I knew I would be called to write an article about the connection between integrative nutrition and substance abuse at some point. Having been rocked by it myself, I know the power of addiction on the human body, and I also know the power of nutrition. But I had no idea what I was in for when I started. I’ve spent months researching the topic to make sure what I say is accurate. I’m over 200 references in, and I’ve barely scratched the surface. There is so much published clinical research on the connection between integrative nutrition ingredients (food, hydration, sleep, physical activity, relationships, spiritual practice, etc.) and substance abuse, it’s hard to imagine why more people aren’t talking about it. But they aren’t. Despite an initial proposal for a nutrition protocol back in 1955 (122), and a declaration in 1990 by the American Dietetic Association that “nutrition intervention is an essential component of treatment and recovery”(123), we have made little progress towards using nutrition as a standard practice in adjunctive treatment for substance abuse recovery, and there is no standard of care. (123) I hope I can be a part of changing that.
Much of what I’ve read I already knew, but there’s one especially fascinating tidbit I learned that I had always wondered about: the weight paradox in addiction and recovery. It’s not as cut and dry as many believe.
Although substance abuse related malnutrition can sometimes result in low BMI, malnourished can also present as obese. Research is all over the board with plenty of studies showing a positive, a negative, and no relationship at all between weight, BMI, and alcohol consumption (94,177,190). This is in part because the contributory factors to weight gain and weight loss are endless and difficult to control for, and because alcohol affects almost every vital function of the body (194) and every single component of the energy-balance (metabolism) equation (187).
I’ve personally calculated how many alcohol calories I consumed a day toward the end, and I know about how many calories I eat every day. The weight on the scale didn’t add up — not in active addiction, and not in early recovery either. Yes, sugar was a problem, but it was nowhere even in the vicinity of the alcohol calories I consumed.
Again, the contributory factors are endless, but here’s a particularly fascinating one: Alcohol has a completely different metabolic impact in social drinkers and binge drinkers than it does in people with substance abuse disorder (185), in part because of all the damage done by nutritional malabsorption (94). For instance, in social drinkers, alcohol seems to have no effect on body composition or metabolism when consumed in small amounts (178), probably because the calories are offset by food choices or other healthy habits like exercise. (184, 189,195) Binge drinkers, on the other hand, have a higher risk of obesity which increases relative to consumption quantity (184). In these heavier alcohol consumers, we often see weight gain and fat storage not only because it represents a more significant amount of extra non-nutritive calories, but also because it suppresses the body’s fat metabolism potential (180) as well as that of protein and carbohydrates (to a slightly lesser extent) (183).
In both social and binge drinkers though, alcohol is a viable source of energy for the body (179), used much like any other calorie (196), and will to some degree follow the standard metabolic formula of calories in-calories out as far as weight gain or weight loss is considered. But with chronic heavy alcohol consumption, those calories are not efficiently utilized, so they contribute less to weight (175). Alcohol calories actually count more in moderate non-daily consumers than some moderate daily consumers and more than all heavy consumers (187). And then we have the role alcohol plays in metabolic syndrome, which is its own topic but not completely unrelated; here while we may not have excess weight overall, we often have abnormal waist to hip ratios which when combined with rest of the cluster of characteristics of metabolic syndrome, significantly increases risk of heart disease, stroke, and type 2 diabetes.
Since the tipping point between drinking patters and specific causes for weight related issues will be different for everyone, weight management can be an even trickier more time-consuming process in recovery, but the health benefits and quality of life are totally worth it! Reach out if you need help.
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