Alcohol and nutrition among homeless people: two sides of the same coin

New research finds nutrient deficiencies in heavy drinking homeless people, but evidence is limited. Health complications caused by nutritional deficiencies in homeless problem-drinkers can be avoided if they are addressed early, write Dr Sharea Ijaz and Zoe Trinder-Widdess, NIHR CLAHRC West, Bristol.

We often hear that homelessness is on the rise in the UK. We can see evidence of this on our streets every day. And we also know that heavy drinking among homeless people is a common problem.

Alcohol provides calories as well as taking the mind off what must often be a grim reality. But alcohol doesn’t provide important vitamins that maintain health and prevent disease and, in excess, even depletes them.

Without access to the same level of health care as you and me, this vulnerable group suffers unattended until their health is bad enough to lead to an A&E visit. Once treated, they go back to the same cycle of poor nutrition, heavy drinking and, inevitably, more ill health. Needless to say this has implications for our society, as well as financial implications for the healthcare system.

Homeless heavy drinkers are likely to have different, and probably higher, nutritional needs than the general population, or even housed heavy drinkers. It’s not clear what these nutritional needs are however, especially in terms of key vitamins and minerals. Knowing the range of the most common nutritional deficiencies would inform the development of an intervention to counter these deficiencies, to prevent illness in this high-risk group. In the long term, this could save the health system money, especially in A&E attendances. And it would also improve the health and quality of life of those homeless and vulnerably housed people who are heavy drinkers.

The recent evidence review that we’ve produced at NIHR CLAHRC West found that although there is limited data on nutritional deficiencies in the homeless drinking population, deficiencies do exist and could possibly be underestimated.

Read the full review.

Besides the expected B1 deficiency which has long been associated with heavy drinking, the homeless drinkers also had deficiencies in vitamin C and B6 to varying degrees. Because there was no evidence on some nutrients such as vitamin A and D, we cannot say to what extent these deficiencies may also be present. To get the full picture we need to carry out a detailed study. Until that happens, the existing evidence on vitamin C, B1 and B6 can still be used to achieve some health benefits for homeless problem drinkers.

There are a few ways to counter nutritional deficiencies. The easiest probably is to raise awareness and provide information to people to make healthier food choices. But it’s obviously much harder for homeless people to make those healthy choices for themselves. We also know that vitamin B1 deficiency over time leads to cognitive impairment. Once in this state, any counselling or health promotion effort to bring about nutritional improvement by behaviour change is unlikely to work.

Another option would be to give homeless heavy drinking people nutrition-rich meals. Other practical, simple and safe interventions could be providing fortified foods or vitamin supplements. But we don’t know how effective such treatments could be. We are continuing our work to evaluate the kind of treatments that would help improve nutrition for homeless drinkers.

In the past, fortification of beer has been advocated in some parts of the world. Although tempting, this constitutes an ethical dilemma of turning a ‘bad product’ in to a ‘super food’. But the idea is not very different from needle exchange programmes – the aim being to prevent disease when we know the risky behaviour cannot always be stopped.

But the key message is that health complications caused by nutritional deficiencies in homeless problem-drinkers can be avoided if deficiencies are addressed early. This will also lessen the burden on the healthcare system.

This article was first published on the SMMGP website.