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Everyday habits to support liver health
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The liver’s an incredible organ with a lot of important jobs to do, from removing toxins and helping with digestion to fending off infections and keeping you healthy. It’s also got an incredible superpower – the ability to regenerate and heal after damage i. But, in order for the liver to keep on doing its best, it needs you to do your part to help keep it healthy. And, to do that, it’s important to be aware of the connection between liver health and alcohol use.
It's no exaggeration to say that alcohol represents a serious threat to liver health. In fact, globally, 20% of deaths from liver cancer and 25% of deaths from cirrhosis were related to alcohol use in 2019ii. And, worldwide, our consumption of alcohol has been on the rise for decades.
Read on to learn more about alcoholic liver disease (ALD), its various stages, the effects alcohol has on the liver, and how you can protect your liver from alcohol damage.
How Alcohol Impacts Liver Function
Cells called hepatocytes are responsible for handling the liver’s most important biological processes, including metabolising carbohydrates, lipids, and proteins, eliminating toxins from our body, and activating immune cells to stop inflammationiii. These hepatocytes are the cells that make up the liver tissues, and they can be severely damaged when alcohol is involved.4
Hepatic lesions, also called liver lesions, are cell abnormalities that can form as a result of excessive alcohol consumption.4 The most common results of the formation of these lesions are steatosis (fatty liver), hepatitis, and cirrhosis (we’ll get into these later).4 Ultimately, they can lead to liver cancer, including one of the fiercest, known as hepatocellular carcinoma.iv
We know that the liver is a powerhouse organ, with an incredible capacity to heal and regenerate, but it’s also not bullet-proofed. Whenever your liver needs to process and metabolise alcohol, some cells die, and it ultimately becomes more and more difficult for the liver to regenerate and keep you healthy.
Metabolism of alcohol in the liver
When you drink alcohol, your liver then has the task of breaking down the alcohol molecule so that it can be removed from your body.5 The alcohol molecule, known as ethanol, breaks down into a substance called acetaldehyde, which is a carcinogenic substance capable of causing cancer.v Usually, acetaldehyde doesn’t stay in the body long before it’s eliminated, but the more alcohol consumed, the greater the burden on the liver, and this toxic substance can cause plenty of damage to the liver before it’s eliminated.5
Progression of Alcohol-Induced Liver Damage
Alcohol-related liver disease (ARLD) exists on a spectrum, with the earliest signs of liver distress manifesting as fatty liver disease (steatosis), and progressing to alcoholic hepatitis, then cirrhosis, and ultimately liver cancer. Let’s take a look at each of these stages.4
Fatty liver disease
Although the term is now considered outdated and carries a bit of stigma with it, you may have heard of fatty liver disease. The term fatty liver disease actually refers to two types of conditions, now referred to as:
Alcoholic steatohepatitis (previously called alcoholic fatty liver disease), and metabolic dysfunction-associated steatotic liver disease, or MASLD (previously called NASLD).
When it comes to alcohol and liver disease the more you drink, the more alcohol your liver needs to process. When it breaks down the alcohol to remove it from your body, it the process results in acetaldehyde (the toxic by product mentioned above), which damages the liver cells.
Alcoholic hepatitis
Alcoholic hepatitis refers to swelling or inflammation of the liver as a result of long-term heavy drinking.
Some of its symptoms include jaundice, enlarged liver (hepatomegaly), a generalised feeling of beingunwell, and inflammation of the liver.vi
If untreated, and, importantly, if a person with alcoholic hepatitis continues drinking, it is very likely to progress to alcoholic cirrhosis.6
Alcoholic cirrhosis
Cirrhosis is a later stage of alcoholic liver disease, and it’s marked by significant scarring on the liver. At this stage, a patient may still not have obvious signs of illness, but after a diagnosis of cirrhosis, it’s critical to stop drinking to prevent any further damage.
It’s important to remember that although the liver has an amazing capacity to regenerate, cirrhosis is a condition that is irreversible. Once the liver tissue is scarred, the damage is permanent, although lifestyle changes, most importantly quitting drinking, can help prevent further damage and liver failure.vii
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Recognising the Warning Signs
Signs and symptoms of alcoholic liver disease usually don’t crop up until the liver has already experienced significant damage. For this reason, you probably won’t notice any “early” signs. However, there are some signs to look out for if you’re a heavy drinker and are concerned about the health of your liver.
First signs of alcohol-related liver issues
Some of the first signs of the effects alcohol has on the liver that you may notice can include:viii
- Stomach ache
- Loss of appetite
- Fatigue and feeling ill or unwell
- Diarrhoea
If you notice any of these signs of liver damage from alcohol, it may be a good idea to limit your consumption and start discussing your lifestyle with your doctor.
As the disease progresses, the symptoms become more severe. Some symptoms can include:
- Yellowing of the eyes and skin (known as jaundice)
- Swelling in the feet, ankles, and abdomen
- Itchy skin and possible hair loss
- Weight loss
- Weakness
- Running a fever with bouts of shivering
- Mental confusion, memory problems, and insomnia
- Blood in your vomit or stool
- Bleeding and bruising more easily
If you experience any of these symptoms, and if you are a heavy drinker, talk to your doctor about your alcohol use and any concerns you have, and the sooner the better.
Moderation as a Key to Liver Health
We mentioned before that there is no amount of alcohol that’s considered “safe” for consumptionix, but a good term to be familiar with is a “standard” drink.
Recommended limits for safer alcohol consumption
According to the US National Institute on Alcohol Abuse and Alcoholism, a standard drink refers to one that contains 14 grams of pure alcoholx. But what does that mean exactly? Let’s break it down:10
- 12 ounces (350 ml) of beer (at approximately 5 percent ABV)
- 5 ounces (150 ml) of wine (at approximately 12 percent ABV)
- 1.5 ounces (45 ml) of spirits (at approximately 40 percent ABV)10
Reducing risks: Tips for responsible drinking
The World Health Organization now states that there is no amount of alcohol consumption that’s considered safe and without health consequences.9 Despite that, many people will continue to enjoy an alcoholic beverage from time to time, and here are a few ways to do so more mindfully, while keeping in mind what alcohol does to your liver:
- Don’t drink on an empty stomach. Eat before and while drinking.
- Don’t combine alcohol and drugs (even prescription drugs). Tell your doctor about your alcohol consumption if you are taking any prescription drugs to avoid any negative interactions.
- Stay hydrated. While drinking, try having a glass of water in between alcoholic drinks.
- Watch the size of your drinks. If you can choose a smaller glass of wine or beer, do so.
- Try drinks with a lower ABV. If you normally drink spirits, try a light beer or cider instead, as these will have a lower amount of alcohol by volume (ABV).
- Set limits for yourself. You can do this by limiting the number of drinks you have in a day or by limiting the number of days in the week that you drink alcohol.
Frequently Asked Questions about Liver Function and Alcohol
A few signs of liver disease that you may notice in its earliest stages can include stomach ache, loss of appetite, fatigue and feeling ill or unwell, and diarrhoea.
Liver damage from the first two stages of ALD is generally reversible, provided that you stop drinking alcohol completely. Liver damage at the point of cirrhosis is usually not reversible.
If you’re concerned about your liver health, especially if it relates to your drinking habits, the first thing you’ll want to do is talk to your doctor. An honest conversation can go a long way toward assessing the health of your liver and setting you on the right path to better health and quality of life.
Your doctor may start with a simple blood test, or even an CT or MRI scan to examine the health of your liver. In more advanced cases of liver issues, a biopsy may be required to check out what’s going on with your liver.
Staying hydrated is always a good idea. If you don’t want to stop drinking completely, it’s a good idea to drink water along with your alcoholic beverages. In fact, a recent study indicates that water consumption is linked to lower risks of fatty liver disease diagnoses.xi So, fill up that water bottle, and drink up!
Research has shown that alcohol-related liver disease (ARLD) may not happen until a person consumes about 100 kg of alcohol in a lifetime.
This actually breaks down to an average daily consumption of 30 grams per day, which is just over twice the amount of a standard drink that we described above.
So, if you’re drinking twice or more than the indicated standard, you’re increasing your risk of ARLD and cirrhosis significantly.
Despite how normal it seems in our everyday lives, alcohol actually poses a significant risk to our liver function and overall health. Even if you don’t consider your drinking habits to be problematic, it can be important to take a look at your consumption and look at ways to reduce your risks of alcohol-related liver diseases.
