Nutrition and addiction – can dietary changes assist with recovery? Margherita Grotzkyj-Giorgi Margherita Grotzkyj-Giorgi is completing a PhD on the role of nutrition in relation to alcohol misuse in socially excluded populations, at the Centre for Health Services Studies at the University of Kent. [email protected] Abstract While many of the most widely used treatment interventions engage with the psychological, social and spiritual dimensions of addiction, some of the biological aspects can at times be neglected. It is increasingly being recognised that there is a close, exacerbating relationship between problematic substance use and poor nutrition. Key words Nutrition, alcohol and drugs addiction, brain function recovery, biology In many cases, dietary imbalances relating to amino Drug and alcohol abuse can significantly damage acid, vitamins, healthy fats, good carbohydrates the digestive processes of the body, and many addicts and proteins, can lead to a wide variety of experience digestive problems such as constipation, medical problems such as cognitive impairment diarrhoea, indigestion and poor appetite (Holford et (memory), heart disease or diabetes. These are al , 2008).The damage of the delicate inner lining of often accompanied by a host of psychological and intestines caused by chronic alcohol or heroin abuse behavioural issues. For many people struggling with impairs the absorption of amino acids, vitamins and drug dependence, learning about good nutrition minerals (Holford et al , 2008). A healthy gut means is critical in the recovery process and is often a healthy brain too. The gut’s job is to extract instrumental in securing long-term success. nutrients from digested food, such as the amino Users of different substances are confronted by acids from proteins to make neurotransmitters. different challenges. Alcohol is so calorie-dense Vitamins and minerals are needed to make them (with seven calories per gram of alcohol it is second work properly, so having a healthy gut is key to only to fat, with nine calories per gram) that getting the brain working properly. Addictive drinkers often experience a sense of being sated. In substances, mainly alcohol, caffeine, painkillers fact, these ‘empty’ calories do not support the health and heroin, can damage or even shut down the of the body and over time produce a chronic state digestive processes, preventing the brain from being of malnutrition. Opiate or cocaine users are often so nourished properly. Conversely, a well-nourished distracted by the cycle of getting high, crashing and brain means fewer withdrawal symptoms during the looking for another high, that eating and self-care early stages of detoxification and higher possibility are severely neglected. of achieving long-term recovery. 24 $RUGSAND!LCOHOL4ODAYs6OLUME)SSUEs*UNE©0AVILION*OURNALS"RIGHTON ,TD Nutrition and addiction – can dietary changes assist with recovery? In some worst cases (ie. severe addicts or also important implications for mood, as when intestines are severely damaged), short-term deficiency of nutrients like amino acids, folic intravenous nutritional therapy may be required in acid and the other B-complex vitamins also order to bypass a severely damaged gut. Generally have a serious impact. Sugar and caffeine can (ie. when the addiction is not severe), a good diet generate mood swings, so intake of both should with short-term nutritional supplementation should be reduced during the early stages of recovery recover a poor gut and in turn revitalise the brain. (Holford et al , 2008). Regular intake of good-quality, fresh food should provide enough macronutrients and micronutrients Tyrosine and tryptophan to help in maintaining a drug-free lifestyle. Alcohol and drug use prevents the body from During the initial phases of recovery, however, properly processing two important amino acids, special emphasis should be placed on educating tyrosine and tryptophan. They are responsible for service users about changing dietary habits and the production of the neurotransmitters adrenalin, moving from a junk food- and convenience food- dopamine and serotonin. These compounds are based diet to a healthier diet, without falling into essential for emotional stability, mental clarity and a food deprivation. Indeed, caloric intake should general state of well-being (Bandaret & Lieberman, be substantial but calories should be coming from 1989). Decreased levels of these neurotransmitters fresh, good quality food like fruits, vegetables, fish, negatively affect mood and behaviour. In fact, drug nuts and pulses rather than trans-fat-laden, highly craving and other abstinence symptoms are the processed convenience food like ready meals, fish result of malfunctions of reward centres of the brain and chips, cakes and sweets. The processing of involving the neurotransmitters and the enzymes food and addition of colorants and preservatives that control them. Research indicates that it is depletes food of essential micronutrients and in possible to reduce stress, depression and anxiety, the case of fats, transforms natural, beneficial fatty as increase glucose and neurotransmitters receptor acids into ‘synthetic’ molecules (trans-fats) that sensitivity, and to restore serotonin, dopamine, are not recognised by enzymes and may end up enkephalins, taurine and gamma-aminobutyric stored in fat cells or, worse, they may interfere acid (GABA) with amino acid supplementation, with biochemical processes. On the other hand, which will give the client a generally improved fresh food, or food properly prepared and cooked, feeling of well-being (Brown et al , 1990; Bonner retains macro- and micronutrients, fibres and water et al , 2004). that are essential for correct functioning of the Phenylalanine is a precursor of tyrosine that is body and mind. then used to produce dopamine and noradrenaline. The education process of choosing healthy and Supplementation with phenylalanine has been nutritious food should be carried out within the shown to elevate mood, increase confidence, context of psychological and social re-education motivation and energy levels, and indirectly (Battaglia, 2008) because learning to eat properly is decrease drug cravings (Ehrenpreis, 1983). part of learning to care for oneself. Good nutrition, Tyrosine supplementation has been indicated to relaxation, and exercise all play an important role increase energy and emotional/mental alertness in successful detoxification from alcohol and drugs (Bandaret et al , 1989). abuse. Learning to make healthy food choices is Tryptophan is integral to the production of important to achieve a healthy lifestyle. Because serotonin, which has a calming effect and is they have neglected their diet for long time, important for proper sleep. It is found in foods addicts experience gastrointestinal disorders such such as bananas, milk and sunflower seeds, as well as diarrhoea, constipation and an inability to digest as turkey meat. Increased intake of tryptophan foods properly, along with a poor appetite. As has been shown to stabilise mood, improve sleep a result, they have a special need for foods that and reduce frequency and severity of alcohol are high in nutrients to rebuild damaged tissues withdrawal symptoms (Sahley & Birkner, 2001; and organs and to regain appropriate functioning Bonner et al , 2004). Additionally, a small pilot study of the various systems including the nervous and reported tryptophan supplementation to ameliorate gastrointestinal systems (Battaglia, 2008). cognitive functions, particularly visual memory, in Carefully selected nutrition with the right types of abstinent chronic alcohol abusers (Grotzkyj-Giorgi high protein and high carbohydrate foods can make et al, 2009). Tryptophan is metabolised along a big difference in coping with cravings during the three metabolic pathways. Serotonin and melatonin early stage of recovery (Bonner et al , 2004). There are pathways are physiologically relevant because $RUGSAND!LCOHOL4ODAYs6OLUME)SSUEs*UNE©0AVILION*OURNALS"RIGHTON ,TD 25 Nutrition and addiction – can dietary changes assist with recovery? they produce an important neurotransmitter to tryptophan supplementation improved (serotonin) and sleep hormone/antioxidant cognitive outcomes and increased the level of (melatonin). However, serotonin and melatonin neuroprotectant kynurenic acid (Grotzkyj-Giorgi pathways of tryptophan metabolism account only et al , 2009). for ~10% of tryptophan degradation (Badawy, In summary, amino acid therapy together 2002). In fact, more than 90% of dietary with multivitamin and mineral supplementation tryptophan is metabolised along the kynurenine- should be considered during the early stages nicotinic acid pathway (Badawy, 2002). The of alcohol and drugs recovery and possibly kynurenine-nicotinic acid pathway produces a continued by following a healthy diet. number of physiologically active metabolites, No drug currently in wide use – medical collectively known as kynurenines. Kynurenines or recreational – addresses the root cause of are neuroactive molecules, with some of them neurotransmitter imbalance. Medical drugs causing damage to the brain (kynurenine, merely stimulate temporary excessive release of quinolinic acid) and some others protecting pre-existing neurotransmitter stores or block the neurons (kynurenic acid). Kynurenines act on action of adrenalin, for example. They do not n-methyl-D-aspartate (NMDA) and nicotinic increase the production of neurotransmitters. acid (NA) receptors. NMDA receptors are How