What Vitamins Do Heavy Drinkers Need?

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KEY TAKEAWAYS

Heavy drinkers need:

  • 200 to 300mg vitamin B1 (thiamine) per day in divided doses, while undergoing withdrawal or during periods of excessive drinking [1].
  • 50mg thiamine per day for maintenance following withdrawal, for as long as malnutrition exists [1].
  • 500mg niacin, 1500mg calcium, 150mg magnesium, and 250mg Vitamin C from dietary sources daily.
  • Strong Vitamin B compound may be prescribed to alcoholics where there is clear evidence of deficiency, poor diet or absorption, or co-occurring illness likely to increase incidence of deficiency when combined with alcohol intake; or when the patient is undergoing withdrawal or detox from alcohol. [2]

Chronic alcoholics are typically deficient in vitamin B1 (thiamine), vitamin B6, vitamin B9 (folate), and vitamin A[3].

Even in small amounts, drinking alcohol raises stomach acidity levels and reduces the ability to absorb nutrients through the stomach mucosa and small intestine[4].

Vitamin B Deficiency In Alcohol Dependence

Excessive alcohol intake results in inflammatory lesions on the stomach and small intestine walls, reducing the ability of mucosal cells to absorb nutrients, including vitamin B, from food[5][6].

Chronic alcoholics are particularly susceptible to deficiency of B vitamins[7].

Studies suggest that lower levels of Vitamin B1 in blood serum are both created and reinforced by alcohol consumption, and craving alcohol[8].

Sub-sections particularly at risk of developing Vitamin B deficiency include those with:

  • Long term history of alcohol abuse and physical dependence
  • Pancreatic, small intestine, or liver dysfunction that would result in reduced ability to absorb digestive nutrients. This includes conditions such as Crohn's disease, Celiac disease and HIV[9].
  • Conditions typically indicative of co-existing vitamin B deficiencies such as peripheral neuropathy, heart muscle weakness,  or persistent skin rashes or ulcers[10].

Signs & Symptoms Of Vitamin B Deficiency

Most issues relating to deficiency can be detected via physical assessment or blood test by a healthcare professional. Symptoms include:
  • Shortness of breath or difficulty breathing (may indicate anaemia)[11]
  • Low energy, tiredness, fatigue
  • Headaches
  • Skin issues, such as acne, rashes, dry or flaked skin, cracked lips, wrinkles, dermatitis, and psoriasis. Less common manifestations of skin issues include vitiligo, stomatitis, and hair changes[12].
  • Reduced bone density and function[13].
  • Oxygen insufficiency in the gut, resulting in nausea and diarrhoea.
  • Enlarged red blood cells (Macrocytosis) are associated with deficiency of B12 and can cause long term complications if left untreated, including fatal and non-fatal coronary disease, heart attack, and stroke[14].
  • Neurological issues are particularly prevalent in deficiencies of vitamin B12 and include vision problems, impaired cognition, memory loss, and pins and needles (paraesthesia)[15].
  • Pellagra - a deficiency disease caused by lack of niacin (vitamin B3) in the diet. Symptoms include skin eruptions, diarrhoea, and cognitive dysfunction. In non-alcoholic populations, it is often seen in areas with high dependence on corn or rice as a food source. In chronic alcohol abuse, Pellagra is maintained or worsened by the reduced absorption of B vitamins, in turn reducing conversion of Tryptophan to Niacin[16].
  • Wernicke's Encephalopathy - symptoms include cognitive decline, confusion, loss of muscle coordination and muscle tremor in extremities. This may progress later to Wernicks-Korsakoff's syndrome.
  • Beriberi - Caused by thiamine (B1) deficiency, Beriberi comes in two variants, wet and dry.
    Wet beriberi results in shortness of breath, tachycardia, and swollen lower legs
    Dry beriberi symptoms include myopathy, peripheral neuropathy, vomiting and paralysis, in extreme cases[17].

Other Vitamin Deficiencies In Alcoholism

Long term drinkers with nutritional issues usually suffer from more deficiencies than vitamin B alone.

Vitamin A

Chronic alcohol abuse lowers vitamin A levels present in the liver but increases it in other tissues[18].

Continued alcohol intake over long term periods causes continuing reduction of Vitamin A liver levels over time[19].

A common indicator of reduced vitamin A in alcoholics is impaired night vision (Nyctalopia).

Vitamin C

Vitamin C deficiency in alcoholics can occur with:

  • Increased vitamin C excretion secondary to high alcohol intake.
  • Malnutrition or lack of appetite as a result of alcohol intake.
  • Intestinal absorption issues due to alcohol intake or pancreatic issues.

One study demonstrated that alcohol increases vitamin C excretion in urine by 47%, [20] making it harder for alcoholics to retain it in the body.

Vitamin Deficiency Treatment In Heavy Drinkers

Vitamin B protects the liver from damage as a result of excess alcohol consumption and can help stabilise mood swings and cognitive function.

Evidence suggests[21] that strong Vitamin B compound should be prescribed to alcoholics where:

  • There is clear evidence of deficiency, poor diet or absorption; or
  • Co-occurring illness likely to increase incidence of deficiency when combined with alcohol intake; or
  • The patient is undergoing withdrawal or detox from alcohol.

Heavy drinkers may benefit from adding vitamin B1, B2, B3, B6, and B9 supplements as indicated by symptoms of deficiencies, and under professional medical guidance.

Vitamin B1 deficiency can be treated by ceasing alcohol consumption (with professional help), improving nutritional factors, and taking B1 supplements.

Vitamin B2 (riboflavin) and Vitamin B9 (folate) have been found to have positive effects on comfort of detoxification from alcohol in a 2012 German study[22].

Evidence suggests that administering Niacin (vitamin B3) may help reduce risk of alcohol addiction as it appears to improve alcohol clearance from the body, and prevent the production of opiate-like by-products of alcohol biobreakdown in the body[23].

Safety Measures

Some precautions are advised when taking B vitamins:

  • Take only the recommended dose as advised by your professional healthcare practitioner.
  • Since B12 can interact with other medications such as metformin, advise your healthcare practitioner of all other medications you may be taking.

Mineral and Anti-Oxidant Supplementation In Alcoholism

Supplements with anti-oxidative properties may help to neutralise metabolites of alcohol which normally have damaging effects[24].

Glutamine

Glutamine is a naturally occurring essential amino acid which is underproduced in conditions of extreme stress or in ongoing heavy alcohol intake.

Alcohol intake suppresses Glutamine uptake at Glutamate receptors.

Supplementation with glutamine can additionally assist in attempts to reduce weight as it reduces the body's desire for sugar and carbohydrate.

Magnesium

Supplementation of magnesium 500mg to 1500mg a day may improve cognitive deficits related to chronic alcohol abuse by enhancing cerebral flow that is often reduced in chronic alcoholics[25].

Zinc

Chronic alcohol abuse is commonly seen in patients with low systemic zinc levels, although only in those who are generally under-nourished[26].

Nutrition As A Natural Source Of Vitamins During Alcohol Abuse

Although chronic alcoholics are typically under 90% of the ideal body mass index, a 1997 study found only 18% were considered malnourished[27].

However, a substantial proportion of alcoholic patients in the study suffered from specific vitamin deficiencies correlating closely with increased alcohol intake.

At least half of a heavy drinkers calorie intake per day is from alcohol consumption. Compare this to just 4% of overall calories in the average non-alcoholic population (US)[28].

Beyond effects on the stomach lining, high alcohol intake typically acts as an appetite suppressant, reducing vitamins and mineral intake from the general diet.

Nutritional Recommendations

Increasing intake of nutrient dense foods can help to holistically recover lost or mal-absorbed vitamins in the body.

Nutritional guidance:

  • Include 500mg niacin, 1500mg calcium, 150mg magnesium, and 250mg Vitamin C from dietary sources daily.
  • Include 3-4 oz of fish 2-4 times per week or add flaxseed to a daily meal. Both are good sources of omega-three fatty acids.
  • Fish with the highest content of omega-three fatty acids include sardines, pacific herring, Atlantic herring, salmon, Atlantic halibut, coho, lake trout, pink, and king salmon, atlantic mackerel, albacore tuna as well as bluefish.
  • Breakfast cereals are abundant in flaxseed. Flaxseed can also be added to juices and smoothies.
  • By following nutritional guidelines, and completing withdrawal or detox from alcohol, depleted vitamin levels can be restored in tissues and blood serum.
  • A good mineral or multivitamin supplement will work cooperatively with improved intake of essential nutrients.

Last Updated: January 18, 2023

About the author

Peter Szczepanski

Peter has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. Peter also co-authored the new 6th edition of Drugs In Use by Linda Dodds, writing Chapter 15 on Alcohol Related Liver Disease. Find Peter on Respiratory Academy, Aston University graduates, University of Birmingham, Q, Pharmaceutical Journal, the Dudley Pharmaceutical Committee, Dudley Council, Twitter, and LinkedIn.