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