What is Alcoholic Liver Disease?

Can you explain the progression of alcoholic liver disease and how regular alcohol consumption can lead to this condition?

Alcoholic liver disease covers a spectrum of disorders - from the fatty liver to episodes of alcoholic hepatitis and culminating in cirrhosis, which is the end-stage and irreversible form of liver injury related to the alcohol consumption.

The liver tolerates some alcohol consumption, but as the consumption of alcohol increases, it leads to disorders of the metabolism of the liver. It varies with individuals. The initial stage involves the accumulation of fat in the liver cells, also known as fatty liver. If the consumption of alcohol persists, it can lead to alcoholic hepatitis. With continued and increased alcohol consumption, the liver disease may progress to severe irreversible damage to the liver known as cirrhosis, described by progressive scarring and nodules.

The amount and duration of the individual’s alcohol intake are the highest risk factors for the development of alcoholic liver disease. The type of alcohol plays a lesser role. Women are more susceptible than men. Obesity and high-fat diet also increase the risk of alcoholic liver disease. Concurrent hepatitis B/C infection is associated with more severe disease. Many other different factors, such as genetic, metabolic, environmental and immunological, all play a role in alcoholic liver disease.

One "standard" drink (or one alcoholic unit) contains about 14 grams of pure alcohol, which is found in approximately a can of beer, a glass of wine or a shot of spirits (e.g., whiskey, gin).

At-risk drinking is defined as:

  • Men: over 14 drinks/week or more than 4 drinks/occasion (Binge drinking)
  • Women: over 7 drinks/ week or more than 3 drinks/occasion (Binge drinking)

Significant drinking is defined as more than 21 drinks/week for Males, more than 14 drinks/week for Females and heavy alcohol use is defined as binge drinking more than 4 days a month.

What are the early warning signs and symptoms of alcoholic liver disease that people should be aware of, and when should they seek medical help?

Persistent and heavy drinking takes a huge toll on the liver, and can lead to a variety of problems such as liver inflammation, liver dysfunction and failure including fatty liver, hepatitis and fibrosis/cirrhosis of the liver amongst many other health and social problems such as pancreatitis, heart diseases, cancer and alcohol use disorder.

Early-stage alcoholic liver disease has little or no symptoms as the liver has a large capacity to compensate till a point where it starts failing. Warning symptoms are vague and non-specific, they can include -

  • Nausea and vomiting
  • Abdominal pain or discomfort
  • Loss of appetite or weight
  • Increased thirst
  • Fatigue, Weakness, Malaise
  • Fever (in alcoholic hepatitis)
  • Mood swings, Confusion, Alteration of the sleep cycles
  • Fainting episodes

Signs may include lower limb or abdominal swelling/accumulation of fluid, jaundice (yellow discoloration of eyes/ skin and tea-coloured urine), large spleen, parotid gland enlargement, white nails and engorged veins around the bellybutton or vomiting of blood.

People who have any of the above signs and symptoms, especially those with a significant history of heavy alcohol consumption and/or are carriers of Hepatitis B/C should seek early medical attention.

Anyone who thinks that someone has an alcohol problem or dependence should highlight and encourage the individual to seek help and support early.

Are there any misconceptions about alcoholic liver disease that you think are important to clarify for the public?

Humans do not need any alcohol for life, nutritional guidelines do not recommend that individuals who do not drink alcohol start drinking for any reason.

Although there are some purported health benefits of alcohol in limited amounts (e.g., red wine) for the heart and it may decrease the risk of strokes and diabetes. It must be highlighted any potential benefits of alcohol are relatively small and may not apply to all individuals.

Alcohol adds calories but has little to no nutrients and overall, the risk of consumption of alcohol far outweighs any benefits it may confer. Emerging evidence suggests that even drinking within the recommended limits may increase the overall risk of death from various causes, such as cancer and heart disease.

Can alcoholic liver disease be reversed at any stage, and what lifestyle modifications are most crucial for someone diagnosed with this condition?

Yes, the first stage is called alcoholic fatty liver disease, it involves the accumulation of small fat droplets around liver cells. Fatty liver disease rarely causes any symptoms, but it's an important warning sign that one is drinking at a harmful level. If one stops drinking alcohol for 2-3 weeks, the liver should return to normal. Fatty liver is generally considered a reversible condition.

There’s currently no specific medical treatment for alcoholic fatty liver disease. The main treatment is to stop drinking, period. This reduces the risk of further damage to the liver and gives it the best chance of recovering. There are many good alcohol treatment programs and support groups available as well.

To minimise the risk of other liver related diseases such as Hepatitis. Hepatitis A and B has good vaccines available and Hepatitis C has new effective antiviral therapy. Keeping a healthy and active lifestyle including regular exercises and a balanced diet will also minimise the risk of metabolic syndrome which includes obesity, high cholesterol, hypertension diabetes, heart diseases and fatty liver.

Could you discuss the latest advancements in treating alcoholic liver disease and any emerging research or therapies that show promise?

The only disease for which there is specific treatment is alcoholic hepatitis. Researchers have studied corticosteroids and pentoxifylline and have some reported some success. In recent years advances in the understanding of the molecular mechanisms of alcoholic liver disease have yielded the identification of new therapeutic targets, some of the emerging and promising therapies includes granulocyte colony-stimulating factor (GCSF), N-acetylcysteine (NAC), IL-1 receptor antagonist, though more studies and trials are required.

There are study groups actively looking at new treatments for alcoholic hepatitis and are also performing basic science and translational research into the mechanisms of liver injury in alcoholic hepatitis and related liver diseases.

A multidisciplinary approach and a sound public health policy are important - for timely identification and early treatment of liver-related complications, infectious and metabolic disease, malnutrition, and addiction counselling is key.

What are 10 Common Myths About Alcohol?

Alcohol has no nutritional value. It contains little to no vitamins, minerals or proteins. It does contain a significant number of calories.

The action of alcohol causes opening of the blood vessels on the skin surfaces, thus the person feels “warm” but the blood is cooled faster by greater exposure to the environment and lowering the body’s core temperature.

Hangovers are caused by the amount of alcohol consumed and the rate at which it is consumed, not by the kind of alcohol consumed. However, people who mix drinks may be drinking more alcohol because they are trying different kinds, resulting in a higher concentration of alcohol.

While metabolizing alcohol, the liver cannot perform its normal functions, one of which is keeping the blood sugar at a normal concentration- resulting on low blood sugar states (hypoglycaemia). The change in blood vessels and dehydration can cause headaches. Other components of alcoholic beverages might contribute to hangover symptoms or make a hangover worse such as congeners and sulphites. A hangover is actually a "mini-withdrawal" episode, when the central nervous system is released from the depressed state, the opposite state "rebound" develops-individuals may feel on edge and irritable.

Alcohol can lead to far greater harms than just a bad hangover. Alcohol is one of the causal factors in many traumatic accidents such as drunk driving, falls etc. Too much alcohol can suppress the central nervous system to such an extent, that it can lead to coma or death.

Alcohol is a depressant; it sedates the central nervous system. One of the first areas of the brain to be affected is the cerebral cortex, which controls judgment, self-control and inhibitions. The depression on this part of the brain may result in excitable behaviour, as inhibitions are lost.

Alcoholics are of many kinds: those who drink daily; those who drink on weekends; those who drink in binges which could occur weeks or months apart. The measure of alcoholism is not when or how often one drinks, but whether or not one can control the drinking once it begins.

Although a full stomach will help delay the absorption of alcohol into the bloodstream, alcohol will still get into your blood, depending on the amount consumed, you can still get drunk, albeit with a slower onset.

Those with alcohol use disorder cannot control their alcohol use well, and it can get worse over time. It may start out when one drink more, or more often than one planned. One might try to cut down but not succeed often and eventually, needing to drink more alcohol to feel the same effects. They may have nausea, crankiness, and other withdrawal symptoms if they suddenly stop drinking. There is treatment for alcohol use disorder such as medications, counselling and behavioural therapy and support programs.

Coffee, cold shower, fresh air, etc does not help to sober you up. It takes time for the body to metabolise and getting rid of the effects of alcohol. On the average, the body metabolises one standard drink per hour.

Many purported “hangover remedies” do not have strong scientific evidence of efficacy or safety, not anything more than placebo effects and may contain harmful substance as they are not as tightly regulated as they are marketed as supplements and not medicines in many countries.

Like other commonly misused substances, alcohol is highly addictive and causes tens of thousands of deaths every year due to health and social related effects of alcohol such as alcohol liver diseases, accidents, mental health issues etc. In fact, studies shown that alcohol-related deaths are one of the leading of preventable deaths in many countries, more than smoking and other illicit drug abuse.