Important Tips for Recognizing and Preventing Alcoholic Liver Disease

Here at Westchester Health, many of our adult patients drink, some of them heavily. In these cases, we do our best to warn them of the dangers of heavy drinking over a long period of time, explain how this can damage many of their vital organs and threaten their life, and refer them to support groups and/or treatment facilities.

Our main concern is the damage long-term alcohol consumption can do to the liver. Alcoholic liver disease, the main cause of liver disease in the U.S., leads to a buildup of fats and scarring of the liver, both of which are very serious. To try and prevent this potentially fatal disease, we offer these guidelines for recognizing the causes, stages and risk factors, as well as ways to try to reverse its effects.

Why your liver is so important

Steven Silverman, MD

After the brain, the liver is the most complex organ in the human body, performing over 500 functions, including:

  • producing 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 blood clotting after an injury
  • storing energy

If your liver is damaged, it can affect your whole body. Unfortunately, this damage can take a long time to become noticeable since the liver is generally effective at repairing and regenerating itself. Often, by the time the damage is found, it is irreversible.

What causes alcoholic liver disease

Acetaldehyde is a toxic chemical produced by alcohol. It damages the liver and leads to liver scarring, such as cirrhosis or end-stage liver disease. Not all heavy regular drinkers develop liver damage, and it is not known why alcoholic liver disease affects some people and not others.

Risk factors for alcoholic liver disease

A number of factors increase the risk of developing alcoholic liver disease.

  1. People who drink beer and liquor are more likely to experience liver disease compared to those who consume wine or other alcoholic beverages.
  2. Women metabolize alcohol more slowly than men, making them more susceptible to developing alcoholic liver disease. Evidence suggests that women are twice as sensitive to alcohol-related liver damage as men.
  3. Women who consume high amounts of alcohol and also carry excess body weight have a greater chance of developing chronic liver disease and dying as a result of liver disease.
  4. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 13% of women who drink in the U.S. consume more than seven drinks in a week.
  5. Hepatitis C increases the risk of developing alcoholic liver disease. In addition, a regular drinker who has had any type of hepatitis has a higher chance of developing liver disease.
  6. Genetic factors can also affect someone’s risk. If a person experiences changes in the genetic profiles of particular enzymes that are key to alcohol metabolism, such as ADH, ALDH or CYP4502E1, they will have a higher chance of developing alcoholic liver disease.

The 4 stages of alcoholic liver disease

1) 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 to happen. There are normally no symptoms, and this stage is reversible if the person abstains from alcohol for at least 2 weeks. If the accumulation of fatty acids in the liver is severe, the person may experience:

  • weakness
  • nausea
  • abdominal pain
  • loss of appetite
  • feel generally unwell

2) Alcoholic hepatitis

Hepatitis describes the inflammation, or swelling, of the liver from any cause. In alcoholic liver disease, this can happen after many years of heavy drinking. It can also occur after binge drinking or heavy drinking over a relatively short period. Alcoholic hepatitis is usually reversible if the person abstains from alcohol for several months, or for some people, several years.

Symptoms may include:

  • pain or tenderness in the abdomen
  • jaundice (yellowing of the skin and whites of the eyes)
  • spider-like veins on the skin
  • general tiredness
  • fever
  • nausea
  • loss of appetite

3) Fibrosis

Fibrosis is an excessive accumulation of certain types of protein in the liver, including collagen. Fibrosis is present in most types of chronic liver diseases, and advanced liver fibrosis results in cirrhosis.

4) Cirrhosis

Cirrhosis of the liver occurs when the liver has been inflamed for a long time, resulting in scarring and loss of function. This can be a life-threatening condition. Cirrhosis damage is irreversible, but the person can prevent further damage by abstaining from alcohol. This can improve liver function, but if the damage is permanent and severe enough, the person may need a liver transplant to survive.

Early-stage cirrhosis:

  • feeling tired and weak
  • palms may be blotchy and red
  • weight loss
  • itchy skin
  • insomnia
  • abdominal pain and tenderness
  • loss of appetite

End-stage cirrhosis

  • hair loss
  • continued weight loss
  • jaundice
  • dark urine
  • black or pale stools
  • dizziness
  • fatigue
  • loss of libido
  • bleeding gums and nose
  • easily bruised skin
  • edema (swelling)
  • vomiting with blood in the vomit
  • muscle cramps
  • irregular breathing
  • accelerated heartbeat
  • increased abdominal girth
  • personality changes
  • confusion
  • infections
  • problems walking (staggering)

At this stage, since the liver no longer processes toxins properly, the person will have heightened sensitivity to medications and alcohol.

Guidelines for safe alcohol consumption

To prevent alcoholic liver disease and other conditions linked to the overconsumption of alcohol, we at Westchester Health advise our patients to follow the CDC national guidelines for alcohol consumption. NOTE: It’s important to keep in mind that everyone is different, and some people are more at risk than others from the effects of alcohol.

One drink is equivalent to:

  • 12 fluid ounces of beer at 5% alcohol
  • 5 fluid ounces of wine at 12% alcohol
  • 5 fluid ounces of spirits at 40% alcohol.

The guidelines classify moderate drinking as:

  • up to 1 drink a day for women
  • up to 2 drinks for men

And define high-risk drinking as:

  • 4 or more drinks in a day or 8 or more drinks in a week for women
  • 5 or more drinks in a day or 15 or more drinks in a week for men

Binge drinking is when a woman consumes 4 or more drinks, or a man consumes 5 or more drinks within 2 hours.

Resources and support groups to help you stop drinking

Concerned about your alcohol consumption and risk of liver disease? Come see us.

If you’ve become concerned about the amount of alcohol you’re drinking on a daily or weekly basis and the implications this might have for liver disease, please call (914) 232-1919 to make an appointment with one of our Westchester Health gastroenterologists (liver specialists). He/she will examine you, perform any needed tests, answer all your questions, explain what steps you can take to improve your liver function, and possibly refer you to a support group and/or treatment facility. If your condition is serious enough, you may need liver surgery or a transplant, which our gastroenterologist will discuss with you as well. Our #1 goal is to try to reverse disease and help you become as healthy as possible. Whenever, wherever you need us, we’re here for you.

By Steven Silverman, MD, a Gastroenterologist and Internist with Westchester Health, member of Northwell Health Physician Partners