Nutritional interventions, supplements form essential component of recovery from alcohol use disorder

Photo Cred: Vinicius Amnx Amano/Unsplash

By Kat Black

Nutrition and diet are crucial in the early stages of recovery from an alcohol use disorder. In fact, nutritional habits can be a determining factor in the likelihood of relapse, said Victoria Abel, MA, MNT, CAN, a nutritionist at the Center for Addiction Nutrition in Prescott, Arizona. She recalled an experience with a patient who had previously never stayed sober beyond three months, a critical timeframe often associated with post-acute withdrawal syndrome (or “PAWS”).

“There’s a really challenging and slippery time, about two to three months sober, that a lot of people relapse because their body is having a secondary detox,” said Abel. The patient followed a nutrition plan prescribed by Abel and, for the first time, was able to maintain sobriety past the PAWS window.

A 2004 study published in Journal of the Academy of Nutrition and Dietetics linked improved recovery outcomes with nutrition education in substance abuse treatment programs. The reason for this, said Abel, is twofold: a healthy nutritional regimen both counteracts alcohol cravings by healing the way that sugars are processed in the body, and combats the anxiety that may drive people to drink.

“The majority of folks use [alcohol and drugs] to manage anxiety,” Abel said. “If we can naturally reduce that anxiety through proper food and supplementation, we’re going to reduce relapse.”  

Supplements and nutrition restoration in early recovery

Addressing the nutritional deficiencies caused by excessive alcohol use is particularly vital in the first few weeks of recovery, said Lynn Smith, MS, RDN, a dietitian and nutritionist at Source Nutrition and InnerBalance Health Center in Loveland, Colorado.   

“[Alcoholics] may have elevated liver enzymes,” said Smith. “They may have imbalances in their red blood cell sizes due to B12 or folate deficiencies. We see people with vitamin D [deficiency], 8 to 10 below 20 routinely. Homocysteine may be imbalanced.”  According to research published in Indian Journal of Endocrinology and Metabolism and The Journal of Clinical Endocrinology and Metabolism, alcohol use disorders can also impact thyroid function and are associated with activation of the hypothalamic-pituitary-adrenal (HPA) axis, which leads to elevated levels of cortisol (the “stress hormone”).

Smith initially prescribes her patients a round of intensive nutrient therapy overlaid with a basic nutrition protocol, which she recommends maintaining for one to four months before tapering off. “The very first thing is to start somebody on an anti-inflammatory, hypoglycemic diet that is designed to balance blood sugar and calm inflammation in the body,” she said. A 2010 study published in World Journal of Gastroenterology links systemic inflammation with heavy alcohol consumption. Smith frequently prescribes evening primrose, which contains omega-6 fatty acids, for its anti-inflammatory effects.

Other supplements in Smith’s restoration treatment plan may include powdered aminos, ashwagandha, antioxidants, digestive enzymes and probiotics, zinc, and the intravenous “Myers cocktail” (magnesium, calcium, B vitamins, and vitamin C). She may also give her patients milk thistle, alpha lipoic acid, and phosphatidylcholine to support the damaged liver. Most of Smith’s patients will also receive a glycine supplement since glycine is used to make gamma-aminobutyric acid (GABA), a neurotransmitter that regulates the nervous system and is depleted by chronic alcohol use.

Smith said that she notices a difference in her patients just two weeks into the intensive nutritional regimen. “You can literally look at them and see the vitality coming back into their eyes and to their skin and to their aura and their sense of humor. And the smiles come back.”

Maintaining nutrition in long-term sobriety

One problem that people may repeatedly encounter in recovery is frequent exposure to sugar – even, or perhaps especially, in treatment settings, said Smith. “People go to treatment, and they put out bowls of candy and serve them ice cream and cookies all day. All that sugar does is create more inflammation and more sugar and more [alcohol] cravings.”

Conversely, a protein-rich and vegetable-heavy diet naturally curbs both anxiety and cravings, which leads to better sobriety outcomes over time. Breakfast is particularly important, said Abel. “A non-sweet protein breakfast can set you up for a beautiful reduction in sugar and alcohol cravings. If we start our day with sugar, the body is going to be craving sugar all day long.” She suggested starting the day with eggs, sausage, bacon, tofu, or beans. She may also recommend taking an L-glutamine supplement before meals to lessen sugar and alcohol cravings and restore the lining of the gastrointestinal tract.

Above all, Abel emphasized the importance of nutritional moderation. “I have an 85-15 rule,” she said. “Eight-five percent of the time I want you to eat really well – 15 percent of the time, do you.”

A balance of “healthy” food and the occasional indulgence, she said, is an effective counterpoint to the “all-or-nothing” mentality that is often present in alcohol use disorder.