how alcohol affects liver - alcohol liver disease-ALD

How does Alcohol Affect the Liver?

Alcohol, without a doubt, is harmful to the body. It affects several body organs, with the liver being one of those that are affected the most. 

It is a known fact that alcohol causes a huge number of hospitalizations and deaths. The statistics, given by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) regarding alcoholic liver disease, are truly concerning. To wit: 

  • Of the 83,517 people (aged 12 years old and above) who died from liver disease in 2018, 47.8% involved alcohol use. 
  • 1 of 3 people who received a liver transplant in the United States did so because of alcohol-related liver disease. 

With these scary numbers, it is important to take care of your liver – as well as your other organs. Since knowledge is power, one of the best ways to do so is to equip yourself with knowledge as to how alcohol affects your liver. 

Normal Liver vs. Liver with Cirrhosis

What is the Liver? 

The liver is the largest organ inside the body, weighing as much as 3.3. pounds. According to the National Institutes of Health, this football-sized tissue is located on the right side of your stomach. It does many things, such as:

  • Making bile, which helps in digestion and the elimination of wastes from the body 
  • Transforming the food you eat into nutrients that are delivered to the different parts of the body 
  • Removing infectious bacteria and harmful substances (such as alcohol) from the bloodstream 
  • Transforming harmful ammonia into urea, which can be excreted through urine 
  • Synthesizing immune factors 
  • Synthesizing cholesterol and proteins 
  • Storing iron 
  • Regulating blood clotting
  • Clearing bilirubin, a substance that can turn you ‘yellow’, from the circulation 

How does Alcohol Affect the Liver?

The liver is the primary site of alcohol metabolism. As it breaks down alcohol, harmful substances such as acetaldehyde and free radicals are released to the body. The release of these byproducts puts the liver at risk of alcohol-related injury or disease. 

While the liver can regenerate itself, it is not immune to the damaging effects of high quantities of alcohol. According to an NIAAA article written by Dr. Jacquelyn Maher,liver injury in men becomes apparent after taking 600 kilograms of alcohol throughout the years. That means taking 1 liter of wine, 8 ounces of distilled spirits, 72 ounces of beer every day – for 20 years. For women, the threshold is lower – one-fourth to one-half of the said amounts are enough to bring alcohol-related liver disease.

While this feat seems to be impossible, a lot of people have done (and continue to do) so, and it is showcased by the alcohol-related liver disease/death statistics mentioned above. 

What are Alcohol-Related Liver Diseases?

Should you continue with your binge drinking ways, you may develop any (or all) of the following alcohol-related liver diseases: 

Fatty Liver

As the name suggests, it involves some degree of fat accumulation in the liver. It occurs in almost all heavy drinkers, though occasional alcohol users may experience this as well. This condition is reversible and will probably not lead to further liver disease if abstinence is observed right away. 

Alcoholic Hepatitis

This condition is marked by the inflammation and eventual destruction of the liver. Fibrosis, or the replacement of healthy tissue with scar tissue, can occur. Symptoms of alcoholic hepatitis include yellowing of the eyes and skin (jaundice), fever, nausea, vomiting, bleeding, and abdominal pain. 

According to researchers from the University of Toronto – Center of Addiction and Mental Health, as much as 50% of the people diagnosed with severe alcoholic hepatitis die from the complications. And of the remaining alcoholics who continue to drink despite the warning, approximately 40% of them might eventually develop cirrhosis.

Alcoholic Cirrhosis

Cirrhosis is considered the most advanced form of alcohol-related liver disease. According to Dr. Maher, approximately 15 to 30% of heavy drinkers are at risk of developing this condition. 

Alcoholic Cirrhosis occurs when the liver has become extensively fibrotic. With more scar tissue than healthy tissue, the blood vessels stiffen, thereby resulting in extensive liver damage. This impairs liver function, which can affect the performance of the kidneys and the brain in the long run. 

Complications such as portal hypertension and kidney failure make alcoholic cirrhosis highly fatal. Although this is the case, progression can be delayed, if not stopped, by abstaining from alcohol. 

Liver Cancer

Because of alcohol’s damaging effects on the liver, chronic use of such has been linked with liver cancer. According to the American Cancer Society (ACS), heavy alcohol use, which leads to liver scarring and inflammation, might raise one’s risk of developing liver cancer. ACS puts the 5-year survival rate at 30%, as long as liver cancer is diagnosed early.

How is Alcoholic Liver Disease Diagnosed?

Diagnosing this type of liver disease remains a challenge for many clinicians. However, a history of alcohol abuse, coupled with physical signs, can help draw a picture.

Laboratory values also play a role in the confirmation of alcoholic liver disease, since it is one of the most objective ways to measure abnormalities in the body. The three markers that are utilized in the screening of liver injury are gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). 

Below is a characteristic table of the following markers and their relations with alcohol use:

Marker Normal Range Length of time results remain high/abnormal Implication
GGT 8 to 61 U/L 2-6 weeks, depending on the level of alcohol abstinence Intake of more or less 70 drinks per week for several weeks
AST 8 to 48 U/L 7 days, maybe reduced with abstinence
The total amount of alcohol taken is unknown, is usually correlated with heavy drinking
ALT 7 to 55 units per liter (U/L) Unknown The total amount of alcohol taken is unknown, is usually correlated with heavy drinking

Source: Biomarkers of Heavy Drinking (NIAAA) and Liver Function Tests, Mayo Clinic

Alcoholic liver disease may be a death sentence for some, however, it can be treated with the right lifestyle changes. Alcohol abstinence is the best way to go, as this can help prevent further scarring and injury of the liver. Expectedly, such can lower one’s risk of developing liver cancer as well. Coupled with losing weight and smoking cessation, alcohol abstinence can help restore your liver’s health. 


Latest posts by Raychel Ria Agramon, BSN, RN, MPM (see all)

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