Does Drinking Alcohol Cause MS? | Alcohol's Effects | Alcohol and Disease-Modifying Therapies | Support

If you're living with multiple sclerosis (MS), you may wonder how moderate or heavy alcohol consumption could affect your disease and overall well-being. As one MyMSTeam member said, “I need to stop burying my symptoms with alcohol — it never serves me well the next day.”

If you or a loved one have MS, it is a good idea to get an overview of the association between alcohol and risk factors for MS, medications, symptoms, and severity. Talk to your neurologist to see if your drinking habits could interfere with your MS symptoms or treatment.

Does Drinking Alcohol Cause MS?

Research has yet to determine a root cause of MS, but scientists believe that a combination of genetic and environmental factors are at play. Evidence is mixed as to whether alcohol consumption is an environmental risk factor for MS.

On one end of the spectrum, a 2006 study showed that people who drank hard liquor daily had a 6.7-fold increased risk of MS. On the other hand, a large 2014 study showed that individuals who reported moderate alcohol consumption had around half the odds of developing MS compared to those who did not drink alcohol.

However, two other fairly recent studies found no significant association between drinking alcohol and developing MS.

To date, there is not enough evidence to say whether alcohol leads to an increased risk of developing MS.

Alcohol’s Effect on Symptoms of MS

In people with MS, alcohol consumption has been shown to reduce symptoms in certain instances. Some research suggests that short-term alcohol use may affect the immune system in beneficial ways, such as by dampening the immune response that can lead to inflammation. However, the same research suggests that long-term alcohol abuse or heavy drinking may impair the immune system, and could increase the inflammatory response characteristic of MS. From this study, it became evident that much more research is needed before a conclusion can be made.

One MyMSTeam member shared, “I was having a good day until I had an alcoholic beverage, and then came pain 30 minutes later. Alcohol has never affected my symptoms until now.”

Another member found that it was helpful to avoid alcohol completely: “Today, after a few years of no alcohol use, I got my motor skills back. My leg actually bends again, and my rhythm and hips are much better.”

A 2017 study showed that moderate drinking (more than three glasses of red wine per week) was associated with a lower Multiple Sclerosis Severity Score and a lower Expanded Disability Status Scale score, as compared to mild or no alcohol use. Interestingly, this study also showed that the volume of lesions on MRI increased with alcohol consumption. The researchers suggested the results may be because of red wine’s brain-protecting effects, although they called for further studies. One MyMSTeam member noted, “Red wine contains resveratrol that helps us fight the environmental concerns toward the brain.”

That said, the central nervous system side effects of alcohol use, such as impaired coordination or slurred speech, can be similar to symptoms of MS. If you already have trouble with speech, balance, cognition, or urinary continence because of MS, alcohol may compound these issues while you’re drinking.

As one MyMSTeam member said, “One drink anymore makes me feel like I’ve had 10! Didn’t bother me at all until the MS.” A review of multiple studies showed that “alcohol seemed to have a negative effect on disability progression in MS,” although results varied by country. Moderate or high levels of alcohol consumption have also been associated with more severe brain lesions on MRI, which may indicate more severe MS disease progression. Overall, the review of these studies was inconclusive and that alcohol “might be related to both good and bad outcomes in MS.”

Alcohol and Disease-Modifying Therapies

Although alcohol likely does not decrease the effectiveness of disease-modifying therapies (DMTs), it has known interactions with many medications, which can lead to unwanted side effects. Talk to your doctor about any potential risks of drinking with the medications you take.

In some cases, the effects of alcohol may be stronger while you’re on DMTs. One MyMSTeam member shared, “I’ve just noticed my tolerance is almost nonexistent. One glass of wine and I’m floored.” Another said, “Moderation is key, but at different stages of medication use, abstinence is best!”

Here are some examples of DMTs that may require caution regarding alcohol consumption.

Injectable Medications

Glatiramer acetate (Copaxone) can cause alcohol intolerance as an infrequent side effect. Alcohol intolerance is the impaired ability to break down alcohol, which can cause uncomfortable reactions such as skin flushing, stuffy nose, low blood pressure, and gastrointestinal symptoms. Caution is recommended with alcohol if you are taking this medication.

Although there are no specific warnings or studies about Copaxone and alcohol, several injectable DMTs can cause liver problems. Therefore, caution may be recommended with alcohol if you’re on a DMT. Signs of a serious liver problem after taking glatiramer may include:

• Dark urine
• Low appetite
• Nausea or vomiting
• Pale stools
• Tender or pain in the upper abdomen
• Yellowing of the skin or eyes
• Fever
• Malaise (feeling generally unwell)

Other injectable DMTs that may affect the liver include interferon beta-1a (sold as Avonex and Rebif) and interferon beta-1b (sold as Betaseron). Let your doctor know if you plan to drink alcohol while taking these medications, so you can receive personalized advice based on any liver concerns and your overall health status. Your doctor can also monitor liver function to watch for issues.

Oral Medications

Taking diroximel fumarate (Vumerity) at the same time as alcohol can reduce the absorption of the medication. However, the manufacturer advises that if you are taking Vumerity, you do not have to stop drinking alcohol altogether. Talk to your neurologist about whether you should time alcoholic drinks around your medication intake or if you should avoid drinking alcohol.

There are no specific warnings regarding alcohol on the medication labels. Several oral DMTs can cause abnormal liver function test results or serious liver injury, and caution with alcohol may be recommended when using these drugs. They include:

• Cladribine (Mavenclad)
• Dimethyl fumarate (Tecfidera)
• Fingolimod (Gilenya)
• Ozanimod (Zeposia)
• Ponesimod (Ponvory)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio)

Infused Medications

Infused DMTs such as alemtuzumab (Lemtrada), mitoxantrone (previously sold as Novantrone), ocrelizumab (Ocrevus), and natalizumab (Tysabri) have no specific warnings regarding alcohol. However, they can cause liver problems as side effects, and therefore, caution may be recommended with alcohol use if you are taking any of them.

Taking any type of DMT is a commitment and requires you to be consistent for treatment to be effective at slowing disease progression. Unfortunately, forgetfulness is the second leading cause of poor DMT adherence for people with MS. Studies show that alcohol consumption contributes to nonadherence, making it more difficult to manage life with MS and could potentially increase the rate of relapse or symptom severity.

Additionally, alcohol intake is not always assessed in routine MS appointments. Because many people with MS take multiple medications, additional substances — including alcohol, caffeine, dietary supplements, and cannabis — could further contribute to side effects associated with polypharmacy (the daily use of five or more medications).

Always speak with your doctor about your drinking, particularly if it seems to be interacting with your medications or making your MS symptoms worse. Your physician can offer advice and guidance on alcohol use customized to your specific situation.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 191,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

What are your experiences drinking alcohol with MS? Has alcohol consumption reduced or increased your symptoms in the past? What advice do you have for other people living with MS? Share your tips and experiences in a comment below or on MyMSTeam.