Using Nutrition to Help Recover from Addiction

Dr. David Wiss

September 4, 2022

Addictions

Nutrition in Recovery from Alcohol and Drug Addictions

This article applies the eight different nutrition frameworks to recovery from substance use disorders. This work has been the basis of Nutrition in Recovery, our group practice in Los Angeles which provides group trauma-informed nutrition education and individual counseling to addiction treatment centers.

Applying the macronutrient model to Nutrition in Recovery, we could say with confidence that many people in early recovery or middle stage or even later recovery do benefit from a higher protein diet, which in some cases means dialing down the carbohydrates and dialing up the protein [1]. But of course, everyone is different, which is why we avoid over-generalized guidelines.

There is evidence to suggest that since protein contains amino acids, it is important for neurotransmitter production. We do recommend a high protein diet for mental health, along with Mindful and Soulful Eating practices, which teach how to tune in to your hunger and fullness cues.

There's emerging data on cross-addictions such as food. Cross-addiction can become problematic for people in recovery [2]. So dialing up the protein and dialing down the carbohydrates does have an evidence base, especially if there is a food addiction present.

It's also important to think about the types of fats that people consume. Emphasis should be on omega-3, which a lot of people associate with fish oil. Omega-3 fatty acids best come from salmon, sardines, mackerels, and then of course, there's some plant sources like flax seeds, walnuts, and chia seeds.

I encourage people to eat flax seeds, walnuts, and chia seeds every day. Put flax seeds into your smoothie, put walnuts into your snack bag and drink chia seeds soaked in water. If you do nothing else, this is a really good place to start. Don’t forget to drink at least two liters of water every day!

Looking at the micronutrient model, I think it's safe to say that a nutrient-rich diet is the best way forward, which shouldn’t be surprising. The way to translate that is just to eat a lot of real food, in an adulterated state, when possible. This is most certainly one pathway to using nutrition for better mental health, which has a primary goal to reduce inflammation.

And after one is moving in that direction, the next step is to make sure to be eating from all six food groups daily:

• Fruits (F)
• Vegetables (V)
• Whole Grain (G)
• Dairy or Dairy Alternative (D)
• Protein or Protein Alternative (P)
• Beans, Nuts, and Seeds (bns)

Supplements that might be helpful include:

• Multivitamin
• B-complex
• Vitamin D
• Magnesium
• Probiotics
• Omega-3 (fish oil supplements are best but plant-based versions are available)

And then there's a whole world of herbal and other types of stress relieving supplements. If you've heard the term adaptogens, these are compounds that are supposed to help people adapt to stress. My favorite is Rhodiola Rosea. It's a really great supplement that I use and recommend often.

When thinking about the food group model, I try to get people to use this model to eat from all six different food groups daily for optimal nutrition during recovery. Once again, we have fruits, vegetables, whole grains, dairy or a dairy alternative (e.g., oat milk), protein or a protein alternative (e.g., protein concentrates such as isolates or powders), and beans, nuts and seeds. Most systems don't utilize this last food group, which makes the Wise Mind Nutrition system unique!

I try to get people in recovery to eat more beans, eat more nuts and eat more seeds. Most people don't eat enough of these foods, but people in recovery specifically should focus on getting more of them.

The anti-inflammatory model can suggest foods that people in recovery should consume less of. But when you do functional medicine lab testing, you can learn what foods are important to include more of (the best anti-inflammatory foods for each individual). When you figure out what foods are pro-inflammatory for you, you also figure out which foods are not. And then you start eating more of the foods that are not. And this method does seem to be very helpful to people.

By the way, antioxidant and anti-inflammatory don't mean the same exact thing, but they're often used interchangeably. Antioxidant means it's scavenging free radicals and reducing oxidative stress, which can certainly be contributing to inflammation. But there are other ways that inflammatory processes develop and ensue as well (e.g., injury).

I'm big on avocados and olives. Those are big important sources of fat in the foods that we often recommend for anti-inflammatory purposes. Getting the right kind of fats in the diet (and at regular intervals) is one way to teach the brain how to stop stress eating, along with emotional regulation skills, of course!

So with respect to nutrition and recovery, we're talking about the gut health model most of the time. So instead of getting people in early recovery to start trying to diet or change their weight, which we know can be a risk factor for eating disorders, we're getting people to think about gut health. We're trying to get people to think about healing their gut, which is often damaged from drugs and alcohol (and medications) as well as from stress and trauma and from imbalanced food intake.

The integrity of the gut lining can easily become compromised. There's probably a loss of beneficial bacteria. Focusing on repairing gut health is Nutrition in Recovery 101. This is what we're doing first and foremost, especially because if gut health is imbalanced or there's a “leaky gut” it's going to make it difficult for nutrients to be absorbed, especially if coming off of alcohol and opiates [3].

Gut health can actually affect how medications work. So it's really important, especially for people that have a lot of prescriptive care, to be focusing on nutrition. And I've always made the argument that nutrition and malnutrition should be addressed before psychiatric diagnoses are made because in many cases, people have such poor eating that it creates symptoms of psychiatric disorders. So we should really start to think about merging nutritional care with psychiatric care.


Nutrition in Recovery Gut Health Summary Recommendations

• Daily probiotics
• Fermented foods such as sauerkraut or kimchi
• Fermented dairy products such as full-fat unsweetened yogurt and kefir
• Beans daily (which are high in soluble fiber)
• Drinking chia seeds soaked in water daily (2 Tbsp. per 16 oz. water and shake, otherwise eating chia seeds can work but let them expand first)
• Whole grains such as oats, barley, farro, quinoa
• Bone broth
• Full spectrum of colors from fruits and vegetables (which are the best anti inflammatory foods to eat)


The Nutrition for Mental Health Model

This is the newest way of viewing nutrition. It's not about calories. It's not about macronutrients. It's about how food affects our gut, which in turn affects our brain, which in turn affects our behavior, and the way we interact with people. The Mediterranean Diet is the best diet for depression.

We have to think about the psychology of eating, often referred to as nutritional psychology. Changing our food environment is great, but we have to think about binge eating disorder, people that have food addiction, reward-based eating, body dissatisfaction, dieting behavior that drives restrained eating which drives binge eating, and so much more. When we focus on gut health, this is often referred to as nutritional psychiatry.

We teach you how to practice mindful eating, reduce chronic inflammation, and improve your eating behaviors which may include alternatives to comfort food when feeling stressed. Working on body image is also critical to the recovery journey, and may be one psychosocial pathway to fight inflammation. Are you here for it?

I have written several articles about implementing trauma-informed nutrition education and care into addiction facilities [4-7]. If you cannot access the articles, feel free to send a message and we can help you out!

If you are in recovery from any form of addiction, the Wise Mind Nutrition program is the perfect complement to your healing journey. Many people do not have access to a registered dietitian nutritionist who specializes in substance use disorders, and in that case, choose to use the app-based program along with therapy and other forms of care. We are here to help you establish a healthy relationship with food, one bite at a time!

References
1. Wiss DA. The Role of Nutrition in Addiction Recovery: What We Know and What We Don’t. Elsevier. Published online 2019. doi:10.1016/b978-0-323-54856-4.00002-x
2. Wiss DA, Brewerton TD. Incorporating food addiction into disordered eating: the disordered eating food addiction nutrition guide (DEFANG). Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2017;22(1):49-59. doi:10.1007/s40519-016-0344-y
3. Wiss DA. A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health. Frontiers in Public Health. 2019;7:193. doi:10.3389/fpubh.2019.00193
4. Wiss DA, Waterhous TS. Nutrition Therapy for Eating Disorders, Substance Use Disorders, and Addictions. In: Eating Disorders, Addictions and Substance Use Disorders, Research, Clinical and Treatment Perspectives. Springer; 2014:509-532. doi:10.1007/978-3-642-45378-6_23
5. Wiss DA, Schellenberger M, Prelip ML. Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment Centers. Journal of Community Health. Published online 2018:1-7. doi:10.1007/s10900-018-0557-2
6. Wiss DA, Schellenberger M, Prelip ML. Registered Dietitian Nutritionists in Substance Use Disorder Treatment Centers. Journal of the Academy of Nutrition and Dietetics. 2018;118(12). doi:10.1016/j.jand.2017.08.113
7. Wiss DA, Russell L, Prelip M. Staff-perceived barriers to nutrition intervention in substance use disorder treatment. Public Health Nutr. Published online 2020:1-10. doi:10.1017/s1368980020003882