How does Alcohol affect your Liver? All you need to know about Alcohol-related Liver Disease.

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Your liver sustains the greatest degree of tissue injury by heavy drinking because it is the primary site of ethanol metabolism. Ethanol forms the base of every alcoholic drink both natural and industrially produced.

Ethanol is edible but it has harmful after-effects on your body system, doesn’t matter whether you’re drinking moderately or too much.

Moderate and excessive alcohol consumption produces a wide spectrum of hepatic lesions (liver wounds), the most common of which are steatosis, hepatitis, and fibrosis/cirrhosis

Steatosis is the earliest response to heavy drinking and is characterized by the deposition of fat in hepatocytes. Steatosis can progress to steatohepatitis, which is a more severe, inflammatory type of liver injury.

This stage of liver disease may continue to fibrosis and later develop into cirrhosis which causes excessive damage to your liver. (1,2)

This article review to you all the after-effects of alcohol intake whether moderate or in excess.

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What is Alcohol-related liver disease (ARLD)?

Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms.

Symptoms

What are the symptoms of alcohol-related liver disease (ARLD)?

ARLD does not usually cause any symptoms until the liver has been severely damaged.

When this happens, symptoms can include:

  • feeling sick
  • weight loss
  • loss of appetite
  • yellowing of the whites of the eyes or skin (jaundice)
  • swelling in the ankles and tummy
  • confusion or drowsiness
  • vomiting blood or passing blood in your stools

This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage.

If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged.(1, 3,,4,5, 6)

Alcohol and your liver

How does alcohol affect your Liver?

fatty liver due to alcohol

The liver is one of the most complex organs in the body.

Its functions include:

  • filtering toxins from the blood
  • aiding digestion of food
  • regulating blood sugar and cholesterol levels
  • helping fight infection and disease

The liver is very resilient and capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die.

The liver can develop new cells, but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver.

Causes

Alcohol-related liver disease (ARLD) is caused by either drinking too much or moderate alcohol whether artificial or natural. The more you drink above the recommended limits, the higher your risk of developing ARLD.

There are 2 ways alcohol drinking alcohol whether moderate or too much can cause ARLD.

These include

  • drinking a large amount of alcohol in a short amount of time (binge drinking) – can cause fatty liver disease and, less commonly, alcoholic hepatitis
  • drinking more than the recommended limits of alcohol over many years – can cause hepatitis and cirrhosis, the more serious types of ARLD.

Evidence suggests people who regularly drink more than the recommended maximum amounts are most at risk of developing ARLD.

For low-risk drinking:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over 3 days or more if you drink as much as 14 units a week
  • If you want to cut down, try to have several drink-free days each week.

Other factors may contribute.

As well as you drink alcohol, other factors can increase your chances of developing ARLD.

These include:

  • being overweight or obese
  • being female (women appear to be more vulnerable than men to the harmful effects of alcohol)
  • having a pre-existing liver condition, such as hepatitis C
  • genetics (alcohol dependence and problems processing alcohol often run in families) (1,7,8,9)

How do you calculate alcohol units?

With so many different drinks and glass sizes, from shots to pints – not to mention bottles – it’s easy to get confused about how many units are in your drink.

The idea of counting alcohol units was first introduced in the UK in 1987 to help people keep track of their drinking.

Units are a simple way of expressing the quantity of pure alcohol in a drink.

One unit equals 10ml or 8g of pure alcohol, which is around the amount of alcohol the average adult can process in an hour.

This means that within an hour there should be, in theory, little or no alcohol left in the blood of an adult, although this will vary from person to person.

The number of units in a drink is based on the size of the drink, as well as its alcohol strength.

For example, a pint of strong lager contains 3 units of alcohol, whereas the same volume of lower-strength lager has just over 2 units.

Knowing your units will help you stay in control of your drinking but the problem is “how many people can actually keep calculating the amount of their  alcohol intake?” And the catch here is that you will rarely find an organized bar that can offer such a service, especially in developing countries.

Calculating units

Using units is a simpler way of representing a drink’s alcohol content – usually expressed by the standard measure of alcohol by volume (ABV).

ABV is a measure of the amount of pure alcohol as a percentage of the total volume of liquid in a drink.

You can find the ABV on the labels of cans and bottles, sometimes written as “vol” or “alcohol volume”, or you can ask bar staff about particular drinks.

For example, a wine that says “12% ABV” or “alcohol volume 12%” means 12% of the volume of that drink is pure alcohol.

You can work out how many units there are in any drink by multiplying the total volume of a drink (in ml) by its ABV (measured as a percentage) and dividing the result by 1,000.

strength (ABV) x volume (ml) ÷ 1,000 = units

For example, to work out the number of units in a pint (568ml) of strong lager (ABV 5.2%):

5.2 (%) x 568 (ml) ÷ 1,000 = 2.95 units

Drinks and units

Here are some alcoholic drinks and their units:

A 750ml bottle of red, white or rosé wine (ABV 13.5%) contains 10 units.

See the guide below to find out how many units are in your favourite tipple.

Units and calories for drinks

Type of drink       Number of alcohol units

Single small shot of spirits* (25ml, ABV 40%)   1 unit

Alcopop (275ml, ABV 5.5%) 1.5 units

A small glass of red/white/rosé wine (125ml, ABV 12%) 1.5 units

Bottle of lager/beer/cider (330ml, ABV 5%)        1.7 units

Can of lager/beer/cider (440ml, ABV 5.5%)         2.4 units

Pint of lower-strength lager/beer/cider (ABV 3.6%)      2 units

Standard glass of red/white/rosé wine (175ml, ABV 12%)     2.1 units

Pint of higher-strength lager/beer/cider (ABV 5.2%)     3 units

Large glass of red/white/rosé wine (250ml, ABV 12%) 3 units. (10,11,12)

Treatment

Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol and make changes to their lifestyle.

Stopping drinking alcohol

Treatment for ARLD involves stopping drinking alcohol. This is known as abstinence, which can be vital depending on what stage the condition is at.

If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for a period of time (this could be months or years).

After this point, it’s usually safe to start drinking again if you stick to the NHS guidelines on alcohol units. However, it’s important to check with your doctor first.

If you have a more serious form of ARLD (alcoholic hepatitis or cirrhosis) lifelong abstinence is recommended.

This is because stopping drinking is the only way to prevent your liver damage from getting worse and potentially stop you from dying of liver disease.

Stopping drinking is not easy, especially as an estimated 70% of people with ARLD have an alcohol dependency problem.

Nevertheless, if you have alcohol-related cirrhosis or alcoholic hepatitis and do not stop drinking, no medical or surgical treatment can prevent liver failure.

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Withdrawal symptoms

If you’re abstaining from alcohol, you may suffer withdrawal symptoms.

These will be at their worst for the first 48 hours but should start to improve as your body adjusts to being without alcohol. This usually takes 3 to 7 days from the time of your last drink.

Many people initially experience disturbed sleep when abstaining from alcohol, but in most cases, their sleep pattern returns to normal within a month.

In some cases, you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems.

You may also be offered a medicine called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process.

Some people need to stay in a hospital or a specialist rehabilitation clinic during the initial withdrawal phases so their progress can be closely monitored.

If you’re staying at home, you’ll regularly see a nurse or another health professional. You might see them at home if you cannot handle it alone. (13,14,15, 16, 17)

Preventing relapses

Once you have stopped drinking, you may need further treatment to help ensure you do not start drinking again.

The first treatment usually offered is psychological therapy. This involves seeing a therapist to talk about your thoughts and feelings, and how these affect your behaviour and well-being.

If psychological therapy alone is not effective, you may also need medicine to help you abstain from alcohol, such as:

  • acamprosate
  • disulfiram
  • naltrexone

Self-help groups

Many people with alcohol dependence find it useful to attend self-help groups to help them stop drinking.

One of the most well-known is Alcoholics Anonymous (see the AA website for details), but there are many other groups that can help.

See alcohol support for more information about the help available.

Diet and nutrition

Malnutrition is common in people with ARLD, so it’s important to eat a balanced diet to make sure you get all the nutrients you need.

Avoiding salty foods and not adding salt to foods you eat can reduce your risk of developing swelling in your legs, feet and tummy caused by a build-up of fluid.

The damage to your liver can also mean it’s unable to store glycogen, a carbohydrate that provides short-term energy.

When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. This means you may need extra energy and protein in your diet.

Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat 3 or 4 small meals a day, rather than 1 or 2 large meals.

  • your dietitian can help you get the right diet.

In the most serious cases of malnutrition, nutrients may need to be provided through a feeding tube inserted through the nose and into the stomach.

Medicine for symptoms

The use of medicine to directly treat ARLD is controversial. Many experts have argued there’s limited evidence for its effectiveness.

For people with severe alcoholic hepatitis, treatment in the hospital may be necessary.

Specific treatment with corticosteroids may be used to reduce inflammation of the liver in some people with this condition.

Liver transplants

In the most serious cases of ARLD, the liver loses its ability to function, leading to liver failure.

A liver transplant is currently the only way to cure irreversible liver failure.

A liver transplant may be considered if:

  • you develop progressive liver failure, despite not drinking alcohol
  • you’re otherwise well enough to survive such an operation
  • you commit to not drinking alcohol for the rest of your life.

Taking medicines with ARLD

If you have ARLD, it’s important to talk to your doctor or pharmacist before taking over-the-counter or prescription medicines.

ARLD can affect the way the body processes some medicines.

There’s currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life.

This reduces the risk of further damage to your liver and gives it the best chance of recovering. (1,18,19)

Diagnosis

Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver.

This is because the condition causes few obvious symptoms in the early stages.

Blood tests

Blood tests used to assess the liver are known as liver function tests.

But liver function tests can be normal at many stages of liver disease.

Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver.

A low level of serum albumin suggests your liver is not functioning properly.

A blood test may also look for signs of abnormal blood clotting, which can indicate significant liver damage.

Further testing

If your symptoms or liver function test suggest an advanced form of ARLD (either alcoholic hepatitis or cirrhosis), you may need further tests.

Imaging tests

Scans may be needed to produce detailed images of your liver.

This may include:

  • an ultrasound scan
  • a CT scan
  • an MRI scan

Some scans may also measure the stiffness of the liver, which is a good indication of whether your liver is scarred.

Liver biopsy

During a liver biopsy, a fine needle is inserted into your body (usually between your ribs).

A small sample of liver cells is taken and sent to a laboratory to be examined under a microscope.

The biopsy is usually carried out under local anaesthetic, either as a day case or with an overnight stay in the hospital.

Your liver tissue will be examined to determine the degree of scarring in the liver and the cause of the damage.

Endoscopy

An endoscope is a long, thin, flexible tube with a light and a video camera at one end.

During an endoscopy, the instrument is passed down your oesophagus (the long tube that carries food from the throat to the stomach) and into your stomach.

Pictures of your oesophagus and stomach are transmitted to an external screen. The doctor will be looking for swollen veins (varies), which are a sign of cirrhosis. (20,21, 22)

Complications

What are the possible Complications?

Death rates linked to ARLD have risen considerably over the last few decades.

Alcohol drinking is now one of the most common causes of death in some developed and developing countries along with smoking and high blood pressure.

Life-threatening complications of ARLD include:

  • internal (variceal) bleeding
  • the build-up of toxins in the brain (encephalopathy)
  • fluid accumulation in the abdomen (ascites) with associated kidney failure
  • liver cancer
  • increased vulnerability to infection.(22,1,23)

Prevention

How do you prevent alcohol-related liver disease?

The most effective way to prevent ARLD is to stop drinking alcohol or stick to the recommended limits:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over 3 days or more if you drink as much as 14 units a week
  • if you want to cut down, try to have several drink-free days each week

A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits.

Even if you have been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short-term and long-term benefits for your liver and overall health.

See our alcohol advice pages for more information and support.(1,24,25)

Conclusion

Moderate and excessive alcohol consumption produces a wide spectrum of hepatic lesions (liver wounds), the most common of which are steatosis, hepatitis, and fibrosis/cirrhosis.

ARLD does not usually cause any symptoms until the liver has been severely damaged.

Alcohol-related liver disease (ARLD) is caused by either drinking too much or moderate alcohol whether artificial or natural. The more you drink above the recommended limits, the higher your risk of developing ARLD.

With so many different drinks and glass sizes, from shots to pints – not to mention bottles – it’s easy to get confused about how many units are in your drink.

There’s currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk of further damage to your liver and gives it the best chance of recovering.

Alcohol-related liver disease (ARLD) is often first suspected when tests for other medical conditions show a damaged liver. This is because the condition causes few obvious symptoms in the early stages.

Alcohol drinking is now one of the most common causes of death in some developed and developing countries along with smoking and high blood pressure with life-threatening complications.

The most effective way to prevent ARLD is to stop drinking alcohol for the rest of your life.

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The content provided in living Good Blog is for informational and educational purposes only. It’s not intended to provide medical advice or take the place of such advice or treatment from a personal doctor. All readers/viewers of this content are advised to consult their qualified health professionals regarding specific health questions. Living Good Blog takes no responsibility for possible health consequences of any person(s) reading or following the information in this educational content. Viewers of this content, especially those taking prescription or over-the-counter medication, should consult their physicians before beginning any nutrition, supplement or lifestyle program.

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