Alcohol, Smoking, and Multiple Sclerosis: Should I Quit Immediately?

Multiple sclerosis (MS) is a potentially disabling autoimmune disease that affects the central nervous system. The science is still out about the effects alcohol has on MS. Smoking increases your risk of developing MS and is associated with higher levels of disability and faster disease progression.

What is multiple sclerosis?

Multiple sclerosis (MS) is a potentially disabling autoimmune disease that affects the central nervous system (CNS). The exact cause of MS is unknown. With MS, your immune system attacks the myelin sheath, the protective cover that surrounds the nerves of the brain and spinal cord. The nerves are damaged and left exposed, which leads to symptoms such as:

Risk factors include aspects of both genetics and lifestyle. Some risk factors cannot be changed, like age, genes, and family history. Other risk factors are modifiable, such as heavy alcohol use and cigarette smoking. Experts suggest keeping alcohol consumption to a minimum and quitting smoking entirely if you have been diagnosed with MS.

Multiple sclerosis & smoking – the effects:

Smoking cigarettes irritates the lungs and starts a process of inflammation in the body. A study published in the Journal of the American Medical Association (JAMA) showed that the pro-inflammatory nature of cigarettes in the lungs had a cross-reaction with inflammation on the myelin sheath that surrounds and protects the body’s nerves.

This means cigarette smoking may be damaging to the central nervous system (CNS) directly. The study also suggested that damaging compounds in cigarette smoke, like cyanates and carbon monoxide, are directly toxic to brain cells.

Several studies have shown that people who smoke are more likely to be diagnosed with MS than non-smokers. Secondhand smoke also increases your risk for MS. Smokers who are diagnosed with MS often get a more progressive form of the disease compared to nonsmokers.

Studies have also shown a positive association between smoking and MS: the more cigarettes you smoke, the higher your chance of being diagnosed with the disease.

People with MS who smoke are at greater risk of becoming disabled by the disease. They tend to experience greater disease activity and faster rates of brain atrophy. People with MS who smoke also tend to have more relapses than nonsmokers and receive smaller benefits from disease-modifying therapies (DMTs).

Quitting smoking can slow the progression of your MS and decrease symptoms. The effects of smoking on people with MS have been shown to be reversible. Ask your healthcare provider for help quitting smoking, and if friends and family smoke, ask them not to smoke around you.

Alcohol and multiple sclerosis

The research on alcohol and MS isn’t quite as straightforward as it is with smoking. There is no scientific evidence that shows that drinking in moderation can worsen MS. According to the Centers for Disease Control and Prevention (CDC), moderate drinking is described as one drink a day for women, and two for men.

The results of scientific studies on alcohol and MS are conflicting. Some studies show that alcohol worsens MS symptoms and the progression of the disease, but other studies show that moderate drinking can be beneficial. One study showed that people who drank more than four drinks per week had lower disability scores than non-drinkers. That study also showed the disadvantages of drinking: the same study participants had higher accumulations of T2LV, lesions that may be associated with the progression of MS.

It is generally accepted that heavy alcohol use is associated with increased disease activity. A study that looked at 72,000 people in the United Kingdom showed that heavy alcohol use (described in this study as daily or almost daily drinking) was associated with severe neurodegeneration and optical nerve damage in people with MS.

This same study also showed that moderate drinking was associated with a lower risk of being diagnosed with MS. The researchers found that people with MS who drank between one alcoholic beverage per month and four or fewer drinks per week had a lower chance of having an MS diagnosis. The researchers suggested that may not be due to a supposed protective effect of alcohol but instead caused by the sick quitters’ effect. This means that people who are diagnosed with MS often quit or profoundly limit their drinking because of illness. This could have influenced the results of the study; more studies are needed to investigate this effect.

Dangers of alcohol with MS

Drinking alcohol may be dangerous if you have MS because:

• Worsens symptoms. MS symptoms, like balance and coordination issues, can worsen with alcohol.
• Impacts bladder. Alcohol is irritating to the bladder, which may have nerve damage from MS.
• Depresses CNS. Alcohol depresses the CNS.
• Interactions with medications. Alcohol can interfere with some MS medications.
• Increases health risks. Alcohol consumption can increase your risk for other health conditions, which could worsen your MS.

The relationship between alcohol use and MS is still unclear. Whether or not you should drink alcohol may depend on your individual situation, symptoms, what medications or other (DMTs) you are using, and the progression of your MS. Speak with your healthcare provider before choosing to drink alcohol. Your healthcare team can discuss the effect alcohol may have and give you guidance for your specific situation.

The studies on cigarette smoking and MS are very clear. Cigarette smoking and exposure to secondary smoke from people around you increase the risk of being diagnosed with MS. It also increases the progression of the disease if you have already been diagnosed. If you smoke, quitting now can help your specific DMTs work more effectively and can slow the progression of your MS.