If you’re living with multiple sclerosis (MS), you may wonder how moderate or heavy alcohol consumption could affect your condition 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 live with MS, it’s important to understand the potential impacts of alcohol and discuss drinking habits with your neurologist.

Does Drinking Alcohol Cause MS?

Neurology research has yet to determine the root cause of MS, but scientists believe that a combination of genetic and environmental factors is at play.

Research on the relationship between alcohol and MS has produced mixed results. For example, one review found that while some studies report no link between alcohol use and MS risk, others suggest alcohol might even offer a protective effect.

However, other studies report nearly the opposite. Some research has found that people with MS were more likely to start drinking at a younger age, consume alcohol more regularly, and favor wine and hard liquor compared to those without MS. In addition, alcohol dependence has been linked to a higher risk of developing MS.

This conflicting evidence may reflect the complex ways alcohol interacts with the body. Low to moderate alcohol use might reduce inflammatory immune activity associated with MS. At the same time, alcohol can damage the central nervous system (CNS) and promote demyelination — the breakdown of the protective covering around nerve fibers. Because of these opposing effects, it's still unclear whether alcohol raises or lowers the risk of MS.

Alcohol’s Effect on MS Symptoms

For some people with MS, alcohol consumption has been shown to reduce symptoms. Research suggests that alcohol may have some modulating effect on the immune cells, although this has mostly been studied in laboratory setting.

At the same time, however, heavy or long-term alcohol use may weaken the immune system and could actually worsen the inflammation associated with MS. Given these conflicting results, it’s clear that more research is needed. It’s also worth noting that in a lab setting most researchers use substances that are different from the common alcoholic beverages.

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 magnetic resonance imaging (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.

That said, the CNS 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 (thinking), or bladder control because of MS, alcohol may make these issues worse 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 suggests that alcohol “might be related both to bad and to good outcomes in MS.”

Alcohol and Disease-Modifying Therapies

Most disease-modifying therapies (DMTs) don’t come with specific rules about alcohol. However, you should always review your medications and medical history with your doctor before deciding if it’s safe to drink.

In some cases, the side 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!”

Talk to your neurologist and review examples of DMTs that could affect your decision to drink alcohol.

Injectable Medications

Glatiramer acetate (Copaxone, Glatopa) can cause alcohol intolerance as an infrequent side effect. Alcohol intolerance means your body has trouble breaking down alcohol, which can cause unpleasant reactions such as skin flushing, stuffy nose, low blood pressure, and gastrointestinal symptoms. Be careful with alcohol if you’re taking this medication.

Although there are no specific warnings or studies about glatiramer acetate and alcohol, several injectable DMTs can cause liver problems. In rare instances, people have experienced liver problems with glatiramer acetate, which went away when they stopped taking it. Your doctor can monitor your liver function with blood tests to see if you’re having a bad reaction to your medication.

Other injectable DMTs, such as interferons, may also affect the liver. Let your doctor know if you plan to drink alcohol while taking these medications, so they can give you advice based on any liver concerns and your overall health.

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 or if you should avoid drinking alcohol.

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.

Infused Medications

Infused DMTs have no specific warnings regarding alcohol. However, it’s always possible to develop liver problems while using any medication.

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 drinking alcohol can make it harder for people with MS to stick to their treatment plans. This can lead to more relapses or worsen symptoms, making it harder to manage the condition.

Additionally, doctors don’t always ask about alcohol intake. 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).

MS Comorbidities and Alcohol

The risk of developing other health problems (called comorbidities) is important for people with MS to consider. Alcohol and other lifestyle choices can make it more likely to develop common comorbidities like heart disease, diabetes, and depression. Although it’s not always possible to control the outcome of MS, focusing on what you can change, like alcohol intake, can empower you to take control of your health. Changing your drinking habits is one step to protect against MS progression and other health issues that can affect your quality of life.

Ultimately, everyone with MS is different and may have a different reaction to alcohol. Excessive alcohol is always advised against as it causes multiple health problems. 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 based on your situation.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 219,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you notice a significant association between your MS symptoms and drinking alcohol? How do you feel about moderate alcohol consumption? Share your tips and experiences in a comment below or on your Activities page.