What role does nutrition play in patients with addiction?

Malnutrition and changes in body composition

In addition to psychological and somatic consequences, patients who use addictive substances long-term also face significant changes in nutritional status. Malnutrition and altered body composition are driven by reduced food intake, lower nutrient absorption, and dysregulation of hormones that influence feelings of satiety and hunger. 

Specifically, among people who use drugs, low energy and protein intake has been described, along with frequent plasma deficiencies of vitamins A, C, D, and E, iron, selenium, and potassium. These deficiencies can occur even at normal body weight, and anthropometry alone is not sufficient to assess nutritional risk.

Craving for sugar

After initiating substitution or detoxification treatment, patients often report loss of appetite and nausea, and food becomes the last item on their list of priorities. Between the first and sixth month, sugar cravings occur and weight gain is common.

Available data suggest that after the sixth month, sugar cravings decrease, appetite improves, and eating habits begin to become more structured. However, a preference for sweets persists even with education and can therefore have a long-term impact on nutritional status and metabolic health.

In relation to a higher risk of relapse, the literature also mentions women’s concerns about weight gain, which should be taken into account during treatment.

Relapse risks

Epidemiological studies show a high prevalence of depression and anxiety among people who use drugs, which complicates recovery and increases the risk of relapse. Insufficient nutritional intake of precursors for neurotransmitter synthesis can impair brain function, mood, and behavior, thereby contributing to this risk. 

In a study in which patients dependent on opioids were given a combination of amino acids (phenylalanine, tryptophan, tyrosine, and glutamine) during detoxification, a significant reduction in craving was observed. Certain minerals and vitamins are also essential for neurotransmitter synthesis, and their deficiencies are associated with depression. The authors state that their supplementation can be considered not only to correct malnutrition but also as relapse prevention. Omega-3 fatty acids may also influence behavior.

Administration of DHA to patients in detoxification led to a reduction in anger scores, while EPA supplementation was associated with lower levels of anxiety. According to the authors, specific nutrients —⁠ amino acids, vitamins, minerals, and omega-3 fatty acids —⁠ may contribute to improvements in mental health and reduced relapse risk, although further high-quality studies are needed to confirm these results.

Impact of the microbiota on reward pathways

Another angle on the relationship between nutrition and addictions comes from findings on the gut–brain axis. The composition of the gut microbiota can influence the brain’s reward system and craving.

Highly processed foods, which patients in recovery often prefer, worsen microbiota diversity and may hinder the restoration of natural reward pathways in the brain. Conversely, a diet based on whole foods and rich in fiber supports a healthy gut microbiome and thereby psychological resilience.

The role of prebiotics and probiotics

There is currently moderate evidence to support including prebiotics and probiotics in nutritional interventions. Prebiotics, i.e., indigestible food components utilized by the gut microbiota, can influence mood, anxiety, and addictive behavior via bacterial metabolites.

Probiotics have been associated in studies with changes in brain activity in areas regulating emotions and with improvements in certain psychological difficulties. However, a direct effect on addiction treatment has not yet been convincingly demonstrated and requires further research.

Nutritional care and education in treatment centers are still more the exception than the rule. Yet even simple interventions have led in studies to improved diet quality among patients and can support treatment outcomes. Monitoring nutritional status and implementing basic nutritional interventions should therefore become a routine part of addiction care.

Editorial Team, Medscope.pro

Sources:

1. Mahboub N., Rizk R., Karavetian M. et al. Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: A narrative review. Nutrition Reviews 78(7), 459–475, doi: 10.1093/nutrit/nuaa095.

2. Balmori A., de la Puente M. P. Importance of Nutrition Care During the Addiction Recovery Process. Psychoactives 4(3) 19, doi: 10.3390/psychoactives4030019.