Diet and Substance Use

Carbohydrates represent vital macronutrients in human and rodent dietary patterns, playing pivotal roles in essential metabolic pathways and providing essential energy for proper bodily functions. Maintaining sugar homeostasis and intake necessitates intricate hormonal and nervous system regulation to ensure proper energy balance within the body. This narrative review by Witek, Wydra & Filip (2022) delves into the repercussions of high-sugar diets (HSD) or sugar consumption during the perinatal and postnatal periods on neural and behavioral disruptions, as well as the development of substance use disorders (SUD). Emotional and behavioral disturbances may oftentimes predict SUD, which prompted the authors to explore how HSD exacerbates impulsive behavior, stress, anxiety, and depression. Moreover, besides its influence on mood disturbances, added sugar can contribute to food addiction, altering the sensitivity of brain reward neurotransmission signaling. These findings hold significance for evaluating sugar intake, particularly through maternal dietary patterns, from a clinical perspective aimed at preventing SUD or managing pre-existing emotional disorders. [NPID: Sugar, predictors of SUD, carbohydrates, glucose, sucrose, fructose, high-sugar diet, substance use disorder, vulnerability to SUD]

Dietary interventions for substance use disorders (SUDs) are rarely used in standard therapy. The aim of this study by Kemp et al. (2022) is to investigate the potential impact of diet on the results of early recovery. 33 participants chose to be in either the whole food, plant-based, 10-week therapy group or the conventional treatment center diet control group. To supplement the diet, both groups had access to weekly sessions in nutrition education. Participants completed examinations to measure mental health markers at baseline, week 3, and week 10. The Plant-based Diet Indices (PDI) and the Healthy Eating Index-2015 (HEI-2015) mean values were computed, while grounded theory was employed in the collection and analysis of semi-structured interviews. Analysis of the results revealed that HEI-2015 and PDI scores were considerably higher in the intervention group. Time had a statistically significant influence on all psychosocial outcomes, but not conditionally. In particular, the Rosenberg Self-Esteem outcome showed a significant condition by time interaction. The high PDI group exhibited substantially stronger resilience at 10 weeks (P =.031). Qualitative findings indicated that every participant derived significance and worth from the event. The authors comment that their results on early addiction therapy indicate that whole food plant-based nutrition has small but significant benefits, and that further research should be done on its application to the treatment of SUD. [NPID: Substance Use Disorder, plant based nutrition, vegetarian, vegan, diet]

When people are compelled to consume very appetizing food for enjoyment rather than to meet a caloric demand, this is known as hedonic hunger (HH). HH is not currently recognized as a disorder by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Earlier studies have found correlations in physiology, neurobiology, and therapy between HH, binge eating, and drug use, raising the possibility of food addiction (FA). The objective of this narrative review by Takgbajouah & Buscemi (2022) was to examine the literature on the developmental parallels between substance use, binge eating behavior, HH, and other use disorders to add to the body of evidence supporting a developmental model of use disorders, to support the recognition of FA as an official use disorder, and to guide the creation of interventions that specifically target modifiable symptoms related to use disorders. The authors summarize available research on the developmental variables connected to both HH and drug abuse. Adverse childhood experiences and attachment have been connected to drug use as well as unhealthy food patterns, insecure attachment, emotional dysregulation, obsessive behaviors, and drug abuse. Finally, In light of a developmental theory of use disorders and the formal inclusion of FA in the next DSM edition, the authors examined relevant clinical and research ramifications. [NPID: Food addiction, adverse childhood experiences, attachment, hedonic hunger, substance use]

Alcohol use disorder (AUD) leads to derangements in the gut microbiota population that negatively impact liver cirrhosis. Recent evidence points to fecal microbiota transplant (FMT) as a potential intervention to address the impact of alcohol consumption on the microbiome. In this double-blind, randomized clinical trial by Bajaj et al. (2020), the authors evaluated the FMT intervention in a population of 20 cirrhotic patients due to AUD (males, 65 ± 6.4 years of age, Model for End-Stage Liver Disease [MELD] score 8.9 ± 2.7, problem drinking AUDIT-10 score >8). The patients were divided into two groups, receiving either a placebo or an FMT enema (supplemented with Lachnospiraceae and Ruminococcaceae spp.). The participants underwent a myriad of comprehensive tests at the start of the study to collect data on their quality of life, cognition, alcohol craving (questionnaires), alcohol consumption (urinary ethylglucuronide/creatinine ratio), plasma/stool short-chain fatty acids (SCFAs), serum IL-6, serum lipopolysaccharide-binding protein, and stool microbiome (tested twice; at the beginning of the study and after 15 days. Finally, the participants were followed up at the 6th-month marker to conduct a serious adverse event (SAE) analysis. Analysis of the results revealed that the majority of participants receiving the FMT reported a substantial reduction in their cravings for alcohol (90%) compared to their peers receiving placebos (30%), had better cognition, quality of life, and a lower urinary ethylglucuronide/creatinine value. In addition, FMT recipients demonstrated a decrease in serum lipopolysaccharide-binding protein, serum IL-6, and an increase in butyrate/isobutyrate ratio, compared to placebo recipients, denoting a decrease in systemic inflammation. Analysis of the gut microbiota in FMT recipients demonstrated a higher Ruminococcaceae population in addition to several SCFA producers. SAE incidence was substantially higher in the placebo group compared to FMT recipients at the 6 months follow-up analysis. The authors conclude that their study demonstrates the safety and efficacy of FMT in reducing alcohol intake and cravings, improving the gut microbiome, and decreasing alcohol-related SAE in patients with AUD-related liver cirrhosis. [NPID: Alcohol use disorder, liver cirrhosis, gut microbiome, randomized clinical trial, fecal microbiota transplant]

Carbohydrates are essential macronutrients for both rodent and human dietary patterns. Carbohydrates are involved in key metabolic processes as sources of energy and are critical to homeostasis. The regulation of sugar metabolism and consumption involves several nervous and hormonal controls to maintain energy balance. Processed foods contain significant amounts of added sugars, which lead to cardiovascular, nervous, and metabolic derangements. Current epidemiological evidence demonstrates an uptrend in the consumption of sweet food items by both children and adults (including reproductive-age adults and pregnant women), which may impact future offspring’s health and pertinence to develop physical and mental pathological conditions during early life and adulthood. In this narrative review by Witek, Wydra & Filip (2022), the authors investigate how high-sugar diets (HSD) and sugar intake (particularly, fructose and glucose) during the perinatal and/or postnatal periods of life impact behavioral and neural development and its influence on substance use disorder (SUD), a disorder that could be predicted by some emotional and behavioral cues that were found to be influenced by HSD, in addition to stress, depression, and anxiety. These facts postulate viewing added sugars as a type of food addiction, able to modulate cerebral reward neurotransmission signaling, similar to the effect of food and other addictive substances. Through a search of Scopus, PubMed and the Multidisciplinary Digital Publishing Institute open-access scientific journals, the authors gathered relevant experimental studies, reviews, and epidemiological data (1990 - inception) and presented them in their review. [NPID: Carbohydrates, fructose, glucose, high sugar diet, predictors of SUD, substance use disorder, sucrose, sugar, vulnerability to SUD]

Countries around the world imposed several quarantine measures due to COVID-19. Sudden lockdown measures were postulated to enhance addiction-related behaviors, for example, screen use, caloric/salty food consumption, and substance use. In this study by Rolland et al. (2020), the authors investigated the changes in, and factors enhancing, addiction-related habits during the early COVID-19 containment phase in a population of 11391 French participants. During the study, the participants filled out web-based surveys for six days (days 8 to 13 of the COVID-19 containment), providing data on socio-demographics, general stress, psychiatric/addiction history, lockdown conditions, mental well-being, and changes in addiction-related behaviors. Analysis of the results revealed that study participants had enhanced addiction-related behaviors during the containment period, with increases observed in screen use, caloric/salty food, alcohol, tobacco, and cannabis use. In addition, the participants demonstrated a reduction in well-being scores and an increase in stress scores in conjunction with the rise in addiction-related behaviors. Females, young participants (<29), presence of a partner, small space confinement, solitary lockdown, and current or past history of receiving psychiatric treatment was associated with an increase in caloric/salty food intake, while female gender, age < 29, employment, having no partner, quarantine without access to outdoor spaces, intermediate/high education level, lockdown alone, unemployment and residing in urban environments were factors associated with an increase in screen time. Tobacco use was increased in participants who had no partners, females, employment in a workplace, and had an intermediate/low education level, while alcohol use was increased in individuals 30 to 49 years of age (n = 7108), currently receiving psychiatric treatment and highly educated. Finally, cannabis use was noted to increase in individuals who had an intermediate to low level of education. The authors conclude that the early phase of COVID-19 confinement was associated with an overall increase in several addiction-related habits, stress levels, and a reduction in well-being. [NPID: COVID-19, containment, eating behaviors, screen use, internet use, substance use, public health, mental health, pandemic, lifestyle, online survey, addiction]

Poor nutritional status is seen frequently in Substance Use Disorder (SUD). Amongst the essential dietary micronutrients, Vitamin B9 (folate) is especially important for health. In this prospective longitudinal cohort study by Bemanian et al. (2022), the authors evaluated the levels of serum folate amongst a population of SUD patients and explored the causative factors related to SUD on folate levels. 663 participants underwent annual evaluations of their serum micronutrient levels for five years (May 2016 to June 2020), revealing that 48% of participants suffered from low serum folate levels and that 23% were deficient in folate, with around 60% of the participants maintaining an unfavorable level of folate for at least one following assessment. Save for weekly use of cannabis and alcohol, no other substance was found to affect serum folate levels on weekly use. Injectable substances and higher doses of opioid agonist therapy medications (OAT), however, were linked to a reduction in serum folate. The authors conclude that their results highlight the necessity of recognizing and addressing nutritional challenges amongst populations with severe SUD. [NPID: Folate, nutrition, opioid agonist therapy, substance use disorder, vitamin]

The purpose of this 2020 article was to help clinicians identify the symptoms of food addiction, with the assessment process, case conceptualization, and the implementation of treatment strategies. There are logical steps that physicians can take to contextualize high food addiction scores, even when the use of validated research instruments is not practical. The current literature is lacking a description of a more comprehensive approach to the examination of food addiction. Firstly, dietary restraint should be considered since this can increase addiction-like eating behaviors and may even lead to false positive diagnoses. Moreover, the presence of symptoms of other psychiatric symptoms may guide treatments such as dietary interventions. Some people argue about the value of a food addiction diagnosis among patients with eating disorders such as anorexia nervosa (binge/purge-type), bulimia nervosa, and binge eating disorder. While a proportion of the population believe that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating, others have demonstrated that enhanced knowledge on the food addiction model can reduce stigma associated with obesity. This review aims to inform healthcare professionals on the diagnosis of food addiction, including the need to consider dietary restraint, and the signs of other psychiatric disorders such as substance use disorder, posttraumatic stress disorder, depression, anxiety, and attention deficit hyperactivity disorder. [NPID: substance, abuse, addiction, food addiction, addict, anorexia, bulimia, binge eating, eating, obesity, diet, PTSD, stress, ADHD, anxiety, depressive]

According to Qamar et al. (2019), the gut microbiome plays an important role in the body and contributes to digestive health, the immune system, and brain function. Changes in the diversity of the microbiota is said to influence human physiology and has been implicated in inflammation, depression, obesity, and addiction. Some animal studies have suggested that the gut microbiome even plays a role in the regulation of pain, emotion, and cognition. Furthermore, alcoholism has been associated with gut microbiome dysbiosis (disruption of gut microbiota balance) and can therefore have detrimental effects on the gut-brain axis balance. Imbalances in the microbiome have also been correlated with behavioral changes and alcohol dependence in the host. The aim of this study was to prove the connection between alcohol-induced gut microbiota dysbiosis and any behavioral consequences, through identification and analysis of relevant research. [NPID: substance use, addiction, drugs, inflammation, digestive health, the immune system, brain function, microbiota, inflammation, depression, obesity, addiction, pain, emotional regulation, cognition, dysbiosis, gut-brain axis]

This 2018 article discusses the potential roles of alcohol and the microbiome in the occurrence of psychiatric disorders. Alcohol consumption, and alcohol withdrawal, have been associated with the increase of known innate immune signaling molecules in the brain, and thereby with neuroinflammation. The microbiota has been demonstrated to also play a major role in this process. Thus, Hillemacher et al. explain that the disruption of this communication between the microbiome and the brain may be a significant factor in many psychiatric disorders. Modification in microbiota composition, also referred to as dysbiosis, may result in microbe-host dyshomeostasis and could have detrimental effects. Many pathologies are linked with alterations in the microbiota function and structure in the gut, suggesting a connection between dysbiosis and disease etiology, including irritable bowel syndrome depression, anxiety disorders, schizophrenia, and alcoholism. Alcohol-induced changes in the microbiome may elevate the risk of developing psychiatric disorders and may explain reward-seeking behaviors, anxiety, depression, and craving in withdrawal. [NPID: anxiety, substance use, addiction, drugs, alcohol, microbiome, gut-brain axis, withdrawal, immunity, the immune system, neuroinflammation, dysbiosis]

Hakimian et al. (2019) developed a new model of chronic opioid exposure that allows self-administration of opioids followed by periods of extinction, to mimic addiction in humans. Using this model, this study demonstrated that a diet high in omega-3 polyunsaturated fatty acids (n-3 PUFAs) can ameliorate oxycodone-seeking behaviors in the absence of drug availability and also reduce anxiety. Given the evidence that gut microbiota may have a hugely influential role in brain function, neuropathology, and anxiety, this study examined the microbiome composition and the effects of chronic opioid exposure and n-3 PUFA supplementation. The results showed opioid withdrawal leading to a significant depletion in specific microbiota genera, while supplementation with n-3 PUFAs were found to increase microbial richness, phylogenetic diversity, and evenness in the gut, and also reduced the basal activation state of microglia in the striatum. These findings, although preclinical, suggest n-3 PUFA-rich diets could be used in the alleviation of anxiety-induced opioid-seeking behavior and relapse in human opioid addiction. [NPID: substance use, addiction, drugs, opioids, animal, PUFAs, omega-3s, gut microbiota, neuropathology, anxiety, gut-brain axis, reward, reward pathways]

The purpose of this 2019 review was to discuss the potential beneficial effects of gut microbiota modulation in managing alcohol liver disease (ALD), a disorder caused by excessive alcohol consumption. ALD can be a broad range of hepatic injuries including asymptomatic steatosis, alcoholic steatohepatitis (ASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC), and its risk factors are highly variable. Among them, the intestinal microbiota and its metabolites have been identified as paramount in ALD pathophysiology, which is what Meroni et al. (2019) discusses in this review. It was mentioned that ethanol abuse triggers alterations in intestinal flora taxonomic composition, mucosal inflammation, and intestinal barrier derangement, which is what leads to pathogenic bacteria, Gram-negative microbial products, and pro-inflammatory luminal metabolites entering the bloodstream. [NPID: substance use, addiction, drugs, gut microbiota, alcohol liver disease, hepatic injuries, steatosis, alcoholic steatohepatitis, fibrosis, cirrhosis, hepatocellular carcinoma, gastrointestinal, gut microbiome, gut-brain axis, microbiota, ethanol, inflammation, mucosal inflammation]

The primary aim of this 2019 cross-sectional descriptive study was to uncover the prevalence of nutritional services and the utilization of registered dietitian nutritionists at substance use disorder treatment centers in Los Angeles. Wiss and his colleagues (2019) firstly identified 128 facilities that listed substance abuse as their primary focus of care by taking advantage of the Substance Abuse and Mental Health Services Administration Treatment Services Locator. The facilities within a 25-mile radius of the Los Angeles metropolitan area were asked what type of services they offered, the credentials of the professional providing the services, and whether any kind of nutrition services were available, all through a phone interview. The data collected revealed that only 39 sites (30.5%) offered any type of nutrition services on site, and the odds of a residential level of care offering nutrition services was 2.7 times higher than outpatient only facilities (p = 0.02). Moreover, less than 7% of the 39 facilities utilized the services of a dietician, while only 8 (20.5%) called for the services of a registered dietician nutritionist. The authors suggested including dietitian nutritionists in the treatment team of recovery programs designed to help with substance use disorder since it may lead to improved clinical outcomes. [NPID: substance use, addiction, drugs, Los Angeles, recovery]

Since evidence has been accumulating for gut microbiota’s role in eating disorders (EDs) and alcohol and substance use disorders, Temko and colleagues (2017) conducted this systematic review examining preclinical and clinical studies that evaluated the gut microbiota, EDs and alcohol and substance use disorders. The result was 12 original papers, some of which suggested that dysbiosis (gut microflora imbalance) and gut microbial byproducts may influence the pathophysiology of EDs via direct and indirect interference with peptide hormone signaling, and one of which conducted on mice implied that manipulations in the gut microbiota may also affect cocaine-related behaviors. Dysbiosis was actually shown to correlate with alcohol use disorder-related symptoms such as craving, depression and anxiety, supporting gut microbiota’s potential role in behavioral correlates of EDs and alcohol and substance use disorders. [NPID: substance use, addiction, drugs, eating disorders, recovery, alcohol, gut microbiota, dysbiosis, cocaine, craving, depression, anxiety]

With opioid overdose deaths rising in the United States, this 2019 review presents a biopsychosocial approach, that connects social and biological theories related to the addiction crisis, to help develop more effective preventative strategies. With genetic and epigenetic factors (those associated with brain reward pathways and impulsivity) known to predict addiction vulnerability, as well as evidence indicating environmental factors are marked contributors and psychosocial factors such as stress, trauma, and adverse childhood experiences are linked to emotional pain (leading to self-medication), Wiss’ biopsychosocial model integrates concepts from several disciplines and supports multicausality rather than a reductionist approach. The emerging role of nutrition therapy in the treatment of opioid use disorder is discussed, especially focusing on gastrointestinal health. While the author attempts to identify the risk and protective factors that may influence substance-seeking behavior, he presents potential solutions at multiple levels, considering both individual and population health. It was suggested that nutrition be given greater importance, along with cross-disciplinary collaborative efforts, new ideas, and fiscal resources in our efforts to tackle this epidemic. [NPID: substance use, recovery, addiction, opioid, prevention, reward, impulsivity, stress, trauma, drugs, childhood abuse, childhood, emotional pain, self-medication, gastrointestinal health]