Scientists are finding that addressing nutritional deficiencies and gut bacteria health may be missing pieces of the sobriety puzzle.
Overcoming alcohol addiction isn’t easy, even with expert help. Estimated success rates in the few years following treatment vary between 20 and 50 percent, depending on the criteria used and severity of addiction.
To improve treatment success, a small but growing number of holistic addiction treatment centers are digging deeper. Their aim is to identify and treat underlying biochemical imbalances and address genetic factors that can contribute to alcohol cravings, anxiety, and depression, which are often barriers to addiction treatment.
The process of bringing the brain and the rest of the body back into balance is sometimes called “biochemical repair.” Nutritional therapy, using both dietary changes and supplements, is a key part of this approach.
“If you give the brain the nutrients it needs to get past biochemical and genetic deficiencies, inefficiencies, and blockages, people treated for addiction have a better chance of staying sober,” said William Billica, MD, at InnerBalance Health Center for alcohol and drug addiction treatment in Loveland, Colorado.
Correcting nutritional deficiencies is essential for alcohol treatment
People entering alcohol treatment commonly have deficiencies of some nutrients, such as zinc, several B vitamins, and protein.
“The alcoholics I see in the clinic have been consuming about 15 drinks a day, on average,” said Craig McClain, MD, director of the University of Louisville’s Alcohol Research Center. “That equates to over 2,000 calories, but those are empty calories. So, they haven’t been getting adequate nutrition and lack critical nutrients.”
For example, McClain has found that people who have an alcohol addiction are often deficient in zinc. That’s partly because they haven’t been consuming enough of the mineral through food, like meat, whole grains, nuts, and dairy products. But it’s also because alcohol decreases absorption of zinc in the gut and increases zinc loss through urine.
Zinc deficiency can show up as a reduced sense of taste and smell, crusty skin sores on the face, and poor night vision. Zinc deficiency also has been linked to depression, irritability, confusion, and apathy, which are often challenges for people with an alcohol addiction.
The combination of zinc deficiency and heavy drinking can cause the gut to become “leaky,” McClain also noted. When the gut doesn’t provide a good barrier between the intestinal contents and the rest of the body, toxins (such as from harmful bacteria) can travel to the liver and contribute to the damage of alcohol-related liver disease.
McClain commonly recommends a daily dose of 220 milligrams (mg) of zinc sulfate (which contains 50 mg of zinc) for his patients who have an alcohol addiction. Taking it with a meal helps avoid potential side effects of abdominal pain and nausea.
Billica told Healthline that everyone entering InnerBalance Health Center’s addiction treatment program is generally started on a basic level of nutritional support, including a multivitamin. Nutritional supplementation is then fine-tuned based on lab test results. A similar approach is followed at other holistic treatment centers.
“Heavy alcohol use can really deplete B vitamins, so we replenish those based on what lab tests show,” said Melissa Blackburn-Borg, CNP, a holistic nutritionist at the Canadian Health Recovery Centre on the outskirts of Peterborough, Ontario.
To guide supplementation of B vitamins, Billica also checks for genetic mutations (such as MTHFR) that can affect the body’s ability to make the active form of certain B vitamins, like folate and vitamin B-6.
Shortfalls of the active forms of folate and vitamin B-6 are among the factors that can slow the body’s production of serotonin and dopamine in the brain. Those are feel-good chemicals (neurotransmitters) that play a role in managing cravings, including for alcohol and sweets.
Keeping blood sugar steady helps control cravings
Holistic addiction treatment centers have found that balancing blood sugar is a critical part of staying sober.
Practitioners at InnerBalance Health Center do a four-hour glucose tolerance test on everyone when they enter the treatment program. That can help catch low blood sugar episodes (hypoglycemia) that other tests may miss.
“I’ve looked at glucose tolerance test results of about 500 patients who came to our treatment center over a couple of years, and hypoglycemia is a huge issue,” Billica said. “About 98 percent of alcoholic patients (and 75 to 80 percent of patients with drug addiction) had blood sugar drop below 60 mg/dL [milligrams per deciliter] during the test. Sometimes it dropped much lower than that.”
A normal fasting blood sugar level is 70 to 99 mg/dL.
When blood sugar crashes like that, your brain signals you to look for a way to raise it and boost energy levels. That can trigger cravings.
“When someone is riding a blood sugar low, it can be easy to mistake a craving for something sweet as an alcohol craving,” Blackburn-Borg said.
Healthy eating habits are essential in the effort to keep blood sugar steady and control cravings for alcohol (and sugar).
Holistic treatment centers often focus on foods that have a low Glycemic Index (GI) and minimize or avoid heavily processed fare and sugar-sweetened foods. They also make it a point to include protein and some healthy fat to balance carbs in meals and snacks. Those efforts can help avoid large blood sugar swings.
The well-planned, balanced meals offered at holistic treatment centers are viewed as an essential part of addiction recovery and long-term abstinence. People who already have access to whole foods and meals that have a low GI may opt for an outpatient holistic treatment program that doesn’t supply meals, such as the Health Recovery Center in Minneapolis, Minnesota.
Many treatment centers are also helping teach people in recovery how to prepare foods and plan meals so they can maintain success when they go home.
“Our chefs teach the patients how to make low-Glycemic Index meals,” said Daniel Lettenberger-Klein, MS, LMFT, executive director of Bluff Plantation, an addiction treatment center in Augusta, Georgia. “And the patients grow their own vegetables on-site, as the season allows.”
Holistic treatment centers also tend to restrict the amount and timing of caffeine, which might contribute to hypoglycemia symptoms and can certainly interfere with sleep. Insomnia is a common challenge in people receiving treatment for an alcohol addiction.
“When someone has an unhealthy liver, the body’s detoxification of substances like caffeine is slower,” Blackburn-Borg said. “So, we don’t allow caffeinated coffee after 9:30 a.m.”
Sodas and similar drinks (whether caffeinated and sweetened with sugar or not) are often off-limits at holistic treatment centers.
Dopamine balance plays a critical role in managing cravings
Besides low blood sugar levels, another reason why people with an alcohol addiction reach for sugar is because it lights up the pleasure center of the brain, Lettenberger-Klein said. It does that by triggering the release of dopamine. That brings about feelings of happiness and stress relief.
Getting a dopamine fix is often a big reason people start self-medicating with alcohol.
“The first time people drink alcohol, they’ll notice a spike in dopamine that makes them feel good,” said Kenneth Blum, PhD, a neuroscientist and a clinical consultant for holistic addiction treatment centers, including Summit Estate Recovery Center in Los Gatos, California.
“If you’re prone to addiction, such as genetically, you’ll feel like this dopamine burst is what you’ve been missing for a long time, because it suddenly helps you feel ‘normal.’ But, if you’re continually drinking alcohol, you’ll get a reduction in receptors for dopamine in the brain. So, you eventually end up with very low function of dopamine,” Blum said.
This problem is compounded in people who have unhealthy eating habits that supply little of the protein building blocks (amino acids) that the body uses to make dopamine.
Even worse, some people have a genetic variant that dampens dopamine’s effects. Specifically, Blum co-discovered that some people have a genetic variant in the dopamine D2 receptor gene that results in having 30 to 40 percent fewer dopamine receptors. So, they get a blunted pleasure response to alcohol and other substances.
About one-third of people in the United States carry the dopamine D2 receptor gene variant. Blum said that makes them prone to addictions and relapse.
Blum and others are helping people fight back against this addictive tendency. One of the simplest things people can do is change their eating habits.
High-protein eating habits can help increase the number of dopamine receptors in the brain. Protein also supplies the building blocks that our bodies use to make dopamine.
“Dopamine is made in the brain from certain amino acids,” Blum explained. “Two of the main ones are tyrosine and phenylalanine.” Those are found in foods like red meats, turkey, chicken, fish, eggs, cheese, nuts, and legumes (beans).
To help people follow a diet that’s high in protein and has a low GI, Joan Borsten co-authored the “Malibu Beach Recovery Diet Cookbook” (originally called “Dopamine for Dinner”), working in conjunction with four chefs at an addiction treatment center she used to own. This dietary approach has since been adopted by other addiction treatment centers.
Meditation, yoga and other exercise, music therapy, and acupuncture can also help promote dopamine release. Such therapies are sometimes included at holistic addiction treatment centers, such as Bridging the Gaps in Winchester, Virginia.
Blum’s goal is to support dopamine function beyond eating habits and lifestyle, though. He pioneered the development of a new, clinically validated genetic test called the Genetic Addiction Risk Score (GARS). The test covers about 10 different genes and variants that are significantly involved in addiction.
Based on the GARS test results, one of six patented, customized nutritional supplements (restoreGEN) may be advised to help balance dopamine and other neurotransmitters involved in cravings and addiction. Blum and his colleagues have tested the effectiveness and safety of the core nutritional formula (containing amino acids and other key nutrients) in more than 30 studies.
Gut bacteria influence the brain, too
There’s a rapidly growing appreciation for the role of our gut microbiota in many aspects of health and disease. Alcohol addiction is no exception.
Scientists are looking at the link between inflammation, neurotransmitters, and the bacteria and other microbes (microbiota) that live in our gut. For example, it’s already known that gut bacteria can influence brain functions and can produce neurotransmitters, including dopamine, serotonin, and GABA. But that’s not all.
“We’ve found that in people with alcoholic liver disease, there’s a significant alteration in the gut microbiota, and that alteration plays a critical role in the development of liver disease,” McClain said. “Additionally, it’s thought that the inflammation that alcoholics get in the liver can also happen in the brain. That brain inflammation has been linked to cravings, anxiety, and depression.”
McClain noted a study led by scientists in Belgium that looked at the gut microbiota of 60 people starting rehab for alcohol addiction. In this group, 43 percent had a leaky gut at the start of the study and smaller numbers of certain anti-inflammatory gut bacteria compared to those without a leaky gut.
A leaky gut allows toxins from harmful bacteria to get into the bloodstream and cause inflammation. Plus, as alcohol influences the makeup of the gut microbiota, there’s a decrease in beneficial substances that the bacteria make.
After three weeks of avoiding alcohol, those who entered the study with a leaky gut and unhealthy microbiota (which did partially improve with abstinence) still had higher scores for depression, anxiety, and alcohol cravings compared to those who started rehab with a healthier gut and microbiota. That could ultimately influence the risk of relapse.
“Although this study wasn’t the type that can show cause and effect, it does suggest there’s a link between the gut microbiota, addiction, and cravings,” McClain said. “It’s something that’s under heavy investigation right now.”
McClain said scientists don’t yet know if taking certain probiotics (beneficial bacteria and other microbes) or prebiotics (indigestible fibers that nourish microbes) would help people who have an alcohol addiction. The tricky part is that the benefits likely differ based on several variables, such as a person’s usual eating habits, current microbiota, and ethnicity.
One way around this may be to give a person the beneficial end products that the good microbes produce.
“The microbes are making a lot of things as a collective,” said Shirish Barve, PhD, a professor of medicine, pharmacology, and toxicology at the University of Louisville. That makes it challenging to figure out exactly which of their end products to put into a nutritional product. But Barve and McClain told Healthline they’re investigating such a solution.
At minimum, one thing people dealing with addiction can do is follow a balanced, healthy eating plan that’s rich in whole, plant-based foods like vegetables, fruits, nuts, seeds, and whole grains to help fuel beneficial bacteria.
Lastly, remember that efforts to improve physical health and repair the body’s biochemistry are complementary to many traditional therapies for addiction, not stand-alone solutions.
“If people only work on their nutrition and the biochemical part of alcohol treatment but don’t work on things like their lifestyle and stress management skills, their chances of fixing their addictions are much less,” Billica said. “And, although some people may do OK without the biochemical repair approaches, combining all of these therapies significantly improves the odds of staying sober.”
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