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Alcohol and Health

Alcoholic Myopathy: Signs, Causes, and Treatment

April 22, 2024
18 min read
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A team of researchers and psychologists who specialize in behavioral health and neuroscience. This group collaborates to produce insightful and evidence-based content.
April 22, 2024
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Certified recovery coach specialized in helping everyone redefine their relationship with alcohol. His approach in coaching focuses on habit formation and addressing the stress in our lives.
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Recognized by Fortune and Fast Company as a top innovator shaping the future of health and known for his pivotal role in helping individuals change their relationship with alcohol.
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April 22, 2024
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Alcoholic Myopathy: More Than Just a Muscle Ache

  • Alcoholic myopathy is a type of muscle disease caused by excessive drinking. It’s linked to nutritional deficiencies as well as to a reduction in protein synthesis combined with an uptick in protein breakdown.
  • Treatment involves therapies that promote protein synthesis, exercise, and — above all — a reduction in alcohol intake.
  • Reframe can help you monitor and track your drinking patterns while helping you change your relationship with alcohol and learn the science behind its effects on your muscles (and on the rest of your body).

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. Let’s learn what those sore muscles after drinking are all about — and what we can do about it!

What Is Myopathy?

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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, it’s 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 five 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 possibilities (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 the 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 is 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 are 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, created by professional physical therapists, is very helpful as well.
  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!

Summary FAQs

1. What is alcoholic myopathy?

Alcoholic myopathy is a condition that results from excessive drinking. Symptoms include muscle weakness, cramping, and atrophy (a decrease in muscle mass).

2. What is the difference between acute and chronic alcoholic myopathy, and what are the signs and symptoms of both?

Acute alcoholic myopathy occurs suddenly and is often associated with a recent binge of heavy drinking. Acute alcoholic myopathy symptoms include muscle pain, swelling, and weakness, particularly in the shoulders, thighs, and hips, which can lead to difficulty walking and moving. 

Chronic alcoholic myopathy takes longer to develop and is usually the result of long-term alcohol misuse. It’s characterized by a slow but progressive muscle wasting and weakness and lacks the pain and tenderness typically seen in the acute form. 

3. How is alcoholic myopathy treated?

Alcoholic myopathy is treated through therapies that target protein synthesis and reduce protein degeneration, exercise, and a reduction in alcohol intake.

Ready To Move on to a New Relationship With Alcohol? Reframe Can Help!

Although it isn’t a treatment for alcohol use disorder (AUD), the Reframe app can help you cut back on drinking gradually with the science-backed knowledge to empower you 100% of the way. Our proven program has helped millions of people around the world drink less and live more. And we want to help you get there, too!

The Reframe app equips you with the knowledge and skills you need to not only survive drinking less, but to thrive while you navigate the journey. Our daily research-backed readings teach you the neuroscience of alcohol, and our in-app Toolkit provides the resources and activities you need to navigate each challenge.

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Plus, we’re always introducing new features to optimize your in-app experience. We recently launched our in-app chatbot, Melody, powered by the world’s most powerful AI technology. Melody is here to help as you adjust to a life with less (or no) alcohol. 

And that’s not all! Every month, we launch fun challenges, like Dry/Damp January, Mental Health May, and Outdoorsy June. You won’t want to miss out on the chance to participate alongside fellow Reframers (or solo if that’s more your thing!).

The Reframe app is free for 7 days, so you don’t have anything to lose by trying it. Are you ready to feel empowered and discover life beyond alcohol? Then download our app through the App Store or Google Play today! 

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At Reframe, we do science, not stigma. We base our articles on the latest peer-reviewed research in psychology, neuroscience, and behavioral science. We follow the Reframe Content Creation Guidelines, to ensure that we share accurate and actionable information with our readers. This aids them in making informed decisions on their wellness journey.
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