5 Reasons to Avoid Alcohol If You Have AS

If you have ankylosing spondylitis (AS), you might wonder how alcohol is affecting your symptoms, treatment course, and disease progression. Alcohol in moderation might be safe with AS, but it is always important to ask your healthcare provider and follow their advice.

A general misconception about alcohol is that because it is legal, widely available, and generally socially acceptable, it is less harmful to the body than other substances, such as illegal ones. But the reality is that alcohol can be extremely damaging to the body, especially if you consume it in larger quantities and over long time periods.

Chronic alcohol misuse can lead to a wide range of effects on the body over time, but even short-term use might negatively affect people with AS. Unfortunately, there is a lot of conflicting information on how it might affect people with AS, so it is hard to know if drinking is safe to do with AS. 

This article covers the effects that drinking alcohol might have on AS, including bone weakness, gut health troubles, weight gain, liver and kidney problems, and interactions with treatment. 

Bone Weakness 

Overconsumption of alcohol can have adverse effects on your bone health. For example, a 2019 analysis of six studies published in the journal Drug and Alcohol Dependence found that alcohol increases the risk for osteoporosis. This disease causes the bones to become weak and brittle.

The Drug and Alcohol Dependence report compared nondrinkers and drinkers and found:

• People who consumed half a drink to one drink per day had a 1.38 times risk for osteoporosis.
• People who consumed one to two drinks had a 1.34 times increased risk for osteoporosis.
• People who consumed two or more drinks per day had a 1.63 times higher risk for osteoporosis

The reason for the higher risk, especially for people drinking more than two drinks per day, is that alcohol interferes with the body's absorption of calcium and vitamin D, which are essential for bone health.

Having AS also increases your risk for osteoporosis, so avoiding alcohol might help to better manage your bone health.

A 2015 RMD Open report finds osteoporosis is quite common in people with AS and is related to both systemic inflammation (inflammation throughout the body) and decreased mobility. In addition, people with AS are at an increased risk for vertebral (spinal) fractures, and having low bone density (from osteoporosis) further adds to that risk. 

AS Progression

Consuming alcohol with AS might also increase AS progression and the risk of spinal damage. A study reported in 2019 in the journal Arthritis Research and Therapy found alcohol consumption could be linked to the progression of spinal structural damage in axial spondyloarthritis (axSpA).

AS is a subtype of axSpA, a group of conditions that affect the spine and sacroiliac (SI) joint linking the pelvis and lower spine.

The Arthritis Research and Therapy study analyzed participants' medical records (using blood work and imaging studies), disease activity, and demographic information over two years.

Study participants were also given questionnaires to record their alcohol consumption per week, including information about quantity, type, and occasion. They were divided into two groups—drinkers and nondrinkers. Researchers used a four-point system and X-rays of the lower back and neck to measure disease progression.

Results showed considerable differences between people with AS who drank and those who didn't. Bone changes and disease progression within two years were twice as significant for the drinkers. Researchers also found higher numbers of syndesmophytes (bony growths) in the drinkers compared to the nondrinkers.  

Gut Health

People with AS might also experience inflammatory bowel disease (IBD), which can make their immune systems more sensitive to the effects of alcohol.

In addition, taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) or Aleve (naproxen), which are commonly given for AS, might affect the entire gastrointestinal tract. Some biologic drugs used in treating AS may increase IBD risk.

Inflammation of the GI tract and stomach makes it harder for the body to absorb nutrients, and adding alcohol to the mix worsens this problem.

Alcohol and its metabolites (the intermediate or end result of metabolism), especially in large amounts, can overwhelm the GI tract, and this is without an inflammatory condition. Alcohol and its metabolites encourage intestinal inflammation.

According to one 2017 Alcohol Research report, this inflammatory response exacerbates alcohol-induced organ damage. It also creates a vicious cycle of harmful effects from the alcohol on the body, both locally and systemically.

Weight Gain

Alcohol consumption might cause you to gain weight because it keeps the body from burning fat and leads to hunger and poor food choices, according to a 2015 Current Obesity Reports article. Those extra pounds can stress already inflamed joints. It is, therefore, vital to keep weight under control as part of an AS healthy lifestyle. 

Most studies show that light to moderate drinking is not linked to obesity, whereas heavy drinking is closely related to weight gain. A theory for this link is that alcohol can influence hunger via different mechanisms, such as opioid, serotonergic, and GABAergic pathways in the brain, which might increase appetite. 

Alcohol might also amplify appetite perception without hunger and in response to food stimuli, according to the previously noted Current Obesity Reports article. The research also shows beer and spirit drinkers have poorer dietary habits than wine drinkers.

Other studies also link sedentary behaviors and alcohol intake with weight gain. For people who are physically active, alcohol might not cause the same amount of weight gain.

Liver and Kidney Damage

The overconsumption of alcohol can lead to liver and kidney damage. The liver is responsible for processing medicines and foods. If you drink too much alcohol, the liver becomes damaged from cirrhosis (liver scarring). That scarring will keep the liver from functioning correctly and absorbing your AS medicines properly.

According to the National Kidney Foundation, a damaged liver can overtax the kidneys. Because the kidneys can only do so much to manage blood flow and filter the blood, they will start to fail with this overexertion.

Interactions With Medication

Your healthcare provider might discourage you from drinking alcohol because it might interact with some of the medications you take to treat AS. For example, alcohol might reduce the effects of disease-modifying antirheumatic drugs (DMARDs) like methotrexate.

Alcohol might also intensify the effects of over-the-counter (OTC) pain relievers like NSAIDs and acetaminophen. Consuming alcohol while taking NSAIDs might increase the risk of gastrointestinal bleeding, and alcohol with Tylenol (acetaminophen) can lead to liver problems.

Summary  

Alcohol can have a wide range of effects on the body, including on how you treat and manage ankylosing spondylitis. Consuming alcohol when you have AS might lead to bone weakness, damage to the spine, gut health troubles, weight gain, and liver and kidney problems. It might also intensify or reduce the effects of some medications you take to treat AS.

A Word From Verywell 

When managing the effects of ankylosing spondylitis, it is crucial to listen to your body. If you experience signs of gastrointestinal inflammation (stomach pain, heartburn, etc.) or have concerns about your bone health, let your healthcare provider know. Your rheumatologist (a specialist in arthritis) should be testing your liver enzymes regularly, so make sure you follow up on getting blood work done.

Let your rheumatologist know about your drinking habits. They can give you information and advise you on how much alcohol is safe based on your health condition and the treatments you take to manage AS. If you find reducing your alcohol consumption challenging, ask your healthcare provider about resources to help you.