More than 14 million U.S. adults have alcohol use disorder (AUD), defined as a chronic, relapsing brain disease characterized by the inability to control or stop drinking alcohol – despite negative consequences. AUD includes both alcohol abuse (as with binge drinking), and alcohol dependence. (1)
Unfortunately, less than 10% of those with AUD seek treatment. (1) For those who do enter into treatment programs, a multi-specialty approach that includes medical, behavioral, and nutrition therapy can increase their chances of recovery. Some addiction treatment centers employ dietitians as part of a recovery team, but often it’s lacking. If you work in a general outpatient practice, tapping into this population can provide some rewarding opportunities.
Nutrition Concerns with Alcohol Use Disorder
As with any health condition, there is no one-size-fits-all diet that’s best for those with AUD. Medical nutrition therapy should focus on correcting nutrition imbalances and reducing the risk of related health conditions. In addition, working on healthier eating and lifestyle habits can help restore mental health, and may reduce the risk of relapse. Here are a few things to consider:
Malnutrition is common
Not only does alcohol replace more nutrient-dense foods, but also, it interferes with the absorption and metabolism of many nutrients. In particular, the following micronutrients are often low, and deficiencies can worsen damage caused by alcohol abuse, throughout the body: (2,3)
• B1 (thiamin)
• B2 (riboflavin)
• B6 (pyridoxine)
• Folate
• Vitamin C
• Vitamin D
• Magnesium
• Zinc
Thiamin deficiency is especially common among those with chronic alcoholic abuse and is associated with cognitive defects. Therefore, it’s recommended that patients supplement with 50 mg to as much as 250 mg per day. (2,3,4)
Unless levels of other nutrients are severely depleted, most often, a healthy diet along with a regular daily multivitamin is adequate to correct any imbalances over time. (2) Be cautious with any vitamin A and beta-carotene supplementation. Alcohol interferes with vitamin A metabolism, and supplements can be toxic to the liver, so it’s important to work with the patient’s clinician to verify levels before supplementing. (2,3)
Protein intake is also frequently lower than recommended in patients with AUD. In addition, alcohol interferes with the metabolism of amino acids and promotes loss of skeletal muscle and protein catabolism throughout the body. (3) Encourage patients to include protein foods at each meal and an evening snack, to meet a daily goal of 1.2-1.5 g/kg. (5)
Liver damage may be repaired
Liver damage can range from fatty liver, to hepatic steatohepatitis, to cirrhosis in patients with AUD. In early stages, alcoholic liver damage can be improved with abstinence and lifestyle strategies.
Nutrition goals for alcohol-related fatty liver are the same as nonalcoholic fatty liver disease. A healthier diet pattern can reduce fat storage and inflammation and minimize oxidative stress in the liver cells. The focus should be on ways to incorporate more healthy fats from mono and polyunsaturated sources, such as olive oil, avocados, fish, and nuts; high-fiber whole grains and legumes; fewer refined carbs, and more antioxidant-rich foods like colorful fruits and vegetables.
There is some evidence that antioxidant and anti-inflammatory supplements like silymarin (milk thistle), curcumin, resveratrol, soy protein, and tea polyphenols may be helpful in promoting liver health, but clinical trials on these are lacking. (5)
Sugar cravings emerge
Reports of sugar cravings are common among patients in recovery. For some, sweets may provide the dopamine boost that was provided by alcohol. There is also some thought that abnormal glucose regulation and ghrelin (the hunger hormone) levels might play role in sugar cravings, especially in those who are in early recovery.
A balanced diet that replaces refined carbs with more complex carbs and includes protein with meals and snacks can be helpful in managing sugar-cravings. In addition, educate patients that hypoglycemia may be a trigger for cravings (for both sugar and alcohol). Encourage them to eat small, frequent meals throughout the day, and a balanced snack before bed to keep blood sugar levels steady.
Nourishing the gut can help the brain
Finally, promoting brain health and neurotransmitter function is an essential part of medical nutrition therapy for recovery. It’s well known that a healthier diet, especially one that’s rich in omega-3 fats and complex carbs can help the brain work better and boost serotonin levels. There is also evidence that a healthier and more diverse gut microbiome is associated with less depression and mood disorders.
On the flip side, researchers have found that alcohol consumption is associated with inflammation in the brain, as well as unhealthy changes, known as dysbiosis, in the gut microbiome. Some theorize that alcohol-induced dysbiosis is a root cause of some psychiatric disorders that involve reward-seeking behaviors. (6)
Therefore, diet strategies to improve gut health should be included in your toolbox when working with patients with AUD. Educate patients on ways to incorporate probiotic-rich foods like yogurt, kefir, or fermented vegetables such as kimchi and sauerkraut. In addition, a probiotic supplement may be helpful for some. These, plus a plant-forward diet can help the microbiome nourish and thrive.
The Bottom Line
Working with patients in recovery for AUD can present some challenges, especially with regard to making behavior changes. Often, patients need basic, how-to information and practical meal tips in addition to education on why changes are important. It’s also important to reinforce that the process of healing the body and brain takes time so results may not be apparent for weeks or months.
REFERENCES:
1. National Institutes of Health: Alcohol Use Disorder. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
2. National Institutes of Health: Relationships Between Nutrition, Alcohol Use and Liver Disease. https://pubs.niaaa.nih.gov/publications/arh27-3/220-231.htm
3. Annual Review of Nutrition: Alcohol: Its Metabolism and Interaction with Nutrients. https://www.annualreviews.org/doi/full/10.1146/annurev.nutr.20.1.395
4. Thiamine (Vitamin B1) Treatment in Patients with Alcohol Dependence. https://www.ncbi.nlm.nih.gov/pubmed/27818067
5. Hepatobiliary and Pancreatic Diseases International: Dietary Supplementation in Patients with Alcoholic Liver Disease: A Review on Current Evidence. https://www.ncbi.nlm.nih.gov/pubmed/27498574
6. Progress in Neuro-Psychopharmacology and Biological Psychiatry: Alcohol, Microbiome, and Their Effect on Psychiatric Disorders. https://www.ncbi.nlm.nih.gov/pubmed/29705711
