For many right now-- nutrition and exercise may not seem important which I get.. but it is because it can help you with the high levels of stress , mental health and if you are in recovery.. it's affecting all of us.

See stress effects our hormones (cortisol) , our neurotransmitters (ie serotonin), our Micro-nutrients (vitamins and minerals like our B Vitamins and Magnesium etc), our sleep and how we digest our foods...

Yes, stress is primal and yes, we have it from time to time.. we even may have the "fight or flight" stress but our bodies aren't made to sustain long term stress...

So from years of education and years of helping clients in a Health & Wellness Coaching aspect to now a Nutritional one, here are some steps that may be helpful..

Listen to your body. When something doesn’t feel right (mentally, emotionally or physically) acknowledging it is the first step to overcoming. Use the resources available to you to seek support, if needed. They are out there from Health & Wellness Coaches, Nutritionist, Therapist etc.. Please reach out.

Stay hydrated. Staying properly hydrated with water is just as important as eating healthy. A good habit is to always have water with you wherever you go. Avoid sugary drinks and alcoholic beverages, which can cause spikes in blood sugar that can increase hunger along with other aspects of mental health and those in recovery.

Practice healthy sleep habits. Eight hours is the recommended amount of sleep per night. The quality of your sleep impacts mental clarity, blood pressure and immunity. Sleeping less than six hours can affect your hormones and metabolism.

Exercise and stay active. Deep breathing, muscular exertion and regular movement can help improve your well-being, immunity and focus. Studies also show that it is helpful with depression, anxiety and for those in recovery it can lessen cravings plus it relieves stress and fills time that otherwise may not be filled.

Eat healthy meals and snacks. Adopting healthy eating habits involves making mindful decisions and avoiding processed foods as much as possible. If you have a long day ahead of you or you know your day will be stressful, make sure you have healthy, nutritious and protein-rich snacks on hand. These types of foods and snacks help optimize your brain and body, and can help minimize the stress that comes with hunger and low energy.

Prioritize stress management. Stress is normal, but living with it constantly is unhealthy and can become debilitating to your well-being. Long-term stress can contribute to obesity, heart disease and high blood pressure. Again use resources for mental health care (like counseling and/or emotional support via telehealth or AA meetings via video etc) to ensure that stress doesn’t stand in the way of your health.

Contributor- Maxine Barish-Wreden, M.D., ABIHM
Sutter Medical Foundation
Sutter Medical Center, Sacramento  (Link Here)

From a young age, we’re taught that eating well helps us look and feel our physical best. What we’re not always told is that good nutrition significantly affects our mental health, too. A healthy, well-balanced diet can help us think clearly and feel more alert. It can also improve concentration and attention span.

Conversely, an inadequate diet can lead to fatigue, impaired decision-making, and can slow down reaction time. In fact, a poor diet can actually aggravate, and may even lead to, stress and depression.
Maxine Barish-Wreden, M.D., a complementary and integrative medicine physician with Sutter Medical Foundation, says one of the biggest health impairments is society’s reliance on processed foods. These foods are high in flours and sugar and train the brain to crave more of them, rather than nutrient-rich foods such as fruits and vegetables.

“A lot of the processed foods we eat are highly addictive and stimulate the dopamine centers in our brain, which are associated with pleasure and reward,” Dr. Barish-Wreden says. “In order to stop craving unhealthy foods, you’ve got to stop eating those foods. You actually start to change the physiology in the brain when you pull added sugars and refined carbohydrates from your diet.”

Stress and Depression, Sugar and processed foods can lead to inflammation throughout the body and brain, which may contribute to mood disorders, including anxiety and depression. When we’re feeling stressed or depressed, it’s often processed foods we reach for in search of a quick pick-me-up. During busy or difficult periods, a cup of coffee stands in for a complete breakfast and fresh fruits and vegetables are replaced with high-fat, high-calorie fast food. When feeling down, a pint of ice cream becomes dinner (or you skip dinner altogether).

According to the American Dietetic Association, people tend to either eat too much or too little when depressed or under stress. Eat too much and you find yourself dealing with sluggishness and weight gain. Eat too little and the resulting exhaustion makes this a hard habit to break. In either case, poor diet during periods of stress and depression only makes matters worse. This cycle is a vicious one, but it can be overcome.

To boost your mental health, focus on eating plenty of fruits and vegetables along with foods rich in omega-3 fatty acids, such as salmon. Dark green leafy vegetables in particular are brain protective. Nuts, seeds and legumes, such as beans and lentils, are also excellent brain foods. Dr. Barish-Wreden says a healthy diet can be more effective for treating depression than prescription medications.
“Studies have shown a reduction in depression of 40 to 60 percent when people are eating the right foods, which is a better outcome than most drugs,” Dr. Barish-Wreden says.

A Healthy Gut Researchers continue to prove the old adage that you are what you eat, most recently by exploring the strong connection between our intestines and brain. Our guts and brain are physically linked via the vagus nerve, and the two are able to send messages to one another. While the gut is able to influence emotional behavior in the brain, the brain can also alter the type of bacteria living in the gut.

According to the American Psychological Association, gut bacteria produce an array of neurochemicals that the brain uses for the regulation of physiological and mental processes, including mood. It’s believed 95 percent of the body's supply of serotonin, a mood stabilizer, is produced by gut bacteria. Stress is thought to suppress beneficial gut bacteria.

Failing to keep the bacteria in our guts happy with a healthy diet can lead to depression, says Dr. Barish-Wreden. Depression can take hold when the gut is inflamed by processed foods such as sugar and flours, even whole grain flours. To remedy this, Dr. Barish-Wreden says people need to scrap their poor dietary habits.

“Reducing flour and sugar helps create a new microbiome of healthy bacteria. Adding fresh fruits, fiber, fish and fermented foods will also help your gut bacteria truly thrive,” she says.
Mindful EatingPaying attention to how you feel when you eat, and what you eat, is one of the first steps in making sure you’re getting well-balanced meals and snacks. Since many of us don’t pay close attention to our eating habits, nutritionists recommend keeping a food journal. Documenting what, where and when you eat is a great way to gain insight into your patterns.

If you find you overeat when stressed, it may be helpful to stop what you’re doing when the urge to eat arises, and to write down your feelings. By doing this, you may discover what’s really bothering you. If you under eat, it may help to schedule five or six smaller meals instead of three large ones.

Sometimes, stress and depression are severe and can’t be managed alone. For some, eating disorders develop. If you find it hard to control your eating habits, whether you’re eating too much or too little, your health may be in jeopardy. If this is the case, you should seek professional counseling. Asking for help is never a sign of weakness or failure, especially in situations too difficult to handle alone.
Brain Food Your brain and nervous system depend on nutrition to build new proteins, cells and tissues. In order to function effectively, your body requires a variety of carbohydrates, proteins and minerals. To get all the nutrients that improve mental functioning, nutritionists suggest eating meals and snacks that include a variety of foods, instead of eating the same meals each day.

Here are the top three foods to incorporate into a healthy mental diet:

• Complex carbohydrates -- such as brown rice and starchy vegetables can give you energy. Quinoa, millet, beets and sweet potatoes have more nutritional value and will keep you satisfied longer than the simple carbohydrates found in sugar and candy.
• Lean proteins -- also lend energy that allows your body to think and react quickly. Good sources of protein include chicken, meat, fish, eggs, soybeans, nuts and seeds.
• Fatty acids -- are crucial for the proper function of your brain and nervous system. You can find them in fish, meat, eggs, nuts and flax seeds.
  

Healthy Eating Tips

• Steer clear of processed snack foods, such as potato chips, which can impair your ability to concentrate. Pass up sugar-filled snacks, such as candy and soft drinks, which lead to ups and downs in energy levels.
• Consume plenty of healthy fats, such as olive oil, coconut oil and avocado. This will support your brain function.
• Have a healthy snack when hunger strikes, such as fruit, nuts, hard-boiled eggs, baked sweet potatoes or edamame. This will give you more energy than packaged products.
• Develop a healthy shopping list and stick to it.
• Don’t shop while hungry, since you’ll be more apt to make unhealthy impulse purchases.
• Think about where and when you eat. Don’t eat in front of the television, which can be distracting and cause you to overeat. Instead, find a place to sit, relax and really notice what you’re eating. Chew slowly. Savor the taste and texture.

December 2014 Issue
CPE Monthly: Substance Abuse and Nutrition
By Alyssa Salz, MS, RD, LD
Today's Dietitian
Vol. 16 No. 12 P. 44

The dietitian's role in treating substance abuse is an important but often lacking part of patients' long-term recovery process. Nutrition therapy for substance abuse is complex, as the nutritional risks vary depending on the substance of choice and negative conditions for successful treatment are common, including poor support, co-occurring mental health disorders, or poverty.

Addiction is defined as a chronic brain disorder characterized by compulsive and relapsing behavior.1 Predisposing factors for an addiction include psychological vulnerability, biochemical abnormalities, genetics, and environmental conditioning.1 Social isolation, depression, and anxiety are common among substance abusers, and drugs and/or alcohol often are used to relieve these negative feelings because they increase dopamine activity, which boosts mood.

Proper nutrition and hydration are key to the substance abuse healing process because they help restore physical and mental health and improve the chance of recovery. Macro- and micronutrient deficiencies can lead to symptoms of depression, anxiety, and low energy, all of which can lead someone to start using drugs or alcohol or trigger a relapse.

Substance abuse generally leads to a lack of proper nutrition, either as a result of not eating enough throughout the day or eating foods that are low in necessary nutrients.2 Certain substances, such as stimulants, may suppress appetite and disrupt metabolic and neuroendocrine regulation, leading to improper calorie consumption and impaired nutrient processing.1 Other substances may lead to an increase in appetite, causing weight gain.

Many programs that target substance abuse prevention address nutrition because a healthful lifestyle can promote mental health. And for those who are battling substance abuse, nutrition plays the same key role in maintaining recovery while also improving the resulting health conditions and deficiencies.

Individualized nutrition counseling and comprehensive nutrition education programs provided to the substance abuse population have been found to significantly improve three-month sobriety success rates.3 Just as patients with diabetes or heart disease receive nutrition education to manage their diseases, patients dealing with substance abuse should have nutrition education that addresses their specific risk factors and increases their chances of recovery.3

Medical nutrition therapy (MNT) and nutrition education for this population should target the following goals:

• heal and nourish the body damaged by alcohol or substance abuse;
• stabilize mood and reduce stress;
• reduce cravings for drugs and alcohol;
• address medical conditions that are co-occurring or have resulted from substance abuse; and
• encourage self-care and a healthful lifestyle.

This continuing education course reviews the effects of substance abuse as they relate to nutrition and health, and addresses the role RDs play during treatment to correct nutrition-related deficiencies, address resulting health disparities, and improve the lives of addicts by providing tools for lasting recovery.

Heal and Nourish

Substance abuse is known to lead to vitamin and mineral deficiencies that threaten physical and mental health, damage vital organs and the nervous system, and decrease immunity.4 Harmful lifestyles often are associated with addiction, such as poor eating patterns, lack of exercise, and changes in sleep patterns. These compounding factors result in an increased risk of long-term health problems, including metabolic syndrome, diabetes, hypertension, weight problems, and eating disorders.

To help an individual recover from the effects of substance abuse, it's important to supply them with balanced, calorically appropriate meals. This may be difficult during the initial detox period but should be a targeted goal as soon as the patient is deemed stable for oral intake.1 Calculating adequate calories for each patient will help them manage hypoglycemia, improve deficiencies, and achieve or maintain an appropriate weight. Encouraging them to consume regularly scheduled meals and snacks and to increase their level and amount of physical activity will help address these issues as well as contribute to stress management and improved sleep.2

It's vital to correct any nutritional deficiencies and address any medical conditions, as continued malnutrition and instability increase disease risk and will produce cravings for drugs or alcohol. Increased consumption of nutrient-dense foods (eg, fruits, vegetables, whole grains, fish) and antioxidants is important; these foods help decrease inflammation, reduce cell oxidation, and provide the basics of a healthful diet.4

Psychotherapy also is an important part of the healing process for substance abuse patients. They should be encouraged to seek regular help from counselors and/or support groups since psychological and social problems are common.

Normalize Neurotransmitters and Mood

Psychoactive substances may lead to psychiatric problems, as the substances can have toxic effects on brain chemistry. Before detoxification, neurotransmitters are decreased due to poor nutrition and altered amino acid absorption and utilization.2 This leaves addicts feeling depressed, agitated, and unregulated early in recovery. It's thought that these imbalances disappear over a period of weeks but may last as long as one year after an addict becomes sober.2

For some, mood and behavior abnormalities may have been present before the substance abuse. With proper diagnosis of any possible underlying mental health disorders, a healthful diet and education on how nutrition influences mood and brain chemistry, recovery can be enhanced.

An understanding of how food affects mood and the risk of substance abuse begins with macronutrients. Carbohydrates are the body's main source of energy; without this macronutrient, the brain can't properly function, blood sugar becomes unstable, and neurotransmitters become disrupted. Unstable blood sugar can lead to feelings of frustration, anxiety, and cravings.

Carbohydrates aid in the production of serotonin, which facilitates a happy, stable mood; aids in sleep; and helps curb food cravings. Low serotonin levels can result in sleep problems, irritability, and depression.

Insulin release following carbohydrate intake helps glucose enter cells, where it's used for energy and triggers tryptophan's entry into the brain.5 Then folic acid and vitamins B6 and B12 help the synthesis of tryptophan to serotonin. Ensuring that clients receive adequate carbohydrates and tryptophan-rich foods, such as dairy and meats, helps stabilize these reactions.

Amino acids, the building blocks of protein, also are the foundation of neurotransmitters. Low levels of neurotransmitters, particularly dopamine, can trigger an individual to turn to substances to feel better, as most substances markedly impact the body's dopamine levels. Dopamine is made from the amino acid tyrosine, and serotonin is made from tryptophan.5 If an individual lacks either of these amino acids, synthesis of the respective neurotransmitter is disrupted, which affects mood, aggression, and the desire for drugs or alcohol.5

Dietary fat also plays a role in maintaining mental health. Because it affects inflammation and cell membrane integrity, limiting dietary fat directly influences mood. Research has shown that increased inflammation or proinflammatory cytokines result in more depressive symptoms.6

Omega-3 fatty acid consumption may help with depression by assisting in the uptake of neurotransmitters and decreasing inflammation. Having a proper balance of omega-6 and omega-3 fatty acids helps neurotransmitter receptors function, which in turn helps increase the amount of neurotransmitters that can be active in the brain.4 Supplements containing polyunsaturated fatty acids have been recommended to help reduce anxiety in people with substance abuse.4

Other vitamins important for mental health include iron, folate, and vitamins B6 and B12. Deficiencies of any of these nutrients can mimic mental health problems such as depression, fatigue, poor attention, and altered sleep.2

Encouraging patients to drink adequate amounts of hydrating fluids also will help them manage mood while ensuring adequate absorption of any medications they take to prevent side effects from withdrawal or underlying psychiatric disorders. Common symptoms of dehydration include irritability, trouble concentrating, and disorientation. Dehydration also commonly results from detoxification, so monitoring daily intake and output values will help determine appropriate fluid intake recommendations.1

Caffeine intake should be monitored, as it triggers the same reward centers of the brain as do substances and can markedly impact anxiety and sleep. Low caffeine intake and smoking cessation have been shown to improve long-term sobriety for all addictions.1

Reduce Cravings

Anxiety, irritability, and low mood or energy levels are triggers for cravings. All of these symptoms can result from low blood sugar, dehydration, high levels of caffeine, and an unbalanced diet. Increased relapse occurs when an individual has poor eating habits, mainly because of the impact on cravings. Encouraging balanced meals and regular eating times helps patients decrease these events. Generally, a diet relatively high in complex carbohydrates, moderate in protein, and low in fat and sugar is recommended to help sustain recovery.7 It isn't wise to advise clients to follow a high-protein diet, as excess protein will strain the already damaged liver.7

Often in early recovery, patients struggle with differentiating hunger from cravings for drugs or alcohol and emotions. Addicts commonly forget what normal hunger feels like and may perceive a craving for substances when actually they're just hungry. Similarly, many addicts will switch to sweets to replace their drug dependency; some of this is a result of seeking pleasurable foods that trigger a physiological response (such as increasing dopamine), emotional eating, or experiencing irregular blood sugar levels. Monitoring sweets intake may be important with some clients because approximately 50% of substance abusers also have co-occurring eating disorders, so monitoring signs of binge behavior may help in properly identifying possible binge-eating disorder or bulimia.1

RDs can help educate patients on identifying physical hunger cues and encourage more frequent, balanced eating to help them maintain a normal level of hunger and satiety rather than getting overly hungry.

MNT for Substance Abuse

Depending on the substances different individuals abuse, their nutritional status, weight problems, and disease may differ, leading to a need for a full assessment to determine their individual requirements. This course first examines the common needs for MNT in substance abuse and then discusses the specific nutritional threats each substance poses as well as the recommendations for addressing those threats.

Malnutrition

Malnutrition related to addiction is categorized as primary or secondary. Primary malnutrition occurs when the substance replaces other dietary nutrients.8 Secondary malnutrition results from improper nutrient metabolism, absorption, utilization, or excretion even though the diet may be adequate. Both types of malnutrition can result from any substance use.

Patients struggling with multiple addictions show increased deficiencies due to malnutrition. One study revealed that 70% of addicts suffered vitamin D deficiency and low levels of vitamin C, and another showed that 50% were deficient either in iron or vitamins (vitamins A, C, and E being most common) during detox.9,10

MNT for malnutrition includes correcting any deficiencies, providing an adequate diet, and addressing any alterations that need to be made to the diet due to oral, digestive, or metabolic issues. A once-a-day, low-potency multivitamin/mineral supplement may be useful for those unable to consume a calorically adequate diet and those with dietary limitations or severe gastrointestinal damage.7

Metabolic Syndrome

Substance abuse, especially alcohol abuse, is associated with an increased risk of metabolic syndrome, which consists of increased abdominal obesity, hyperglycemia, abnormal cholesterol, and hypertension. The mechanisms through which substance abuse contributes to this condition includes increased cell damage, reduced energy production, cells' reduced antioxidant potential, and enhanced excitotoxicity.11 Some substances, including alcohol and marijuana, lead to higher calorie intakes, increased weight circumference, and poorer nutritional profiles, all of which will lead to an increased metabolic syndrome risk.

The prevalence of metabolic syndrome in substance abusers is reported to be 5% to 31%, with a higher risk for those who abuse alcohol and opioids.11 Higher risk is thought to be associated with an increased period of dependence on a substance.12

Counseling patients on lifestyle changes to decrease their risk of cardiovascular disease and diabetes is important. This includes encouraging exercise, weight loss, dietary changes to reduce blood pressure and cholesterol, and quitting smoking.

Weight Management and Eating Disorders

Weight management is a common nutritional concern related to substance abuse. Detoxification programs commonly lead to weight gain, as addicts turn to food instead of their drugs of choice. Biochemical changes result in increased appetite and a preference for highly palatable foods, and confusion in hunger/fullness cues arise. However, for some, weight gain is important due to significant protein-energy malnutrition and low BMI as a result of substance use.13 Increased calorie intake and weight can lead to obesity, diabetes, hypertension, and cardiovascular disease, so RDs should monitor and counsel patients on healthful eating and weight management.

While in treatment, most patients reduce their levels of exercise either due to lack of time, the program structure, or lack of motivation. Increased abnormal liver tests are common in refeeding among hospitalized drug addicts, which is theorized to be caused by a lack of exercise and increase in weight.14 In a study from the Journal of the American Dietetic Association, daily weight change had a significant positive correlation with changes in serum alanine transaminase or aspartate amino transferase concentrations from admission to discharge.14 RDs can help monitor weight gain and laboratory results and identify patient goals for achieving or maintaining a healthy weight. RDs also can work with program administrators to develop exercise programs during and after treatment that can help to level patients' liver enzymes and manage their weight.

With the high occurrence of eating disorders in the substance abuse population, care must be taken in making recommendations for weight management to ensure they aren't too restrictive and weight gain or loss is monitored and steady. In women younger than 30 with alcoholism, 72% also have an eating disorder, and other substances such as cocaine are associated with a higher prevalence of eating disorders, so precautions and available resources are helpful when working with these populations.1

Pharmacotherapy

Pharmacotherapy is a common component of addiction treatment. These medications are intended to improve mood stability and recovery success and to assist with any medical or mental health problems resulting from or co-occurring with detoxification. RDs can help manage the nutritional implications of these medications.

Medication-assisted treatment for substance abuse has been effective for alcohol and opioid dependence. It's important for dietitians to be familiar with these common medications, as the side effects may influence patients' nutritional status.

Dietitians need to be cautious when recommending supplementation in this population due to addicts' quick-fix mindset and already-taxed bodies. A damaged liver may not be able to correctly process certain supplements, and the supplements may ultimately have a negative impact on liver health.2 However, a study funded by the National Institutes of Health suggested that a common over-the-counter herbal supplement, N-acetylcysteine, can reduce the cravings of cocaine and heroin addicts and possibly alcoholics during withdrawal.1

Naltrexone (ReVia, Vivitrol, Depade), disulfiram (Antabuse), and acamprosate calcium (Campral) are used to treat alcoholism. Naltrexone, which also has been used with opiate and narcotic dependence, may cause anorexia, weight loss, nausea, and vomiting.15 Disulfiram may cause nausea and vomiting, and if patients ingest alcohol, they will become very ill. Therefore, care must be taken to ensure that all traces of alcohol are eliminated from patients' diets, including any that may be used in recipes.1,15 Acamprosate calcium may cause an increase in appetite, increased weight, and taste changes.15 Dietitians should take note of these side effects and work with patients to identify ways to promote adequate nutritional intake.

Medications used for opioid dependence include methadone, buprenorphine (Suboxone, Subutex), and naltrexone. Methadone treatment may produce extreme constipation, abdominal pain, dry mouth, appetite abnormalities, hypokalemia, hypomagnesemia, and weight gain.15 Encouraging and outlining a diet with adequate fluids and fiber may help with these side effects. Methadone, like disulfiram, can cause patients to become very ill if they ingest alcohol, so abstinence should be advised.1,15 Buprenorphine, like the other medications, can influence digestion and appetite, so dietitians should advise patients to slowly increase fiber and make sure meals are appetizing and aromatic.15 Stool softeners also are commonly used to help manage secondary constipation in opiate and cocaine addicts.

Buproprion (Wellbutrin, Zyban) is commonly used for depression, nicotine dependence, and methamphetamine addiction, and tricyclic antidepressants (imipramine, desipramine) are used to help with depression, insomnia, and pain. Both of these medications can result in dry mouth, constipation, changes in appetite, and nausea.15

Substances' Nutritional Impact

Alcohol
Alcohol is a major cause of nutritional deficiency in the United States.16 Alcohol provides calories but little nutrition to the body. Many alcoholics are malnourished, either due to ingesting a nutritionally inadequate diet or changes in the body's ability to use the nutrients it receives.8
Alcoholism affects every area of the body. It can cause insomnia, anorexia, weight changes, gastrointestinal cramping, decreased digestive enzymes, ulcers, muscle wasting, liver disease, and abnormal glucose levels depending on the amount of alcohol ingested. Those who take in more than 30% of their total calories in alcohol generally have a significant decrease in their intake of all macronutrients and deficiencies in vitamin A, vitamin C, and thiamine.8

Alcohol's impact on digestion and the absorption of essential nutrients is important to understand when treating an alcoholic. Alcohol interferes with protein metabolism, leading to important clinical consequences, including low albumin levels, increased fluid in the abdomen, reduced blood clotting, and decreased urea production (resulting in excessive ammonia levels), which may increase the likelihood of altered brain function (eg, hepatic encephalopathy).8

Liver disease resulting from alcoholism alters the organ's ability to take up beta-carotene and/or convert it to vitamin A, causing disorders such as night blindness.8 Dietitians should be cautious when treating alcoholics with low vitamin A levels because blood levels may be inconsistent with what's stored in tissues and because high doses are toxic. It's recommended that patients with low vitamin A and night blindness be treated with 2 mg of vitamin A per day for several weeks.8 Zinc treatment also may be useful, as it's needed for vitamin A metabolism.8

The body moves through four stages of liver damage as alcoholism progresses: fatty liver, alcoholic hepatitis, cirrhosis, and encephalopathy or coma.1 Protein-calorie malnutrition predicts survival in patients with alcoholic liver disease. Forty-five percent to 70% of alcoholics with liver disease also are glucose intolerant or diabetic.2

Treatment goals for patients with alcoholism are to reverse malnutrition, prevent alcoholic liver disease, and establish a healthful lifestyle and coping skills for avoiding alcohol use. If malnourished, alcoholics benefit from a diet high in carbohydrates and moderate in protein. Low-calorie diets and fasting should be avoided because of the nutritional risks and the possibility that a patient has an existing eating disorder or may cross over to a new addiction with food, dieting, or exercise.4

The diet should include a mix of omega-3 and omega-6 fatty acids since the amount and type of fats impact hepatic steatosis, fibrosis, and cirrhosis.1 If tube feeding or total parenteral nutrition is required, dietitians should avoid glutamine-enriched formulas, as they increase ammonia levels. The amino acid taurine, in addition to patients' prescribed diets, has been used to help maintain recovery after detoxification, as it represses the rewarding effect in the brain associated with alcohol.4
Wernicke-Korsakoff's syndrome (wet brain), which occurs with heavy alcohol use due to a lack of thiamine, may be prevented with thiamine supplementation during intervention. Thiamin deficiency occurs because of decreased absorption as a result of the diuretic effect of alcohol and the utilization of thiamin in detoxifying alcohol.8

Opioids (Narcotics)
Opioids are used to treat pain and include codeine, oxycodone, heroin, methadone, and morphine. These drugs slow body movements and can cause sedation, leading to slower digestion and constipation.

Withdrawal symptoms can occur with opioids, even with a short duration of use. It brings a wide range of symptoms, mainly diarrhea, nausea, and vomiting, which can lead to poor oral intake, dehydration, and electrolyte imbalances.16 Nutrient deficits may be caused by poor nutritional intake or the drug's impact on digestion and absorption. Opioids are water soluble, so they clear the body faster than do fat-soluble drugs but produce painful and uncomfortable detox periods. Heroin use can cause glucose intolerance, but this usually resolves with abstinence. For that reason, patients will require blood sugar monitoring and balanced, frequent meals.1

When newly abstaining from opioids, patients typically have very low pain tolerance, increased heart rate, anxiety, and trouble sleeping. These symptoms commonly cause them to relapse to their drug of choice. Pharmacotherapy, counseling, and lifestyle changes help prevent relapse in this population of addicts.

Stimulants
Stimulants, including crack, cocaine, amphetamines, methamphetamine, nicotine, and caffeine, generally lead to decreased appetite and weight loss. Cocaine has been associated with anorexia and eating disorders and may impact energy intake and requirements.13 Large amounts of stimulants result in insomnia, paranoia, anxiety, malnutrition, and memory problems.1

When individuals first discontinue stimulant use, dehydration and electrolyte imbalances may occur, so careful monitoring is important. Since low weight and eating disorders may be of concern, encouraging and educating patients on proper nutrition and helping them achieve a healthy BMI is important.

Methamphetamine abusers commonly suffer severe dental problems that interfere with diet quality. One study reported that 41.3% of methamphetamine users had dental disease, and nearly 60% had missing teeth. Dietitians should offer nutrition education to support dental health and recommend foods with an appropriate consistency.17

Marijuana
Marijuana, which impairs memory, attention, judgment, and balance and increases heart rate, is the most commonly used drug in the United States. The main nutritional impact of this drug is increased appetite.16 Long-term users may be overweight and may need a calorically restricted diet and an exercise program to help them achieve a healthy weight.

Since marijuana is a fat-soluble drug, it can take up to six months for a daily user's brain to return to normal functioning after abstaining.

Promoting Self-Care and a Healthful Lifestyle

RDs should help promote a healthful lifestyle to accompany substance abuse patients' recovery. Important aspects of self-care include physical activity, proper sleep, and devoting time for pleasurable activities. These activities may help to keep patients positive, improve health, establish new routines, and reduce idle time that may lead to relapse. Exercise is thought to stimulate some of the same circuits in the brain as do most substances, so promoting healthful activities may be a good way to replace old behaviors. Lack of sleep can lead to a decrease in well-being, reduced cognitive function, and reduced energy, so encouraging patients to practice healthful bedtime routines is beneficial.

Patients must be educated on the importance of nutrition in their recovery process. Grocery shopping, cooking, and preparing foods are important skills that dietitians can promote for patients in recovery. Cooking classes or recipes may be of interest to clients who are unsure about how to cook or are looking for ideas for healthful options. Financial struggles and unstable living situations are common obstacles to recovery that can lead to food insecurity, which significantly contributes to the nutritional status of drug abusers and to relatively unbalanced diets.13 Educating patients on nutrition resources, budget-friendly options, and support may be helpful.

Overall, dietitians play an important part in the process of recovery for patients seeking help for substance abuse. Many patients must be encouraged to understand how nutrition can play an important part in their recovery process, and they need help navigating the struggles that arise so they can achieve a healthful lifestyle.

References

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Nutrition should be apart of the healing process for those in recovery with or without mental health diagnoses because food is medicine ... We are what we eat and what we eat can not only nourish us but also heal us... Study below shows a change is needed...

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David A Wiss (a1), Lisa Russell (a2) and Michael Prelip (a1)
DOI: https://doi.org/10.1017/S1368980020003882
Published online by Cambridge University Press: 03 November 2020

ABSTRACT

Objective: While organizational change in substance use disorder treatment has been extensively studied, there is no research describing facility-wide changes related to nutrition interventions. This study evaluates staff-perceived barriers to change before and after a wellness initiative.

Design: A pre-intervention questionnaire was administered to participating staff prior to facility-wide changes (n=40). The questions were designed to assess barriers across five domains: 1) provision of nutrition-related treatment; 2) implementation of nutrition education; 3) screening, detecting, monitoring (nutrition behaviors); 4) facility-wide collaboration; and 5) menu changes and client satisfaction. A 5-point Likert-scale was used to indicate the extent to which staff anticipate difficulty or ease in implementing facility-wide nutrition changes, perceived as organizational barriers. Follow-up questionnaires were identical to the pretest except that it examined barriers experienced, rather than anticipated (n=50).

Setting: A multisite substance use disorder treatment center in Northern California which began implementing nutrition programming changes in order to improve care.
Participants: Staff members who consented to participate.

Results: From pre to post, we observed significant decreases in perceived barriers related to the provision of nutrition-related treatment (p=0.019), facility-wide collaboration (p=0.036), menu changes and client satisfaction (p=0.024). Implementation of nutrition education and the domain of screening, detecting, monitoring did not reach statistical significance.

Conclusion: Our results show that staff training, food service changes, the use of targeted curriculum for nutrition groups, and the encouragement of discussing self-care in individual counseling sessions, can lead to positive shifts about nutrition-related organizational change among staff.