With everything we know about addiction today, why is it that we often miss the importance of something so basic as food as a key component in long-term recovery?

Over the last 30 years, the U.S. government has invested hundreds of millions of dollars on research aimed at understanding how drugs work - from the physiology of the brain to the sociology of addiction. We know about neurotransmitters, receptor sites, synapses, and electrochemical impulses. We have colorful pet scans to assist us in understanding the neuropathways of various chemicals. We have the scientific evidence to support and understand some of the cravings, mood swings, and irrational behavior, as well as the mental dulling and apathy people with addictions struggle to overcome. All of these help us better understand how chemicals affect the brain, especially in people with addictions. Yet, even though we literally "are what we eat," most of us continue to disrespect our bodies. Addiction treatment frequently focuses on the psychosocial aspects of the substance abuser's life. The biological focus of addiction often ends at the withdrawal management stage for acute intoxication and treatment of any serious medical problems. We have lost sight of the fact that the substance abuser's body has adapted over the years to the effects of chronic intoxication. The body needs energy, fuel, and nutrients to repair these systems. Recovery programs are constantly faced with the consequences of relapse triggers, relationship conflict, mood swings, fatigue, and memory loss. Where there is a problem in one area, there is often a rippling effect in other areas. For example, a client who is suffering with fatigue will have little patience for resolving a conflict within the family. When the fight happens at home, this will perhaps become a relapse trigger. Experience and research simply reinforce the importance of good nutrition as a recovery tool for repairing the brain and re-balancing the neurochemical systems.

Every action has a reaction

Alcohol is literally a poison to the liver. If the liver is diseased enough to be enlarged, then many other organs have been battered as well. The stomach, brain, and pancreas may be affected, as well as the heart, nervous, endocrine, and immune systems. Cocaine affects the neurochemistry of the brain, which in turn affects the nervous system - blood vessels close down, blood pressure goes up, and the pulse increases placing a strain on the heart. Cocaine use can also cause renal failure and birth defects. IV drug users are prone to abscesses. It takes a long time to repair these systems. The question of how to turn the damage around can only be answered by understanding the degree of wasting and disease in the body as well as which substances have been abused. By incorporating a proper nutrition program into the recovery process, many problems can be reduced or eliminated.

The balancing act

The first step is to begin the lengthy process of rebalancing the chemicals in your client's brain. From our observations of Bellwood clients and their eating habits, most people are unaware of the importance of maintaining body fuel levels and brain chemical balance. They don't understand that food plays a key role in how we feel and in turn, how we behave. Most substance abusers don't eat regularly, if they eat at all - and then it's often the wrong kind of food that remains in the body as fat.
There are only three appropriate fuel sources for the human body: carbohydrates, proteins and fats. Each will fuel the body. Some are more efficient and longer lasting than others. How they are combined and the quantity consumed will decide if food stays in the body as fat or burns efficiently in the form of physical energy and positive feelings. All substance abusers, regardless of their addiction, need a steady supply of complex carbohydrates in order to maintain consistent energy to the brain, which is necessary to maintain all of the other systems - nervous, endocrine, immune, and gastrointestinal. Cravings are directly related to the reduction of neurotransmitters and empty receptor sites that must be filled. When they are empty, the brain sends out signals for glucose (the byproduct of carbohydrates) so powerful that your client may crave a quick fix from whatever works at the moment. This may lead to a relapse. That is why maintaining a continuous level of the three major food groups is necessary. It is important to understand the role that each of these essential foods plays in the recovery process.

Carbohydrates

Carbohydrates are the first source of energy coming from foods of plant origin. Carbohydrates, unlike protein, minerals, and fats, are not building blocks for the human body but rather the fuel that runs the "engine" and are broken down in digestion into glucose. Everyone needs high quality, large molecule carbohydrates like those found in vegetables, beans, brown rice, nuts, and seeds to fuel the body. However, the amount of carbohydrates consumed should depend on the level of physical activity. In general, all addicts need increased carbohydrates to provide a consistent level of glucose (blood sugar) to maintain a continuous, integrated, electrochemical flow of messages in the brain to combat mood swings. Bellwood clients tell us that they now realize that a drop in blood sugar feels the same as craving for cocaine.
Complex carbohydrates take a longer time to split and enter the blood stream, which is beneficial due to the fact that as glucose enters the blood stream there is a parallel production of insulin. Insulin moves the glucose from the blood into the cells that need it - and the brain always needs glucose. However the brain does not need, nor can it use efficiently, low quality simple carbohydrates highly sweetened with sugars or starchy foods like white bread, bagels and pasta. Foods of this type convert into sugar in seconds in the mouth (Ross, 1999). The body cannot tolerate the amount of carbohydrates in highly processed foods like candy and cookies when it isn't balanced with protein, fiber, and fat.
An addict will tend to binge on simple carbohydrates, such as starches and sugars, while in withdrawal or when dealing with cravings in recovery. These food choices affect the brain's pleasure center almost as quickly as the user's drug of choice and, therefore, leave the addict crashing not long after they are consumed. When the improper food choice "high" wears off, the craving may send the client into relapse. Some clients may feel irritable or get a headache as soon as the middle of a meal, while others will crave salt and sugar mid-evening (Ross, 1999). Eating the proper amount of carbohydrates is ineffective if not balanced with protein and fat.

Protein

During the digestion process protein is broken down into amino acids, which are the building blocks that produce neurotransmitters and also help in building and maintaining body systems. Proteins provide long lasting energy, up to three-to-four hours. Although, one can get protein from foods of both plant and animal origins, the only complete protein is found in animal protein e.g., beef, chicken, fish, pork, cheese, eggs, milk, or cream. Red meat, much maligned, contains beneficial fats as well as important minerals (iron and zinc) that are essential (Ross, 1999). Plant sources contain incomplete proteins and therefore must be combined at a meal in order to be valuable e.g., nuts with beans, seeds with legumes, or lentils with tofu.
The individual in recovery will find carrying snacks of protein and carbohydrates will help them manage fatigue and cravings. At Bellwood we insist that our clients have three snacks of protein and carbohydrate daily along with three meals. For example, our chef provides vegetables and hummus dip, cheese and vegetable platters, or nuts and fruit between breakfast and lunch and again at 3 pm. In the evening, meat and fish sandwiches (on whole grain breads and rolls) are available for each client before they go to bed. Throughout the day there is always peanut butter and wholegrain bread for toasting at snack time. They are encouraged to drink eight glasses of water a day and to drink plenty of juices and herb teas. Protein powder is available as well. The emphasis on protein is to kick-start the production of neurotransmitters. We do not allow our clients to have coffee with caffeine or sweets for dessert. We do not encourage the habit of using sugar to replace the drugs of choice for addicts. This we believe will help them form new eating habits essential to combat cravings upon graduation.

Fat - The ultimate fuel

The calorie factor in fat is an issue, having double the calories of an equal weight of carbohydrate or protein. But it is not the only issue. Overeating foods containing fat - especially saturated fat should be avoided. However, fat in a meal, when combined together with carbohydrate and protein, provides a fuel supply that will last four to five hours. A substance abuser that has AIDs, is using heroin, and wasting away, is no different than any other substance abuser in terms of their nutritional needs. They must eat plenty of protein for cell building, a modest amount fat to ensure a slower digestion process, and a constant supply of high quality complex carbohydrates as well as nutritional supplements of minerals and vitamins. Our clients take a fortified multivitamin with minerals each day.
The greatest percentage of fat in the diet should come from monounsaturated fats (such as canola oil, safflower oil, olives, olive oil, avocados, and many nuts, including almonds, cashews, and peanuts). Avoid foods that contain saturated fats. (They are usually solid or almost solid at room temperature). All animal fats, such as those in meat, poultry, and dairy products are saturated. Processed and fast foods are also saturated. Vegetable oils also can be saturated. Palm, palm kernel and coconut oils are saturated vegetable oils. Also avoid hydrogenated oils - the body doesn't know how to deal with that fat (sometimes called "funny fat") so it shoots it into the arteries. Most of the packaged products in the grocery store contain hydrogenated oil for shelf life. So, have your client read their labels. Suggest they use cold pressed olive oil for cooking, and extra virgin olive oil or flax seed oil for salads or on toast. Flax seed oil should not be used for cooking as it becomes poisonous when heated. Most foods that contain protein also contain fat. Fats carry the vitamins A, D, E, and K and some contain essential fatty acids - which we all need. Some fat sources, such as salmon, tuna, mackerel, and flaxseed oil, contain essential fats such as Omega 3 and Omega 6. These fats help in the formation of cell membranes and control mood modulation, which is extremely important for those with addictions. Butter is a good source of fat, but should be used in moderation. Protein foods with very little fat are white fish, low fat cottage cheese, skim milk, legumes, and tofu. The trick is to control the intake and vary the source. The amount of fat appropriate for a meal might be between 10 and 20 grams depending on activity level (Martinic, 2000).
When the body feeds itself

If fuel levels drop and no food is available, the body is equipped to feed itself. This phenomenon is familiar to most substance abusers whose main caloric intake may be alcohol. They may have noticed that at times when they felt hungry, but did not manage to eat, they were no longer hungry after a period of time. This is due to the fact that they were starting to be fed by their body's store of glucose and protein. The brain releases hormones to the liver that signal it to release some of its stored glucose.
This will supply energy for about an hour. If they still do not eat, the liver will send out for some of their own protein cells, which can be converted to fuel for energy (Martinic 2000). Some of the protein used for fuel may be the lining of the intestinal tract or nutrient carriers from the bloodstream or muscle or parts of the immune system. With the constant skipping of meals the intestinal tract can eventually become damaged and digestion problems result.
However, repair starts with better eating patterns and that means three meals a day and three snacks a day. Clients stressed and accustomed to eating infrequently and improperly, often come to treatment saying, "that is too much food, I'll get fat." They say that if they have no breakfast they are not hungry at noon. But if they eat breakfast they are "starving" by lunchtime. We explain that because they had breakfast, the adrenal gland was not taking responsibility for feeding them all morning and stopping their appetites. People, who usually go all day with no food and are not hungry, have simply trained their adrenal gland, pancreas, and liver to keep them fed until dinner in the evening.
Our clients leave our facility feeling better about their bodies with a changed view of food and nutrition. They feel physically stronger and more capable of withstanding the significant challenges they must face after residential treatment. At our facility, clients unanimously thank Chef Daniel and his staff for the quality of the food and the difference this nurturing atmosphere has made in their lives, upon graduating. This was not always the case. There was a time when we served "institutional" food in a sterile hospital cafeteria atmosphere.
The results of prioritizing and improving the quality of meals and snacks as well as renovating our dining room to resemble a warm and lively French Bistro with music and fresh flowers, has made an enormous difference to our client's physical and mental health and our staff's morale. The stage is now set for clients and families to practice communication and healthy socially interaction in a fun atmosphere.

Delayed reactions

Having protein at regular intervals will not only maintain fuel levels for up to four hours, but it will also prevent a drop within the next 24 hours.
For example, if there is no protein at breakfast - even if all other meals and snacks during the day contain protein - there can be a drop in fuel shortly after dinner in the evening. This drop in fuel or blood sugar (blood glucose) can cause a sweet or salt craving. The fatigue you feel after lunch or mid-afternoon may be the delayed reaction from no protein at bedtime snack. At Bellwood we encourage clients to eat every two-and-a-half hours - three meals and three snacks daily. This regime will reduce mood swings and the cravings that can lead to relapse.

A case study

Addiction is a complex beast and not all cases can be handled in the same way. Recently a 52-year-old female senior executive for a major corporation came into treatment with an advanced case of cirrhosis due to chronic alcoholism and malnutrition. Her abdomen was distended dramatically due to an enlarged liver and ascites. She was severely jaundiced. Most of the staff had never seen such an extreme case, this being more prevalent in the 1950s, and 1960s. We were unable to put her on our regular meal regime. She had abused alcohol and denied the problem until she was left with five-percent usage of her liver - which could no longer process complete protein even though her body needed it to function and repair the damage.
We introduced vegetable protein - beans, lentils and light cheeses into her diet and reduced her fat and salt intake. She was exhausted easily. We insisted on six small meals, at least five servings of fresh fruits and vegetables every day, and less fluid. In addition to consultations and advice from a gastrointestinal specialist, our doctors continued to monitor her liver functions and weight (measuring fluid retention) weekly. Repair was slow. When she left our facility her skin was pale yellow (a huge improvement) and her belly was not nearly as distended. Nutrition will play a critical role in repairing her liver and other damaged organs. Fatigue will be an ongoing recovery issue. Her long-term prognosis is not good without a liver transplant and the fact that she is an alcoholic means a transplant may not be an option.

A rebirth of the spirit

Make no mistake - addiction is a degrading and destructive disease. The substance abuser will need to address many issues in order to stay clean and sober. It is a complex biopsychosocial disease requiring more than simply changing what we put into our bodies to tackle its devastating consequences. Addiction is cruel, unfair, blind, mysterious, and irrational. However, the experience of addiction can teach valuable lessons to us all. People can learn about addiction without being addicted and individuals with addiction problems must commit to doing whatever is necessary to stop their use of alcohol, drugs, and drug-like foods. Once understanding begins, a commitment to life and health will begin. A rebirth of the spirit will follow. Learning to respect and nourish one's body - which houses the essence of who we are - is essential for recovery. Just as learning to accept our shared vulnerability, imperfection, and need for each other and for values that surpass immediate personal pleasure, is truly the gift of addiction.

M. Linda Bell, ICADC, FACATA, CCS, is the president and CEO of Bellwood Health Services. Ms. Bell has lectured and designed addiction training programs for business, industry, and healthcare organizations across North America, including the Canadian Department of National Defence and the United States Navy. She can be reached via e-mail at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it or to purchase Ms. Martinic's book visit www.bellwood.ca

Connie Martin has been the executive assistant to the president of Bellwood for fours years. She is the editor of the Bellwood Newsletter and currently writes the president's keynote speeches and designs her presentations. She is the Canada Council Award winning author of "Happily Ever After...the dream," a play with music. Ms. Martin also conducts music therapy at Bellwood Health Services. She can be reached via e-mail at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
    Dupont, Robert L., M.D. (1997). The Selfish Brain, Learning from Addiction, Washington: American Psychiatric Press. Inc.,
    Martinic, Helen, RD. (2000). Food, Mood & Energy, Toronto, Norwest, 2nd. Edition.
    Ross, Julia. (1999). The Diet Cure, New York: Penguin.

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