Surviving Opioids - Beyond an Epidemic
Surviving Opioids - Beyond an Epidemic
Introduction to Amino Acid Supplementation for Opioid Addiction
Folks in early recovery don’t necessarily lack the discipline to make and stick to changes, but they usually lack the guidance and direction, and it's hard today with so much information available, all of which will at some point contradict something else you’ve heard.
One of my favorite topics to discuss involves nutritional deficiencies and supplementation, which is the topic for episode 16.
General disclaimer : any time we're talking about supplements, you don’t want to be starting or stopping anything without being in contact with someone qualified who knows your personal history.
Nutrition is a nuanced topic - there’s no one size fits all, but there are enough basic patterns that come up to speak broadly on the topic then you can tailor fit that to your own case.
Disclaimer #2 : There are certain psychiatric conditions like bipolar disorder that are extremely sensitive to any changes in lifestyle or nutrition, and it’s hard enough getting someone stabilized on psychotropic medications that I’m always very careful to remind someone with this diagnosis not to run out and haphazardly start taking something that you hear me or anyone else talking about.
So that being said - this episode is introducing you to the topic of amino acid (and other dietary) supplementation as it can be applied to recovery from opioid dependency.
When you discontinue the use of opiates, the abnormal biochemical balances that you had been getting artificially once again become unbalanced.
So the nutritional targeting that we're talking about here is attempting to quickly give the brain those necessary building blocks to start producing your own neuro transmitters at a normal level.
If you enjoy the episode, please leave a rating, share it with someone who could benefit from the information, and reach out on Instagram at ReactionRecovery.
Hello lovely podcast people. Welcome back to Surviving Opioids podcast where we talk all things opioid addiction and recovery. I’m your host Jeff Simone. I’m a Doctor of Pharmacy, Advanced Dietary Supplement Adviser, Certified Professional Recovery Coach, founder of Reaction Recovery – which is a private coaching service where I work with clients one on one to develop a lifestyle approach that puts them in the best position to get better…. That’s what all of us is trying to do, get better.
Because like I say all the time, we will feel better one way or another, either slowly through regular, repeated action, or quickly by relapsing back onto the thing that we’ve known for years to make us feel instantly better…at least for a few minutes…
It’s been my experience that folks in early recovery don’t necessarily lack the discipline to make and stick to changes, but they lack the direction…. And its hard today with so much information available, all of which will at some point contradict something else you’ve heard, it’s hard in the beginning to sort all of that out and know the right path to walk down, and even if we are on the right path, we then need lots of personalized and relentless accountability to stay on track.
So that’s what Ive positioned myself to do… And I happen to think that through my educational, professional, and personal experience that I’m… one of the best to do it.
And you don’t have to be a client of mine to benefit from the information - the majority of people I interact with and who consume my content are online through stuff like this, the podcast, the website, I have some youtube videos, some blog posts, I’m active on Instagram, I’ll usually write out my thoughts on a specific recovery related topic most days so those are all posted…. I have over 300 posts with long captions so all of that info is free for your public consumption.
I’ll get messages sometimes asking how to help – and I give answers – but mostly what I say is this is way too complicated to answer in a text message, go to my Instagram, read my posts, follow my stories, listen to the podcast, you’ll get a feel for what I’m all about…..
So with that all said, one of my favorite topics to discuss is around nutritional deficiencies and supplementation, and I’ll go into some of that today… General disclaimer any time I’m talking about supplements is you really don’t want to be starting or stopping anything without being in contact with someone qualified who knows your personal history.
Nutrition is a very nuanced topic, there’s no one size fits all, but there are a lot of basic patterns that I see come up so I can speak broadly on the topic then you can tailor fit that to your own case… there are certain psychiatric conditions like bipolar disorder that are extremely sensitive to any changes in lifestyle or nutrition, and it’s hard enough getting someone stabilized on psychotropic medications that I’m always very careful to remind someone with this diagnosis not to just run out and haphazardly start taking something that you hear me or anyone else talking about….So word to the wise….
Alright, todays topic is around supplementations…. When you discontinue the use of opiates, the abnormal biochemical balances that you had been getting artificially to compensate for the effect of those drugs once again becomes unbalanced.
The system is basically shocked into trying to establish a new biochemical balance which isn’t going to depend on these external substances -these external opioids. So. The nutritional targeting that we're talking about here is trying to quickly give your brain those necessary building blocks to start producing our own neuro transmitters at a normal level… and there really should be some sense of urgency here because like I’ve experienced and seen with lots of people, when you were taking a lot of stuff for long periods of time, that down-regulation that comes on the heels of an abrupt detox – if that’s what you’ve chosen to do – is incredibly painful for the person… I’ve mentioned before that I was taking over 1000 mg of oxycodone/day for a lot of years – and although I’ve met lots of people who have had more intense experiences than me as the result of their addiction, in terms of actual amount consumed over that length of time, I haven’t met anyone – so I can speak very confidently about what is needed to start feeling better physically….and that’s the component that were talking about here.
This is not a movie where someone shakes and throws up for a few days then all of a sudden theyre better – no, this can last a very long time, and if its not taken seriously, that lack of neurochemical stimulation can be so painful that lasting sobriety is probably not happening.
But even if the dose wasn’t that high, withdrawal from virtually any psychotropic substance is going to be accompanied by some symptoms….. Irritability, tiredness. Fatigue, lack of focus. It's it's going to be there to some degree or another, and with opiates it's about as strong as anything else. If you've been using it for a relatively short period of time, your symptoms might be mild, but with most people, by the time that they seek help, by the time that they reach out to somebody. No, they've been using this stuff for for a long time.
Remember restoring the nutrients needed for these typical neuronal functions, It's one of the best ways, The best assistance that we have to rebalance the brain chemistry that's been disrupted by these by these drugs. Like it's doing things in theory, that prescription drugs are not doing - OK so there's certainly a place and a time for pharmaceutical medications, absolutely. but those drugs are not restoring normal brain functioning, Sometimes they actually make it more imbalanced over the long term, but they can and often do reverse some of the short term symptoms and discomforts.
The strategy behind supplements is that hopefully we kind of go at this aggressively. We go at this. With enough precision that once the achieved benefit is realized, well then we can back off at some point. You know, certainly back off from that initial load. You might still want to take some things from from time to time. I mean I I still do, but not nearly like like you might have needed to in the beginning. So again, the whole purpose of this. Is to help you function more normally in your daily life while you taper off and/or completely discontinue Opioid use.
Also keep in mind that although each of us has essentially the same fundamental brain chemistry. Each one of us has an absolutely unique biochemical makeup. And that's where this genetic vulnerability piece comes in, which is a piece of the puzzle, always in behavioral health, but certainly to the addiction recovery puzzle. For example, some people seem to need more dopamine than others to feel and behave at their best, other people need more serotonin and other people need more GABA, you know, it really does vary based on a lot of things, based on childhood experiences, genetic makeups. Nutrition…So these individual genetically based variations in biochemical makeup translates to varying nutritional needs for the person.
So that would be a consideration for all the classic drugs of abuse but Unlike some other substances. There's a long term cascade effect from opiate use that a lot of people aren't familiar with, which includes malnutrition and chronic pain… Opiates are stimulating endorphin and enkephalin receptors… artificially stimulating. If you want to think of it like that, which sends a full signal that there are plenty of endorphins and enkephalins around, and that the brains requirement for.. proteins.. for those Types of proteins are satisfied. Well This also has the effect of short circuiting hunger, making the opioid user unaware of the fact that she needs to eat. And if this occurs frequently, overtime, a condition of general malnutrition can result, which is pretty common by the way I would. I would consider most, if not all chronically opioid addicted people to be malnourished, whether or not they're underweight or not. It doesn't really matter.
You can easily be malnourished and and still be of a normal appearing weight for you or even overweight for body.. Also, A lot of people that are addicted opioids over consume the calorically dense, hyper palatable foods. It's just it's just what we crave. It's what feels good. .. I remember pretty much my whole last year of opiate addiction. I think I was eating like almost like a full box of entenmann's Donuts every day, and that's not unusual. You know, talk to anybody who’s living that life, and if you just kind of dig into their diet. It does look like that…
It'll be a big bowl of frosted flakes in the morning. Some orange juice and and maybe coffee and. You know maybe a mcchicken sandwhich for lunch, lots of sweets and ice cream for dinner, so they might be getting the calories in, so keeping the weight on, but malnourished nonetheless.
Chronic pain is another cascade effect symptom of opioid use. This is known in the medical community. It's not talked about quite as much. But by occupying endorphin and enkephalin receptors in the brain, opioid drugs cause a downregulation or reduction in the normal production of the body's natural painkilling neurotransmitters to compensate for all these artificial opioids. Well After long term use, when the drug is no longer around, even minor physical or emotional pain. Might be perceived as severe because the brain is relatively incapable of producing endorphins, enkephalins on its own.
And again this phenomenon is. Very well understood by by researchers. So This is why even if somebody starts taking opioids, not for pain. If they're just taking them to abuse them and then become addicted.. well, overtime, once you stop that product, you're going to be hypersensitive to pain. Emotional pain for sure. Like I talked about in the endorphin episode
But Also, they're going to be much more sensitive to physical pain 'cause your body is just not producing enough of its natural endorphins and the whole system has been down regulated, so it's a big problem and it is where having the right mindset can really help too – like understanding and Just accepting the fact that I'm not going to be feeling well for a while and things are going to be… uh, weird and there are going to be sensitivities that feel very exaggerated for a little while.
But anybody who's malnourished over time, Amino acid deficiencies are a problem, and they absolutely are for people who are chronic users of opioids. Endorphins and enkephalins are made from several amino acids. You know I talked about. I talked about DLPA - DL phenylalanine, but also tyrosine, glycine leucine. Methionine.. a lot of these are commonly deficient in opioid user.
Then These deficiencies cause the brain's ability to produce them to be compromised, which causes opiate cravings. And then of course the use of opiates themselves causes malnutrition, which worsens the nutrient shortage and just causes this whole vicious cycle to be going on of substance craving substance use worsened nutrient shortage over and over until the cycle finally gets broken – hopefully gets broken... So correcting a lot of these cascade effect symptoms that the opioid abuse may have caused is important. And a lot of factors affect how these developed – genetics, stress levels, diet, environmental toxins, Other things…
And the best way to determine the exact biochemical Causes of cascade Effects is to have biochemical testing done by a qualified lab If you have access to it. For example like when I work with people, the more tests that they can possibly present to me, the better equipped I am to start pointing them in the right direction, especially as it relates to correcting nutritional deficiencies, which again like I said, they will be present in everyone straight across the board…. There's there's there's. No exceptions, the only question is where exactly those deficiencies are showing up. And like I've said before also. This is just a percentage. This is just a piece of the recovery pie… but when we're talking about something like opioid recovery where the success rate is so low. Even if we're only talking about say just say 10-15%, maybe 20% in some people of the pie at first. In terms of recovery, were in no place to Scoff at percentages like that. It's just too significant. Because we know that if. Folks don't feel well for long enough the risk of relapse goes way up. Especially for the folks who have decided to proceed with full abstinence….
Now That's a little bit different for the opioid maintenance clients, because they are still taking opioids which are stimulating the endorphin receptors so the urgency is not quite as strong to correct some of these deficiencies and put those neurotransmitters back in place.
But As far as the actual tests. That I would recommend, it's going to vary depending upon the means of the patient. Depending upon the insurance plan. Generally speaking an elemental analysis would be good, amino acid analysis, essential fatty acid analysis. These are all from blood. Complete blood panels. Some people like getting like digestive analyses - stool screens, other toxin tests, Food Sensitivity Testing I would certainly recommend if if if somebody has access to it.
Because the starting point to good health is a strong and balanced biochemical foundation, and the scientific way to understand exactly how to achieve this is through testing individual testing, which reveals the state of your biochemical health. Now that's the most precise way of doing this. But even if you choose not to make use of these tests, which I would say most people don’t, just understanding how they work and what they can accomplish is good, then if you don't get the results that you want with just some empirical supplementations, well you can always come back and do more extensive testing later on….
Because substance problems don't happen in a vacuum. They don't just appear out of nowhere. Invariably it's accompanied by other symptoms, which are often the result of the same biochemical imbalances which cause or contributed to the substance abuse. It's really hard to overcome a long term substance problem unless you also deal with the underlying biochemical imbalances.
And of course, emotional pain is going to be a trigger for opioid use, but also physical pain certainly is. So addressing physical pains is important too - some patients I’ll suggest looking into physical therapy/ occupational therapy, If there's something that needs to be worked out. You know, sometimes just some stretching, swimming, yoga, all that kind of stuff helps simulate the delivery of nutrients to the cells.
I did a full episode on DLPAD L. Phenylalanine that's probably worth a listen. That's a very important amino acid in. Restoring normal enkephalin and endorphin levels because it slows down the action of enzymes which deactivate them. And so this helps enkephalins occupy receptors and block pain impulses for longer than normal periods, which restores some of their painkilling effects.
So again, overall there are usually five amino acids that are often deficient in this population. Sometimes we can see it on an amino acid analysis, but even if we don’t have that, just kind of treating it empirically usually has benefit because theres a pretty good deal of certainty that a lot of these will be deficient, so the five are going to be DLPA L leucine L methionine, L glycine, and L tyrosine.
DLPA is usually dosed three times a day, maximum 2 grams, three times a day. That's a pretty high dose. I usually recommend lower, especially to start then we work it up or down as we need, it’s dosed one hour before meals.
Again, like I mentioned before, if you're taking any kind of antidepressant medication, you need to be run any supplements by that prescriber before starting so the doc is aware and can add it to their notes if they think it’s a good idea… A note of course it that most traditionally trained physicians don’t have much training in dietary medicine so a lot of times they just tell people not to worry about, because that tends to be a much safer thing to say
But that also goes for all amino acid supplements. It really goes for everything. Ideally, ideally anything you put in your body should be sort of run by somebody else, but specifically for certain amino acid supplements and we do recommend that that all providers are on the same page here…..
L. Leucine is going to be dosed up to 500 milligrams three times a day. Again, one hour before meals, most amino acids are going to be dosed one hour before meals. And the reason is amino acids are just building blocks of protein, so they’re what would be found in any kind of meal. If you have a hamburger, you're getting amino acids. The problem is that we're getting. Most of them all at once, and they're all in there, all competing for absorption.
So when I am dosing with a specific amino acid, I don't want it to be competing With the amino acids that are in your food, so I would prefer them to be given one hour before so that stuff can get absorbed by itself, get into your bloodstream before you consume anything else through your food.
L methionine is going to be usually dosed up to 500 milligrams, three times a day. L glycine is going to be Max Max 2000 milligrams in each dose. You know you can do it this once, twice, sometimes three times a day. I also like l glycine, just as a nighttime supplement for awhile, OK? So if somebody’s symptoms aren't too severe, but they're having difficulty sleeping, especially following an opioid detox post/ Acute withdrawal state. L glycine can really help to be to be dosed at night – it really helps smoothe out the sleep cycle without causing any kind of sedation.
L tyrosine is usually dosed twice a day. It’s a very good amino acid for a lot of people. So it would be first thing in the morning around whatever. 7 AM/ 8:00 AM and then around 1:00 PM two PM. You don't really want to take tyrosine later than 3:00 PM 'cause some people do find that it's a little bit stimulating. You know it has a little bit of like a caffeine. Affect for some.. other people don't get that response, but taking it earlier in the day is the best bet in terms of hoping that it avoids interfering with sleep.
I also recommend people taking like a multi mineral supplement OK. Pure encapsulations makes it pretty good one. It's a multi vitamin multi mineral combo supplement. You don't have to get that particular brand and it's a little bit maybe more expensive than some of the other ones. Just make sure that your mineral supplement contains some minimums that I’m looking for:
So generally speaking, about 1000 milligrams of calcium. Even want to have around around 200 milligrams of magnesium, but 100 milligrams of potassium. 20 milligrams iron. 20 milligrams zinc. 400 micrograms chromium 60 micrograms selenium. Yes, that's that's about what you're looking for in a in a multi mineral supplement.
And you want to take all this stuff for at least 2 months, at least, probably more. You know, I usually tell people like what you're taking in the beginning or right away, It might seem like a pretty aggressive. Approach.. I don't personally consider it to be aggressive, but if you're not used to taking supplements It might feel like a lot, but that's not forever. Its just To get a loading dose, filling some of those deficiencies, get the concentrations up in your bloodstream, get you through those initial weeks, couple months when relapse risk is very high, and then over time you start backing off on them.
For example, there's never been a time for me since getting sober where I haven’t been taking any supplements at all – I take as little as necessary now because I know how to get this stuff in my diet, and my regimen today looks a lot different than it did that first year, but I’m always auditing my own routine, my own nutrition, I’m not a robot, so I’m not perfectly adherent like any human.
This idea of you shouldn't need to take anything because you can get it all in your diet, for most people – no that is not true in practice, its true in theory only. The standard American diet or standard western diet is not even close to providing everything that you need. Not even close. For most people that is – maybe 5-10% of people are dialed in to a full and balanced nutritional approach but most are not.
Sometimes its even just the way that we prepare food – A lot of the cheaper food preparation practices that we use today do so at the expense of stripping some of these nutrients out of the preparation process or out of the ground itself before harvesting… the point is that its very hard to get everything that our brains and bodies need to feel completely and fully nourished so again needing to take supplements for a little bit, it's a small price to pay if it means that you're going to come out the other side feeling better and better positioned to stay free from this chronic longstanding. Opioid Addiction. ….
(slow) But no two people are alike. No two people have exactly the same response to anything – whether its pharmaceuticals, foods, nutritional supplements everything. So what I’ve been talking about today - I'm making very broad generalized statements. And when we're talking supplementations, everything needs to be individualized for the patient. That's where the value of working with somebody. One on one is and also working with somebody that you're speaking with regularly.
It's not just you meet with somebody for an hour, they give you a supplement regimen and then you never talk to them again… or you talk to them in 6 months at your next follow-up visit.
To get it right, the best approach is someone who you’re following up with regularly. So like I mentioned before, when I’m working with people, we’re meeting every week, but we’re keeping in contact daily.
I’m constantly checking in any time we're adding anything, subtracting something we want to see what's going on, what's it doing to your sleep data? How does your resting heart rate look? How is your mood? How are your cravings? What are you feeling like during the day? All that kind of stuff is what’s needed if this approach is going to actually be valuable to you over time. We’re constantly tweaking and turning the dial in your particular supplement regimen so that it is unique and individualized for you. ….
But dietary supplementation does help, it does help, especially in the beginning because there are real neurochemical abnormalities going on beyond the underlying issues.. That’s important to keep in mind…
VIDEO:
Once in a while you'll hear somebody in recovery say something like “Heroin was never my problem. I was my problem.” You've heard that that kind of thing has become popular recently, and it's like, do did you forget what your heroin addiction felt like??
I understand what you're saying…Yes, your dysregulated nervous system is what sought about the chemicals as self-medications to begin with, but regardless of any underlying stuff, years and years of repeated exposure to those drugs has changed your brain, so that process must be respected.
Make no mistake, once this opioid physical dependency has developed, Heroin is your problem, its now your number one problem. and yes you will need to deal with all the underlying stuff eventually, hopefully sooner than later, but you need to address the physiological changes that have gone on in your brain and body. These things. Have happened. And that's where addressing the physiology and neurochemical deficiencies can have a huge impact.
For me, and I've probably said this before, I didn't think that I was ever going to feel better, ever. My first cold turkey detox was in 2013, and I stayed abstinent for 5 months, and although I wasn’t physically sick that whole time, I never felt normal. For a lot of us that have taken large amounts of this stuff that is a myth that you're going to just rip the drugs away and start talking to somebody about gratitude and acceptance and suddenly everything is just going to feel fine.
That was not my experience, and that's not the experience of hardly anybody that I see. For me personally, and part of the reason that I now do what I do is because I consider that to be one of the specific things that was different this time around .. I didn’t have those products the first time I kicked opiates, this time I did, and I started to feel better. There was no other difference in my physical condition that would’ve accounted for it, if anything I was older this this past time, I was in much worse physical shape, so it should have been even harder.
But no, within a few months, things werent great by any means, but I felt good enough to start doing all the other stuff- taking all the other actions that have kept me on this path. That’s the goal- not to walk around in a state of euphoria – but to feel well enough that you can do what you need to do…
So to summarize all this, just remember that no two people are exactly alike. No two people have exactly the same response to anything. Everyone reacts in different ways to different drugs depending on your genetic and biochemical makeup, Nutrition, diet, health status.
Supplementation approaches can help you tailor a recovery strategy to your own biochemical needs. And in a lot of ways, that is the first step to maintaining a biochemical balance that you need to be healthy and stay substance free - like a lot of other people that I've seen…..
Keep in mind. A lot of this stuff takes time to build up. Some of it works almost immediately if the deficiencies are that severe, but a lot of it just does take time to to build up consistent steady state levels in your body. So the earlier that we can get started, the better. If we have that luxury.. like for example long term opioid tapers - maintenance tapers… Somebody that's on like a methadone taper. For example we do have that luxury, we have that luxury of full control over our taper so we can get these supplements on board and at least reduce the discomfort of that whole process. That's the idea.
None of this stuff is going to be curative. There’s no such thing – it’s all an attempt to mitigate distress and relieve discomfort… Opioid withdrawal will be uncomfortable no matter how you twist or turn it, but with regard to the degree of discomfort, there is a lot of variability there, and there's a lot of things that we can do - little little tricks to the trade that that can offset some of that stuff and… nutritional supplementations is certainly one of them.
Alright, hope this was helpful – as usual I went longer than planned, but I’ll come back to this topic a lot. Follow on Instagram for more daily topics or send me an email through the website www.reactionrecovery.com. I’m available to talk. If you know someone who might benefit from these podcast topics, send them the link, keep the conversation going…. Bye for now.