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Vol. 16 No. 12 P. 44

Suggested CDR Learning Codes: 5000, 5350; Level 2

Take this course and earn 2 CEUs on our Continuing Education Learning Library

The dietitian'' 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 the 1 last update 05 Jun 2020 plays the same key role in maintaining recovery while also improving the resulting health conditions and deficiencies.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

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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 for 1 last update 05 Jun 2020 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.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 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 main source of energy; without this macronutrient, the brain can''s used for energy and triggers tryptophan''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

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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''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 the 1 last update 05 Jun 2020 of hunger and satiety rather than getting overly hungry. 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'' 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''s important for dietitians to be familiar with these common medications, as the side effects may influence patients'' 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'' 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 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 stored in tissues and because high doses are toxic. 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''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 for 1 last update 05 Jun 2020 sedation, leading to slower digestion and constipation. 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 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''s important for a dietitian to monitor her for which of the following conditions and provide treatment if the condition is present?
a. Glucose intolerance
b. Eating disorder
c. Dehydration
d. Digestive disorders

5. A 23-year-old man is about to be discharged after completing alcohol treatment. He has received proper nutrition education, tools for acquiring and preparing healthful foods, and exercise recommendations. What other recommendation would be included in his discharge plan?
a. Adopt a low-calorie diet.
b. Take a multivitamin plus glutamine supplements.
c. Seek psychotherapy and/or a support group.
d. Adopt a high-protein, low-carbohydrate diet.

6. Metabolic syndrome is most common among those who abuse which of the following substances?
a. Opioids
b. Marijuana
c. Stimulants
d. Alcohol

7. A patient has been prescribed disulfiram (Antabuse) while recovering from polysubstance abuse. It''t include which of the following?
a. Added sugar
b. Alcohol
c. Caffeine
d. Gluten

8. A patient with dental disease or missing teeth may need an altered-consistency diet and education on nutrition for dental health. Most likely this is as a result of use of which of the following substances?
a. Methamphetamine
b. Heroin
c. Alcohol
d. Marijuana

reverses diabetes type 2 cure (☑ expected findings) | reverses diabetes type 2 onset symptomshow to reverses diabetes type 2 for 9. Eating disorders co-occur in what percentage of patients recovering from substance abuse?
a. 10
b. 25
c. 35
d. 50

10. Which substance is known to be a leading cause of nutrition deficiencies?
a. Opiates
b. Marijuana
c. Alcohol
d. Stimulants

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1. Escott-Stump S. Nutrition and Diagnosis-Related Care. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2008.

2. Emerson M, Dubois C, Hatcher A, et al. Psychiatric nutrition therapy: a resource guide for dietetics professionals practicing in behavioral health care. Dietetics in Developmental and Psychiatric Disorders Practice Group of the American Dietetic Association. http://www3.nd.edu/~jkaiser/PsychPapers/Psychiatric Nutrition the 1 last update 05 Jun 2020 Therapy 08.31.06.pdf. 2006.2. Emerson M, Dubois C, Hatcher A, et al. Psychiatric nutrition therapy: a resource guide for dietetics professionals practicing in behavioral health care. Dietetics in Developmental and Psychiatric Disorders Practice Group of the American Dietetic Association. http://www3.nd.edu/~jkaiser/PsychPapers/Psychiatric Nutrition Therapy 08.31.06.pdf. 2006.

reverses diabetes type 2 in skinny people (🔴 pathophys) | reverses diabetes type 2 eating planhow to reverses diabetes type 2 for 3. Grant LP, Haughton B, Sachan DS. Nutrition education is positively associated with substance abuse treatment program outcomes. J Am Diet Assoc. 2004;104(4):604-610.

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