Alcoholic Myopathy: Signs, Causes, and Treatment

We all know those muscle aches we wake up with the morning after we finish a long hike, try a new kickboxing workout, or stretch our limbs in a new yoga routine. But maybe you’ve experienced this effect after a night of drinking. What gives? Was there a set of jumping jacks (or 10, or 20) you forgot you did between rounds of Trivia Night? Or did a night out on the town magically serve as an equivalent of a trip to the gym?

Turns out, booze itself might be the culprit. Alcohol can induce a condition known as alcoholic myopathy, an uncomfortable muscle condition. How does alcohol cause muscle weakness? What’s the connection between alcohol, muscle wasting, and muscle weakness after drinking? And why do alcoholics have skinny legs? Let’s learn what those sore muscles after drinking are all about — and what we can do about it!

What Is Myopathy?

Derived from the Greek “myo” (muscle) and “pathy” (suffering), the term myopathy describes various types of muscle disease. What’s behind this “muscle suffering?” It could have a number of different causes, but the result is that the structure, metabolism, or function of our skeletal muscles is affected to the point of interfering with our daily life.

Myopathy can be chronic or acute. Symptoms can range from mildly unpleasant to downright debilitating:

• Muscle cramps
• Spasms
• Muscle stiffness
• Decreased muscle mass

The causes can vary, but generally fall into two categories: inherited and acquired.

Inherited vs. Acquired Myopathy

Inherited myopathy includes congenital myopathies (in which all muscles are usually affected), those caused by mitochondrial deficiencies, metabolic myopathies (caused by faulty metabolic processes that deplete the muscles of resources they need to function) and muscular dystrophies (progressive degeneration of muscles).

Acquired myopathies, on the other hand, have a number of possible causes ranging from autoimmune or inflammatory diseases to endocrine issues, electrolyte imbalances, illness, and — yes — toxins, such as alcohol.

Early detection is key! A healthcare professional can help pinpoint the root of the problem and make an accurate diagnosis. In the case of alcoholic myopathy, we can do a great deal of prevention before we even get to the point of symptoms.

All About Alcoholic Myopathy

So what does alcohol have to do with it? Can it really affect our muscles? Science says yes! While the mechanism isn’t very well understood, the connection between muscle weakness, alcohol, muscle atrophy, and muscle pain is well-documented and can lead to serious problems if left unaddressed.

How common is alcoholic myopathy? According to an Alcohol Research article, as many as 40 to 60% of people diagnosed with alcohol use disorder (AUD) will develop alcoholic myopathy. While the liver gets the most airtime when it comes to the negative effects of alcohol on the body, muscle disease is actually about 5 times more common.

Alcoholic Myopathy Signs and Symptoms

Alcoholic myopathy can be acute (arising after a heavy binge) or chronic (building up over time). Here are the signs of each:

• Acute alcoholic myopathy: Our muscles might swell and feel tender. We might experience unusually intense muscle aches after drinking that feel a lot different than everyday aches and pains. Cramping, dark urine, and (in severe cases) kidney failure are also a possibility (and should never be ignored).
• Chronic alcoholic myopathy: Chronic alcoholic myopathy signs and symptoms creep up in more subtle ways. It might be painless, showing up as muscle atrophy — the so-called “alcoholic’s skinny legs.” Symptoms can also include tightness or twitching after drinking alcohol for a long period of time.

The Science Behind Alcoholic Myopathy

There are three main ways in which alcohol messes with our muscles:

1. Nutritional deficiencies. This cause is especially common in heavy drinkers. Booze is notorious for sapping our bodies of much-needed nutrients, and our muscles can suffer as a result. For one thing, we might not be eating enough protein, which serves as the building material for muscle fibers. Moreover, chronic malnutrition often leaves us deficient in many micronutrients, such as folate, thiamine, vitamin B6, zinc, iron, and vitamin D. (The last in particular has been associated with alcoholic myopathy).
2. Protein synthesis disruption. Alcohol misuse is known to put a damper on protein synthesis — and scientists have figured out exactly why. Alcohol affects a group of proteins called mammalian target of rapamycin (mTOR), which act as production crew in charge of integrating signals necessary for protein synthesis. Those signals come from anabolic hormones, nutrients, and myokines.
   ‍
   In addition to messing with mTOR, alcohol decreases insulin-like growth factor-1 (IGF-1) and disrupts the dynamics of the SMAD family of transcription factors involved in muscle generation. All this to say, alcohol slows (and can prevent) muscle growth, no matter how much we work out.
3. Protein degeneration. To make matters worse, alcohol also leads to protein degeneration by interfering with two molecular systems — the ubiquitin proteasome pathway (UPP) and the autophagic–lysosomal system. The result? A double-whammy, as far as muscles concerned.

While these three are the main mechanisms behind alcoholic myopathy, booze contributes in other ways as well. Its tendency to cause inflammation can make matters worse. It can also cause oxidative stress (a process that contributes to tissue damage), mitochondrial dysfunction (glitches in the ways muscle cells use energy), and epigenetic changes that tweak the cellular processes supporting muscle function.

Finally, alcohol can also make it more difficult to bounce back from tissue injuries — not just because of its effects on muscle growth, but by causing dehydration and electrolyte imbalances.

Risk Factors for Alcoholic Myopathy

How long does alcoholic myopathy take to develop? It depends. For some of us, the symptoms start cropping up sooner rather than later. However, there are a few factors that tend to make chronic alcoholic myopathy in particular more likely to show up.

• Liver cirrhosis. Scientists have found a strong correlation between liver cirrhosis and alcoholic myopathy. Once alcohol has taken a toll on our liver, it tends to cause muscle degeneration as well, contributing to chronic alcoholic myopathy in particular.
• Lifetime alcohol consumption. The total amount of alcohol we put in our bodies has a cumulative effect, so the longer we spend drinking excessively, the higher the chances that our muscles will suffer the consequences.
• Certain medical conditions. Health conditions that broadly affect our body (for example, diabetes or chronic infection related to HIV) can speed up the process of alcoholic myopathy.
• Inactivity. It goes without saying that being inactive makes it harder for our muscles to thrive. Add alcohol to the mix, and things can go downhill quickly.
• Age. Unfortunately, as we age, we tend to lose muscle mass. Alcohol speeds up aging and accelerates the process of age-related muscle degeneration.
• Gender. While men are about four times as likely to end up with acute alcoholic myopathy, women are more likely to develop the chronic kind.

Diagnosis and Treatment: Pathways to Recovery

Now for the big question, can alcoholic myopathy be reversed? Yes, it can (Phew!). If we go easy on the booze, our muscles have a chance to recover. There are several strategies doctors use to give our muscles a helping hand.

• Quit or cut back on alcohol. This one shouldn’t come as a surprise — putting a stop on alcohol misuse gets right to the root of the problem.
• Therapies to boost muscle synthesis. Some therapies boost the process of muscle synthesis, mainly by targeting certain molecules (such as insulin-like growth factor-1 (IGF-1)) that speed up our natural muscle regeneration processes.
• Therapies to curb muscle degradation. On the flip side, some methods start from the other end and try to put a stop to muscle degradation by tweaking the molecular pathways involved.
• Exercise and flexibility training. Last but not least, exercise can boost our muscles’ regenerative power, leading to improved recovery. Aerobic exercise, as well as resistance training, has been shown to help.

Tips for the Journey

So what can you do to give your muscles (and the rest of your body and mind) a breather when it comes to alcohol? Here are a few tips:

1. Track your drinking. Start by becoming a “scientist” of your own drinking habits. When do you usually drink? On the couch with friends? At a bar on Thursday night while watching a sports game? Out on the town with the usual suspects on a Saturday night? There’s no judgment here — just start by gathering information to get an idea of what your patterns are.
2. Find your “why.” Changing your habits can be tricky (especially at first) and having a reason to change can provide that much-needed boost of motivation. If you’re struggling with alcoholic myopathy, focus on what you’ll be able to do once your muscles have a chance to recover. Maybe it’s going for a run or a hike, maybe it’s trying a new workout routine, or maybe it’s simply going about your day with ease and comfort. Focusing on these perks will help you get there!
3. Decide on a limit. Set a limit ahead of time and try to stick to it. Writing it down, setting a reminder on your phone, or telling an accountability buddy can help!
4. Take days off. Schedule booze-free days and try to stick to your plan. Your muscles will thank you in the morning!
5. Find joy in movement. Find a form of exercise you enjoy and make it a habit. If going to the gym isn’t your thing — no problem! These days, all you need is a yoga mat (or any non-slippery surface that has some cushioning to it) and an internet connection. Try any of the free exercise routines on YouTube, where you can find anything from simple yoga sequences to cardio kickboxing, HIIT workouts, or fun dance workouts. Popsugar Fitness is a great one to start with if you want a little bit of everything. Fitness Blender is very helpful as well, and is created by professional physical therapists.
6. Talk to a physical therapist or doctor. Speaking of physical therapists, they can be a lifeline when it comes to correcting any muscle issues before they get worse through targeted routines and bodywork. But if you’re feeling like alcohol has taken a real toll on your overall health and might require medical help, don’t hesitate to talk to your doctor about it. They can help direct you to any treatment you might need (for your muscles or otherwise) to nip the problem in the bud before it progresses. You got this!

Summing Up

We rarely think about how much our muscles do for us every day until something goes wrong or doesn’t feel quite like it should. Let’s be proactive about our health — both when it comes to our muscles and in our journey to a happier, healthier version of ourselves. In the words of writer Haruki Murakami, “I move, therefore I am.” So let’s keep moving!