Diet and Substance Use
The CNP Diet and Substance Use Research Category consolidates research exploring the interdependent relationship between dietary intake and substance use. To view each original study on the open internet, click “Original.” To view the CNP-written abstract summary, click “CNP Summary.” While only some of the CNP-written abstract summaries are available below for free, all abstract summaries are available to CNP members through the CNP Library Membership.
FEATURED CNP RESEARCH SUMMARY
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.
2022
A high-sugar diet consumption, metabolism and health impacts with a focus on the development of substance use disorder: A narrative review
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]
2020
Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: Survey study
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]
2022
Folate status as a nutritional indicator among people with substance use disorder; a prospective cohort study in Norway
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]
CNP Research Summary can be found in the CNP Library Membership
2020
Food addiction and psychosocial adversity: Biological embedding, contextual factors, and public health implications
There are several factors that may usher drug and food addictions, of which, stress, trauma, and adversity are of remarkable importance in early life settings. Published works identified the relationship between traumatic stress and substance abuse, however, the links between food addiction and obesity are not well understood. In this review by Wiss et al. (2020), the authors explore the psychosocial and neurobiological contributors to addiction-like patterns that lead to increasing BMI throughout the lifespan of an individual. It is postulated that adversity during early childhood and adolescence may lead to enduring glucocorticoid and dopaminergic derangements, increasing the vulnerability to addiction in later life. The authors bring more focus on allostatic load (the increasing load of chronic stress and life events), the hypothalamic-pituitary-adrenal axis, and the role of epigenetics in biological embedding (the pathology behind how experiences lead to physiological side effects). The authors present a conceptual model for food addiction, which recognizes the biological planting of hardship and the role of many factors, in addition to discussing the relationship of dietary restraint (a symptom of eating disorders) to the context of food addiction. The authors comment that the concepts behind several public health and policy recommendations are established on the foundation that enhancing the understanding of biopsychosocial mechanisms behind food addiction could help reduce the stigma linked to obesity and eating disorders.[NPID: Adverse childhood experience, biopsychosocial, dopamine, early life adversity, eating disorder, epigenetics, food addiction, obesity, stress, trauma]
2020
Separating the signal from the noise: How psychiatric diagnoses can help discern food addiction from dietary restraint
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]
CNP Research Summary can be found in the CNP Library Membership
2021
Microbiome and substances of abuse
While there is a growing body of evidence indicating correlations between the gut microbiota (microbial community in the intestine) and the brain, this 2021 article looked at the relationship between the gut microbiome and substances of abuse. Alcohol has been the most widely investigated substance of abuse in this field up to now. In some patients with alcohol-use-disorder, alcohol intake has been seen to alter the gut microbiota composition and the permeability of the intestinal barrier. To add to this, alcohol has been found to induce inflammation, although it is unclear in human studies whether it is central inflammation that occurs. Animal studies have determined that neuroinflammation increases during alcohol withdrawal. There has been less research conducted on opioids and stimulants. The available literature showed that chronic morphine intake causes an unbalancing of the gut bacteria (called dysbiosis), an increase in intestinal permeability, and likely leads to neuroinflammation. These effects may explain symptoms such as tolerance, hyperalgesia (increased sensitivity to or extreme response to pain), and deficits in reward behavior. So, while substances such as cocaine can induce dysbiosis, the microbiome can modulate the behavioral response to stimulant drugs. Moreover, quitting tobacco use is associated with increased microbiota diversity. All in all, the findings of this narrative review suggest that there is a bidirectional influence in the development of substance use disorders. [NPID: substances, abused, tobacco, cigarettes, alcohol, cocaine, opioids, microbiota, bacteria, gut, intestine, stimulants, drugs, inflammation]
2019
Meta-analysis of alcohol induced gut dysbiosis and the resulting behavioral impact
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]
CNP Research Summary can be found in the CNP Library Membership
2016
The role of the gut-brain axis in alcohol use disorders
Gorky & Schwaber (2016) believe that the inflammation found in the amygdala in alcohol exposure and withdrawal may cause disturbance of neural function and could be observed as anxiety and autonomic distress in withdrawal. Since the mechanisms contributing to this response are not known, this article reviewed the literature that implicates alcohol and other substances of abuse with the cause of gut microbiome dysbiosis. There is evidence that suggests that gut dysbiosis contributes to neuroinflammation (particularly in the context of alcohol exposure and withdrawal), the neuroinflammation in the amygdala affect the effects of the microglia and astrocytes on neural cells, and that amygdala neuroinflammation itself contributes directly to withdrawal behavior and symptoms. Since the gut is associated with the anxiogenic response (cause of anxiety), modification of the gut microbiome serves as a safe and promising therapeutic strategy for patients suffering with withdrawal symptoms. [NPID: substance use, addiction, drugs, inflammation, amygdala, withdrawal, alcohol, anxiety, autonomic distress, dysbiosis, neuroinflammation]
2018
Alcohol, microbiome, and their effect on psychiatric disorders
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]
CNP Research Summary can be found in the CNP Library Membership
2021
A biological framework for emotional dysregulation in alcohol misuse: From gut to brain
Here, Carbia et al. (2021) outline the overlapping impacts of chronic alcohol use, inflammation, and microbiome modifications on brain circuitry in the front of the limbic system. This article also goes on to discuss the interdependent relationship between social cognition, immunity, and the microbiome in connection with alcohol misuse (from binge drinking to addiction). While repeated intoxication with alcohol promotes inflammatory processes and sensitization of the immune system, the inflammatory cascade in alcohol use disorder (AUD) is also regulated by modifications in the gut microbiota. In addition, the microbes in the gut have been implicated in influencing social and emotional cognition. Since inflammation and social cognition are potent modulators of one another, the role of the gut microbiota seems to be a common underlying feature in both alcohol use disorder and addiction. The author here proposes a framework of how emotional dysregulation and alcohol-related microbiome dysbiosis could accelerate the cycle of addiction. Adolescence is highlighted as a sensitive period for the developing gut-brain axis, as alcohol’s harmful effects and emotional dysregulation meet one another. [NPID: substance use, addiction, drugs, inflammation, brain circuitry, limbic system, social cognition, immunity, binge drinking, inflammation, emotional cognition, emotion dysregulation, dysbiosis]
2019
Dietary supplementation with omega-3 polyunsaturated fatty acids reduces opioid-seeking behaviors and alters the gut microbiome
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]
CNP Research Summary can be found in the CNP Library Membership
2020
The mechanism of dysbiosis in alcoholic liver disease leading to liver cancer
This 2020 review discusses the role of alcohol-induced dysbiosis in the development of alcoholic liver disease (ALD) and its progression to hepatocellular carcinoma (HCC). Méndez-Sánchez et al. (2020) explains that the increased metabolism of ethanol in the gut, as a result of excessive alcohol consumption, promotes gut dysfunction and bacterial overgrowth, and sets a leaky gut. The bacteria, endotoxins, and ethanol metabolites then reach the liver through the enterohepatic circulation, leading to the activation of the nuclear factor kappa-B pathway and release of pro-inflammatory cytokines and chemokines via specific Toll-like receptors of liver cells. The HCC is a result of the promotion of hepatocytes’ mitogenic activity and the inhibition of cellular apoptosis that follows the cytokine and chemokine secretions. Drugs designed to regulate microbiota have proven effectiveness in prolonging the overall survival of patients with hepatocellular carcinoma, which has increased support for its employment as a co-adjuvant for HCC treatment. [NPID: substance use, addiction, drugs, dysbiosis, alcoholic liver disease, hepatocellular carcinoma, gut dysfunction, bacterial overgrowth, leaky gut, endotoxins, ethanol metabolites, enterohepatic circulation, pro-inflammatory cytokines, HCC]
2019
Alcohol or gut microbiota: Who is the guilty?
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]
CNP Research Summary can be found in the CNP Library Membership
2018
Registered dietitian nutritionists in substance use disorder treatment centers
This 2018 article introduced a “holistic” approach for treating substance use disorder (SUD) involving healthful eating. Wiss et al. (2018) explains the urgent need for improved treatment modalities that would prevent overdose and death, reduce the health care burden, and improve the populations’ quality of life. Interest in food and nutrition in relation to addiction was first documented in 1955 when the relationship between hunger and coca leaf consumption was studied. There have been many experiments ever since but due to the ethical and legal challenges with controlled trial research involving use of illicit substances, most of the data remain retrospective, speculative, and underpowered. [NPID: substance use, addiction, drugs, recovery, overdose, quality of life, coca leaf]
2019
Rapid assessment of nutrition services in Los Angeles substance use disorder treatment centers
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]
CNP Research Summary can be found in the CNP Library Membership
2019
Chapter 2 - The role of nutrition in addiction recovery: What we know and what we don't
This 2019 review presents the impacts of alcohol, cocaine, methamphetamine, and opioids on nutritional status, by exploring gut health, microbiome, and associated neural interactions in particular. Not only are the homeostatic and hedonic mechanisms of eating behavior discussed, Wiss (2019) delves into effective treatment modalities: he mentions human research that made a case for individual nutrition counseling, group education, and the implementation of food service guidelines. The prioritisation of recovery programs were suggested also to improve eating habits, overall health, and importantly to tackle the crisis of addictive disorders. Not only would promoting good nutrition be cost-effective but it would lead to improvement of resource allocation. Therefore, Wiss (2019) feels that public health measures promoting nutrition standards in treatment settings should be implemented. [NPID: substance use, addiction, drugs, alcohol, cocaine, methamphetamine, opioids, gut health, microbiome, neural interactions, hedonic, hedonism, recovery]
2017
The microbiota, the gut and the brain in eating and alcohol use disorders: A ‘ménage à trois’?
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]
CNP Research Summary can be found in the CNP Library Membership
2019
A potential role for the gut microbiome in substance use disorders
Meckel & Kiraly (2019) summarize the clinical and preclinical evidence suggesting a potential role for gut dysbiosis (imbalance of gut microflora) in the pathogenesis of substance use disorders. The role of alterations in gut microbiome and its metabolites (which occur as a consequence of substance use disorders) in mediating behavioral response to drugs of abuse was also explored. While these substance use disorders remain a major public health crisis with limited effective treatment options, improving our understanding of gut microbiome’s role in these disorders may offer a promising avenue for developing novel therapeutic products. [NPID: substance use, addiction, drugs, gut dysbiosis, gut microflora, gut-brain axis, recovery, drugs]
2019
A biopsychosocial overview of the opioid crisis: Considering nutrition and gastrointestinal health
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]