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> Health Concerns > Alcohol Withdrawal
ALCOHOL WITHDRAWALVisit The Healthy Living Bookshelf:
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A majority of people who have been drinking alcohol and decide to stop (often for health-related reasons) are able to do so without much trouble. Alcohol withdrawal typically becomes difficult only when problem drinkers—alcoholics—attempt to quit. Almost inevitably, alcoholics need help in achieving this goal. Sometimes, this help requires medical intervention in detoxification centers. Finding doctors who work with alcohol detoxification is often as easy as calling the local chapter of Alcoholics Anonymous (AA) and asking for referral information. Most programs successful in getting alcoholics to quit drinking are either part of the AA network or employ AA techniques. Natural approaches to alcohol withdrawal should not substitute for detox centers or for AA or AA-related programs. Checklist for Alcohol Withdrawal
What are the symptoms of alcohol withdrawal? A person typically has a mild to severe hangover that lasts several days. Symptoms may include stomach upset; headache; shakes or jitters; feelings of generalized anxiety or panic attacks; and insomnia that may be accompanied by bad dreams. There may be also be increases in heart rate, breathing rate, and body temperature. In a small proportion of alcoholics, withdrawal may result in severe symptoms, such as hallucinations, delirium tremens (DTs), or generalized seizures.  How is it treated? Treatments in detoxification centers may begin with an injection of vitamin B1 in cases that involve malnutrition. The conventional treatment is to ensure rest and adequate nutrition (especially fluid intake and multiple B vitamins, including thiamine). In cases of severe withdrawal symptoms, a nervous system depressant, such as a benzodiazepine, is prescribed with a dosage that is tapered down over three to five days. Dietary changes that may be helpful: Some of the nutritional deficiencies associated with alcoholism can be caused by a poor diet—a factor that needs correction on an individual basis. Improving the overall diet should be done in conjunction with a doctor. Sometimes liver or pancreatic disease associated with alcoholism also contributes to nutritional deficiencies. These problems require medical assessment and intervention. In one trial, a hospital diet was compared with a special diet including fruit and wheat germ and excluding caffeinated coffee, junk food, dairy products, and peanut butter.1 After six months, fewer than 38% of those on the hospital diet remained sober, compared with over 81% of those eating the special diet. A review of the research shows that diets loaded with junk food increase alcohol intake in animals.2 In a human trial, restricting sugar, increasing complex carbohydrates, and eliminating caffeine also led to a reduction in alcohol craving.3 While the support for dietary intervention remains somewhat unclear, some doctors suggest that alcoholics reduce sugar and junk food intake and avoid caffeine. Lifestyle changes that may be helpful: Most experts agree that alcoholics must stop drinking completely in order to overcome the addiction. Moreover, before nutritional supplements can be used, effective treatment of the malabsorption problems requires a complete avoidance of alcohol. Nutritional supplements that may be helpful: Many alcoholics are deficient in B vitamins, including vitamin B3. John Cleary, M.D., observed that some alcoholics spontaneously stopped drinking in association with taking niacin supplements (niacin is a form of vitamin B3). Cleary concluded that alcoholism might be a manifestation of niacin deficiency in some people and recommended that alcoholics consider supplementation with 500 mg of niacin per day.4 Without specifying the amount of niacin used, Cleary’s preliminary research findings suggested that niacin supplementation helped wean some alcoholics away from alcohol.5 Activated vitamin B3 used intravenously has also helped alcoholics quit drinking.6 Niacinamide—a safer form of the same vitamin—might have similar actions and has been reported to improve alcohol metabolism in animals.7 Deficiencies of other B-complex vitamins are common with chronic alcohol use.8 The situation is exacerbated by the fact that alcoholics have an increased need for B vitamins.9 It is possible that successful treatment of B-complex vitamin deficiencies may actually reduce alcohol cravings, because animals crave alcohol when fed a B-complex-deficient diet.10 Many doctors recommend 100 mg of B-complex vitamins per day. Alcoholics may be deficient in a substance called prostaglandin E1 (PGE1) and in gamma-linolenic acid (GLA), a precursor to PGE1.11 In a double-blind study of alcoholics who were in a detoxification program, supplementation with 4 grams per day of evening primrose oil (containing 360 mg of GLA) led to greater improvement than did placebo in some, but not all, parameters of liver function.12 The daily combination of 3 grams of vitamin C, 3 grams of niacin, 600 mg of vitamin B6, and 600 IU of vitamin E has been used by researchers from the University of Mississippi Medical Center in an attempt to reduce anxiety and depression in alcoholics.13 Although the effect of vitamin supplementation was no better than placebo in treating alcohol-associated depression, the vitamins did result in a significant drop in anxiety within three weeks of use. Because of possible side effects, anyone taking such high amounts of niacin and vitamin B6 must do so only under the care of a doctor. Although the incidence of B-complex deficiencies is known to be high in alcoholics, the incidence of other vitamin deficiencies remains less clear.14 Nonetheless, deficiencies of vitamin A, vitamin D, vitamin E, and vitamin C are seen in many alcoholics. While some reports have suggested it may be safer for alcoholics to supplement with beta-carotene instead of vitamin A,15 potential problems accompany the use of either vitamin A or beta-carotene in correcting the deficiency induced by alcoholism.16 These problems result in part because the combinations of alcohol and vitamin A or alcohol and beta-carotene appear to increase potential damage to the liver. Thus, vitamin A-depleted alcoholics require a doctor’s intervention, including supplementation with vitamin A and beta-carotene accompanied by assessment of liver function. Supplementing with vitamin C, on the other hand, appears to help the body rid itself of alcohol.17 Some doctors recommend 1 to 3 grams per day of vitamin C. Kenneth Blum and researchers at the University of Texas have examined neurotransmitter deficiencies in alcoholics. Neurotransmitters are the chemicals the body makes to allow nerve cells to pass messages (of pain, touch, thought, etc.) from cell to cell. Amino acids are the precursors of these neurotransmitters. In double-blind research, a group of alcoholics were treated with 1.5 grams of D,L-phenylalanine (DLPA), 900 mg of L-tyrosine, 300 mg of L-glutamine, and 400 mg of L-tryptophan (now available only by prescription) per day, plus a multivitamin-mineral supplement.18 This nutritional supplement regimen led to a significant reduction in withdrawal symptoms and decreased stress in alcoholics compared to the effects of placebo. The amino acid, L-glutamine, has also been used as an isolated supplement. Animal research has shown that glutamine supplementation reduces alcohol intake, a finding that has been confirmed in double-blind human research.19 In that trial, 1 gram of glutamine per day given in divided portions with meals decreased both the desire to drink and anxiety levels. Alcoholics are sometimes deficient in magnesium, and some researchers believe that symptoms of withdrawal may result in part from this deficiency.20 Nonetheless, a double-blind trial reported that magnesium injections did not reduce symptoms of alcohol withdrawal.21 Because of the multiple nutrient deficiencies associated with alcoholism, most alcoholics who quit drinking should supplement with a high-potency multivitamin-mineral for at least several months after the detoxification period. Whether or not the supplement should include iron should be discussed with a doctor. Herbs that may be helpful: Milk thistle extract is commonly recommended to counteract the harmful effects of alcohol on the liver.22 Milk thistle extracts have been shown in one double-blind study to reduce death due to alcohol-induced cirrhosis of the liver,23 though another double-blind study did not confirm this finding.24 Milk thistle extract may protect the cells of the liver by both blocking the entrance of harmful toxins and helping remove these toxins from the liver cells.25 26 Milk thistle has also been reported to regenerate injured liver cells.27 Kudzu is most famous as a quick-growing weed in the southern United States. Alcoholic hamsters (one of the few animals to become so besides humans) were found to have decreased interest in drinking when fed kudzu extract.28 Traditional Chinese medicine practitioners generally recommend 3 to 5 grams of root three times per day; some herbal practitioners also suggest that 3 to 4 ml of tincture taken three times per day may also be helpful to reduce alcohol cravings. Nonetheless, a double-blind trial using 1.2 grams of powdered kudzu root twice per day failed to show any benefit in helping alcoholics remain abstinent from alcohol.29 References: 
1. Guenther RM. Role of nutritional therapy in alcoholism treatment. Int J Biosoc Res 1983;4:5–18. 2. Werbach MR. Alcohol craving. Int J Altern Complementary Med 1993;July:32. 3. Biery JR, Williford JH, McMullen EA. Alcohol craving in rehabilitation: assessment of nutrition therapy. J Am Diet Assoc 1991;91:463–6. 4. Cleary JP. Etiology and biological treatment of alcohol addiction. J Neuro Ortho Med Surg 1985;6:75–7. 5. Smith RF. A five-year field trial of massive nicotinic acid therapy of alcoholics in Michigan. J Orthomolec Psychiatry 1974;3:327–31. 6. O’Halloren P. Pyridine nucleotides in the prevention, diagnosis and treatment of problem drinkers. West J Surg Obstet Gynecol 1961;69:101–4. 7. Eriksson CJP. Increase in hepatic NAD level—its effect on the redox state and on ethanol and acetaldehyde metabolism. Fed Eur Biochem Soc 1974;40:3117–20. 8. Baker H. A vitamin profile of alcoholism. Int J Vitam Nutr Res 1983;(suppl 24):179. 9. Schuckit MA. Alcohol and Alcoholism. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds, Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill, 1998, 2503–8. 10. Norton VP. Interrelationships of nutrition and voluntary alcohol consumption in experimental animals. Br J Addiction 1977;72:205–12. 11. Horrobin DF. Essential fatty acids, prostaglandins, and alcoholism: an overview. Alcohol Clin Exp Res 1987;11:2–9. 12. Glen I, Skinner F, Glen E, MacDonell L. The role of essential fatty acids in alcohol dependence and tissue damage. Alcohol Clin Exp Res 1987;11:37–41. 13. Replogle WH, Eicke FJ. Megavitamin therapy in the reduction of anxiety and depression among alcoholics. J Orthomolec Med 1988;4:221–4. 14. Morgan MY, Levine JA. Alcohol and nutrition. Proc Natl Acad Sci 1988;47:85–98. 15. Chapman K, Prabhudesai M, Erdman JW. Vitamin A status of alcoholics upon admission and after two weeks of hospitalization. J Am Coll Nutr 1993;12:77–83. 16. Leo MA, Lieber CS. Alcohol, vitamin A, and beta-carotene: adverse interactions, including hepatotoxicity and carcinogenicity. Am J Clin Nutr 1999;69:1071–85 [review]. 17. Chen M, Boyce W, Hsu JM. Effect of ascorbic acid on plasma alcohol clearance. J Am Coll Nutr 1990;9:185–9. 18. Blum K. A commentary on neurotransmitter restoration as a common mode of treatment for alcohol, cocaine and opiate abuse. Integr Psychiatr 1986;6:199–204. 19. Rogers LL, Pelton RB. Glutamine in the treatment of alcoholism. Q J Stud Alcohol 1957;18:581–7. 20. Embry CK, Lippmann S. Use of magnesium sulfate in alcohol withdrawal. Am Fam Phys 1987;35:167–70. 21. Wilson A, Vulcano B. A double-blind, placebo-controlled trial of magnesium sulfate in the ethanol withdrawal syndrome. Alcohol Clin Exp Res 1984;8:542–5. 22. Leng-Peschlowe. Alchohol-related liver diseases-use of Legalon®. Z Klin Med 1994;2:22–7. 23. Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989;9:105–13. 24. Parés A, Planas R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol 1998;28:615–21. 25. Faulstich H, Jahn W, Wieland T. Silibinin inhibition of amatoxin uptake in the perfused rat liver. Arzneimittelforschung 1980;30:452–4. 26. Tuchweber B, Sieck R, Trost W. Prevention by silibinin of phalloidin induced hepatotoxicity. Toxicol Appl Pharmacol 1979;51:265–75. 27. Sonnenbichler J, Zetl I. Stimulating influence of a flavonolignan derivative on proliferation, RNA synthesis and protein synthesis in liver cells. In: Okolicsanyi L, Csomos G, Crepaldi G eds, Assessment and Management of Hepatobiliary Disease. Berlin: Springer-Verlag, 1987, 265–72. 28. Keung W, Vallee B. Daidzin and daidzein suppress free-choice ethanol intake by Syrian golden hamsters. Proc Natl Acad Sci USA 1993;90:10,008–12. 29. Shebek J, Rindone JP. A pilot study exploring the effect of kudzu root on the drinking habits of patients with chronic alcoholism. J Alt Compl Med 2000;6:45–8. |
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