“Nutrition Interventions Amidst and Opioid Crisis: The Emerging Role of the RDN” by David Wiss MS RDN
The opioid crisis has reached epidemic proportions. The time to include nutrition into the treatment paradigm has arrived. David Wiss is not afraid to take the lead, and is doing research on this topic at the University of California, Los Angeles.
This presentation was given at the Food and Nutrition Conference and Expo (FNCE) on Sunday October 21, 2018 in Chicago which was an invited presentation in response to the opioid crisis. Here David Wiss describes the impact of opioids on nutritional status and gastrointestinal health, identifies common disordered and dysfunctional eating patterns common to opioid-addicted populations, and describes nutrition therapy protocols for specific substances including opioids and for poly-substance abuse.
The presentation is 1:29:01 and was moderated by my dear friend and colleague Tammy Beasley, RDN. If you want to skip the video, and go straight to the slides, you can do so HERE.
In summary, nutrition interventions have not yet been standardized or widely implemented as a treatment modality for substance use disorder (SUDs). Emphasis should be placed on gastrointestinal health, and reintroduction of foods high in fiber and antioxidants such as fruits, vegetables, whole grains, beans, nuts, and seeds. Adequate intake of protein and omega-3 essential fatty acids should be consumed daily. Regular meal patterns can help to stabilize blood sugar. Water should replace sweetened beverages. Caffeine and nicotine intake should be monitored. Dietary supplements can be very helpful in the recovery process, but should not supplant whole foods. Once nutrition behavior has improved, use of dietary supplements should be reevaluated. Lab tests and stool samples assessing gut function should provide valuable insights in upcoming years. In addition to expertise with the interaction between specific substances and nutritional status, RDNs working in treatment settings should specialize in gastrointestinal health, eating disorders, and should be current with food addiction research. There is a timely need for specialized nutrition expertise in SUD treatment settings, including outpatient clinics and “sober living” environments. Public health campaigns and specialized training programs targeting primary care physicians, mental health professionals, and other SUD treatment professionals are warranted.Read more
Nutrition in Recovery is a private practice founded by David Wiss MS RDN, who recounts:
The vision was born in 2006 ago when I got sober and used nutrition and exercise as part of my personal recovery. I had made attempts at getting sober previously, but never felt comfortable in my skin, mostly plagued by lethargy and anxiety, which left me pessimistic about sobriety. I had always assumed nutrition was about fitness and weight, which is how it is presented by society. But when I began to exercise and eat a wide range of plant foods, something dramatic happened to my mental health. There were dramatic changes in my body which served as positive reinforcement, but the real outcome was that I became optimistic and found some inner-peace. My thoughts cleared up and so did my skin. My bowel movements became regular, and my heartburn went away. I woke up feeling refreshed in the morning, and when I read recovery-related literature, it was actually sinking in. Previously it seemed as though my eyes were just skimming the page. At that point I knew that nutrition is important for recovery from addiction and wondered why no one ever told me so. From there I was able to quit smoking and became a non-competitive athlete. I can remember being extremely excited to go to the grocery store and buy fresh food to experiment with in the kitchen.
After working as a personal trainer for a few years, I was accepted into a master’s program in nutrition where I completed training to become a Registered Dietitian Nutritionist. I worked at UCLA Medical Center and gained experience with eating disorders. The field of nutrition for addiction recovery was unchartered and I started a private practice immediately after passing my exam. I have not had a slow week since. I have run groups at many different treatment facilities and have trained other dietitians to do the same. I fell in love with academic research and began publishing scientific articles. I taught myself the basics of neuroscience, nutrition-related hormones, and gastrointestinal health. With this information I was able to conceptualize eating behavior in order to create real change in the people I work with. Most of my referrals come from previous clients, and mental health professionals who have seen my work transform people. Currently I am working on my PhD in Public Health from UCLA.
I am not attached to any particular food philosophy. I do not try to convert people to eat the way I eat, although I do eat strategically without much effort. I am a believer in using whole foods and developing life skills to cook and prepare food when possible. Supplements can be helpful, but they are designed to support behavior change. I specialize in helping people to make gradual and stepwise changes in their food choices. I am an expert in nutrition but can serve the role of a coach. I look at the entire dimension of wellness: food, beverage, exercise, supplements, sleep, sunlight, etc. I am recovered, and love to help other people become the same. I spend the first hour collecting information about you and from there will have a better picture of the direction we are headed. Some people need structure, other people just need a safe place to talk about food and body. Some people need tips for grocery shopping, other people just need some accountability for their recovery. I try to find the intersection between giving my clients what they want and giving them what they need. Let’s take a journey together and see where it goes!
Peer-Reviewed Journal Articles by David A. Wiss MS RDN
(ORCID Link Takes You Directly To The Articles)
Wiss, D. A., Avena, N., & Rada, P. (2018). Sugar addiction: From evolution to revolution. Frontiers in Psychiatry, 9(545). doi:10.3389/fpsyt.2018.00545
Wiss, D. A., Schellenberger, M., & Prelip, M. L. (2018). Rapid assessment of nutrition services in Los Angeles substance use disorder treatment centers. Journal of Community Health. https://doi.org/10.1007/s10900-018-0557-2
Wiss, D. A., Schellenberger, M., & Prelip, M. L. (In Press). Registered dietitian nutritionists in substance use disorder treatment centers. Journal of the Academy of Nutrition and Dietetics. doi:10.1016/j.jand.2017.08.113
Wiss, D. A., Criscitelli, K., Gold, M., & Avena, N. (2017). Preclinical evidence for the addiction potential of highly palatable foods: Current developments related to maternal influence. Appetite.doi:10.1016/j.appet.2016.12.019
Wiss, D. A., & Brewerton, T. B. (2016). Incorporating food addiction into disordered eating: The disordered eating and food addiction nutrition guide (DEFANG). Eating and Weight Disorders. doi:10.1007/s40519-016-0344-y
Wiss, D. A., & Waterhous, T. S. (2014). Nutrition therapy for eating disorders, substance use disorders, and addictions. In Brewerton, T. D., & Dennis, A. B., Eating disorders, substance use disorders, and addictions (pp. 509-532). Heidelberg, Germany: Springer Publishing.
Specter, S. E., & Wiss, D. A. (2014). Muscle dysmorphia: Where body image obsession, compulsive exercise, disordered eating, and substance abuse intersect in susceptible males. In Brewerton, T. D., & Dennis, A. B., Eating disorders, substance use disorders, and addictions (pp. 439-457). Heidelberg, Germany:Springer Publishing.Read more
Is There Science to Sugar Addiction???
I know, I know, I know…food addiction and sugar addiction are controversial topics, especially in the eating disorder community, where any kind of “diet” beliefs or behaviors are viewed as harmful. I agree that many of the proponents of sugar addiction and food addiction carry a very punitive “food negative” message. Is there a way to accept the science of food addiction AND be “eating disorder friendly” at the same time??? That takes skill. One has to be able to hold multiple things true at the same time, and separate emotions and personal bias from their work. But it can be done!!! In fact, it HAS TO be done!
The revolution is now.
Our latest publication: “Sugar Addiction: From Evolution to Revolution” has been recently published in the prestigious Frontiers in Psychiatry. I will say this was the hardest peer-review I have ever gotten through! It is published OPEN ACCESS so download it HERE. For those who work with eating disorders, there is a special section to address the controversies! Enjoy! Feedback always welcomed.
Want to learn more about Food Addiction? Check out our FAQ page on it.
Want to learn more about Eating Disorders? We got that too.
Nutrition in Recovery specializes in the nutritional management of addictions, eating disorders, body image, mental health, and weight management. We offer group education and individual counseling. We love to help people finally make peace with food and exercise. Nutrition in Recovery also offers general wellness services, sports nutrition, and medical nutrition therapy for various chronic diseases, including gastrointestinal issues. Whatever brings you into our office, we are prepared to help you on your journey to recovery.
We pride ourselves on being flexible with different food philosophies. We do not believe that any single food philosophy works for all people. In fact, we think that only having one food philosophy is not scientific. We are skilled in making an individual assessment in order to figure out the best treatment approach for you. We have a team of experts at Nutrition in Recovery and can therefore get you in touch with the best person for your specific needs.Read more
Nutrition in Recovery is thrilled about our new monthly newsletter! Get the latest information on Nutrition for Addiction and Disordered Eating! Check out our latest video on Vaping!
This video is about Vaping, which can impact appetite, and be used for weight loss and control. In other words, vaping is linked to disordered eating. Exactly how can vaping relate to disordered eating? Find out the specifics!
Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.
We send out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.
Within the next year you can look forward to the following topics being covered:
Men and Eating Disorders
View last month’s video on Attentional Bias & Disordered Eating
Recent Podcasts with David Wiss
Nourished Brain Solutions podcast with Sarah Thomsen Ferreria MS, MPH, RD
Mindfully Nourished Solutions: Integrative Nutrition-Gut-Brain Connection
Linking Nutrition and Addiction (recorded July 9, 2018)
This conversation covers all of the basics linking nutrition to Substance Use Disorders and to recovery. This is a great example of how much can be covered in one hour on podcasts with David Wiss.
The Exploding Human with Bob Nickman
Gut Health & More (recorded August 10, 2018)
This conversation discusses the significance of maintaining a healthy gut for optimal health. We talk about testing that is available, and larger public health issues. There will be more podcasts with David Wiss in the future, so stay tuned!Read more
Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment
One of our research studies “Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment Centers” was recently published in the Journal of Community Health.
We assessed the prevalence of nutrition services in Los Angeles treatment centers and found that is was quite low! The article offers some important ideas about the addiction crisis.
Link to article: http://link.springer.com/article/10.1007/s10900-018-0557-2
Direct download HERE
The objective of this study was to determine the prevalence of nutrition services and utilization of registered dietitian nutritionists at substance use disorder treatment centers in Los Angeles. This cross-sectional descriptive study utilized phone interviews with facilities within a 25-mile radius of the Los Angeles metropolitan area using the Substance Abuse and Mental Health Services Administration Treatment Services Locator to identify facilities that included a listing of substance abuse as primary focus of care (n=128). Facilities were asked if they offered any kind of nutrition services, the type of services that were offered, and the credential of the professional providing the services. We compared facilities that offered a residential level of care to those offering outpatient services only. The Fisher’s exact test was used to determine statistical significance. The study showed that only 39 sites (30.5%) offered any type of nutrition services on site, and the odds of a residential level of care offering nutrition services was 2.7 times higher than outpatient only facilities (p=0.02). Of the 39 facilities offering nutrition services, only 8 (20.5%) utilized a registered dietitian nutritionist. Overall fewer than 7% of the facilities utilized the services of a dietitian. Recovery programs for substance use disorder should consider using a registered dietitian nutritionist as a member of the treatment team, which may contribute to better clinical outcomes.Read more
Addiction Transfer via Nutrition During Pregnancy
Ever wondered about the impact of nutrition during pregnancy? This presentation reviews the evidence from animal models.
Preclinical evidence for the addiction potential of highly palatable foods: Current developments related to maternal influence
by David Wiss, Kristen Criscitelli, Mark Gold, Nicole Avena
It is well established that obesity has reached pandemic proportions. Over the last four decades the
prevalence of obesity and morbid obesity have risen substantially in both men and women worldwide.
Although there are many causative factors leading to excessive weight gain including genetics and
sedentary lifestyle, the transformation of the food environment has undoubtedly contributed to the
dangerously high rates of obesity. The current food landscape is inundated with food engineered to
contain artificially high levels of sugar and fat. Overconsumption of these types of food overrides the
homeostatic mechanisms, which under normal circumstances regulate appetite and body mass, leading
to hedonic eating. Evidence from the animal literature has illustrated nutrition-influenced perturbations
that occur within the mesolimbic dopamine pathway, as well as maladaptive behavioral responses that
result from chronic ingestion of highly palatable foods. These neurobehavioral adaptations are similar to
what is observed in drugs of abuse. Recent evidence also supports that maternal exposure to these foods
is capable of provoking neurobehavioral alterations in offspring. Therefore the purpose of this review is
to summarize the current developments on the addictive potential of highly palatable foods, as well as
illuminate the impact of maternal hyperphagia and obesity on the reward-related neurocircuitry and
addiction-like behaviors in the offspring.
Journal Article HERE
Recorded webinar below!
This is a mini-webinar reviewing recent evidence of the impact of highly palatable foods on the neurodevelopment of the offspring, using animal models. The video is 10:19 and is highly recommended for those interested in brain chemistry, hormones, and epigenetics. This is a sensitive topic. Feedback is always welcome!