Vitamins and their possible mechanisms of action against the liver injury caused by al-cohol consumption. Tetrahydrofolate (THF), 5,10-methylenetetrahydrofolate (5,10-Methylene THF), methylenetetrahydrofolate reductase (MTHFR), and 5-methyltetrahydrofolate (5-Methyl THF), the initial methyl donor for transmethylation processes, are all involved in vitamin metabolism. 5-Methyl THF and homocysteine (Hcy) are substrates for methionine synthase (MS) in the synthesis of methionine, which is converted to S-adenosylmethionine (SAM) by methionine adenosyltransferase (MAT) in transmethylation processes. S-adenosylhomocysteine (SAH) is a product and inhibitor of methyltransferase reaction (MTs) as well as a substrate for the bidirectional enzyme SAH hydrolase (SAHH), which creates homocysteine or SAH when SAH is in excess. Hcy is metabolized by cystathionine beta-synthase (CBS) and cystathionase to produce cysteine and glutathione (GSH) in transsulfuration processes. It is also important to note that SAM inhibits MTHFR while promoting CBS expression.
2.4. Vitamin E
Alcoholic cirrhosis results in a combination of undernutrition and overnutrition, which requires individualized management, including monitoring of nutritional status and nutritional guidance. Considering that enteral nutrition for liver failure contains approximately 200 kcal, overfeeding should be avoided by subtracting the amount of enteral nutrition from the total energy. Energy intake is based on 25–35 kcal/kg (standard body weight)/day in the absence of glucose intolerance. In the presence of glucose intolerance, 25 kcal/kg/day and protein requirements are based on 1.0–1.5 g/kg/day (including BCAA preparations) in the absence of protein intolerance.
Imbalances in Glutamate and GABA
Therefore, nutrition education can positively influence recovery outcomes and should be a critical component of AUD/SUD treatment programs 18. Approximately 16.5% of the United States population met the diagnostic criteria for substance use disorder (SUD) in 2021, including 29.5 million individuals with alcohol use disorder (AUD). Individuals with AUD are at increased risk for malnutrition, and impairments in nutritional status in chronic alcohol users can be detrimental to physical and emotional well-being. Furthermore, these nutritional deficiencies could contribute to the never-ending cycle of alcoholism and related pathologies, thereby jeopardizing the prospects of recovery and treatment outcomes. Improving nutritional status in AUD patients may not only compensate for general malnutrition but could also reduce adverse symptoms during recovery, thereby promoting abstinence and successful treatment of AUD.
1. Total Calories, Carbohydrates, Fats, and Proteins Recommended for ALD
You’ll need to be especially careful not to replace alcohol with sugar or caffeine. They can also affect your mood when they wear off, which could make you want to drink. Possible scores range from 0–47 with higher scores indicating more severe alcohol dependence. That’s what evens out your moods, helps you sleep better, and soothes the urge for alcohol. Experts suggest a diet with lots of complex carbs like whole grains, veggies, peas, and beans. Too little could eventually cause serious learning and memory problems, a condition called Wernicke-Korsakoff’s syndrome.
1.1. Total Calories and Nutritional Support Route Recommended for ALD
As iron and alcohol independently cause oxidative stress, patients with hemochromatosis who consume alcohol exhibit cumulative liver damage, resulting in toxic damage to the liver due to alcohol-induced damage and increased intestinal iron absorption. This results in accelerated pathological progression to cirrhosis and increased predisposition to hepatocellular carcinoma 148. Ferroptosis is an iron-dependent cell death pathway accompanied by massive lipid peroxidation, and increasing evidence shows that ferroptosis plays an important role in the pathogenesis of various types of liver diseases, including ALD 149. In addition to phlebotomy and iron chelation, attempts are being made to improve fibrosis by regulating iron-related proteins; however, this is still in the research stage 112.
- A 2019 study found that 42% of individuals with AUD admitted to the intensive care unit (ICU) were severely deficient in vitamin C.
- In addition, Kaur et al. 103 studied examined vitamin E supplementation in ethanol-treated mice and found that it restored redox state, decreased apoptosis, and lowered oxidative stress markers.
- Another contributing factor to the risk of ALD is high hepatic iron levels, which has been identified as a predictor of mortality in patients with alcoholic cirrhosis 112.
- Frequent assessments of blood magnesium levels are recommended for patients with chronic alcoholism.
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. Notably, selenium supplementation may be as effective as antioxidant therapy 153. For example, zinc is involved in neurotransmitter synthesis and cognitive function, while magnesium supports nerve function and reduces nerve excitability. A 2019 study found that 42% of individuals with AUD admitted to the intensive care unit (ICU) were severely deficient in vitamin C. This deficiency can have detrimental effects on overall health, including the brain.
Chronic alcohol consumption can lead to an increased risk of peptic ulcers and gastritis, both of which can cause pain and inflammation in the digestive tract. Additionally, alcohol can cause irritation to the lining of the stomach and intestines, leading to nausea and vomiting and impairing nutrient absorption. These conditions not only cause discomfort but are particularly concerning because they can further impair the body’s ability to absorb nutrients. This impairment exacerbates the body’s nutritional deficiencies, creating a vicious cycle where malnutrition can worsen the severity of these digestive complications, and these complications, in turn, further diminish the body’s nutritional status. A personalized plan can help make the most of nutritional therapy, so you may want to consider working with a dietitian. They’ll help you create a diet that addresses your unique health situation, weight, and personal diet needs.
Vesicular glutamate transporters (VGLUT) are required for packaging and exocytotic release of glutamate. VGLUT is inhibited by AcAc and BHB through a competitive interaction with the VGLUT allosteric activator Cl− (83). A decrease in the concentration of glutamate per vesicle from VGLUT inhibition reduces glutamatergic activation, thereby dampening excitation. BHB and AcAc may also dampen neuronal excitability via their effect on K+/ATP channels, having been shown to reduce the spontaneous firing rate of substantia nigra pars reticulata neurons in vitro (84).
Nutritional Support for Alcoholic Liver Disease
Chronic alcohol consumption can lead to long-term dehydration, which can have severe health consequences, such as decreased kidney function, electrolyte imbalances, and impaired cognitive function. Wernicke-Korsakoff Syndrome (WKS), commonly referred to as wet brain, is a form of dementia that can be caused by long-term alcohol abuse. This disorder is the result of a thiamine (vitamin B1) deficiency, a common consequence of prolonged and excessive drinking 3.
Recommended Dietary Allowances
In short, while the role of central vs. peripheral ghrelin needs further exploration, the involvement of ghrelin receptor signaling in mediating alcohol reward has important clinical implications in the management of AUD. Vitamin E contributes to the histological improvement of liver injury in NASH 128. Alcoholics nutritional therapy for alcohol use disorder with cirrhosis tend to have low vitamin E levels in the liver 129, while alcoholics without cirrhosis generally have normal vitamin E levels. Vitamin E supplementation restores the normal oxidative reduction status, reduces apoptosis, and prevents oxidative stress 130. Vitamin E administration ameliorates learning and memory deficits induced by perinatal ethanol exposure and increases hippocampal brain-derived neurotrophic factor levels in a dose-dependent manner 131. Recent preclinical and clinical studies show beneficial effects of a nutritional state of ketosis on alcohol withdrawal symptoms (6–8).
- Alcohol use disorder affects about 7.2% of people older than 12 years old, including 6.9% of males and 7.8% of females 8.
- 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.
- In addition, the addition of fish oil promoted hepatic autophagy and lipid degradation, and subsequently inhibited the accumulation of lipids in the liver.
- The human gut microbiome, a complex ecosystem of trillions of microorganisms residing in the gastrointestinal tract, plays a crucial role in overall health and well-being.
- The far-reaching health impacts of alcohol addiction are complex and closely connected to nutritional well-being.
- This results in accelerated pathological progression to cirrhosis and increased predisposition to hepatocellular carcinoma 148.
Foods for Your Brain
However, further studies are required to clarify the relationship between alcohol consumption and the intake of vitamin B to be able to provide nutritional management strategies for chronic liver disease. Glucagon-like peptide-1 (GLP-1), a gut-brain peptide produced in the intestine and hindbrain (nucleus tractus solitarius), is secreted in response to meal ingestion 147, 148. By targeting its receptor (GLP-1R), it facilitates insulin secretion and normalizes plasma glucose, which forms the basis for the approval of GLP-1R agonists for the treatment of diabetes 149.
It is recommended that those who consume alcohol regularly include 250mg vitamin C, 150mg magnesium, 1500mg calcium, and 500mg niacin from dietary sources each day. The B vitamins are important for various metabolic processes in the liver, such as detoxification and energy production. Deficiencies in B vitamins can lead to neurological and psychiatric symptoms, including depression, irritability, anxiety, and cognitive impairment. Vitamin B1 (thiamine) deficiency, in particular, can lead to Wernicke-Korsakoff syndrome, a severe neurological disorder. Long-term alcohol users may benefit from B1, B2, B3, B6, and B9 supplements, under medical guidance. Implementing nutritional therapy as part of an alcohol addiction recovery plan can present various challenges and barriers.
Eat beans, peas, lentils, pork, brown rice, and fortified foods like breakfast cereal. Alcohol and poor eating can stop your liver from releasing glucose into your blood. When you drink too much, you’re more likely to eat foods that are high in added sugar, salt, and saturated fat.
