If you’re living with multiple sclerosis (MS), you may wonder how moderate or heavy alcohol consumption could affect your disease and overall well-being. As one MyMSTeam member said, “I need to stop burying my symptoms with alcohol — it never serves me well the next day.”

If you or a loved one have MS, it’s important to understand the potential impacts of alcohol and discuss drinking habits with your neurologist.

Does Drinking Alcohol Cause MS?

Neurology research has yet to determine the root cause of MS, but scientists believe that a combination of genetic and environmental factors is at play.

One review of research on MS and alcohol wasn’t able to establish a consistent link between the two. For example, the review noted that some studies say that drinking alcohol isn’t associated with a higher risk of developing MS. Others even report that alcohol might help protect against MS. In fact, one study from the Journal of Personalized Medicine pointed to a 20 percent risk reduction in people who drink alcohol versus those who don’t.

However, different studies have almost the opposite findings. Some studies report that before being diagnosed, people with MS start drinking at younger ages, are more likely to be regular drinkers and to drink wine and hard liquor more often than people without MS. Studies have also found that people with alcohol dependence have a higher chance of developing MS.

It seems that some of the effects of alcohol may prevent MS, while others increase MS. Specifically, low or moderate drinking reduces inflammatory immune responses associated with MS. But, alcohol also affects the central nervous system (CNS) and promotes demyelination — when the protective covering of nerve fibers in the central nervous system is damaged or destroyed. As a result, there’s not a clear answer on whether MS causes or prevents MS. Maybe it does a little bit of both.

Alcohol’s Effect on MS Symptoms

In some people with MS, alcohol consumption has been shown to reduce symptoms. Research suggests that drinking alcohol in the short term might actually help the immune system by reducing its activity. This can lower inflammation, which is the body’s response to injury or infection. However, the same research suggests that long-term alcohol abuse or heavy drinking may impair the immune system and could increase the inflammatory response characteristic of MS. Given these conflicting results, it’s clear that more research is needed.

One MyMSTeam member shared, “I was having a good day until I had an alcoholic beverage, and then came pain 30 minutes later. Alcohol has never affected my symptoms until now.”

Another member found that it was helpful to avoid alcohol completely: “Today, after a few years of no alcohol use, I got my motor skills back. My leg actually bends again, and my rhythm and hips are much better.”

A 2017 study showed that moderate drinking (more than three glasses of red wine per week) was associated with a lower Multiple Sclerosis Severity Score and a lower Expanded Disability Status Scale score, as compared to mild or no alcohol use. Interestingly, this study also showed that the volume of lesions on magnetic resonance imaging (MRI) increased with alcohol consumption. The researchers suggested the results may be because of red wine’s brain-protecting effects, although they called for further studies. One MyMSTeam member noted, “Red wine contains resveratrol that helps us fight the environmental concerns toward the brain.”

That said, the CNS side effects of alcohol use, such as impaired coordination or slurred speech, can be similar to symptoms of MS. If you already have trouble with speech, balance, cognition (thinking), or bladder control because of MS, alcohol may make these issues worse while you’re drinking.

As one MyMSTeam member said, “One drink anymore makes me feel like I’ve had 10! Didn’t bother me at all until the MS.”

A review of multiple studies showed that “alcohol seemed to have a negative effect on disability progression in MS,” although results varied by country. Moderate or high levels of alcohol consumption have also been associated with more severe brain lesions on MRI, which may indicate more severe MS disease progression. Overall, the review of these studies was inconclusive and suggests that alcohol “might be related to both good and bad outcomes in MS.”

Alcohol and Disease-Modifying Therapies

Most disease-modifying therapies (DMTs) don’t come with specific rules about alcohol. However, you should always review your medications and medical history with your doctor before deciding if it’s safe to drink.

In some cases, the side effects of alcohol may be stronger while you’re on DMTs. One MyMSTeam member shared, “I’ve just noticed my tolerance is almost nonexistent. One glass of wine, and I’m floored.”

Another said, “Moderation is key, but at different stages of medication use, abstinence is best!”

Talk to your neurologist and review examples of DMTs that could affect your decision to drink alcohol.

Injectable Medications

Glatiramer acetate (Copaxone, Glatopa) can cause alcohol intolerance as an infrequent side effect. Alcohol intolerance means your body has trouble breaking down alcohol, which can cause unpleasant reactions such as skin flushing, stuffy nose, low blood pressure, and gastrointestinal symptoms. Be careful with alcohol if you’re taking this medication.

Although there are no specific warnings or studies about glatiramer acetate and alcohol, several injectable DMTs can cause liver problems. In rare instances, people have experienced liver problems with glatiramer acetate, which went away when they stopped taking it. Your doctor can monitor your liver function with blood tests to see if you’re having a bad reaction to your medication.

Other injectable DMTs that may affect the liver include:

• Interferon beta-1a (Avonex, Rebif)
• Interfeont beta-1b (Betaseron, Extavia)
• Peginterferon beta-1a (Plegridy)
• Ofatumumab (Kesimpta)

Let your doctor know if you plan to drink alcohol while taking these medications, so they can give you advice based on any liver concerns and your overall health.

Oral Medications

Taking diroximel fumarate (Vumerity) at the same time as alcohol can reduce the absorption of the medication. However, the manufacturer advises that if you are taking Vumerity, you do not have to stop drinking alcohol altogether. Talk to your neurologist about whether you should time alcoholic drinks around your medication or if you should avoid drinking alcohol.

There are no specific warnings regarding alcohol on the medication labels. Several oral DMTs can cause abnormal liver function test results or serious liver injury, and caution with alcohol may be recommended when using these drugs. They include:

• Cladribine (Mavenclad)
• Dimethyl fumarate (Tecfidera)
• Fingolimod (Gilenya, Tascenso ODT)
• Ozanimod (Zeposia)
• Ponesimod (Ponvory)
• Siponimod (Mayzent)
• Teriflunomide (Aubagio)

Infused Medications

Infused DMTs have no specific warnings regarding alcohol. These include:

• Alemtuzumab (Lemtrada)
• Novantrone (Mitoxantrone)
• Natalizumab (Tysabri)
• Natalizumab-sztn (Tyruko)
• Ocrelizumab (Ocrevus)
• Ublituximab-xiiy (Briumvi)

However, it’s always possible to develop liver problems while using any medication.

Taking any type of DMT is a commitment and requires you to be consistent for treatment to be effective at slowing disease progression. Unfortunately, forgetfulness is the second leading cause of poor DMT adherence for people with MS. Studies show that drinking alcohol can make it harder for people with MS to stick to their treatment plans. This can lead to more relapses or worsen symptoms, making it harder to manage the condition.

Additionally, doctors don’t always ask about alcohol intake. Because many people with MS take multiple medications, additional substances — including alcohol, caffeine, dietary supplements, and cannabis — could further contribute to side effects associated with polypharmacy (the daily use of five or more medications).

Read more about treatments and therapies for MS.

MS Comorbidities and Alcohol

The risk of developing other health problems (called comorbidities) is important for people with MS to consider. Alcohol and other lifestyle choices can make it more likely to develop common comorbidities like heart disease, diabetes, and depression. Although it’s not always possible to control the outcome of MS, focusing on what you can change, like alcohol intake, can empower you to take control of your health. Changing your drinking habits is one step to protect against MS progression and other health issues that can affect your quality of life.

Ultimately, everyone with MS is different and may have a different reaction to alcohol. Always speak with your doctor about your drinking, particularly if it seems to be interacting with your medications or making your MS symptoms worse. Your physician can offer advice and guidance on alcohol based on your situation.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 213,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

Do you notice a significant association between your MS symptoms and drinking alcohol? How do you feel about moderate alcohol consumption? Share your tips and experiences in a comment below or on your Activities page.