.
Introduction

Welcome to the ISOM webpage for addiction. The purpose of this resource is to provide information on potential causes and promoters of addiction that are related to nutrition, micronutrients, and metabolism. Understanding these factors can be an important and productive part of both addressing and recovering from addiction.

The information provided is not intended to be a substitute for medical advice from a licensed physician or other qualified healthcare professional.

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Page Contents

What is addiction?

Addiction, or Substance Use Disorder (SUD) is a condition that involves the uncontrolled use of a substance (such as alcohol, drugs, or tobacco) or a behavior (such as gambling) despite negative consequences.

People with addictions have an intense focus on the substance, which can result in impairment of daily life, in addition to social, physical, and behavioral changes. While the person may be aware of the problem, they cannot stop without intervention.

Symptoms of addiction include, but are not limited to:

  • Decline in attendance and/or performance at work/school
  • Using substances in hazardous situations
  • Sudden mood changes or irritability
  • Engaging in suspicious behaviors
  • Financial problems
  • Withdrawal symptoms

Withdrawal

Withdrawal symptoms may occur when a person drastically reduces or completely stops using a substance they are addicted to. Withdrawal symptoms vary based on the person and substance of abuse.

Typical withdrawal symptoms include:

  • drug or alcohol craving
  • irritability
  • anxiety
  • sleep issues
  • restlessness
  • aggressive behaviours

A craving state may continue after withdrawal  which results from addiction-induced changes in stress and dopamine pathways.

(Sinha, “Chronic Stress, Drug Use, and Vulnerability to Addiction.”)


References

American Psychiatric Association webpage https://www.psychiatry.org/patients-families/addiction/what-is-addiction

MentralHealth.gov –  “Mental Health and Substance Use Disorders” https://www.mentalhealth.gov/what-to-look-for/mental-health-substance-use-disorders

Sinha, R. (2008). Chronic Stress, Drug Use, and Vulnerability to Addiction. Annals of the New York Academy of Sciences, 1141, 105–130. https://doi.org/10.1196/annals.1441.030

Medical standard of care for addiction

The medical approach for addressing addictions involves psychological and pharmacological treatments. This approach does not consider or address nutritional and environmental contributors to addictions.

Medical approaches for treating addictions can include (Underwood, 2020):

  • Medically-assisted detoxification to remove addictive substances from the body
  • Cognitive Behavioral Therapy
  • Rational Emotive Behavior Therapy to help address negative thoughts
  • Contingency management therapy to reinforce positive behavior
  • Twelve-step facilitation therapy – also known as “12-step programs”
  • Treatment with medications to address substance cravings and addictive behaviours, and improve mood

Medications commonly taken for addiction include:

  • Benzodiazepines
  • Antidepressants
  • Clonidine
  • Naltrexone

Medications specific to the substance of addiction may be used:

  • Alcohol addiction
    • Acamprosate
    • Disulfiram
  • Heroin and Opiate addiction
    • Methadone
    • Buprenorphine

These medications work by controlling drug cravings, relieving withdrawal symptoms, and preventing relapses.


References

American Psychiatric Association webpage https://www.psychiatry.org/patients-families/addiction/what-is-addiction

Addiction Center – “Addiction Treatment Medications” https://www.addictioncenter.com/treatment/medications/

Why consider the orthomolecular approach?

Addictions have numerous biological contributors that have been identified through nutritional research and clinical practice.

An orthomolecular approach:

  • identifies the drivers and causes of addictions and focuses on understanding them
  • works WITH the body to restore balance and normal function, and considers the person with the condition vs. just the condition
  • addresses nutrient depletions that promote or sustain addictions, whereas medications do not
  • can be done SAFELY in conjunction with most medical interventions

Contributing factors for addiction

Contributing factors are substances, contexts or conditions that have roles in the causation or promotion of addiction.

Contributing factors

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)


References

Biery, J. R., Williford, J. H., & McMullen, E. A. (1991). Alcohol craving in rehabilitation: Assessment of nutrition therapy. Journal of the American Dietetic Association, 91(4), 463–466.

Chopra, K., & Tiwari, V. (2012). Alcoholic neuropathy: Possible mechanisms and future treatment possibilities. British Journal of Clinical Pharmacology, 73(3), 348–362. https://doi.org/10.1111/j.1365-2125.2011.04111.x

Jeynes, K. D., & Gibson, E. L. (2017). The importance of nutrition in aiding recovery from substance use disorders: A review. Drug and Alcohol Dependence, 179, 229–239. https://doi.org/10.1016/j.drugalcdep.2017.07.006

Nabipour, S., Ayu Said, M., & Hussain Habil, M. (2014). Burden and Nutritional Deficiencies in Opiate Addiction- Systematic Review Article. Iranian Journal of Public Health, 43(8), 1022–1032. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411899/

Nair, S. S., Prathibha, P., Rejitha, S., & Indira, M. (2015). Ethanol induced hepatic mitochondrial dysfunction is attenuated by all trans retinoic acid supplementation. Life Sciences, 135, 101–109. https://doi.org/10.1016/j.lfs.2015.05.023

Neale, J., Nettleton, S., Pickering, L., & Fischer, J. (2012). Eating patterns among heroin users: A qualitative study with implications for nutritional interventions. Addiction (Abingdon, England), 107(3), 635–641. https://doi.org/10.1111/j.1360-0443.2011.03660.x

Preston, A. M. (1991). Cigarette smoking-nutritional implications. Progress in Food & Nutrition Science, 15(4), 183–217.

Varela, P., Marcos, A., Ripoll, S., Santacruz, I., & Requejo, A. M. (1997). Effects of human immunodeficiency virus infection and detoxification time on anthropometric measurements and dietary intake of male drug addicts. The American Journal of Clinical Nutrition, 66(2), 509S-514S. https://doi.org/10.1093/ajcn/66.2.509S

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)


References

Mediterranean Diet 101: Meal Plan, Foods List, and Tips. (2021, October 25). Healthline. https://www.healthline.com/nutrition/mediterranean-diet-meal-plan

The Paleo Diet—A Beginner’s Guide + Meal Plan. (2018, August 1). Healthline. https://www.healthline.com/nutrition/paleo-diet-meal-plan-and-menu

  • 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).

References

 Petralli, G. (2008). The HPA Axis: The “Home” of Alcoholism. 23(4), 4.

Sinha, R. (2008). Chronic Stress, Drug Use, and Vulnerability to Addiction. Annals of the New York Academy of Sciences, 1141, 105–130. https://doi.org/10.1196/annals.1441.030

Zelfand, E. (2021, July 15). How Niacin May Help Treat Alcoholism. https://ericazelfand.com/how-niacin-may-help-treat-alcoholism/

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

References

Beiser, T., & Yaka, R. (2019). The Role of Oxidative Stress in Cocaine Addiction. Journal of Neurology & Neuromedicine, 4, 17–21. https://doi.org/10.29245/2572.942X/2019/1.1239

Karajibani, M., Montazerifar, F., & Khazaei Feizabad, A. (2017). Study of Oxidants and Antioxidants in Addicts. International Journal of High Risk Behaviors and Addiction, 6(2), Article 2. https://doi.org/10.5812/ijhrba.35057

Zeng, X.-S., Geng, W.-S., Wang, Z.-Q., & Jia, J.-J. (2020). Morphine Addiction and Oxidative Stress: The Potential Effects of Thioredoxin-1. Frontiers in Pharmacology, 11, 82. https://doi.org/10.3389/fphar.2020.00082

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).


References

Bowirrat, A., & Oscar-Berman, M. (2005). Relationship between dopaminergic neurotransmission, alcoholism, and reward deficiency syndrome. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 132B(1), 29–37. https://doi.org/10.1002/ajmg.b.30080

Bowirrat, A., & Oscar-Berman, M. (2005). Relationship between dopaminergic neurotransmission, alcoholism, and reward deficiency syndrome. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 132B(1), 29–37. https://doi.org/10.1002/ajmg.b.30080

Pidoplichko, V. I., Noguchi, J., Areola, O. O., Liang, Y., Peterson, J., Zhang, T., & Dani, J. A. (2004). Nicotinic Cholinergic Synaptic Mechanisms in the Ventral Tegmental Area Contribute to Nicotine Addiction. Learning & Memory, 11(1), 60–69. https://doi.org/10.1101/lm.70004

Rao, P. S. S., Bell, R., Engleman, E., & Sari, Y. (2015). Targeting glutamate uptake to treat alcohol use disorders. Frontiers in Neuroscience, 9, 144. https://doi.org/10.3389/fnins.2015.00144

Orthomolecular interventions for addiction

Orthomolecular interventions are substances like vitamins and minerals that have roles in promoting or addressing addiction, depending on the amount present inthe body.

Vitamins

Vitamin B1 and alcohol addiction

    • Thiamin deficiency is a common effect of alcoholism (Dastur et al., 1976; Morgan, 1982).
    • Thiamin deficiency can ( Zimatkin & Zimatkina, 1996):
      • promote increased alcohol consumption
      • result from excessive alcohol consumption
    • Alcohol decreases thiamin availability in the body by (Jeynes & Gibson, 2017):
      • decreasing its absorption by intestinal cells
      • decreasing production of the enzyme that converts thiamin to the metabolically important coenzyme thiamin pyrophosphate (TPP)

Causes of thiamin deficiencies:

  • inadequate intake and excessive consumption of refined grains and sugars
  • poor nutrient absorption
  • excessive alcohol consumption

Top food sources of thiamin based on typical serving size:

  • pork, lean
  • green peas
  • long-grain, brown rice
  • pecans
  • lentils

Comprehensive food list:
Table 2. Some Food Sources of Thiamin (Thiamin, 2014)
https://lpi.oregonstate.edu/mic/vitamins/thiamin

Referenced Dietary Intakes

RDAs for Thiamin (mg/day)
Children (9-13 years): 0.9 (M) 0.9 (F)
Adolescents (14-18 years): 1.2 (M) 1.0 (F)
Adults (19 years and older): 1.2 (M) 1.1 (F)

Vitamin B1 Supplementation

Amounts of thiamin used in practice and research range from 50–1000 mg/day in divided doses.
(Thiamin, 2014)

Vitamin B1 supplementation and alcoholism

  • Thiamin supplementation during alcohol detoxification helps prevent complications associated with the withdrawal symptom delirium tremens (DTs) (Smith, 2021).
  • Thiamin (with magnesium and folate) may help prevent the serious neurological condition called Wernicke’s encephalopathy. (“Best Vitamin And Mineral Supplements For Alcohol Detox.”)

SAFETY, SIDE EFFECTS
There are no well-established toxic effects from consumption of excess thiamin in food or through long-term, oral supplementation (up to 200 mg/day) (Thiamin, 2014).

VITAMIN B1 AND MEDICATIONS
Thiamin is not known to interact with any medications (Thiamin, 2014).


References

Dastur, D. K., Santhadevi, N., Quadros, E. V., Avari, F. C. R., Wadia, N. H., Desai, M. M., & Bharucha, E. P. (1976). The B-vitamins in malnutrition with alcoholism: A model of intervitamin relationships*. British Journal of Nutrition, 36(2), 143–159. https://doi.org/10.1017/S0007114500020158

Jeynes, K. D., & Gibson, E. L. (2017). The importance of nutrition in aiding recovery from substance use disorders: A review. Drug and Alcohol Dependence, 179, 229–239. https://doi.org/10.1016/j.drugalcdep.2017.07.006

Morgan, M. Y. (1982). Alcohol and Nutrition. British Medical Bulletin, 38(1), 21–30. https://doi.org/10.1093/oxfordjournals.bmb.a071727

Smith, J. (2021, October 4). Best Vitamin And Mineral Supplements For Alcohol Detox. Addiction Resource. https://www.addictionresource.net/treatment/detox/alcohol/nutrition/supplements/

Thiamin. (2014, April 22). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/thiamin

Zimatkin, S. M., & Zimatkina, T. I. (1996). Thiamine Deficiency As Predisposition To, And Consequence Of, Increased Alcohol Consumption. Alcohol and Alcoholism, 31(4), 421–427. https://doi.org/10.1093/oxfordjournals.alcalc.a008172

There are two main forms of nicotinic acid known medically as Niacin and Nicotinamide.

Vitamin B3 deficiency is known as pellagra. Dr. Abram Hoffer reported that the earliest symptoms of subclinical pellagra appear as anxiety, depression, and fatigue (Prousky, 2015.)

Actions of vitamin B3 in regards to mental health:

  • helps correct subclinical pellagra
  • increases serotonin production by diverting more tryptophan conversion to serotonin (Gedye, 2001)
  • has sedative, benzodiazepine effects (Hoffer, 1962)
  • can increase the effectiveness of some sedatives, tranquilizers, and anticonvulsants (Hoffer, 1962, 24-31)

Vitamin B3 and alcohol addiction

  • People with alcoholism have been shown to be deficient in vitamin B3 (Badawy, 2014).
  • Niacin is depleted by (Petralli, “The HPA Axis: The ‘Home’ of Alcoholism.”):
    • excessive metabolism of carbohydrates (alcoholics typically consume high-sugar, high-carbohydrate diets)
    • chronic stress (promoted by alcohol consumption)
  • Nicotinamide adenine dinucleotide (NAD) is a molecule required for energy production in all cells, is created from niacin.
    • Low cell energy causes issues with physical and mental health
    • Chronic heavy alcohol consumption reduces body capacity to synthesize NAD (Zelfand, 2021)
  • In the context of low vitamin B3, the amino acid tryptophan is converted to vitamin B3 instead of serotonin. Low serotonin is associated with (Petralli, “The HPA Axis: The ‘Home’ of Alcoholism.”):
    • carbohydrate and alcohol cravings
    • compulsive/addictive behaviour

Causes of vitamin B3 deficiencies (Niacin, 2014):

  • inadequate oral intake
  • poor bioavailability from grain sources
  • issues with absorption of tryptophan
  • some metabolic disorders, and the long-term chemotherapy treatments

Top food sources of vitamin B3 based on serving size:

  • chicken
  • tuna
  • turkey
  • salmon
  • beef

Comprehensive food list:
Table 2. Some Food Sources of Niacin (Niacin, 2014)
https://lpi.oregonstate.edu/mic/vitamins/niacin

Referenced Dietary Intakes

Tolerable Upper Intake Level (UL) for Niacin and niacinamide (mg/day)
Children (9-13 years): 20
Adolescents (14-18 years): 30
Adults (19 years and older): 35

The Food and Nutrition Board set the tolerable upper intake level (UL) for niacin (nicotinic acid and nicotinamide) at 35 mg/day in adults to avoid the adverse effect of flushing. (Niacin, 2014)

1. Vitamin B3 (niacin) Supplementation

  • Amounts of niacin/nicotinic acid used in practice and research range from 100–3000 mg/day in divided doses (Niacin, 2014).

Vitamin B3 supplementation and alcohol addiction

  • The beneficial effects of vitamin B3 in alcoholism appear to be due to increased production of NAD (Maclean, 2013).
  • Beneficial manifestations of niacin supplementation in the context of alcoholism include (Smith, 1974):
    • stabilization of mood
    • decreased insomnia
    • increased social and emotional function
    • reduction of need for other forms of medication
    • decreased drinking recidivism
    • Typical dosing of niacin for addressing alcohol cravings is 500-3000 mg/day (Zelfland, 2021)

The niacin flush

Niacin causes capillaries to dilate which results in increased blood flow to the skin. This effect is known as the “niacin flush”. It is harmless, but can be uncomfortable.

About the niacin flush:

  • Causes a“prickly heat” sensation
  • Causes the skin to feel warm and become red
  • The flush begins in the forehead and works its way down the body, rarely affecting the toes
  • The flush usually begins a few minutes after taking the niacin supplement
  • The flush may last for several hours
  • Each time that niacin is taken, the degree of flushing decreases
  • Most people will flush with 100 mg of niacin, some people will flush with less than 100 mg
  • The higher the initial niacin dose, the greater the initial flush
  • If the niacin supplementation is interrupted for several days, the flushing will resume as if starting for the first time, but not as strong as the original flush

Reducing the niacin flush

In a guide for patients, updated in 2018 by his long-time assistant Frances Fuller, Dr. Hoffer explained ways to mitigate the niacin flush. 

Actions to take to reduce the niacin flush include:

  • Taking 2 to 4 g of vitamin C at the beginning of a meal, and then taking niacin at the end of the meal. (Vitamin C decreases the flush by neutralizing histamine in the blood)
  • Taking the niacin with a cold beverage
  • Avoiding hot showers or baths immediately after taking niacin
  • Starting with a lower amount of niacin and gradually increasing the daily dose—for example starting with 125 mg, then doubling the amount every 4-5 days (flushing should stop shortly after reaching 1,000 mg per day)

Chronic exposure to allergens, either food-based or environmental, can stimulate continuous production of histamine. This ongoing supply of histamine can be a reason why some people continue to flush, even after long-term niacin supplementation.

SAFETY, SIDE EFFECTS

  • People who may be more susceptible to the effects of excess niacin intake include those with: abnormal liver function or liver disease, diabetes, active peptic ulcer disease, gout, cardiac arrhythmias, inflammatory bowel disease, migraine headaches, or alcoholism (Niacin, 2014).
  • Extended-release niacin has been associated with increased risk of serious adverse events (Anderson et al. 2014).
  • Although rare, serum aminotransferase levels should periodically be tested to monitor possible hepatotoxicity in patients who take large doses of vitamin B3 (Gaby, 2011).

2. Vitamin B3 (nicotinamide) Supplementation

  • Amounts of nicotinamide used in practice and research range from 300–3000 mg/day in divided doses (Niacin, 2014).
  • Dr. Abram Hoffer recommended 1500–6000 mg of niacinamide for all patients with psychiatric syndromes (Hoffer, 1995).

SAFETY, SIDE EFFECTS

  • Niacinamide supplementation doses of 1500-6000 mg have been used for extended amounts of time in children and adolescents without side effects or complications (Hoffer, 1971: Hoffer, 1999).
  • Niacinamide does not generally cause flushing. The most common side effect of niacinamide supplementation is sedation (Werbach, 1997, p133-60).
  • At very high doses (≥10 g/day), nausea, vomiting, and signs of liver toxicity (elevated liver enzymes, jaundice) have been observed (Niacin, 2014).

References

Anderson, T. J., Boden, W. E., Desvigne-Nickens, P., Fleg, J. L., Kashyap, M. L., McBride, R., & Probstfield, J. L. (2014). Safety Profile of Extended-Release Niacin in the AIM-HIGH Trial. New England Journal of Medicine, 371(3), 288–290. https://doi.org/10.1056/NEJMc1311039

Badawy, A. A.-B. (2014). Pellagra and Alcoholism: A Biochemical Perspective. Alcohol and Alcoholism, 49(3), 238–250. https://doi.org/10.1093/alcalc/agu010

Buist, R. A. (1985). Anxiety neurosis: The lactate connection. International Clinical Nutrition Review. 5:1-4. 

Gedye, A. (2001). Hypothesized treatment for migraines using low doses of tryptophan, niacin, calcium, caffeine, and acetylsalicylic acid. Medical Hypotheses, 56(1), 91–94. https://doi.org/10.1054/mehy.2000.1117

Hoffer, A.(1995). Vitamin B-3: Niacin and its amide. Townsend Letter for Doctors & Patients 147:30-39.

Hoffer. A. (1999). Dr. Hoffer’s ABC of Natural Nutrition for Children. CCNM Press.

Maclean, M. (2013). The Genetics and Neurochemistry of Schizophrenia and Addiction: Enhanced Options for Treatment Using Nicotinic Acid (Vitamin B3). 28(2), 6.

Niacin. (2014, April 22). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/niacin

Petralli, G. (2008). The HPA Axis: The “Home” of Alcoholism. 23(4), 4.

Prousky J, (2015) Anxiety: Orthomolecular diagnosis and treatment. CCNM Press.

Smith, R. F. (1974). A Five-Year Field Trial of Massive Nicotinic Acid Therapy of Alcoholics in Michigan. ORTHOMOLECULAR PSYCHIATRY, 3(4), 5.

Zelfland, E. (2021, July 27). Niacin for Alcoholism. Nutrition In Focus. https://www.allergyresearchgroup.com/blog/niacin-for-alcoholism/

Vitamin B12 and mental health

A deficiency of vitamin B12 can affect mood, emotions, sleep, and can result in psychiatric disorders. (Valizadeh & Valizadeh, 2011)

Roles of vitamin B12 in the brain:

  • Required for the synthesis of neurotransmitters including serotonin and dopamine
  • Required for the preservation of protective myelin sheath around neurons
  • Important for homocysteine metabolism

Psychiatric manifestations of vitamin B12 deficiency include (Oh & Brown, 2003: Dommisse, 1991):

  • agitation, restlessness, irritability
  • dementia
  • depression, fatigue
  • mild memory impairment
  • negativism
  • panic/phobic disorders
  • personality changes
  • psychosis

Vitamin B12 and addiction

  • Supplementation with vitamin B12 during recovery may support healing of the brain and affected areas of the nervous system.  (“These Are the 4 Best Vitamins for Opiate Withdrawal.”)

Vitamin B12 deficiency

40% of Americans have low levels of vitamin B12, and 20% of elderly people have severe vitamin B12 deficiencies. This is due to a decreased ability to absorb B12 with older age (Wolters et al., 2004) (Andrès et al., 2004) (Greenblatt & Brogan, 2016).

People with depression may have higher needs due to decreased vitamin B12 transport across the blood-brain barrier (Arora, Sequeira, Hernández, Alarcon, & Quadros, 2017), or because of increased breakdown of vitamin B12 in brain tissue (Gaby, 2011)

Vitamin B12 levels can be normal in blood tests but be deficient in the cerebral spinal fluid. (Prousky, 2015)

Vitamin B12 and vegetarians

When comparing omnivores and vegetarians, it was found that vegetarians had (Kapoor et al., 2017):

• significantly lower Serum B12 levels

• significantly higher Methylmalonic Acid (MMA) levels

The most common causes of vitamin B12 deficiency:

  • vitamin B12-deficient diet
  • vegetarianism or veganism
  • decreased stomach acid production
  • bacterial overgrowth in the small intestine

Top food sources of vitamin B12 by serving size:

  • clams, mussels
  • mackerel
  • crab
  • beef

Comprehensive food list:

Table 2. Some Food Sources of vitamin B12 (Vitamin B12, 2014)

https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12

Referenced Dietary Intakes

RDAs for vitamin B12 (mcg/day)

Adolescents (14-18 years): 2.4 (M) 2.4 (F)

Adults (19-50 years): 2.4 (M) 2.4 (F)

Adults (51 years and older): 2.4 (M) 2.4 (F)

Tolerable Upper Intake

Not established due to low potential for toxicity.

1. Vitamin B12 Supplementation

  • Amounts of vitamin B12 used in practice and research range from 1000–5000 IU/day in divided doses.
  • The preferred form of vitamin B12 is methylcobalamin, due to its greater tissue retention (“Methylcobalamin”, 1998)
  • Vitamin B12 is best absorbed in sublingual form.
  • “Those strict vegetarians who eat no animal products (vegans) need supplemental vitamin B12 to meet their requirements” (Vitamin B12, 2014)
  • Vitamin B12 supplementation may have the best clinical response when used in the context of anxiety and fatigue or depression (Prousky, 2015)

2. Vitamin B12 injections

  • A typical injection regimen is 1000 mcg every 2 weeks.
  • Patients who respond to vitamin B12 injections typically need ongoing injections to maintain symptom improvement (Gaby, 2011).
  • Daily 5 mg B12 injections for two weeks in men and women with normal serum B12 were found to improve appetite, mood, energy, and sleep to the 4-week follow-up (Ellis & Nasser, 1973).

SAFETY, SIDE EFFECTS

  • The Institute of Medicine states that “no adverse effects have been associated with excess vitamin B12 intake from food and supplements in healthy individuals” (Vitamin B12, 2014).

References

Andrès, E., Loukili, N. H., Noel, E., Kaltenbach, G., Abdelgheni, M. B., Perrin, A. E., Noblet-Dick, M., Maloisel, F., Schlienger, J.-L., & Blicklé, J.-F. (2004). Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 171(3), 251–259. https://doi.org/10.1503/cmaj.1031155

Arora, K., Sequeira, J. M., Hernández, A. I., Alarcon, J. M., & Quadros, E. V. (2017). Behavioral alterations are associated with vitamin B12 deficiency in the transcobalamin receptor/CD320 KO mouse. PLoS ONE, 12(5). https://doi.org/10.1371/journal.pone.0177156

Dommisse, J. (1991). Subtle vitamin-B12 deficiency and psychiatry: A largely unnoticed but devastating relationship? Medical Hypotheses, 34(2), 131–140. https://doi.org/10.1016/0306-9877(91)90181-w

Ellis, F. R., & Nasser, S. (1973). A pilot study of vitamin B12 in the treatment of tiredness. British Journal of Nutrition, 30(2), 277–283. https://doi.org/10.1079/BJN19730033

Gaby, A. R. (2011). Nutritional Medicine. Alan R. Gaby, VitalBook file.

Methylcobalamin. (1998). Alternative Medicine Review: A Journal of Clinical Therapeutic, 3(6), 461–463.

Oh, R., & Brown, D. L. (2003). Vitamin B12 deficiency. American Family Physician, 67(5), 979–986.

Prousky J, (2015) Anxiety: Orthomolecular diagnosis and treatment, Kindle Edition. CCNM Press.

These Are the 4 Best Vitamins for Opiate Withdrawal. (2019, March 23). The Health Supplement Review. https://thehealthsupplementreview.com/these-are-the-4-best-vitamins-for-opiate-withdrawal/

Valizadeh, M., & Valizadeh, N. (2011). Obsessive Compulsive Disorder as Early Manifestation of B12 Deficiency. Indian Journal of Psychological Medicine, 33(2), 203–204. https://doi.org/10.4103/0253-7176.92051

Vitamin B12. (2014, April 22). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/vitamin-B12

Wolters, M., Ströhle, A., & Hahn, A. (2004). Cobalamin: A critical vitamin in the elderly. Preventive Medicine, 39(6), 1256–1266. https://doi.org/10.1016/j.ypmed.2004.04.047

Vitamin C is required for the synthesis of many compounds important for good mental health. Some of these are:

  • tyrosine
  • thyroxine
  • norepinephrine
  • epinephrine
  • serotonin
  • carnitine
  • corticosteroids.

Vitamin C has been shown in research to (Meister, 1994):

  • reduce psychological stress
  • decrease blood pressure
  • lower cortisol levels

Functions of vitamin C in the brain (Smythies, 1996):

  • Prevents oxidation of dopamine into toxic derivatives (Baez, Segura-Aguilar, Widerslen, Johansson, & Mannervik, 1997)
  • Protects NMDA receptors from glutamate toxicity
  • Counteracts the effects of amphetamines
  • Enhances the effects of older antipsychotic medications like haloperidol

Vitamin C and mental health

  • 3 g/day of vitamin C supplementation in healthy volunteers significantly decreased monoamine oxidase activity (MAO). MAO is responsible for metabolizing serotonin, norepinephrine, and dopamine. (Gaby, 2011)
  • Vitamin C exerts a powerful antioxidant and anti-inflammatory effect in the body. It plays a role in brain health by supporting the production of serotonin, and the regulation of dopamine and glutamate. (Zelfand, “Vitamin C, Pain and Opioid Use Disorder.”)

Vitamin C and addiction

Vitamin C deficiency and vulnerability to addiction

  • Chronic stress significantly depletes vitamin C.
  • Vitamin C plays an essential role in the body’s response to stress by helping to regulate cortisol.
  • Deficiency of vitamin C may result in higher levels of cortisol and an impaired stress response, which may increase vulnerability to addiction (Zelfand, 2020).

Opioid addiction and vitamin C depletion:

  • Chronic use of opioids can deplete vitamin C resulting in a greater level of oxidative stress damage in the body (Zelfand, 2020).

Vitamin C and opioid withdrawal

  • Through its interruption of the brain chemistry associated with opioid addiction vitamin C has been found to help reduce withdrawal symptoms. (Zelfand, 2020).
  • Vitamin C also plays a role in the recycling of glutathione, an important antioxidant in the body that is depleted by opioid addiction (Zelfand, 2020).
  • By preserving concentrations of glutathione in red blood cells and liver cells, vitamin C can help to address glutathione depletion, Low levels of glutathione can contribute to the perseverance of addiction (Zelfand, 2020).

Vitamin C and smoking

  • Smoking increases the body’s requirements for vitamin C while at the same time decreasing the body’s absorption of it (Healthfully, n.d.).  
  • Vitamin C deficiency in smokers is evidenced by lower levels in the bloodstream Schectman et al., 1989).

Causes of vitamin C deficiency

  • restrictive diets
  • diet lacking in sources of vitamin C, especially fresh fruit and vegetables
  • digestive tract disorders, e.g. diarrhea, Crohn’s and colitis
  • smoking
  • alcoholism
  • chronic inflammatory conditions

Signs of vitamin C deficiency

  • bleeding or swollen gums
  • frequent nosebleeds
  • dry hair, split ends
  • easy bruising
  • slow wound healing
  • fatigue
  • moodiness
  • depression and cognitive impairment (Plevin & Galletly, 2020)

Top sources of vitamin C based on serving size

  • grapefruit and orange juice
  • strawberries
  • kiwifruit
  • orange
  • sweet pepper
  • broccoli

Comprehensive food list:

Table 3. Some Food Sources of vitamin C (Vitamin C, 2014)

https://lpi.oregonstate.edu/mic/vitamins/vitamin-C

Referenced Dietary Intakes

RDAs for vitamin C (mg/day)

Adolescents (14-18 years): 75 (M) 65 (F)

Adults (19-50 years): 90 (M) 75 (F)

Smokers: 125 (M) 110 (F)

Tolerable Upper Intake: 2000 mg /day

(Office of Dietary Supplements – Vitamin C, n.d.)

Vitamin C supplementation

  • Amounts of vitamin C used in practice and research range from 500–6000 mg/day in divided doses.

Vitamin C Supplementation and opiod addiction

  • Several studies have demonstrated the effectiveness of vitamin C in helping to reduce symptoms associated with withdrawal from opioids (Opiate Withdrawal Vitamins, 2018).
  • The availability and affordability of vitamin C, along with its tolerability and overall safety make it a viable option in supporting withdrawal from opioids (Zelfand, 2020). 
  • A suggested dose for vitamin C in the form of sodium ascorbate is anywhere from 25 to 85 grams per day in divided doses up to bowel tolerance for those withdrawing completely at the outset. (Zefland)
  • Taking 2 grams of sodium ascorbate every two waking hours over a period of three days has found to be effective in those withdrawing incrementally.  The dose can then be increased as needed to help offset withdrawal symptoms (Millar, T. (2020).
  • Individuals undergoing treatment with methadone have also found relief from relevant side effects and symptoms through supplementation of up to 5 grams of vitamin C per day (Scher, 1976).

Vitamin C and smoking

  • Increasing the intake of vitamin C through supplementation can help to prevent deficiency in smokers (Schectman et al., 1989).

SAFETY, SIDE EFFECTS

  • Vitamin C has low toxicity and is not believed to cause serious adverse effects at high intakes (Office of Dietary Supplements – Vitamin C, n.d.).
  • Vitamin C at higher doses can, in some people, cause side effects such as nausea, abdominal cramps, and other digestive tract disturbances

Vitamin C and medications

  • Vitamin C has been shown beneficial and safe when used in conjunction with depression medications.

References

Baez, S., Segura-Aguilar, J., Widersten, M., Johansson, A. S., & Mannervik, B. (1997). Glutathione transferases catalyse the detoxication of oxidized metabolites (o-quinones) of catecholamines and may serve as an antioxidant system preventing degenerative cellular processes. Biochemical Journal, 324(Pt 1), 25–28.
Gaby, A. R. (2011). Nutritional Medicine (VitalBook file).
Healthfully. (n.d.). Healthfully. Retrieved December 1, 2021, from https://healthfully.com/vitamins-for-smoking-detox-6166688.html

Meister, A. (1994). Glutathione, ascorbate, and cellular protection. Cancer Research, 54(7 Supplement), 1969s–1975s

(Millar, T. (2020) Personal communication to Zefland.

Office of Dietary Supplements—Vitamin C. (n.d.). Retrieved December 4, 2020, from https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/

Opiate Withdrawal Vitamins: Top 12 Vitamins THAT WORK. (2018, February 28). Opiate Addiction Support. https://opiateaddictionsupport.com/opiate-withdrawal-vitamins/

Plevin, D., & Galletly, C. (2020). The neuropsychiatric effects of vitamin C deficiency: A systematic review. BMC Psychiatry, 20(1), 315. https://doi.org/10.1186/s12888-020-02730-w

Schectman, G., Byrd, J. C., & Gruchow, H. W. (1989). The influence of smoking on vitamin C status in adults. American Journal of Public Health, 79(2), 158–162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1349925/

Scher, J. (1976). Massive Vitamin C as an Adjunct in Methadone Maintenance and Detoxification. ORTHOMOLECULAR PSYCHIATRY, 5(3), 8.

Smythies, J. (1996). Oxidative reactions and schizophrenia: A review-discussion. Schizophrenia Research, 24(3), 357–364. https://www.academia.edu/24021570/Oxidative_reactions_and_schizophrenia_A_review_discussion

Vitamin C. (2014, April 22). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/vitamin-C

Zelfand, E. (2021, July 15). How Niacin May Help Treat Alcoholism. https://ericazelfand.com/how-niacin-may-help-treat-alcoholism/

Vitamin D, which is made from cholesterol in the skin and UVB radiation, is a neurosteroid hormone that has roles in brain development and normal brain function.

Vitamin D and mental health

  • Vitamin D regulates the transcription of genes involved in pathways for synaptic plasticity, neuronal development and protection against oxidative stress (Graham et al., 2015).
  • Vitamin D-deficient cells produce higher levels of the inflammatory cytokines TNF-α and IL-6, while cells treated with vitamin D release significantly less.
  • In the adrenal glands, vitamin D regulates tyrosine hydroxylase, which is the rate-limiting enzyme for the synthesis of dopamine, epinephrine, and norepinephrine.
  • In the brain, vitamin D regulates the synthesis, release, and function of serotonin. Serotonin modulates executive function, sensory gating, social behaviour, and impulsivity (Patrick & Ames, 2015).

Vitamin D and addiction

  • Roles of vitamin D in addiction include reduction of pro-inflammatory cytokines and oxidative stress, and neurotransmitter synthesis and regulation in the brain and gut.

Causes of vitamin D deficiency

  • limited sun exposure
  • strict vegan diet (most sources of vitamin D are animal-based)
  • darker skin (the pigment melanin reduces the vitamin D production by the skin)
  • digestive tract and kidney issues
  • obesity (vitamin D is sequestered by fat cells)

Measuring vitamin D

The best indicator of vitamin D status is serum 25(OH)D, also known as 25-hydroxyvitamin D. 25(OH)D reflects the amount of vitamin D in the body that is produced by the skin and obtained from food and supplements.

Vitamin D levels and health status

Institute of Medicine, Food and Nutrition Board. (2010)

Serum (ng/ml)  and Health status

<20  deficient 20–39  generally considered adequate 40–50  adequate >50–60   proposed optimum health level

>200  potentially toxic

Top sources of vitamin D based on serving size (Office of Dietary Supplements – Vitamin D, 2020)

  • cod liver oil
  • trout
  • pink salmon
  • sardines
  • fortified cereal, milk, and orange juice
  • fortified almond, soy, and oat milks
  • egg yolk

Comprehensive food list

Table 3: Vitamin D Content of Selected Foods https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

Referenced Dietary Intakes

RDAs for vitamin D (IU/day)

Adolescents (14-18 years): 600 (M) 600 (F)

Adults (19-50 years): 600 (M) 600 (F)

Adults (51 years and older): 800 (M) 800 (F)

Tolerable Upper Intake: 4000 IU/day

(Office of dietary supplements, 2020)

Vitamin D supplementation

  • Amounts of vitamin D used in practice and research range from 400-14,000 IU/day. (Vitamin D, 2014)

SAFETY, SIDE EFFECTS (Vitamin D, 2014)

  • “Research suggests that vitamin D toxicity is very unlikely in healthy people at intake levels lower than 10,000 IU/day”
  • Vitamin D can increase risk of hypercalcemia with calcium-related medical conditions – including primary hyperparathyroidism, sarcoidosis, tuberculosis, and lymphoma
  • Certain medical conditions can increase the risk of hypercalcemia in response to vitamin D, including primary hyperparathyroidism, sarcoidosis, tuberculosis, and lymphoma

Some drugs that affect vitamin D absorption or metabolism include (Vitamin D, 2014):

  • cholestyramine
  • colestipol
  • orlistat
  • mineral oil
  • phenytoin
  • fosphenytoin
  • phenobarbital
  • carbamazepine
  • rifampin
  • cimetidine
  • ketoconazole
  • glucocorticoids
  • HIV treatment drugs

References

Graham, K. A., Keefe, R. S., Lieberman, J. A., Calikoglu, A. S., Lansing, K. M., & Perkins, D. O. (2015). Relationship of low vitamin D status with positive, negative and cognitive symptom domains in people with first‐episode schizophrenia. Early Intervention in Psychiatry, 9(5), 397-405.

Institute of Medicine, Food and Nutrition Board. (2010). Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academy Press.

Office of Dietary Supplements—Vitamin D. (2020). https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

Patrick, R. P., & Ames, B. N. (2015). Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. The FASEB Journal, 29(6), 2207- 2222.

Vitamin D. (2014, April 22). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/vitamins/vitamin-D

Minerals

Magnesium and mental health

Magnesium in the context of mental health (Kirkland, Sarlo, & Holton, 2018):

  • calms neurotransmission by regulating glutamate and GABA
  • modulates the HPA axis
  • has roles in the synthesis of serotonin and dopamine
  • regulates cortisol levels
  • increases brain-derived neurotrophic factor (BDNF)
  • is required for enzyme systems that use thiamine (vitamin B1) and pyridoxine (vitamin B6) – these vitamins are cofactors in the production of serotonin, GABA, and melatonin (Kanofsky, & Sandyk, 1991)
  • decreases activation of the NMDA receptor which in turn, decreases excitatory neurotransmission (Bartlik, Bijlani, & Music, 2014)

Magnesium and alcohol addiction

Magnesium in the context of alcohol addiction (Kirkland, Sarlo, & Holton, 2018):

  • calms neurotransmission by regulating glutamate and GABA
  • modulates the hypothalamic–pituitary–adrenal (HPA) axis
  • has roles in the synthesis of serotonin and dopamine
  • regulates cortisol levels
  • increases brain-derived neurotrophic factor (BDNF)
  • deficiency promotes anxiety and decreases stress tolerance (Henrotte, 1986).

Magnesium deficiency and alcohol addiction

  • Alcohol consumption depletes magnesium (McLean and Manchip, 1999)
  • Magnesium deficiency in alcoholics is common, with a prevalence of between 13–50 percent. (Dingwall et al., 2015) (Wilkens Knudsen et al., 2014).

Magnesium and opioid withdrawal:

  • Magnesium deficiency can contribute to the pain, and nervous system and muscular issues, experienced by individuals withdrawing from opioids (Nabipour et al., 2014).
  • Magnesium exerts a calming effect, helping the body to relax both mentally and physically during withdrawal (Miller-Reiter et al., 1995).

Causes of magnesium deficiencies include:

  • loss of soil magnesium due to farming practices
  • following the standard American diet pattern, as it is high in processed and nutrient-deficient foods,
  • decreased magnesium levels in foods, especially cereal grains (Guo, Nazim, Liang, & Yang, 2016)
  • low dietary protein (needed for magnesium absorption)
  • gastrointestinal disorders (e.g. Crohn’s disease, malabsorption syndromes, and prolonged diarrhea)
  • stress, which causes magnesium to be lost through urine (Deans, 2011), and
  • chronically elevated cortisol, which depletes magnesium (Cuciureanu, & Vink, 2011).
  • high doses of supplemental zinc (competes for absorption)
  • alcoholism
  • certain diuretic medications
  • lower dietary intake, absorption, and increased loss of magnesium (common in the elderly)

Top sources of magnesium based on serving size

  • Brazil nuts
  • oat bran
  • brown rice (whole grain)
  • mackerel

Comprehensive food list:

Table 2. Some Food Sources of Magnesium (Magnesium, 2014)

https://lpi.oregonstate.edu/mic/minerals/magnesium

Referenced Dietary Intakes

RDAs for magnesium (mg/day)

Adolescents (14-18 years): 410 (M) 360 (F)

Adults (19-30 years): 400 (M) 310 (F)

Adults (31 years and older): 420 (M) 320 (F)

Supplementing magnesium

  • Amounts of magnesium used in practice and research range from 100–750 mg a day in divided doses (elemental magnesium dose).
  • Correction of magnesium deficiency with magnesium supplementation has resulted in significant improvement in psychiatric symptoms (Kanofsky & Sandyk, 1991).

Magnesium supplementation – beneficial forms and dosing (Greenblatt, 2018)

  • Magnesium glycinate supplementation of 120-240 mg per meal and at bedtime has been shown to benefit mood
  • Magnesium glycinate or citrate supplementation of 240-360 mg before bed supports sleep onset and sleeping through the night
  • Administration of 732 mg per day of magnesium L-aspartate hydrochloride for 12 weeks in individuals undergoing methadone treatment was found to reduce illicit opioid use (Gaby, 2017; Miller-Reiter et al., 1995).
  • Some beneficial forms of magnesium include magnesium aspartate, magnesium glycinate, magnesium threonate
  • The magnesium oxide form is less beneficial

SAFETY, SIDE EFFECTS

  • Side effects of magnesium supplementation are rare, but can include a laxative effect, dizziness or faintness, sluggishness, cognitive impairment, and depression.
  • An effective strategy for dosing magnesium is to gradually increase the amount to bowel tolerance, then reduce slightly.
  • Magnesium is best taken in divided doses throughout the day. Caution is required for high doses of magnesium with existing kidney disease.

References

Bartlik, B., Bijlani, V., & Music, D. (2014, July 22). Magnesium: An essential supplement for psychiatric patients—Psychiatry Advisor. Psychiatry Advisor. https://www.psychiatryadvisor.com/home/therapies/magnesium-an-essential-supplement-for-psychiatric-patients/

Cuciureanu, M. D., & Vink, R. (2011). Magnesium and stress. In R. Vink & M. Nechifor (Eds.), Magnesium in the Central Nervous System. University of Adelaide Press. http://www.ncbi.nlm.nih.gov/books/NBK507250/

Deans, E. (2011, June 12). Magnesium and the brain: The original chill pill. Psychology Today. http:/www.psychol- ogytoday.com/blog/evolutionary-psychiatry/201106/magnesium-and-the-brain-the-original-chill-pill

Dingwall, K. M., Delima, J. F., Gent, D., & Batey, R. G. (2015). Hypomagnesaemia and its potential impact on thiamine utilisation in patients with alcohol misuse at the Alice Springs Hospital. Drug and Alcohol Review, 34(3), 323–328. https://doi.org/10.1111/dar.12237

Gaby, A. R. (2017). Nutritional Medicine—Second Edition (Second). Fritz Perlberg Publishing.

Greenblatt, J. (2018). Orthomolecular Applications in Integrative Psychiatry, Depression [Pdf].

Guo, W., Nazim, H., Liang, Z., & Yang, D. (2016). Magnesium deficiency in plants: An urgent problem. The Crop Journal, 4(2), 83–91. https://doi.org/10.1016/j.cj.2015.11.003

Henrotte, J. G. (1986). Type A behavior and magnesium metabolism. Magnesium, 5(3–4), 201–210.

Kanofsky, J. D., & Sandyk, R. (1991). Magnesium Deficiency in Chronic Schizophrenia. International Journal of Neuroscience, 61(1–2), 87–90. https://doi.org/10.3109/00207459108986275

Kirkland, A. E., Sarlo, G. L., & Holton, K. F. (2018). The Role of Magnesium in Neurological Disorders. Nutrients, 10(6). https://doi.org/10.3390/nu10060730

Magnesium. (2014, April 23). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/minerals/magnesium

Miller-Reiter, E., Fodor, G., Presslich, O., & Kasper, S. (1995). P-10-8 The use of magnesium in opioid detoxification and withdrawal. European Neuropsychopharmacology, 5(3), 395. https://doi.org/10.1016/0924-977X(95)90727-U

Nabipour, S., Ayu Said, M., & Hussain Habil, M. (2014). Burden and Nutritional Deficiencies in Opiate Addiction- Systematic Review Article. Iranian Journal of Public Health, 43(8), 1022–1032. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411899/

Wilkens Knudsen, A., Jensen, J.-E. B., Nordgaard-Lassen, I., Almdal, T., Kondrup, J., & Becker, U. (2014). Nutritional intake and status in persons with alcohol dependency: Data from an outpatient treatment programme. European Journal of Nutrition, 53(7), 1483–1492. https://doi.org/10.1007/s00394-014-0651-x

Zinc and mental health

  • Zinc regulates the storage and release of neurotransmitters (Zinc Regulates, 2017)
  • Zinc has critical roles in axonal and synaptic transmission development and brain cell growth and metabolism (Pfeiffer & Braverman, 1982).
  • Zinc is required for the production of the enzyme, superoxide dismutase, and therefore helps to provide antioxidant support in the body.  (Preston, “Cigarette Smoking-Nutritional Implications.”)
  • Zinc has anti-anxiety and antidepressant effects, and  is critical for regulating excitatory glutamate and NMDA receptor activity in the brain. (Andrews, 1990; Joshi, Akhtar, Najmi, Khuroo, & Goswami, 2012).

Zinc and alcohol addiction

  • Alcohol consumption frequently promotes zinc deficiency and altered zinc metabolism (Barve et al., 2017).

Causes of low zinc with alcohol consumption:

  • decreased intake and increased urinary excretion (Jeynes & Gibson, 2017).
  • negative effects on zinc transporters (Skalny et al., 2018)

Effects of low zinc in the context of alcoholism:

  • Impediments to neurotransmission
  • leaky gut with a corresponding increase in gut toxins in the blood and brain  (Skalny et al., 2018)
  • increased inflammatory signaling
  • increased oxidative stress

Zinc and smoking addiction

  • tobacco smoke is high in cadmium. Cadmium competes with zinc for body enzyme binding sites, altering enzyme function in a negative way. Increasing body levels of zinc can help mitigate the effects of cadmium.

Top sources of zinc based on serving size

  • oyster, cooked
  • beef, chuck, blade roast, cooked
  • beef, ground, 90% lean meat, cooked
  • crab, Dungeness, cooked
  • fortified, whole-grain toasted oat cereal

Comprehensive food list:

Table 2. Some Food Sources of Zinc

https://lpi.oregonstate.edu/mic/minerals/zinc

Referenced Dietary Intakes

RDAs for zinc (mg/day)

Adolescents (14-18 years): 11 (M) 9 (F)

Adults (19 years and older): 11 (M) 8 (F)

Supplementing zinc

  • Amounts of zinc used in practice and research range from 10–200 mg/day in divided doses (Zinc, 2014).
  • “Long-term zinc supplementation should be accompanied by a copper supplement (1–4 mg/day, depending on the zinc dose), in order to prevent zinc-induced copper deficiency” (Gaby)
  • Typical dosing of zinc to treat alcohol-induced organ injury is 50 mg of elemental zinc  (Barve et al., “Development, Prevention, and Treatment of Alcohol-Induced Organ Injury.”)
  • Zinc is best taken with food to prevent nausea.

SAFETY, SIDE EFFECTS

  • High zinc intakes can inhibit copper absorption, sometimes producing copper deficiency and associated anemia (Office of Dietary Supplements, 2014).
  • Intakes of zinc should not exceed the UL (40 mg/day for adults) in order to limit the risk of copper deficiency in particular
  • Milder gastrointestinal distress has been reported at doses of 50 to 150 mg/day of supplemental zinc (Zinc, 2014).

References

Andrews, R. R. (1990). Unification of the  findings in schizophrenia by reference to the effects of gestational zinc deficiency. Medical Hypotheses, 31(2), 141-153.

Barve, S., Chen, S.-Y., Kirpich, I., Watson, W. H., & McClain, C. (2017). Development, Prevention, and Treatment of Alcohol-Induced Organ Injury: The Role of Nutrition. Alcohol Research: Current Reviews, 38(2), 289–302. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513692/

Gaby, A. R. (2011). Nutritional Medicine (VitalBook file).

Jeynes, K. D., & Gibson, E. L. (2017). The importance of nutrition in aiding recovery from substance use disorders: A review. Drug and Alcohol Dependence, 179, 229–239. https://doi.org/10.1016/j.drugalcdep.2017.07.006

Office of Dietary Supplements—Zinc. (n.d.). Retrieved October 29, 2020, from https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

Pfeiffer, C. C., & Braverman, E. R. (1982). Zinc, the brain and behavior. Biological Psychiatry, 17(4), 513–532.

Preston, A. M. (1991). Cigarette smoking-nutritional implications. Progress in Food & Nutrition Science, 15(4), 183–217.

Zinc. (2014, April 23). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/minerals/zinc

Skalny, A. V., Skalnaya, M. G., Grabeklis, A. R., Skalnaya, A. A., & Tinkov, A. A. (2018). Zinc deficiency as a mediator of toxic effects of alcohol abuse. European Journal of Nutrition, 57(7), 2313–2322. https://doi.org/10.1007/s00394-017-1584-y

Fatty acids and lipids

Essential fatty acids and mental health

  • Polyunsaturated fatty acids (PUFAs) (omega 3 and 6 fatty acids) are necessary for normal development and function of the brain.
  • Omega 3 fatty acids and their metabolites have roles in regulating inflammation, neuroinflammation, and neurotransmission (Larrieu, & Layé, 2018).

Essential fatty acids and addiction

EFAs and alcohol addiction

  • Addictive behaviours are associated with neuroinflammation.
  • Studies show that alcohol-induced neuronal inflammation and damage can be offset by essential fatty acids (Barve et al., 2017).
  • Fish oil has been shown to alleviate withdrawal symptoms (Shi et al., 2019).
  • Omega 3 fatty acid intake supports healthy brain function while recovering from chronic alcohol use (Smith, 2021).

Omega 3 fatty acids and opioid withdrawal

  • Low omega 3 fatty acid status has been linked to decreased levels of dopamine. (“These Are the 4 Best Vitamins for Opiate Withdrawal.”)
  • Supplementation with omega 3 fatty acids may help to reduce drug-seeking behaviours during opioid maintenance and withdrawal as a result of the protective role they may play in mitigating composition of the gut microbiome (Hakimian et al., 2019).
  • Preclinical data suggests that a diet enriched with omega 3 fatty acids may also help to alleviate anxiety and associated behaviours that accompany withdrawal (Hakimian et al., 2019).

Omega 3 fatty acids and opiod relapse prevention

  • Supplementation with omega 3 fatty acids may help to facilitate a positive shift in the composition of the gut microbiome.
  • This may help to reduce anxiety, which is often a contributing factor in relapse (Hakimian et al., 2019).

Reasons for EFA deficiencies

  • Inadequate dietary intake
  • Poor absorption
  • Deficiencies of nutrients required for EFA metabolism
  • Issues with metabolism that cause decreased incorporation of, or increased removal of, fatty acids from cell membranes

Top EPA and DHA (omega 3) food sources by serving size

  • herring, pacific
  • salmon, chinook
  • sardines, pacific
  • salmon, atlantic
  • oysters, pacific

Comprehensive food list:

Table 4. Food Sources of EPA (20:5n-3) and DHA (22:6n-3) (Office of Dietary Supplements, n.d.)

https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids

Top α-Linolenic Acid (omega 3) food sources by serving size

  • flax seed oil
  • chia seeds
  • walnuts
  • flax seeds ground

Comprehensive food list:

Table 3. Food Sources of α-Linolenic Acid (18:3n-3) (Office of Dietary Supplements, n.d.)

https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids

Top Linoleic Acid (omega-6) sources by serving size

  • safflower oil
  • sunflower seeds
  • pine nuts
  • sunflower oil

Comprehensive food list: Table 2. Food Sources of Linoleic Acid (18:2n-6)

(Office of Dietary Supplements, n.d.)

https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids

Commonly suggested amounts for dietary fatty acid consumption:

  • cold water fish – 2 to 3 times a week, or
  • flaxseed oil – 2 to 6 tbsp daily, or
  • ground flax seed – 2 tbsp daily

Flaxseed oil may have negative effects in about 3% people, including: hypomania, mania, behaviour changes. (Prousky, 2015)

Referenced Dietary Intakes

Adequate Intakes for Alpha linolenic acid (Omega 3) (g/day) (Institute of Medicine, 2002)

Adolescents (14–18 years): 1.6 (M) 1.1 (F)

Adults (19 years and older):  1.6 (M) 1.1 (F)

Recommendations for long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) (mg/day) (European Food Safety Authority, 2009)

Adults: 250 mg/day (M+F)

Supplementing omega 3 fatty acids

  • Supplementation of omega 3 fatty acids seems beneficial for addressing depression (Bruinsma & Taren, 2000).
  • Amounts of omega 3 fatty acids used in practice and research range from 1–4 g/day of combined EPA and DHA, in divided doses.
  • Fish oil and E-EPA are generally well tolerated, but may cause gastrointestinal side effects in some individuals (Gaby)
  • Long-term supplementation with EPA and DHA should be accompanied by a vitamin E supplement (Gaby), as polyunsaturated fatty acids increase vitamin E requirements in the body.

SAFETY, SIDE EFFECTS

  • Common side effects of high dose EPA and DHA supplementation include heartburn, nausea, gastrointestinal discomfort, diarrhea, headache, and odoriferous sweat
  • The European Food Safety Authority considers long-term consumption of EPA and DHA supplements at combined doses of up to about 5 g/day appears to be safe.
  • The FDA recommends not exceeding 3 g/day EPA and DHA combined, with up to 2 g/day from dietary supplements (Office of Dietary Supplements, n.d.).

OMEGA 3 FATTY ACIDS AND MEDICATIONS

  • Use caution when supplementing omega 3 fatty acids while taking blood-thinning medications, or blood-sugar issues (Essential fatty acids, 2014).

References

Barve, S., Chen, S.-Y., Kirpich, I., Watson, W. H., & McClain, C. (2017). Development, Prevention, and Treatment of Alcohol-Induced Organ Injury: The Role of Nutrition. Alcohol Research: Current Reviews, 38(2), 289–302. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513692/

Bruinsma, K. A., & Taren, D. L. (2000). Dieting, Essential Fatty Acid Intake, and Depression. Nutrition Reviews, 58(4), 98–108. https://doi.org/10.1111/j.1753-4887.2000.tb07539.x

Essential Fatty Acids. (2014, April 28). Linus Pauling Institute. https://lpi.oregonstate.edu/mic/other-nutrients/essential-fatty-acids

European Food Safety Authority. Labelling reference intake values for n-3 and n-6 polyunsaturated fatty acids. (2009, July 10). https://www.efsa.europa.eu/en/efsajournal/pub/1176

Institute of Medicine. (2002). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. https://doi.org/10.17226/10490

Gaby, A. R. (2011). Nutritional Medicine (VitalBook file).

Larrieu, T., & Layé, S. (2018). Food for Mood: Relevance of Nutritional Omega-3 Fatty Acids for Depression and Anxiety. Frontiers in Physiology, 9. https://doi.org/10.3389/fphys.2018.01047

Hakimian, J. K., Dong, T. S., Barahona, J. A., Lagishetty, V., Tiwari, S., Azani, D., Barrera, M., Lee, S., Severino, A. L., Mittal, N., Cahill, C. M., Jacobs, J. P., & Walwyn, W. M. (2019). Dietary Supplementation with Omega-3 Polyunsaturated Fatty Acids Reduces Opioid-Seeking Behaviors and Alters the Gut Microbiome. Nutrients, 11(8), E1900. https://doi.org/10.3390/nu11081900

Office of Dietary Supplements—Omega-3 Fatty Acids. (n.d.). Retrieved October 29, 2020, from https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/

Prousky J, (2015) Anxiety: Orthomolecular diagnosis and treatment, Kindle Edition. CCNM Press.

Shi, Z., Xie, Y., Ren, H., He, B., Wang, M., Wan, J.-B., Yuan, T.-F., Yao, X., & Su, H. (2019). Fish oil treatment reduces chronic alcohol exposure induced synaptic changes. Addiction Biology, 24(4), 577–589. https://doi.org/10.1111/adb.12623

Smith, J. (2021, October 4). Best Vitamin And Mineral Supplements For Alcohol Detox. Addiction Resource. https://www.addictionresource.net/treatment/detox/alcohol/nutrition/supplements/

Amino acids

GABA and mental health

  • GABA is the most important calming neurotransmitter in the body. 
  • Low levels of GABA are associated with anxiety (Lydiard 2003: Braverman 2003)
  • GABA levels are depleted by chronic substance abuse

Food sources of GABA

There are no food sources of GABA.

Referenced Dietary Intakes

RDAs/Upper intakes GABA
Not established.

Supplementing GABA

  • Amounts of GABA used in practice and research range from 25–3000 mg/day in divided doses.
  • It has been proposed that GABA taken orally does not cross the blood-brain barrier in amounts sufficient for an effect. However, many people do see results from oral supplementation.
  • GABA is best taken away from meals.
  • 125 mg of GABA taken sublingually has been shown to promote mental and physical relaxation.
  • One or two 250–500 mg doses of GABA can be taken at bedtime or during times of stress.
  • Supplementing 2 to 3 g/day of GABA has been shown to help with sleep, promote relaxation, and control symptoms of anxiety (Braverman, 2010)

SAFETY, SIDE EFFECTS

Commonly reported side effects include (Gamma Aminobutyric Acid, n.d.):

  • upset stomach
  • headache
  • sleepiness
  • muscle weakness

GABA AND MEDICATIONS

  • Supplementing GABA while taking blood pressure medications may cause blood pressure to drop too low.
  • Consult medical advice before supplementing GABA with antidepressant medications (3 Amazing Benefits of GABA, n.d.).

References

3 Amazing Benefits of GABA. (n.d.). Psychology Today. Retrieved October 29, 2020, from https://www.psychologytoday.com/blog/sleep-newzzz/201901/3-amazing-benefits-gaba

Braverman, E. R. (2003). The healing nutrients within. Laguna Beach, CA: Basic Health Publications.

Braverman, E. R. (2012). The Healing Nutrients Within: Facts, Findings, and New Research on Amino Acids (3rd ed. Edition). Basic Health Publications, Inc.

Gamma Aminobutyric Acid: Uses and Side Effects of GABA Supplement. (n.d.). Retrieved October 29, 2020, from https://www.healthline.com/health/gamma-aminobutyric-acid#takeaway

Lydiard, R. B. (2001). Irritable bowel syndrome, anxiety, and depression: What are the links? The Journal of Clinical Psychiatry, 62(Suppl8), 38–45.

Roles of glutamine in mental health:

  • is a precursor molecule for the production of the neurotransmitters glutamate and GABA. 
  • provides fuel for the brain and stimulates many brain functions  (Treatment Protocol for Alcoholism, n.d.)
  • supports brain detoxification by supporting glutathione production (Yu et al., 1999) 
  • protects digestive tract cells from damage.

Glutamine and addiction

  • Glutamine decreases physiological cravings in general (Addiction, n.d.), and especially for alcohol
  • Glutamine is made in the body by the kidneys and liver and certain brain cells. Chronic alcohol consumption damages the liver and kidneys which reduces their production of glutamine. (Treatment Protocol for Alcoholism, n.d.)
  • Glutamine can be converted into glucose in the brain without raising insulin levels. Elevated insulin promotes alcohol cravings.

Referenced Dietary Intakes

RDAs/Upper intakes for glutamine: Not established.

Supplementing glutamine

  • Amounts of glutamine used in practice and research range from 5–30 g/day in divided doses (Glutamine Uses, Side Effects & Warnings, n.d.).
  • Starting at the low end of the dosing range is recommended for seniors. (Drugs.com)
  • A recommended dose in children is up to 0.7 g/kg of body weight daily. (WebMD)

SAFETY, SIDE EFFECTS

·       In general, glutamine is well tolerated by most people.

·       Side of effects of glutamine are generally mild and could include (Glutamine Uses, Side Effects & Warnings, n.d.):

o   heartburn, stomach pain, or bloating

o   nausea

o   swelling in hands or feet

o   muscle or joint pain, back pain

o   dizziness

o   headache, fatigue

o   mild skin rash or itching

o   dry mouth

o   runny nose

o   cough

o   increased sweating

  • Avoid supplementing with glutamine with acute liver or kidney failure, or with cirrhosis, chronic kidney problems, Reye’s Syndrome, or any disorder that results in the accumulation of ammonia in the blood
  • Individuals with impaired liver function should not take large doses of glutamine.  A conservative dose of 1-2 g per day may be possible in some individuals with alcoholic liver disease to help reduce cravings (Gaby, 2017).
  • Consult a practitioner before taking glutamine if you are pregnant or breastfeeding (Glutamine, n.d.).
  • Avoid glutamine if you are at risk of seizures (Glutamine, n.d.)
  • In very rare cases, mania or hypomania has been noted with doses of 2-4 g per day.  Symptoms resolved with cessation of glutamine supplementation (Gaby, 2017).
  • Individuals with MSG sensitivity may also be sensitive to glutamine (Glutamine, n.d.).
  • Supplementation with glutamine may exacerbate Crohn’s disease symptoms (Gaby, 2017)

GLUTAMINE AND MEDICATIONS

·    The effectiveness of anticonvulsant medications used in the prevention of seizures may be reduced with glutamine supplementation (WebMD)

·    The effectiveness of Lactulose may be decreased with glutamine supplementation (Drugbank.com)

·    Large doses of glutamine have been found to reduce the severity of side effects associated with certain chemotherapies, without obviously interfering with the effectiveness of the chemo treatment. (Gaby, 2011)


References

Addiction. (n.d.). Integrative Psychiatry. Retrieved December 21, 2021, from https://www.integrativepsychiatry.net/health-condition/addiction/

Gaby, A. R. (2017). Nutritional Medicine—Second Edition (Second). Fritz Perlberg Publishing.

Glutamine: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews. (n.d.). WebMD. Retrieved December 22, 2021, from https://www.webmd.com/vitamins/ai/ingredientmono-878/glutamine

Glutamine (n.d.). Drugs.com. Retrieved December 20, 2020, from https://www.drugs.com/mtm/glutamine.html

L-Glutamine (n.d.). Medlineplus. Retrieved December 20, 2020, from  https://medlineplus.gov/druginfo/meds/a617035.html

Treatment Protocol for Alcoholism. (n.d.). Retrieved December 21, 2021, from http://orthomolecular.org/resources/omns/v01n06.shtml

  • N-acetylcysteine, more commonly known as NAC, is a derivative of the amino acid cysteine.

NAC in the context of mental health:

  • has roles in inflammation regulation and antioxidant production, and is required for the production of glutathione
  • modulates neurotransmitters including glutamate and dopamine, and provides neurotrophic support (Dean, Giorlando, & Berk, 2011)
  • regulates inflammation
  • supports mitochondrial energy production
  • supports neurotransmitter metabolism

Food sources of NAC

  • NAC is not found in food, but can be made by the body from the amino acid cysteine.

Food sources high in cysteine include (Foods Highest in Cystine, n.d.):

  • beef, lamb, pork
  • poultry
  • fish

Supplementing NAC in the context of addiction

  • Amounts of NAC used in practice and research range from 600 to 3600 mg a day in divided doses.
  • NAC needs to be taken away from food for maximum therapeutic effect.
  • NAC supplementation has been shown to increase blood glutathione levels (Lavoie et al., 2007), and regulate metabolism of glutamate and GABA (Dean, Giorlando, & Berk, 2011).

SAFETY, SIDE EFFECTS

  • NAC can be safely combined with atypical antipsychotic medication and can be combined with all classes of psychiatric medication. 

Side effects of NAC can include:

  • mild nausea
  • upset stomach and indigestion
  • diarrhea
  • tiredness or weakness
  • sweating
  • skin rash

References

Berk, M., Copolov, D., Dean, O., Lu, K., Jeavons, S., Schapkaitz, I., … & Ording-Jespersen, S. (2008). N-acetyl cysteine as a glutathione precursor for schizophrenia—a double-blind, randomized, placebo-controlled trial. Biological Psychiatry, 64(5), 361-368.

Dean, O., Giorlando, F., & Berk, M. (2011). N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action. Journal of Psychiatry and Neuroscience, 36(2), 78.

Foods highest in Cystine. (n.d.). Retrieved December 8, 2020, from https://nutritiondata.self.com/foods-000085000000000000000-10.html?

Lavoie, S., Murray, M. M., Deppen, P., Knyazeva, M. G., Berk, M., Boulat, O., . . . Do, K. Q. (2007). Glutathione pre- cursor, N-Acetyl-cysteine, improves mismatch negativity in schizophrenia patients. Neuropsychopharmacology, 33(9), 2187-2199.

Phenylalanine is an essential amino acid. It can be found in 3 forms: L-phenylalanine , D-phenylalanine and DL-phenylalanine, a combination of both (Phenylketonuria, n.d.).

Phenylalanine and mental health

  • People have reported mood improvement after taking phenylalanine. This may be because phenylalanine increases production of chemicals in the brain such as dopamine and norepinephrine (PHENYLALANINE: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews, n.d.)
  • Phenylalanine also appears to protect endorphins from routine destruction. Supplementation of phenylalanine therefore increases endorphins levels and can improve depressed moods” (Greenblatt & Brogan, 2016) Page 139.

Causes of Phenylalanine deficiencies

  • A low-protein diet
  • phenylketonuria (PKU, genetic condition)

Top food sources of phenylalanine (Metcalf & MPH, n.d.):

  • Meat
  • Egg
  • Fish
  • Cheese

Phenylalanine Supplementation

  • Amounts of phenylalanine used in practice and research range from 75–5,000 mg/day in divided doses (Metcalf & MPH, n.d.).
  • D-phenylalanine is more effective than L-phenylalanine at raising phenylethylamine levels (Borison et al., 1978) (Gaby).

DL-phenylalanine and Withdrawal:

  • DL-phenylalanine contains two forms of the amino acid phenylalanine. Used in combination, they may help with the depression, anxiety, and fatigue that can accompany withdrawal from opioids.
  • Over the longer term, supplementation with DL-phenylalanine may also help to increase dopamine and endorphins in the brain (Opiate Withdrawal Vitamins, 2018).

SAFETY, SIDE EFFECTS

  • Side effects are often mild, and primarily include (Gaby):
    • Anxiety
    • Sleep disturbances
    • Gastrointestinal symptoms
    • Transient headaches or vertigo
  • Phenylalanine can trigger allergic reactions in some individuals. Symptoms of allergic reactions include (Metcalf, n.d.):
    • Itching
    • Swelling of the face or hands
    • Trouble breathing
    • Tingling feeling in the mouth
  • Phenylalanine  should be avoided in people with phenylketonuria and schizophrenia (Metcalf, n.d.).
  • Phenylalanine should be used with caution in those with high blood pressure, anxiety, sleep issues, or current antidepressant use (Metcalf, n.d.).

References

Borison, R. L., Maple, P. J., Havdala, H. S., & Diamond, B. I. (1978).

Metabolism of an amino acid with antidepressant properties. Research Communications in Chemical Pathology and Pharmacology, 21(2), 363–366.

Gaby, A. R. (2011). Nutritional Medicine (VitalBook file).

Greenblatt, J. M., & Brogan, K. (Eds.). (2016). Integrative Therapies for Depression: Redefining Models for Assessment, Treatment and Prevention (1st edition). CRC Press.

Metcalf, E. (n.d.). Phenylalanine: Uses and Risks. WebMD. Retrieved December 22, 2021, from https://www.webmd.com/vitamins-and-supplements/phenylalanine-uses-and-risks

Opiate Withdrawal Vitamins: Top 12 Vitamins THAT WORK. (2018, February 28). Opiate Addiction Support. https://opiateaddictionsupport.com/opiate-withdrawal-vitamins/

Theanine and mental health

  • Theanine is a calming amino acid. The L-theanine form of theanine is extracted from green tea.
  • L-theanine helps reduce anxiety by enhancing alpha brain wave activity and increasing GABA synthesis. Increased GABA levels promote feelings of calm and well-being by raising brain serotonin and dopamine levels (Mason, 2001).

Referenced Dietary Intakes

RDAs/Upper intakes for theanine
Not established.

Supplementing theanine

  • Amounts of theanine used in practice and research range from 100–400 mg/day in divided doses (L-Theanine Uses, Benefits, n.d.).
  • L-theanine dosing (Lopes Sakamoto, F., Metzker Pereira Ribeiro, R., Amador Bueno, A., & Oliveira Santos, 2019):
  • Daily supplementation of L-theanine of 200 to 400 mg for up to 8 weeks has been shown in published research to decrease anxiety symptoms and decrease stress, with both acute and chronic anxiety.
  • A 50 to 200 mg dose of L-theanine usually results in a calming effect within 30 to 40 minutes.
  • Supplementing 200 mg of L-theanine once or twice a day can help address moderate anxiety symptoms.

SAFETY, SIDE EFFECTS

  • Side effects of high-dose theanine supplementation may include headache or sleepiness (Theanine: Uses, Side Effects, n.d.).
  • Taking L-theanine does not increase drowsiness, reduce the ability to concentrate, or lead to the development of tolerance or dependence.

L-THEANINE AND MEDICATIONS

  • Taking theanine along with medications for high blood pressure may cause blood pressure to go too low  (Theanine: Uses, Side Effects, n.d.).

References

L-Theanine Uses, Benefits & Dosage—Drugs.com Herbal Database. (n.d.). Drugs.Com. Retrieved October 29, 2020, from https://www.drugs.com/npp/l-theanine.html

Lopes Sakamoto F, Metzker Pereira Ribeiro R, Amador Bueno A & Oliveira Santos H. (2019) Psychotropic effects of L-theanine and its clinical properties: From the management of anxiety and stress to a potential use in schizophrenia. Pharmacological Research, 147, 104395. https://doi.org/10.1016/j.phrs.2019.104395

Mason R. (2001) 200 mg of zen: L-Theanine boosts alpha waves, promotes alert relaxation. Alternative and Complementary Therapies, 7(2), 91–95. https://doi.org/10.1089/10762800151125092

Theanine: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved October 29, 2020, from https://www.webmd.com/vitamins/ai/ingredientmono-1053/theanine

Tryptophan and 5-HTP and mental health

  • Serotonin, regarded as the happy, feel good neurotransmitter, is synthesized from the amino acid tryptophan. Tryptophan is converted in the body to 5-HTP , which is then converted into the neurotransmitter serotonin.
  • Serotonin is depleted by substance abuse. Tryptophan and 5-HTP help maintain proper serotonin levels

Food sources of tryptophan

Common sources of tryptophan (Richard et al. 2009):

  • turkey
  • chicken
  • tuna
  • oats
  • peanuts

Referenced Dietary Intakes

The recommended daily allowance for tryptophan for adults is estimated to be between 250 mg/day and 425 mg/day (Richard et al. 2009).

1. Supplementing tryptophan

  • Amounts of tryptophan used in practice and research range from 50–6000 mg/day in divided doses.
  • Carbohydrate consumption increases the amount of TRP that crosses the Blood Brain Barrier (BBB) (Richard et al., 2009). Therefore tryptophan is best taken away from meals, but with a small amount of carbohydrate to facilitate absorption. 5-HTP transport across the Blood-Brain Barrier (BBB) is not affected by dietary protein consumption and can be taken with meals (Werbach, 1997).
  • The optimal dose of tryptophan has been found in practice to be 2 g/day, taken with vitamin B6 (Prousky, 2015).
  • L-tryptophan increases serotonin levels, suggesting that it is most likely to be effective in serotonin-deficient patients. This includes patients with a history of a positive response to SSRIs or other serotonergic drugs (Gaby).
  • A dosage of 6 g/day or less  is recommended when L-tryptophan is used by itself,  and 4 g/day or less is recommended when given in combination with 2 g/day of niacinamide. These should be given in two separate doses per day to minimize fluctuation of tryptophan concentration (Chouinard et al., 1977) (Chouinard et al., n.d.).
  • The dose required can be reduced by administering L-tryptophan and niacinamide on an empty stomach along with carbohydrates. (Gaby)
  • L-tryptophan may cause fatigue. When this is experienced, the addition of 500 mg of L-tyrosine twice a day in addition to the L-tryptophan dose can prevent the fatigue and potentially increase the antidepressant effect of L-tryptophan. (Gaby)
  • For tryptophan-deficent individuals, L-tryptophan supplementation can provide a larger range of benefits than supplementation with 5-HTP.
  • Supplementation with 5-HTP may help to promote relaxation and sleep and help to regulate mood (Opiate Withdrawal Vitamins, 2018). 

SAFETY, SIDE EFFECTS – Tryptophan

  • Side effects of L-tryptophan supplementation can include heartburn, stomach pain, belching and gas, nausea, vomiting, diarrhea, and loss of appetite, headache, lightheadedness, drowsiness, dry mouth, visual blurring, muscle weakness, and sexual problems in some people (L-Tryptophan: Uses, Side Effects, n.d.).
  • High doses of tryptophan can promote bronchial asthma aggravation and nausea.
  • Tryptophan should not be used during pregnancy, with lupus, or with adrenal insufficiency (Prousky, 2015).
  • Co-administering L-tryptophan and antidepressants that increase serotonergic activity (SSRIs, amitriptyline, monoamine oxidase inhibitors) may increase the efficacy and toxicity of the drugs (Gaby).

TRYPTOPHAN AND MEDICATIONS

  • Supplementing tryptophan or 5-HTP while on SSRI or MAOI medications is not generally recommended as it may promote an excessive buildup of serotonin  (Birdsall, 1998).
  • Do not supplement tryptophan if taking morphine (Prousky, 2015)
  • Avoid taking tryptophan or 5-HTP (or limit to very low doses) if receiving electroconvulsive therapy (Gaby)

2. Supplementing 5-HTP

Referenced Dietary Intakes

RDAs/Upper intakes for 5-HTP

None established.

  • Amounts of 5-HTP used in practice and research range from 100–900 mg/day in divided doses (Prousky, 2015; Rakel, 2012).
  • 5-HTP can be taken with meals, as opposed to tryptophan, which needs to be taken away from meals.
  • Common amounts of 5-HTP used for addressing anxiety range from 100 to 900 mg daily in divided doses  (Prousky, 2015; Rakel, 2012).
  • SAFETY, SIDE EFFECTS – 5-HTP
  • Side effects of 5-HTP supplementation are typically minimal and can include heartburn, flatulence, rumbling sensations, feeling of fullness, mild, nausea, vomiting, and hypomania (Werbach 1999: Murray & Pizzorno, 1998, p. 391-93)
  • Other possible side effects include, stomach pain, diarrhea, drowsiness, sexual problems, and muscle problems (5-Htp: Uses, Side Effects, n.d.).
  • High-dose supplementation – from 6-10 grams daily – have been linked to severe stomach problems and muscle spasms (5-HTP: Uses, Side Effects, n.d.).

5-HTP AND MEDICATIONS

  • Supplementing tryptophan or 5-HTP while on SSRI or MAOI medications is not generally recommended as it may cause an excessive buildup of serotonin (Birdsall, 1998).
  • Avoid taking tryptophan or 5-HTP (or limit to very low doses) if receiving electroconvulsive therapy (Gaby)

References

5-HTP: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved October 29, 2020, from https://www.webmd.com/vitamins/ai/ingredientmono-794/5-htp

Birdsall, T. C. (1998). 5-Hydroxytryptophan: A clinically-effective serotonin precursor. Alternative Medicine Review: A Journal of Clinical Therapeutic, 3(4), 271–280.

Chouinard, G., Young, S. N., Annable, L., & Sourkes, T. L. (1977). Tryptophan-nicotinamide combination in depression. Lancet (London, England), 1(8005), 249. https://doi.org/10.1016/s0140-6736(77)91036-4

Chouinard, G., Young, S. N., Annable, L., & Sourkes, T. L. (n.d.). Tryptophan-nicotinamide, imipramine and their combination in depression. Acta Psychiatrica Scandinavica, 59(4), 395–414. Retrieved August 26, 2021, from https://www.academia.edu/24627244/Tryptophan_nicotinamide_imipramine_and_their_combination_in_depression

Gaby, A. R. (2011). Nutritional Medicine (VitalBook file).

L-Tryptophan: Uses, Side Effects, Interactions, Dosage, and Warning. (n.d.). Retrieved October 29, 2020, from https://www.webmd.com/vitamins/ai/ingredientmono-326/l-tryptophan

Murray, M., & Pizzorno J. (1998). Encyclopedia of Natural Medicine. Revised 2nd ed. Rocklin, CA: Prima Publishing.

Opiate Withdrawal Vitamins: Top 12 Vitamins THAT WORK. (2018, February 28). Opiate Addiction Support. https://opiateaddictionsupport.com/opiate-withdrawal-vitamins/

Prousky J, (2015) Anxiety: Orthomolecular diagnosis and treatment. CCNM Press.

Rakel, D., (2012). Integrative Medicine (3rd ed.). Elsiver.

Richard, D. M., Dawes, M. A., Mathias, C. W., Acheson, A., Hill-Kapturczak, N., & Dougherty, D. M. (2009). L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications. International Journal of Tryptophan Research : IJTR, 2, 45–60.

Werbach, M. R. (1997). Adverse effects of nutritional supplements. Foundations of Nutritional Medicine. Tarzanna, CA: Third Line Press, Inc,.

Tyrosine is a dietary amino acid that also functions as a neurotransmitter.

The body can also make tyrosine from the amino acid phenylalanine

Tyrosine and mental health

Tyrosine is a precursor molecule for the neurotransmitters dopamine, noepinephrine, and epinephrine, and is also required for the production of thyroid hormones.

Tyrosine and opioid WIthdrawal:

  • Tyrosine may help to mitigate symptoms of depression, anxiety, and fatigue that accompany opioid withdrawal (Opiate Withdrawal Vitamins, 2018).

Causes of deficiencies

  • a low-protein diet

Top sources of tyrosine based on serving size (Top Foods High in Tyrosine, n.d.)

  • sesame seeds
  • cheese
  • soybeans
  • meat and poultry
  • fish

Supplementing tyrosine

  • Amounts of tyrosine used in practice and research range from 100–1000 mg/day in divided doses (Mahoney et al., 2007).
  • Tyrosine seems to be safe when used in doses up to 150 mg/kg per day for up to 3 months”  (Tyrosine, n.d.) (Gaby).
  • Since L-tyrosine may act as a mild stimulant, Tyrosine should not be taken near bedtime. L-tyrosine is likely most effective when it is taken with carbohydrates on an empty stomach (Gaby).

SAFETY, SIDE EFFECTS

  • Some people may experience side effects such as nausea, headache, fatigue, heartburn, and joint pain (Tyrosine, n.d.)
  • People who have migraine headaches may need to avoid tyrosine, as it can trigger migraine headaches
  • People with hyperthyroidism or Graves disease may need to avoid supplementing tyrosine as it may promote increased thyroid hormone production

TYROSINE AND MEDICATIONS

  • Tyrosine may decrease how much levodopa the body absorbs (Tyrosine, n.d.)
  • Tyrosine may increase how much thyroid hormone the body produces

References

Gaby, A. R. (2011). Nutritional Medicine (VitalBook file).

Mahoney, C. R., Castellani, J., Kramer, F. M., Young, A., & Lieberman, H. R. (2007). Tyrosine supplementation mitigates working memory decrements during cold exposure. 

Opiate Withdrawal Vitamins: Top 12 Vitamins THAT WORK. (2018, February 28). Opiate Addiction Support. https://opiateaddictionsupport.com/opiate-withdrawal-vitamins/

Physiology & Behavior, 92(4), 575–582. https://doi.org/10.1016/j.physbeh.2007.05.003

Top Foods High in Tyrosine. (n.d.). WebMD. Retrieved August 15, 2021, from https://www.webmd.com/diet/foods-high-in-tyrosine

Tyrosine: Health Benefits, Side Effects, Uses, Dose & Precautions. (n.d.). RxList. Retrieved August 15, 2021, from https://www.rxlist.com/tyrosine/supplements.htm

Multinutrient formulas

B-complex vitamins and Mental health

  • Conditions including stress, illness, poor diet and nutrient absorption, as well as certain medications can increase needs for B-vitamins.
  • A good quality B-complex can address the minimum nutrient requirements for the important B-vitamins including vitamins B1, B3, B6, B12, and folate.

“A trial of B-complex supplement seems advisable, especially in older persons and in persons taking medications that may deplete this vitamin” (Rakel, 2012).

“In my experience, supplementation with a high-potency B-complex vitamin sometimes improves chronic anxiety in patients who have no clinical evidence of B-vitamin deficiency” (Gaby, 2011).

Further reading

Lewis, J. E., Tiozzo, E., Melillo, A. B., Leonard, S., Chen, L., Mendez, A., Woolger, J. M., & Konefal, J. (2013). The effect of methylated vitamin B complex on depressive and anxiety symptoms and quality of life in adults with depression. ISRN Psychiatry, 2013, 621453. https://doi.org/10.1155/2013/621453


References

Gaby, A. R. (2011). Nutritional Medicine. Alan R. Gaby, VitalBook file.

Rakel, D., (2012). Integrative Medicine (3rd ed.). Elsiver.

Multivitamins and mental health

  • Conditions including stress, illness, poor diet and nutrient absorption, as well as certain medications can increase needs for many different vitamins and minerals.
  • A good quality multivitamin/mineral formula can address the minimum nutrient requirements for the important vitamins and minerals.

Use of multiple nutrients at the same time may play a role in helping to reduce toxicity in individuals recovering from opioid addiction.  (Libby et al., “Methodology: Use of Orthomolecular Techniques for Alcohol and Drug Abuse, in a Post-Detox Setting.”)


References

Libby, A. F., Smart, W., McLeod, C., Wauchope, J. J., & Gutierrez, H. (1982). Methodology: Use of Orthomolecular Techniques for Alcohol and Drug Abuse, in a Post-Detox Setting. ORTHOMOLECULAR PSYCHIATRY, 11(4), 12.

Resources

This section contains useful information and tools for getting started as well as exploring further the orthomolecular approach to addressing addiction.

Common nutrient deficiencies from chronic alcohol abuse include (Center, 2018):

  • vitamin A, B-vitamins, vitamin C, and vitamin D
  • magnesium
  • omega 3 fatty acids
  • glutamine, tyrosine, theanine, tryptophan, phenylalanine

BASIC FIRST STEPS

1. Eat a healthy diet

  • ensure sufficient protein, fats, and cholesterol
  • eat a variety of colourful vegetables and fruit
  • avoid sugar and starches

Diets to consider:

2. Supplement basic nutrients for support with addiction;

Multivitamin
Reason:  broad spectrum nutrient support
Typical dosing: 1–2x day

AND/OR

B-complex
Reason: full spectrum of B-vitamins, supports brain function, blood sugar control
Typical dosing: B50 2–4/day

Vitamin C
Reason: antioxidant, anti-inflammatory, supports neurotransmitter production
Typical dosing: 1000–6000 mg/day

Vitamin D
Reason: regulates serotonin production, protects against neuronal oxidative stress
Typical dosing: 1000–5000 IU

Chromium
Reason: regulates blood-sugar levels
Typical dosing: 200–400 mcg/day

Magnesium
Reason: calms neurotransmission, anti-stress, serotonin and dopamine production
Typical dosing: 100–750 mg/day

Zinc
Reason: antioxidant support, neurotransmitter regulation
Typical dosing: 50 mg/day

Fish oil
Reason: anti-inflammatory, brain supportive
Typical dosing: 1000–4000 mg (of fish oil)

NAC
Reason: antioxidant support, helps regulate addictions
Typical dosing: 500–3000 mg/day

3. Decrease caffeine or other stimulants (gradually)


FURTHER STEPS

1. Continue with basic nutrients for support with addiction 

2. Include additional nutrients shown important with alcohol addiction 

Vitamin B1 (thiamine)
Reason: decreased by alcohol consumption, deficiency promotes alcohol consumption
Typical dosing with alcohol addiction:

Vitamin B3
Reason: serotonin production, sedative effect, cellular energy production, addresses cravings
Typical dosing with alcohol addiction: 500-3000 mg/day (niacin) 

Glutamine
Reason: reduces cravings, calming by supporting GABA production
Typical dosing with alcohol addiction: 500-3000 mg/day

Tyrosine
Reason: addresses dopamine, norepinephrine deficiencies
Typical dosing with alcohol addiction: 500-2000 mg/day in divided doses 

D,L-Phenylalanine 
Reason: addresses dopamine, endorphin deficiencies
Typical dosing with alcohol addiction: 500-2000 mg/day in divided doses 

Tryptophan/5-HTP
Reason: addresses serotonin deficiencies
Typical dosing with alcohol addiction:
Tryptophan 500–2000 mg/day,
5-HTP 100-300 mg/ 3x day 

GABA
Reason: calming neurotransmitter, depleted by substance abuse
Typical dosing with alcohol addiction: 100–500 mg 2-3x day

3. Reduce sources of stress if possible

4. Ensure good sleep

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379

5.  Address psychological and spiritual aspects driving the addiction


References

Center, R. R. (2018, May 10). Addressing Nutritional Deficiencies and Substance Abuse in Recovery. Reflections Recovery Center. https://reflectionsrehab.com/blog/nutritional-deficiencies-and-substance-abuse-nutrition-in-addiction-recovery/

Common nutrient deficiencies from chronic opioid abuse include (Center, 2018):

  • vitamin A, B-vitamins, vitamin C, and vitamin D
  • magnesium, calcium
  • omega 3 fatty acids
  • glutamine, tyrosine, tryptophan, phenylalanine

BASIC FIRST STEPS

1. Eat a healthy diet

  • ensure sufficient protein, fats, and cholesterol
  • eat a variety of colourful vegetables and fruit
  • avoid sugar and starches

Diets to consider:

2. Supplement basic nutrients for support with addiction;

Multivitamin
Reason:  broad spectrum nutrient support
Typical dosing: 1–2x day

AND/OR

B-complex
Reason: full spectrum of B-vitamins, supports brain function, blood sugar control
Typical dosing: B50 2–4/day

Vitamin C
Reason: antioxidant, anti-inflammatory, supports neurotransmitter production
Typical dosing: 1000–6000 mg/day

Vitamin D
Reason: regulates serotonin production, protects against neuronal oxidative stress
Typical dosing: 1000–5000 IU

Magnesium
Reason: calms neurotransmission, anti-stress, serotonin and dopamine production
Typical dosing: 100–750 mg/day

Zinc
Reason: antioxidant support, neurotransmitter regulation
Typical dosing: 50 mg/day

Fish oil
Reason: anti-inflammatory, brain supportive
Typical dosing: 1000–4000 mg (of fish oil)

NAC
Reason: antioxidant support, helps regulate addictions
Typical dosing: 500–3000 mg/day

3. Decrease caffeine or other stimulants (gradually)


FURTHER STEPS

1. Continue with basic nutrients for support with addiction 

2. Include additional nutrients shown important with opioid addiction 

Theanine
Reason: calming, supports increased GABA, serotonin and dopamine levels
Typical dosing with opioid addiction: 100–400 mg/day

Tyrosine
Reason: addresses dopamine, norepinephrine deficiencies
Typical dosing with opioid addiction: 500-2000 mg/day in divided doses 

Phenylalanine
Reason: addresses dopamine, endorphin deficiencies
Typical dosing with opioid addiction: 500-2000 mg/day in divided doses 

Tryptophan/5-HTP
Reason: addresses serotonin deficiencies
Typical dosing with opioid addiction:
Tryptophan 500–2000 mg/day,
5-HTP 100-300 mg/ 3x day 

GABA
Reason: calming neurotransmitter, depleted by substance abuse
Typical dosing with opioid addiction:  100–500 mg 2-3x day

3. Reduce sources of stress if possible

4. Ensure good sleep

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379

5.  Address psychological and spiritual aspects driving the addiction


References

Center, R. R. (2018, May 10). Addressing Nutritional Deficiencies and Substance Abuse in Recovery. Reflections Recovery Center. https://reflectionsrehab.com/blog/nutritional-deficiencies-and-substance-abuse-nutrition-in-addiction-recovery/

Common nutrient deficiencies from chronic smoking include (Preston, 1991):

  • vitamin C, vitamin E, beta-carotene
  • selenium, zinc

BASIC FIRST STEPS

1. Eat a healthy diet

  • ensure sufficient protein, fats, and cholesterol
  • eat a variety of colourful vegetables and fruit
  • avoid sugar and starches

Diets to consider:

2. Supplement basic nutrients for support with addiction;

Multivitamin
Reason:  broad spectrum nutrient support
Typical dosing: 1–2x day

AND/OR

B-complex
Reason: full spectrum of B-vitamins, supports brain function, blood sugar control
Typical dosing: B50 2–4/day

Vitamin C
Reason: antioxidant, anti-inflammatory, supports neurotransmitter production
Typical dosing: 1000–6000 mg/day

Vitamin D
Reason: regulates serotonin production, protects against neuronal oxidative stress
Typical dosing: 1000–5000 IU

Magnesium
Reason: calms neurotransmission, anti-stress, serotonin and dopamine production
Typical dosing: 100–750 mg/day

Zinc
Reason: antioxidant support, neurotransmitter regulation
Typical dosing: 50 mg/day

Fish oil
Reason: anti-inflammatory, brain supportive
Typical dosing: 1000–4000 mg (of fish oil)

NAC
Reason: antioxidant support, helps regulate addictions
Typical dosing: 500–3000 mg/day

3. Decrease caffeine or other stimulants (gradually)


FURTHER STEPS

1. Continue with basic nutrients for support with addiction 

2. Include additional nutrients shown important with smoking addiction 

Vitamin A 
Reason: protects lung cells
Typical dosing with smoking addiction: 10,000 IU

Vitamin E 
Reason: depleted by smoking, decreases risk of lung tumours
Typical dosing with smoking addiction: 400 IU/day

Glutamine
Reason: reduces cravings, calming by supporting GABA production
Typical dosing with smoking addiction: 500-3000 mg/day

Theanine
Reason: calming, supports increased GABA, serotonin and dopamine levels
Typical dosing with smoking addiction: 100–400 mg/day

Tyrosine
Reason: addresses dopamine, norepinephrine deficiencies
Typical dosing with smoking addiction: 500-2000 mg/day in divided doses

Tryptophan/5-HTP
Reason: addresses serotonin deficiencies
Typical dosing with smoking addiction:
Tryptophan 500–2000 mg/day,
5-HTP 100-300 mg/ 3x day 

3. Reduce sources of stress if possible

4. Ensure good sleep

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep/art-20048379

5.  Address psychological and spiritual aspects driving the addiction


References

Preston, A. M. (1991). Cigarette smoking-nutritional implications. Progress in Food & Nutrition Science, 15(4), 183–217.