Alcoholic Myopathy: Causes, Symptoms & Treatment
What is Alcoholic Myopathy?
Alcoholic myopathy is a condition involving muscle weakness and loss of muscle due to abnormal breakdown of muscle tissue.2 This muscular degeneration leads to muscle dysfunction, which impacts various parts of the body and their functionality and can be either acute or chronic.2,3
Diagnosing alcoholic myopathy involves a detailed medical and family history as well as bloodwork to rule out any other issues that could be causing symptoms.2 The provider will ask about alcohol or other substance use and most likely conduct drug screening.2 Testing will be done to check your muscle strength and function, and can include electromyography (EMG) and muscle biopsy to measure the functioning of your muscles.2
Between 40% and 60% of individuals with chronic alcohol use disorder develop alcoholic myopathy.1,2 Alcohol use is a major factor in the development of both acute and chronic alcoholic myopathy, although the pattern of drinking can strongly influence which form develops.2 Acute alcoholic myopathy results from binge drinking, while chronic alcoholic myopathy results from long-term, usually heavy drinking.1,2 Alcohol and the product it forms when it is metabolized are toxic to the muscles and nervous system, which can lead to the breakdown of muscle tissue, causing either acute or chronic alcoholic myopathy, depending on your patterns of alcohol use.3
Acute Alcoholic Myopathy
Acute alcohol-induced myopathy most often occurs after binge drinking. However, factors such as caloric deprivation and fasting can also predispose you to the condition.3
Most often affecting the muscles near the body’s midline, acute alcohol-related myopathy develops over hours to days and includes symptoms such as pain, weakness, tenderness, and swelling. Often, the disease manifests as rhabdomyolysis, which is a breakdown of muscle tissue and release of muscle-fiber content into the blood. Following abstinence, acute alcoholic myopathy typically resolves within 1 to 2 weeks.1 This form of myopathy can also be associated with signs of acute livery injury and congestive cardiac failure.3
Chronic Alcoholic Myopathy
More common than acute alcohol-induced myopathy, the chronic version of the disease is associated with cumulative lifetime consumption of alcohol.1,3 Thus, it typically affects people between the ages of 40 and 60.3
Chronic alcohol-involved myopathy has a higher incidence in patients with signs of other alcohol-related organ dysfunction. For example, it’s present in 82% of people with alcohol-related cardiomyopathy and 50% of people with liver cirrhosis. Also, those with chronic alcohol-induced myopathy may be predisposed to episodes of acute alcoholic skeletal myopathy, which causes loss of strength and function in skeletal muscles.3
Symptoms of Alcoholic Myopathy
The symptoms of alcoholic myopathy can vary between people, and not everyone will experience all symptoms.3 In addition, the symptoms of acute alcoholic myopathy are significantly different from chronic alcoholic myopathy.1,3
Symptoms associated with acute alcoholic myopathy include:1,2,3
- Dark urine.
- Muscle tenderness.
- Muscle weakness.
- Swelling in affected muscles, usually in the extremities.
- Kidney failure in severe cases.
Chronic alcoholic myopathy symptoms include:1,2,3
- Abnormal walking.
- Dark urine.
- Increasing weakness affecting the muscles surrounding the pelvis and shoulders that progresses over a period of weeks or months.
- Muscle wasting (atrophy).
- Tightness of the muscles.
- Twitching of the muscles.
- Usually painless, although some people may complain of muscle cramps.
Causes and Risk Factors for Alcoholic Myopathy
Alcohol-related myopathy happens as a direct result of alcohol consumption.1,3 Alcohol affects the body, including the muscles, which leads to muscle weakness and wasting. Alcohol consumption and alcohol use disorders commonly lead to:1,2,3
- Nutritional deficiencies, including deficiencies in protein, iron, B vitamins, and vitamin D. These nutrients are important in building and maintaining muscle, and alcohol can prevent the body from properly absorbing nutrients in the diet.
- Breakdown of muscle tissue. Alcohol contributes to this at a cellular level, while raising inflammation and slowing the body’s ability to repair damage.
- Harmful effects on organ tissues. Both alcohol and acetaldehyde, a product formed by alcohol breakdown, are harmful to organ tissues.
- Electrolyte imbalances. Alcohol can throw off the electrolyte balance in the body, which can be harmful to the muscles of the body.
Not all heavy or long-term drinkers will develop alcoholic myopathy. Risk factors for developing alcohol-related myopathy include:1,2,3
- Drinking larger amounts of alcohol, especially in people with long histories of drinking.
- Chronic, heavy alcohol use for more than 5 years.
- 40-60 years of age.
- Gender: Men are four times more likely to develop acute alcoholic myopathy, while women are more likely to develop chronic alcoholic myopathy.
- People with other alcohol-related health issues, such as cirrhosis, hepatitis, pancreatitis, or heart issues.
- Muscle injuries. People who injure their muscles, through accidents, falls, or seizures from alcohol withdrawal may be more likely to develop myopathy.
- Prior history of alcoholic myopathy.
- Not eating a healthy diet. This can be due to fasting, not eating enough, or having trouble absorbing nutrients properly.
How to Treat Alcoholic Myopathy
Alcoholic myopathy can lead to major complications. When muscle fibers break down, they release proteins and electrolytes into the blood, which can cause other issues.2,4 This can lead to high levels of potassium in the blood (hyperkalemia), which can make the heart beat abnormally and is potentially fatal.4 Alcoholic myopathy can also cause failure of the kidneys or other organs, which can be fatal if untreated.2 In addition, alcoholic myopathy is a progressive condition that can cause muscle atrophy and lead to an abnormal way of walking.2
When alcohol use is stopped, the symptoms of alcohol-related myopathy often improve significantly.2,3 If cutting down on alcohol use or quitting alcohol altogether is difficult, you may have an alcohol use disorder and need to attend treatment to address it.2 For people who are experiencing more severe symptoms or complications associated with their myopathy, hospital care may be needed and can involve intravenous fluids vitamin supplementation and dialysis.2,3 Recovery is possible, although the treatment is tailored to each patient’s unique needs.2,3
Is Alcoholic Myopathy Reversible?
In most cases, alcoholic myopathy is a reversible condition. Total abstinence from alcohol can often help reverse the symptoms.1,2 For acute alcoholic myopathy, symptoms can typically be reversed within a few days to weeks, while chronic alcoholic myopathy can often take between 2 months to a year to be reversed.1,2 Recovery from alcoholic myopathy can be supported by addressing any imbalances in vitamins and electrolyte levels.1