How Alcohol Impacts The Liver

How Does Alcohol Affect The Liver?

While alcohol misuse affects many organs and systems in the body, it primarily affects the liver, as the liver plays a primary role in metabolizing alcohol.

The liver acts as the primary filter to break down toxins and other harmful substances, such as drugs and alcohol, into less harmful by-products. The liver also stores and releases the body’s glucose supply, produces bile, produces important proteins for maintaining blood volume, and stores essential vitamins and nutrients.

How Alcohol Is Metabolized Through The Liver

Approximately 90% of the alcohol absorbed into the bloodstream is metabolized by the liver, primarily through the oxidative pathway.

In the first step of the oxidative pathway, alcohol is broken down into acetaldehyde by the enzyme alcohol dehydrogenase (ADH). Acetaldehyde is a highly toxic compound associated with alcohol metabolism in the liver. Acetaldehyde distorts liver function and structure, is a known carcinogen, and damages chromosomes, which are important building blocks for genetic information.

In the second step of the oxidative pathway, acetaldehyde is broken down into acetate by aldehyde dehydrogenase (ALDH). Acetate is then broken down into carbon dioxide, water, and oxygen for easy elimination. In addition to the oxidative pathway, fatty acids bind to and remove small amounts of alcohol. In this process, they form compounds called fatty acid ethyl esters (FAEEs), which are also toxic to the liver.

It takes the liver approximately one hour to process one standard alcoholic beverage. Therefore, if a person consumes more than one standard alcoholic beverage per hour, the liver becomes overwhelmed and the alcohol begins to build up in the bloodstream, increasing the blood alcohol content.

The higher someone’s blood alcohol content, the longer it takes to process alcohol, as the liver can only process a certain amount of alcohol at a time. As more unmetabolized alcohol builds up in the bloodstream, the person feels the effects of alcohol intoxication. This increase in alcohol in the bloodstream not only affects vital organs, such as the brain and the heart, but also affects judgment and coordination.

Unhealthy alcohol consumption, whether binge drinking or chronic alcohol consumption, causes destruction of the liver in phases, starting with fatty liver disease, followed by alcoholic hepatitis, and then scarring of the liver (cirrhosis). Although this is the normal progression of alcohol liver diseases, heavy drinkers may develop alcoholic cirrhosis without first developing hepatitis.

How Does Mixing Alcohol And Drugs Affect The Liver?

Mixing alcohol with other drugs, including prescription medications, over-the-counter drugs, or illicit drugs, can also be very dangerous for your liver.

Never consume alcohol and medications or drugs at the same time, without speaking with your physician first. When combined, certain medications (such as acetaminophen (Tylenol) can lead to severe damage to your liver.

Other medications that are dangerous to combine with alcohol include certain antibiotics, antidepressants, benzodiazepines, sedatives, and painkillers.

What Is Alcohol-Associated (Alcoholic) Liver Disease?

Alcoholic liver disease is liver damage caused by alcohol use. Clinical experts have changed the name from alcoholic liver disease to alcohol-associated liver disease, as a person does not have to have an addiction or dependency to alcohol for their alcohol consumption to damage their liver.

Liver damage can result from heavy alcohol use, regardless of whether there is an addiction or dependency. Frequent drinking, binge drinking, and chronic drinking can damage the liver in a stepwise fashion, starting with fatty liver disease, followed by alcoholic hepatitis, and then scarring of the liver (cirrhosis). Signs and symptoms of alcoholic associated liver disease do not occur until the liver has been severely damaged.

Stages Of Alcohol-Associated Liver Disease

The three progressive stages of alcohol associated liver disease include steatosis (fatty liver disease), alcoholic hepatitis, and cirrhosis of the liver.

1. Steatosis (fatty liver disease) is the earliest stage of alcohol associated liver disease and occurs from fat buildup in the liver. When the liver metabolizes alcohol, it increases fat cell production (free fatty acid buildup) and decreases fat breakdown (fatty acid oxidation), both of which contribute to the accumulation of fat in the liver. Steatosis is usually asymptomatic and can be reversible if the person stops drinking. Steatosis is suspected in individuals with elevated liver enzymes. It can be confirmed through imaging studies, such as ultrasound or CT scans, which reveal fatty buildup within the liver. If the person continues to drink, steatosis can progress to alcoholic hepatitis.

2. Alcoholic hepatitis is characterized by progressive inflammation that occurs from the chronic fat buildup in the liver in people with long-term, heavy alcohol intake. Alcoholic hepatitis in mild forms can be reversible and asymptomatic. Still, in more severe forms, it can present with yellowing of the skin (jaundice), fatigue, elevated liver enzymes, upper abdominal swelling, and hepatomegaly.
3. Cirrhosis is the late stage of chronic liver disease from long-term alcohol use, and it occurs when the inflammation in the liver permanently damages the liver, turning healthy liver tissue into scar tissue. It is considered late-stage and even end-stage liver disease. As scar tissue continues to form in the liver, the liver shrinks, and its function continues to decline. People can present with fluid in the abdomen (ascites), confusion, fatigue, yellowing of the skin (jaundice), bleeding disorder, and a shrunken liver on imaging tests. Cirrhosis is irreversible.

Signs And Symptoms Of Alcohol-Associated Liver Disease

People who regularly abuse alcohol have a compounded risk of developing liver disease if they develop an infection or are genetically predisposed to liver problems. Those consuming more than two drinks daily put themselves at risk of liver disease.

Common symptoms of liver disease include:

• Yellowish skin and eyes (jaundice)
• Abdominal pain and swelling
• Swelling in the legs and ankles
• Dark urine
• Nausea or vomiting
• Itchy skin
• Tendency to bruise and bleed easily
• Chronic fatigue
• Fever
• Disorientation and confusion
• Weakness
• Loss of appetite
• Pale, bloody, or tar-colored stool
• Increase in liver enzymes

Liver disease caused by alcohol is avoidable. Most reputable sources cite moderate alcohol consumption as one drink per day for women and two drinks for men. In general, there isn’t a type of alcoholic beverage that is safer for the liver.

Short-Term Damage To The Liver

The damaging short-term effects of alcohol on the liver can occur when people consume more than one drink per hour, or if women consume two or more drinks per day, or men consume three or more drinks per day.

The increase in alcohol in your system will reduce your liver’s ability to break down and process fat, and as a result, fat will begin to deposit in the liver, a condition called steatosis. Although people are generally asymptomatic during this time frame, this short-term effect can lead to further progression of alcoholic liver disease with long-term damage to the liver when people continue to consume alcohol in unhealthy amounts.

Long-Term Damage To The Liver

Long-term damage to the liver can be defined as having alcoholic hepatitis or cirrhosis, which can present as yellowing skin, ascites, bleeding disorders, fatigue, swelling in the abdomen and lower limbs, and hepatic encephalopathy. Hepatic encephalopathy is a sign of end-stage liver disease and occurs when the liver can no longer process toxins in the blood, such as ammonia, which builds up in the brain. Symptoms include:

• Confusion
• Disorientation
• Flapping tremors
• Slurred speech
• Excessive sleeping
• Coma

Liver cancer can also occur from long-term alcohol consumption. Cirrhosis can lead to end-stage liver disease, where the liver is too damaged to regain function, and the only cure is a liver transplant.

How Much Alcohol Can You Drink Before It Affects Your Liver?

Experts conclude that the impact of alcohol’s effects depends on many factors, including a person’s weight, size, and whether they are male or female. Women absorb more alcohol from each drink in comparison to men, so they are at greater risk of liver damage, since it takes longer for the liver to metabolize one drink in women compared to men.

Most cases of alcoholic liver disease occur in people who have consumed heavy amounts of alcohol, typically 3 to 6 drinks per day, for 10 years or more.

The safest way to protect your liver is not to drink alcohol at all. If that doesn’t feel realistic, avoid heavy drinking and aim to average less than one drink per day.

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Is Alcohol-Associated Liver Disease Reversible?

Some alcohol associated liver diseases can be reversible with abstinence from alcohol, depending on the stage of the liver disease:

• Fatty Liver Disease: Reversible with abstinence.
• Alcoholic Hepatitis: Can be reversible with abstinence, depending on the stage of alcoholic hepatitis.
• Cirrhosis: Abstinence is helpful; however, it is often irreversible and fatal due to secondary complications. A liver transplant can restore liver function.
• Liver Cancer: Abstinence is helpful; however, it is most often irreversible and fatal. A liver transplant can restore liver function.

Liver Transplant

For people with cirrhosis, a liver transplant can be a life-saving solution. The scarred and non-functioning liver is replaced with a new one, effectively eliminating the problems caused by end-stage cirrhosis. However, this option is reserved for those with no effective medical or surgical alternatives, who are considered a low risk for relapse, and who are ready to commit to the life-long medication regimen it requires.

For people with liver cancer, a liver transplant can be a curative option for carefully selected patients. Because the entire liver is removed, the transplant eliminates both the tumor and the underlying liver disease that often contributed to the cancer in the first place. However, this option is only available when the cancer has not metastasized and if the tumor meets size and number requirements. Chances of long-term success are greatly reduced if the cancer has spread to other parts of the body.

Treatment For Alcohol Addiction

Alcohol addiction is best treated with the goal of abstinence in mind, especially if you have signs and symptoms of alcohol related liver damage. Alcohol related liver damage can be reversible with abstinence, but if you continue to drink, alcohol can worsen the liver disease, and this can eventually be fatal.

There are no FDA-approved medications that treat alcohol associated liver disease directly; however, some healthcare providers may prescribe short-term steroids or pentoxifylline to help reduce inflammation in severe alcoholic hepatitis.

If you are at risk of alcohol withdrawal, then detox in a medically supervised setting is highly recommended, as alcohol withdrawal can be deadly. During detox, benzodiazepines may be administered to prevent alcohol withdrawal seizures. Once you have safely undergone an effective detox program, you can either enter inpatient or outpatient alcohol addiction treatment, depending on the severity of your alcohol use disorder, your social support structure, and insurance status.

Medications such as naltrexone, acamprosate, and disulfiram can be administered to help reduce urges and cravings. Psychotherapy options in the form of individual and group therapy that offer cognitive behavioral therapy can help you understand your triggers, the unhealthy thoughts and behaviors associated with alcohol use, and how to adopt healthy coping skills.

Find Support Today

If you or someone you love is struggling with alcohol misuse and are worried about its impacts on the liver, it may be time to seek help. To learn more about your treatment options, contact a treatment provider or visit our rehab directory to find a rehabilitation center today.