Alcohol and the Liver

What is alcohol-related liver disease?

Alcohol-related liver disease can occur in people who drink excessively, usually over a long period of time. Acute (sudden) liver damage can occur after drinking large amounts of alcohol in a shorter period of time; however, most alcohol-related liver disease affects people who have been drinking alcohol above moderate amounts for several years.
People can develop alcohol-related liver disease even if they are not alcohol dependent. This condition can occur even if people do not become intoxicated when consuming alcohol. In fact, nine out of ten people who drink excessively are not alcohol dependent.

What are some types of alcohol-related liver disease?

One type of liver disease caused by alcohol is alcohol-related fatty liver disease*, in which excess fat accumulates in liver cells. Most "heavy drinkers" develop this condition. It usually resolves with cessation of alcohol.
Alcohol-associated hepatitis is an inflammation (swelling) of the liver. Liver cells can be destroyed by this condition. It can reverse if a person stops drinking alcohol.
Alcohol-associated cirrhosis is the most serious type of alcohol-related liver disease. A liver affected by cirrhosis has become hardened with scar tissue. This makes it harder for the liver to function. Cirrhosis may be reversible in its early stages, but is generally not reversible in very advanced stages.

Who is at risk for alcohol-associated liver disease?

Alcohol is toxic to liver cells, so the more you drink, the greater your risk of developing some level of alcohol-associated liver disease. People who drink moderately are at lower risk but may still be at risk. Additionally, women are generally more susceptible to alcohol's effects on the liver.
Alcohol includes beer, wine, and spirits. Spirits have a higher alcohol content than beer or wine; However, it's false to think that beer or wine are safer alternatives. Any type of alcohol consumed in more than moderate amounts can cause serious liver damage.

Alcohol servings are:
• Beer: 12 ounces
• Wine: 5 ounces
• Spirits: 1 to 1.5 ounces

People can still develop alcohol-related liver disease even if they don't have alcohol use disorder (AUD), but it's important to note that people with AUD are at increased risk of liver disease. Alcohol use disorder is a medical condition that was formerly known as alcohol dependence, alcohol addiction, and alcoholism. AUD is now considered a brain disorder that can range from mild to severe. People with AUD can seek help through behavioral therapy, medication, and support groups. Research has shown that these therapies have been highly effective in helping people recover from AUD. It is strongly recommended, however, that anyone with AUD undergo a complete physical examination to detect and/or treat any liver disease that may be present.

What is moderate alcohol consumption?

Moderate alcohol consumption for men means consuming no more than two alcoholic drinks per day.
Moderate alcohol consumption for women means consuming no more than one alcoholic drink per day.

Can excessive drinking cause liver damage?

Liver damage can also occur from binge eating, when four to five alcoholic drinks are consumed within two hours. Excessive alcohol consumption can also cause acute (sudden) alcoholic hepatitis, a rapid inflammation of the liver, which can be life-threatening.
What are the symptoms of alcohol-associated liver disease?
Like most liver diseases, people with alcohol-associated liver disease may not feel sick. The most common symptom is fatigue (feeling extremely tired). If liver disease begins to progress, symptoms may include:

• Loss of appetite
• Weight loss
• Jaundice (yellowing of the eyes and skin)
• Fluid accumulation in the abdominal area (ascites) or around the ankles (edema)
• Confusion
• Vomiting or vomiting blood
• Passing blood during bowel movements

How is alcohol-related liver disease diagnosed?

The diagnosis begins with a doctor taking a complete medical history and performing a physical exam. Initial tests include blood tests and possibly imaging tests such as ultrasound. Depending on the results of these tests, further diagnostic tests may be necessary to determine the extent of liver damage.
People often feel uncomfortable discussing their alcohol consumption with doctors, but it is very important that you provide your doctor with accurate information about your alcohol consumption, just as you do when discussing your eating habits, exercise, and medication use. Over-the-counter products such as vitamins or supplements are all important components in reaching an accurate diagnosis.

How is alcohol-related liver disease treated?

The first step in treating alcohol-related liver disease is to stop drinking. If you have fatty liver disease* or alcoholic hepatitis, the only way to reverse the damage is to stop drinking.
It may be advisable to discuss medical supervision with your doctor when quitting drinking. Medications can help if someone is dependent on alcohol and experiencing withdrawal. If alcohol dependence is a problem, treatment for quitting drinking may include counseling, admission to a treatment center, and seeking support programs such as AA.
Treatment for liver disease will depend on the diagnosis. Alcohol-related fatty liver disease* usually resolves spontaneously without treatment if the person stops drinking alcohol.
Alcohol-associated hepatitis can be treated with medications, but your doctor should evaluate whether such treatments are appropriate because they can have serious side effects.
If the damage has progressed to cirrhosis, the liver no longer performs its normal function. One of the liver's main functions is to filter toxins from the body. Treatment of cirrhosis often involves treating complications.

Nutritional therapy may be offered to people with alcohol-related liver disease. Your doctor may refer you to a dietitian who can help you plan nutritious meals. If a person is unable to eat, nutrients can be provided through a feeding tube.

Is liver transplant an option for people with alcohol-related liver disease?

People with cirrhosis may be candidates for transplant. Each patient is individually evaluated based on their overall health, and if a doctor believes transplantation is an option, they will refer the patient to a transplant center for a thorough medical, psychological, and financial evaluation. To receive a transplanted liver, the liver transplant team typically needs to be certain that the patient will take care of the new liver and never return to drinking alcohol.