Monday, January 16, 2017

Bolstering Your Body as You Recover from Alcohol Abuse

Here's an excerpt from the fifth edition of my book:

Alcohol spurs a pleasure center in the brain to produce a substance called dopamine. That's what creates that good feeling. The secret to healing alcoholism is finding other ways to get the “buzz” associated with dopamine without drinking. Diet and supplements are part of the solution.
What are the symptoms of alcohol abuse?

·         Frequent infections
·         Neglect of food intake
·         Night blindness
·         Numbness and tingling
·         Slow healing of cuts and scrapes
·         In men: Liver damage causing decreased testosterone levels and testicular atrophy, enlargement of the breasts, and erectile dysfunction.
·         In women after menopause: Liver damage causing increased estrogen levels and increased risk of estrogen-related cancers.

Alcoholics and other heavy drinkers experience a variety of nutritional problems. Some of these nutritional deficiencies are caused by an impaired ability to absorb nutrients. Others are caused by the fact that alcoholics tend not to eat. Alcohol stimulates appetite, but some of the same genetic alterations that predispose people to alcoholism also induce anorexia.                

Some problem drinkers have an abnormality in the brain’s production of the enzyme tyrosine hydroxylase. This chemical allows the brain to convert the amino acid tyrosine into the mood-lifting hormone norepinephrine. Chronic use of alcohol depletes the enzyme, and sets off not one or two but three vicious cycles.         

The first problem is that depletion of the enzyme by excess alcohol causes depression, and depression leads the alcoholic to drink. Since physical activity helps the remaining tyrosine hydroxylase work more effectively, alcoholics with this defect tend to be driven to remain active and alert. Their bodies burn more calories.   

The second problem is that depression leads to sugar cravings. Higher sugar levels clear alcohol out of the bloodstream, and the result is a craving for both alcohol and sugar. Finally, many alcoholics consume alcohol and sugar almost to the total exclusion of other nutritious foods—and even when these alcoholics do eat healthy food, their bodies have trouble absorbing nutrients.

What can you do to bring your drinking under control and remedy nutritional deficits?
·         Eliminate table sugar, sweets, pastries, and soft drinks sweetened with cane sugar or corn syrup.
·         Eat fruit in moderation. Do not eat dried fruit, citrus, or grapes.
·         Avoid bread, potatoes, and rice.
·         Unless you have been diagnosed as having cirrhosis, eat a protein food (preferably lean meat or soy) 3 times a day.
Nutritional Supplements
To help you control your drinking:
·         5-HTP: 400 mg daily.
·         Benfotiamine: 300-600 mg daily.
·         L-glutamine: 500–600 mg daily. (This is the minimum dose that is commercially available in the United States. A smaller dose would be sufficient. )
·         DL-phenylalanine (a mixture of D- and L-phenylalanine): 1,500 mg daily.
·         Pyridoxal-5’-phosphate (activated vitamin B6): 200 mg extended-release tablet.
To remedy nutritional deficits:
·         L-carnitine: 500 mg twice a day.
·         Magnesium: 250 mg with breakfast and in the afternoon.
·         Selenium: 200 micrograms per day.
·         Vitamin A: Only 5,000 IU per day.
·         Vitamin B: Any complete supplement (providing the RDA of all B vitamins), 3 times a day.
·         Vitamin C: 1,000 mg twice a day with meals.
·         Vitamin E: 400 IU per day.
·         Zinc picolinate: 30 mg per day.  

One of the most important things you can do to manage your health if you drink heavily is to avoid sugar. Alcohol aggravates the crash that follows a sugar high, making you want to drink to boost your blood sugar levels temporarily only to have them crash again. You can break this cycle by avoiding sugar. Eliminate table sugar, sweets, and pastries. Be especially careful to eliminate soft drinks sweetened with high-fructose syrup. In alcoholics, this form of sugar, more than any other, contributes to reactive hypoglycemia and the soar and crash cycle of sugar consumption.      

The most important nutritional supplements any problem drinker can take are those that help restore control over drinking. The supplement 5-HTP is a source of a form of the amino acid tryptophan that can easily enter the brain. The brain converts tryptophan into serotonin, which reduces carbohydrate craving and improves the quality of sleep. Benfotiamine, a concentrated form of vitamin B1 (thiamine) ameliorates brain effects of chronic disease, and may ameliorate or stop an alcoholism-related form of dementia known as Wernicke-Korsakov syndrome. It also helps the brain maintain the circuits that enable control over drinking. One clinical trial found that alcoholics who took benfotiamine drank as many as 1000 fewer drinks over a 6-month period while on the drug. The effects of the supplement are particularly pronounced in female alcoholics. L-glutamine helps the brain produce a chemical known as gamma-aminobutyric acid (GABA), which induces sleep. D-phenylalanine, a component of DL-phenylalanine, decreases alcohol craving by increasing the production of the reward chemical enkephalin in the brain. L-phenylalanine increases production of another reward chemical, dopamine, as well as a stimulant hormone, noradrenaline. This reduces depression. Pyridoxal-5’-phosphate, the activated form of vitamin B6, helps the gastrointestinal tract absorb amino acids. Alcoholics usually have a vitamin B6 deficiency.

Compared to the long-term effects of heavy drinking, any potential side effects of these five supplements are quite mild, but people who take prescription drugs must use caution. Avoid 5-HTP if you take antidepressants or St. John’s wort. The combination can cause an unhealthy elation or euphoria known as serotonin syndrome (see Depression). L-glutamine does not react in any detrimental ways with prescription drugs, although people with bipolar disorder should only use it under supervision. In very rare cases, L-glutamine has aggravated manic symptoms. People taking one of the older-style antidepressants such as imipramine (Tofranil) should not take phenylalanine. The combination can also cause elation or euphoria with impaired judgment. If you have high blood pressure, check your blood pressure every day when taking phenylalanine. Discontinue the supplement if your blood pressure is unusually elevated (by more than 10 mm/Hg for either the higher or lower number). Pyridoxal-5’-phosphate can interact with prescription drugs for arrhythmia, asthma, epilepsy, Parkinson’s disease, and tuberculosis, increasing their toxicity.

The next group of supplements offers you a degree of protection against the worst long-term effects of heavy drinking. Excessive alcohol consumption impairs the liver’s ability to synthesize the amino acid L-carnitine. This amino acid is critical for the ability of the heart and the skeletal muscles to make energy from fatty acids during times of oxygen deprivation or other kinds of stress. It also helps protect the brain from tissue degeneration similar to that in Alzheimer’s disease. L-carnitine helps protect against alcohol-induced fatty liver disease. It helps your liver process dietary fat, increases the production of HDL (“good”) cholesterol, and lowers triglycerides.

L-carnitine is nontoxic. People with HIV and AIDS who take didanosine (ddI), stavudine (d4t), or zalcitabine (ddC) cocktails and anyone treated with the antibiotics pivampicillin, pivcephalexin, or pivmecillinam (primarily used in Europe and Latin America) is likely to be deficient in L-carnitine and especially needs this supplement.     

Some researchers believe that magnesium deficiencies cause the alcohol withdrawal symptom known as delirium tremens (DT), a terrifying combination of un controllable shaking and hallucinations. Magnesium deficiency is likely to be the major reason heavy drinkers are a high risk for heart disease.

Don’t overdose magnesium. In addition to its role as a dietary supplement, magnesium is part of the active ingredient in milk of magnesia, the laxative. You should also avoid taking magnesium while you are on any antibiotic. Magnesium reduces the body’s absorption of most antibiotics. Eating green beans, rhubarb, spinach, or sweet potatoes within 2 hours of taking magnesium keeps your body from absorbing the supplement, so unless you eat green beans, rhubarb, spinach, or sweet potatoes for breakfast or on your coffee break, take magnesium with breakfast and in the afternoon.                 Selenium, vitamin C, and vitamin E are antioxidants that prevent destruction of liver cells. Taking these antioxidants before you drink moderates the toxic effects of alcohol on the liver and helps prevent fatty liver. Selenium is better absorbed if it is not taken at the same time as vitamin C.              
Vitamin A and zinc deficiencies produce the major complications of alcohol abuse: poor night vision, slow healing of wounds to the skin, depressed production of testosterone and estrogen, and poor immune function. Alcohol interferes with the intestines’ability to absorb vitamin A and zinc, and the liver’s constant need to manufacture the detoxifying enzymes alcohol dehydrogenase and acetaldehyde dehydrogenase depletes the vitamin A and zinc that make it through the intestines. Tissue damage makes it impossible for the liver to store these nutrients or to process them in large quantities. Only consistent, low-dose supplementation can correct this problem as long as you drink.    
People who drink heavily should take no more than 5,000 IU of vitamin A per day. This dosage will not cause birth defects and is safe for women who may become pregnant (although alcohol is not safe for the baby). The first signs of vitamin A overdose are dry skin and chapped lips, especially in dry weather. Later signs of toxicity are headache, mood swings, and pain in muscles and joints. In massive doses, vitamin A itself can cause liver damage. Discontinue vitamin A at the first sign of toxicity.

Do not take more than 50 mg of any zinc supplement daily. In rare cases, excessive intake of zinc depletes copper to cause anemia, that is, a deficiency of red blood cells, and neutropenia, a serious deficiency of white blood cells.            

The liver’s constant need to make detoxifying enzymes also stresses its ability to activate various types of vitamin B. High levels of alcohol in the bloodstream cause the kidneys to excrete folic acid, and a deficiency of thiamine results in a greater urge to drink. 
Vitamin B12 can help correct numbness and tingling. Vitamin B deficiencies are most severe in heavy drinkers who also use diuretics, especially furosemide (Lasix), or medications for asthma, bipolar disorder, or seizures. Women who drink heavily and use oral contraceptives also tend to have vitamin B deficiency.          

Don’t take a vitamin B tablet with coffee, tea, or herb tinctures. Tannins in coffee, tea, and tinctures can deactivate thiamine. Ask your doctor before taking vitamin B and any prescription drug for arrhythmia, asthma, epilepsy, Parkinson’s disease, or tuberculosis. Vitamin B6 (pyridoxine) can increase their toxicity.

Concepts for Coping with Alcoholism and Alcohol Abuse

·         Any kind of steroid drug, whether an anabolic steroid or cortisone shot, increases cravings for alcohol.

·         The “munchies” are your body’s way of fighting depression. Eating carbohydrates increases the amount of sugar in your bloodstream. This “pushes” an amino acid use to make antidepressant serotonin into your brain. If you have frequent attacks of carbohydrate cravings, consider taking steps to deal with depression.

There is a biological reason people who drink heavily tend also to smoke. Researchers at Texas A&M University Health Science Center in Temple, Texas, found nicotine can reduce blood-alcohol concentrations. The physicians conducting the study believe this effect may be because nicotine causes food and drink to stay in the stomach longer, where the alcohol is broken down rather than absorbed by the body.

A medication prescribed to prevent alcoholics from drinking may actually worsen the problem for some people. Researchers at the Brown University in Providence, Rhode Island and at the Providence Veterans Affairs Medical Center found the drug naltrexone causes alcoholics with a specific gene variation to have a greater urge to drink. Naltrexone is used to reduce alcohol cravings. The Rhode Island researchers recruited 90 men and women identified as heavy drinkers. The scientists discovered gene variations among the participants. Depending on which gene variation they had, the participants either had no reaction to the drug at all, the expected decrease in urges to drink, or an increased urge to drink alcohol.

Manzardo AM, Pendleton T, Poje A, Penick EC, Butler MG. Change in psychiatric symptomatology after benfotiamine treatment in males is related to lifetime alcoholism severity. Drug Alcohol Depend. 2015 Jul 1;152: 257-63. doi: 10. 1016/j. drugalcdep. 2015. 03. 032. Epub 2015 Apr 8. PMID: 25908323. Abstract.

Manzardo AM, He J, Poje A, Penick EC, Campbell J, Butler MG. Double-blind, randomized placebo-controlled clinical trial of benfotiamine for severe alcohol dependence. Drug Alcohol Depend. 2013 Dec 1;133(2): 562-70. doi: 10. 1016/j. drugalcdep. 2013. 07. 035. Epub 2013 Aug 11. PMID: 23992649. Abstract. 

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