Understanding Stimulant Drugs’ Impact on Metabolism Can Enhance Harm Reduction and Treatment Strategies
By Gabrielle Simons, MS, RD, LDN on January 8, 2024 — Medically Reviewed by Eliza Whitaker, MS, RDN
Photo by freestocks @freestocks/Unsplash
Nutritional interventions are an overlooked yet crucial part of addiction treatment due to the impact of drugs on metabolism and body weight.
Stimulant use disorder and stimulant-related overdose deaths are on the rise.
It is well documented that some users, especially women, turn to stimulant drugs in order to lose weight.
A more nuanced understanding of the metabolic impact of stimulant drugs reveals a seesaw effect of stimulant use on body weight: weight loss during chronic use is often followed by excessive weight gain during sobriety.
Research shows that the cause may be more nuanced than a simple loss of appetite, followed by its return upon cessation of drug use.
Understanding the mechanism behind weight change with stimulant use will help dietitians and other clinicians support their patients to cope with the weight gain psychologically and return to metabolic homeostasis.
It will also aid individuals who are recovering from a substance use disorder (SUD) to better understand and manage the potential impact of substance use on their body weight.
In this article, we discuss substance use disorders (SUDs), eating disorders (EDs), and poor body image. If you or someone you know is struggling with an ED or SUD, it's important to seek support and treatment. Here are some resources for finding help and information:
What are stimulants?
Stimulants come in both prescription (Adderall for ADHD) and illicit varieties (cocaine and methamphetamine), but either kind can be misused, and both prescription and illicit stimulants can be addictive.
They work by acting on the central nervous system, specifically impacting the neurotransmitters dopamine and norepinephrine.
According to 2020 data, 7% of the US population misused a stimulant drug in the past year, and the number of first-time users increased significantly since 2015.
It is widely believed that stimulants lead to weight loss because they reduce appetite. According to this hypothesis, when and if a person stops using, the appetite returns, and so does the weight.
Co-occurring eating disorders and substance use disorders
Eating disorders (EDs) are more prevalent in the population with SUD than in the general population.
Some may develop the ED and then go on to abuse drugs or alcohol or the other way around. In a 2018 paper published in the Journal of the Academy of Nutrition, the authors refer to the “bidirectional association between SUDs and ED” and outline how dietitians can be integrated into the SUD care team.
Since then, the Academy has published updated standards of practice for registered dietitians in mental health in addictions and eating disorders. It would be highly beneficial for dietitians treating EDs to be familiar with the signs and symptoms of SUD and the nutrition impacts, and vice versa.
Stimulant use and body weight
A study of 297 female participants in substance use disorder treatment facilities examined the prevalence and nature of weight-related concerns related to drug use.
Fifty-two percent of participants listed stimulants as their drug of choice (39% reported amphetamines or stimulants, and 13% reported cocaine or crack as their drug of choice).
One-third of the participants stated that they initially used drugs in order to lose weight. Nearly half of participants (45%) reported concern that weight gain would trigger relapse, and a total of 34% of participants said they often, usually, or always use drugs in order to lose weight.
The participants who reported weight concerns also reported that they believed drug use would make them more attractive. It should be noted that the majority of participants (61%) were White/Caucasian. About one-fifth were African American, and 8% were Hispanic. That means these results are not necessarily generalizable to diverse populations.
More research should definitely be carried out with BIPOC participants because beauty standards differ widely between populations.
Dr. David Wiss, creator of Wise Mind Nutrition and dietitian with over a decade of experience treating people with SUD and EDs, added:
“It is important to assess if the body image concerns pre-date substance use. It is not uncommon for people to gravitate toward substances in order to manage weight. This presentation might be different from the individual who only experiences body image concerns after getting sober. ”
He explained, “When mental health issues arise during development years, they tend to be more "sticky" or have a lasting legacy that persists into adulthood.”
According to Dr. Wiss, body image concerns that emerge during puberty are more likely to have clinical significance compared to those that appear later in life, such as at age 30 following weight gain during rehabilitation.
“Therapeutic interventions can identify and target sensitive developmental periods and do specific work around those years,” he concluded.
Metabolic effects of stimulant use
This section will summarize research on how stimulants impact metabolism.
Research shows that cocaine users weigh 6 kg less than their drug-naive controls, and people who use methamphetamine weigh 4 BMI points less than controls.
It is widely believed that weight loss is due to the appetite-reducing effect of stimulant drugs. If you lose your appetite, you eat less and lose weight. There may be more to the story.
A targeted review of the nutritional and metabolic alterations due to stimulant use proposed, based on pre-clinical and limited clinical studies:
Cocaine use may increase appetite following an initial period of appetite suppression.
Cocaine impacts hunger and satiety-sensing hormones, altering the body’s ability to sense and respond to energy status.
Cocaine may increase the desire for high-calorie foods, changing not just how much someone eats but also a person’s food choices.
Cocaine may increase the burning of fat for fuel so that even with increased caloric intake, a person can lose weight while using it.
Results of a cross-sectional case-control study of 35 men with cocaine use disorder and 30 drug-naive men revealed:
Caloric (and specifically fat and carbohydrate) intake was higher among cocaine users than the control group (according to food frequency questionnaires).
Body weight, tricep skinfold thickness, and percent fat mass were significantly lower in cocaine-using men than in the control group.
Leptin, the “satiety hormone,” trended lower in the cocaine-using group, but there was no significant difference.
A limitation of the study is that nutrient intake was estimated based on food frequency questionnaires. The gold standard for assessing food intake is a 24-hour recall, but any self-reported food intake is subject to error.
In a paper discussing the mechanisms by which chronic cocaine use impairs fat storage, Billing and Ersche note:
“Excessive weight gain only occurs upon the discontinuation of cocaine use, as the dietary preference for fat-rich food persists but the effects on fat mobilization and oxidation wane.”
Why should we care? (Patient and practitioner applications)
Dietitians and allied health professionals working in recovery can use this information to help their clients/patients.
Equipped with this information, individuals can also better comprehend the metabolic changes during recovery and proactively engage with dietitians or health professionals to maintain their health, thus playing an active and informed role in their own recovery journey.
Think of it like recovering from an illness that affects your weight — where you lose weight during the illness, but gain more than your normal weight back during recovery. This can lead to feelings of frustration and failure and potentially harmful attempts to regain control over your weight and appetite.
However, if you're informed about these changes in advance and understand why they're happening, you can seek the help of a dietitian to mitigate these effects and maintain metabolic health. This knowledge can be a vital tool in the recovery process.
To help people in recovery return to metabolic health, Dr. Wiss suggests identifying all of the health-promoting foods they have been missing, usually sources of fiber, polyphenols, omega-3, and protein.
“Integrating an exercise regimen can also help with achieving a new homeostasis, but it is wise to emphasize the mental health benefits (including eating behavior) of exercise rather than weight loss goal,” he adds.
The bottom line
In short, knowledge is power.
In this case, we should care to understand the metabolic impact of stimulants because this knowledge may:
Reduce self-blame for weight gain in abstinence.
Inform harm reduction techniques while a person is using, such as nutrition education and assistance in obtaining nutritious food.
Inform nutrition education interventions in SUD treatment facilities.
Help patients mitigate excessive weight gain and subsequent metabolic impacts.
Be used for drug prevention campaigns.
Cocaine and other stimulants often cause weight loss during chronic use, but they also lead to metabolic damage, changes in appetite, and excessive weight gain during abstinence.
If you or a loved one is struggling with body image and weight gain in recovery, it is highly advisable to seek out a weight-neutral registered dietitian.
For support with an eating disorder or disordered eating behaviors, seek out an eating disorder dietitian in your area. Many treatment centers now provide virtual visits, as well.
Note: All information in this article is for educational purposes only and should not be interpreted as medical advice. The reader should consult with a healthcare provider before using any supplements or making any dietary or lifestyle changes. Read the full medical disclaimer.
Dietitian Insights articles are authored by registered dietitians who utilize only high-quality sources, including peer-reviewed studies and reputable agencies, to provide the most up-to-date, evidence-based insights. Read our editorial process to learn more about how our content is medically reviewed and kept current and credible.
-
Wiss DA, Schellenberger M, Prelip ML. Registered Dietitian Nutritionists in Substance Use Disorder Treatment Centers. J Acad Nutr Diet. 2018;118(12):2217-2221. doi:10.1016/j.jand.2017.08.113
Warren CS, Lindsay AR, White EK, Claudat K, Velasquez SC. Weight-related concerns related to drug use for women in substance abuse treatment: prevalence and relationships with eating pathology. J Subst Abuse Treat. 2013;44(5):494-501. doi:10.1016/j.jsat.2012.08.222
Verdejo-Garcia A, Crossin R. Nutritional and metabolic alterations arising from stimulant use: A targeted review of an emerging field. Neurosci Biobehav Rev. 2021;120:303-306. doi:10.1016/j.neubiorev.2020.11.006
Ersche KD, Stochl J, Woodward JM, Fletcher PC. The skinny on cocaine: insights into eating behavior and body weight in cocaine-dependent men. Appetite. 2013;71:75-80. doi:10.1016/j.appet.2013.07.011
Billing L, Ersche KD. Cocaine's appetite for fat and the consequences on body weight. Am J Drug Alcohol Abuse. 2015;41(2):115-118. doi:10.3109/00952990.2014.966196
Additional practitioner resources
Practitioners wanting to learn more about nutrition in addiction treatment can find additional resources through the Academy of Nutrition and Dietetics’ Behavioral Health Nutrition Dietetic Practice Group.
Recent research points to the potential of omega-3 supplementation during pregnancy in reducing food allergy risk among offspring.