Do your recommendations differ depending on what substance the individual is withdrawing from (i.e. alcohol, opiates, stimulants, etc.)?

Absolutely. I will often use laboratory data to warrant any aggressive nutrient interventions but there are some guiding principles that are important for each substance. For example, alcohol and opiates create the most gut dysfunction, whereas meth creates the most oral dysfunction. Cocaine use has been associated with essential fatty acid deficiency as well as neurohormonal alterations that can lead to rapid weight gain. All substances are associated with an increased preference for sugar and "comfort food". For more information about specific nutritional deficiencies associated with specific substances, refer to the slideshow at: http://www.nutritioninrecovery.com/food-addiction/nutrition-interventions-in-addiction-recovery-the-role-of-the-dietitian-in-substance-abuse-treatment-2/

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What are some Specific Dietary Recommendations you would make to Someone Recovering from Drug or Alcohol Addiction?

a.     Eliminate sugar-sweetened beverages. Drink only water, black coffee, unsweetened tea, organic milk, unsweetened milk alternatives, and chia seeds soaked in water. Do not drink fruit juices, Gatorade, and energy drinks. The occasional vegetable juice is OK but do not do juice cleanses.

b.     Avoid refined grains and aim to eat 100% whole grains.

c.     Keep caffeine intake limited to a maximum of 400 mg/day.

d.     Reduce exposure to highly palatable and highly processed foods with added sugars, salts, and fats. These foods light up the brain like drugs of abuse and can perpetuate the cycle of addiction.

e.     Increase protein intake and spread out over the course of the day. Instead of having one or two large protein-based meals in the day, make sure every meal/snack contains a minimum of 10-15 g protein.

f.      Eat smaller meals every 2-4 hours starting with breakfast within 30 minutes of waking up. The mantra I encourage is "never hungry, never full".

g.     Increase fiber intake gradually yet progressively over time. Many addicts have a fiber aversion due to compromised gut health but will need to be persistent about their intake, increasing by 2-4 g/daily each week until reaching 38 g/day for men, 25 g/day for women. 50% of vegetables should be raw, and increase intake of beans, nuts, and seeds.

h.     Increased need for antioxidant vitamins A, C, E, and selenium that should be obtained through food and not supplements. Emphasize fruits and vegetables!

i.      Increased need for omega-3 fatty acids that should be obtained through fatty fish, chia seeds, flax seeds, and walnuts.  

j.      Get small doses of sunlight for vitamin D. 20-30 min 2-3 times/week can make a big difference!

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How does the Neuroscience of Nutrition Impact those Recovering from Addiction?

Amino acids (building blocks of protein) are pre-cursors of neurotransmitters including serotonin, dopamine, and norepinephrine. Since dopamine is the key neurotransmitter involved with addiction (associated with "reward"), it is critical to restore depleted dopamine levels through a higher protein intake. Phenylalanine is an essential amino acid (which is widespread in food) that becomes tyrosine, which is converted to dopamine, which can then become norepinephrine. While there some professionals who believe in amino acid therapy, I believe that this approach fails to emphasize the importance of changing eating behavior, therefore I believe it is better to make dietary changes and get the amino acids from a consistent stream of high biological value protein throughout the day. I emphasize eating behavior first, supplements second.

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Why is Proper Nutrition so Important for Recovering Addicts?

At the most basic level, substance abuse is associated with both primary and secondary malnutrition. Primary malnourishment occurs when the substance reduces or displaces food intake. Secondary malnutrition occurs when there are alterations in the absorption, metabolism, utilization, and excretion of nutrients due to compromised oral, gastrointestinal, circulatory, metabolic, and neurological health. An example is thiamine deficiency common in alcoholics, which is both primary and secondary.

Other primary goals of nutrition therapy for addiction recovery includes: healing the gut function, disrupting the potential for cross-addiction into food, recovering compromised neurological function, and stabilizing the endocrine system (hormones). Other goals can include achieving a healthy body weight and avoiding excessive and persistent weight gain, although concerns about weight should be secondary to concerns about overall health. Individuals with a history of addiction are at higher risk for developing disordered eating behavior (and vice versa), therefore it is important that nutrition behavior be monitored by a qualified professional such as a Registered Dietitian Nutritionist specializing in behavioral health.

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Susan B. Krevoy Eating Disorders Treatment Program

David A. Wiss, MS, RDN, CPT has teamed up with Dr. Susan Krevoy to provide affordable outpatient treatment for individuals struggling with eating disorders. The Nutrition In Recovery group will be conducted on Thursday nights from 6:00-7:30pm at 9454 Wilshire Blvd., Penthouse, Beverly Hills, CA 90212. Click HERE to meet the treatment team and check out the incredible introductory offers! 

Caffeine, Children, and Addiction

Addictive substances are characterized by their stimulation of the neurotransmitter dopamine at various sites throughout the brain. Caffeine is known to stimulate dopaminergic pathways and therefore has significant addictive potential. Many individuals experience withdrawals from caffeine that include severe headaches. Caffeine Use Disorder is now a recognized clinical diagnosis in the DSM-5. By exposing children to addictive substances during critical periods of brain development, dysfunctional brain circuitry can develop, placing the child at higher risk for developing other addictions that are substance-related or behavioral (i.e. internet gaming, gambling). It appears that the profit-driven food and beverage industry is stimulating the creation of addicts at younger and younger ages in the US, leading to a tremendous healthcare burden. For many people the substance-seeking behavior leads to illicit drugs and/or alcohol, others become addicted to highly palatable foods, and many cross-addict through various substance-related and behavioral addictions. It is possible that chronic caffeine exposure during childhood and adolescence is a significant contributor to the growing problem of addiction in our country.