When looking at nutrition and recovery from addiction, there are many issues to consider. The eating patterns and preferences developed during a period of active substance use can be hard to change. Access to nutritious foods may be difficult and most of all the challenge of completely changing your approach to eating in the midst of trying to recover from a substance use disorder might seem overwhelming. In this article Khary Rigg, Ph.D and Kelly Miller, NTMC introduce us to the importance of nutrition in addiction recovery and highlight some practical, evidence-based actions to consider when advocating for nutritional interventions in recovery care.
Drug addiction is a global concern that has reached epidemic levels in many countries. As a result, there is a worldwide focus on improving outcomes for people in treatment. Unfortunately, addiction treatment outcomes are generally poor. For example, the majority of people who receive treatment return to substance use or report a poor quality of life.
Some of the factors that contribute to poor treatment outcomes include depression, anxiety, insomnia, anger, and drug cravings. These symptoms can sabotage treatment by triggering relapse and early dropout. Innovative strategies to improve treatment outcomes are needed and nutrition therapy is a promising intervention for addressing some of the issues that undermine recovery.
Nutrition therapy uses food to prevent and reverse the course of chronic conditions such as diabetes, heart disease, and arthritis, but rarely is it applied to drug addiction. Research supports using nutrition therapy in an addiction treatment context, but many providers are unaware of how diet can be used to promote recovery. To understand the role that diet can play in recovery, it is important to first acknowledge the nutritional consequences of misusing drugs.
Nutritional Consequences of Drug Misuse
Chronic drug misuse can interact with and change brain chemistry. Some of these brain alterations can cause unhealthy eating patterns and impair metabolic absorption of nutrients. Malnutrition can also be a consequence of drug misuse. It is not uncommon for individuals with addictive disorders to experience unstable housing, have dysfunctional family relationships, and experience criminal justice involvement, all of which make healthy eating more challenging.
Individuals whose lifestyles center around misusing drugs may start eating infrequently due to diminished interest in food and appetite suppression from increased dopamine levels. People with addictive disorders also tend to be challenged with food insecurity, the inability to obtain healthy food on a day-to-day basis. Another consideration is that some drugs are xerostomic, reducing saliva needed to prevent tooth decay and gum infection.
Clearly, misusing drugs can negatively impact nutritional status. Some of these issues are due to physical or metabolic changes, while others stem from lifestyle choices and poor oral health. Addiction providers might benefit from giving greater attention to dietary issues during the screening/assessment process and utilizing nutrition therapy as an adjunct to traditional drug treatment.
Nutrition During Acute Detoxification
Acute detoxification (detox), which lasts anywhere from three days to three weeks, is usually the first phase of treatment. The primary goals of detox are to safely manage withdrawal symptoms and stabilize the patient. Common physical withdrawals during detox include nausea, abdominal cramping, vomiting, and diarrhea. What is often overlooked is that while experiencing these symptoms, most individuals suffer from at least one nutrient deficiency due to loss of bodily fluids or lack of appetite. It is important for addiction providers to be aware that these nutrient deficiencies can cause dangerous outcomes such as irregular heartbeat leading to circulatory problems and heart attack.
Patients may begin detox from different starting points in terms of how well they can handle solid foods. For this reason, it may be wise to start slowly to allow the digestive system to ramp up to taking more solid foods. Getting protein into the individual in the most digestible form would be the best place to start. Warm soups or broths like chicken noodle, lentil or beef can be a great choice for helping clients receive more mood stabilizing protein in a form that is easy on the digestive tract. Adding high nutrient protein shakes that include the nine essential amino acids can help the individual reacclimate to taking in nutrient dense food while simultaneously waking up the digestive system.
Cravings for sugar, sweets, and high caffeine energy drinks are normal during the detox phase because the brain is looking for mood stabilization and neurotransmitter stimulation. But consuming these foods and beverages only exacerbates low energy states, anxiety, anxiousness and mood swings. Alternatively, providing low caffeine herbal teas, like green and white tea can be far more beneficial because they contain an amino acid called theanine that helps patients stay alert during the day and increases their sense of calm. Caffeine also suppresses appetite, so limiting intake is paramount in readjusting to normal hunger and satiety hormones. Fruits like grapes, raspberries and apples can also help patients with sugar cravings while providing fiber that helps regulate blood sugar.
Nutrition During Post-Acute Detoxification
After acute detox, which is typically the next 30-90 days of treatment, individuals are stable enough to begin a well-rounded, balanced diet that includes nutrient dense foods. Following a simple model like PFF, which stands for protein, fat, and fiber is a useful framework for teaching individuals the benefits of eating a well-balanced diet that supports their recovery goals. First and foremost, protein should be the foundational nutrient that patients focus on during this stage of treatment. Protein provides crucial amino acids that are necessary for repairing any damage that may have taken place in the body, and they are also highly important precursors to the mood regulating neurotransmitters, dopamine, serotonin and the endorphins.
When individuals enter into treatment, their neurotransmitters are typically low and unbalanced due to substance misuse. Helping clients rebalance their brain chemistry is key to addressing anxiety, depression, apathy, irritability, insomnia and lethargy. High protein foods provide the necessary building blocks for manufacturing adequate neurotransmitter levels, resulting in mood stability. Individuals should aim for at least 60-90 grams of protein a day, spread throughout the day by consuming three meals and two snacks. Animal proteins like eggs, beef, chicken, fish and turkey provide the best source for meeting protein goals and meals can be easily built around these foods. High protein snacks might include low sugar yogurts, parmesan and cottage cheese, and beef sticks.
Another important nutrient for people in recovery is healthy fats. These may include fatty fish (salmon, tuna and anchovies), avocados, extra virgin olive oil, coconut oil, cheese, nuts and seeds. Fats are important for supporting brain structure and function, especially omega-3 fatty acids from fatty fish sources. Healthy fats also help regulate blood sugar, slow down digestion, and assist the body in absorbing fat-soluble nutrients. One of the most important benefits of omega-3 fatty acids in recovery is the ability to increase dopamine production and bind to dopamine receptors, further helping individuals stabilize brain function and relieve symptoms of low energy, apathy and anhedonia.
Lastly, fiber in the form of fruits and vegetables is the best way to provide the crucial cofactors that support amino acids in making neurotransmitters. In order to make dopamine from its amino acid precursor phenylalanine, certain B vitamins, folate, iron, zinc, vitamin c and magnesium must also be present in the diet. Consuming foods like collard greens, spinach, bell peppers, kiwis, avocado and bananas is important for providing these supportive vitamins and minerals.
The goal of this article was to raise awareness among drug treatment professionals about the nutritional consequences of misusing drugs and the role that diet can play in promoting recovery. Eating a balanced diet that consists of all three macronutrients, protein, fat, and complex carbohydrates is the best course of action for repairing nutrient deficiencies and stabilizing mood. While certain subgroups of patients may require specialized diets such as pregnant women and individuals with diabetes, the nutritional guidelines mentioned in this article should serve as a starting point for using nutrition to improve addiction treatment outcomes and quality of life for patients.
About the Authors
Khary Rigg, Ph.D, is an Associate Professor in the Department of Mental Health Law & Policy at the University of South Florida. He is a behavioral health services and policy researcher with over 15 years of experience studying substance use disorders. He earned his Ph.D. from University of Miami and completed a post-doctoral fellowship in health services research at the University of Pennsylvania Perelman School of Medicine. Dr. Rigg also has appointments in the Department of Sociology and the Florida Mental Health Institute. His studies generate findings that support effective clinical practice across healthcare and community settings. A common theme throughout his work is a concern for the health and well-being of people with addictive disorders.
Kelly Miller, NTMC, is a Nutritional Therapist and owner of The Addiction Nutritionist LLC. She provides nutrition coaching, psychoeducation, and training for clinicians on how to improve recovery outcomes by implementing nutritional interventions into their programming. Kelly owns and operates a virtual nutrition practice that serves both individuals in recovery from SUD as well as treatment professionals. She developed the PAWS Protocol, a nutritional intervention designed to meet the unique needs of individuals in recovery. Kelly also sits on the Board of STIGMA, a non-profit that serves those experiencing hunger, homelessness and addiction. She is dedicated to educating professionals on the importance of using evidence based nutritional therapy in their practices.