ALCOHOL AND ITS EFFECTS ON THE LIVER..

Alcohol Effects on the Liver

The liver is an organ that takes the most abuse from alcohol consumption and is probably the most commonly thought of when discussing the harming effects of alcohol on your body. It's also the subject of which the most information is available.1

Alcoholic Liver Disease (ALD) is a blanket term in which conditions related specifically to the liver and alcohol use fall under. The most prevalent types of Alcoholic Liver Disease, or ALD, are fatty liver, alcoholic hepatitis, and cirrhosis.1 Often, as people continue to drink heavily, they progress from fatty liver to hepatitis to cirrhosis. All three of the disorders can occur together.1 ALD – and particularly cirrhosis – has long been one of the most prevalent and devastation conditions caused by alcohol consumption and is one of the leading causes of alcohol-related death.2

Fatty Liver, which occurs after acute alcohol ingestion, is generally reversible with abstinence and is not thought to predispose to any chronic form of liver disease if abstinence and/or moderation are maintained.3 It is estimated by the National Institutes of Health that about 20 percent of alcoholics and heavy drinkers develop fatty liver, or steatosis.1 Other sources estimate that 90-100 percent of patients with heavy drinking will develop this disease.4 The condition can lead to death if alcohol consumption is not reduced or stopped.1

Alcoholic Hepatitis is inflammation of the liver caused by alcohol.1,5 This is usually diagnosed through a liver biopsy after common clinical signs including swollen liver, nausea, vomiting, fever, jaundice and abdominal pain, among others, are observed.1 Only a small percentage of heavy drinkers develop alcoholic hepatitis, yet the disease can occur in people who drink only moderately or binge just once. And though damage from alcoholic hepatitis often can be reversed in people who stop drinking, the disease is likely to progress to cirrhosis and liver failure in people who continue to drink. It is estimated that in severe cases, the mortality rate is 50 percent.1 If heavy drinking continues, 40 percent of those with alcoholic hepatitis will further develop into cirrhosis.1 Researchers are learning more about how and why alcoholic hepatitis occurs, but less is known about how to treat alcoholic hepatitis effectively. When damage is severe enough that the liver no longer functions, a transplant may be an option.5

Cirrhosis of the liver is the most serious and final form of ALD and a cause of many deaths and serious illnesses.1 Cirrhosis occurs when the cells of the liver are damaged and can't repair themselves. As live cells die, scar tissue forms. When this scar tissue builds up, blood can't flow through the liver properly.6 The primary job of the liver is to filter and clean the blood supply. When this tissue is scarred, it keeps blood from flowing normally causing a build up of poisons and wastes in the body.6 Prolonged periods of this poisoning and malnutrition lead to a condition known as hepatic encephalopathy, a condition in the brain with a bevy of problems that will be addressed separately. Women are at a greater risk then men in developing alcohol cirrhosis.6 Drunkenness is not essential for the development of this disease.7 About 10 percent to 15 percent of people with alcoholism develop cirrhosis, but many survive it. The 5-year survival rate for people with cirrhosis who stop drinking is about 90 percent, compared with 70 percent in those who do not stop drinking.1 Signs and symptoms of this disease may not be present until the disease is relatively advanced.7 The signs and symptoms include but are not limited to loss of appetite, nausea, jaundice, abdominal pain, fever, ascites (abdominal fluid buildup), confusion, thirst and fatigue.7 Once liver cells have been damaged, nothing can be done to repair the liver or cure cirrhosis.6 Treatment is aimed at avoiding further damage to the liver, and preventing and treating complication such as bleeding from broken blood vessels.6 Also stopping offending medications and alcohol is vital to the management cirrhosis.8

Alcohol can be a factor in several other forms of liver disease not specifically attributed to it, and may interact with risk factors for other forms of liver disease.1 An example of this is people with alcohol-related cirrhosis are at a higher risk of developing liver cancer. Those with Hepatitis B or C accompanied with heavy drinking are at a much higher risk of cirrhosis than with heavy drinking alone.1

Interestingly enough, mortality rates from cirrhosis have declined in the United States as well as some other countries since the 1970's. Some of the factors that have contributed to this decline are increased participation in treatment for alcohol problems and Alcoholics Anonymous membership, less consumption of alcohol and changes in the types of alcoholic beverages consumed.1


Alcohol, or ethyl alcohol (ethanol), refers to the intoxicating ingredient found in wine, beer and hard liquor.  Alcohol arises naturally from carbohydrates when certain micro-organisms metabolize them in the absence of oxygen, called fermentation.

Beer, wine and other liquor contain different amounts of alcohol.  The amount of alcohol in distilled liquor is known as ?proof?.  Proof refers to the amount of alcohol in the liquor; for example, 100 proof liquor contains 50% alcohol, 40 proof liquor contains 20% alcohol, and so on.  Traditional wine has approximately 8-14% alcohol, while regular beer has 4-6% alcohol.

Recent studies show that moderate use of alcohol may have a beneficial effect on the coronary system.  In general, for healthy people, one drink per day for women and no more than two drinks per day for men would be considered the maximum amount of alcohol consumption to be considered moderate use.  (By ?healthy? people, we are referring to non-pregnant women, individuals not addicted to alcohol, and people without pre-existing medical conditions, among others).  However, the amount of alcohol that a person can drink safely is highly individual, depending on genetics, age, sex, weight and family history, etc.  A ?drink? is considered to be:

    4-5 ounces of wine

    10 ounces of wine cooler

    12 ounces of beer
    1-1/4 ounces of distilled liquor (80 proof whiskey, vodka, scotch, or rum)

How Alcohol Travels Through the Body

Alcohol is metabolized extremely quickly by the body.  Unlike foods, which require time for digestion, alcohol needs no digestion and is quickly absorbed.   Alcohol gets ?VIP? treatment in the body ? absorbing and metabolizing before most other nutrients.  About 20 percent is absorbed directly across the walls of an empty stomach and can reach the brain within one minute.

Once alcohol reaches the stomach, it begins to break down with the alcohol dehydrogenase enzyme.  This process reduces the amount of alcohol entering the blood by approximately 20%.  (Women produce less of this enzyme, which may help to partially explain why women become more intoxicated on less alcohol than men.). In addition, about 10% of the alcohol is expelled in the breath and urine.

Alcohol is rapidly absorbed in the upper portion of the small intestine. The alcohol-laden blood then travels to the liver via the veins and capillaries of the digestive tract, which affects nearly every liver cell.  The liver cells are the only cells in our body that can produce enough of the enzyme alcohol dehydrogenase to oxidize alcohol at an appreciable rate.

Though alcohol affects every organ of the body, it?s most dramatic impact is upon the liver.  The liver cells normally prefer fatty acids as fuel, and package excess fatty acids as triglycerides, which they then route to other tissues of the body.  However, when alcohol is present, the liver cells are forced to first metabolize the alcohol, letting the fatty acids accumulate, sometimes in huge amounts.  Alcohol metabolism permanently changes liver cell structure, which impairs the liver?s ability to metabolize fats.  This explains why heavy drinkers tend to develop fatty livers.

The liver is able to metabolize about ½ ounce of ethanol per hour (approximately one drink, depending on a person?s body size, food intake, etc.).  If more alcohol arrives in the liver than the enzymes can handle, the excess alcohol travels to all parts of the body, circulating until the liver enzymes are finally able to process it. (Which is another good reason not to consume more than one drink per hour.).
How the Liver Breaks Down Alcohol

The alcohol dehydrogenase enzyme breaks down alcohol by removing hydrogen in two steps:

1.      Alcohol dehydrogenase oxidizes alcohol to acetaldehyde

2.      Acetaldehyde dehydrogenase oxidizes the acetaldehyde to acetyl CoA. These reactions produce hydrogen ions (acid). The B vitamin niacin (in its role as the coenzyme NAD) picks up these hydrogen ions (becoming NADH).  Thus when alcohol is metabolized, NAD diminishes and NADH increases.

    During alcohol metabolism, NAD becomes unavailable for the many other vital body processes for which it is needed, including glycolysis, the TCA cycle and the electron transport chain.   Without NAD, the energy pathway is blocked, and alternative routes are taken, with serious physical consequences:

    The accumulation of hydrogen atoms shifts the body?s balance toward acid.

    The accumulation of NADH slows the TCA cycle, resulting in a build up of pyruvate and acetyl CoA.  Excess acetyl CoA results in fatty acid synthesis and fat begins to clog the liver.   (An accumulation of fat in the liver can be observed after only a single night of heavy drinking).

Fatty Liver and Liver Disease

With moderate drinking, the liver can process alcohol fairly safely.  However, heavy drinking overtaxes the liver resulting in serious consequences.  A liver clogged with fat causes liver cells to become less efficient at performing their necessary tasks, resulting in impairment of a person?s nutritional health.  Fatty liver is the first stage of liver deterioration in heavy drinkers, and interferes with the distribution of oxygen and nutrients to the liver?s cells.  If the condition persists long enough, the liver cells will die, forming fibrous scar tissue (the second stage of liver deterioration, or fibrosis).  Some liver cells can regenerate with good nutrition and abstinence, however in the last stage of deterioration, or cirrhosis, the damage to the liver cells is the least reversible.
Alcohol and Malnutrition

For moderate drinkers, alcohol does not suppress food intake, and may actually increase appetite.  Chronic alcohol consumption appears to have the opposite effect.  Alcohol causes euphoria, which depresses appetite, so that heavy drinkers tend to eat poorly and become malnourished.

Alcohol is very rich in energy, packing 7 calories per gram.  But like pure sugar or fat, the calories are void of nutrients.  The more calories an individual consumes in alcohol, the less likely it is that they will eat enough food to obtain adequate nutrients.  To make matters worse, chronic alcohol abuse not only displaces calories from needed nutrients, but also interferes with the body?s metabolism of nutrients, leading to damage of the liver, digestive system, and nearly every bodily organ.

Health Effects of Alcohol Consumption

*Arthritis 
Increases risk of gouty arthritis

*Cancer
   Increases the risk of cancer in the liver, pancreas, rectum, breast, mouth, pharynx, larynx and esophagus

*Fetal Alcohol Syndrome
   Causes physical and behavioral abnormalities in the fetus

*Heart Disease
   Raises blood pressure, blood lipids and the risk of stroke and heart disease in heavy drinkers.  Heart disease is generally lower in light to moderate drinkers.

*Hyperglycermia
  Raises blood glucose

*Hypoglycemia
   Lowers blood glucose, especially for people with diabetes

*Kidney Disease
   Enlarges the kidneys, alters hormone functions, and increases the risk of kidney failure

*Liver Disease
   Causes fatty liver, alcoholic hepatitis and cirrhosis

*Malnutrition
   Increases the risk of protein-energy malnutrition,; low intakes of protein, calcium, iron, vitamin A, vitamin C, thiamine, vitamin B6 and riboflavin, and impaired absorption of calcium, phosphorus, vitamin D and zinc.

*Nervous Disorders
   Causes neuropathy and dementia; impairs balance and memory

*Obesity
   Increases energy intake, but not a primary cause of obesity

*Psychological disturbances
   Causes depression, anxiety and insomnia

To Drink or Not to Drink?

Moderate use of alcohol can be an enjoyable, safe experience if used with caution. If you do choose to drink, sip each drink slowly, and always consume alcohol with food.  Spaces drinks out to no more than one drink per hour, and consume plenty of water in between drinks.  Never drink while pregnant and never drive when intoxicated.

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