[Extracted from the website of British Liver Trust]
Most people think that alcohol is fairly harmless and just something to be enjoyed. Other than a few ill-effects the next day and maybe putting on a bit of extra weight, alcohol does not seem to have any long lasting effects. But alcohol can cause harm.
It is a mistake to think that you have to be a heavy drinker to run into problems. Although it can take as long as 10 to 20 years, drinking just a bit more than you should over time can seriously harm your liver. Not feeling any side effects from drinking does not mean that you are not risking chronic ill-health or lasting liver damage from alcohol-related liver disease. Vast numbers of us now fall into this category.
The liver is your largest internal organ. Among hundreds of jobs, it has to deal with the alcohol you drink. If you’re drinking too much, your liver has to literally soak up the punishment. With so few nerve endings to signal pain you won’t know that your liver is complaining. If you’re drinking a lot on a regular basis, chances are that you will not feel anything happening until your liver has had enough. The harm to your liver at this stage will be severe – and could even be fatal.
This is not an attempt to put you off drinking. Being more sensible about how you drink is the aim. It can be easy to underestimate how much alcohol you are drinking and often difficult to stop after a certain number of drinks. A little more knowledge about alcohol itself will help. Taking a few minutes to read this leaflet to help you understand the effect alcohol has on you and your liver is a big step in the right direction.
This information is written to signpost the ways to safer drinking. It gives you short and long-term odds on the things that will go wrong if you ignore them.
The message is simple: when you raise a glass, spare your liver a thought. If you keep track of how much you drink, you should stay in better shape and around for longer to enjoy it.
Jim's story
Jim is 55 years old. He used to visit his local pub most days to meet up with his mates. He had two to three pints at lunch and a couple of drinks in the evening (roughly 60 units of alcohol a week). Recently, over the course of a few weeks he noticed his abdomen had become swollen and tight. After tests, it was discovered that this was due to the build up of fluid (ascites), caused by cirrhosis of the liver. Jim took his doctor’s advice and has stopped drinking completely. After six months the fluid has gone and he is now feeling well and fitter, even though his liver will never fully recover. If he had continued drinking even a small amount, things could have been worse. Half of people with ascites die within two years of diagnosis.
What is alcohol ?
Alcohol is derived from the fermentation of sugar by yeast. It is a drug. The main psychoactive ingredient in alcoholic drinks is ethanol, or ethyl alcohol.
Ethanol dissolves quickly in water and is quickly absorbed into the bloodstream. In the short term, in small doses, it acts on receptors in the brain to make people feel uninhibited and provides a general sense of well-being. Drinking more alcohol starts to affect the balance and the speech centre of the brain. If you drink regularly, the brain’s receptors adapt to the alcohol and higher doses are needed to cause the same effect.
Alcohol is a depressant. Rather than acting as a stimulant, alcohol is likely to have the opposite effect on people who drink heavily.
What happens when you drink alcohol ?
Alcohol is quickly soaked up through the lining of the stomach and the upper part of the gut (intestine) and into your blood stream. The higher the concentration of alcohol, the faster it will be absorbed (whisky will be faster than beer, for example).
From there, the alcohol is carried to your liver as well as other organs and body tissue. Your brain will be affected by the flow of alcohol which acts on the central nervous system to alter your physical coordination and mental judgement.
Your liver cannot store alcohol. It metabolises (processes) about 90 per cent of the alcohol you drink to eliminate it from your body. It breaks down the alcohol into water, gas (carbon dioxide) and fat.
What happens to the liver if you drink too much ?
Along with the central nervous system, the liver suffers the most from alcohol consumption.
Your liver can only handle a certain amount of alcohol in any given time (one unit an hour). If you are drinking quickly, your liver cells will have to work overtime to process the alcohol. When this is more than the liver can deal with, the excess is transported to the rest of your organs.
Your liver needs water to do its job. As alcohol acts as a diuretic (makes you pass urine), it dehydrates you and forces the liver to divert water from elsewhere.
When the liver is processing alcohol it produces a substance called acetaldehyde. This has a toxic effect on the liver itself, as well as the brain and stomach lining. This is what causes your hangover.
Acetaldehyde is subsequently broken down into a chemical called acetate, which is broken down further into carbon dioxide and water outside the liver.
Regular and heavy drinking over time can strain or disrupt this process, leading to alcoholic liver disease.
The first stage of disease may not seem all that significant but must be acted upon. The later stages are very serious and can threaten your life.
Fatty liver
When the liver breaks down alcohol, it stores the fat in your liver. There should be little or no fat in a healthy liver. Too much of this fat can build up if you drink more than the liver can cope with, leading to fatty liver disease. You can get a fatty liver without drinking. This is called, perhaps unoriginally, ‘non-alcoholic fatty liver disease’ (NAFLD).
It is thought that if you are overweight and drinking too much, you will be increasing the chances of damaging your liver, as it receives fat from both food and alcohol.
Fatty livers return to normal if you drink within the sensible limit. If you carry on drinking above that limit you are running the risk of more serious damage.
Alcoholic hepatitis
If you have a fatty liver and continue to drink, you have up to a one in three chance of getting alcoholic hepatitis. This is a condition where your liver becomes puffy, swollen and tender. It can affect you suddenly – after a weekend of binge drinking, for example – and if your liver fails, it can kill you. Alcoholic hepatitis can happen to you at an early stage or after many years of excessive drinking.
Fibrosis
Scar tissue, which is generated to protect injured tissue from further damage and will disappear in a healthy liver, may keep building up. This scarring is known as fibrosis.
Cirrhosis
The final stage of alcoholic liver disease is cirrhosis. This is usually the result of long-term, continuous damage to the liver.
Irregular bumps, known as nodules, replace the smooth liver tissue and the liver becomes harder. The effect of this, together with continued scarring from fibrosis, means that the liver will run out of healthy cells to support normal functions. This can lead to complete liver failure.
By the time you discover you have cirrhosis your quality of life may be severely damaged as your liver will have stopped working efficiently. If you carry on drinking at this stage you will speed up the damage to your liver and rapidly increase your chances of dying.
The odds are one in ten that you will develop cirrhosis if you drink too much over a long period of time. In the UK, the number of people dying from cirrhosis each year is increasing.
As well as all the problems related to the liver not doing its job, people with cirrhosis also have a much higher chance of getting liver cancer. Each year, three to five per cent of people with cirrhosis will develop liver cancer.
Henry’s story
Henry is 35. He started drinking heavily with the Rugby Club at University and continued to see his friends at the pub where he drank up to five pints of strong lager three times a week (45 units of alcohol a week). Henry went on a ‘bender’ with friends abroad, drinking day and night for nearly a week. Afterwards he didn’t feel good and his friends noticed he looked a bit yellow. Henry’s doctor admitted him to hospital at once where he was treated for severe alcoholic hepatitis. Despite attempts to save him, Henry was among the one in 10 people who die despite treatment.
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