Nutrient Deficiencies In Alcohol Use Disorder

The National Institute on Alcohol Abuse and Alcoholism estimated that in 2015 over six percent of adults in the United States, including approximately 9.8 million men and 5.3 million women, suffered from alcohol use disorder. (11) According to results of the 2018 Canadian Community Health Survey (CCHS), approximately 5.9 million people in Canada are considered heavy drinkers. (16) In addition to the negative impact on the social, relational, and emotional well-being of sufferers, alcohol use disorder may also have physical health consequences. Among these consequences are deficiencies in nutrients, such as protein, vitamins, and minerals, as well as the associated health complications.

Read on to learn about alcohol use disorder, associated nutrient deficiencies, and dietary nutrients in the treatment of alcohol abuse.

What is alcohol use disorder?

Alcohol use disorder (AUD) is the medical term for alcohol abuse, addiction or severe problem drinking. AUD is characterized by the inability to control alcohol intake, compulsive alcohol use, and a negative emotional state when not drinking. (11) The Centers for Disease Control and Prevention defines excessive drinking as consuming:

• Over four drinks on a single occasion or eight drinks per week for women, and
• Over five drinks on a single occasion or 15 drinks per week for men (3)

Understanding nutrient deficiencies

Nutrient deficiencies can be broken down into two main categories: macronutrient deficiencies (components in food that provide energy, namely carbohydrates, fats, and proteins) and micronutrient deficiencies (vitamins and minerals).

Nutrient deficiency can occur for several reasons, including:

• Certain medications (e.g., diuretics, oral contraceptives, proton-pump inhibitors, statins)
• Impaired digestion or nutrient absorption
• Increased metabolic nutrient loss (e.g., critical illness, aging)
• Increased nutrient requirements (e.g., during adolescence, pregnancy, and lactation)
• Low dietary intake
• Poor-quality diet (1)(9)

Several of these factors may contribute to AUD-related nutrient deficiencies, and are explored further below.

Individuals with alcohol use disorder may become nutrient deficient due to decreased dietary intake and quality.

Complications of alcohol abuse

According to the National Institute on Alcohol Abuse and Alcoholism, individuals who abuse alcohol commonly eat poorly, (10) which may lead to poor overall diet quality and reduced intake of essential nutrients. Furthermore, alcohol intake may reduce the secretion of pancreatic enzymes, damage cells lining the gastrointestinal tract, and impair the transport, storage, and excretion of nutrients. These mechanisms may contribute to impaired breakdown of food and absorption of nutrients, resulting in the nutrient deficiencies seen in AUD. (5)

The nutrient deficiencies commonly associated with AUD include:

• Calcium
• Iron
• Magnesium
• Thiamine (vitamin B1)
• Vitamin A
• Zinc (5)

Research suggests that the nutrient deficiencies seen in AUD may contribute to further complications, including alcoholic myopathy, osteopenia, osteoporosis, anxiety, and depression. In individuals with AUD, poor nutrient status may impact the ability to regain good health and overcome substance abuse. (6) Nutrient deficiency symptoms include general weakness, fatigue, impaired memory, and numbness and tingling in the hands and feet. (1) Furthermore, mineral deficiencies may result in mineral deficiency diseases, such as zinc-related night blindness and skin lesions. (5)

Alcoholic liver disease in alcohol use disorder

In the United States, alcohol intake is also the number one cause of liver disease. (16) Alcoholic liver disease (ALD) is characterized by a history of alcohol abuse and liver disease, including alcoholic fatty liver, alcoholic hepatitis (chronic liver inflammation), fibrosis (scarring and thickening), and cirrhosis (an advanced stage of scarring that impairs organ function). (2)

Nutrient deficiencies in individuals with ALD may be a result of inadequate calorie consumption, replacement of nutritious food with calories from alcohol, side effects of certain medications, as well as maldigestion and malabsorption resulting from a decrease in bile and pancreatic enzyme production. (4)

Several nutrient deficiencies have been associated with ALD, including:

• Cobalamin (vitamin B12)
• Folate
• Magnesium
• Protein
• Thiamine (vitamin B1)
• Vitamin C
• Vitamin D
• Zinc (14)

Research in individuals with ALD has found that the severity of malnutrition is positively correlated with the severity of the disease. (8)

Dietary nutrients in the treatment of AUD

Nutritional interventions in AUD are complex and should be personalized depending on an individual’s nutrient and health status. In some cases, the absorption and/or metabolism of oral dietary supplements may be impaired, and intravenous vitamin supplementation may be required. (7) While we recommend working with an integrative practitioner experienced in AUD or ALD, below are several examples of dietary nutrients that may be beneficial in individuals with alcohol use disorder.

Electrolytes

The group of elements including sodium, potassium, calcium, magnesium, chloride, phosphorus, and bicarbonate are known as electrolytes. Electrolytes play an essential role in maintaining fluid balance, regulating nerve and muscle function, and maintaining acid-base balance. (15) Electrolyte disturbances are common in individuals with AUD, and it may be necessary to replenish electrolytes. (8)(13)

Branched-chain amino acids

Branched-chain amino acids (BCAAs), which include leucine, isoleucine, and valine, are a group of essential amino acids. Amino acids are organic compounds that are the building blocks of protein. Levels of BCAAs may be reduced when there is cirrhosis of the liver. While there are mixed findings regarding supplementation of BCAAs in ALD, recent randomized controlled trials in patients with alcoholic cirrhosis suggest that long-term supplementation of BCAAs may improve quality of life while decreasing the risk of morbidity and mortality. (14)

As a dietary supplement, BCAAs are commonly found in powder format.

B vitamins

Excessive alcohol intake is associated with deficiencies in the water-soluble vitamins thiamine (B1), pyridoxine (B6), folate (B9), and cobalamin (B12). (4)(14) Supplementing with folate and vitamin B12 may be required in cases of alcoholic hepatitis in order to protect liver cells and assist in the repair of damaged cells. Additionally, thiamine and pyridoxine deficiency are associated with primary tissue damage and neurologic disorders, respectively. (4) B vitamins are commonly formulated as B-complex supplements, containing all eight B vitamins.

Vitamin C

A water-soluble antioxidant, vitamin C helps to protect cells in the body from oxidative stress and damage. A review study in the British Medical Journal found that vitamin C supplementation may increase blood ethanol clearance, suggesting that the vitamin may also play a role in the metabolism of alcohol. (7)

Vitamin D

Individuals with alcoholic liver disease may have a decreased ability to store fat-soluble vitamins, including vitamin D. (4) Vitamin D deficiency is associated with a reduced immune response and increased risk of certain infections, (12) as well as an increased risk of abnormal bone metabolism and bone loss. Supplemental vitamin D requirements should be determined and adjusted based on blood test results of vitamin D. (4)

The bottom line

In addition to dietary interventions, integrative treatment and recovery from alcohol use disorder may involve counseling, medication, and support groups such as Alcoholics Anonymous. Seek out support from family, friends, and qualified health professionals. If you are a patient, speak to your integrative healthcare provider before taking new supplements.