Alcohol intolerance is a feature of both fibromyalgia and chronic fatigue syndrome (ME/CFS) that we rarely see in symptoms lists. Yet most people who have FM or ME/CFS find that they can no longer drink much, if any, alcohol.
While a few are able to occasionally have one or two drinks with only minimal problems, for others even a very small alcoholic beverage can trigger a severe flare or relapse that may last for days, weeks or sometimes even months.
Research on alcohol and FM/ME/CFS
Most references to alcohol intolerance issues with FM and ME/CFS patients are anecdotal reports found in blogs and forums. However, I did find one study with the stated objective “To examine the anecdotal observation that patients with chronic fatigue syndrome develop alcohol intolerance.”
This 2004 study, conducted in the UK, compared self-reported alcohol use pre-and post-diagnosis for 114 ME/CFS patients. The researchers found that two-thirds of the participants had reduced or ceased their alcohol intake after developing ME/CFS. The most common reasons given were:
- Increased tiredness – 67%
- Increased nausea – 33%
- Sleep disturbance – 24%
- Exacerbated hangovers – 23%
One-third of the subjects reported they had stopped drinking because "it seemed sensible." Many of those had been advised by their doctors to stop due to their ME/CFS diagnosis.
Causes of alcohol intolerance
I haven't been able to find any research into exactly why people who have FM and ME/CFS seem to have trouble processing alcohol, but popular theories include:
- When the liver breaks down alcohol, enzymes produce toxins which people with FM and ME/CFS do not process well. One of those toxins is acetaldehyde, which is known to contribute to the hangover effect.
- Alcohol promotes inflammation, which increases pain.
- Alcohol depletes glutathione, which is already thought to be low in people with FM and ME/CFS.
Another problem with drinking alcohol when you have FM or ME/CFS is that has negative interactions with many medications you may be taking.
- Alcohol increases the effects of Lyrica, tramadol and opioids like hydrocodone and oxycodone, which could increase side effects or worse, could result in an overdose.
- Drinking alcohol while taking antidepressants, including Savella and Cymbalta, increases your risk of liver damage. Since alcohol is a depressant, it also counteracts the antidepressant effects of the medication.
- Acetaminophen (Tylenol) or any medication containing acetaminophen should not be mixed with alcohol due to a significantly increased risk of liver damage. Note: Vicodin, Lortab, Percocet and many over-the-counter cold and allergy medications all contain acetaminophen.
If you're going to drink
It can be tempting to have a drink in a social situation where others are drinking. It may also seem like a drink would help you relax or relieve some of your aches and pains. But if you have FM or ME/CFS, be aware that instead of making you feel better, that drink may actually cause you to feel worse and that “worse” feeling may last for several days or even longer.
If you do decide to drink alcohol, at least try to drink a lot of water as well. When you drink alcohol, your body requires more water than usual to flush out the toxins. If that extra water is not readily available, it will be pulled from other areas of the body, which can increase many of your FM and ME/CFS symptoms.
For suggestions of drinks you might try instead of alcohol, read “Non-Alcholic Alternatives for Holiday Cheer” by Dr. Christina Lasich.
Woolley J, et al. Alcohol use in chronic fatigue syndrome. J Psychosom Res. 2004 Feb;56(2):203-6.