Overview: Nutrition as a Powerful Tool for Recovery
Nutrition is a prerequisite for total health, and total health is a desired end-goal for long-term success for addiction recovery. (1) Having best-in-class dining and nutrition programs as well as addressing the whole person, we believe, are key components of a successful recovery program.
According to the National Institute on Drug Abuse, drug abuse and addiction cost Americans more than $740 billion annually in lost workplace productivity, healthcare expenses, and crime-related costs. (2) The relapse rate for substance use disorders is estimated to be between 40% and 60%. This rate is similar to rates of relapse for other chronic diseases such as hypertension or asthma. (3) Just like hypertension and asthma, substance use disorders can be diminished with proper nutrition interventions.
While surely these statistics are not news, recent studies explore the impact nutrition can have on long-term outcomes. Continued research is needed to maximize the potential benefits, but an understanding of the positive effect proper nutrition can have on success rates, especially in early recovery, can give substance use treatment centers a leg up on their counterparts who overlook the importance of nutrition.
In the interest of simplicity, let’s focus on early recovery and the importance of food cravings. It is necessary for those in recovery, and those administering treatment, to use all the tools at their disposal and gain every possible advantage. Research shows that nutrition is proven to be a very powerful tool.
Malnutrition: The Chicken or the Egg
How are food cravings related to nutrition? Furthermore, how can those very food cravings hinder recovery from substance use disorders? Can treatment centers use patients’ cravings as information that may ultimately help them to further tailor treatment to the individual?
Food cravings are a natural way for the body to alert an individual that a deficiency needs to be addressed. Cravings are a natural function present in all humans, those struggling with addiction or not, as part of our innate survival skills. (1) We may crave salt which signals that we need to balance our electrolytes. Banana cravings are possibly a sign of potassium deficiency, chocolate cravings perhaps reflective of low magnesium, dairy can suggest a need for calcium while a strong desire for a burger points to anemia.
What if a person has cravings for multiple foods? Multiple cravings could suggest multiple nutrient deficiencies. In short, malnutrition is defined as multiple nutrient deficiencies. It can’t be said with absolute certainty that every craving equates to a deficiency, however, a patient’s food cravings can signal those administering treatment that there is a need that needs to be addressed. This allows the practitioner to use “food as medicine” and address the patient’s very carnal, physical needs through nutrition. (1)
Studies show that alcohol and drug addiction can be caused by malnutrition. Conversely, the role of malnutrition in addiction is complex — we know that in the late stages of addiction there is complete drug dependence, and this makes the need for the substance of choice to override the need for any natural substance, such as food. (1) Drug addiction hijacks the neurobiological mechanisms for reward, motivation, decision-making, learning, and memory — forcing these mechanisms to be responsive to the drug of choice, versus natural substances, such as nutrients. (4) This, of course, naturally lends itself to malnutrition as a consequence of addiction. (1)
We can leave the discussion of whether malnutrition is the chicken or the egg up to the scientists, but the good news is, regardless of its origin, addressing malnutrition greatly affects overall health, reduces cravings, improves mood, and makes the patient more comfortable during the detox period. All of these benefits are big wins, especially in early recovery.
What is an important takeaway regarding the topic of malnutrition is that, according to Jeynes and Gibson in their 2017 review, malnutrition promotes drug seeking and can impede recovery from substance abuse disorders. As mentioned, malnutrition activates the carnal instinct for survival — and this can trigger maladaptive patterns of food, sex, gambling that are associated with addiction. (4)
Cross-sensitivity: The Food and Addiction Connection
Multiple studies confirm that food and drug cues activate the same areas of the brain. In studying food addiction and cross-sensitivity, researchers have found that the same neurobiological pathways that are associated with substance abuse also modulate food consumption. (4) Wow – This is important information for the treatment professional! Food is, in fact, pivotal in addiction recovery.
Furthermore, human brain imaging shows that processed foods (high carb, high fat, filled with preservatives) can act like a traditional drug of abuse, causing brain changes almost indistinguishable from those produced by drugs. (4) To disregard the potential food-addiction connection would be to overlook a major building block of recovery.
To summarize this concept, malnutrition and body-wide imbalances can lead to cravings; cravings can transfer to other addictive substances. Addressing the total nutrition needs of the individual will help stabilize overall health, therefore lowering rates of relapse. Whether malnutrition, cravings, food addiction or drug addiction comes first, the truth of the matter is that changing the neurobiological response in response to overall reward-seeking behavior can only help to improve long-term outcomes. (4)
Foods that Trigger Drug and Alcohol Cravings
What does using nutrition as a weapon in the arsenal of treatment look like? Studies suggest that carbohydrates have abuse potential. There are theories that salt and processed foods are addictive, however, most detailed research is centered around sugar and fat. (4) There are countless studies done on sugar and its addictive properties, but eliminating sugar and addressing possible sugar addiction is only the tip of the iceberg when it comes to creating a diet that will help withdrawal symptoms, mood symptoms, and nutrient deficiencies.
The pitfalls of sugar consumption in cases of addiction are numerous and too extensive to include in a short blog post, but here is a shortlist of the reasons why processed sugar is better to be avoided:
- Sugar is shown to create the same addiction response as drugs and alcohol: tolerance, withdrawal, and cross-sensitization. (4)
- Sugar can cause addictive behaviors in people with high reward sensitivity. (1)
- Sugar (and caffeine) can generate mood swings. (6)
- Sugar binging, like drug abuse, continually stimulates dopamine release. (4) Because of this, studies show that sugar may to some extent be a substitute for rewarding drugs when not available. (1)
- Sugar content can dilute nutritional quality because it masks the desire to seek out more nutritious foods. (1)
- Disruption of insulin regulation and the adverse effects of glycemia could lead to increased drug or alcohol cravings. (1)
The role of fat is especially important in cases of alcoholism. Dopamine reward pathways motivate food consumption, but also increase triglyceride levels. Higher fat can stimulate the desire for alcohol intake. (4) This is vital information for treatment centers that specifically focus on alcohol use disorders.
Importantly, drugs and alcohol strip the brain of essential fats. It is necessary to replace these during treatment. Studies show that the rate of relapse for cocaine and alcohol use was lowered in those who supplemented with Omega 3’s and 6’s or if their diet consisted of proper amounts of Omega’s. (6)
Scientists have hypothesized that salt is a mild opiate agonist. (4) More research is needed on the topic, but if proven true, this will be an important discovery for treatment centers. Any way that stimulating the opioid response can be avoided will support positive treatment outcomes. Replacing salt with creative use of herbs in recipes is an easy way to reduce the dependency on this potential opiate antagonist.
Other Foods Helpful to the Recovery Process
The addiction process depletes the body of essential amino acids and B vitamins. This is reflected in cravings, mood, energy, sleep, and motivation. For a patient to have vitality, addressing this malnutrition is essential. (6)
90% of our body’s serotonin is manufactured in the gut. Serotonin is an important neurotransmitter imperative for mood regulation. Specific amino acids commonly found to be low in those suffering from addiction are tyrosine and tryptophan. They are responsible for the production of adrenaline, dopamine, and serotonin. When levels are optimal in the body, these key amino acids can enhance mood, confidence, energy levels, improve sleep, reduce cravings, and reduce the severity of alcohol withdrawal episodes in early recovery. (6)
High protein, high calorie, nutrient-dense diet is a very good start when it comes to addressing addiction malnutrition. Fresh food, with proper amounts of macro and micronutrients, nourish the whole body, minimizing imbalance, cravings, and mood issues. (6)
Long-Term Success is Our Mutual Goal
To support our clients’ goals, a fresh, whole food, nutrient-dense diet comprised of a complete profile of macro and micronutrients low in processed sugar and carbohydrates must be implemented as a comprehensive approach to menu creation aimed to help support patient recovery.
More research will be revealed over time, but it is already clear that treatment centers that include nutrition as part of treatment protocols are going to be ahead of the rest. It is proven that a well-nourished brain and body means fewer withdrawal symptoms in the early stages of detoxification.
- Jeynes K, Gibson E. The importance of nutrition in aiding recovery from substance use disorders: A review. Drug Alcohol Depend. 2017;179:229-239. doi:10.1016/j.drugalcdep.2017.07.006
- Trends & Statistics. Drugabuse.gov. https://www.drugabuse.gov/related-topics/trends-statistics. Published 2017. Accessed December 31, 2019.
- Treatment and Recovery. Drugabuse.gov. https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery. Published 2018. Accessed December 31, 2019.
- Blumenthal D, Gold M. Neurobiology of food addiction. Curr Opin Clin Nutr Metab Care. 2010;13(4):359-365. doi:10.1097/mco.0b013e32833ad4d4
- Hone-Blanchet A, Fecteau S. Overlap of food addiction and substance use disorders definitions: Analysis of animal and human studies. Neuropharmacology. 2014;85:81-90. doi:10.1016/j.neuropharm.2014.05.019
- Grotzkyj‐Giorgi M. Nutrition and addiction — can dietary changes assist with recovery?. Drugs Alcohol Today. 2009;9(2):24-28. doi:10.1108/17459265200900016
- Westwater M, Fletcher P, Ziauddeen H. Sugar addiction: the state of the science. Eur J Nutr. 2016;55(S2):55-69. doi:10.1007/s00394-016-1229-6