestive problems (e.g., diarrhea, constipation, and gas), skin conditions, and changes in the way foods taste. During long-term alcohol use, there are risks for brain damage, nerve damage, liver disease, heart and pancreas problems, and certain types of cancer. These problems need to be identified and treated during the recovery process—ideally by a team of health care professionals.

In the early stages of detoxification and recovery, the client needs to introduce meals slowly since their body might not be used to digesting food. It’s a good idea to start off with small and frequent meals. Some people may start to gain weight. If they want weight management advice, they should be referred to a nutritionist. If, however, gaining appropriate amounts of weight bothers the client or their eating behavior seems out of control, they may need professional help for body image and/or disordered eating problems.

Food shouldn’t replace drugs as a coping mechanism. Sugar and caffeine are common substitutes used during recovery because they produce highs and lows. These low-nutrient foods can prevent them from consuming enough healthy food, and they affect their mood and cravings. However, these foods are preferable to starting alcohol or drug use again.

A diet for recovery should include:

  • Complex carbohydrates (50% to 55% of the calories you consume), which means plenty of grains, fruits, and vegetable

  • Dairy products or other foods rich in calcium (calcium-fortified beverages, tofu, kale), two to three cups per day

  • Moderate protein (15% to 20% of calories): two to four ounces twice a day of meat or fish (or another high-protein food such as tofu)

  • Fat choices (30% of calories), preferably good oils such as canola, olive, flaxseed and those found in fish

 

Supportive Structures and Services Must Be Part Of the Recovery Diet

Behavioral interventions are of limited use without supportive social groups and structures that improve access to safe and nutritional foods, alleviate poverty, and treat additional mental health issues. Referrals to health care providers, mental health, and nutritional professionals are great tools in the recovery process, and they can provide holistic care and support for someone who is recovering from addiction.

Recommendations can include:

    • Eat a variety of foods from all the food groups (fruits/vegetables, grains, dairy, and meat or alternatives)

    • Eat food high in fiber, such as bran and oat cereals and muffins, legumes, fruits and vegetables

    • Eat breakfast and try not to skip other meals

    • Slowly cut back to drinking less than two cups of caffeinated coffee, tea or pop a day

    • Limit sugar and sweets

    • Drink plenty of water

    • Take multivitamins (talk to your health care provider about the options)

    • Enjoy some form of activity every day

 

When Food Is The Addiction 

What a client eats can be a critical part of recovery from alcohol and drugs.  Sometimes though, it is the problem.  As noted earlier, the idea that a person can be addicted to food has gained increasing support. That comes from brain imaging and other studies of the effects of compulsive overeating on pleasure centers in the brain.

Experiments in animals and humans show that, for some people, the same reward and pleasure centers of the brain that are triggered by addictive drugs like cocaine and heroin are also activated by food, especially highly palatable foods. Highly palatable foods are foods rich in:

  • Sugar

  • Fat

  • Salt

Like addictive drugs, highly palatable foods trigger feel-good brain chemicals such as dopamine. Once people experience pleasure associated with increased dopamine transmission in the brain’s reward pathway from eating certain foods, they quickly feel the need to eat again.

The reward signals from highly palatable foods may override other signals of fullness and satisfaction. As a result, people keep eating, even when they’re not hungry. Compulsive overeating is a type of behavioral addiction, meaning that someone can become preoccupied with a behavior (such as eating, or gambling, or shopping) that triggers intense pleasure. People with food addictions lose control over their eating behavior and find themselves spending excessive amounts of time involved with food and overeating, or anticipating the emotional effects of compulsive overeating.

People who show signs of food addiction may also develop a kind of tolerance to food. They eat more and more, only to find that food satisfies them less and less.

Scientists believe that food addiction may play an important role in obesity. But normal-weight people may also struggle with food addiction. Their bodies may simply be genetically programmed to better handle the extra calories they take in. Or they may increase their physical activity to compensate for overeating.

People who are addicted to food will continue to eat despite negative consequences, such as weight gain or damaged relationships. And like people who are addicted to drugs or gambling, people who are addicted to food will have trouble stopping their behavior, even if they want to or have tried many times to cut back.

Eating too much every once in a while is normal. So is eating for emotional reasons. “From the moment we’re born, we’re nurtured with food, rewarded with food, and so emotional connections to food are normal,” says Michelle May, MD, author of Eat What You Love, Love What You Eat.

People who compulsively overeat, though, may use food as their only way of coping with negative emotions. As a result, they often feel that their eating is out of control. They think about food all the time and feel guilty, ashamed, or depressed after eating. 

Some people who overeat have a clinical disorder called binge eating disorder (BED). People with BED compulsively eat large amounts of food in a short amount of time and feel guilt or shame afterward. And they do so often: at least once a week over a period of at least three months.

Not everyone who overeats is a binger. Someone might eat a lot of food throughout the day rather than all in one sitting. And they might not do it regularly, but only when they are feeling stressed, lonely, or upset.

Conclusion

At this point, the role of nutrition in drug and alcohol recovery can no longer be ignored. Research consistently shows that not only are individuals with a substance use disorder typically nutrient-deficient, but in addition, substances of use and food (especially sweet food) stimulate similar areas of the brain.  Food could potentially become a rewarding substitute for alcohol or drugs, and differentiating between a food craving and substance craving could possibly be difficult to tease apart.

This leads us to two aspects of nutrition in recovery therapy that we need to consider. The first is that many patients with substance use disorders tend to have a poorer nutritional status than non-users. These drug users either have food insecurity or have increasingly worse nutritional habits.  For example, one might consume less food, consume less nutritious food, skip meals, lose nutrients through vomiting and diarrhea, or have difficulty absorbing nutrients due to gut damage. Thus, reversing malnutrition and increasing knowledge of a healthy diet is important to address this issue.

The second is that those suffering from or in recovery from substance use disorders have difficulty controlling their food intake.   For example, in place of seeking out drugs, one might start overeating instead. Knowledge of good food choices can help this, but skill-building is especially important, considering the relationship between food cravings, drug cravings, and the dopamine reward system.

According to the World Health Organization’s international standards for the treatment of drug use disorders, a primary goal of long-term residential treatment patients is to acquire a healthier lifestyle, achieved through proper nutrition, sleep, health monitoring, and adherence to treatment.   But how is nutrition actually addressed, if at all, in treatment centers?

Some treatment centers offer nutrition education as part of the recovery process. Several studies have looked at the effectiveness of nutrition education and found that it improves overall treatment outcomes.  Proper nutrition education may help recovering individuals continue to abstain from drugs and maintain a healthy lifestyle well after receiving treatment.

Whether or not nutrition education is a part of every treatment program, it’s clear that nutrition education is an essential part of not only the recovery process but in the maintenance of recovery. Nutrition is important to anyone’s life, but considering the nutritional challenges that arise from substance use disorders, it’s especially important to those who are looking to make a healthy and successful recovery.

 

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