Alcoholism

Repairing Nutritional Damage

You probably know someone with a drinking problem. In fact, maybe that person is you.

Problems with alcohol are fairly common in the United States. "Two-thirds of all Americans drink," says Charles H. Halsted, M.D., chief of clinical nutrition and metabolism at the University of California, Davis. "Sixty percent are light to moderate drinkers, but up to 10 percent drink excessively."

The light to moderate drinkers are probably in pretty good health, according to Dr. Halsted. (There is a wide range of opinion as to what constitutes moderate drinking; experts define it as anywhere from four drinks a week to one or two drinks a day.) "Moderate drinking is probably safe and may even be beneficial, since it lowers the risk of cardiovascular disease," he says.

But excessive alcohol consumption is another story. Excessive drinking on a daily basis--more than three drinks for a woman and more than six for a man--increases your risk of cancer and can damage the liver, pancreas, intestines and brain, says Dr. Halsted. It can cause diarrhea, osteoporosis, night blindness and anemia and can knock as many as 15 years off your life span. It can also cause nutritional deficiency diseases such as scurvy and pellagra. Although rare in this country, when scurvy and pellagra do occur, it's usually in alcoholics.

The Liquid Saboteur

How does alcohol damage your health? It hinders your body's ability to absorb, process, use and store the nutrients found in food--plus it tends to edge out food in your diet.

"The problem is that alcoholic beverages are devoid of vitamins and minerals," says Charles S. Lieber, M.D., director of the Alcohol Research Center for the National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism in Bethesda, Maryland, professor of medicine and pathology at Mount Sinai School of Medicine in New York City and director of the Alcohol Research and Treatment Center, the liver disease and nutrition section and the gastrointestinal-liver training program at the Bronx Veterans Affairs Medical Center in New York. "Alcoholic beverages are full of empty calories. Yet if you're a heavy drinker, those empty calories replace other nutrients in the diet. In addition, alcohol has a direct, toxic effect on the gastrointestinal tract."

The result is that many, if not most, of the vitamins, minerals and other nutrients extracted from food during digestion cannot be absorbed through the intestinal wall and into the bloodstream. Compounding the problem is the fact that alcohol is toxic to the liver, the organ that processes nutrients. Normally the liver either stores the nutrients it receives or, after processing, sends them cascading back into your bloodstream to be used throughout your body.

But once the liver is damaged, your body's ability to use vitamins is significantly reduced. The liver is no longer able to process, store or use many of the water-soluble vitamins such as thiamin, B₆ and folate (the naturally occurring form of folic acid). And since a damaged liver produces less bile, a substance the body uses to prepare fat-soluble vitamins for absorption by the intestines, your body is no longer able to use vitamins A, D and E, either.

You also have to keep in mind that your liver manufactures the transportation system that escorts minerals throughout your body. It provides proteins on which minerals hitch rides to get to where they're needed. But if the liver is damaged, the minerals can't get out of the liver. The result can be a mineral deficiency throughout your body--and a potentially toxic buildup of minerals in the liver.

Antioxidant Protection

Although alcohol devastates the body both directly as a toxin and indirectly through nutrient loss, scientists are beginning to suspect that it may also affect the body by destroying or otherwise interfering with the body's use of the antioxidants vitamin C, vitamin E and selenium. Antioxidants are substances that protect your body's healthy molecules against damage by unstable molecules called free radicals.

In a study in France of 102 recovering alcoholics, researchers found that blood levels of vitamin C, vitamin E and selenium remained lower in the former drinkers, even after they ditched the booze and began eating balanced diets, than in a similar group of men who drank only occasionally. Researchers also found high concentrations of free radicals, those unstable molecules that damage your body's healthy molecules by stealing electrons in order to balance themselves.

Scientists are not ready to draw any definite conclusions, but it looks as though at least some of the damage caused by alcohol occurs simply because there aren't enough antioxidants in the blood to put a half nelson on those roving free radicals. Recovering alcoholics should pay special attention to getting the Daily Values of these important nutrients. The Daily Value for vitamin E is 30 international units, and for vitamin C, 60 milligrams. For selenium, the Daily Value is 70 micrograms.

Problem drinkers also have difficulty getting enough protein and calories to maintain a healthy weight. Aside from that, the main nutritional deficiencies caused by heavy drinking are of vitamin A, thiamin, folate, vitamin B₆, zinc and magnesium, says Dr. Halsted.

Vitamin A: Finding the Right Balance

Vitamin A deficiency occurs because alcohol metabolism promotes excretion of vitamin A in bile. So it should come as no surprise that a study of 28 alcoholics, done at the University of Illinois in Urbana, found that 57 percent had low levels of vitamin A. Vitamin A plays an important part in helping you to reproduce, to grow new cells, to fight infection and, because of its important role in the retina, to see at night. Another study found that half of alcoholics who have severe liver disease also have night blindness. (Among those who don't have severe liver disease, 15 percent have night blindness.)

Although it seems like common sense that the answer to a vitamin A deficiency is to simply pop a couple of pills, giving supplemental vitamin A to people with alcohol problems is tricky, cautions Dr. Lieber.

"Vitamin A can be toxic to the liver if taken in large amounts. But so is alcohol. So if you supplement vitamin A in an alcoholic, you have to be careful not to add insult to injury and enhance the toxic effects of alcohol," he says. "It's important to correct the deficiency. But at the same time, it's important to avoid any excess. There's a very small therapeutic window."

For a while, researchers wondered if they could avoid the toxic effects of supplementation and still prevent a vitamin A deficiency by prescribing beta-carotene, a nontoxic precursor of vitamin A that occurs naturally in dark green, leafy vegetables and in orange and yellow vegetables. But for a drinker, beta-carotene has the same problem as vitamin A itself, says Dr. Lieber. Although it's seemingly nontoxic to everyone else in the world, too much beta-carotene can damage an alcoholic's liver just as easily as vitamin A.

To squeeze through that narrow therapeutic window between too little and too much vitamin A, Dr. Lieber recommends that people who drink excessively correct any vitamin A deficiency, when present, with a multivitamin/mineral supplement that does not exceed 5,000 international units of vitamin A for men or 4,000 international units for women. They should avoid any supplement with a higher dose of vitamin A as well as any preparation that has excess beta-carotene (more than about 10,000 international units), he says.

It's a short hop from helping to hurting with vitamin A, says Dr. Lieber. But sticking to a multivitamin/mineral supplement with no more than 5,000 or 4,000 international units, as explained above, should give you the most benefit at the least risk.

Think Thiamin for the Brain

The unsteady gait, confusion and poor memory that many of us associate with someone who drinks excessively is just as likely to be caused by a lack of thiamin as by too much to drink.

"thiamin is an important player in the way the brain works," explains Dr. Halsted. Scientists feel that the vitamin is involved in the production and release of neurotransmitters--molecules that zip messages between brain and body--as well as in the transmission of electrical impulses along nerves.

And although the brain requires a continuous supply of thiamin, the body does not store it in any appreciable amount. Researchers report that 30 to 80 percent of alcoholics are deficient in thiamin.

Laboratory studies indicate that a thiamin deficiency from alcohol abuse disrupts the ability of brain cells to do their job, resulting in impaired function and cell death. This may eventually lead to Wernicke-Korsakoff syndrome, a brain disorder characterized by an unsteady gait and memory loss.

Some doctors prescribe 50 milligrams of thiamin a day to temporarily supplement the diets of alcoholics, but it's not known whether this can actually reverse the brain damage caused by a thiamin deficiency, says Dr. Halsted.

Building with Bs

Aside from a thiamin deficiency, excessive drinking can also cause a deficiency of vitamin B₆, a nutrient needed to transmit nerve impulses. Doctors report that even a mild deficiency of vitamin B₆ alters brain waves and that a severe deficiency can cause convulsive seizures.

"Pyridoxine, or vitamin B₆, seems to be destroyed by alcohol," says Dr. Halsted. Over 50 percent of those who drink excessively seem to have deficiencies. Eating a well-balanced diet that includes the Daily Value of vitamin B₆--two milligrams--can correct the problem, says Dr. Halsted, but only if no further alcohol is consumed. Good food sources of vitamin B₆ include potatoes, bananas, chick-peas, prune juice and chicken breast.

Folate, another B vitamin, is also in low supply when people drink excessively, says Dr. Halsted. Since folic acid is one vitamin that does not significantly alter the taste of any beverage in which it's dissolved, some people have even suggested that manufacturers add folic acid to alcoholic beverages as they are bottled or canned.

Until that is done, however, a well-balanced diet full of folate-rich green, leafy vegetables or perhaps a multivitamin/mineral supplement containing the Daily Value of 400 micrograms of folic acid will help correct the deficiency, says Dr. Halsted.

Reversing a Mineral Deficiency

Because alcohol can derail the transportation system that escorts minerals such as zinc and magnesium out of the liver and into your bloodstream, researchers agree that anyone with a drinking problem also runs the risk of zinc and magnesium deficiencies.

Both zinc and magnesium are excreted in relatively large amounts when people are drinking excessively, says Dr. Halsted. They can be replaced by eating a well-balanced diet, he adds. Shellfish, pot roast and eggs are all good sources of zinc, while nuts, whole grains, vegetables and tofu are pretty decent sources of magnesium.

If you have heart or kidney problems, it's important that you talk to your doctor before taking magnesium supplements.

Vitamins Won't Correct the Addiction

There are three things you should remember about alcohol and nutrition, says Dr. Halsted.

First, there is no nutrient that will reduce the craving for alcohol, as some early scientific reports may have led people to believe. "The sum total of evidence seems to point more toward an addictive gene that causes the craving and results in excessive alcohol consumption," says Dr. Halsted. "So there's no way that nutrition will affect it."

Second, since nutrient levels can vary so widely from person to person, anyone who has a problem with alcohol should have his nutritional status individually evaluated by a doctor. If your doctor doesn't seem to know much about nutrition, you can contact the American Board of Nutrition for a referral to a doctor in your area who does. Write to the American Board of Nutrition, WEBB 234, 1675 University Boulevard, Birmingham, AL 35294-3360.

The third thing you should remember is this: "For the alcoholic, the only cure is abstinence," says Dr. Halsted. "There's no point in popping a vitamin pill or eating a balanced diet while you're still drinking. You can eat a balanced diet and take vitamins, but if you still drink in excess for 10 to 15 years, you run the risk of getting liver disease."

After you've stopped drinking, there is some good nutritional news, however. "A lot of the damage is reversible once you're on a regular, balanced diet that meets the Recommended Dietary Allowances for vitamins and minerals," says Dr. Halsted.