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NUTRITIONAL DEFICIENCY & ALCOHOL USE DISORDERS

NUTRITIONAL DEFICIENCY & ALCOHOL USE DISORDERS . Ann M. Manzardo, Ph.D. Department of Psychiatry & Behavioral Sciences Kansas University Medical Center Kansas City, Kansas. Nutritional Deficiencies. Once common, now rare in west Availability of food ↑ Nationalized fortification of foods

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NUTRITIONAL DEFICIENCY & ALCOHOL USE DISORDERS

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  1. NUTRITIONAL DEFICIENCY & ALCOHOL USE DISORDERS Ann M. Manzardo, Ph.D. Department of Psychiatry & Behavioral Sciences Kansas University Medical Center Kansas City, Kansas © AMSP

  2. Nutritional Deficiencies • Once common, now rare in west • Availability of food ↑ • Nationalized fortification of foods • Began in US, early 1900’s • Iodine added to salt (goiters) • Expanded to other nutrients, 1940’s © AMSP

  3. Nationalized Fortification • Dairy products • Calcium/vitamin D to milk (rickets) • Vitamin A to margarine (night blindness) • Grain products • Replaced B vitamins lost in milling • Niacin, thiamine, riboflavin • Folate added 1998 © AMSP

  4. Who is at Risk Today? • High risk groups in western countries • Elderly • Medical conditions (vomiting/GI) • Certain psychiatric conditions → Alcohol Use Disorders (AUDs) © AMSP

  5. Lecture Focus: Nutrition & AUDs • Definitions • AUDs & nutrition • Thiamine • Other B vitamins • How to help © AMSP

  6. Abuse vs.Dependence Dependence ( ≥3) • Tolerance • Withdrawal • Not sticking to limits • Unable to cut down • ↑ time with ETOH • ↓ time elsewhere • Use in spite of problems Abuse ( ≥1) • Role failure • Risk of harm • Run-ins with law • Relationship trouble Repeats 12 months © AMSP

  7. What is a Micronutrient? • Needed in small amounts (<100 mcg/day) • “Essential” for bodily functions • Diet may be only source • 2 kinds • Vitamins – organic compounds • Minerals – “trace” elements, ions or salts © AMSP

  8. B-Complex Vitamins Meats: poultry, eggs, fish & liver Beans & grains; Brewer’s yeast • Thiamine (B1) • Riboflavin (B2) • Niacin (B3) • Pantothenic acid (B5) • Pyridoxine (B6) • Biotin (B7) • Folate (B9) • Cobalamin (B12) © AMSP

  9. Lecture Focus: Nutrition & AUDs • Definitions • AUDs & nutrition • Thiamine • Other B vitamins • How to help © AMSP

  10. AUDs → Nutritional Deficiency • Lifestyle factors • Poor dietary habits • ↓ Access to food (poverty, homelessness) • Alcohol preferred to food © AMSP

  11. AUDs → Nutritional Deficiency • Gastric Problems • Alcohol damage • Gastric mucosa inflamed • Barrier to absorption • ↓ absorption of nutrients © AMSP

  12. AUDs → Nutritional Deficiency cont’d • Selective loss of B vitamins • B vitamins water (not fat) soluble • Low cellular stores • Levels ↓ quickly • ↑ daily intake needed • → Thiamine Deficiency (B1) © AMSP

  13. Lecture Focus: Nutrition & AUDs • Definitions • AUDs & nutrition • Thiamine (B1) • Other B vitamins • How to help © AMSP

  14. Thiamine Function Oxidative Metabolism Thiamine (B1) Glycolysis Kreb Cycle Generates ATP for energy Anaerobic Metabolism ↑ lactic acid ↑ cell damage/death © AMSP

  15. Thiamine Function cont’d Pentose Phosphate Shunt DNA RNA Glucose-6-P Ribose-5-P Transketolase Thiamine (B1) Transaldolase ↓ Cell Growth © AMSP

  16. Consequences of Thiamine Deficiency • Tissue-selective damage • Heart muscles/neurons • ↑ energy demand • ↓ energy stores • 2 clinical syndromes (wet/dry beriberi) © AMSP

  17. Wet Beriberi • Cardiovascular • Irregular heartbeat • Heart failure • Edema (fluid retention) © AMSP

  18. Dry Beriberi • Neurological • Pain/numbness in limbs (neuropathy) • Balance/coordination problems • Emotional disturbances © AMSP

  19. Neurological Syndromes • Rare but serious • 2 main syndromes • Wernicke’s encephalopathy • Korsakoff’s syndrome © AMSP

  20. Wernicke’s Encephalopathy • Sudden onset of symptoms • Impaired eye movement • Can’t look to side • Jerky movement • Staggering gait (ataxia) • Reversible with treatment Opthalmoplegia of left eye Nystagmus © AMSP

  21. Korsakoff ‘s Syndrome • Memory loss (amnesia) • ↓ Formation (anterograde) • ↓ Recall (retrograde) • Confabulation • False memories/beliefs • “Storytelling” • Lack of insight © AMSP

  22. Genetic Vulnerability • Sub-population identified • ~10% of Non AUD • ~ 30% of Wernicke-KorsakoffSyndrome • Abnormal transketolase enzyme • ↓ affinity for thiamine (B1) • ↑ levels needed to activate • ↑ alcohol-related problems © AMSP

  23. Lecture Focus: Nutrition & AUDs • Definitions • AUDs & nutrition • Thiamine (B1) • Other B vitamins • How to help © AMSP

  24. Other B vitamin deficiencies • Folate (B9), >40% • Pyridoxine (B6), up to 50% • Riboflavin (B2), ~17% • Overlapping effects on: • DNA, RNA, red blood cell (RBC) synthesis • Sugar metabolism • Cell growth/energy production © AMSP

  25. Folate (B9) Deficiency • Anemia, 2 types • Abnormally large RBCs, megaloblastic • Ruptured RBCs, hemolytic • ↓ appetite • Weakness, fatigue • Hair loss © AMSP

  26. Pyridoxine (B6) Deficiency • Similar to niacin (B3) deficiency • Failure to process iron to heme • Anemia, sideroblastic • ↓ healthy RBCs • ↑ abnormal RBC (sideroblasts) © AMSP

  27. Pyridoxine (B6) Deficiency • Skin inflammation • Dermatitis • Lips/mouth, cheilosis • Neuropathy in hands/feet • Neurological problems • Seizures © AMSP

  28. Riboflavin (B2) Deficiency • Inflamed skin/mucous membranes • Mouth ulcers • Cheilosis • Eyes • Bloodshot, itchy/watery • ↑ sensitivity to light © AMSP

  29. Riboflavin (B2) Deficiency cont’d • SeborrheicDermatitis • Scaly, oily rash • Near glands • Face/upper lip • Genitals (scrotum, vulva) • Permanent scarring possible © AMSP

  30. Lecture Focus: Nutrition & AUDs • Definitions • AUDs & nutrition • Thiamine (B1) • Other B vitamins • How to help © AMSP

  31. Treatment of Nutritional Deficiency • Supplement guidelines • Full B-complex, 7-14 days • Oral, daily treatment • Add minerals, help vitamins work • Prenatal vitamins often used • Inexpensive/easy © AMSP

  32. Treatment of Nutritional Deficiency cont’d B-Complex Vitamins • 100 mg thiamine (B1) • 1.3 mg riboflavin (B2) • 10-50 mg niacin (B3) • 300mg biotin (B7) • 1 mg folate (B9) • 1-3 mg pyridoxine (B6) • 6-12 mg cobalamin (B12) • 10 mg pantothenic acid (B5) © AMSP

  33. Treatment of Nutritional Deficiency cont’d Wernicke-Korsakoff Syndrome • Hospitalization • IV thiamine, 100 mg • 1-2 x daily • 3-5 days • Include full B-complex © AMSP

  34. Treatment of Nutritional Deficiency cont’d Alternative Supplements • Fat soluble B1 analogues • Allithiamine, natural product • Benfotiamine, synthetic • Sustained ↑ in blood levels • Inexpensive/safe © AMSP

  35. Treatment of Alcohol Abuse Brief Intervention • 15-min initial contact, 5 A’s • Assess/screen • Advise to quit/reduce • Agree on goals • Assist with motivation • Arrange follow-up © AMSP

  36. Treatment of Alcohol Abuse or Dependence • Refer to 12-step program • Alcoholics Anonymous • Refer to higher-level care • Day treatment • Residential • Clean & sober living environment © AMSP

  37. Treatment of Alcohol Abuse or Dependence cont’d Medications for AUDs • Naltrexone (Revia), 50-150 mg/day • Acamprosate (Campral), 2 g/day • Disulfiram (Antabuse), 250 mg/day © AMSP

  38. Summary Topics Reviewed • AUDs → nutritional deficiencies • What kinds of deficiencies • Consequences • How to help © AMSP

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