Nutritional Treatment for Detoxification andRecovery from Alcoholism:

The Functional/ Molecular Medicine Approachby David A. Arneson, NMD, and Angela Pinkhasova, MD (Russia), NMD (Candidate)

IntroductionConventional treatment for

alcoholism, or drug dependency, hasbeen focused on mono-therapeuticapproaches. The literature is inundatedwith treatment regimes that are based onmedical, counseling, or spirituaily-basedapproaches, Unfortunately, rarely arethese protocols used simultaneously andrarely is treatment successful when theholistic approach is ignored. At best, mosttreatment programs, even those claimingholistic treatment, are bimodal in theirapproach. And when they are utilizedtogether, nutrition is often overlooked asa necessary component of detoxificationand recovery. Certainly, one can findample information, on the Internet andelsewhere, on the nutritional aspects oftreatment of alcoholism. However, rarelydo these nutritional protocols address thedeeper issues. Fortunately, there areleaders in the field of integrative/functional medicine who are changing theway we look at treating chronic disease- nutritionally. Alcoholism is nowrecognized as a chronic disease. Whentreatment programs utilize body-mind-spirit approaches with well-designednutritional protocols, the successes aredynamic. In this monograph we willattempt to introduce the concepts offunctional/molecular medicine for thetreatment of alcoholism and suggest whystudying the deeper issues of nutritionaltherapy is an absolute necessity forsuccessful detoxification and subsequentsuccessful recovery.

Functional/Molecular MedicineFunctional medicine is a practice of

medicine that focuses on holistictreatment of the individual rather than thetreatment of the disease symptom. Theprimary focus is prevention of diseasestates but it is highly efficient in returningindividuals to health even when thedisease is created by lifestyle choices.Functional medicine requires that thepractitioner understand how things aredesigned to work, and for what purpose,at the molecular level and how thisdesign/purpose affects the function of theorganism as a whole. There is

recognition, by the physician, that thereare numerous complex actions andinteractions that must occur at the cellularlevels to keep the patient at optimumhealth. This complexity is compoundedwhen we accept that each individual is"an island unto himself." The individualnature of each patient must berecognized as well as how his/herdisease manifests itself throughenvironmental influences. Functionalmedicine is not about ignoring science. Itis intimately involved with science, yetunderstands that movement towardscience-based health on the physicallevel must coexist with emotional andspiritual health.*'

Molecular medicine, and how theenvironment influences molecular andcellular events, is an integral part offunctional medicine. Molecular medicineaddresses cellular function and howthese functions change through thechanging internal and external influencesof the individual environment.Unfortunately, molecular medicinewithout the necessary focused nutritionalcomponents along with pharmaceuticaldrug components is common in thetreatment of alcohol and drugdependency. Many times, rather thanassist the patient to recovery, thepharmaceutical treatment adds to thechemical burden, resulting in abnormalmetabolism at the cellular level. It maybe that chemical therapy at this level issometimes necessary, especially if thepatient is a danger to self or others. Yetin our clinical experience, we find this israrely the case when the programencompasses functional/molecularmedicine with nutritional components.

One of the primary advocates ofmolecular medicine with the nutritionalcomponent is Majid Ali, MD.'"'"^ Dr. Allstates that molecular medicine refers toa practice of medicine based onmolecular events that occur before cellsand tissues are injured by disease.Rather than treat the disease, we shoulddesign treatment protocols, based onknowledge of cellular structure andfunction, which satisfy the cellularrequirements of the individual.'*^ There is

little doubt that the treatment ofalcoholism, and drug dependency,benefits from this approach.

Functional medicine has been in theprocess of conceptualisation for the pastdecade through the practice ofnaturopathy, with physicians trained inscience and nutrition, and holisticaltyeducated medical doctors and healthprofessionals. Since the early 9O's, itsleading proponent has been JefferyBland, PhD.*' In this article we usefunctional medicine as meaning bothfunctional/molecular medicine withnecessary nutritional/environmentalcomponents. In both concepts one thingis abundantly clear - nutritional therapyis not so much about what we eat or drink.Rather, it is about how what we eat ordrink - in combination with environmentalfactors - affects genetic functions andmolecular events in the body and mind.Jeffery Bland states, "We are not reallywhat we eat but what we absorb fromwhat we eat."^^ He goes on to point outthat gastrointestinal dysfunction (commonin alcoholics), causes poor absorption ofnutrients.

Nutritional BackgroundAdequate and balanced nutrition is

commonly overlooked in well-meaningdetoxification and recovery programs.This is especially true in programs {lowor non-funded) that treat the lowereconomic status clients.' While most

[somatropin (rDNA) for injection]

WHY PAYMORE PER lU?

lowest cost > highest quality > fast delivery

gauranteed satisfaction and delivery

Order Toll Free 1-866-601-2019www.clubhgh.com

TOWNSEND LETTER (or DOCTORS & PATIENTS - JANUARY 200B 63

Alcoholism

programs encourage recoveringalcoholics to eat and take basic vitaminsand supplements, what is lacking is aclear understanding by most mono-therapeutic treatment programs of thedepths of physiological changes causedby alcoholism. Furthermore, mostprograms have little ability to assesswhether the patient can adequatelyabsorb nutrients taken orally.

Time is needed to bring the alcoholicback to an acceptable state of health sothat body functions (both physical andmental) can be assessed at baselineconditions. Furthermore, what is missingin many programs is the ability to providequality nutrients in sufficient quantities (orprovide accessibility to these nutrients)to assist the client's recovery through thehealing of tissue damage andneurotransmitter dysfunction.The meansto deliver these nutrients, especially in thedetoxification stages or early in recovery,need to be considered. Furthermore,many alcoholics and drug addicts, havingsuffered through years ofmalnourishment, suffer profound andpossibly irreversible physiologicalchanges which intensify discomfort inrecovery and, for many, lead to relapse.Embedded In the multi-disciplinaryapproach is an intense focus onnutritional deficits and the profound long-term effects of chronic malnutrition andalcohol intoxication.

Proper intake of oral nutrition -including water, proteins, carbohydrates,fats, vitamins, and minerals - is theabsolute basis of our health and mentalwell-being. All treatment interventionsmust start with an assessment ofnutritional status of the individual.Treatment will be less effective if thepatient has impaired cognitive functiondue to nutritional deficiencies from thelong-term effects of alcohol and/or drugabuse. Proper hydration may be the mostimportant factor since every biochemicalprocess in the human body operates in afluid matrix. Fluid is essential intransporting nutrients and removingwaste products in and out of cells. It isnecessary for all digestive, absorption,circulatory, and excretory events, as wellas the absorption of water-solublevitamins. Proteins supply energy as wellas needed building blocks for hormones,neurotransmitters, antibodies, enzymes,and help maintain the proper acid-alkali

balance of the body. Carbohydratessupply necessary energy along with fiberwhich keeps gastrointestinal functionnormalized. Fats are essential inproviding energy and support cellularfunction. In addition, proteins,carbohydrates, and fats are also integralparts of cellular membranes andmembrane function. It is also well knownthat alcohol interferes with the absorptionof nutrients, especially vitamins. Vitamins,which are essential for life and goodquality health, are cofactors (also knownas coenzymes) for enzymatic processesin the body. Additionally, two vitamins,vitamins A and D, are consideredhormones. The major macro-minerals -sodium, potassium, calcium, andmagnesium - function in energymetabolism, membrane transport, andthe maintenance of the membranepotential. Also necessary for life, and ofspecial importance, are the micro-minerals - chromium, copper, iron,selenium, and zinc. Common nutrientdeficiencies in alcoholics are thiamine,folic acid (most common deficiency).Vitamin B-12, niacin, riboflavin. VitaminB-6, zinc. Vitamin C. and Magnesium. Anyprocess that interferes with the abovenumerous oral nutrients can causedisease states. But most of the time thesedisease states remain subclinical -especially in alcoholism.

The fact that nutrition has often beenoverlooked in the past in the areas ofpharmacology, standard medicalpractices, and treatment of addiction isnot surprising. More than two-thirds of themedical schools in the United States stilldo not have a specific nutrition course intheir curriculum.^ This ongoing failure toteach nutrition and practice nutritionalmedicine is embedded in the idea that weget our recommended daily allowance(RDA) of nutrients if we eat within certaindefined parameters. There is a clearunderstanding now that even RDAs ofthese nutrients, established by the Foodand Nutrition Board of the NationalAcademy of Sciences (NAS) in 1941, maykeep subclinical disease statessubclinical. Because the RDAs forvitamins are minimum amounts that willonly prevent the signs and symptoms ofdeficiency diseases, the daily intakeshould often be higher thanrecommended. This is especially true fortreatment of alcoholism. Furthermore,however well RDAs work as a guideline,for any given person, they may be anunderestimate or overestimate of theamounts actually needed for any specific

health problem. The fact that alcoholicshave impaired utilization of the basicnutrients is unquestioned, but the levelof deficiency is unique to each alcoholic.^In fact, these subclinical states may existbefore active alcoholism because of poornutrition. Furthermore, de/acfo nutritionaldeficits must exist in a subclinical statebefore they become clinically apparent.^"^

All chronic alcoholics suffer from somelevel of nutritional deficiencies.^^'" Thealcoholic obtains most, if not all. his/herdaily energy requirements from ethanol,which although not a nutrient, containsapproximately 7 calories per gram andrepresents about 3% to 5% of the dailyenergy intake of the adult Americanpopulation. As the most widely abuseddrug of our society, ethanol contributesdramatically to the development ofdisease states of several organ systems,especially the liver'^ and gastrointestinaltract.'3 For many, the result is diminishedutilization of oral nutrients that arenecessary for normal health which leadsto the subsequent state ofmalnutrition."'^

Treating alcoholic malnutrition andend organ injury is a complex problem.Damage to vital organ function via thetoxic effects of alcohol is just one of themany issues that need to be addressed.Absorption, assimilation, and eliminationare all impaired to some degree.Unfortunately, the efficacy of intestinalabsorption in a given patient cannot bepredicted adequately.^" Inadequate diet,digestion, and malabsorption contributeto secondary malnutrition.'^'^ Alcoholcauses changes in protein digestion andmetabolism,^' absorption, metabolism,and utilization of vi tamins,"^^ anddeficiencies of minerals.^*

Lack of quality oral nutrition, impairedutilization of these nutrients, andexcessive loss and reduced storage ofthese nutrients, all impede a return tomental and physical health and recovery.In fact, the central paradox in treatingchronic alcoholism is getting enoughnutrients into the alcoholic for organ repairso that the organ itself can utilize thenutrients in the most efficient mannerpossible. This is one reason that sometreatment programs have begun to supplyvital nutrients in muoh higher quantitiesto recovering alcoholics than one wouldsupply a person in reasonably goodhealth.^^ Nutritional supplementation andthe correction of subclinical deficienciesare not only vital for improvement ofgeneral physiological health duringdetoxification and treatment,'^ but also

S4 TOWNSEND LETTER for DOCTORS & PATIENTS - JANUARY 2005

absolutely necessary for relapseprevention. Improving nutritional status isnot only paramount in the detoxificationstages and early treatment, it has alsobeen shown, at least in the long-term, todecrease the over-all relapse rate.'^^

Not only do nutritional deficienciesincrease alcohol cravings, they alsopromote complications in alcoholics suchas heart disease, liver disease, high bloodpressure, diabetes, osteoporosis, andincreased cancer risk.^' Additionally, thechronic use of alcohol has been shownto promote the development ofdepression,'^^'^*' Nutritional therapieshave been shown to not only reducehepatotoxicity, reduce withdrawalsyndromes and cravings, they alsoalleviate depression and anxiety.^^

Well-intentioned "nutritionally" basedhospital diets have been shown to be lesseffective in treating alcoholism than wholefood diets, tn one such trial, coffee, junkfood, dairy products, and peanut butterwere replaced by a special diet whichincluded fruit and a whole foods protocol.At the six-month review, fewer than 38%of those on the hospital diet had remainedsober, compared to 81% of those eatingthe special diet.^ Other trials have shownthat restricting sugar, increasing complexcarbohydrates, and eliminating caffeinereduced alcohol cravings.^" Whenalcoholics are placed on diets high in rawfoods, many spontaneously avoid alcohol(and tobacco); those placed on nutrient-loaded diets along with multivitaminsupplements did far better at follow-up inabstaining from alcohol than did thecontrols.^' Unfortunately, research islimited involving nutritional treatment ofalcoholism or drug addiction. However,in the well-planned nutritionally basedprograms that have been implemented,negative results are rare.

Joan Larson, director of HealthRecovery Center and author of SevenWeeks to Sobriety, has compiledastonishing statistics after designing aprogram that utilized nutrition as thefoundation of alcoholic recovery. Onehundred alcoholic clients, chosen atrandom, were followed up 3.5 years aftercompleting the program. At discharge (7-weeks), 85% were free of anxiety, 94%claimed no sleep problems, 98% claimedno shakiness, 96% were free fromdizziness, and 95% were subjectivelydepression-free. Furthermore, at the 6-month interview 92% were abstinent fromalcohol, 85% of whom had remainedcontinually abstinent since treatment.Some three years later, 95 of the original

100 subjects were interviewed and 74%had remained abstinent.'^

It has been known for some time thatcertain systemic problems, such ashypoglycemia, can cause an increase inthe desire to use alcohol." In fact, it hasbeen noted that almost all alcoholicssuffer from some level of dysfunctionalblood sugar regulation.^ This conditionin itself increases alcohol cravings plusthe desire to increase sugar intake.Control of blood sugar is paramount inrecovery and has to be included in alllevels of the treatment regime.

In the common type of 28-daytreatment program where nutritional

Alcoholism

support is not the foundation ofwithdrawal and recovery, residualsymptoms such as ongoing anxiety,insomnia, tremors and shakiness,dizziness, depression, and impairedcognitive function are not uncommon forup to 4-8 weeks after discharge."^^ It isfor this reason that we feel the currentunderstanding of the mechanisms ofwithdrawal and detoxification, especiallyin treating alcoholism, must be redefined.Withdrawal encompasses more than just

The Definitive Guidefor

Treating the EFFECTS of TOXICITY

The DetOXX book by Dr. Patricia KaneYou will quickly discover why so

many healthcare professionals areTalking ab The DetOXX book!

"I found the recent course presented byPatricia & Ed Kane to be one of themost valuable and informativecourses ! 've taken. It waswell organized, clearly presented,and abundant in basic,clinically relevant andexciting new information.It has made a impactupon my approach tonutritional management."

-Thelma Jones, MD

$29.95

www.detoxxbook.com

45 Reese Road Millville NJ 08332

TOWNSENO LETTER lor DOCTORS ft MTIENTS - JANUARY 2005

Alcoholism

clinical phases where the alcoholdisappears from the human system. Forexample, it has been recognized,especially in opiate dependency, that thewithdrawal syndrome does not end in 5-7 days. Subtle signs and symptomsexisting past the currently acceptedwithdrawal phase, termed the "protractedwithdrawal syndrome,"^' may last up tosix months. This is one of the reasonsthat maintenance programs such asmethadone treatment, along with otherpsychotropics such as benzodiazepines,are utilized for extended periods of theopiate withdrawal.^^^ In comparison toalcohol, opiates by themselves may beone of the least toxic drugs on humanphysiologic functions and tissues whilethe long-term effects of alcohol on liverfunction, gastrointestinal function, andbrain neurochemistry have been welldocumented.'^^^"^''^^ It is our positionthat the long-term effects of alcohol onorgan system function contribute greatlyto the high relapse rates amongrecovering alcoholics. Repair of affectedorgans requires a strong nutritionalfoundation during treatment and ongoingrecovery. This primary focus on a"nutritional foundation" is lacking in almostall alcoholic treatment protocols at thistime.

Every biochemical process at themind-body level is controlled by genetics.We receive one set of genes from ourmother and one set from our father atconception. We are the combination ofgenetics from these two people and alsoall of our past relatives. Certainexpressions of gene function cannot bechanged (our genotype), such as our eyecolor. However, we still carry enoughgenetic differences that we all function atthe molecular level somewhat differentlyOur phenotype, or how genes areexpressed through environmentalinfluences, is the most importantconsideration in the treatment of anychronic disease including alcoholism,Mutations of genes can cause variantsof gene products. However, in one study,high vitamin therapy at least partlyrestored enzymatic function in 50 geneticdiseases."^ Therefore, it is critical,especially in the nutritional treatment ofalcoholism, that the clinician understandssome basic concepts about genetics andbiochemistry (i.e., functional/molecularmedicine). Additionally, nutritional

treatment of any disease requires someknowledge of nutrient absorption,distribution, metabolism and elimination.

All metabolic reactions (energy-requiring events) in biological systemsrequire enzymes. Enzymes are proteins(the products of gene expression) thatserve as catalyst to increase the rates ofreactions without being destroyed in theprocess. As mentioned above, thesemetabolic events are changeable throughenvironmental factors. The environmentalfactors that control the rate and extent ofenzymatic reactions are: 1) The amountof substrate the enzyme has to act on.The basic substrates of biologicalsystems are proteins, carbohydrates, andfats - the food we eat. At this ievel onemust also consider the concentration ofenzymes available to act on thesubstrate. Our genes largely determinethe concentration of enzymes availablefor metabolic reactions but only if theamount of protein substrates is availablefor the production of enzymes. Enzymescan also break down products of enzymicreactions (catabolic reactions). Anexampie of this function involves thenormaiiy occurring enzyme monomineoxidase, which breaks down excessiveserotonin or dopamine at the brain level.Monomine oxidase inhibitors arecommonly used by psychiatrists to treatdepression. In fact, at least half of themost commonly prescribed drugs in theUnited States act as inhibitors ofenzymes;" 2) Enzyme reactions vary inefficacy in relationship to temperature atwhich they are exposed. Highertemperatures typically increase whilelower temperatures decrease velocity ofthese reactions; 3) Enzyme reactions areaffected by the pH (acidity or alkalinity)of the environment. The pH optimumchanges with different enzymes. Forexample, enzyme reactions in thestomach exist in a low pH (highly acidic)environment; 4) Cofactors, or coenzymes(vitamins, minerals, and some non-vitamins), are needed for most, if not all.metabolic enzyme activity. Furthermore,enzymes contain an active site that bindspreferentially to the substrate with whichit is to act upon. Once the product isgenerated, the enzyme disassociates andthe product is available to provide itsdesigned function. However, it's importantto note that rarely is the productgenerated the final product. Therefore,the study of biochemistry requiresfollowing basic nutrients, and theirconversion to products, throughmetabolic pathways. The product of one

enzyme/substrate reaction is more oftenthe substrate for the next reaction.

An example is the conversion of theprotein tryptophan to the brainneurotransmitter serotonin. Lowserotonin, as well as changes in theneurotransmitters dopamine and GABA,'^has been implicated in alcoholism anddepression."*^ Supplementing tryptophanis a commonly suggested treatmentadjunct. Tryptophan. an essential aminoacid (which cannot be synthesized in thebody), is taken into the system throughoral nutrition. Although tryptophan can betaken as a singular amino acid, it normallyenters the body as part of a larger proteincompiex (polypeptides) which goesthrough enzymatic cleavage at thestomach, and later the small intestine, toyield the singular amino acid. It is thenabsorbed from the gastrointestinal tractand delivered to the liver for subsequentprocessing. These necessary events arecommonly impaired in alcoholism.^' Atleast two products are generated and twoenzyme-related events are neededbefore serotonin is formed at the brainlevel. Furthermore, the serotonin notutilized as a neurotransmitter iseventually utilized as a substrate togenerate melatonin (necessary for goodquality sleep among other activities). Thisconversion requires severai moreenzyme related- events. The essential co-enzymes needed for these reactions arevitamin B-6, niacin, and magnesium."''**Genetic variants, substrate and cofactorsconcentration, or environmental factorscan affect the quantity, or quality, of anymolecule in any metabolic pathway.

As a side note, the clinician must bewarned about supplementing higherdoses of L-tryptophan, Tryptophan can beutilized in several metabolic pathways inthe liver. Too much supplementaltryptophan can yield undesirablemetabolic products and at highconcentrations liver damage mayoccur."^« 5-Hydroxytryptophan (5-HTP),which bypasses liver processing, issometimes utilized in the place of L-tryptophan to avoid this potential problem.However, at least theoretically, it must benoted that any nutrient supplementationin excess may have the potential to harmthe client.

Nutritional therapy is a complex issue.Clinicians, who wish to pursue this levelof treatment for their client, mustunderstand extensive information onmetabolism and genetic function. Withoutunderstanding the intricacy of molecularfunctions, and how they are activated and

TOWNSEND LETTER lor DOCTORS ft PATIENTS - JANUARY 200fi

manipulated through nutritionaltreatment, the clinician is more likely tocreate more harm then good. Even ifharm is not caused to the client, treatmentoften fails to produce the desired result.Just taking one particular vitamin, oramino acid, to address health issues indetoxification and recovery is akin tosupplying the client with just Prozac to"cure" their depression, Majid Aii, says itbest: Wo molecule exists in biology alone,functionally or structurally. This is self-evident. And yet we physicians insist indiagnosing "a nutrient deficiency" tounderstand "a disease" which we canthen treat with "a nutrient therapy" Thecentral issue here is: Mononutrienttherapy has no place in the clinicalpractice of molecular medicine *°

Nutrient therapies become complexbecause all nutrients that enter thehuman body have multiple functions. Asan example, magnesium is involved inover 300 metabolic processes. It isessential for the production of ATP (amolecule which delivers energy forcellular processes) and for the synthesisof nucleic acids and proteins. In fact,magnesium is necessary for every majorbiological process.^^ Magnesiumdeficiencies are common in alcoholismdue to decreased intake, vomiting,diarrhea, and increased loss throughurinary excretion.^ Another example ofmultiple coenzyme functions involvesvitamin B-6. Vitamin B-6 is a coenzymefor over 100 enzyme-related events in thehuman body and is essential for theproduction of most majorneurotransmitters including serotonin,dopamine, norepinephrine, and GABA.Vitamin B-6 is also necessary forproduction of nucleic acids, haemoglobin,and proper nerve function.̂ ^ It is a matterof fact that the absorption of all B-vttaminsis affected by alcohol abuse. The level ofdeficiency varies, as was mentionedpreviously, from person to person.

Assessing nutrient deficiencies isdifficult. Many times lab tests may shownormal results even if specific levels arewithin defined parameters. As anexample, only 1% of the magnesium inthe human body is free in the blood andthe rest is found in the cell or bone." Inone lab study, involving alcoholic patientswith low hemocrit, multiple nutrientdeficiencies were noted. The researchersfound that normal laboratory parameters,used for non-alcoholic patients, wereinadequate when applied to alcoholicpatients. This makes sense sincenutrients have multiple and complex

interactions at the cellular level and allalcoholics have varying degrees ofdeficiencies,^ Since all chronic alcoholicssuffer from some level of nutrientdeficiencies, then the best treatmentprotocols appear to Involve designingbalanced nutritional protocols, especiallyutilizing intravenous vitamins andminerals, which will assist the patient inrecovery and detoxification. The goal withcomprehensive IV nutritional therapy isto provide necessary nutritional supportat the cellular level in the individual

Alcoholism

alcoholic whose gastrointestinal tract iscompromised. Ultimately, this therapy willassist the individual back to a state ofhealth so that oral nutrition will suffice intheir ongoing health. Initial physicalmeasurements such as body weight,height, and percent body fat would allowthe clinician a point from which tomeasure therapeutic efficacy of the

Distributing Supplements To Health ProfessionalsOver 5000 products from 100 Manufacturers

DoctorsFOR NUTRITION.

TlDhealthThe Clear Choice For AllYour Supplement Needs

Whoiesaie Pricing for theLicensed Heaith Professional

Patient Direct Fulfillment

Fast & FriendlyCustomer Service

FREE SHIPPINGon orders over $300

BiiiUiHrtD'n!

lllli«ilICll \K

LIfEnhance

Serving Health Professionals Since 1983800-824-2434 www.tidhealth.com

TOWNSEND LETTER for DOCTORS A PATIENTS - JANUARV 2005 87

Alcoholism

treatment. A measurement ofpsychological parameters duringtreatment, whether subjective orobjective, can also be used to measuretherapeutic efficacy of the treatmentprotocol.

ConclusionThe successful treatment of the

disease of alcoholism requires knowledgeof cellular and biochemical events.Functional medicine recognizes thatnutrition is the necessary cornerstone forall good health, which includes adequatedetoxification and continued recovery inalcoholism. Through the utilization ofnutritional therapy, the patient can bebrought back to health quickly so that hisbody and mind functions can be utilizedat the fullest extent. It has becomeapparent that mono-therapies, of anynature, have low success ratios in thetreatment of alcoholism. It is time forhealth professionals of all disciplines tocome together, with open minds, to utilizeholistic treatment regimes that improvethe success of treatment. In the fewprograms where this has occurredsuccess ratios for continued recoveryhave risen dramatically.

Correspondence:Dr. David Arneson. NMD550 W. Indian School Road. Suite 122Phoenix, Arizona 85013 USA602-234-1158Fax 602-234-9691thesourcenmc @ msn.com

References1. J Chick: Alcohol, health, and the heart: Implications

for clinicians. Alcohol and Alcoholism 1998, 33:576-91.

2 C Lo: Integrating nulrilion as a ttiome throughoutthe medical school curriculum. American Journalof Clinical Nutrition 2000, 72:8825.8898,

3. LM Mjelde-Mossey: Nutrition and recovery fromalcoholism. In- Treatment Choices for Alcoholismand Substance Abuse Edited by Milkman, pp. 74-B6: Macmillin, New York: 1990: 74-86.

4. JD Biachley, JP Knochel: Ethanol and minerals.Phatmacologyand Therapeutics 1987.33:435-48.

5. PR Ryle, AD Thomson: Nutrition and Vitamins inAlcoholism. In: In Clinical Biochemistry ofAlcoholism Edited by SB Hosaiki: Harper & Row.New York; 1984,

6. B Wood: Alcohol and nutrition, Australian Alcohol/OrugRevlew^984. 3(2):107-10,

7. PJ Fahey, JM Boltri. JS Monk: Key issues innutrition. Postgrad Medicine 1987, 81:123,

8. EB Feldman, E Kaufman: Malnutrition in theAlcoholic and Related Nutritional Oeficiancies. In:Encyclopedic Handbook ot Alchoholism Edited byEM Pattison, E Kaulman. pp, 25S-62: New York:Gardner Press; 1982: 255-62.

9. S Shaw, CS Lieber. HA Schneider, CE Anderson.DB Courson: Alcoholism. In: Nutritional Support lorMedical Practice, 2nd ed. New York: Harper & Row;1983.

10. JR Graves: Role of Nutrition in the Treatment ofAlcoholism. In: Progress in Alcohol Rssearch. vol,1. pp 247-63, Utrecht: VNU Science Press; 1985:247-63.

11 CM Leevy, 0 Frank. CB Leevy. H Baker: Nutritionalfactors in liver disease of the alcoholic. Acta MsdicaScandir^avica 1985, 703:67-69.

12. TM Brody. J Larner, KP Minneman: Nutritionalaspects of pharmacology. In: Human Pharmacolgy-Molecular to Clinical Edited by M Brown, pp. 843-860. St, Louis: Mosby; 1998: 843-860.

13. MJ World, PR Ryle. A.D.Thomson: Alcoholicmalnutrrtion and the small intestine. Alcohol andAlcoholism. 1985. 20:89-124,

14. CSLeiber:/Vu(rfl©v1988. 46:241.15. S Shaw. CS Lieber: In: Modern Nutrition in Health

and Disease Edited by RS Goodhart, ME Shils. pp.1229. Philadelphia- Lea & Febiger; 1980: 1229.

16. CS Leiber: Alcohol and the liver: Metabolism olethanol. metabolic effects and pathogenesis otinjury. Acta Medica Scandinavica 1985. 703:11 -55.

17. JM Larson: Correcting chemistry. In: Seven WeeksTo Sobriety, pp, 117-118. New York: BallantineWellspring; 1997:117-118.

18. CS Leiber: Alcohol nutrition interaction. Jouma/o/Dentistry for Children ̂ 96A. 51:137-40,

19. I Diamond: Alcoholic myopathy andcardiomyopathy, N EnglJMed 1989. 320:458-59.

20. PSWissel: Drug and Nutrient Interactions: 1987.21. L Gloria. M Cravo. ME Camilo: Nutritional

Deficiencies in Chronic Alcoholics: Relation toDietary Intake and Alcohol Consumption. TheAmerican Journal of Gastrosnterotogy 1997.92:485-89.

22. NA Aliyev, ZN Aliyev. AR Altguliyev: Amino acidneurolransinitters in alcohol withdrawal. Alcoholand Alcoholism 1994. 29:643-47.

23. CA Allan. I Smith, M Mellin: Changes inpsychological symptoms during ambulantdetoxification. Alcohol and Alcoholism 2002.37:241-4.

24. M Driessen. S Meier. A Hill. T Wetterling. W Lange.K Junghanns: The course ot anxiety, depressionand drinking behaviours after completeddetoxification In alcoholics with and withoutcomorbJd anxiety and depressive disordefs. Alcoholand Alcoholism 2001, 36:249-55,

25. JP MacMurray, DG Nessman. MG Haviland. DLAnderson. JSrud>*fcohoA 1987. 46:277-80.

26. AT McLeilan. GE Woody. CP O'Brien: Developmentof psychiatric illnesses in drug abusers. N EngI JMed1979. 301:1310-1314.

27. R Verhaul. Wvd Brink. PGM-A, A Ihree-pathwaypeychobiological model of craving for alcohol.AkMhol and Alcoholism. 1999. 34:197-222

28. PP Vescovi. V Coiro: Persistence of defectiveserotonergic and GABAergic controls of growthhormone secretion in long-term abstinentalcoholics. Alcohol and Alcoholism. 1997, 32:85-90.

29. RM Guenther: Role of nutritional therapy inalcoholism treatment. IntJBiosoc Res 1993, 4:5-18.

30. MR Werbach: Alcohol craving, Int j AltemComplementary Med ̂ ^3. Ju\^.^2.

31. UD Register: Influence of nutrients on the Intakeof akx>hol. J Am Diet Assoc 1972, 61:159-62,

32. J Chick. CK Erickson: Conference summary:Consensus Conference on Alcohol Dependenceand the Rote of Pharmacotherapy in its Treatment.Alcohol Clin Exp Res 1996, 20:391-402.

33. CK Erikson: Voice of the Victims, Alcohol Clin ExpRes 1996. 20:403,

34. K Forander: Q J Stud Alcohol ^95a. 19:379.35. DE Smith. RB Seymour: Nutritional counseling and

other concerns in supporting recovery. In: CliniciarTSGuide to substance abuse, pp, 319-326 New Yiork:Magraw-Hill; 2001: 319-326

36. D Mossberg: Clinical conditions in alcoholics duringlong term abstinence. Alcoholism. Clinical andExperimental Research 1984. 8:250.

37. WR Martin, D Jasinki: Psychological parametersof morphine in man: tolerance, early abstinence,protracted abstinence J Psychiatry Res 1969.7:9-17,

38. AT McLeilan, CP O'Brien. D Melzger. Al AUerman.J Cornish. H Urscel: How effective Is substanceabuse treatment-compared to what? In: AddictiveStates Edited by CP O'Brien. J JaHe, pp. 231-252.NewYorK: Raven Press; 1992: 231-252.

39. CP O'Brien: Treatment of alcoholism as a chronicdisorder. In: Toward a Molecular Basis of AlcoholUse and Abuse. Edited by B Jasson. H Jornvall.pp. 349-359, Basel, Switzerland: BirkhausorVeriag;1994: 349-359.

40. Majid All. M.D.: Intravenous Nutrient Protocols inMolecular Medicine. In: Nutritional Medicine:Principles and Practice {unpublished manuscript).Institute of Preventive Medicine, 95 East MainStreet. Denville. New Jersey 07843. pp 1-7.

41. Jeffery Bland Ph,D: Functional Medicine: Nutrition'sInfo Revolution. In: Holistic Health Care. E.Goldman, ed. April 15. 2002; vol. 3, No. 1;pp1. 6-7,

42. JE Pizzorno. MT Murray, and JS Bland: Functionalmedicine in natural medicine. In Textbook ofNatural Medicine, 2nd ed. Churchhill-Livingstone.New York. 1999-Vol 1:pp3-15.

43. P Champe and R. Harvey: Lippincott's IllustratedReviews: Biochemistry, 2nd ed, J,B, LippincottCompany. Philadelphia. 1994

44. J Growden-. Neurotransmitters in Ihe diet. In:Nutrition and the Brain. R Wurtman. et al. New York.NY: Raven Press. 1979: Vol 3: ppi 17-167

45. Metabolic Pathways Chart. SIGMA ChemicalCompany. P.O, Box 14508. St. Louis, Missouri.63178.

46. BN Ames, I Elson-Schwab. and EA Silver: High-dose vitamin therapy stimulates van ant enzymeswilh decreased coenzyme binding afiinlty(increased Km): relevance to genetic disease andpolymorphisms, American Journal ol ClinicalNutritionVo\. 75. No. 4. 616-658. April 2002.

47. ML Cohen and TM Brody: 5-HydroKylryptamlne(Serotonin) and therapeulic agents that modulateserotonergic neurotransmission. In: HumanPharmacology: Molecular lo Clinical, 3rd ed. Editedby M. Brown. Mosby Year-Book. Inc. St. Louis. MO1998, pp 157-166.

48 JR Cooper. FE Bloom, and RH Rolh: Serotonin (5-Hydroxytryptamine) and Histamine. In: TheBiochemical Basis ol Neuropharmacology, 7th ed.Oxford University Press. New York. NY 1996pp.352-391.

49. M Ali. MD: The Butterfly and Ufa Span Nutrition.Isl ed. 1992. pp. IV

50. PDeWitte:The role of neurotransmitters in alcoholdependence: animal research. Alcohol Alcohol.March 1996; 31 Supp11: 13-6.

51. L Feinman: Absorption and utilization of nutrientsin alcoholism. Alcohol Health and Research World13(3):207-210. 1989.

52. CS Leiber: The cntluence of alcohol on nutritionalslatus. Nutrition Reviews 46(7):241-254, 1988.

53. CS Leiber: Alcohol and nutrition: An overview.Alcohol Health & Rgsearch World 13(3):197-205.1989,

54. L Marsano and Cj Mcclain: Effects of alcohol onelectrolytes and minerals. Alcohol Health SResearch WorW13(3):255-260. 1989.

55. PDR for Nutntional Supplements. S Hendler andD Rorvik. eds. 2003.

56. EB Flink: Magnesium deficiency in alcoholism.Alcoholism: Clinical and Expenmental Research10(6): 590-592. 1986

57. MJ Rosenthal and JS Goodwin: Cognitive effectsof nutritional deficiency. Advances in NutritionResearch7: 71-100. 1985

56, D Savage and J Lindenbaum: Anemia in Alcoholics.Medicine (Ballimore) 65(5): 322-38. 1986.

59. J Bland and SH Benum: How your dielcommunicates with your genes. In: GeneticNutritioneering, Keats/NTC/ContemporaryPublishing Group. Inc, 1999. pp 51,

TOWNSEND LETTER for DOCTORS & PATIENTS - JANUARV 200S