Drinking too much alcohol can cause leg pain. There is more than one reason for this. But together, this leg pain is sometimes called alcohol legs. Some of the reasons for leg pain from alcohol are reversible. For instance, you can fix dehydration with drinking adequate amounts of water and electrolytes. But other causes of alcohol related leg pain are not reversible and can cause chronic discomfort or even disability.
Alcohol Damages the Nerves
Excessive alcohol consumption is one of the leading causes of peripheral neuropathy. So, neuropathy leg pain is a common side-effect of long-term alcohol abuse. In fact, by some estimates 2 of 3 people who abuse alcohol chronically, will suffer from neuropathy.
Like many other negative effects of alcohol, the exact mechanism is not fully understood. Still, some of it has to do with malnutrition. People who abuse alcohol tend to be malnourished. Often they lack thiamine, also known as vitamin B1. Thiamine is essential for proper nerve function. Other deficiencies include other B vitamins and folic acid. A different mechanism might be a direct toxic effect of alcohol or one of its metabolites on nerves.
No matter the exact mechanism, alcohol neuropathy will result in pain and paresthesia (“pins and needles” and “walking on clouds” sensations). These will often be made worse by the central nervous system effects of alcohol. Of these, the relevant one is ataxia, which is the inability to walk properly.
Alcohol Legs from Dehydration
Drinking alcohol can result in dehydration. There are two reasons for this. First, alcohol acts as a diuretic. It inhibits a molecule called vasopressin. Another name for vasopressin is anti-diuretic hormone (ADH). So, if there is less vasopressin, there is more diuresis. This means there is more fluid loss in the urine. Second, alcohol dilates blood vessels. Dilated blood vessels tend to lose fluid, and this can exacerbate dehydration.
But will the dehydration cause night cramps or night leg pain? The connection between dehydration and cramps is not straightforward. Since the 1920’s and 1930’s scientific studies have attempted to examine water and electrolyte imbalances in the context of muscle cramps. You might be surprised to learn that results have been conflicting. While there is evidence that replenishing fluid and electrolytes will diminish cramps, there are also results that do not support this theory. In fact, there is a competing theory that claims that most cramps are a result of sensitized muscles that over-react to nerve stimuli.
Alcohol Muscle Damage
Alcohol can cause muscle damage. The professional term for this is alcohol myopathy. The word myopathy basically means dysfunction. There is a spectrum of symptoms for alcoholic myopathy. Some people will have muscle damage, and not only muscle dysfunction. These people will lose muscle protein in the urine, and the urine will be dark. This is called myoglobinuria. When this happens people will experience muscle cramps.
However, some people will have even more severe symptoms. They will have weakness along with the cramps. If they do not stop consuming alcohol, symptoms may become chronic. In some people, symptoms will be chronic even if they do stop drinking. Under the microscope, these people will have muscle damage. The mechanism for alcoholic myopathy is complex.
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