Can We Help Fight the Opioid Crisis with Nutrition Therapy?
By Lisa Andrews, MEd, RD, LD
The ongoing opioid crisis (as well as other substance abuse crises) presents a unique intervention opportunity for dietitians in the Opioid Addiction Recovery process. Nutrition aids in healing during substance abuse recovery, and can help reduce the likelihood of relapse.
The Opioid Crisis
Not a day goes by that you don’t hear about a death or overdose related to opioids. According to the Centers for Disease Control and Prevention (CDC), “In 2016, more than 64,000 people died from drug overdoses in the U.S., the most of any year on record and a 19% increase from 2015. More than half of these were opioid-related, with especially large increases in deaths from heroin and illicit fentanyl.”
On average, 90 people are killed daily in the US in deaths related to opioids. Opioids also increase the strain on the foster system, increase the risk of hepatitis and HIV related to needle use, and reduce life expectancy in the US (1).
Combatting the Crisis
Experts from the John Hopkins Bloomberg School of Public Health and Clinton Health Initiative advise evidence-based strategies to combat the opioid crisis from health care, advocacy, non-profit, government, academic, and business environments. Leaders in pain treatment, pharmacy benefits, health policy, law enforcement and insurance were among the stakeholders gathered to issue a special report on the opioid crisis. The report, which was presented at a summit on October 30th, 2018 contains 10 specific recommendations on ways to fight the opioid epidemic (1).
Dietitians are a key part of the process. Nutrition and hydration are necessary to aid in healing during substance abuse recovery, as they improve mental and physical well-being and increase the likelihood of recovery. Deficiencies in macro and micronutrients may lead to poor energy, anxiety, and symptoms of
depression, which could increase the chance of drug or alcohol relapse. Individuals abusing drugs are often malnourished since stimulant drugs may reduce appetite and intake while other drugs may impair digestion, absorption, and transport of nutrients (2). Those suffering from opioid or other addictions
are often malnourished as a result of not eating enough, lacking finances to purchase and prepare nutritious foods, and/or choosing foods that are low in nutritional value. Poor eating behaviors may also be due to limited or lack of nutrition knowledge and education (2).
Opiate addicts have been found to suffer calcium and magnesium deficits related to poor diet and addicts generally eat less than the recommended servings of fruits, vegetables, and grains. During heroin withdrawal, weight gain can occur due to higher intake of sweets and other “comfort foods,” which may provide similar dopamine responses in the brain. High-sugar foods should be limited as high sugar intake may lead to relapse. Carbohydrate metabolism may be altered during opiate withdrawal as well, and therefore higher protein intake is advised (3).
Opioids depress the central nervous system which slows down the all of the body’s systems, including digestion. Opioids can impact the gastrointestinal tract by causing chronic constipation, appetite loss, and malabsorption of nutrients. While undergoing detox, the patient may experience nausea, vomiting, diarrhea and anorexia, or a lack of desire to eat. Diarrhea and vomiting can lead to a low level of potassium which can cause potentially dangerous fluid and electrolyte imbalances.
High Sugar Intake
Sugar can sometimes cause a similar sensation that is produced by drugs or alcohol. A study found that up to 30 percent of caloric intake comes from added sugar. This can happen because sugary foods can increase levels of dopamine, one of the brain chemicals involved in the euphoric reactions to drugs or alcohol. Eating large quantities of sugar can cause the brain to have responses that are similar to those that occur with opioid addiction. A high-sugar diet can also cause side effects such as low levels of vitamins, high blood sugar levels, high cholesterol, and an increased risk of diabetes and heart disease.
Another point to consider is the use of caffeine during recovery. During my time as a clinical dietitian at the VA Medical Center, patients were not permitted caffeinated beverages since caffeine could make recovery more difficult by disrupting sleep or increasing anxiety. As caffeine is a drug that affects the central nervous system, it can also be abused and cause withdrawal symptoms when taken away. Ironically, most AA meetings will have a full pot of coffee waiting when you arrive (4).
7 Steps for dietitians working with those in recovery
1. Perform a complete nutrition assessment to evaluate for nutrient deficiencies, weight changes and/or eating disorders.
2. Help your clients maintain hydration during episodes of nausea, vomiting or diarrhea related to withdrawal. Encourage water, juice, or milk instead of soda, sugary drinks, or caffeinated beverages.
3. Provide nutrient-dense, but palatable food during treatment such as seasoned vegetables, fresh fruit, and whole grains.
4. Promote intake of high-calcium foods such as low-fat cheese, cottage cheese, milk, and Greek yogurt.
5. Encourage sources of B12, iron, and folate such as lean meat, eggs, lentils, beans, and leafy greens.
6. Promote regular meal and snack times to prevent highs and lows in blood sugar.
7. Limit intake of highly processed/high-sugar treats to aid in blood sugar maintenance and weight management.
Additional strategies include limiting the amount of table salt and high-sodium foods, including processed foods, fast foods, and convenience items. Keep healthy snacks available all the time, such as nuts and fruit, to keep the mood stable, maintain energy levels and reduce cravings.
Maintenance After Rehab
After rehab, it is very important to keep a balanced approach to eating. Try to make sure that food is being used as a source of energy and health instead of being used for emotional comfort. Follow-up regularly with a nutritionist or dietitian. Have regular checkups with a doctor. This can help prevent reverting back to poor eating patterns or food addiction.
*These statements have not been evaluated by the Food and Drug Administration.
This information is for educational purposes only. The statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Consult your physician if you have any question regarding a medical condition
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2. Sepideh NABIPOUR,1 Mas AYU SAID,*,1 and Mohd HUSSAIN HABIL2 Burden and Nutritional Deficiencies in Opiate Addiction- Systematic Review Article. Iran J Public Health. 2014 Aug; 43(8): 1022–1032.