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Alcoholic myopathy is a disease that causes muscle weakness and changes in muscle structure, making muscles smaller and less functional. Alcohol consumption and alcohol use disorders commonly lead to nutritional deficiencies, including deficiencies in protein, iron, B vitamins, and vitamin D, which are essential for building and maintaining muscles. Alcohol also causes oxidative stress, leading to tissue damage and improper energy storage, which can cause problems with muscle contractions and weakness. About 40% to 60% of individuals with chronic alcohol use disorder develop alcoholic myopathy, and the condition can be acute or chronic, depending on drinking patterns.
| Characteristics | Values |
|---|---|
| What is caused | Alcoholic myopathy |
| What it affects | Pelvis and shoulder muscles |
| Muscle type affected | Skeletal muscles |
| Muscle weakness | Progressive weakness over weeks to months |
| Muscle structure | Muscles become smaller |
| Muscle function | Reduced function |
| Muscle recovery | Alcohol delays muscle recovery |
| Muscle pain | Pain, tenderness |
| Muscle swelling | Swelling of affected muscles |
| Nutritional deficiencies | Deficiency in protein, iron, B vitamins, vitamin D |
| Muscle contractions | Improper energy storage causes problems with muscle contractions |
| Treatment | Ghrelin injections, drugs that block myostatin |
| Prevention | Abstinence from alcohol |
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What You'll Learn
Alcoholic myopathy
There are two types of alcoholic myopathy: acute and chronic. Acute alcoholic myopathy occurs after binge drinking and can lead to a potentially life-threatening condition called rhabdomyolysis, where alcohol causes a breakdown of muscle tissue and the release of muscle-fibre content into the blood. This can cause kidney failure and kidney dialysis, requiring treatment with machines that filter the blood. Chronic alcoholic myopathy, on the other hand, is linked to a lifetime of consuming high amounts of alcohol. It is caused by prolonged, consistent alcohol abuse and results in tissue damage and deficiencies in various vitamins and minerals.
The symptoms of alcoholic myopathy vary between individuals, and not everyone will experience all the symptoms. Acute alcoholic myopathy symptoms include muscle weakness, muscle tenderness, swelling in affected muscles, dark urine, and abnormal walking. Chronic alcoholic myopathy presents with progressive proximal muscle weakness over weeks to months. It is often associated with other alcohol-related organ dysfunction, such as cardiomyopathy and liver cirrhosis.
The best cure for alcoholic myopathy is to stop drinking alcohol. In most cases, the condition resolves within 1 to 2 weeks of abstinence from alcohol. For chronic alcoholic myopathy, it can take longer to recover muscle strength and movement, but it is reversible. About 85% of people recover within 2 to 12 months of quitting alcohol, and full recovery is typically achieved within 5 years of sobriety.
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Nutritional deficiencies
Alcoholic myopathy is caused by prolonged, consistent alcohol abuse rather than binge drinking. It is characterised by a reduced cross-sectional area of muscle fibres and impaired anabolic signalling. Nutritional factors may also contribute to alcoholic myopathy as muscle weakness and histologic myopathy among alcoholics are more severe in the presence of malnutrition. However, no clear relationship has been identified between alcoholic myopathy and the following nutrients:
- Thiamine (vitamin B1)
- Riboflavin (vitamin B2)
- Pyridoxine (vitamin B6)
- Folate (vitamin B9)
- Cobalamin (vitamin B12)
- Beta-carotene (provitamin A)
- Retinol (vitamin A)
- Vitamin D
- Copper
- Zinc
However, deficiencies of alpha-tocopherol (vitamin E) and selenium have been proposed as candidate risk factors for alcoholic myopathy.
Vitamin D deficiency is a common nutritional deficiency that can cause muscle weakness. Vitamin D is crucial for bone health and low levels of vitamin D in the blood have been associated with an increased risk of certain cancers. Most adults need 15 micrograms (mcg) of vitamin D each day, which can be obtained by consuming fatty fish such as salmon, tuna, mackerel, and sardines, as well as fortified foods like cow's milk, soy milk, almond milk, and breakfast cereals.
Magnesium deficiency is another common nutritional deficiency that can cause muscle cramps, restless leg syndrome, fatigue, and migraines. Consuming magnesium-rich foods such as almonds, cashews, peanuts, spinach, black beans, and edamame can help increase magnesium levels.
Other nutritional deficiencies that can cause muscle weakness or aches include calcium, vitamin B12, iodine, and iron deficiencies.
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Dehydration
Alcohol is a diuretic, which means it causes the body to remove fluids from the blood through the renal system, including the kidneys, ureters, and bladder, at a much quicker rate than other liquids. Alcohol suppresses the release of a hormone called vasopressin, also known as the antidiuretic hormone, which normally helps the kidneys reabsorb water. With less vasopressin in the system, the body excretes more water, causing increased urination. This leads to dehydration if the fluid loss is not adequately replaced.
Drinking alcohol also causes increased sweating and urine production, which can further contribute to dehydration, especially in hot weather. Additionally, heavy drinking may cause vomiting and diarrhea, resulting in additional fluid loss and further exacerbating dehydration.
To prevent dehydration when drinking alcohol, it is important to stay hydrated by consuming water or electrolyte-rich beverages alongside alcoholic drinks. Eating meals or snacks with high water content, such as watermelon, cucumbers, oranges, and leafy greens, can also help maintain hydration levels.
It is worth noting that alcohol can also affect muscle function and endurance. Alcohol disrupts the water balance in muscle cells, impairing their ability to produce adenosine triphosphate (ATP), which is the primary source of energy for muscle contraction. Additionally, alcohol inhibits the process of gluconeogenesis, reducing the formation of glucose from non-glucose substances, which further decreases the energy available to the muscles. As a result, alcohol consumption can lead to muscle stiffness, cramping, and even loss of muscle mass over time.
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Cardiomyopathy
Alcoholic cardiomyopathy (ACM) is a disease caused by long-term alcohol consumption that leads to heart failure. The heart is unable to pump blood efficiently, which can cause fluid to build up in the lungs, making it difficult to breathe. This condition is more common in males between the ages of 35 and 50 who have a significant history of alcohol use. It is also more likely to occur in people with alcohol use disorder or a genetic predisposition that causes them to process alcohol more slowly.
The exact mechanism by which alcohol causes ACM is not fully understood, but it is believed to involve a combination of genetic, environmental, and lifestyle factors. Alcohol can cause oxidative stress, inflammation, and damage to heart cells, leading to ventricular dilation and impaired cardiac function. It can also cause deficiencies in essential vitamins and minerals, such as thiamine, magnesium, and selenium, which are important for proper heart function.
The signs and symptoms of ACM can vary depending on the severity of the condition. In the early stages, people may not experience any symptoms. However, as the condition progresses, they may experience fatigue, shortness of breath, palpitations, lightheadedness, chest pain, swelling of the legs and ankles, and increased pressure and bulging of veins in the neck. In some cases, ACM can lead to arrhythmias or irregular heart rhythms, which can be life-threatening.
Treatment for ACM involves lifestyle changes, including complete abstinence from alcohol, a low-sodium diet, and fluid restriction. Medications such as ACE inhibitors, beta-blockers, and diuretics may also be prescribed to reduce strain on the heart. In severe cases, surgical insertion of an ICD or a pacemaker may be necessary to improve heart function. It is important to note that the recovery from ACM depends on the severity of the condition and the extent of heart damage caused by alcohol consumption.
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Mitochondrial dysfunction
Alcoholic myopathy is a common condition in patients with alcohol use disorder, characterised by muscle weakness and muscle pain. It is caused by prolonged, consistent alcohol abuse rather than binge drinking. The muscle weakness associated with alcoholic myopathy is linked to mitochondrial dysfunction and repair issues. Mitochondria are the powerhouses of cells, responsible for producing cellular energy in the form of ATP.
Several studies have found evidence of mitochondrial dysfunction in alcoholic myopathy. Alcohol inhibits mitochondrial fusion in skeletal muscle, leading to a decline in mitochondrial integrity and respiration rates. Chronic alcohol consumption also results in lower levels of aerobic metabolic reactions, which depend on mitochondrial functions, and higher levels of anaerobic reactions, which do not. Additionally, alcohol causes oxidative stress by generating excessive free radicals that damage tissues and deplete protective compounds. This interference with cellular activities, such as glycogen and lipid storage, can lead to improper energy storage and subsequent problems with muscle contractions, ultimately causing muscle weakness.
Further research suggests that alcohol specifically affects a gene involved in mitochondrial fusion and repair. This discovery implies that other environmental factors may also impact mitochondrial fusion and repair processes. Identifying the specific proteins involved in mitochondrial fusion is crucial for developing drugs to treat alcohol-induced muscle weakness.
Mechanisms underlying the development of alcoholic myopathy are still being investigated, and nutritional factors may play a role. Malnutrition, in conjunction with alcohol abuse, exacerbates muscle weakness and histologic myopathy. However, the exact relationship between alcoholic myopathy and specific micronutrients remains unclear.
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Frequently asked questions
Yes, alcohol can cause muscle weakness. Alcoholic myopathy is a disease that causes increased muscle weakness and changes muscle structure, making muscles smaller and less able to function.
Alcoholic myopathy is a common issue in people who struggle with alcohol use disorder. It is a condition involving muscle weakness and loss of muscle due to an abnormal breakdown of muscle tissue.
Alcoholic myopathy is caused by prolonged, consistent alcohol abuse rather than binge drinking. Alcohol and the product it forms when metabolised are toxic to the muscles and nervous system.
The symptoms of alcoholic myopathy include weakness, pain, tenderness, swelling, and tightness of the muscles. It can also lead to difficulty urinating and damage to the heart muscle, known as cardiomyopathy.
Yes, alcoholic myopathy can be treated. It normally resolves by itself when alcohol use is stopped. About 85% of people recover within 2 to 12 months of quitting all alcohol and are fully recovered within 5 years of sobriety.
