Alcoholic Neuropathy

Long-term heavy alcohol use, particularly when accompanied by nutritional deficiencies, can damage the body’s nerves, leading to a host of painful and debilitating symptoms. Alcoholic neuropathy can affect both sensory and motor nerves, causing pain, hypersensitivity, numbness, muscle weakness, and lack of coordination and fine motor controls, largely in the extremities.

What is alcoholic neuropathy?

Alcoholic neuropathy is progressive damage to peripheral nerves and, in extreme cases, the autonomic nervous system, through chronic, heavy alcohol use.

Alcoholic neuropathy is one of the most common adverse health effects of alcohol abuse, estimated to affect 25% to 66% of alcoholics.[1]

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What causes alcoholic neuropathy?

The symptoms of alcoholic neuropathy are caused by the degeneration of nerve cells' axons from the toxic effects of alcohol, the long fibers that transmit electrical signs from nerve to nerve, and a loss of myelin, the fatty coating that protects nerves.

However, there’s continued dispute about the exact mechanism of this nerve damage. It may be caused by:

  • damage to nerves by ethanol and acetaldehyde, which is produced when the body metabolizes ethanol

  • nutritional deficiencies, especially vitamins B1 (thiamine), B6, and B12, all essential for the working and protection of nerve cells

  • liver cirrhosis and dysfunction of the kidneys and stomach, impeding the body’s ability to detoxify waste materials

  • Toxic effects of impurities in alcoholic beverages, eg lead

  • deranged blood glucose, as in diabetic neuropathy

  • a combination of the above[2]

Nutritional/vitamin deficiencies

Alcoholics are often deficient in essential vitamins and nutrients because they eat irregularly, don’t eat nutritious foods, or don’t eat at all. Alcoholic gastritis and nausea and vomiting induced by alcohol toxicity or withdrawal can reduce appetite and caloric intake. Furthermore, alcoholic damage to the lining of the gastrointestinal symptom can impair the body’s ability to absorb essential nutrients. Large amounts of alcohol intake can also impact the storage and metabolism of vitamins.[3]

How soon does alcoholism cause neuropathy?

It’s unclear how much alcohol and how many years of excessive drinking cause neuropathy. One study suggests neuropathy is associated with consuming more than 100g of ethanol—eight to ten drinks—a day for ten years or more.[4] 

However, vulnerability to neuropathy and its severity and speed of progression varies. Women, continuous as opposed to episodic drinkers, and people with a family history of the disorder appear to be more vulnerable to alcoholic neuropathy and more severe presentations.

What are the symptoms of alcoholic neuropathy?

The symptoms of alcoholic neuropathy can be grouped into three categories: sensory symptoms, motor symptoms, and autonomic symptoms.

Sensory symptoms

Sensory symptoms, caused by damage to sensory nerves, usually begin in the feet before progressing to the legs, hands, and arms. Usually, when sensory function becomes impaired above the ankle, they will also spread into the hands, a distribution known as the stocking-and-glove pattern.[5] Symptoms also often develop symmetrically.

Sensory symptoms include:

  • Paresthesias: abnormal sensations, often tingling, pins and needles, prickling, and burning

  • Chronic pain: this may be burning, aching, or throbbing. It may be intermittent, triggered by touch, or constant.

  • Hypersensitivity: including exaggerated, painful response to light touches (allodynia), intolerance to heat

  • Decreased or loss of sensation: Lack of deep sensation/superficial sensation characterized by loss of a sense of positioning can also lead to impaired fine motor skills, making writing, typing, getting dressed, and even walking difficult. 

Motor symptoms

Motor symptoms tend to follow sensory symptoms and similarly affect the feet, legs, and hands first. They include:

  • muscle cramps

  • muscle weakness

  • ataxia (lack of voluntary coordination of muscle movements, leading to gait unsteadiness, frequent falls

  • reduced or absent reflexes (motor nerve conduction velocity)

  • difficulty swallowing (dysphagia) 

  • speech impairment (dysarthria)

Autonomic neuropathy

In severe cases, alcoholic neuropathy can damage the nerves that control automatic bodily functions. This can lead to:

  • dizziness, usually when standing or with eyes closed

  • erectile dysfunction

  • impairment of bowel and bladder function

  • chronic diarrhea[6]

Related: How alcohol affects appearance

How to prevent alcoholic neuropathy

The best way to prevent alcoholic neuropathy is to avoid excessive alcohol consumption and to seek treatment for alcoholism if you have difficulty doing so.

People who struggle with alcoholism should try to eat a healthy and balanced diet, even if they don't feel hungry.

They should also take supplements important for nerve function, including

  • thiamine (vitamin B1)

  • niacin (vitamin B3)

  • vitamin B6

  • folate (vitamin B9), also known as folic acid

  • vitamin B12

  • vitamin E

How is alcoholic neuropathy treated?

The first step in treating alcoholic neuropathy is abstaining from alcohol, sometimes through rehab. Abstinence can prevent the progression and reoccurrence of neuropathy and, after a few months, improve symptoms in some people.

A treatment plan will also include vitamin supplementation, especially with thiamine. However, supplementation won’t improve symptoms in people who continue to drink.[7]

Early alcoholic neuropathy, usually presenting as sensory symptoms in the extremities, is reversible if the patient stops drinking and establishes proper nutrition. However, more severe cases may be intractable, even with abstinence, and lead to lifelong impairment.

Symptom management may include:

  • medication for nerve pain, such as tricyclic antidepressants and anticonvulsants

  • medication to make urinating easier

  • physical therapy to strengthen weakened muscles and improve gait and balance

Alcohol addiction treatment

If you’re struggling to control your drinking and worried about alcoholic neuropathy, help is available. For a list of rehabs and treatment centers near you, visit our rehab directory.