Alcohol and liver disease

• How alcohol can damage the liver
• Drinking most days of the week increases the risk
• How excessive drinking can lead to fatty liver
• The four stages of liver disease
• How to reverse problems with your liver
• Facts
• Staying in control

This is a part of your body that does regular overtime.

The liver is our largest organ and it has 500 different roles. One of the liver’s most important functions is to break down food and convert it into energy when you need it. Your liver also helps the body to get rid of waste products and plays a vital role in fighting infections, particularly in the bowel (1).

And yet, when your liver is damaged, you generally won’t know about it – until things get serious. Regularly drinking over the government’s daily unit guidelines can increase your risk of developing liver disease and cause irreparable damage to this very important part of your body.

In fact, this level of drinking is a major cause of the 25% increase in deaths from liver disease in England over the last decade (from 9,231 in 2001 to 11,575 in 2009) (2). Overall, alcoholic liver disease accounts for well over a third (37%) of liver disease deaths. And figures show victims of liver disease are getting younger – more than 1 in 10 of deaths of people in their 40s are from liver disease, most of them from alcoholic liver disease (3).

Drinking too much alcohol can damage the liver in two main ways

Liver disease is the term used to describe damage to the liver and there are two types. Acute is when liver problems develop over a few months and chronic liver disease is damage over a number of years.

There are lots of different causes of liver disease, including drinking alcohol to excess which causes ‘alcoholic liver disease’. Scientists are not sure exactly why drinking too much alcohol can damage your liver but the reasons include:

1. Oxidative stress. When our liver tries to break down alcohol, the resulting chemical reaction  can damage its cells. This damage  can lead to inflammation and scarring as the liver tries to repair itself.
2. Toxins in gut bacteria. Alcohol can damage our intestine which lets toxins from our gut bacteria get into the liver. These toxins can also lead to inflammation and scarring.

How much alcohol is too much? Find out here...

If you drink most days of the week, you will increase your risk of developing liver disease.

Evidence about how much and how often you need to drink to increase your chances of developing liver disease is unclear. But all the research shows that the more alcohol you drink, the more likely you are to develop liver disease.

The NHS identifies the following two groups as at a high risk of developing serious types of alcoholic liver disease:

1. Men who drink more than 35 units of alcohol a week for 10 years or more
2. Women who drink more than 28 units of alcohol a week for 10 years or more (4)

Evidence suggests that other factors that increase your risk of developing liver disease include:

• being dependent on alcohol – around seven in 10 of people with alcoholic liver disease have an alcohol dependency problem
• being female – this could be because women develop higher levels of alcohol in the blood than men even if they’ve drunk the same amount of alcohol (5)
• being overweight – excess weight can exacerbate many of the mechanisms of liver damage caused by excessive drinking (6)
• genetics – certain genetic factors, including those affecting the liver’s handling of fat, influence the risk of a heavy drinker developing liver disease.

What is alcohol poisoning? Find out here...

Excessive drinking can make your liver get fat – reducing your consumption can help it return to its normal size

Drink more than eight units a day (four pints of 4% lager) if you’re a man and over five units a day (a couple of 175ml glasses of wine) if you’re a woman, for two or three weeks and you’re likely to develop something called “fatty liver’ (7).

The liver turns glucose into fat which it sends round the body to store for use when we need it. Alcohol affects the way the liver handles fat  so your liver cells get stuffed full of it.

If this happens, you may feel a vague discomfort in your abdomen because your liver is swollen. You might also feel sick and lose your appetite. A blood test may be able to show if you have fatty liver.

The good news: your liver will start shedding the excess fat if you stop drinking for two weeks and don’t exceed the daily unit guidelines after that. If you don’t change your drinking pattern, the bad news is that fatty liver is the first stage of liver disease.

Are you drinking too much? Find out with our alcohol asessment tool

The four stages of liver disease

People can spend 20 years damaging their liver and not feel any of the effects this is doing to them. This is because the liver has enormous reserves so that you can damage an awful lot of it and it can still do all of its jobs.

Early symptoms of liver disease can include:

• fatigue
• nausea
• vomiting
• diarrhoea
• abdominal pains 

Later stage liver damage symptoms are more serious – and you’ll know about them.

They can include:

• jaundice (yellow skin)
• vomiting blood
• fatigue
• weakness, loss of appetite
• itching
• easy bruising
• swelling of the legs ankles, or abdomen
• liver cancer
• bleeding in the gut
• increased sensitivity to alcohol and drugs, both medical and recreational (because the liver cannot process them) (8) (9)

When you develop cirrhosis, cutting out alcohol is essential to prevent you from dying from liver failure which is when your liver stops working completely. In the most serious cases of cirrhosis, you will only be considered for a liver transplant if you do not drink alcohol for at least three months.

If you start soon enough, you can reverse problems with your liver caused by alcohol

Drinking within the government’s daily unit guidelines and taking a regular break from alcohol will help your liver stay healthy. Reducing the amount you drink can help reverse damage, or early stage liver disease.

Once cirrhosis develops, prognosis partly depends on whether or not you continue drinking. People who have had no previous symptoms who stop drinking when they have cirrhosis, have an 80% chance of being alive after 10 years. Those who continue to drink have a much higher risk of dying. Even for those with symptoms, stopping drinking has a beneficial effect – it is never “too late” to stop drinking – even with cirrhosis.  

Facts

• 90-100% of heavy drinkers have alcoholic fatty liver disease
• one in four drinkers with fatty liver disease will develop alcoholic hepatitis
• one in five drinkers with fatty liver disease will develop cirrhosis (10)

Staying in control

The government advises that people should not regularly drink more than the daily unit guidelines of 3-4 units of alcohol for men (equivalent to a pint and a half of 4% beer) and 2-3 units of alcohol for women (equivalent to a 175 ml glass of wine). ‘Regularly’ means drinking every day or most days of the week.

Here are three ways you can cut back and keep your drinking under control.

1. Give alcohol-free days a go. If you drink regularly, your body starts to build up a tolerance to alcohol. This is one of the main reasons why it’s important to consider taking regular breaks from drinking. Test out having a break for yourself and see what positive results you notice.

2. Eat well. A healthy meal before you start drinking, and low-fat, low-salt snacks between drinks can help to slow down the absorption of alcohol. Good nutrition can help to support your liver to function and plays a crucial role in your health (11).

3. Keep track of what you’re drinking. Your liver can't tell you if you're drinking too much, but the MyDrinkaware drink tracking tool can. It can even help you cut down. my.drinkaware.co.uk

Further information

Your GP can help you figure out if you should make any changes in your drinking, and offer help and advice along the way.

If you’re concerned about someone’s drinking, or your own, Drinkline runs a free, confidential helpline. Call 0800 917 8282.

The British Liver Trust provides support and information on liver disease and also funds research. Call their free helpline Monday to Friday from 10am to 4.30pm on 0800 652 7330. Or visit www.britishlivertrust.org.uk