Too much alcohol consumption for longer periods can cause damage to the body, including your nerves. This can result in a condition known as alcoholic neuropathy or peripheral alcohol neuropathy.
This is why if you’re dealing with alcohol addiction, it’s better to understand how detrimental alcohol can be to your nerves so you can get the needed help and prevent further complications.
This article looks at what alcoholic neuropathy is, its causes, how it feels, diagnosis, treatment options, and what you can do to overcome your drinking habit.
What is Alcoholic Neuropathy?
Alcoholic neuropathy is a type of nerve damage that comes about as a result of long-term heavy alcohol intake.
It often affects the peripheral nerves (nerves outside the brain and the spinal cord) and can present with symptoms such as tingling sensations in the feet that don’t have any other known cause.
Studies show that 65% of all people diagnosed with an alcohol use disorder in the US also have alcoholic neuropathy.
The good news is that cutting back on alcohol intake or avoiding it completely can prevent continued nerve damage and complications. Nonetheless, reversing the damage that has already been done can take longer or become impossible.
Besides alcohol consumption, other causes of neuropathy may include non-alcohol-related nutritional imbalances, metabolic issues, infections, traumatic injuries, inherited, and exposure to toxins.
How Does Alcohol Cause Neuropathy?
Alcohol is an anti-nutrient, and too much intake can inhibit the absorption of crucial nutrients that promote nerve health.
When this happens, the body prioritizes where the little existing amount of these nutrients go, and often the furthest nerves are not a priority, thus the effects of the nerves.
1. Alcohol can deprive you of nutrients
These may include:
i. Vitamin B6
Vitamin B6 or pyridoxine plays an important role in maintaining the covering of nerve endings, also known as the myelin sheath.
Myelin sheath is an insulating layer around the nerves that allows electrical impulses to transmit quickly and efficiently along the nerve cells. A deficiency can interfere with this process, causing the impulses to slow.
Vitamin B6 is also responsible for the metabolism of neurotransmitters like GABA and serotonin, which are essential for signal transmission.
Without these transmissions, one can experience reduced sensation or a complete lack of sensation, among other symptoms.
ii. Vitamin B12
Vitamin B12 is essential for nerve regeneration, nerve cell survival, and myelin sheath maintenance. All these benefits help protect the nerve from damage.
Niacin, or vitamin B3, is another essential vitamin that can prolong the lifespan of nerves. It also helps fight nerve inflammation which further promotes their functions and prevents damage.
Also known as vitamin B1, thiamine is a coenzyme in carbohydrate metabolism, which is the main energy source for nerves to function.
A deficiency in thiamine can cause pins and needles sensations in the feet, spreading proximally and to the distal arms.
Folate is essential for the biosynthesis of DNA and RNA and for DNA repair. These roles are essential for nerve cell division during nerve tissue repair and rapid growth. That’s why folic acid is essential in peripheral nerve injury repair.
A deficiency in folate overlaps with those of vitamin B12 deficiency. They may include things like numbness and tingling in the hands and feet and muscle weakness,
vi. Vitamin E
Vitamin E is another essential nutrient for the nervous system. It has been shown to reduce sensory neural loss and improve nerve regeneration after an injury.
A deficiency can cause nerve pain, difficulty in coordination, loss of reflexes in the legs, and loss of sensation in the extremities.
2. Alcohol can increase toxin accumulation
This occurs when alcohol damages the kidneys and the liver in a way that interferes with detoxification processes causing toxins to build up. This can cause damage to various tissues and cells in the body, including nerve cells.
3. Alcohol facilitates poor dietary choices
In most cases, heavy drinkers don’t put so much consideration into what they eat.
Moreover, in most cases, their diet is deficient in essential nutrients, including the B vitamins, which are essential for nerve health and function, thus increasing your risk of neuropathy.
Signs and Symptoms of Alcohol Neuropathy:
The signs and symptoms of alcohol neuropathy are often subtle and build up slowly over time. With continued alcohol intake, the damage will progress, and the symptoms will become more evident.
However, the person experiencing them may not even realize they are related to alcohol. Symptoms can include:
Arms, legs, hands, and feet:
- Tingling sensation
- Pins and needle sensations
- Burning, shooting, stabbing, or freezing pains
- Inability to feel pain or recognize temperature
- Sensitivity to touch
- Muscle weakness, spasms, cramps, and aches
- Unsteady gait and difficulty walking
- Lack of motor coordination
Urinary and bowel:
- Urine incontinence or difficulty urinating
- Constipation and diarrhea
- Nausea and vomiting
- Trouble swallowing, eating, and talking
- Impotence or erectile dysfunction
- Sexual dysfunction
- Excessive sweating
- Breathing problems
- Irregular blood pressure and heart rate
- Heat intolerance
How Much Alcohol Causes Alcoholic Neuropathy?
The exact amount of alcohol intake that can lead to alcoholic neuropathy is not clear and can vary from person to person. However, this type of neuropathy is linked to too much drinking for longer durations throughout a lifetime.
One study suggested that taking more than 100 grams of alcohol daily over a long period (years) could lead to alcohol-related neuropathies.
For better reference, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) states that one standard drink (such as 12 oz of regular beer or 5 oz of wine) contains 14 grams of pure alcohol.
How Common is Alcoholic Neuropathy?
According to research, up to half of long-term heavy drinkers develop alcoholic neuropathies.
To be more precise, one study found that 25%-66% of all chronic alcohol users in the United States experience some form of nerve damage. The study also indicated that the majority of those affected were middle-class, working men, and continuous drinkers.
While men were shown to be affected the most, the condition was also shown to be severe when it occurs in women: this includes disease progression rate and the severity of symptoms.
How to Know If You Have Alcoholic Neuropathy?
A diagnosis of alcohol neuropathy is often done by a qualified health practitioner and may require a combination of the following:
1. Social history
Here your doctor will ask about your alcohol intake history. How much you drink, how often, and for how long you’ve been drinking.
This part of your history has to be clear to rule out other possible causes of your neuropathy.
2. Medical history
Your healthcare provider will likely ask about your previous medical history, any recent symptoms and changes, and any history of pre-existing medical conditions like type 2 diabetes. This can help rule out other common causes of neuropathies.
Your doctor may also ask about your nutrition, including what you eat in a typical day, to ascertain any habits associated with poor nutrition.
3. Physical examination
This involves the healthcare provider looking out for any physical signs of alcoholic neuropathy by performing a complete neurological exam.
A neurological exam will check for various things, including changes in your ability to feel sensations, poor balance, and trouble walking properly, muscle weakness, and changes in your reflexes.
Common positive findings for alcoholic neuropathy will include:
- Diminished sensation to vibration and pain
- Weakness in the ankle and toes with flexion and extension
- Diminished deep tendon reflexes
- Atrophy of foot muscles
- Gait ataxia (abnormal uncoordinated movement)
- Dysfunctional thermo-proprioception. Proprioception is often referred to as the sixth sense. The sense allows you to perceive the location, movement, and action of different body parts.
4. Blood tests or nerve tests
Liver function tests (LFTs)
Chronic alcohol consumption can increase various liver enzymes, including aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase. Increased liver enzymes are a warning sign of inflammation, irritation, or liver damage.
Peripheral neuropathy is a common symptom associated with diabetes, so it’s only wise that your doctor performs tests to rule out diabetes as your cause of neuropathy.
Hemoglobin A1C is a common test to determine your average blood sugar levels for the past three months. Normal A1C level is below 5.7%, while levels between 5.7-6.4% indicate prediabetes. Anything 6.5% and above means you have diabetes.
Thiamine, vitamin B-12, and folic acid levels
As seen earlier, these nutrients play an important role in nerve functions but are often deficient in alcoholic neuropathy. They should be among the first tests in someone with neuropathies.
Additional tests that may be done include:
- Nerve biopsy.
- Nerve conduction tests.
- Electromyography (EMG)
- Upper GI and small bowel series
- Esophagogastroduodenoscopy (EGD)
- Complete blood count (CBC)
How to Treat Alcoholic Neuropathy:
Once an alcoholic neuropathy diagnosis has been confirmed, treatment will often focus on a rehabilitation program consisting of various elements, including:
1. Inpatient rehab or outpatient therapy
The first line of treatment for alcoholic neuropathy is to avoid further damage, which means avoiding alcohol.
While some people can do these on their own or under minimal supervision, i.e, outpatient therapy, others may find it quite difficult, thus requiring an inpatient rehab admission.
If someone is a heavy drinker, stopping alcohol all at once without putting any necessary measures in place can put them at risk for alcohol withdrawal. A rehab can be a safe environment for them to detox and receive the needed support without complications.
Once there’s no more damage from alcohol coming in, the doctor can now focus on managing the symptoms and improving the existing damage.
This may involve:
a. Physical therapy
Physical therapy is a way of treating a disease, injury, or deformity using physical methods such as heat treatment, massage, and exercises rather than drugs or surgery.
For alcoholic peripheral neuropathy, the physical therapy may involve things like
- Balance and gait training with assistive devices for safety, such as a cane or a walker
- Strength training for the weak muscles
- Range of motion (ROM)exercises and stretching. ROM is how far you can move your joint in different directions. ROM exercises are aimed at improving the movement of a specific joint, thus improving that specific joint function.
Stretching can help prevent contracture and maintain normal gait mechanics.
b. Occupational therapy
Occupation therapy refers to the use of particular activities (occupations), techniques, and equipment to help you recover, regain, or improve your independence.
Unlike physical therapy, which focuses on mobility and body functions, occupational therapy helps patients adapt to their environment and learn different ways to get things done without experiencing pain.
This may involve a combination of various elements to maximize function, such as compensatory strategies to accommodate for weak muscles or training in the performance of activities for daily living, e.g., checking your water temperature with gloves before bathing.
2. Nutritional supplementations
Here the health care provider will recommend supplements for various existing nutrient deficiencies, including:
- Vitamin B complex
- Vitamin E
How to Prevent Alcoholic Neuropathy?
Prevention is always better than cure. If you’re afraid you could end up developing alcoholic peripheral neuropathy, here are a few things you can do to lower your risk:
- Avoid excessive amounts of alcohol or avoid it altogether, especially if you begin to notice any signs of neuropathy, like numbness after drinking.
- Eat a healthy and balanced diet rich in fruits and vegetables.
- Take vitamin supplements for deficiencies if necessary.
- Seek help if you’re finding it difficult to avoid alcohol.
How to Stop Drinking at Home:
- Take to evaluate your relationship with drinking: how much you drink, why you drink, and how it’s affecting you
- Set yourself a drink limit
- Have a few alcohol-free days each week
- Change your after-work routine
- Keep attractive non-alcoholic options at home
- Delay that first drink
- Don’t keep alcohol in the house
- Limit the time you spend with friends that drink
- Avoid tempting environments like clubs
- Maintain proper hydration
- Manage your stress
- Fill in your drinking time with other healthy habits like exercise
Alcoholic neuropathy is a common condition affecting about half of all chronic alcohol users. It occurs when too much alcohol damage the nerves outside the brain and spinal cord.
The primary mode of treatment is to avoid alcohol, followed by a focus on improving the damage caused.
In some cases, alcohol neuropathy cannot be reversed, but various treatment modalities, including physiotherapy and occupational therapy, can help you get back on your feet.
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