Living with a chronic illness comes with sacrifices, but does alcohol really have to be one of them?

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Even in (short-lived) stretches of sobriety, I still wake up feeling hungover. With fingers swollen like vienna sausages, brain fog so severe I’m confused about what country I’m in, and flu-like symptoms, I think, “I should’ve just had a drink.”

The term “autoimmune disease” covers dozens of chronic illnesses. From rheumatoid arthritis and lupus to Hashimoto’s thyroiditis and multiple sclerosis, these diseases occur when the immune system mistakenly attacks healthy cells in the body.

Some people living with these chronic conditions do everything they can to stave off inflammation and brain fog. They eat organic foods, stand on their heads, and eschew sugar in favor of vegetables.

But despite it all, they still drink alcohol. (It’s me, I’m “some people.”)

Where a night of drinking for most people would typically result in a headache and an unhinged Instagram story, those with autoimmune diseases are often left with some additional gifts.

After the apparent initial hangover wears off, we’re left with distended bellies, decision fatigue, bowel issues, tingling hands and feet, and other subtle side effects that most of us have just accepted as the standard of living.

How much would my life improve from avoiding alcohol?

This question is often compounded by an even more existential inquiry: If having a chronic condition already steals so much happiness and functionality, why would I want to give up another activity I enjoy?

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Are there any secrets to reducing the aftereffects of alcohol for people with autoimmune diseases? What drinks are best? What night-of or morning-after rituals should I adopt to lessen my brain fog and safeguard my already compromised immune system?

If you’re like me and not yet ready to commit to sobriety, here are some tips for drinking with an autoimmune disease.

What’s worse than alcohol for autoimmune disease? Sugar.

A high sugar intake may increase inflammation and exacerbate every symptom of your autoimmune disease. (I learned this the hard way after three jumbo watermelon margaritas left me in bed for 3 days.)

To reduce harm to yourself, espresso martinis, frozen margaritas, and basically any cocktail available at a Rainforest Cafe — I’m sorry to say — will make you feel worse.

There’s no perfect drink for people with autoimmune diseases. However, polyphenol-rich dry red wine and clear liquors mixed with soda waters or lower sugar swaps, like some green juices, are your friends.

Hard kombuchas with no added sugar also go down easy and support your gut with probiotics.

The terms “functional medicine” and “root cause” send me spiraling. If you’re like me, they probably conjure up memories of being pitched a pyramid scheme or receiving an uninvited lecture by someone who claims they’ve reversed their autoimmune disease.

Though I think this type of language only serves to shame those who haven’t achieved remission into thinking it’s their fault, there is merit in functional medicine.

Supplements like glutathione, for example, may help alleviate symptoms of autoimmune disease.

When fatigue is your greatest fight, try starting your day with some powdered energy-boosting mushrooms in your tea or coffee.

Having an autoimmune disease may also increase your risk of developing autoimmune hepatitis. If you frequently test the limits of your liver, taking a liver support supplement can never be a bad idea.

Start with something simple like milk thistle or dandelion root, and see how your body responds.

If you manage your autoimmune disease with just a multivitamin, yoga, and a prayer, feel free to skip to the next section.

While I want to encourage people to live their lives despite their autoimmune disease, some medications have dire side effects when mixed with alcohol.

Medication-alcohol interactions are a more serious concern for those actively treating type 1 diabetes, lupus, or rheumatoid arthritis.

You’ll also want to proceed with caution if you handle occasional flare-ups and autoimmune disease-related pain with over-the-counter pain relievers. Consuming alcohol alongside anti-inflammatories can increase the risk of bleeding in your gastrointestinal tract.

As a general To Drink or Not to Drink rule, I always moderate my drinking when I’m enduring a flare-up.

Unfortunately, we can’t plan our flare-ups around our social life. Before a big night, take inventory of your body. If you’re already feeling stiff and fatigued, alcohol will only inflame the flare-up.

If you make routine visits to a rheumatologist or endocrinologist, you’ve probably been preached some form of a restrictive diet.

In the early days of my illness, it seemed about every person I’ve ever made eye contact with had some secret diet that cured their mother’s cousin’s best friend’s favorite blogger’s daughter’s autoimmune disease.

Whether it was keto, intermittent fasting, zero sugar, plant-based, all meat, or only water, all these diets contradicted each other.

What’s more, in a quick Google search, you can find tons of articles about alcohol worsening autoimmune symptoms and evidence to suggest moderate alcohol consumption might actually have a positive impact on autoimmune diseases like RA and Hashimoto’s.

Despite all we know, the body and its inner workings can still be a bit of a mystery. Even if you follow the perfect autoimmune protocol, a study could come out next year saying red wine and red meat are the best for your health.

This brings us to my next point.

Just like sugar, stress is also a massive risk factor for people with autoimmune diseases. Even if you blew it out the night before and are left with only empty cans, a bag of Cheetos, and a compromising Polaroid as evidence of what happened, don’t beat yourself up.

Your body is already destroying itself for no reason. Don’t let your mind join the beatdown.

Remember, you’re living through a pandemic with a preexisting condition; if alcohol adds joy or, dare I say, structure to your day, so be it.

Don’t let autoimmune bloggers who claim they’ve reversed their illness through abstaining from everything wonderful in the world make you feel like you’re a failure.

Save the stress and pour yourself a sauvignon blanc (if that’s what you’re into).

There’s a reason we’ve been drinking for millennia: It helps us connect, gives us a chance to briefly escape, and can taste delicious.

It can also still be part of your lifestyle if you have an autoimmune disease. Remember, moderation is key.

But even if you down a bevy of sugary beverages and wake up with a raging headache and another unhinged Instagram story — remember — you’re allowed to make mistakes, too.

Kiki Dy is a copywriter, essayist, and yoga instructor. When she is not working, she is probably shortening her life span in some fun-filled manner. You can contact her via Twitter, which she intends to use professionally despite her username.