Alcoholic liver disease is the result of an overconsumption of alcohol that leads to a buildup of fats and scarring of the liver. It can be fatal.
Alcoholic liver disease is the main cause of liver disease in Western nations. In Asian countries, it mostly results from viral hepatitis.
According to the Centers for Disease Control and Prevention (CDC), in 2013, the number of deaths from alcoholic liver disease in the United States was 18,146, while chronic liver disease and cirrhosis overall are estimated to cause 11.5 fatalities per 100,000 people.
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Why is the liver important?
Alcoholic liver disease compromises a range of essential functions.
After the brain, the liver is the most complex organ in the human body, with over 500 functions. These include:
- Making proteins to fight infection and disease
- Filtering out blood toxins
- Manufacturing hormones, proteins, and other vital chemicals
- Regulating blood cholesterol and sugar levels
- Producing proteins that enable clotting and stop bleeding following an injury
- Storing energy.
If the liver is damaged, it can affect the whole body. Once damage begins, it can take a long time to become noticeable, as the liver is generally effective at regenerating and repairing itself. Often, by the time the damage is found, it is irreversible.
Causes of alcoholic liver disease
Not all heavy regular drinkers develop liver damage. It is not known why alcoholic liver disease affects some people and not others.
Acetaldehyde is a toxic chemical that is produced by alcohol. It damages the liver and leads to liver scarring, as in cirrhosis or end-state liver disease. Some people appear to be more susceptible than others.
Risk factors for alcoholic liver disease
A number of factors increase the risk of developing alcoholic liver disease.
People who drink beer and liquor, or spirits, are more likely to experience liver disease, compared with those who consume other alcoholic beverages, such as wine.
Women metabolize alcohol more slowly than men, and so they are more susceptible to developing alcoholic liver disease. Evidence suggests that women are twice as sensitive to alcohol-related liver damage as men.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 13 percent of women who drink in the U.S. consume more than seven drinks in a week.
Hepatitis C increases the risk, and a regular drinker who has had any type of hepatitis has a higher chance of developing liver disease.
Genetic changes can affect the risk. If a person experience changes in the genetic profiles of particular enzymes that are key to alcohol metabolism, such as ADH, ALDH, CYP4502E1, they will have a higher chance of developing alcoholic liver disease.
Stages of alcoholic liver disease
Alcoholic liver disease has four main stages.
Alcoholic fatty liver disease
Heavy drinking can cause fatty acids to collect in the liver. Sometimes, heavy drinking over a short period, even less than a week, can cause this. There are normally no symptoms, and this stage is reversible if the individual abstains from alcohol for at least 2 weeks.
If the accumulation of fatty acids in the liver is severe, the patient may experience weakness, nausea, abdominal pain, loss of appetite, and feel generally unwell.
Hepatitis means inflammation, or swelling, of the liver from any cause. In alcoholic liver disease, the liver undergoes inflammation. This can happen after many years of heavy drinking.
Alcohol is the main cause of liver disease in western countries.
More rarely, alcoholic hepatitis can affect individuals involved in binge drinking, or heavy drinking over a relatively short period.
If the patient abstains from alcohol for some months, alcoholic hepatitis is usually reversible. Some people may have to abstain for years.
Cirrhosis occurs when the liver has been inflamed for a long time, leading to scarring and a loss of function. This can be a life-threatening condition. Cirrhosis damage is irreversible, but the patient can prevent further damage by avoiding alcohol.
A long period of abstention can improve liver function, but if the damage is permanent and severe, the patient may need a liver transplant to survive.
During the early stage of cirrhosis, the patient will feel tired and weak, their palms may be blotchy and red, they lose more weight, have itchy skin, insomnia, abdominal pain and tenderness, and a loss of appetite.
In end-stage cirrhosis, there will be hair loss and continued weight loss, jaundice, dark urine, black or pale stools, dizziness, fatigue, loss of libido, bleeding gums and nose, easily bruised skin, edema, vomiting, with blood in the vomit, muscle cramps, irregular breathing, accelerated heartbeat, increased abdominal girth, personality changes, confusion, infections, and walking problems, for example, staggering.
As the liver no longer processes toxins properly, there will be heightened sensitivity to medications and alcohol.
Preventing alcoholic liver disease
To prevent alcoholic liver disease and other conditions linked to the consumption of alcohol, people are advised to follow national guidelines for alcohol consumption.
The guidelines classify moderate drinking as up to one drink a day for women, up to two drinks for men, and only over the age of 21 years. One drink is equivalent to 12 fluid ounces of beer at 5 percent alcohol, 5 fluid ounces of wine at 12 percent alcohol, or 1.5 fluid ounces of spirits at 40 percent alcohol.
The guidelines define high-risk drinking as four or more drinks on any day, or eight or more drinks in a week for women, and five or more drinks on any day or fifteen or more drinks per week for men.
Binge drinking is when a woman consumes four or more drinks, or a man consumes five or more drinks, within 2 hours.
The NIAAA also notes that everyone is different, and some people are more at risk than others from the effects of alcohol.