Alcoholic Myopathy: What Heavy Drinking Does to Your Muscles

This article is for educational purposes only. It is not medical advice and should not replace care from a licensed healthcare professional.

Many people recognize that binge drinking or abusing alcohol contributes to liver damage. What they do not realize is that drinking heavily can contribute to damage to muscle tissue throughout the body, a disease known as alcoholic myopathy.

It is important to understand the symptoms of alcoholic myopathy in order to recognize it and get treatment early, potentially preventing physical disability and permanent muscle damage.

What Is Alcoholic Myopathy?

Alcoholic myopathy is a muscle disease caused by chronic, heavy use of alcohol, or an episode of binge drinking.[1] It happens when ethanol and its byproduct, acetaldehyde, interfere with the body’s ability to build and maintain healthy muscle tissue, triggering oxidative stress, and depriving skeletal muscle of the necessary nutrients to function, and causing inflammation that affects muscle repair.[2]

Alcoholic myopathy is the most underdiagnosed complication of alcohol use disorder. According to the Handbook of Substance Misuse and Addictions, alcoholic myopathy develops in 40–60% of people with alcohol use disorders and goes unnoticed because the symptoms develop slowly and are often attributed to general fatigue or older age.[3]

There are two different types of alcoholic myopathy:

1. Chronic alcoholic myopathy: A slow progressive muscle wasting disease that develops over years of continuous heavy drinking. that occurs primarily in the proximal muscles (arms, shoulders, hips, thighs).
2. Acute alcoholic myopathy: Sudden muscle damage that can occur as a result of binge drinking (4 to 5 or more drinks in a single episode.) This may be experienced as weakness or fatigue which resolves over several days without specific treatment. A more-extreme form can occur, with severe muscle pain, swelling, and a dangerous condition called rhabdomyolysis, which is the injury to muscle that results in the release of large amounts of muscle fibers into circulation and can lead to kidney failure.

Alcoholic Myopathy Symptoms to Watch For

Recognizing symptoms of alcoholic myopathy is essential for early diagnosis and prompt treatment to minimize loss of muscle mass and strength, which can become permanent and disabling. The symptoms can vary substantially.

The following are a few of the common symptoms of alcohol myopathy:

• Weakness in the proximal muscles, such as hip, thigh, or shoulder muscles, resulting in difficulty climbing stairs, standing from a seated position, or lifting your arms above your shoulders.
• Muscle wasting or atrophy of upper arms and legs, making a person’s muscular appearance “sunken in.”
• Muscle pain or cramps that cause aching, tenderness, or cramping and worsen with physical activity
• Reduced strength in the ability to perform normal daily activities
• Persistent fatigue that is not caused by exertion from physical activity
• Impaired coordination and balance due to weakened muscles or atrophy

Signs more specific to severe acute alcoholic myopathy:

• Sudden onset of severe muscle pain
• Significant swelling of the involved muscles
• Dark urine indicating muscle breakdown (rhabdomyolysis) and kidney damage
• Fever and general illness

The symptoms of alcoholic myopathy do not occur in isolation. Alcoholic myopathy will typically also occur along with other disorders such as neuropathy (nerve injury), cardiomyopathy (damage to the heart muscle), liver failure, and cirrhosis of the liver. All are caused by the same chronic pattern of heavy alcohol abuse.[4]

How Alcohol Damages Muscle Tissue

Understanding the pathophysiological mechanisms of alcoholic myopathy can assist in understanding why the weakness from alcohol is so extensive in patients with alcohol use disorder.

• Disruption of protein biosynthesis: Ethanol (the type of alcohol in beverages) directly interferes with the protein biosynthesis necessary for muscle building, repair of muscle fibers, and maintenance of muscle fibers. Even moderate consumption of alcohol on a regular basis for prolonged periods will interfere with protein biosynthesis.
• Oxidative stress: The metabolic byproducts of alcohol breakdown produce large amounts of free radicals that create oxidative stress, damaging muscle at the cellular level.
• Nutritional deficiencies: Alcohol abuse frequently results in malnourishment. Nutritional deficiencies of critical vitamins and minerals (thiamine B1, vitamin D, calcium, and electrolytes) are common among alcoholics or heavy drinkers, which contribute to the development and progression of alcoholic myopathy.
• Mitochondrial dysfunction: Ethanol is toxic to the mitochondria of muscle cells, which prevents them from providing energy for muscular contraction and increases fatigue from muscle use.
• Hormonal imbalance: Chronic alcohol abuse decreases testosterone and growth hormone production, both of which are necessary for maintaining muscle mass.
• Electrolyte imbalances: Heavy drinkers or alcoholics commonly have low sodium potassium, magnesium, and calcium levels. This results in poor contraction of the muscles and leads to cramping and weakness.

Risk Factors for Alcoholic Myopathy

While some heavy drinkers don’t develop alcoholic myopathy, there are several risk factors that can increase this likelihood [5]:

• Greater alcohol consumption, with cumulative effects
• Long-term alcohol consumption
• Long-term moderate drinking
• Poor diet and malnutrition
• Liver disease or cirrhosis
• Co-occurring mental illness that may lead to increased alcohol use
• Lack of physical activity
• Genetic predisposition

Can Alcoholic Myopathy Be Reversed?

Alcoholic myopathy can often be reversed, particularly when caught early.[6] However, recovery will be dependent upon stopping alcohol consumption, as well as treating any nutritional deficiencies that may be present. Physiotherapy may be beneficial.

Getting Help at Alpas Wellness

Alcoholic myopathy is often an indication that chronic alcohol use has caused serious damage to a person’s body. At Alpas Wellness in Virginia, we treat the whole person, not just their symptoms. Our compassionate and professional staff recognize the complex relationship between chronic alcohol abuse, physical health, and mental well-being and assist patients in creating fully individualized treatment plans to address all of these areas together.

If you or a loved one are exhibiting signs of alcohol-related muscle weakness or if your alcohol use has become uncontrollable, help is available. Recovery from alcohol use disorder is possible and begins with just one step.