The neuropathic signs in these asymptomatic cases consist of thinness and tenderness of the leg muscles, loss of depression of some reflexes and an inconstant impairment in the perception of painful and tactile stimuli over the feet and shins. If alcoholic patients are examined electrophysiologically,
a certain proportion will show impairment of peripheral nerve function before the clinical signs of neuropathy can be detected. The majority of alcoholic patients with involvement of the peripheral nerves have symptoms - weakness, tingling, numbness, and pain of the feet and hands. These symptoms are usually insidious in onset and slowly progressive.

Charcot-Marie-Tooth (CMT) neuropathy is characterized by weakness of the feet and hands, foot deformities, including permanently flexed "hammer" toes, and unusually high arches and some loss of sensation in the limbs.

The disease is inherited in different ways: autosomal dominant, autosomal recessive or X-linked. The motor symptoms (weakness) and the pathology (nerve degeneration) resemble very much the alcoholic neuropathy. The main distinctions are: a) presence of foot deformities, b) absence of mildness of sensory symptoms such as tingling, numbness and pain of the
feet and hands.

Recently, we became aware that some of our CMT patients have an excessive daily intake of alcohol (more than three glasses of wine per day). We compared the neurologic signs in the few alcoholic and the large group of non-alcoholic CMT patients. The numbers of alcoholic CMT patients is small and does not allow statistical analysis. However, it is obvious that the alcoholic CMT patients have more severe weakness and/or sensory symptoms than the non-alcoholic CMT patients. Close questioning of two alcoholic CMT patients disclosed that there was a sudden worsening of symptoms after alcohol daily intake on a background of chronic and relatively mild neuropathy. These findings should not surprise us. The abuse of alcohol is more damaging for CMT nerves which already show a degeneration secondary to the undetermined genetic defect.

In conclusion, alcoholic drinks should be forsaken entirely or strictly limited if you have CMT.

Smoking tobacco can also be harmful as the products in the tobacco can harm the nerves and close down the capillaries. If you think you have cold hands and feet all the time, talk to a person who has CMT and smokes.
The following is part of an article on the topic:
CMT and Smoking
by Gregory T. Carter, M.D.
Medical Director, Providence Rehabilitation Hospital
Chehalis, WA, U.S.A.
Let's talk about some of the things smoking cigarettes does to your body with particular attention to CMT. The heart and lungs take the biggest brunt of cigarette smoking. The respiratory (breathing) system is amazingly well-designed and can put up with unbelievable assaults but years of inhaling carbon and tar-laced smoke can oftentimes be too much. Lung cancer, although still relatively uncommon, occurs at a much higher rate in smokers. The more concerning and extremely common problem in long-term smokers is emphysema, also known as chronic obstructive pulmonary disease (COPD). This is really a problem with the airways (bronchi). The bronchi become inflamed from the smoke, which paralyzes the ability of small air-like cells in the bronchial walls to clear mucus and bacteria. This leads to permanent damage and explains why smokers are so prone to chronic bronchitis.

In the end stage of COPD, the lungs also become damaged and overinflated giving people a "barrel chested" appearance. Death from COPD is horrid with a chronic air hunger that cannot be satisfied. I have witnessed it hundreds of times in my patients. This is made even worse in CMT since the phrenic nerve, which controls breathing, is affected. So take everything I just said and multiply it by ten.

Next, let's look at the heart and vascular system. Although these systems are not directly affected by CMT, damage to them can decrease blood flow to vital structures, like nerves, which are involved. Nicotine is a direct cardiac stimulant and also works through adrenaline. This puts a demand on your heart making it pump harder into a vascular system that is "clamping down" from the nicotine which is making your blood vessels constrict. The result: hypertension, peripheral vascular disease and coronary artery disease. The secondary effects: strokes, heart attacks, limb amputation.

Now put that into the context of CMT. The decreased blood flow to the arms and legs can further cause damage by limiting the amount of oxygen that gets to the nerves. Chronic vasoconstriction eventually causes permanent clogging of the arteries known as peripheral vascular disease (PVD). This can lead to the development of ischemic ulcers (open sores) which can get infected and gangrenous, possibly leading to limb amputation. People with CMT are already at risk for neuropathic ulcers, so this is an extremely dangerous situation. Many people with CMT complain of cold hands and feet which can be greatly worsened by cigarette smoking.

The genitourinary system is also affected by smoking which can increase the risk for bladder cancer. Smoking can also lead to impotence in men by cutting down the blood flow to the penis, impairing erectile function which may already be impaired by CMT.

This article was meant to be a brief highlight of some of the perils of cigarette smoking with particular attention to CMT. There are so many health problems associated with smoking that it would take a large book to cover them all, and we didn't even talk about second-hand smoke or chewing tobacco.

In closing let me give you some simple and free advice that may be the most important words you ever hear from a doctor: Don't start smoking. If you already smoke, do whatever it takes to quit (it isn't easy, I suggest formal addiction recovery programs), and if you live with someone who smokes, get them to quit because second-hand smoke is harming your health.