Guest Post: MS and Alcohol: Friend or Foe? Prof G responds… as do MSers

G
By now, we all know the lifestyle drill.
Exercise = good
Smoking = bad
Alcohol = possibly, maybe?

As if this wasn’t confusing enough, the last month has seen the
publication of differing advice on alcohol.
Public Health England announced that drinkers should aim for two
consecutive alcohol-free days a week to reduce health problems and improve
well-being. While a massive worldwide study – the largest to date – published
in the prestigious Lancet journal countered that the safest level of alcohol
consumption was… zero. Any amount – no matter how small – carried risks.
So what does this mean for those of us with multiple sclerosis –
already contending with a serious, chronic health condition?
Should we go sober for October, nudge it into November and
onwards? Has the time come for us to pour our favourite tipple down the sink
and join the fifth of British adults who abstain from alcohol, according to the
Office for National Statistics.
Not so fast, says Gavin Giovannoni, Professor of Neurology at
Barts and The London School of Medicine and Dentistry, and himself partial to a
good pinot. Go teetotal if it suits you, but if not, the key is moderation,
moderation, moderation, he says in an interview with Shift.ms
“I think overall if you have moderate or low alcohol consumption
it’s pretty safe. It’s the excessive alcohol consumption that’s bad for health
in general – and for people with MS.”
And by moderation, Giovannoni means following the UK government
guidelines for women and men and not drinking over 14 units a week or – in
layperson’s terms – no more than a bottle and a half of wine or five pints of
lager every seven days. In addition, he says it is important to have two or
three alcohol-free days a week – and whatever you do – no binge drinking.
Giovannoni points out that not everyone with MS reacts to alcohol
the same way. Depending on how much damage their nervous system has already
sustained, certain MS symptoms – such as issues with speech, cognition and
balance – can become quickly magnified with drinking.
“If someone is very unsteady on their feet and they drink alcohol
it will make those issues worse and put them at risk of falls,” he says.
Drinking can also play havoc with MS fatigue. “When you start drinking
excessively, it disrupts sleep cycles massively. It’s one of the big things I
pick up in my sleep clinic.” 
And, of course, alcohol can impact certain MS drugs. In
particular, combining alcohol with anti-spastic medications like baclofen,
pregabalin, gabapentin – can lead to grogginess and dizziness. Drinking while
taking certain anti-depressants can also be a no-no.
Has Giovannoni ever had to tell his patients to cut back on
drinking. “Yep. It’s actually much more common than you realise,” he says. And yes, he means male and female patients
equally.
In light of all these possible red flags, why doesn’t Giovannoni
just tell his MS patients to cut out drinking completely and point them to the
Lancet study? For one thing, he isn’t comfortable with the methodology used in
the paper. Plus he is loathe to envision a society without drinking.
“I don’t think we should take alcohol out of context here… It
helps disinhibit people, makes them more interactive. It’s an anxiolytic: it
relaxes them. A lot of people enjoy drinking alcohol and I think it has
benefits outside of biology that we can’t ignore.
For better or for worse, he says, alcohol has shaped almost every
single culture throughout history – playing an integral role in celebrations,
religious ceremonies, creativity, friendship and even battle. You might say,
drinking is an integral part of being human. In fact, it might even be part of
being prehuman –  if you believe the
theory of Robert Dudley, author of “The Drunken Monday: Why We Drink and Abuse Alcohol.”
Dudley says our taste for tipple may be a hardwired evolutionary
trait dating from tens of thousands of years ago – when we were mere primates
plucking fermented fruit from the jungle floor and enjoying it. These days, he
says, not much has changed. “We forage for fruits in the jungle and in the
concrete jungle we go down the supermarket aisle.” 
CDIC/Reuters
So what about those on the front line, so to speak? What is the
experience of people with MS when it comes to alcohol? Do they find it a help
or a hindrance?
To find out, I posted a series of questions about alcohol on
Shift.ms – the social network for those with MS. A total of thirty-sex members
replied – between the ages of 27-65. Nineteen were women, seventeen were men.
Some caveats: the survey was not anonymous. Respondents answered
alongside their Shift.ms username – which is linked to their profile. This lack
of privacy might – repeat might – encourage people to be less truthful or
accurate with their answers. The survey was also voluntary. This could have led
the more moderate/teetotal drinkers to respond more compared to heavy/binge
drinkers hesitant to admit to the full amount they consume.
The results: out of the 36 who responded – eight said they
abstained from all alcohol. Of the remaining 28 who still imbibed – sixteen
said they had cut back on drinking due to low tolerance and magnified MS
symptoms, and also general ageing. The remaining twelve opted to continue, saying the pleasure outweighed the pain.
Here are some responses. Some have been lightly edited.
“I like a drink. When I was diagnosed in April my neurologist
told me I drink too much, and I guess she’s right. Before diagnosis I would
easily drink 5 days a week, never to get drunk, just to help unwind after work…
Now I drink less and less often, but I still do it for the relaxation benefits.
Drinking, whether socially or not, has been a part of my life for 20 years. I
enjoy it, so I don’t think I’ll stop anytime soon due to MS.”
Dave, 37, diagnosed
2018, RRMS
“I proper binge drink once a week on a Friday or Saturday. Except
binge drinking for me now is maybe 3 or 4 beers before I’m completely wasted,
where before my tolerance was much higher. I am 100% fatigued the next day to
the point where I can’t keep my eyes open. Why do I keep doing it? Could be as
a coping mechanism, or could just be because I want to enjoy myself with my
friends who are young and disease free?”
NB, 27, diagnosed
2017, RRMS
But not always.
“I was diagnosed two years ago, and I was a social drinker. As my
MS has progressed, my ability to drink has lessened. I’ll have one drink at
home every now and then, but not when I go out. With all the brain buzzing, I
always feel one drink ahead of everyone to begin with. Then I start to feel
more crazy. It’s not worth it anymore.”
Marajade, 41,
diagnosed 2016, RRMS
“I used to be quite a big drinker pre-diagnosis…These days I very
rarely drink, only when I have social situations I can’t avoid (weddings etc.)
to help stop the anxiety attacks. Any more than a couple of pints and I’m wrote
off in bed for a few days, I’m not sure if it’s my MS or just old age, but the
pain outweighs the pleasure these days so I very rarely drink anymore.”
Arbee, 38, diagnosed
2017, RRMS
Eight members no longer drank.
“I used to regularly drink about 7-8 pints of beer on a night
out. Then about three years ago, I realised I was not doing myself any good. So
I stopped. I thought ‘my body already has enough to deal with. Why give it
something else?’”
Chris, 39, diagnosed in 2002, RRMS
“No I don’t drink now! It can throw my balance off, particularly
if more than 1 glass of wine. I’m
glad I
ve quit.
Rachaellouise, 36, diagnosed 2017, RRMS
Some said alcohol helped them cope with living with MS.
“I drink only at the weekend… Guinness is my self-medication of
choice and ticks all the right boxes. Three bottles of Porter kick starts my
weekend on Friday evening finishing with a can of Guinness (I’m a creature of
habit). For the rest of my extended weekend, we are probably looking at 10 cans
a day. If anything, it makes me feel better as I’m not dwelling on all that’s
wrong with me.”
Markp, 46, diagnosed 2009, SPMS
Drinking definitely makes my MS worse nowadays. The day after
drinking, even little amounts, it switches my nerves and muscles off. All of
that aside I still drink.
Mark, 42, diagnosed 2009 SPMS.
Others said they had no choice but to cut back.
“My body will now only let me drink rose – only 1 glass an
evening, so a bottle (4 glasses) lasts me a week. I usually have a glass every
other day.”
Grandma, 62, diagnosed 25 years ago. RRMS now likely SPMS
“In a social situation I may have 2 small glasses at home. I have
a low tolerance for the alcohol now so one drink is plenty. It definitely has
lost its appeal, the only reason I have it now is to spend time with my
husband.”
Potter, diagnosed
2008, age 41, RRMS
“I only drink on weekends and even then it is one small glass of
red wine, maybe two… I am very cautious about alcohol as it disrupts my sleep
and worsens my cognitive problems.”
Clare, 55, diagnosed
2012, RRMS
I can’t drink anymore it really affects my walking. Don’t get me
wrong I still drink, but only a little and I’ve to use the toilet a lot. I
can’t drink like I used to definitely makes symptoms worse.
Bradydenise, 40, diagnosed 2009, RRMS
While at least one member rued his binge-drinking pre-MS days.
“Due to what’s happened to me (cancer, stroke, PPMS) I’m 99%
booze free… I allow myself one drinking session a month with a very close
friend. When I was drinking, I drank a lot a good Irish malt would last two
days max and Guinness was too easy to drink. If I had one bit of advice for
everyone it would be drink in moderation.”
Guinness, 55, diagnosed 2018, PPMS
Readers – now it’s your turn. What’s your experience with drink?
By Rachel Horne
Happy binge drinker at university and early 20’s. Moderate now…
age and MS.
Rachel is a journalist interested in health and women’s issues.
She has an Hons BA from McGill University and a Masters from Columbia
University School of Journalism. Previously she covered international news in
China and financial news for CNN in London. She has MS.

About the author

Rachel Horne

23 comments

Leave a Reply to Anonymous Cancel reply

  • "The World Health Organization estimates that approximately between 4 percent and 25 percent of cancers are attributable to alcohol worldwide. According to The National Institute on Alcohol Abuse and Alcoholism, the leading agency in the United States for research on the health effects of alcohol, women who consume about one drink per day have a 5 – 9 percent higher chance of developing breast cancer than women that do not drink at all."
    http://www.aicr.org/cancer-research-update/2018/2-7/new-study-clarifies-how-alcohol-causes-cancer.html

    "Blood stem cells, found in blood and bone marrow, are immature blood cells that can develop into any type of blood cell, including white blood cells, platelets, and red blood cells. It is important to understand how alcohol damages these cells, as faulty stem cells are known to cause cancer."
    https://www.medicalnewstoday.com/articles/320511.php

    Even light drinkers at risk of cancer
    https://www.medicalnewstoday.com/articles/320021.php?sr

  • Always find it incredible how people who like a drink manage to play down the risks and the damage, find excuses, justify themselves, twist the facts. Now we have the high powered, massive study in the Lancet. Alcohol is a poison. End of.

    • "Always find it incredible how people who like a drink manage to play down the risks and the damage, find excuses, justify themselves, twist the facts."

      Yup..same with cigarettes.

    • "the release of the Surgeon General’s report about the dangers of smoking made him give up cigarettes in 1963, but the report made no mention of cigars, which he continued to smoke."

      Same way clever people exempt beer and wine from the alcohol
      category.

  • Well, you've gotta die from something, and for me the intention is for this NOT to be MS so full on with DMT's and lifestyle changes. But, I'm holding on to drinking in moderation; fine red wine with a bottle lasting a week for me and my partner (who doesn't have MS). I find it relaxes my legs and makes spasticity better, helps me relax befre bed, but too much and it goes 'orribly wrong (just like baclofen, tizanidine and sativex….). Another examle of the great balancing act that is MS ms medication.
    A. Nonny-Moose

  • Good point – re balancing act that is MS…. What surprised me about those responding to my questions was how many MSers had gone teetotal – and also how many were so aware of how alcohol affected them and their MS. Think those more newly diagnosed were more prone to continue drinking as before… whereas those of us further down the line had cut back. Possibly age (getting older) had an impact as well.

  • "Possibly age (getting older) had an impact as well."

    All the young kids like to smoke/drink to look older.
    Most realize if they don't stop they'll never live to be older.

  • "It helps disinhibit people, makes them more interactive. It’s an anxiolytic: it relaxes them."

    It can also make people: violent; disruptive; depressed; less able to react or make quick judgements; prone to accidents resulting in injury to themselves and/or others; incapable of recognising that they are talking mundane nonsense, whilst at the same time believing they are being exceptionally interesting and irresistible.

    And let's not forget foetal alcohol syndrome.

    I think alcohol does incredible harm to society. If it wasn't for the fact so many politicians are funtional alcoholics propping up the Westminster bar, it would be going the same way as tobacco.

    Prof G, I'm disappointed. Enjoy your pinot, but don't encourage others.

    • I think you are misquoting me. I said in moderation (<=14U per week) and 2 or 3 alcohol free days per week. I am referencing the evolutionary psychology literature that supports alcohol as playing a part in our socialisation. What are you are referring to is excessive alcohol consumption.

    • As you know motor vehicles are responsible for harm. Should we recommend that nobody drives a motor vehicle?

    • Yes obviously more people in u.s. died in auto cashes then all the wars combined.

      Autonomous driving won't let drivers make mistakes that kill people.

    • This "evolutionary psychology" is very watery, theoretical stuff, lacking any real evidence. Whereas the damage and carcinogenicity of alcohol is by now well substantiated.
      *There is no safe limit.*

      I am not referring to "excessive consumption" at all – particularly not when it comes to things like impact on judgement, reaction time and depressive effect – and 14 units is quite a lot actually:

      "14 units is equivalent to a bottle and a half of wine or five pints of export-type lager (5% abv)"
      https://www.nhs.uk/news/food-and-diet/new-alcohol-advice-issued/

      Your rather random comparison of driving a motor vehicle makes no logical sense, bears no real relevance. Yes, car crashes can be lethal, but driving doesn't cause insidious, incremental damage. And I would add, if no drivers were at the bottle the previous evening before getting into their car first thing, there would be a good few less accidents.

      Alcohol dulls the mind, numbs the senses, introduces toxins into the body. It's for each individual to decide for themselves, but no one should be playing down the possibility of real damage caused directly or indirectly by alcohol. Least of all a doctor.

    • Crikey, you sound like just the person to go for a pint with down the old Opinion and Hobby Horse.
      BTW the pollution from motor vehicles are both insidious and incremental and are in fact a far greater threat to human health than alcohol ever will be.
      Giving up alcohol won't make you live forever, it'll just seem like it 😉

    • "Yes obviously more people in u.s. died in auto cashes then all the wars combined.

      Autonomous driving won't let drivers make mistakes that kill people."

      Now the next thing to be developed should be autonomous guns then we really might be getting somewhere.

    • "Crikey, you sound like just the person to go for a pint with down the old Opinion and Hobby Horse."

      Lame shot at a personal insult. 🙁

      "BTW the pollution from motor vehicles are both insidious and incremental and are in fact a far greater threat to human health than alcohol ever will be."

      That's taking the irrelevant analogy and illogical argument much too far. Two wrongs don't make a right. Bit like smoking 20 a day and justify it by saying opioid painkillers and rabid dogs kill people too.

      "Giving up alcohol won't make you live forever, it'll just seem like it ;-)"

      If you truly feel that way, then that is shocking, and a real shame. Each to their own.

    • My mistake, said hostelry is of course the Po-face and Taliban 😉

      Whatever, I leave you with these wise words as beer-o-clock inevitably beckons.

      Of vintage wine I am a lover;
      To drink deep would be my delight;
      If 'twere not for the bleak hangover
      I'd get me loaded every night;
      I'd whoop it up with song and laughter –
      If 'twere not for the morning after.
      For though to soberness I'm given
      It is a thought I've often thunk:
      The nearest that is Earth to Heaven
      Is to get sublimely drunk;
      Is to achieve divine elation
      By means of generous libation.
      Alas, the wine-cups claim their payment
      And as the price if often pain,
      if we could sense what morning grey meant
      We never would get soused again;
      Rather than buy a hob-nailed liver
      I'm sure that we'd abstain for ever.
      Yet how I love the glow of liquor,
      As joyfully I drink it up!
      hoping that unto life's last flicker
      With praise I'll raise the ruby cup;
      And let me like a jolly monk
      Proceed to get sublimely drunk.

      Robert William Service

    • Think you should be more sensible and responsible on a public, medical forum.

      Some facts about alcohol and cancer risk, and how cutting down reduces risk:

      https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer/alcohol-facts-and-evidence#alcohol_facts0

      "The more alcohol someone drinks, the more their cancer risk increases. But even quite small amounts of alcohol, around 1 drink a day, can increase cancer risk. Expert reports have concluded that there is no safe lower limit of alcohol drinking where cancer risk isn't increased."

      People with MS who are on certain DMTs may already have a higher risk of cancer, and also because their ability to exercise may be reduced by disability.

  • Tried to post on this from my iPhone before but had some trouble – sorry if this comes up as a double post.

    This might help to put some better context around the Lancet study.

    The study's headline outcome was based on relative risk ratio and didn't include absolute risk ratio (despite their guidelines for meta-analysis saying that ARR should be included). The journal later asked the authors for the ARR which was then published in a press release, and it tells a different story.

    "Specifically, comparing no drinks with one drink a day the risk of developing one of the 23 alcohol-related health problems was 0.5% higher — meaning 914 in 100,000 15–95 year olds would develop a condition in one year if they did not drink, but 918 people in 100,000 who drank one alcoholic drink a day would develop an alcohol-related health problem in a year."

    Now putting that in a different context – from this article – https://medium.com/wintoncentre/the-risks-of-alcohol-again-2ae8cb006a4a

    "Let’s consider one drink a day (10g, 1.25 UK units) compared to none, for which the authors estimated an extra 4 (918–914) in 100,000 people would experience a (serious) alcohol-related condition.
    That means, to experience one extra problem, 25,000 people need to drink 10g alcohol a day for a year, that’s 3,650g a year each."

    "To put this in perspective, a standard 70cl bottle of gin contains 224 g of alcohol, so 3,650g a year is equivalent to around 16 bottles of gin per person. That’s a total of 400,000 bottles of gin among 25,000 people, being associated with one extra health problem. Which indicates a rather low level of harm in these occasional drinkers."

    "Next look at 2 drinks a day, that’s 20g, or 2.5 units, slightly above the current UK guidelines of 14 units a week for both men and women."

    "In this case, compared to non-drinkers an extra 63 (977–914) in 100,000 people experience a health problem each year. That means, to experience one extra problem, 1,600 people need to drink 20g alcohol a day for a year, in which case we would expect 16 instead of 15 problems between them. That’s 7.3 kg a year each, equivalent to around 32 bottles of gin per person. So a total of 50,000 bottles of gin among these 1,600 people is associated with one extra health problem. Which still indicates a very low level of harm in drinkers drinking just more than the UK guidelines."

    So to my mind – the message hasn't really changed – all things in moderation. On balance given the place alcohol has in facilitating important social interactions I think there is an argument for nice bottle of wine or a quiet beer among friends.

  • On the BBC today, New study results show a third of those aged 16 to 24 years do not drink alcohol. Compared to in 2015 it was a fifth.
    So this might be interesting for an MS, younger adults and alcohol study perhaps.

By Rachel Horne

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