Why alcohol causes peripheral neuropathy

If you’ve been drinking heavily for a long time, you may have started to notice strange sensations in your hands and feet. This can feel like a tingling that never really goes away, a burning pain that flares up at night, numbness that makes it hard to feel the floor, or a strange weakness when you try to walk. These are often the first signs of alcohol peripheral neuropathy, a form of nerve damage that affects nearly half of all people with a serious drinking problem.

How the peripheral nervous system works

Your peripheral nervous system is the network of nerves that runs from your brain and spinal cord out to every other part of your body. These nerves carry two kinds of signals.

Sensory nerves carry information back to your brain about what you’re touching. This includes whether something is hot or cold, and where your arms and legs are.

Motor nerves carry instructions from your brain to your muscles, telling them when to move and how.

When this system is working properly, you don’t think about it. You feel the ground under your feet, can grip a cup without dropping it, and walk without having to concentrate on every step. But when something damages these nerves, the signals start to go wrong. You experience pain for no reason, or feel nothing when something should hurt, or sometimes find that your muscles don’t respond the way they should.

Heavy drinking over a long time is one of the most common causes of peripheral nervous system damage.

Additional Read: The Dark Side of Drinking

The chronic effects of alcohol on nerves

Alcohol damages your nerves in a few different ways.

The most straightforward is that alcohol is poisonous to nerve tissue. When your body breaks down alcohol, it produces a substance called acetaldehyde. This damages the structure of nerve cells themselves, particularly the long fibres called axons that carry signals between your brain and your hands and feet.

Alcohol also interferes with how your nerves sustain themselves. Your nerve cells are extremely long, and they depend on a constant supply of proteins and other essentials being shipped from the main part of the nerve cell out to the far ends. Alcohol disrupts this supply chain, which means the distant parts of your nerves stop receiving what they need to function and repair themselves. The longest nerves are affected first, so you usually notice the changes in your feet and hands first, before it spreads closer to the body.

Finally, chronic alcohol use creates a kind of chemical damage in nerve tissue that makes it harder for the body to repair itself. This ongoing low-level inflammation means nerves struggle to heal, even when the direct toxic effects have stopped.

The role of vitamin deficiencies

Alcohol and nerve function are also connected through nutrition, because heavy drinking uses up the vitamins your nerves need to stay healthy.

The most important of these is thiamine, also known as vitamin B1. Your nerves rely on thiamine to produce energy and maintain their protective outer coating. Heavy alcohol use causes thiamine deficiency in a few different ways. It reduces how much thiamine you absorb from food by damaging the lining of your gut. It interferes with your liver’s ability to store thiamine. And it disrupts the way your body activates it. Up to 80% of heavy drinkers have some degree of thiamine deficiency.

Vitamin B12 deficiency is also common in people who drink heavily, partly because of a poor diet and because alcohol damages the stomach cells that help absorb the vitamin. B12 keeps the protective coating around your nerves healthy, and without enough of it, nerves become vulnerable to damage.

This combination of vitamin deficiency, alcohol, B1, and B12 depletion means your nerves are being poisoned and starved at the same time.

Additional Read: How Alcohol Changes your Features

Recognising alcoholic neuropathy symptoms

The symptoms of nerve damage from alcohol use tend to develop over months or years, which means they can be easy to ignore or miss altogether.

The first things you notice are usually changes in how things feel. This is when you might first notice tingling in your hands and feet from alcohol use, a sensation that feels like pins and needles that doesn’t go away. This can turn into burning pain, particularly at night, or patches of numbness where you can’t feel temperature or touch properly. It can feel like you’re wearing gloves or socks, which is why doctors call this pattern a “glove and stocking” distribution.

As it gets worse, you might also start having trouble with your muscles, like weakness in your feet and lower legs, difficulty with balance and coordination, or a tendency to trip. If it gets bad enough, your muscles can start to waste away, and some people develop a wide, unsteady gait as they try to make up for not being able to feel their feet properly.

Neuropathic pain from alcohol can be one of the most distressing symptoms. Unlike ordinary pain, which usually signals that something is wrong, neuropathic pain comes from the damaged nerves themselves misfiring. It can feel like burning or stabbing, or like electric shocks running through your skin, and it often gets worse at night when there are fewer distractions.

Why nerve damage can become permanent

The reason alcoholic neuropathy symptoms often develop so slowly is that your nerves can cover up early damage for a while. But this also means that by the time symptoms become obvious, there may already be a lot of damage underneath.

If you keep drinking, the damage tends to get worse. The longest nerve fibres die back first, and as they do, the area of numbness and weakness spreads from the feet up towards the knees, and from the fingertips up towards the elbows. At a certain point, the damage becomes irreversible. The nerve fibres themselves have died, and no amount of stopping drinking or taking vitamins can bring them back.

This is why catching it early matters so much. In the early stages of thiamine deficiency neuropathy and alcohol-related nerve damage, stopping drinking and getting the vitamins back into your body can stop it from getting worse and allow some recovery. But the window for this is limited, and the longer the damage continues, the less likely full recovery becomes.

Ruling out other causes

If you’re experiencing symptoms like tingling, numbness, or burning pain neuropathy, it’s important to see a doctor, because several other conditions can cause similar problems. Diabetes is the most common cause of peripheral neuropathy overall, and some people have both diabetes and alcohol-related nerve damage at the same time. Other possible causes include certain medications, infections, autoimmune conditions, and conditions that run in families.

A doctor can help work out what is causing your symptoms by looking at your medical history, doing a physical examination, and sometimes running nerve conduction studies or blood tests. Getting the right diagnosis matters because treatment depends on the underlying cause.

Stopping the damage and supporting recovery

The single most important step for alcohol recovery and nerve healing is to stop drinking. As long as alcohol is in your system, the toxic damage continues, and your body can’t absorb the vitamins it needs to repair itself.

High-dose thiamine supplements are often prescribed to build your levels back up quickly, along with other B vitamins and a balanced diet. Some people notice improvement in their symptoms within weeks of stopping drinking and taking vitamins, while others may need months or even years to see the full benefit.

Physical therapy can help with muscle weakness and balance problems, and there are medications that can reduce neuropathic pain while you wait for your nerves to heal. How much you recover depends on your individual body, on how long the harm has been going on, and how severe it has become.

If you’ve noticed any of the warning signs described here, the best thing you can do is act now rather than waiting to see if they get worse. Banbury Lodge provides alcohol detox, rehab, and aftercare, and we can advise you on how to get the medical help you need alongside addiction treatment. Contact us today for advice and support.