Cressida Boyd reports.
Although there is as yet very little evidence of the role of nutrition in tackling drug dependency, drug users generally have bad health. Drug treatment plans tend to involve legal drugs such as methadone to remove dependency on illicit markets, psychotherapeutic interventions, and help with housing, debt and the criminal justice systems.
Yet in spite of its high profile and large NHS budget, hardly anyone completes the government treatment programme. This may be due to too much emphasis on the management of drug use. Management does deliver a lot for communities in terms of security and controlling disease, but recovery-focused treatment needs to be offered. Drug users are some of the most excluded and marginalised people in their communities and they need to be convinced that life is better without drugs.
Currently, Government guidelines make only one single mention of nutrition with regards drug treatment: ‘Drug misusers may suffer from poor nutrition but should only receive oral nutrition support if there are clear medical reasons to do so. They should be given advice on diet and nutrition, especially if drinking heavily’. Drug misuse and dependence: UK Guidelines on Clinical Management (2007), p. 129
The biochemistry of the brain is altered by the drugs or alcohol used by the addict, and these changes to the neural pathways become very hard to undo. In recovery, the addict’s brain is still hardwired to look for the next fix and highly responsive to stress. It needs targeted nutrition and exercise of the brain.
The high levels of trans fatty acids in junk food actively block the effects of the omega 3 fatty acids needed to restore brain chemistry while the micronutrients in good, healthy, balanced meals combined with regular exercise can make the brain more receptive to recovery by improving its neuroplasticity.
Dopamine is involved normal brain function and drugs can destroy dopamine. Many micronutrients contribute to dopamine production, while amino acids such as tyrosin can return dopamine receptors to normal.
Glutamate is essential for learning and memory, and for neuronal remodelling: ingestion of cysteine can help brain pump more glutamate into synapses.
For synthesising serotonin, used for mood, hunger, aggression, sociability and paranoia, the body needs folates, B vitamins, coQ10, ATP, glucose-fructose and other micronutrients. When you are ill your serotonin levels come down – so for drug users with a generally low level of physical health, this is particularlyrelevant.
Some core nutritional interventions should be considered to help recovering addicts to avoid relapse and to remove some of the biochemical stumbling blocks.
Dr Simon Moore
Outcomes of violence are a huge drain on resources. Studies on problem children in Cardiff has highlighted some pertinent background factors including poverty, parental alcohol abuse, poor parenting practices and bad diet. One thing notably absent is the consumption of salad! Some studies have shown evidence that nutritional intake has a bearing on behaviour.
The mechanism at work here is that a predilection for junk food causes hypoglycaemia and fluctuations in blood glucose levels, triggering insulin secretion to soak up glucose, in turn leading to a shortage of glucose that causes nervousness, irritability and aggression.
There is a clear link between excessive confectionary consumption and insulin adn a deficiency of essential fatty acids, although no one has yet looked at this in any detail.
When the children arrive, they are malnourished and may have asthma, ADHD, eczema, or autism. The behaviour of the children used to result in many staff injuries, and staff shortages due to these injuries. The emergency team would respond to half-hourly alarms during the day, and were required to stay overnight.
In 2004 Jan attended a delinquency and diet seminar, which was her catalyst for change.
She retrained the kitchen staff to the concept of quality not quantity, and how to cook from scratch. She started sourcing fresh meat and vegetables locally.
With the children, she started by teaching the girls how better nutrition can improve hair, nails and the whole body. The children were all encouraged to create the menus and prepare healthy snacks, thus giving them an interest in and some ownership over the food choices. The menu consists of appetising, home made meals with vegetarian/ethnic options, seasonal salads and fruits.
The OFSTED report went from ‘satisfactory’ in 2004 to ‘good’ in 2009 – Jan is looking to get an ‘outstanding’ next time.
Helen Sandwell, Nutritionist.
There was no healthy eating advice for prisoners. For former drug users in prison this is especially important because they stop eating to get better highs while physical health impacts on mood, which prompts the need for drugs. Drug users’ chaotic lifestyle leaves little time and money for food, so the foods consumed tend to be convenience foods. Oral health is also a major issue, and prisoners cannot eat healthily with bad gums and no teeth.
The project is to re-educate prisoners with evidence based healthy eating advice, with an aim to reduce re-offending: factors in recidivism include anxiety, impulsivity, depression, aggression, on all of which diet can impact.
Initial visits to the Category A prisons revealed unappealing kitchens with often out of date food. Focus groups were self selecting so the prisoners already had a high interest level. The sessions included healthy eating advice, barriers faced by the prisoners in obtaining better food, and practical exercises to overcome the problems.
Unfortunately there is no money to evaluate the project: food and healthy eating is not a priority, and Government funding of the prison service has already been cut. But Helen is hoping to roll the service out to all of HM Prisons.
Food is essential for survival. We must eat repeatedly, every day. And it is ‘normal’ to take pleasure from eating. Food ‘addiction’ would imply a biochemical condition in the brain craving specific foods – characterised by loss of control, eating more frequent or larger portions, too much of the wrong types of food, or experiencing anxiety if unable to eat.
Currently the research is unclear as to whether eating disorders are addictions: food can produce opiates in the body; sugar and fat have addictive properties; non-palatable foods can be desired and over-consumed. But food intake is regulated by two pathways the homeostatic and the hedonistic, and drugs are regulated only by the hedonistic (rewards) pathway.
However, the notion of food addiction really resonated with patients. Acceptance of food as an addictive substance by both carers and patients made food issues easier to work with. Food addiction is a very real concept: the dopamine pathways are affected and help during withdrawal is needed.
The concept of food addiction is controversial due to the difficulties with definitions and concepts and lack of rigorous scientific data. However there might be a marriage to be made by linking food addiction to other types of addiction, and researching where they fall together and where they don’t.
With regards to nutrition, it may be worth looking at different diets for different disorders, and at which neural pathways become damaged through abuse. Nutrition in recovery must be dense enough to bring people back into health, in order that they can take advantage of any other help that is being given.
Food allergy may occur without addiction but generally addiction is always accompanied by allergy. The addictive person tends to have an allergic history. Food allergy-addiction is rarely suspected because instead of an adverse reaction to the food, a positive ‘pick-me-up’ is experienced. The craving for certain foods is triggered by the need to stop the withdrawal symptoms caused by food addiction.
The relationship between allergy and addiction is often missed because the symptoms are masked or delayed: the body has gradually adapted to the allergen and learns to live with it. Because there are many different forms of the food allergy addictants (eg wheat comes as bread, biscuits, pasta etc), the stimulated state is maintained, and withdrawal is avoided.
This allergy-addiction happens because people with less robust digestive systems cannot break down certain proteins entirely, which results in morphine-like substances (exorphins) being produced to induce a dream-like state. The euphoria produced by exorphins eclipses the innate endorphins normally produced, creating a sense of need only met by consuming more of the particular food.
Testing involves a diet where the same food is not eaten for four days, during which period withdrawal and cravings will be experienced. After the avoidance period the body regains its ability to discriminate an allergen from an addictive substance, or an acute allergic reaction will ensue, convincing the patient that he was in fact allergic to his favourite food or drug.
Discrimination can be conscious or unconscious. It can be not what you do do, but what you don’t do. It can be the collective failure of an organisation, or one individual. Mostly discrimination is unintended. And this discrimination includes professional arrogance – the assumption that the professional knows best.
Duncan came from an atopic family, where the family history includes migraine, psoriasis, asthma and depression. Duncan was diagnosed with ADHD, but on the Feingold diet his symptoms reduced dramatically. Later he was diagnosed with dyslexia, and when put on omega 3 fatty acids underwent unprecedented improvement in only 3 months. At 15 he started to smoke cannabis, becoming addicted at 16. He was admitted to an adult ward to psychiatric hospital and faced attitude problems from the administrators from the very start.
In Duncan’s case, the knowledge his family had garnered over the years was ignored. Thankfully Duncan has recovered, but his case highlights the need to end professional arrogance and pay attention to each individual case. It is crucial to listen to the patient and the patient’s family, and to introduce the routine recognition of atopic clients.
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First Published in May 2010