Alcoholism & Malnutrition

Array of fruits and vegetables lined up in rainbow color orderAlcohol consumption affects almost every part of the body and can often lead to malnutrition in individuals suffering from abuse, dependence, or addiction. Many, if not all, alcoholics will suffer from malnutrition, defined as a lack of proper nourishment. Malnutrition can negatively affect a person’s overall health and lead to numerous health complications, even death.

At Through the Archway, we typically see patients after a course of detox that allows the patient to eliminate alcohol from the body in a safe and controlled manner. This is crucial as alcohol dependence and addiction are among the few circumstances in which withdrawal can cause death if administered inappropriately. However, the physical effects of alcoholism can be longer-lasting in the form of nutritional deficiencies, many of which take time to correct. Because of the varied effects of these various deficiencies, nutritional management becomes a key component during and after treatment.

Several factors work together to make nutritional concerns so common in addicted individuals:

Digestion Problems

First, drinking large amounts of alcohol can interfere with digestion (the breakdown of large food molecules into nutrients) and absorption (the passage of these nutrients from the GI tract into the bloodstream). Alcohol can reduce the amount of macro- and micronutrients metabolized by the body, so even if a person is eating enough of the right foods, they may not be appropriately utilized by the body. This is because the digestive system doesn’t treat alcohol the same way as it does food; the body prioritizes eliminating alcohol because it recognizes that it’s a toxin that needs to be removed from the body. This is done via the digestive system, primarily the liver.

Liver Issues

Most of us know that the liver is one of the most negatively affected organs when it comes to the effects of excessive alcohol consumption. While we all dread the hangover and general next-day malaise, alcohol can cause swelling and inflammation of the liver; long-term drinking can lead to hepatitis, cirrhosis, chronic liver disease, or liver cancer. Even before these severe complications, alcohol reduces the liver’s ability to remove toxins from the body and move vital nutrients into the bloodstream. Without adequate nutrients, the cells, already weakened by prolonged exposure to alcohol, cannot do their job in reinforcing and maintaining bones, organs, etc. This also happens because alcohol is converted to acetaldehyde, which damages DNA – one of the main reasons alcohol is considered a toxin. After being injured, these cells do not have the energy to repair themselves, and the damage to the body continues in a vicious cycle. While the liver is very resilient and may be capable of regenerating itself, prolonged alcohol consumption reduces this ability.

Nutritional Deficiencies

Nutritional deficiencies are widespread in alcoholism. For example, a lack of thiamin (known as Vitamin B1) can cause loss of mental clarity, fatigue, loss of appetite, irritability, and emotional issues. This vitamin is often one of the first that becomes depleted with alcoholism. More severe mental confusion and memory loss may occur if the deficiency continues without treatment. In extreme cases, this can also contribute to Wernicke’s aphasia. This disease is categorized by poor language comprehension, in which a person may speak in long sentences without meaning. Speedy treatment with cessation of drinking and B1 supplementation is the best treatment for this condition.

A person struggling with alcohol addiction often does not eat enough to meet their nutritional needs. This may be due to the GI issues alcohol causes, such as nausea, diarrhea, constipation, or acid reflux. Even if not severe, these conditions can significantly decrease a person’s appetite and make eating difficult or painful. Severe vomiting and diarrhea that lasts more than a day can often cause dehydration, another potentially serious condition that, in extreme cases, requires hospitalization.

Further, a person may not feel hungry enough to eat since alcohol contains calories and can create a false sense of fullness combined with the fullness accompanied by drinking lots of fluids. This lack of healthy food consumption, like fruits and vegetables, can exacerbate severe nutritional deficiencies. The most common deficiencies seen with alcoholism are Vitamins A, C, D, E, and K. Electrolytes such as sodium, potassium, and phosphate are often problematically low. Severe cases can lead to cardiac arrhythmias, where the heart beats irregularly. Left untreated, these electrical malfunctions of the heart can significantly increase the risk of stroke, heart attack, and long-term heart failure.

Muscle Mass Concerns

Alcoholism can also lead to muscle wasting in clients who are not eating enough. This is especially common if a person is not eating enough protein, which is common in alcoholism. In a recent study based on data from the National Health Interview Survey (NHIS), alcoholics who fall into the “underweight’ category are at higher risk for dying from heart disease, cancer, and other causes. Alcohol is the third most common cause of preventable death in the U.S., believed to cause 10% of adult deaths. This link between alcoholism and weight means that nutrition is critical in preventing the diseases linked to alcohol.

Obesity

Conversely, excessive drinking can contribute to obesity. This is commonly seen in individuals who continue to drink in addition to their typical food consumption. Alcohol is relatively high in calories, and many drinks contain high amounts of sugar. If a person is binge drinking, they can consume hundreds if not thousands of extra calories daily. This can cause weight gain of up to several pounds per week. Alcohol-related obesity substantially increases the risk of heart disease, diabetes, and other chronic health and metabolic conditions.

Malnutrition related to alcoholism is prevalent and very serious. A person struggling with this addiction is often depleted of essential nutrients that help keep our bodies functioning. If a person continues to drink without external support, malnutrition will continue to progress, and the damage can become permanent and irreversible. In a rehabilitation environment, an individual struggling with alcohol addiction is typically given well-balanced nutrition and supplements. In time, along with abstinence from alcohol, this can help support a person’s return to a healthier nutritional status and a vastly improved quality of life.

Most importantly, patients need to seek help. Comprehensive dual diagnosis programs like Through the Archway and its companion mental health primary program, The Sylvia Brafman Mental Health Center.

References

  • Bunout D. Nutritional and metabolic effects of alcoholism: their relationship with alcoholic liver disease. Nutrition 1999; 15:583.
  • Adibi, S.A.; Baraona, E.; and Lieber, C.S. Effects of ethanol on amino acids and protein metabolism. In: Lieber, C.S., ed. Medical and Nutritional Complications of Alcoholism: Mechanism and Management. New York: Plenum Press, 1992. pp. 127–155.
  • Thun MJ, Peto R, Lopez AD, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med 1997; 337:1705.
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  • Bode, J.L.; Buchwald, B.; and Goebell, H. Inhibition of ethanol breakdown due to protein deficiency in man. German Medical Monthly 1:149–151, 1971.
  • Sarin SK, Dhingra N, Bansal A, et al. Dietary and nutritional abnormalities in alcoholic liver disease: a comparison with chronic alcoholics without liver disease. Am J Gastroenterol 1997; 92:777.
  • Feinman, L., and Lieber, C.S. Nutrition and diet in alcoholism. In: Shils, M.E.; Olson, J.A.; Shike, M.; and Ross, A.C.; eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore: Williams & Wilkins, 1998. pp. 1523–1542.
  • Gruchow, H.W.; Sobociaski, K.A.; and Barboriak, J.J. Alcohol nutrient intake and hypertension in U.S. adults. JAMA: Journal of the American Medical Association 253:1567–1570, 1985.
  • Lieber, C.S.Do alcohol calories count? American Journal of Clinical Nutrition 54:976–982, 1991a.
  • Cook CC, Thomson AD. B-complex vitamins in the prophylaxis and treatment of Wernicke-Korsakoff syndrome. Br J Hosp Med 1997; 57:461.
  • Pirola, R.C., and Lieber, C.S. The energy cost of the metabolism of drugs including ethanol. Pharmacology 7:185–196, 1972.
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