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


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 Ive 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.