As more studies reveal how diet and health are intertwined, nutrition might finally be gaining ground in addiction treatment.
“People who have been abusing [drugs and alcohol] tend to lose sight of self-care,” says Maura Henninger, a naturopathic doctor based in New York City, and they have to learn it over again.
However, nutrition for addicts is not yet the norm in most treatment programs, one reason being their short duration.
Most people in recovery aren’t thinking about eating well in their first 30 days of sobriety, a common length of stay at rehab.
“This idea that nutrition is critical for addiction recovery has not quite caught on to the majority of treatment providers and to people themselves” in early recovery, says David Wiss, a registered dietitian nutritionist and founder of Los Angeles-based Nutrition in Recovery.
Ravi Chandiramani, a naturopathic doctor at the Sundance Center in Arizona, is one of those working to change that mindset. “I think that in general, people fail to make this correlation between their diet and their physical, mental and emotional health,” he says. “This becomes part of our responsibility as holistically oriented addiction providers to provide some core education on the overarching role of nutrition in health and wellness.”
What the addicted body loses
By the time addicts seek help, many are malnourished, in part because they haven’t been eating well and in part because addiction wreaks havoc on the body’s ability to absorb nutrients.
The type of malnutrition can depend upon the substance being abused. Opiate addicts, for example, often show deficiencies in calcium, vitamins D and B6, and iron, while cocaine addicts generally have low levels of omega-3 fatty acids, Wiss says.
Alcoholics tend toward more deficiencies than other addicts simply because alcohol causes the body to excrete larger quantities of nutrients, Henninger says.
Symptoms of malnutrition vary. Henninger says magnesium loss often shows up as weakness, insomnia and anxiety, while a lot of younger women she treats show signs of early-stage osteoporosis due to calcium loss.
“We commonly see B vitamin deficiencies in alcoholics manifested as factor-deficiency anemia,” Chandiramani says. “Vitamin K deficiencies manifest as clotting problems and slow-to-heal wounds. Vitamin C deficiencies and mineral deficiencies may also result in slow wound healing and immune system challenges.”
The nutrients addicts need
While putting addicts on vitamin and mineral supplements can be helpful, “real food,” as nutritionist Wiss says, is often the best option for long-term recovery. “I see the main problem being related to reward-seeking behavior,” he says, and that shows up in recovering addicts’ preference for processed foods with added sugar, salt and fat as well as for refined carbohydrates.
Dr. Chandiramani says patient education is crucial, especially when it comes to refined carbohydrates. “This has been shown to not only lead to some debilitating disease states down the road but perhaps even more important in this population, refined sugar can have adverse effects on the reward pathways in the brain.”
The recovery diet
So, just what should recovering addicts eat?
- Less sugar — Staying away from sweetened foods (anything with added sugar counts) will help stabilize blood sugar levels, which will help with mood swings, anxiety and depression.
- Fewer refined carbohydrates — Choose whole grains instead.
- More protein — The amino acids in proteins serve as building blocks for neurotransmitters, which are often lacking in addicts.
- More fiber — Fruits and vegetables help begin to heal the gastrointestinal system.
- More healthy fats — Good fats help the body absorb fat-soluble vitamins. Choose olive oil, flaxseed oil and omega-3s (found in fatty fish, nuts and flax seeds).
- Fewer processed foods — Liver repair is critical in early sobriety, says Henninger, so stay away from processed foods with artificial ingredients.
- Less caffeine — Caffeine can exacerbate insomnia and anxiety, which are especially prevalent in early sobriety.
Wiss likes to encourage a “never hungry, never full” diet, encouraging his patients to eat every two to four hours, or six small meals a day. The importance of keeping blood sugar levels stable cannot be overstated, he says. There is a strong connection between mood swings and blood sugar changes, as well as depression and nutritional deficiencies. Both can lead to relapse in early addiction recovery if not managed well.
Healing through nutrition
While nutritional counseling has not been emphasized as an integral part of addiction treatment, it is beginning to become a larger and more visible part of some treatment programs. There’s a huge market, says Wiss, who has made a successful career attracting professional and individual clients seeking his services. “If we start to talk about using nutrition to heal the brain, why wouldn’t nutrition be on the front lines for addiction recovery?” he says.
Dr. Chandiramani sees nutritional counseling as an important area of growth for treatment facilities. The Sundance Center not only relies on a core oral supplement program, but also offers intramuscular and intravenous micronutrient therapies. “Overall, this represents an exciting area of growth for us as we explore novel and effective ways to incorporate nutritional education and therapies into our programs through cooking classes, accessible nutritional screening tests, food sensitivity testing, new spa cuisine-influenced menus, and more,” he says.
Henninger doesn’t start her patients on any kind of nutritional regimen until after the first 30 days of sobriety. For Wiss, the first six weeks should consist of gradually getting more fiber and less sugar into addicts’ diets, followed by a “real food” program of nutrition, which includes keeping a food journal and checking in with hunger throughout the day.
Some long-term goals for Henninger include making sure gut health is optimal. “The gastrointestinal system is the seat of where health is,” she says, and if that’s not working, it can lead to inflammation, immune system abnormalities and a host of other related health problems. She keeps food sensitivities/allergies in mind, and so should patients. She advises green juices to help with energy and liver support, lots of proteins for optimal brain function and for keeping blood sugars stable, and most important, she stresses to her patients to simply enjoy food. “It shouldn’t be about deprivation,” she says.
Wiss agrees. He likes to instill healthy habits all around so that in the end, his patients are living a healthy lifestyle that doesn’t revolve around either drugs or food. From his experience, changing the “quick fix” behavior of addicts is paramount when it comes to meeting long-term recovery goals. Not only should addicts eat from all categories of food, but they also should know how to shop, cook and order for themselves at restaurants with their nutrition in mind. “It really is about falling out of the trap that’s been created by the food industry and not giving into convenience.”