By Lisa MacDonald

Lisa MacDonald, MPH, RD, is the Director of Nutrition Services at Cottonwood Tucson. Her expertise is in eating disorders, nutrition education and weight management. She is committed to scientific integrity and the "non-diet" approach to weight management. Lisa encourages connecting with the body and making informed food decisions as processes leading to a healthy relationship with food and body. Visit www.cottonwooddetucson.com or call 1-800-877-4520. Cottonwood Tucson, an internationally respected program, has been treating co-occurring disorders for more than 20 years and has experience in the treatment of complex and difficult issues. The services include the intensive Adult Program, the Sweetwater Adolescent Program, the InnerPath intensive small group retreats, and Agua Dulce, the extended care home for women. Cottonwood Tucson is CARF accredited. To learn more visit www.cottonwooddetucson.com See page 10 for recommended eating patterns in recovery.

How many people new in recovery really think about their diet? Or are they so focused on sobriety, nutrition is the last thing on their mind?

Let’s take a look at client, A.K., and her struggles with her nutrition. A.K. is a 39 year old single mom with alcohol dependence and depression. When A.K.’s addiction was active, she was consuming a tremendous number of calories from the alcohol. In addition, she was in a pattern of skipping meals followed by large fast food meals. This client had gained a significant amount of weight and had some health issues as a result. One would suspect that in sobriety weight loss would occur due to elimination of the alcohol calories.

However, new in sobriety, A.K. found herself relying on sugar and caffeine to take the place of the alcohol. Her schedule was busy with caring for her son, continuing her career and attending 12-step meetings so the cycle of skipping meals and relying on fast food continued. Her weight kept creeping up and A.K. was not feeling very good about herself. She wanted more sugar and caffeine to self soothe and desire for alcohol was increasing. A.K. quickly realized she was going to need to take care of herself differently in order to stay sober and be healthy.

A.K.’s story is not unusual. With addiction and mental health issues, the body often gets neglected. Inconsistent eating patterns and imbalanced nutrition influence emotional well-being as well as play a role in perpetuating the addiction cycle. How a person eats impacts their energy, concentration, moods, cravings and ability to moderate eating. It is so important that those in recovery view nutrition as supportive in the recovery process.

The Nutrition Prescription for Recovery

The nutrition prescription for recovery is individualized and flexible. There are many "perfect" meal plans out there promoted for health, recovery, energy, weight loss and so on, but every person has different taste preferences, food traditions, biology and schedules. Any nutrition plan must consider these influences on eating in addition to the science of nutrition for long-term success.

Even though an individualized approach is vitally important, let’s start with the basic principles of bringing consistency and balance to eating. Consistency and Balance are the mantra for nutrition in recovery and works for both men and women. Consistency means eating three or more (hopefully at least 4, but as many as 6) times per day and balance means including carbohydrate, protein and fat each time. Inclusion of foods rich in the B vitamins, Omega-3 fatty acids and magnesium (see chart), are also important to emotional well-being. Eating in this fashion keeps blood sugar stable leading to stabilized energy, improved concentration, stabilized moods and decreased cravings for sugar, refined carbohydrates and chemicals.

Energy and Concentration

The best way to describe how foods behave in our bodies energetically is to use the analogy of a fire. Carbohydrates (grains, fruits and veggies) are the flame of the fire. Eaten alone, they are burned and gone pretty quickly. Sugar and refined carbohydrates behave like lighter fluid or kindling, very rapid effect, but short lived. Complex carbohydrates will last a little longer, but really need the support of protein. Proteins (meat, poultry, fish, nuts, seeds, and soy) act as the log in the fire. Protein consumed by itself is like placing a log in a fireplace without a flame to ignite it. Fats (fat naturally occurring in foods as well as added fats; mayonnaise, olive oil, salad dressings etc) create the quality of a waxy Duraflame log or a candle. Eating often (three or more meals per day) is equivalent to stoking the fire, keeping the fire burning consistently. The most sustainable energy and ability to concentrate is attained by eating often and eating a combination of carbohydrate, protein and fat each time a meal or snack is consumed.

Mantra: consistency and balance will help with the management of energy and concentration

Moods

The mood connection with food is remarkable. Carbohydrates, specifically complex carbohydrates, are great contributors of the amino acid tryptophan which is a precursor to serotonin production in the brain. Serotonin is a neurotransmitter or brain chemical that boosts mood, curbs food cravings, increases pain tolerance and aids sleep, all of which are incredibly important to recovery. In addition to carbohydrate rich foods, turkey, lean meats, and dairy products are also good sources of tryptophan. Foods rich in vitamin B-6, B-12 and folic acid facilitate the creation of serotonin from tryptophan. Caffeine, sugar, high fat foods and alcohol deplete serotonin.

The amino acid tyrosine, with the help of folic acid, magnesium and Vitamin B-12, is the precursor to the neurotransmitter dopamine (the pleasure brain chemical) and norepinephrine (mental alertness brain chemical) production. Tyrosine is abundant in protein foods.

Interestingly enough, there seems to be a gender difference in biochemistry leading to desire for different types of food. In general women tend to be more serotonin driven than men and seek carbohydrates for comfort. Men seem to be more dopamine driven and look for protein foods. Regardless of gender we all need a balanced diet leading to the formation of all the neurotransmitters.

Choline, a fat-like substance found in wheat germ and eggs, is converted into the neurotransmitter acetylcholine. This nerve chemical is important in memory and mental functioning.

By including carbohydrates, proteins and fats each time one eats, the brain is being provided with the building blocks for the formation of neurotransmitters positively affecting emotional well-being.

Mantra: consistency and balance will help with the management of moods.

Cravings

Food cravings and cravings for substances are influenced by how one eats. Inconsistent and imbalanced eating create imbalances in the above mentioned neurotransmitters and create blood sugar fluctuations that increase desire for sugar, refined carbohydrates, caffeine and other chemicals. With alcohol addiction, abstinence often leads to increased desire for sugar. Sometimes this desire is sneaky and shows up as a fruit, fruit juice or sugary beverage craving. Fruit is healthy, right? Yes, but it is still sugar and needs to be eaten in appropriate quantities. In addition to sugar, caffeine often becomes a crutch in sobriety. Caffeine feels like fuel in the body due to its stimulant effect. This effect facilitates the skipping of meals leading to increased desire for more sugar, caffeine and typically overeating at a later time. Eating often and including carbohydrates, proteins and fats will help the management of cravings, both food and chemical.

Mantra: consistency and balance will help with the management of cravings.

Moderation of Eating

When nourishment is consistent and balanced we are able to respond to our bodies versus react. If blood sugar swings dramatically, the reaction is usually to overcompensate by overeating or choosing sugar, caffeine and refined carbohydrates. This blood sugar roller coaster ride can create significant weight management issues. Again, by eating three or meals per day and including carbohydrates, proteins and fats each time blood sugar is stabilized, eating is more moderate and weight is more easily managed.

Mantra: consistency and balance will help to moderate eating.

Other Helpful Tools

Eat mindfully-try bringing your full attention to the experience of eating by placing utensils down between bites of food and eating in silence for the first few minutes. Notice how the food looks, sounds, smells, tastes and feels. Eating truly involves all of those senses. Notice which foods feel the best and which foods are just not working. See if you can identify the point at which you have eaten just enough-not too much, not too little-comfortably satisfied. Did you know it takes 20 minutes for your stomach to let your brain know it has had enough? Eating mindfully helps one identify what is satisfying to the senses and helps one self regulate intake.

Plan ahead-carrying out good nutrition is much easier when there is a plan. Try planning 4-5 dinners for the week and shop for everything you need for those 4-5 meals. Having all the ingredients in the house allows for flexibility, not in the mood for tonight’s dinner, make tomorrow night’s instead.

Nutrition Issues in Recovery

As seen in the example of A.K., many nutrition issues may arise in recovery.

Food cravings have already been addressed, but are a significant issue. Weight management can also become a struggle, especially with some of the mood stabilizing medications. Now that chemicals are not going to be used as coping mechanisms, food and eating behaviors may become the next challenge. Eating disorder tendencies increase as chemicals are removed and emotional work is done. Food may take on the role of comfort, not eating may bring a sense of control, purging may become a way to express feelings. It is so important to make eating in a consistent and balanced fashion a priority, to stay tuned into eating behaviors in early recovery and to seek support if issues arise.

As mentioned earlier, with addiction, and mental health issues often one’s health may have been neglected. Liver disease, diabetes, heart disease and other metabolic disorders may arise. These disease states as well as many medications have nutrition implications. The basic principles for nutrition in recovery still apply, but there may be more specific nutrition recommendations to follow. It is important to work with physicians and dietitians for guidance regarding these issues.

Update on A.K.

One year later, A.K. is sober and more than 50 pounds lighter. Her cholesterol, blood sugars and arthritic symptoms have improved. A.K. utilized the nutrition prescription for recovery and had remarkable results. She made nutrition and exercise a priority in her recovery. A.K. is eating four times a day and is keeping her meals and snacks very well balanced. Most importantly, she is including foods she enjoys in her plan. Meal planning, food shopping and healthy cooking have become hobbies for her. A.K. is practicing mindful eating and encouraging her young son to do the same. She recognizes eating well, exercising and other forms of self care are vital to her sobriety.

In closing, remember nutrition is supportive in recovery. Make consistent and balanced eating a priority, a vital component to self care.