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Frequently Asked Questions
Alcohol And The Liver
When excessive alcohol and liver interact, alcohol-related liver disease can occur. Abstaining from alcohol can help prevent or reverse some of these effects.
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How Does Alcohol And The Liver Interact?
The liver is considered the body’s largest filter with over 500 functions such as cleaning our blood and storing energy. When the liver breaks down alcohol (a process known as metabolization) several potentially dangerous by-products are generated. These by-products can damage the liver and the rest of the body when exposed to them for long periods of time.
Chronic and heavy alcohol use destroys liver cells that can result in scarring, hepatitis, and cellular mutation that may lead to cancer. Heavy drinking is defined as 15 drinks or more per week (4+ a day) for men and 8 or more drinks per week (3+ a day) for women. Under normal circumstances the liver has the ability to regenerate and repair itself, but symptoms may not appear until extensive damage has been caused.
Long-term heavy alcohol use is the most common cause of liver disease, but the good news is that it is preventable and can be easily treated if caught early on.
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Types Of Alcohol-Related Liver Disease And Progression
Alcohol-related liver disease can be divided stages that typically progress sequentially: fatty liver, alcoholic hepatitis, and alcoholic cirrhosis.
Fatty Liver (Steatosis)
The earliest stage of alcohol-related liver disease is called steatosis or fatty liver. This occurs when fat accumulates inside liver cells and can even occur in moderate drinkers after one drinking session. Fatty liver is hard to spot because there are usually no symptoms, although some may experience abdominal discomfort. Almost all people who drink heavily will experience fatty liver, but it is reversible and will usually go away with abstinence from drinking.
Alcoholic hepatitis is a widespread inflammation, or swelling, and destruction of tissue and cells in the liver. Fibrosis will often develop alongside this disorder and scar tissue then replaces the healthy liver tissue. Scar tissue prevents blood from flowing through the liver and as it builds up, the liver may stop functioning correctly. According to the Liver Foundation, up to 35% of heavy drinkers develop alcoholic hepatitis. Most cases are diagnosed 10 to 20 years after heavy consumption but can sometimes occur suddenly in a severe form after a period of binge drinking.
Symptoms of alcoholic hepatitis include:
- Loss of appetite
- Abdominal pain or swelling
- Yellowing of the skin and whites of the eyes (jaundice)
- Nausea and vomiting
- Weakness and fatigue
Continuation of alcohol use with fibrosis and hepatitis can lead to liver cancer or other life-threatening complications. Abstinence from consuming alcohol is necessary to stop the development of this disease and can be reversed when treated successfully at this stage.
Alcoholic cirrhosis is the most advanced form of liver disease and is developed by 10 to 20 percent of heavy drinkers. Extensive fibrosis, or scarring of liver tissue, stiffens blood vessels and distorts the internal structure of the liver. The buildup of scar tissue eventually leads to what is referred to as cirrhosis, and treatment options are limited. Alcoholic cirrhosis can also lead to the malfunction of other organs such as the brain and kidneys.
Symptoms of cirrhosis include those of alcoholic hepatitis, along with the following:
- Behavior changes and confusion
- Enlarged spleen
- Accumulation of fluid in the abdomen (ascites)
- High blood pressure in the liver (portal hypertension)
- Bleeding from veins in the esophagus (esophageal varices)
Treatment for patients diagnosed with cirrhosis focuses on stabilization with abstinence and treatment to keep the condition from getting worse. Unfortunately, for some people the symptoms of cirrhosis may sometimes be the first signs of alcohol-related liver disease and is usually fatal. Although alcoholic cirrhosis is irreversible, it may be possible to slow or stop liver damage by discontinuing alcohol consumption permanently. Individuals can also enroll on the national liver transplant list to request a new liver, as long as they are abstinent from alcohol.
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Factors That Increase Risk Of Alcohol-related Liver Disease
Liver disease is more likely to occur among heavy alcohol drinkers as opposed to moderate drinkers. On the other hand, not all of those who drink heavily will develop serious liver disease, regardless of alcohol consumption. The most important risk factor for developing alcohol-related liver disease is the amount of alcohol consumed, but research shows that genetic and environmental factors can affect a persons’ susceptibility.
Factors that may increase the risk for developing alcohol-related liver disease include:
Genetic variations can influence how the body processes and breaks down alcohol. Certain individuals are genetically predisposed to alcoholism and alcohol-related disease.
Obesity is a common contributing factor to fatty liver disease. The combined effect of obesity and heavy alcohol consumption is worse than the effect of either one on its own.
Diet and Nutrition
Many people who drink heavily or binge-drink eat poorly due to loss of appetite or nausea caused by excessive drinking. Alcohol can prevent the body from breaking down and absorbing nutrients in food.
Research shows that women are more susceptible to alcohol-related liver damage than men. This can be explained by metabolism of alcohol in the body and how the process is different between genders. Women also absorb a higher percentage of alcohol
Consuming Alcohol With Other Substances or Medications
Mixing alcohol with medications can be a dangerous combination for one’s liver. Acetaminophen, which is found in Tylenol and over 600 other medicines, can result in severe liver damage when taken with alcohol. Many prescription drugs will have warning labels, so it is important to read the directions for all medications, including over-the-counter drugs. Other medications that are dangerous to combine with alcohol include blood thinners, antidepressants, antibiotics, pain medications, and sedatives.
Treatment For Liver Disease And Alcoholism
Alcohol-related liver disease affects almost all heavy drinkers but fortunately, anyone can improve their overall health and life expectancy if they stop drinking. The earlier that liver damage is diagnosed, the easier it is to treat. There are four different types of treatment for alcohol-related liver disease: abstinence, nutrition therapy, medications, and liver transplants.
The most important thing you can do if you are diagnosed with alcohol-related liver disease is to stop drinking completely. The only possible way to reverse liver damage in early stages is with abstinence. In advanced cases, abstinence will prevent damage from becoming worse. If you are physically addicted to alcohol, medical supervision may be required to reduce the alcohol levels in your body. A sudden reduction in alcohol may lead to withdrawal symptoms including anxiety, hallucinations, and seizures. If you are struggling to quit drinking, discuss treatment options with your healthcare provider.
It is common for people with alcoholism and alcohol-related liver disease to have nutritional deficiencies. Your primary doctor may refer you to a nutritionist or recommend a special diet along with vitamins and supplements.
Depending on the stage and severity of your liver disease, you may be prescribed medication to help reduce inflammation. Such drugs have helped increase survival among those with alcohol-related liver disease. Steroid treatment usually begins with Prednisolone, followed by Pentoxifylline if steroid therapy doesn’t work. At the moment, no other medicine treatment has been found to cure alcoholic hepatitis.
Those who have advanced alcoholic cirrhosis may only be treated with a liver transplant. However, they must have quit drinking completely in order to qualify. They would need to find a transplant center and meet their program requirements, but active alcoholics usually do not qualify. Usually, a person must abstain from alcohol for six months before a transplant and agree not to drink afterwards.
Get Help Today
In order to prevent or recover from liver disease, it is important to stay sober. Participating in support groups or individual therapy can help you maintain sobriety. Treatment options include counseling, medications, an outpatient treatment program or a residential inpatient stay. Talk to a treatment provider today to find rehab options.
American Liver Foundation. (2017). Alcohol-Related Liver Disease. Retrieved on December 6, 2019 from https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/alcohol-related-liver-disease/
National Institute on Alcohol Abuse and Alcoholism. (2007). Alcohol Metabolism: An Update. Retrieved on December 6, 2019 from http://pubs.niaaa.nih.gov/publications/AA72/AA72.htm
U.S. National Library of Public Medicine. (2012). How Does the Liver Work? Retrieved on December 6, 2019 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072577/