What’s the Deal With Alcohol and MS?
Drinking can make your multiple sclerosis worse—but could it ever help? Answers, here.
When you have multiple sclerosis (MS), you’re constantly wondering what to do, what not to do, and how you can feel your best with the condition. You stay active, eat right, and get plenty of sleep. So what about alcohol? Should you worry about drinking too much? Should you drink at all? If you’ve been asking yourself these questions, you’re in luck: We asked two top MS doctors for straight talk about alcohol and MS. Here’s what they told us.
How Does Alcohol Impact MS?
Some people who have MS describe how, after developing the disease, they discovered they could no longer handle their alcohol like they did before, says Barbara Giesser, M.D., a neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA.
Although the evidence is largely anecdotal, experts say it may have to do with the central nervous system (CNS). MS is a chronic inflammatory demyelinating disease of the CNS, while alcohol is a central nervous system (CNS) depressant. Alcohol can directly affect the CNS, causing additional demyelination, according to a 2020 study in the International Journal of Physiology, Pathophysiology and Pharmacology (more on that study later).
Keep in mind, too, that alcohol in large quantities is a neurotoxin and can damage nerve cells over time, says Jennifer Graves, M.D., Ph.D., a neurologist and director of the UCSD Neuroimmunology Research Program at UC San Diego Health. Given that MS itself destroys nerve cells (though disease-modifying drugs are working to halt that progression), it’s easy to see why the alcohol and MS combo can make your symptoms worse.
How Do Alcohol and MS Symptoms Overlap?
Balance, coordination, gait, and cognition are four big ways that MS symptoms and alcohol intoxication can overlap. They aren’t the only ways, however: “In addition, acute intoxication from alcohol could lead to falls and worsening of any underlying cognitive dysfunction from having MS,” says Dr. Graves. “If you have a lot of trouble with balance, thinking, or memory symptoms from MS, it may be better to avoid alcohol altogether.”
Alcohol can also impair your speech and cause tremors. “These symptoms may pre-exist in somebody with MS, but alcohol might be expected to make it worse,” Dr. Giesser explains. Drinking alcohol if you have MS may interrupt sleep and worsen bladder symptoms, both issues with the condition you don’t want to aggravate. If you are having those symptoms already, go easy on the booze, says Dr. Graves.
How Much Is Safe to Drink With MS?
This, we don’t really know. It can be so easy to indulge in a glass of wine or beer (or two), but it can also be tough to determine a level of intoxication where alcohol impacts your MS since the amount varies from one person to the next (no major study has looked at this specifically).
So what can you go by? As a general guideline, the Centers for Disease Control and Prevention recommends moderation (good even without MS!), which means up to one drink per day for women and two drinks per day for men. One drink is equal to:
Beer: 12 ounces of 5% alcohol
Wine: 5 ounces of 12% alcohol
Malt liquor: 8 ounces of 7% alcohol
Distilled spirits or liquor (whiskey, vodka, gin, etc.): 1.5 ounces of 40% alcohol (80-proof)
What Else Should I Be Concerned About?
Alcohol can interact negatively with many different types of medication, Dr. Giesser says. If you have MS and are taking a CNS depressant, like an opiate for pain or another medication with CNS effect, drinking can cause a severe reaction because alcohol is a natural CNS depressant, too, and adding it on top of the medication may overwhelm your body's tolerance for the CNS depressant. “You have to be careful,” she cautions.
Is Alcohol Ever Good for MS?
Going back to that study in the International Journal of Physiology, Pathophysiology and Pharmacology, researchers wondered if alcohol might have a therapeutic effect on MS. Given that it’s a natural immune system suppressant, just like many MS meds, it's not an unreasonable question. Unfortunately, the study found a lack of evidence supporting the benefits of alcohol for MS (although researchers did recommend more studies on larger populations be conducted).
Still, there may be surprising benefits to drinking: A study published in the European Journal of Neurology found that in people with relapsing onset MS, regular consumption of alcohol (and wine, coffee, and fish) was associated with a decreased risk for disease progression. And in a large study of people with MS in Sweden, men and women who consumed alcohol were less likely to develop the disease than their sober counterparts. (However, another study found a significantly increased risk for MS following excessive alcohol use.)
And red wine itself has been touted for its health benefits, including possibly lowering inflammation and preventing damage to blood vessels, thus helping cardiovascular issues (which can be a comorbidity in MS patients). So should you drink alcohol to help your relapsing onset MS? We need more research to know the full picture of how alcohol impacts MS, experts say, but for now it appears that one word is key: Moderation.
“A single glass of red wine with dinner for most patients will not be a problem—a full bottle of red wine with dinner will be,” Dr. Graves adds. “Also, keep in mind you can get flavonoids and antioxidants from other sources.”
“The Greeks said moderation in everything,” Dr. Giesser says. “And the most important piece of advice I give my patients across the spectrum is, live your life. You have to manage your MS, but you have to live your life. So if small amounts of alcohol infrequently are a big quality of life thing, I think that’s OK.”
Ethanol and MS Treatment: International Journal of Physiology, Pathophysiology and Pharmacology. (2020). “Alcohol and Multiple Sclerosis: An Immune System-Based Review.” ncbi.nlm.nih.gov/pmc/articles/PMC7218739/
How Much to Drink: Centers for Disease Control and Prevention. (2019). “Dietary Guidelines for Alcohol.” cdc.gov/alcohol/fact-sheets/moderate-drinking.htm
Swedish Study: JAMA Neurology. (2014). “Alcohol as a Modifiable Lifestyle Factor Affecting Multiple Sclerosis Risk.” jamanetwork.com/journals/jamaneurology/fullarticle/1812407
English Study: JAMA Neurology. (2014). “Alcohol Misuse Disorders and Multiple Sclerosis Risk.” jamanetwork.com/journals/jamaneurology/fullarticle/1901155
Disease Type and Progression: European Journal of Neurology. (2011). “Alcohol, Coffee, Fish, Smoking and Disease Progression in Multiple Sclerosis.” onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1331.2011.03596.x
Red Wine Possible Benefits: Mayo Clinic. (2019). “Red Wine and Resveratrol: Good for Your Heart?” mayoclinic.org/diseases-conditions/heart-disease/in-depth/red-wine/art-20048281