Liver Health: Alcohol and liver health; How to drink responsibly |

Consumption of alcohol and its impact on the liver is a widely discussed topic in the health sector. The impact of consuming huge amounts of alcohol is known to all, but what remains unknown and unexplored is the data behind this. Alcohol-related liver diseases are rising, especially among young adults. As per a report published in the Journal of hepatology in 2023, liver disease accounts for two million deaths annually and is responsible for 4% of all deaths (1 out of every 25 deaths worldwide) and alcohol is one of the most common risk factors.
Alcohol-related liver diseases and other chronic liver diseases account for more than 2% of the deaths in India. For instance, Goa Medical College data reveals that out of the 5,500 patients admitted every month, 25% could have alcohol-related issues. Since 2021, Goa Medical College has been seeing more than 300 deaths annually due to alcoholic liver disease. And the profile of the typical patient is changing too. A few years ago, patients in their mid-forties and fifties would get liver cirrhosis, but today, it isn’t common to see even men in their early twenties. The age of drinking has fallen. Also, the quantity of drink consumed in a single sitting by some is high,” said senior psychiatrist Dr Rajesh Dhume, who is also a nodal officer at Drug Treatment Centre (DTC), North Goa district hospital told TOI.

Alcohol and liver health: How to drink responsibly

The burden of liver disease, including cirrhosis, is increasing globally and in India. This necessitates creating awareness, knowing more about the liver diseases associated with alcohol, and ways to modify lifestyle.

Globally, one in three people drink alcohol

Alcohol consumption is a major concern globally. In 2018, a study published in the Lancet found that globally, one in three people drink alcohol (equivalent to 2.4 billion people), and 2.2% of women and 6.8% of men die from alcohol-related health problems each year, which is equivalent to 2.8 million deaths each year worldwide. The Global Burden of Disease, on the health risks associated with alcohol between 1990 to 2016 in 195 countries, published in the Lancet suggests that there is no safe level of alcohol as any health benefits of alcohol are outweighed by its adverse effects. 2.4 billion people worldwide consume alcohol and on average, each day women consumed 0.73 alcoholic drinks, and men drank 1.7 drinks.

The wider burden of alcohol consumption

Alcohol exerts a multifaceted impact on the human body, affecting nearly every organ system and increasing the risk of various diseases and disorders. It is a ubiquitous part of many cultures worldwide and has a profound impact on the human body. From its initial consumption to its metabolism and eventual excretion, alcohol affects various systems and organs, sometimes with detrimental consequences. When alcohol is consumed, it rapidly enters the bloodstream through the walls of the stomach and the small intestine. Its effects begin to manifest as it reaches the brain, where it acts as a depressant on the central nervous system. This results in altered perception, impaired judgment, and reduced inhibitions, commonly known as intoxication. The extent of these effects depends on factors such as the amount of alcohol consumed, the individual’s tolerance, and their rate of consumption.

Beyond the immediate effects on cognition and behavior, alcohol affects numerous bodily systems. It can disrupt the normal functioning of the cardiovascular system, leading to increased heart rate and blood pressure. Prolonged heavy drinking can contribute to the development of conditions like hypertension, cardiomyopathy, and arrhythmias, significantly increasing the risk of heart disease and stroke.
Alcohol also affects the gastrointestinal tract, irritating the lining of the stomach and intestines and increasing the risk of conditions like gastritis, ulcers, and gastrointestinal bleeding. Chronic alcohol abuse is a significant risk factor for the development of gastrointestinal cancers, particularly those of the esophagus, stomach, liver, and colon.
Moreover, alcohol impairs the body’s ability to absorb essential nutrients, leading to deficiencies in vitamins such as B12, folate, and thiamine. These deficiencies can have far-reaching consequences, contributing to neurological disorders like peripheral neuropathy, Wernicke-Korsakoff syndrome, and cognitive impairment.
The immune system is also compromised by alcohol consumption, making individuals more susceptible to infections and impairing the body’s ability to heal from injuries and illnesses. Chronic alcohol abuse weakens the immune response, increasing the risk of infectious diseases like pneumonia, tuberculosis, and HIV/AIDS.
Alcohol’s impact extends to mental health as well. While it initially produces feelings of euphoria and relaxation, chronic alcohol abuse can lead to the development of mental health disorders such as depression, anxiety, and alcohol use disorder (AUD). These conditions can significantly impair an individual’s quality of life and increase the risk of self-harm and suicide.

Furthermore, alcohol consumption during pregnancy can have severe consequences for both the mother and the developing fetus. Prenatal exposure to alcohol can result in fetal alcohol spectrum disorders (FASDs), which encompass a range of physical, behavioral, and cognitive impairments, including facial abnormalities, growth deficiencies, intellectual disabilities, and behavioral problems.
While moderate alcohol consumption may have some purported health benefits, excessive or chronic abuse poses significant risks to physical and mental well-being. Education, awareness, and responsible drinking practices are essential for minimizing the adverse effects of alcohol on individuals and society as a whole.

Why is alcohol bad for the liver?

Alcohol metabolism in the liver is a complex process that can have significant effects on liver health when alcohol consumption exceeds the liver’s capacity to metabolize it. The primary pathway for alcohol metabolism in the liver involves the enzyme alcohol dehydrogenase (ADH). ADH converts alcohol (ethanol) into acetaldehyde, a toxic byproduct. Acetaldehyde is then further metabolized into acetate by the enzyme aldehyde dehydrogenase (ALDH), which is less toxic and can be further metabolized into carbon dioxide and water for elimination from the body.
Acetaldehyde, the primary metabolite of alcohol, is highly toxic and can damage liver cells. It reacts with proteins, DNA, and lipids, leading to oxidative stress, inflammation, and cell death. Acetaldehyde also impairs liver function by disrupting mitochondrial function, interfering with energy production, and inhibiting the synthesis of essential molecules.

Fatty liver: What are the symptoms, risk factors? How to manage it

Alcohol metabolism generates reactive oxygen species (ROS), such as free radicals and peroxides, which can cause oxidative damage to liver cells. ROS are highly reactive molecules that can oxidize lipids, proteins, and DNA, leading to cellular dysfunction and injury. Chronic alcohol consumption overwhelms the liver’s antioxidant defenses, leading to oxidative stress and further damage to liver tissue.
Alcohol metabolism disrupts the normal metabolism of fats in the liver, leading to the accumulation of fat droplets within liver cells. This condition, known as alcoholic fatty liver disease (AFLD), is an early manifestation of alcohol-induced liver damage and can progress to more severe liver diseases such as alcoholic hepatitis and cirrhosis.

World Liver Day

To create awareness around the liver and keep it healthy, World Liver Day is observed on April 19 every year. It was started by the European Association for the Study of the Liver (EASL) in 2010.
“The liver, a critical organ in the body, carries out essential physiological functions such as detoxification, regulating metabolism, and producing vital proteins. It holds the distinction of being the body’s largest organ and plays a crucial role in purifying blood before circulating it throughout the body. Despite its pivotal role, liver health is often neglected, resulting in around 1.5 billion individuals worldwide suffering from various liver diseases annually, including fatty liver disease. Chronic liver diseases claim the lives of nearly 2 billion people each year. These statistics underscore the importance of adopting healthy liver practices to safeguard our liver health,” says Dr Punit Singla, Director & HOD, Marengo Asia Hospitals Gurugram. Liver diseases may stem from various factors, spanning genetic predispositions to excessive alcohol intake and viral infections.

Foods that compromise your liver health (and what you should eat)

“Some tips for a disease-free, healthy liver are limiting alcohol consumption, Maintaining a healthy weight, Avoiding unhealthy foods, Getting regular check-ups, and timely vaccinations. Liver diseases can remain undetected for extended periods but may inflict significant harm in the interim or by the time symptoms manifest and the disease advances. This underscores the critical importance of routine evaluations of liver health, encompassing overall body health, to forestall the deterioration of liver conditions if they exist. Should symptoms of liver disease such as fatigue, jaundice, or abdominal discomfort arise, seeking prompt medical guidance is essential to address the issue as early as feasible,” Dr. Singla recommends.
“Here are some suggestions to help young adults moderate their alcohol intake: It’s important to know your personal boundaries; recognise the effects of alcohol on your body and adhere to them to prevent intoxication. Set limits for yourself by determining how many drinks you can have on any given occasion or week. To pace yourself and stay hydrated, switch up your alcoholic beverages with water or non-alcoholic ones to cut down on your overall intake,” says Dr. Saibal Chakravorty, Senior Consultant – Internal Medicine, Metro Hospital Noida. “To avoid dangerously high levels of drunkenness and the risks that come with them, such as accidents and alcohol poisoning, avoid binge drinking. Keep an eye out for peer pressure and surround yourself with friends who appreciate your moderation when it comes to drinking. When drinking, schedule your transportation in advance, either by hiring a driver or taking public transportation,” he added.

Modifiable lifestyle changes necessary to make

Balancing alcohol consumption with liver health is essential for minimizing the risk of alcohol-related liver diseases and maintaining overall well-being. Here are several strategies to help achieve this balance:

  • Limiting alcohol consumption to moderate levels is one of the most effective ways to protect liver health. Moderate alcohol consumption is generally defined as up to one drink per day for women and up to two drinks per day for men. This allows individuals to enjoy the social and cultural aspects of drinking while minimizing the risk of liver damage.
  • Understanding your own tolerance for alcohol and recognizing when you’ve reached your limit is crucial for preventing excessive consumption. Avoid binge drinking, which is defined as consuming four or more drinks within two hours for women and five or more drinks for men. Binge drinking puts significant strain on the liver and increases the risk of liver damage and other health complications.
  • Opt for alcoholic beverages with lower alcohol content, such as light beer, wine, or spirits mixed with non-alcoholic mixers. These beverages typically contain fewer calories and less alcohol per serving, reducing the overall impact on liver health. Avoid high-proof liquors and sugary, calorie-laden cocktails, which can increase the risk of liver damage and contribute to weight gain.
  • Drinking plenty of water while consuming alcohol helps to mitigate its dehydrating effects and aids in the body’s detoxification process. Alternate alcoholic drinks with water or other non-alcoholic beverages to maintain hydration and support liver function. Hydration is essential for flushing toxins from the body and reducing the strain on the liver.
  • Consuming a nutritious, balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats provides essential nutrients that support liver health. Incorporate foods that are high in antioxidants, such as berries, leafy greens, and nuts, which help to protect liver cells from oxidative damage caused by alcohol consumption. Avoid processed foods, saturated fats, and excessive sugar, which can contribute to liver inflammation and fatty liver disease.
  • Adopt lifestyle habits that promote liver health, such as getting regular exercise, maintaining a healthy weight, and avoiding exposure to toxins and pollutants. Exercise helps to improve circulation, metabolism, and detoxification, while maintaining a healthy weight reduces the risk of fatty liver disease and insulin resistance. Minimize exposure to environmental toxins and chemicals that can damage liver cells and impair liver function.
  • Schedule regular check-ups with your healthcare provider to monitor your liver health and assess any potential risks associated with alcohol consumption. Your healthcare provider can perform blood tests, imaging studies, and other diagnostic tests to evaluate liver function and detect early signs of liver damage or disease. Be honest with your healthcare provider about your alcohol consumption habits, as this information is crucial for assessing your overall health and well-being.
  • Periodically abstaining from alcohol or taking breaks from drinking can give your liver a chance to recover and repair any damage caused by alcohol consumption. Consider participating in alcohol-free days, weeks, or months to give your liver a break and reset your drinking habits. This can also help you reassess your relationship with alcohol and make healthier choices in the long run.

How to identify the onset of alcohol-related liver disease and get immediate medical assistance

Here are some key symptoms to be aware of:

  • Persistent fatigue and weakness are common early symptoms of ARLD. As the liver becomes damaged, its ability to store and release glucose for energy is compromised, leading to feelings of tiredness and lethargy.
  • Jaundice is characterized by the yellowing of the skin and the whites of the eyes. It occurs when the liver is unable to adequately process bilirubin, a waste product of red blood cell breakdown. Jaundice is a sign of significant liver damage and warrants immediate medical attention.
  • Individuals with ARLD may experience discomfort or pain in the abdominal region, particularly in the upper right quadrant where the liver is located. This pain can range from dull and achy to sharp and intense. Abdominal swelling, or ascites, may also occur due to fluid buildup in the abdominal cavity, further contributing to discomfort and distension.
  • ARLD can cause gastrointestinal symptoms such as nausea and vomiting, especially after meals or alcohol consumption. These symptoms may be accompanied by a loss of appetite and unintended weight loss.
  • Edema, or swelling, in the lower extremities is a common manifestation of advanced liver disease. It occurs due to fluid retention caused by decreased liver function and increased pressure in the veins that drain blood from the legs.
  • As liver function declines, the production of proteins necessary for blood clotting, such as clotting factors, is impaired. This can result in easy bruising, prolonged bleeding from minor injuries, and an increased risk of nosebleeds and gastrointestinal bleeding.
  • Pruritus, or itching, is a common symptom of ARLD, believed to be caused by the buildup of bile salts in the bloodstream due to impaired liver function. The itching is often generalized but can be particularly intense on the palms of the hands and soles of the feet.
  • Changes in urine and stool color can indicate liver dysfunction. Dark urine may result from the presence of bilirubin, while pale or clay-colored stools occur when the liver is unable to adequately excrete bile into the intestines for digestion.
  • Advanced stages of ARLD can lead to hepatic encephalopathy, a condition characterized by cognitive dysfunction, confusion, personality changes, and impaired motor function. This occurs due to the buildup of toxins like ammonia in the bloodstream, which affect brain function.
  • These are visible signs of liver disease characterized by the appearance of spider-like blood vessels on the skin (spider angiomas) and the dilation of veins in the abdomen resembling the legs of a spider (caput medusae). They result from increased pressure in the blood vessels due to liver damage.

Know the signs of liver problems in children

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