How Alcohol Affects the Liver

Today, we will wrap up our discussion of the effects of alcohol on the body by talking about the liver. Recent research revealed that between 2015 and 2019, excessive alcohol use resulting in approximately 140,000 deaths per year in the US. Roughly 40% of those deaths were due to acute causes, such as car crashes, alcohol poisoning, etc. But the majority were caused by chronic alcohol-related conditions, including cancer, heart disease, and liver disease. Most people know that alcohol damages the liver but many believe that liver damage only occurs in people who drink heavily over a long period of time. This is not necessarily true. Let's talk about the ways in which alcohol can cause damage.

Why is the liver so important in the body?

The liver is a very important organ in the body for many reasons. Here are some of the important functions the liver provides:

• Aids in digestion
• Stores energy
• Helps metabolize and eliminate toxins from the body
• Metabolizes many medications
• Metabolizes alcohol - Unfortunately, as the liver breaks down alcohol, it can generate additional toxic substances in the body.

Do you have to be an alcoholic to have liver damage from alcohol?

No! Although liver damage caused by alcohol is often called *alcoholic* liver disease, a better term would be *alcohol-related* liver disease. It is true that higher levels of alcohol intake on a regular basis is more likely to cause liver damage, but it takes less alcohol than you might think to damage the liver.

Long-term intake of just 2 standard drinks a day increases the risk of alcohol-related liver disease in men. Women have an increased risk of liver disease with long-term intake of 1 drink per day.

A standard drink is defined as:

• 12 ounces of beer (5% alcohol) - Some beers have more than 5% alcohol. If you're drinking a beer with 10% alcohol, one standard drink would be 6 ounces.
• 5 ounces of wine (12% alcohol)
• 1.5 ounces of distilled spirits (40% alcohol)

What are some of the adverse effects of alcohol on the liver?

• Alcoholic fatty liver disease (AFLD) - Metabolism of alcohol in the liver generates a chemical which stimulates the production of fatty acids and limits their breakdown. Alcohol also contains a lot of sugars, which can be converted to triglycerides by the liver. These factors cause fat to build up within the liver. This can happen within just 12 weeks of heavy drinking. Initially, AFLD is usually a silent disease, causing few or no symptoms. Over time, it can progress to severe advanced liver disease, that can be life threatening.  The good news is that abstaining from alcohol can reverse AFLD if caught in early stages.  There are other causes of fatty liver disease, including obesity, and diabetes. The combination of alcohol intake with these other causes significantly increases our risk of developing fatty liver disease.
• Alcoholic hepatitis - Liver inflammation caused by alcohol and the toxic breakdown products can cause acute or chronic alcoholic hepatitis. This causes an enlarged liver, jaundice (yellowing of the skin and eyes due to high bilirubin levels), blood clotting problems, and anemia. Over time, with chronic inflammation, irreversible destruction of liver tissue will occur.
• Cirrhosis of the liver - Cirrhosis is the end result of chronic AFLD and/or chronic alcoholic hepatitis. It occurs when the fibrosis and scarring as a result of those conditions becomes extensive. It can lead to a shrunken, non-functioning liver. It can also lead to a type of high blood pressure, called portal hypertension, that is due to blood not flowing through the liver as easily as it should. This can lead to an enlarged spleen, varicose veins within the esophagus, and fluid buildup within the abdominal space outside the organs, among other things. Cirrhosis is not reversible but if a person stops drinking, progression can be stopped so that it will not get worse.

What symptoms are caused by alcoholic liver disease?

Here are the most common symptoms:

• Jaundice
• Poor appetite, nausea and vomiting, weight loss.
• Abdominal pain
• Severe itching of the skin
• Red discoloration of the palms of the hands
• GI bleeding
• Easy bruising
• Hemorrhaging from the esophagus (from the varicose veins)
• Enlarged liver in early stages
• Small or shrunken liver in later stages
• Swelling in the legs
• Fluid buildup in the abdomen
• Encephalopathy (inflammation of the brain) - Causing confusion, behavior change, poor memory, etc.
• Weakness, shrinking muscles

If you have symptoms that may be due to liver disease, you need to see a doctor for an evaluation. This is a potentially life-threatening condition that should be addressed as soon as possible.

If you have any questions about how alcohol affects the liver, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

What Happens When We Drink Alcohol - Part II

Last week, we talked about many of the adverse effects of alcohol on our bodies. Today we will talk about more adverse effects of alcohol, including the various cancers that are associated with alcohol use as well as how alcohol affects fertility and pregnancy.

What is the evidence regarding alcohol and cancer risk?

There is strong evidence that drinking alcohol can cause several types of cancer. The National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen (a substance that causes cancer).

The evidence from research indicates that the more alcohol a person drinks, the higher their risk of developing a cancer that is associated with alcohol. This is particularly true when a person is drinking regularly over time. Even people who have no more than one drink per day have a modestly increased risk of some cancers.

Research from 2009 estimated that 3.5% of cancer deaths in the US were alcohol related.

How does alcohol increase the risk of cancer?

There are several ways that researchers believe alcohol increases cancer risk, including:

• The metabolism of alcohol produces a toxic chemical called acetaldehyde. This chemical can damage DNA as well as proteins within cells.
• Alcohol metabolism generates chemically reactive molecules that contain oxygen. These molecules can damage DNA, proteins, and fats within the body.
• Alcohol reduces the body's ability to breakdown and absorb a variety of nutrients that affect cancer risk.
• Alcohol use increases blood levels of estrogen (in both women and men), which can increase the risk of certain cancers.
• Alcoholic beverages can sometimes contain small amounts of one or more contaminants that increase the risk of cancer.

What cancers are associated with alcohol intake?

Here are the cancers that have been associated with alcohol use:

Head and neck cancer - Includes cancers in the mouth, throat, and larynx

Esophageal cancer - Especially squamous cell carcinoma

Liver Cancer - Higher risk after alcoholic liver disease develops

Breast Cancer - Research indicates that women who consume one alcoholic drink per day have a 5-9 percent higher chance of developing breast cancer, and the risk increases by approximately 7-12% for every additional 10 grams of alcohol drunk per day.

Colorectal cancer - Moderate to heavy alcohol intake is associated with up to a 1.5-fold increased risk of developing colorectal cancer, compared to no alcohol intake.

Evidence is not definitive yet but is accumulating to suggest that alcohol intake is associated with increased risks of melanoma, prostate cancer, and pancreatic cancers.

How does alcohol affect fertility?

Alcohol use can decrease fertility. This can happen in 2 ways.

• Studies suggest that even light drinking in women can make them less likely to conceive.
• Heavy drinking in men can lower both the quantity and quality of sperm.

If you're trying to get pregnant, avoiding alcohol intake is the best advice.

Why is alcohol dangerous during pregnancy?

Alcohol in the mother's blood passes to the baby. There is no known safe amount of alcohol use during pregnancy. There is also no safe time during pregnancy for alcohol use. This makes it important for women to avoid alcohol while they are trying to get pregnant for two reasons.

Alcohol use during pregnancy can cause:

• Miscarriage
• Stillbirth
• Fetal alcohol syndrome - A condition causing a range of lifelong physical, behavioral, and intellectual disabilities.

We can talk further about fetal alcohol syndrome at another time.

Next week, we will wrap up our series with the effects of alcohol on the liver.

If you have any questions about the effects of alcohol, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

What Happens When We Drink Alcohol?

Over the past 20 years, there has been a significant increase in alcohol-related deaths for people between age 25 and 34. You may not drink alcohol yourself but as a parent, you need to let your kids know about the dangers of drinking alcohol. They may not know unless you tell them. Last week, we discussed the idea of Dry January (abstaining from all alcohol intake for the entire month of January). This week, we will focus more on alcohol's effects on the body. You may want to share this information with your teenage or young adult children.

Everyone knows alcohol causes liver problems. Can alcohol cause adverse effects outside the liver?

Most people focus on the liver when they think about the harmful effects of alcohol. But alcohol can damage multiple body systems and organs. We will talk about what it can do all over the body. You may be surprised to hear that we need more than one article to get through them all!

What does alcohol do to the brain and nervous system?

Alcohol has both short-term and long-term effects on the entire brain and the nervous system throughout the body. Alcohol interferes with the nervous system's communication pathways. This affects how the brain and nerves of the body work both while intoxicated and over time.

Short-term effects (while alcohol is in your system) include:

• Loss of inhibition - Resulting in impulsive and often socially inappropriate behaviors.
• Loss of judgement - Resulting in poor decision making and risk-taking behavior.
• Slowed reaction time - Resulting in car crashes, falls, etc.
• Unsteady walking/poor balance and coordination
• Sedation - Can lead to loss of consciousness and complete loss of all thought, speech, and muscle control.
• Loss of memory or inability to convert short-term memories into long-term memory. You might have a black out, with no memory of what happened while you were intoxicated. Or you might remember something the next morning but within 1-2 weeks, that memory will be lost forever, even for really significant events.
• Respiratory depression - The brainstem has to tell your body to breathe. If there is enough alcohol in the brain, you can just stop breathing!

Long-term effects on the nervous system include increased risk of the following:

• Stroke
• Brain hemorrhage (bleeding in the brain)
• Permanent damage to nerves throughout the body - Can cause loss of sensation, chronic nerve pain, and/or loss of muscle function.
• Dementia - Progressive loss of brain function.

How does alcohol affect the heart?

Drinking too much (over a long time or even on a single occasion) can damage the heart. This can cause problems that include:

• Cardiomyopathy - Thinning/overstretching of the heart muscle, which leads to heart failure
• Arrythmias - Irregular heart rhythm
• High blood pressure - Increasing the risk of heart attack

How does alcohol affect your bones and muscles?

Alcohol increases the risk of the following musculoskeletal problems:

• Osteoporosis - Reduced bone density, which increases the risk of fractures
• Inability or impaired ability to heal fractures
• Significant loss of muscle mass and strength
• Muscle inflammation or chronic muscle pain

How does alcohol affect the lungs?

Direct effects on the lungs include increased risk of:

• Pneumonia
• Acute respiratory distress syndrome (ARDS) - This in a potentially deadly inflammatory condition that may happen in response to a minor respiratory infection or chest trauma.

How does alcohol affect the immune system?

Drinking too much on a single occasion or over a long period can weaken your immune system, making you more susceptible to infections such as common viral illnesses, bacterial infections, and tuberculosis.

Next week, we will talk more about the effects of alcohol, including in increased risk of cancer and the effects on the liver.

Dr. Anita Bennett MD - Health Tip Content Editor