"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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This page has been printed from the www.stewartnutrition.co.uk web site.


Alcohol Excess

Alcohol has a deleterious effect on virtually all nutrients and it is not uncommon for some drinkers to compensate for their bad habits by taking high-strength nutritional supplements.  However the only nutrient for which there is clear benefit is vitamin B1 – thiamin.  Supplements of other nutrients especially other B vitamins may well be needed but are not a substitute for a balanced varied diet.  There are some nutrients that could cause harm to heavy drinkers and will mean that many multivitamins and anti-oxidant preparations could be unsuitable.

Vitamin A - retinol
Deficiency of this vitamin, which is stored in the liver, can occur in alcoholics causing night blindness and poor immune function.  However population-based studies in the UK and elsewhere reveal that heavy drinkers have higher levels of retinol in the blood and this is almost certainly due to the increased mobilisation of the vitamin from the liver compared with low consumers.   Supplements can also be damaging to the liver and high intakes may increase the risk of fatty liver disease which is common in heavy, especially overweight drinkers.  http://www.food.gov.uk/multimedia/pdfs/reviewvita.pdf page
It is thus prudent for all not to exceed the Safe Upper Level of 1500 ug per day, which typically means that any vitamin supplement should not provide more than 800 ug per daily dose.  Heavy drinkers especially those with abnormal liver function tests or established alcohol-induced liver disease should not take any supplements of retinol without expert assessment advice.

Beta-carotene
Typically this vegetable-derived form of vitamin A is considered to be safe with a Safe Upper Level of 7,000 ug/day.  However over 20 years ago the observation was made in experimental animals that supplements of beta-carotene might also aggravate alcohol-induced liver damage.
Again it is prudent not to exceed the Safe Upper Level of 7,000 ug per day and those with abnormal liver function tests or alcohol-induced liver disease should probably not take any supplements without expert advice.
The US expert position on beta-carotene is that it should only be used for the correction of proven vitamin A deficiency, which is known to be rare in adults.

Iron
Iron deficiency is relatively unlikely in heavy drinkers as alcohol itself enhances iron absorption and wine is a relatively good source of the mineral though it may not always be well absorbed.
Heavy drinkers are unlikely to need iron supplements and multivitamins with iron should not be taken by anyone with abnormal liver function tests as they may have an excess of iron.  This can be due to the genetic condition haemochromatosis which results in increased iron absorption leading to iron accumulation in the liver and elsewhere causing fatigue, liver disease, arthritis, diabetes and hormonal changes in men and women.
Supplements of iron should not be taken by heavy drinkers without tests to determine what their needs are.  Multivitamins with iron should not be taken by anyone with persistently abnormal liver tests unless they have been demonstrated to be deficient

Vitamin B3 and Alcohol-induced Neurological Pellagra
A retrospective analysis of 22 heavy alcohol consumers in France revealed that at post-mortem pathological changes due to neurological pellagra had been missed and possibly worsened by the administration of vitamins B – thiamin and or vitamin B6.
The authors sensibly recommend that “Multiple vitamin therapy should be given in the treatment of undiagnosed encephalopathies in alcoholic patients.”

Sedaru M et al. The clinical spectrum of alcoholic pellagra encephalopathy.  A retrospective analysis of 22 cases studied pathologically.  Brain. 1988;111:829-42.

Other similar reports of alcohol-induced pellagra appear in the literature and stress the presence of myoclonus, ataxia and oppositional hypertonus in such patients.  The classical features of dermatitis, diarrhoea and dementia may not always be present.

References
Parker, Andrew J. R et al.  Diagnosis and management of alcohol use disorders
BMJ 2008;336:496-501

Assess your intake in units per week.
http://www.drinkaware.co.uk
Institute of Alcohol Studies www.ias.org.uk
Alcohol Concern http://www.alcoholconcern.org.uk



Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
47 Priory Street, Lewes, East Sussex. BN7 1HJ
Tel 01273 487003 Fax: 01273 487576