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How Alcohol Affects the Liver

Last Updated: 6/27/2022

The liver is a large organ on the upper right side of the abdomen that helps your body to filter waste, digest food (bile), store sugar that the body uses for energy, and make proteins for the body (some of these proteins are responsible for helping your blood to clot properly). The liver is also a potentially fragile organ because it is constantly working to keep your body working free of toxins. 

For those who drink alcohol, it is important to know that the liver is the organ responsible for metabolizing alcohol and removing the substance from your body. Each time the liver metabolizes alcohol it is mildly damaged, but it’s generally able to repair itself through routine cellular regeneration. 

That said, over long periods of alcohol misuse or abuse, the constant stress of metabolizing alcohol can begin to take a toll on the liver. This leads to other health complications such as hepatitis or cirrhosis (scarring of the liver), which may or may not be treatable and reversible. 

While not all liver diseases or complications are related to alcohol misuse, alcohol misuse is one of the leading causes of many of the liver complications discussed below. To reduce your risk for alcohol related-liver diseases it is important to be aware of what substances you are introducing to your body (alcohol, medications, etc) and the effect they may have on your liver. 

The most effective way to prevent alcohol-related liver diseases is to drink responsibly and in moderation. 

1. Fatty Liver

Fatty Liver Disease, also known as Hepatic Steatosis, is a condition in which an individual has excessive fat in the liver. Heavy drinking, while not the only cause, is one of the main causes of this condition. A long history of heavy drinking can cause a build-up of fat in your liver cells, making it difficult for your liver to function properly and efficiently in removing toxins from your body. 

In general, this disease is preventable and, in some cases, may even get better over time for those who stop drinking. However, this condition is generally a precursor to a range of increasingly more severe liver issues. 

Those who are diagnosed with this condition and choose not to make lifestyle changes, especially about alcohol consumption, may face further complications like the ones listed below.

  • Enlarged Liver
  • Alcoholic Hepatitis
  • Alcoholic cirrhosis

Some of the symptoms that may be indicative of fatty liver disease include, but are not limited to the following conditions listed below.

  • Swollen abdomen
  • Enlarged blood vessels under the skin
  • Larger than normal breasts in men
  • Red palms
  • Jaundice (yellowing of the skin or eyes)

Currently, there is no singular medication or treatment plan that can act as a cure for fatty liver disease. However, some steps you can take to stop the condition from progressing, and possibly reverse some of the damage done are included below.

  • Stopping the consumption of alcohol
  • Losing weight
  • Exercising 
  • Positive changes in diet

Additionally, being that fatty Liver Disease is a preventable condition, some steps you can take to protect yourself are listed below.

  • Drinking alcohol in moderation
  • Protecting yourself from hepatitis C
  • Practicing caution with potentially dangerous interactions between medications and alcohol.

2. Inflammation of the Liver (Hepatitis)

Hepatitis is the general word used to describe inflammation of the liver. There are various types of Hepatitis including A, B, C, D, E, and alcoholic hepatitis.

Alcoholic hepatitis is an inflammation of the liver caused by a history of heavy drinking that leads to liver cell damage and cell death. Heavy alcohol consumption takes a significant toll on the liver because alcohol is metabolized by the liver. 

Over long periods, this metabolism puts an added stress on the liver causing damage. While generally, this condition develops over time with continued drinking it can develop suddenly, at any point, and rapidly progress into a severe condition leading to liver failure and possibly even death.

Some signs that you may be experiencing alcoholic hepatitis are listed below.

  • Pain or tenderness in the abdomen (specifically in the area around the liver)
  • Nausea
  • Vomiting blood or material that looks like coffee grounds
  • Poor appetite
  • Jaundice (yellowing of the skin or eyes)
  • Weight loss
  • Tiredness
  • Weakness
  • Fever

Some of the ways your doctor may go about diagnosing alcoholic hepatitis include a variety of tests. These tests are listed below.

  • Blood tests
  • Ultrasounds
  • CT scans
  • MRI
  • Liver biopsy (in more severe cases)

It is important to remember that alcoholic hepatitis, much like fatty liver disease, is often considered to be a part of early-stage liver damage. If untreated, there is a possibility that it may develop into cirrhosis. 

While some forms of hepatitis are inheritable or spread by contaminated blood, alcoholic hepatitis is generally considered to be preventable. There is also no specific treatment for alcoholic hepatitis, many of the treatment options focus on reducing symptoms and halting the progression of the disease. It is imperative at this stage that you stop drinking alcohol immediately. 

Detox and inpatient treatment programs may be available and beneficial for those starting their journey toward sobriety and will also ensure that alcohol intake, as well as diet, are monitored consistently by a healthcare professional to ensure the best chance for recovery. 

3. Acute Alcoholic hepatitis

Acute, or severe, alcoholic hepatitis presents and is tested for in the same way as alcoholic hepatitis but often progresses faster and is more aggressive. 

In many cases, the first signs of this condition are fever, which is often indicative of a forming infection, and jaundice, yellowing of the skin and eyes. Acute alcoholic hepatitis has a significant short-term mortality rate. In general, this form of alcoholic hepatitis is most common in those who have been heavily drinking alcohol for more than 10 years.

While the treatment options are limited, the most important factor is that you begin abstaining from alcohol immediately. Making changes to diet such as increased or reduced caloric intake is also suggested. 

Additionally, in some cases of acute alcoholic hepatitis patients may need a liver transplant. That said, it’s important to note that many transplant centers require six months of abstinence from alcohol to consider you an eligible candidate for a transplant. Due to the abstinence requirement, and rapid progression of this condition, many patients suffering are not eligible for urgent transplant requests.


4. Scarring of the Liver (Cirrhosis)

Cirrhosis is a condition in which your liver has become scarred and permanently damaged. The scar tissue essentially replaces healthy liver tissue and greatly impacts the functionality of your liver. Over time, the liver will begin to fail. 

While there are a variety of ways cirrhosis can develop, the most common include alcoholic liver disease, non-alcoholic fatty liver disease, chronic hepatitis C, and chronic hepatitis B. 

Many of the symptoms of cirrhosis are hard to identify early on as cirrhosis is unlikely to develop suddenly without a history of prior liver complications. It is important to acknowledge that these symptoms will often not appear until a significant amount of damage has already occurred. 

Some of the most common symptoms are listed below.

  • Fatigue
  • Severely itchy skin. 
  • Accumulation of fluids in the abdomen and legs
  • Bleeding from the esophagus
  • Confusion or decreased concentration
  • Behavioral changes
  • Enlarged spleen

Currently, there is no specific treatment that is used to cure cirrhosis, but many of the diseases that cause it can be treated or managed if caught early on. Treating the underlying causes in due time may help to prevent cirrhosis from developing or progressing, and may even help to prevent liver failure. 

What to Know More About How Alcohol Affects the Liver?

Alcoholic liver damage can occur at any point in time and is not necessarily only caused by long-term heavy drinking. Situations such as binge drinking or conditions such as alcohol poisoning can put significant stress on the liver in a relatively short period and cause significant cell death, decreased function, and potential scarring. Some people are more at risk for more severe liver complications even with moderate alcohol consumption. 

Additionally, it is important to take into account that many common OTC (over-the-counter) medications are metabolized by the liver (such as Ibuprofen). If you were to take a medication that is processed by the liver while drinking alcohol, the liver will generally prioritize the metabolization of alcohol over that of the medication which can lead to a build-up of the medication in your system. Depending on the medication, a build-up in the liver can result in an overdose.

You should never take medications while drinking alcohol unless you have spoken to your doctor and been told it is okay and are aware of the possible side effects.


What is the Procedure for Diagnosing Alcoholic Liver Disease?

Alcoholic liver disease can be diagnosed by your healthcare provider through complete health history and physical exam. 

The physical exam may include a panel of tests that are listed below.

  • Blood tests
    • Testing for liver function to ensure your liver is working at the correct levels.
  • Liver biopsy
    • This test requires removing small tissue samples from the liver with a needle or during surgery. These samples are then examined under a microscope to determine the damage done to the liver.
  • Ultrasound
    • An ultrasound may help to identify if there is swelling of the liver.
  • CT Scan
    • While similar to an x-ray, these images can show much more detailed images of organs and fat which may help to identify issues such as fatty liver disease.
  • MRI
    • Similar to a CT Scan, MRIs are used to obtain detailed images of internal organs. Oftentimes, a dye is injected into your veins to create a contrast with the organs which may help to identify further complications. 

Depending on your healthcare provider or preexisting health, more or fewer tests may be administered.

What Causes Liver Damage in Alcoholics?

Every time your liver works to process alcohol that has been introduced to the body, some of the liver cells die. In general, the liver can produce new cells and repair itself in a normal cycle, just like many of the other organs in your body. However, prolonged alcohol misuse (heavy drinking, binge drinking), and the stress put on the liver can begin to make it more difficult for the liver to repair itself by regenerating these cells. 

The liver will begin to slow down and have decreased ability to regenerate these new cells which can lead to conditions mentioned above such as Acute Alcoholic Hepatitis or Cirrhosis (scarring of the liver). Many of these liver conditions are hard to identify in their earliest stages and are often not discovered until noticeable complications have begun to take place. 

What are the First Signs of Liver Damage from Alcohol?

Some of the first signs of alcohol-related liver damage you may experience may include, but are not limited to.

  • Fatigue
  • Unexplained weight loss
  • Loss of appetite
  • Nausea or vomiting
  • Swelling of the liver (this may present as pain or tenderness in the upper right side of your abdomen)

It is imperative that if you feel you may be at risk for alcohol-related liver damage you begin an open dialogue with your healthcare provider to ensure that you are receiving the care you need. Many symptoms of liver damage may not occur until the conditions have progressed significantly. 

How to Reduce the Risk of Liver Damage?

The best way to reduce the risk of alcohol-related liver damage is to drink responsibly and in moderation. The process through which the liver metabolizes alcohol, especially in high quantities, can be extremely taxing on the liver which may lead to some of the conditions discussed above. 

Some important non-alcohol-related factors to keep in mind are your diet and exercise habits – both of which can help you to reduce the amount of excess fat in the body and liver, as well as how you are engaging with other medications. Always speak to a healthcare provider if you are regularly taking medication, or plan to take medication when you know you will be consuming alcohol. Many medications are also processed by the liver and the liver can be put under increased stress when faced with metabolizing both substances.  Additionally, getting vaccinated for hepatitis A and hepatitis B can help to protect your liver from the non-alcohol-related forms of hepatitis. 

Most importantly, if you feel as though you or a loved one may be suffering from an alcohol use disorder, you are encouraged to speak to your health care provider and see what resources are available to you to get your drinking habits under control or create a plan of sobriety. 

What are the Safe Levels of Drinking?

Per the National Institute on Alcohol Abuse and Alcoholism, a “standard drink” is equal to 12 ounces of beer (5%), 5 ounces of wine (12%), or 1.5 ounces of spirits (40%). Safe levels of drinking are recommended as 1 standard drink a day for women and 2 standard drinks a day for men.

It is important to remember that these drinks should be preceded or accompanied by food, and other hydrating drinks, such as water or juice, should be consumed alongside these drinks. Additionally, it is suggested that you “sip” or slowly drink any drinks you are having to give your liver an easier time metabolizing the alcohol.