Malnutrition is the condition of not having sufficient vitamins, minerals and other nutrients required for the healthy function of body tissues and organs.

Roles of nutrients in addictions:

• nutrient deficiencies can be a factor in susceptibility to addiction
• nutrients are depleted by addictive substances
• nutrients can help with withdrawal symptoms
• nutrients can help prevent relapse

Nutrient deficiencies and substance abuse

• Nutrient deficiencies increase the likelihood of addictions (Jeynes & Gibson, 2017)
• Substance abuse often causes malnutrition or disorders of metabolism that lead to malnutrition (Nabipour et al., 2014).
• Nutrient deficiencies can cause changes in hormone and neurotransmitter levels which can cause poor mood and decreased energy levels (Nabipour et al., 2014).
• Recovery from substance abuse can be improved with well-balanced nutrient intake from diet and supplementation (Biery et al., 1991).

Reasons for malnutrition with addictions (Jeynes & Gibson, 2017)

• poor intake of nutritional food or poor access to healthy food
• decreased appetite
• damage to the digestive tract or problems with liver function
• increased loss of nutrients by the body

Malnutrition and alcohol addiction

• People with alcoholism are generally malnourished (Chopra & Tiwari, 2012); (Nair et al., 2015)
• Alcoholics typically have inadequate intake of most nutrients
• Alcohol decreases absorption of nutrients by (Jeynes & Gibson, 2017):

• • directly interfering with absorption
  • damaging the digestive tract

Malnutrition and opioid addiction

• Addiction to opioids can result in severe deficiencies of essential nutrients, including proteins, fats, vitamins and minerals (Nabipour et al., 2014)
• Factors including prioritization of the addictive substance over food, loss of appetite, altered taste, low motivation, and lack of access to money or adequate cooking facilities all contribute to malnutrition in the context of opioid addiction.  (Varela et al., 1997; Neale et al., 2012)

• Nutrient deficiencies arising from opioid addiction in turn contribute to impaired digestion and absorption (Nabipour et al., 2014).

Malnutrition and smoking addiction

Tobacco smoke depletes the antioxidant molecules vitamin C, vitamin E, beta-carotene, and selenium (Preston, 1991)

Eating an unhealthy diet is known to lead to nutrient deficiencies, which, in turn, can negatively affect brain function. Imbalances in brain function are implicated in addiction and recovery challenges. 

Foods that promote good brain health:

• whole, fresh foods
• eat sufficient good quality protein (w/fish 3x week) animal + plant-based
• good-quality fats
• minimal amounts of starches
• antioxidant-rich vegetables and fruit

Substances that are bad for brain health:

• sugar-containing foods and snacks
• high glycemic foods (sugars and starches)
• processed fats (processed plant oils, hydrogenated fats)
• artificial ingredients (colours and preservatives)
• fast food meals

Dietary cravings and cravings for addictive substances

Dietary stimulants like coffee, tea, and sugar-containing products can promote cravings for addictive substances.

Blood sugar imbalance and addiction

• Consuming a high-carbohydrate meal or drink causes a rapid rise in blood glucose. The high glucose causes the pancreas to release an abnormally high amount of insulin into the blood, which causes an abrupt drop in blood glucose.
• The excessive drop in blood sugar triggers the release of the hormones epinephrine and norepinephrine, which in turn, trigger the fight or flight response.
• The fight or flight response shows up as hunger, irritability, sweating, palpitations, and anxiety and cravings for addictive substances

Blood sugar imbalance and alcohol addiction

• People who abuse alcohol tend to crave sweets, experience sugar cravings, and have withdrawal symptoms (Sugar Addiction, n.d.).

Blood sugar imbalance and opioid addiction

• Opioid addiction is a contributing factor in blood sugar imbalance by increasing insulin levels and decreasing insulin sensitivity (Nabipour et al., 2014).
• Low blood sugar promotes cravings.

Blood sugar imbalance and smoking addiction

• Consumption of sugar can increase cravings for smoking (Help for Cravings and Tough Situations While You’re Quitting Tobacco, n.d.)

Healthy diets for supporting addiction recovery

Mediterranean diet

• ​​The mediterranean diet is considered a good model for a healthy diet. It includes foods that are beneficial, and also reduces or eliminates foods that promote mental health issues.
• General components of the mediterranean diet include:
  • plenty of vegetables and fruit
  • healthy fats including olive oil
  • regular consumption of seafood
  • poultry, beans, and small amounts of red meat
  • small amounts of dairy as yogurt and cheeses.
  • whole grains instead of refined grains

More information and menu plans:

https://www.healthline.com/nutrition/mediterranean-diet-meal-plan

(Mediterranean Diet 101, 2021)

Paleo diet

Foods to eat:

• meat, fish, eggs
• vegetables, fruits
• nuts, seeds
• healthy fats and oils
• herbs, spices

Foods to avoid:

• sugar, high-fructose corn syrup
• grains
• legumes and beans
• Dairy products
• vegetable oils, and transfats
• artificial sweeteners
• processed foods

More information and menu plans:

https://www.healthline.com/nutrition/paleo-diet-meal-plan-and-menu

(The Paleo Diet — A Beginner’s Guide + Meal Plan, 2018)

• Acute and chronic stress is a well-known risk factor for addiction and relapse vulnerability (Sinha, 2008).
• Prospective and longitudinal studies show that stress is a factor in initiating and escalating drug use in adolescents and young adults (Sinha, 2008).
• Stress impairs proper neurotransmitter function in the prefrontal cortex part of the brain, which results decreased capacity for self-control.
• High emotional stress is associated with (Sinha, 2008):

• • loss of control over impulses
  • inappropriate behaviours
  • inability to delay gratification

Stress and neurotransmitter balance

Chronic stress promotes addictive biochemistry, which is characterized by:

• elevated amounts of excitatory neurotransmitters including glutamate, norepinephrine, and epinephrine
• depressed amounts of cortisol and the calming neurotransmitters serotonin, dopamine, GABA, and endorphins.
• Elevated excitatory neurotransmission can drive mental and physical symptoms that promote self-medication with addictive substances (Petralli, 2008).

Stressful life events and addiction

Population-based and clinical studies show that psychosocial adversity, negative emotions, and chronic distress are associated with vulnerability to addiction.

Some negative life events that are shown to increase abuse of addictive substances include  (Sinha, 2008):

• loss of parent
• parental divorce or conflict
• low parental support
• physical violence or abuse
• emotional abuse
• isolation
• association with deviants
• single-parent family
• childhood sexual abuse
• childhood victimization

Stress and brain nutrients

Chronic stress is known to deplete important nutrients required for mental health and well-being including vitamin C, B-vitamins, calcium, magnesium, iron, and zinc.

Stress and opioid addiction

• Prolonged exposure to stress and trauma can be a root cause of opioid addiction (Zelfand, 2021).
• Chronic stress can lead to an altered stress response that in turn, affects brain chemistry and vulnerability to addiction (Sinha, 2008).

Oxidative stress is the condition in the body where the protective capacity of antioxidant molecules is exceeded by reactive oxygen species (free radicals). It is a factor in both promoting addiction and the negative physiological effects of addictive substances.

Substances of abuse increase oxidative stress in the brain, which then results in:

• damage to brain lipids and protein molecules
• decreased availability of protective antioxidants (especially glutathione)
• increased production of glutamate (a factor in promoting addiction)

Antioxidants depleted by drug-induced free radicals and reactive oxygen species (Karajibani et al., 2017):

• glutathione
• glutathione peroxidase
• superoxide dismutase (SOD)
• catalase
• vitamin A, E, and C

Substances of abuse have been shown to induce oxidative stress in two key structures in the brain rewards system, the nucleus accumbens and the prefrontal cortex (Beiser & Yaka, 2019). The rewards system plays a role in addiction.

Oxidative stress is a factor in addiction

• Oxidative stress has been shown to be higher in alcoholics (Huang et al., 2009)
• Oxidative stress is shown to be a factor in the development of addiction several drugs, including cocaine, methamphetamine, and morphine (Zeng et al., 2020)

Negative effects of oxidative stress caused by substances of abuse can be mediated by:

• antioxidant molecules from diet (especially vitamins A, C, and E)
• supporting the body’s production of antioxidant molecules (especially glutathione) with nutrients

Neurotransmitter imbalances play a role in addiction initiation, continuation, and relapse, as well as driving withdrawal symptoms.

Excitatory vs Inhibitory neurotransmission

Neurotransmitters have excitatory or inhibitory properties. Generally, excitatory neurotransmitters “turn up” the intensity of brain signalling while inhibitory neurotransmitters “turn down” the intensity of brain signalling.

Excitatory neurotransmitters are:

• Acetylcholine
• Glutamate
• Dopamine
• Epinephrine
• Histamine

Inhibitory neurotransmitters are:

• Serotonin
• GABA
• Dopamine (depending on receptor it binds to)

A balance of excitatory and inhibitory neurotransmission is required for normal brain function and mental health (Rao et al., 2015).

The brain reward system

The brain reward system is a group of neural structures that are activated by experiencing rewarding stimuli, like tasty food, sex, or using an addictive drug. (Brain Reward System – Simply Psychology, n.d.)

When experiencing rewarding stimuli the brain releases dopamine, which is the main neurotransmitter connected with pleasure.

Natural vs unnatural rewards

Natural rewards involve fulfillment of physiological drives like hunger or reproduction. Unnatural rewards are results of pleasure seeking activities, alcohol, drugs, gambling and risk-taking. (Bowirrat & Oscar-Berman, 2005)

Brain reward system and substances of abuse

Substances of abuse like alcohol, opioids, stimulants, and nicotine bind to receptors in parts of the brain associated with rewards.

This binding results in:

• more dopamine release than would result from healthy activities
• decreased reabsorption of dopamine which causes reward system overstimulation

Substances of abuse increase dopamine amounts three to five times higher than natural rewards (Bowirrat & Oscar-Berman, 2005)

Chronic overstimulation of the reward systems is a factor in addiction (Brain Reward System – Simply Psychology, n.d.).

Other neurotransmitter pathways associated with reward that are activated by substances of abuse include (Jeynes & Gibson, 2017):

• norepinephrine
• serotonin
• acetylcholine
• opioid
• cannabinoid

Dopamine depletion (Bowirrat & Oscar-Berman, 2005)

• Short-term acute administration of substances of abuse increases neurotransmission.
• Long-term consumption decreases dopamine activity and availability.
• Dopamine levels can remain low for months after discontinuing substance abuse.

Addressing neurotransmitter depletion and imbalances

Amino acids:

• are building blocks in the production of neurotransmitters
• can help with addiction recovery and preventing relapse by supporting restoration of healthy neurotransmitter levels.

Commonly depleted neurotransmitters and amino acids that support their production:

• Dopamine – tyrosine and phenylalanine
• Norepinephrine – tyrosine and phenylalanine
• Serotonin – tryptophan/5-HTP
• GABA – GABA and glutamine

Other nutrients required for neurotransmitter production and balance are:

• vitamins
• minerals
• choline
• omega-3 fatty acids

Neurotransmitter imbalances and smoking

Nicotine stimulates the release of dopamine and other neurotransmitters.

Accumulation of nicotine in the body from chronic smoking leads to excessive excitatory neurotransmission, which reinforces addictive behaviour (Pidoplichko et al., 2004).