A recently published paper in the journal Diabetes Therapy, examines the impact of alcohol use in diabetic patients with distal symmetrical polyneuropathy (DSP). In the paper, Alcohol Consumption as a Causator and/or an Accelerator of Neuropathy in People with Diabetes is Regularly Overlooked, the authors note that the most common cause of DSP next to diabetes is excessive alcohol intake, which is almost never evaluated, and that peripheral nerve damage from these two distinct pathologies is likely to be additive.
Authored by two board certified endocrinologists, the paper makes the point that alcohol use is often underreported by patients. They recommend that in addition to taking a detailed medical history, clinicians should investigate the possibility of recent alcohol consumption by testing for urinary ethyl glucuronide.
The authors caution that “the use of drugs to improve symptoms of DSP (tricyclics, anti-epileptics, serotonin, norepinephrine reuptake inhibitors and analgesics) may in combination with alcohol excessively suppress respiration and cognitive function such that these drugs should not be prescribed or utilized if use of alcohol continues.”
Diabetes and excessive alcohol consumption are both well-known causes of vitamin B1, also known as thiamine, deficiency and the authors note that any thiamine deficiency be corrected in patients with DSP.
It is estimated that 14.5 million people in the US are chronic abusers of alcohol and that the prevalence of peripheral neuropathy in this group is 46.3%.
Physicians should consider counseling patients with DSP to stop consuming alcohol so as to halt its toxic effects on the peripheral nervous system. Many patients relate that their neuropathic symptoms are worsened during episodes when they have consumed alcohol. I often mention this correlation to patients when discussing with them the importance of abstinence from alcohol in the management of their DSP.