Alcoholic Myopathy

What Is Alcoholic Myopathy?

Type 2 muscle atrophy

Myopathy means muscular disease, and generally refers to a disorder in which muscle weakness develops due to some malfunction of the actual muscle fibers. In addition to muscle weakness, symptoms of myopathy may also include muscle cramps or spasm and muscle stiffness. While some recovering alcoholics may have never heard of alcoholic myopathy, it more common than one may think. Some research indicates that about one third of heavy long-term drinkers, aka alcoholics, develop skeletal myopathy.

The history of the myopathy related to alcoholics can be traced back to the 19th century, when there were reports of “alcoholic paralysis” which is believed to be referencing the muscle disease known today as alcoholic myopathy. Most specifically, in the mid 1800's, Magnus Huss wrote Alcoholismus Chronicus in which he reported identifying muscular weakness in patients resulting from alcohol use. Later, in the 1950’s and 1960’s, researchers went on to discover two distinct types of alcoholic myopathy: acute alcoholic myopathy and chronic alcoholic myopathy.

Acute Alcoholic Myopathy

Acute alcoholic myopathy develops suddenly, during an episode of binge drinking or immediately following during withdrawal. Acute alcoholic myopathy is also called “alcoholic rhabdomyolysis”. It can come on rapidly over the course of a few hours and can advance over a few days before receding over the week, given the individual abstains from alcohol. Acute myopathy can present mild to severe symptoms as a result of myonecrosis, the breakdown of muscle tissue.

Symptoms of acute alcoholic myopathy may include muscle pain and swelling in addition to the classic weakness. Often the acute symptoms are reported upon awakening from an alcoholic stupor; they may also accompany withdrawal symptoms and delirium tremens. Tests have revealed that acute alcoholic myopathy affects type I muscle fibers, which can heal rapidly; however type II muscle fibers are involved in chronic alcoholic myopathy.

Typically, full recovery from acute alcoholic myopathy occurs in a matter of days or weeks; however, in extreme cases when kidney failure or hyperkalemia (abnormal potassium level in the blood) occur, the alcoholic may actually die during the episode of acute myopathy. Otherwise, research has shown it takes about 7 to 10 days for the serum creatine kinase levels (reflecting the health of the muscle) to return to normal range.

Chronic Alcoholic Myopathy

In contrast to the acute form, chronic alcoholic myopathy develops much more gradually and lasts far longer. While the acute version may include muscle pain, chronic alcoholic myopathy is usually painless. The absence of pain and gradual onset may explain why it is frequently overlooked and not diagnosed until the symptoms have been present for several years. The recovery time for chronic myopathy is slower and can take many months (again, given the patient abstains from alcohol use).

Chronic alcoholic myopathy is associated with long term alcohol abuse (i.e. years of daily alcoholic drinking). It evolves slowly, over weeks or months as opposed to its acute counterpart which can develop in a matter of hours or days. The main symptom of chronic alcoholic myopathy is muscle weakness and atrophy. It affects proximal muscles, and type 2 muscle fibers. Interestingly, long term corticosteroid use can lead to similar type 2 atrophy as well, a.k.a. “steroid myopathy”.

Other disorders which may co-occur with chronic alcoholic myopathy include peripheral neuropathy. While with myopathy the primary dysfunction exists within the muscle itself, with neuropathy the dysfunction pertains to the nervous system (i.e. nerves or brain). Some research suggests peripheral neuropathy is associated in 72% of cases.

What Causes Alcoholic Myopathy?

Studies have linked the damaging effects of toxic ethanol (drinking alcohol) to alcoholic myopathy. The injurious effects of acetaldehyde as well as ethanol have been directly linked with alcoholic myopathy. Interestingly, acetaldehyde is also a prime suspect in the cause of hangover symptoms.

On a molecular level, the exact mechanism behind how alcohol produces myopathy remains elusive. Various studies and theories have been presented. Impaired IGF-1 signaling, protein deficiency, vitamin and mineral deficiencies, and other factors have been considered. For example, some research results suggested that protein deficiency and ethanol contributed to muscle atrophy in rats given alcohol and those underfed protein had the greatest myopathic effect.

Research suggests that ethanol consumption and malnutrition can lead to alcoholic myopathy, and most likely it is a combination of both working synergistically to produce the myopathy. The long term effect of alcohol abuse itself tends to cause malnutrition, so long term daily drinkers set themselves up to be malnourished, and thus also more vulnerable to the possibility of chronic myopathy.

Treatment for Alcoholic Myopathy

If the root of alcoholic myopathy is ethanol consumption and malnutrition, obviously abstinence from alcohol and proper nutrition are the best place to start. Alcoholic myopathy generally begins to reverse once the individual achieves complete abstinence from alcohol. So if you are a newly recovering alcoholic experiencing chronic myopathy, it is important to know the recovery typically takes many weeks or several months.

As the recovery time frame varies, proactive steps such as nutritional interventions may help to accelerate the recovery process. Physical therapy and acupuncture are sometimes utilized as well to target the effects of chronic myopathy.

Here is a quick response from a neurosurgeon who answered an online inquiry from an individual who asked: is there any treatment for alcoholic myopathy? The MD answered…

“Alcoholic myopathy is a tough condition:
1. stop alcohol
2. correct liver dysfunction
3. get a muscle biopsy to be sure the dx is correct.
4. See a nutritionist
5. Be followed carefully by a darned good neurologist
6. slow rehab with careful attention to enzyme changes.”

There seems to be little information on specific nutritional information to benefit individuals suffering from alcoholic myopathy. After further research, a follow up article is posted with more detailed suggestions for a proactive holistic approach to potentially accelerating recovery from alcoholic myopathy - check out article on "Nutrition in Alcoholic Myopathy Treatment".