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Unlike other research examining weight trends in this population11,17, BMI ≥ 30 kg/m2 was an exclusion criterion for the parent study of the microbiome and it is possible that this cap affected the range and magnitude of weight change observed in this analysis. Nonetheless, the finding that individual weight change during detoxification is not consistent in either direction (weight gain or weight loss), highlights the need to assess the individual and provide a personalized approach to nutrition care. To quantify dietary intake and energy balance of patients with AUD during inpatient treatment. Vitamin E is an antioxidant that protects liver cells from alcohol-induced oxidative damage and may aid in liver tissue regeneration. Alcoholics have been found to have lower levels of vitamin E compared to non-alcoholics.

1.7. Alcoholic Cirrhosis

• Its other functions include immune enhancement, reduction in cancer incidence, inhibition of tumor invasion and metastasis, and in the form of radiation and chemotherapy treatments in clinical applications 151.
• B vitamins, for instance, are important for various metabolic processes in the liver, and deficiencies in these vitamins are especially common in alcohol users, leading to neurological and psychiatric symptoms.
• How long should such a diet be administered/followed to promote long-term recovery?
• For example, a severe deficiency of Vitamin B1 (Thiamine) can lead to the neurological condition Beriberi which is characterized by tissue swelling, nerve inflammation, and loss of muscle control.

Therefore, impaired absorption/metabolism of macro and micro-nutrients adds to the nutritional deficiencies resulting from reductions in total caloric intake. Even in AUD patients with proper dietary habits, impairments in absorption/metabolism could create additional barriers to overall health 55–60. Several studies have shown that blood vitamin levels are low in alcoholic patients.

Cognitive and Mental Health Impacts

Alcoholics often suffer from chronic health disorders requiring medical testing for proper diagnoses. Once a diagnosis is obtained, medical professionals provide treatment plans and nutritional support with continued care and monitoring. Treatment for Wernicke-Korsakoff Syndrome in alcoholics begins with recognizing the underlying medical condition and providing appropriate care. This includes administering thiamine supplements, a balanced nutrition plan, and medication management nutritional therapy for alcohol use disorder to treat any underlying mental or physical health issues. Finally, engaging in activities that stimulate longer-term memory (such as puzzles) can help maintain new learning and knowledge that may be lost soon after due to impaired short-term recall.

Supplements like magnesium, omega-3 fatty acids, zinc, probiotics, and vitamin D3 may also be beneficial but should be discussed with a healthcare provider before supplementation. A great deal of effort has gone into documenting malnutrition in addictive disorders. Reduced intake, impaired absorption, and metabolism of nutrients in alcoholism could dysregulate gut-brain feeding peptides and thereby energy homeostatic and hedonic systems, which could contribute to AUD and related pathology. While general nutrition support exists for hospitalized AUD patients, concerns have been raised about its adequacy. Furthermore, altered nutrition-related behavior in detoxifying patients warrants further investigation for its potential beneficial effects in recovery. Improved nutritional interventions targeting both macro and micro-nutrients are needed to address general malnutrition and impaired emotional and cognitive controls observed in AUD.

ALTERED NUTRITION-RELATED BEHAVIOR IN ALCOHOL ABSTINENCE: CLINICAL IMPLICATIONS

Other feeding peptides implicated in the pathophysiology of addictive disorders are nicely reviewed elsewhere 139, 142. Collectively, these preclinical and clinical studies highlight the involvement of gut-brain peptides in regulating alcohol reward and problematic alcohol drinking (refer to the studies 165, 179 for further detailed review). In addition, these peptides influence mood and emotional behaviors by interacting with brain corticostriatal-limbic circuitry 139, 180–182.

• Whether this heightened preference for sweets/palatable foods is an attempt to restore caloric deficits, alleviate the negative consequences of alcohol withdrawal, or both is less clear.
• Certain vitamins, including vitamins A, D, and K, should be administered with thiamine, folic acid, and pyridoxine to correct deficiencies 64,89.
• In a study regarding trace element levels in cirrhotic patients, there was a significant increase in serum manganese levels in patients with Child–Pugh C cirrhosis compared to patients with Child–Pugh A and B cirrhosis 114.
• In addition, these peptides influence mood and emotional behaviors by interacting with brain corticostriatal-limbic circuitry 139, 180–182.
• Passing through the brain blood barrier and entering the mitochondria of cells in the brain through monocarboxylate transporters, BHB is metabolized into AcAc and then into acetyl-CoA, which feeds into the TCA cycle (Figure 1).

In addition, the pathogenesis of liver damage, especially cirrhosis, further exacerbates nutritional disorders. One of the many risk factors for vitamin C (including the three forms of vitamin C) and E insufficiency is excessive alcohol intake 58,59. When compared to those who do not consume alcohol, urine ascorbic acid excretion increased by 47% after acute alcohol consumption of up to 0.58 g ethanol/kg body weight 61. Furthermore, short-term intravenous vitamin C therapy (500 mg/day for five days) significantly improved serum vitamin C levels in chronic alcoholics with hypovitaminosis C 64.

Patients who are seeking treatment for AUD often present with poor nutritional status and low appetite (44). Recently, Bornebusch et al. (7) retested the effect of a KD diet on alcohol withdrawal symptoms in mice, which included a KE-treated cohort. In two separate experiments, the researchers tested a “ketosis throughout” cohort, in which ketosis was induced during alcohol administration and abstinence, and a “ketosis after” cohort in which ketosis was induced only during abstinence.

Alcohol Recovery: Nutrition And Vitamin Interventions

Healthy, nutrient-dense foods are often more expensive than processed, low-nutrient options. This can make it difficult for some people to access or afford the necessary foods to support their recovery. Nutritional therapy is an integral part of the treatment of alcoholics and plays a vital role in early recovery. This therapy helps improve overall health, reduces cravings for alcohol, and replaces nutrient deficiencies caused by drinking. The most common tests used to diagnose chronic health disorders in alcoholics are blood tests, imaging scans, physical examinations, and biopsies 5. Blood tests measure substances in the blood and screen for nutritional deficiencies that can be indicators of certain disorders like diabetes or anemia.

1. Total Calories, Carbohydrates, Fats, and Proteins Recommended for ALD

Specific dietary and herbal supplementation could be beneficial in the due process. Finally, nutrition-related education and patient counseling beyond early detoxification stages could positively influence recovery outcomes. In summary, a complex interplay between malnutrition and alcohol use disorder further exacerbates AUD symptoms.

In AH patients, for example, a high-protein, high-energy diet should be administered enterally to AH patients without gastrointestinal bleeding complications; it is recommended that AH patients consume 1.2–1.5 g/kg protein and 35–40 Kcal/kg calories per day. Thiamine and other B vitamins should be administered during nutritional supplementation. When anemia is observed, supplementation with iron and folic acid should also be considered. Deficiencies in vitamins and trace elements commonly found in ALD often cause irreversible damage and should always be considered in ALD treatment.

Treatments for Alcohol Use Disorder

Alcohol-induced liver damage, extracellular matrix changes, and inflammation have all been linked to acetaldehyde 26,27. Its actions are triggered by the formation of ROS and a redox imbalance (NAD/NADH). Despite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for Alcohol Use Disorder (AUD). Vitamin D plays a role in reducing inflammation in the liver and may support overall liver health.

Supplementation with vitamin C can aid in liver recovery and reduce oxidative damage caused by alcohol consumption. Glucagon-like peptide 1 (GLP1) is an intestinal hormone that enhances insulin secretion, inhibits glucagon secretion, and decreases gastric motility (127). There is some clinical evidence that the concentration of GLP-1 is increased in response to high fat KDs (109, 128), although experiments in cell culture have yielded contradictory evidence (129). GLP-1 receptor activation by GLP-1 agonists suppresses the effects of alcohol on the mesolimbic dopamine system and decreases alcohol consumption and operant self-administration (130–135).

Alcohol-induced changes in the gut microbiota may contribute to alcohol-induced oxidative stress and intestinal hyperpermeability 9. Microbial therapy such as probiotics improve ALD by restoring normal intestinal flora and strengthening the intestinal barrier 10. Activation of Kupffer cells by intestine-derived lipopolysaccharides is also a major factor in ALD.