The Nutrition Guide: Boosting Recovery with a Healthy Diet

How Substance Abuse Disrupts Nutrition

The main side effect of an unhealthy diet is malnutrition, a condition caused by a lack of nutrients. Substance abuse increases the risk of malnutrition because alcohol and other drugs deprive the body of its ability to absorb nutrients. Many people with substance use disorders ignore dietary needs and rely on their drug of choice to relieve physical or emotional discomfort. “When they’re using, they can’t separate hunger cues from other cues,” Friedell said. “During recovery, it’s hard to differentiate between malnourishment and withdrawal.” Weight gain or loss is an overarching concern for people in recovery. Some people lose too much weight because of malnourishment. Others gain too much weight because they try to replace drugs with food. Each type of substance also causes unique health problems.

Alcohol

Chronic alcohol consumption deprives the body of an important vitamin called thiamine. Every tissue in the body uses thiamine, including tissues in the brain, heart, liver and kidneys. Without the vitamin, the tissues can’t function properly. Low thiamine levels increase the risk of heart disease and heart failure. The brain also suffers. People with thiamine deficiency are more likely to experience dementia and Wernicke-Korsakoff syndrome. The syndrome is associated with incoordination, vision problems, confusion and memory loss. Chronic alcohol use also increases the risk of metabolic syndrome, which is associated with high blood sugar, high cholesterol, high blood pressure and too much body fat. Metabolic syndrome increases the risk of diabetes and heart disease.

Opioids

Opioids slow the way the body functions, making people who take them feel sleepy. The drugs also slow digestion and metabolism. That means the body isn’t able to efficiently process nutrients from food. The most recognizable side effect of disrupted digestion is constipation. Withdrawal from opioid use can disrupt a meal plan. People often feel nauseated, vomit and have diarrhea during withdrawal. These symptoms can prevent food and water consumption at a time when the body needs fuel.

Stimulants

Dramatic weight loss is the primary concern for people who chronically use stimulants, such as cocaine, methamphetamine and prescription ADHD medications. Stimulant users are more likely to develop eating disorders, such as anorexia. People who go on cocaine or crystal meth benders may go days without eating or sleeping. When the bender ends, they’re starving and often binge eat. These dramatic consumption habits increase the risk of malnutrition. Additionally, crystal meth users often have problems with oral hygiene. They may be less likely or unable to consume solid foods because of missing teeth or pain while chewing.

How Eating Disorders Affect the Body

People who abuse alcohol or other drugs are 11 times more likely to have eating disorders than people who don’t have substance abuse issues, according to a study by the National Center on Addiction and Substance Abuse. About half of all people with eating disorders abuse alcohol or other drugs. “With eating disorders, their lab reports are always off, especially with anorexia and bulimia patients,” Friedell said. “Either white blood cell counts, B-12 or electrolyte counts are off.” Different eating disorders affect the body in various ways, but most eating disorders share common side effects. When people consume too few calories, muscles begin to break down. The heart is a muscle, and when it breaks down, a person’s pulse and blood pressure can drop to life-threatening levels. Purging, which can include self-induced vomiting or misuse of laxatives, diuretics or enemas, deprives the body of electrolytes. Electrolytes are chemicals that help muscles flex. Without enough electrolytes, the heart struggles to beat. The digestive system is disrupted by both purging and food deprivation. After these behaviors, the body struggles to break food down and use it. This often leads to constipation.

How Nutrients Affect the Body

A nutrient is a substance that promotes growth and wellness in the body. Nutrients are divided into two categories: macronutrients and micronutrients. The body needs a lot of macronutrients, such as carbohydrates, fats, proteins and water. Humans require low amounts of micronutrients, such as vitamins and minerals.

Vitamins & Minerals

Even though we don’t need a lot of micronutrients, inadequate vitamin or mineral levels can cause devastating side effects. Wernicke-Korsakoff syndrome is caused by a lack of thiamine (vitamin B-1). Low levels of iron, folate or B vitamins can cause symptoms that mimic those of depression, fatigue and sleep problems. Adding vitamin-rich foods to your daily diet helps keep your body healthy and functioning normally. Strive for balanced meals that contain fruits, vegetables and whole grains.

Carbohydrates

The body gets most of its energy from carbohydrates. Without carbs, several parts of the body struggle to function and blood sugar levels fluctuate. These disruptions cause feelings of fogginess, irritability, depression and anxiety. Diets low in carbs can disrupt sleep patterns and cause cravings. Cravings for carbs can be mistaken for drug cravings.

Fiber

Fiber is a unique type of carbohydrate. Unlike other carbs, fiber isn’t converted to energy. Fiber passes through the body without being digested. It regulates blood sugar, lowers blood cholesterol and helps other foods move through the digestive system. Diets low in fiber can increase the risk of high blood sugar, cholesterol problems and constipation.

Protein

Proteins and many hormones are made of amino acids. Hormones are chemicals that regulate mood. People who don’t get enough protein don’t get enough amino acids, which lowers hormone production. Low hormone levels generate feelings of sadness, anger and anxiety. Proteins also boost the body’s immune system, which fights diseases and infections. Most addictive substances weaken the body’s immune system, and low protein consumption can make a fragile immune system weaker.

Fat

Most Americans know they need to reduce the amount of fat in their diets, but not all fat is bad. Moderate amounts of healthy fat can boost mood and help cells throughout the body function. It’s also a reserve source of energy that the body uses when it runs out of carbohydrates. A diet that includes too much unhealthy fat can lead to obesity and a range of health problems.

Water

Water is essential to health. It protects internal parts of the body, lubricates joints and helps the body use other nutrients. The liver and kidneys need water to function, and water prevents constipation. Drinking water is a staple of a healthy diet. Dehydration can cause irritability, dizziness, confusion and fever.

The Role of Nutrition During Rehab

Counseling and therapy are key components of addiction treatment programs. They teach people in recovery healthy ways to cope with difficult emotions and behaviors. But it’s hard for a malnourished brain to learn.

“We have to refeed the person and get them nourished before the therapy can work,” Friedell said. “If their brain isn’t working, coping skills are going to go in one ear and out the other. If they’re eating properly, the psychiatrist can look at mood in a different way.”

The dietitian is involved in a person’s treatment program from the moment he or she walks into rehab.

“If their brain isn’t working, coping skills are going to go in one ear and out the other.”

“We look for disordered eating,” Friedell said. “We ask if they’re eating enough, what their weight is and what they were eating at home. We get a good idea of what their food and nutrients look like, and we look at lab reports.”

The assessment begins with weight, but dietitians also evaluate heart rate, cholesterol levels and other nutritional levels. They also make sure the person hasn’t turned to food as a coping mechanism. Dietitians try to start rehab clients on a healthy diet as soon as possible, but withdrawal complicates most meal plans.

Nutritional Side Effects of Detox

Many rehab clients gain a lot of weight during detox. As drugs leave the body, appetite increases. Dietitians monitor weight closely because it’s dangerous to gain weight too fast. Eating too much can lead to obesity, diabetes, heart disease and other problems. However, increased appetite can be beneficial for people who enter recovery with low body weight.

Some people struggle to eat during medical detox. Alcohol and marijuana withdrawal can cause appetite loss. Withdrawal from opioids can cause nausea, diarrhea and vomiting. Dietitians have to make sure people recovering from these addictions don’t lose too much weight.

Some medications that are used during detox complicate diet plans. Naltrexone (Vivtrol) and disulfiram (Antabuse) can cause nausea and vomiting. Acamprosate (Campral) increases appetite and can make foods taste different. Methadone, buprenorphine (Suboxone) and bupropion (Wellbutrin) can cause constipation and changes in appetite.

Nutrition Therapy

By the time clients are done with detox, they’ve usually been on a structured meal plan for several days. The positive effects of a healthy diet are usually apparent when it’s time to start therapy.

“It can be really rapid if they’re in a structured environment,” Friedell said. “At our facilities, we serve breakfast, lunch, dinner and three snacks. The more structure you have, the more recovery is possible.”

The meal plans at ARS facilities include a balance of protein and carbohydrate sources. Each meal includes a fruit or vegetable, and clients have multiple meals to choose from at each meal time. At adolescent facilities, such as Next Generation Village, teens are served “kid-friendly” foods, Friedell said.

Nutrition therapy isn’t limited to making sure clients eat the right food during treatment. Dietitians teach clients the difference between hunger and drug-related cues or cravings. They also teach them how to create their own meal plan so they can shop for and prepare balanced meals at home.

“We ask them if they have access to a refrigerator or a stove,” Friedell said. “Who does the cooking? Do you have access to a car? Their shopping list will be different if they have a car or if they walk.”

Each of these factors affects the type of diet that’s realistic for people after they leave treatment. Dietitians work with people individually because each person’s nutritional needs are different.

Treating Eating Disorders

People with co-occurring substance use and eating disorders require more intensive therapy than those without eating disorders. At ARS facilities, these people receive individual therapy and one-on-one dietitian appointments.

“For binge eating or purging, we talk about reducing the [problematic] behavior and staying safe,” Friedell said. “If they always purge when they have pizza, we’re probably not going to serve them pizza until they learn more coping skills. We try to teach them not to associate pizza with purging.”

Friedell said exposure therapy is commonly used to help people overcome anxiety associated with a certain food. Clients might also be offered “challenge foods” that they would avoid on their own.

“They practice dining out and practice not eating more than their diet plan,” Friedell said. “If they eat more, they’ll feel like they have to use the [problematic] behavior.”

Maintaining sobriety is easier when the body is healthy and nourished. That’s why comprehensive meal plans are key components of addiction treatment. People in recovery should learn to prepare and eat healthy meals to feel happier and more energized. Maintaining a healthy diet can help prevent relapse and aid a person’s recovery.

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