Editor’s note: This is the plan created by harm reduction worker Ria Tsinas (who has struggled with drugs in the past) and referred to in the article “Nutrition Is an Overlooked Aspect of Harm Reduction,” by Troy Farah.
Tsinas said of her plan, “There were a few holes, but for the most part it did what it was supposed to do. Somebody can make it better, I’m sure. I would just love for somebody to use it or at least start having a conversation about how food is medicine, and it is a really important pragmatic tool in our toolkit of harm reduction.”
Dietary needs and choices are personal, and seeking the advice of a health professional, if possible, is recommended.
For the purposes of this guide, I have chosen to focus on the nutritional needs of people who are detoxing or in the early stages of recovery from problematic drug use. Recently, there has been emerging evidence that demonstrates the important role that nutrition plays in relapse prevention and symptom management.
I am a public health major who has been working with injection drug users and people with substance use disorders for nearly the last 10 years. My predominant focus is on the applied practices of harm reduction. To my surprise, I have heard little-to-nothing about what foods or diet plan might be beneficial to this specific population. As such, I decided that I would investigate and create a plan of my own based on the current research available.
I chose to encourage the consumption of whole foods and limit intake of processed or pre-prepared foods. The population that I serve sometimes does not have access to a kitchen or stove. I wanted to create a plan where foods could be easily accessible and consumed either together or separately, without losing their nutritional integrity.
Many people who use drugs chaotically, or who have a substance use disorder, are nutritionally deficient. There is an increased nutrient requirement caused by the body’s need to detoxify and metabolize drugs. There is also a correlation between sugar and nutrition depletion. Often there are problems with malabsorption of nutrients due to impaired or overworked liver function, and inactivation of vitamins and co-enzymes that are needed to metabolize energy. Additionally, many people suffer from electrolyte loss due to dehydration. Diarrhea is often common in early stages of opioid detoxification.
The nutritional needs of a person who is detoxing from alcohol or other drugs are higher initially. For the first three-to-12 months, the meal pattern would be smaller, more frequent meals throughout the day: three smaller meals and two larger snacks. This can help regulate blood sugar and reduce cravings for sweets.
A blog post in Today’s Dietician discusses the important role that omega-3s play in the diet of this population. Foods high in omega-3 fatty acids can help combat depression and cravings, regulate mood, improve neurological function, and aid in stabilizing blood sugar.
The diet is protein-dense and includes lean animal proteins such as chicken, fish, turkey, dairy, and nuts. It also includes complex carbohydrates, such as beans, lentils, brown rice, sweet potatoes, blueberries and raspberries. Omega-3s are found in foods like tuna, salmon, eggs, walnuts, beans, oatmeal and whole grains.
Additionally, I have included leafy vegetables such as kale, broccoli, spinach and cauliflower—all of which can be eaten raw or cooked. These vegetables are not only high in omega-3s, but also high in fiber, vitamin C, vitamin K, thiamin, riboflavin, folate, potassium and B6. The population I serve tends to be deficient in these vitamins. Healthy fats are included as well—found in avocados, olive oil and butter.
Dehydration and loss of electrolytes is often an issue of concern. Rather than utilize sugary sports drinks, I am including electrolyte-rich foods such as beets, apples, citrus fruits, bananas and raisins.
5 servings of vegetables per day. A serving size is ½ cup raw or 1 cup cooked.
4 servings of protein per day. A serving is 3 ounces.
5 servings of fruit per day. A serving is ½ cup.
3 servings of carbohydrates per day. A serving is ¾ of a cup or the size of a slice of bread.
Fats and oils sparingly.
Breakfast:
1 cup oatmeal with ¼ cup of blueberries and ¼ cup walnuts, and half of a large banana
1 medium-sized orange
1 cup cooked spinach or ½ cup raw, with a teaspoon of olive oil
6 ounces of water
Mid-morning snack:
1 cup cooked or half a cup raw broccoli
1 hard-boiled egg
½ cup apple slices
Lunch:
1 can or 4 ounces of tuna
1 cup raw kale
1 cup raw spinach
¾ of a cup of black beans
1 teaspoon olive oil
The other half of the banana from breakfast
6 ounces of water
Afternoon snack:
2 ounces of turkey breast
¾ of a cup of raspberries
¼ of an ounce of raisins
6 ounces of water
Dinner:
3 ounces of salmon
¾ cup of brown rice
½ cup of cooked beets
½ cup baked sweet potato or baked sweet potato fries
¼ of a small avocado
6 ounces of water
The total day’s calories for this diet are calculated at 2,477. According to current recommendations, caloric intake and nutrient intakes should be higher for this population than for the general population. Needs clearly vary by gender and other factors.
I was aiming to increase mineral levels, but was under in calcium. I realized that I did not include any dairy in this diet, so I might add milk or milk substitute to accommodate. I was also under for vitamin D and E. To accommodate for this, I would increase the serving size of tuna or other fish for lunch or dinner. I might also suggest a fortified oatmeal for breakfast. To address the vitamin E deficiency, I might also swap out the olive oil from one of the meals and use vegetable oil instead. This would lower the linoleic acid, which came out over standard recommendations; however, I was not concerned about the linoleic acid because the diet calls for increased consumption of fatty acids, as explained in the introduction.
Otherwise, the diet plan that I proposed stacked up fairly well for its intended population. I think that eating this way is very approachable. Initially it may take some adjustment, but over time it can be sustainable.