What supplements are recommended for an individual with a history of alcohol use disorder?

From the Guidelines

Individuals with a history of alcohol use disorder should be supplemented with B vitamins, particularly thiamine, folate, and B12, to prevent neurological problems and other deficiencies. The most recent and highest quality study 1 recommends treating demonstrated or suspected vitamin/micronutrient deficiencies in patients with hepatic encephalopathy, as they can compound the condition. Key supplements to consider include:

• Thiamine (vitamin B1): 100mg daily, as alcohol depletes this nutrient and its deficiency can lead to neurological problems such as Wernicke’s encephalopathy 1
• Folate: 400-800mcg daily, to support overall health and prevent deficiencies
• B12: 1000mcg daily, to support nerve function and prevent neurological problems Other supplements that may be beneficial include:
• Magnesium: 300-400mg daily, to help with withdrawal symptoms and muscle cramps
• Zinc: 25-50mg daily, to support immune function and taste perception
• Vitamin D: 1000-2000 IU daily, as many individuals with alcohol use disorder are deficient
• Milk thistle: 150mg of silymarin three times daily, to help protect the liver from alcohol-related damage
• N-acetylcysteine: 600-1800mg daily, to help reduce cravings and support liver detoxification
• Omega-3 fatty acids: 1-2g daily, to reduce inflammation and support brain health It's essential to consult with a healthcare provider before starting any supplement regimen, especially if taking other medications, as interactions can occur 1.

From the FDA Drug Label

In the treatment of Wernicke-Korsakoff syndrome, thiamine hydrochloride has been administered IV in an initial dose of 100 mg, followed by IM doses of 50 to 100 mg daily until the patient is consuming a regular, balanced diet. The recommended supplement for an individual with a history of alcohol use disorder is thiamine, as it is used to treat Wernicke-Korsakoff syndrome, a condition that can occur in individuals with alcohol use disorder. Key points to consider:

• The initial dose of thiamine hydrochloride is 100 mg IV.
• Follow-up doses are 50 to 100 mg IM daily.
• Treatment should continue until the patient is consuming a regular, balanced diet 2.

From the Research

Recommended Supplements for Individuals with Alcohol Use Disorder

The following supplements may be beneficial for individuals with a history of alcohol use disorder:

• Vitamin A: may help alleviate liver disease and other alcohol-related disorders 3
• Carotenoids: may have potential beneficial effects in animal models of alcoholic liver disease (ALD) 4
• Vitamins B3, C, and E: may have antioxidant and anti-inflammatory properties, which can help manage ALD 4
• Silymarin: may have potential beneficial effects in animal models of ALD 4
• Curcumin: may have potential beneficial effects in animal models of ALD 4
• Probiotics: may have potential beneficial effects in animal models of ALD 4
• Zinc: may have potential beneficial effects in animal models of ALD 4
• S-adenosylmethionine: may have potential beneficial effects in animal models of ALD 4
• Garlic: may have potential beneficial effects in animal models of ALD 4
• Thiamine (Vitamin B1): essential for patients with alcohol dependence, as thiamine deficiency is common in this population 5, 6

Importance of Nutrition and Supplementation

Nutritional deficiencies are common in individuals with alcohol use disorder, and supplementation can help prevent or ameliorate alcoholic liver disease 3, 7. A balanced diet and administration of antioxidants can help eliminate reactive oxygen molecules and other reactive molecules generated from abnormal lipid breakdown 3. Healthcare providers should be aware of the presenting features of individual nutrient deficiencies and provide prompt treatment 7.

Treatment Guidelines

Treatment guidelines for thiamine deficiency in patients with alcohol dependence include:

• Parenteral thiamine 200-500mg three times a day for 3-5 days, followed by oral thiamine 250-1000mg/day for patients with established Wernicke's encephalopathy 5
• Parenteral thiamine 250-300mg two times a day for 3-5 days, followed by oral thiamine 250-300mg/day for patients with suspected Wernicke's encephalopathy 5
• Parenteral thiamine 250-500mg/day for 3-5 days, followed by oral thiamine 250-300mg/day for patients at high risk of thiamine deficiency 5
• Oral thiamine 250-500mg/day for 3-5 days, followed by oral thiamine 100-250mg/day for patients at low risk (with uncomplicated alcohol dependence) 5