Vitamin supplements and alcohol withdrawal syndrome: What to know

What is alcohol withdrawal syndrome (AWS)?

Alcohol withdrawal syndrome (AWS) encompasses the symptoms an individual with alcohol use disorder experiences if they stop drinking suddenly, or reduce their alcohol intake significantly.

If someone regularly drinks more than the recommended amounts of alcohol — one drink daily for women and no more than two drinks daily for men — they may experience negative health consequences. For example, their body may become dependent on the alcohol, and their brain chemistry may change.

Alcohol interacts with neurotransmitters including gamma-aminobutyric acid. Therefore, if individuals stop or reduce their alcohol intake, their brain must readjust, leading to withdrawal symptoms.

What vitamins might help?

Heavy alcohol drinking can cause vitamin deficiencies. This deficiency can lead to problems, such as slow wound healing, softening of the bones, skin problems, decreased blood clotting, and neurological damage. Therefore, doctors may recommend nutrient supplementation as part of an individual’s detoxification and recovery process.

One option is high doses of oral vitamin B supplementation, which can help correct deficiencies without causing adverse effects. However, these supplements may not provide enough vitamin B1, which is essential for preventing a condition called Wernicke’s encephalopathy (WE), a medical emergency. Therefore, doctors treating individuals detoxing from alcohol might prescribe additional treatments with vitamin B1.

Doctors may recommend multivitamin supplements containing B1, B2, B3, B6, and vitamin C. These supplements may be given for the initial 3–5 days of alcohol withdrawal, because the person is experiencing issues with nutrient absorption and not be getting enough of these vitamins.

Vitamin C is an essential water-soluble nutrient that the body needs for many biological processes such as, enzyme reactions, hormone synthesis, and tissue structure. It is also an antioxidant. However, some doctors dispute the use of vitamin C supplements and no official guidelines exist for treatment during alcohol withdrawal.

Doctors may also recommend other supplements depending on the individual and their nutritional status.

Nutrient deficiencies in people with alcoholism

The body requires good nutrition to increase energy levels and maintain bodily processes.

However, people who misuse alcohol may eat less food and commonly have deficiencies in zinc, magnesium, selenium, protein, and certain vitamins.

Vitamin B1 (thiamine)

Vitamin B1 is a cofactor for enzymes that metabolize glucose. Deficiencies in vitamin B1 can lead to cell damage or cell death.

B1 deficiency can also lead to WE, a serious neurological concern that can cause permanent mental health issues if a person does not seek medical attention promptly.

Alcohol use disorder can result in deficiencies because of low dietary intake and decreased absorption of B1 in the digestive system. It can also lead to deficiencies in:

• vitamin B2, or riboflavin
• vitamin B3, or niacin
• vitamin B9, or folate

Vitamin A (retinol)

Long-term alcohol use can cause vitamin A levels to fall in the liver, the primary organ that breaks down alcohol and stores vitamin A. This occurs as both substances use similar pathways in the body to metabolize them.

One consequence of alcohol use disorder is night blindness, which experts associate with vitamin A deficiency.

Vitamin C

An individual with alcohol use disorder may develop vitamin C deficiency in several ways:

• insufficient intake due to reasons of neglect or poverty
• insufficient absorption in intestines
• increased levels of vitamin C excretion through urine

People with vitamin C deficiency or scurvy may also have issues with wound healing, swollen and bleeding gums, tooth loss, and jaundice.

Effects on digestion

In addition to dietary issues, alcohol affects how the body digests, stores, and uses nutrients. For example, it can decrease the secretion of digestive enzymes in the pancreas and impair nutrient absorption from the cells of the stomach or intestines.

Alcohol also disrupts the microbiome of the gut. Therefore, long-term alcohol use leads to lower nutrient consumption and can affect how the body uses this limited supply of nutrients. As a result, many individuals who misuse alcohol may become malnourished.

Signs and symptoms of AWS

Individuals may develop mild symptoms within hours of their last alcoholic drink. Doctors use the Clinical Institute for Withdrawal Assessment tool for Alcohol revised scale (CIWA-Ar) to assess and monitor an individual’s AWS symptoms. The CIWA-Ar scale looks for the following symptoms:

• nausea and vomiting
• headache
• sweating
• agitation
• hearing strange noises
• visual disturbances
• tremors
• anxiety
• inability to think clearly or concentrate
• adjustment to their surroundings

AWS varies from mild to life threatening, with the most severe involving a condition called delirium tremens (DT). Up to 5% of individuals withdrawing from chronic alcohol use may experience DT that results in seizures, and it can progress to death without prompt medical treatment. Other symptoms of DT include:

• fever
• high blood pressure
• excessive sweating
• increased heart rate
• increased breathing rate
• feelings of itching or burning

Medical treatment for AWS

Many treatment protocols for AWS involve supportive care as the person withdraws to ease the discomfort of the symptoms.

Doctors often use benzodiazepines to ease AWS. Examples of these include lorazepam (Ativan) and alprazolam (Xanax).

Overall, according to the American Society of Addiction Medicine, the goal of detoxification is to help make withdrawal safer, more humane and prepare the individual for ongoing treatment.

Detoxification process

The timeline of detoxification varies between individuals and depends on the duration and extent of their drinking behavior. It may also depend on any other physical and mental health issues an individual has.

However, a potential detoxification timeline could be:

• 6 hours after the last drink: An individual may notice mild signs and symptoms such as tremors, headache, stomach upset, anxiety, or insomnia.
• Within 24 hours: Individuals may experience hallucinations such as seeing, hearing and feeling things that are not there.
• 24 to 48 hours: The risk of seizures could be highest for some individuals at this point.
• 48 to 72 hours: Individuals might experience visual hallucinations, confusion, or agitation at this stage. There is also still a risk of DT appearing in some individuals.

The symptoms can range in severity. In some individuals, they might resolve within a few days.

Getting help

Recovering from active alcohol addiction is challenging.

People may need professional help to get them through withdrawal, help manage their symptoms, and provide the best chance of successful rehabilitation.

A good first step is to speak with a primary care physician who can provide treatment referrals and medications. They can also evaluate the person’s drinking patterns and overall health and work together to craft a treatment plan.

People can also find support and information from Alcoholics Anonymous and SMART Recovery.

Summary

Alcohol use disorder can mean an individual experiences vitamin deficiencies, as alcohol can affect how the body absorbs and uses vitamins and nutrients. As a result, they may have low levels of vitamin A, B, or C.

Therefore, doctors may advise going through the detoxification process and taking vitamin supplements to prevent any potentially serious conditions associated with deficiencies.

If individuals believe they have a problem with alcohol or if they drink more than the recommended amounts, they should speak with their doctor for support and advice.