Alcohol Liaison Service Alcohol How It Affects Your Liver Information
Introduction Many people think that alcohol is fairly harmless - other than a few ill-effects the next day and perhaps some weight-gain, alcohol doesn t seem to have any long lasting effects. But alcohol can cause harm. Each year in the UK 150,000 people are admitted to hospital and 22,000 people die prematurely from alcohol related causes. That works out at 400 people dying every day. The cost to society has been estimated at over 20 billion. You don t have to be a heavy drinker to run into problems. Drinking just a bit more than you should over time can seriously harm your liver. Not feeling any side effects from drinking doesn t mean that you are not risking chronic ill-health or lasting liver damage from alcohol-related liver disease. The liver is your largest internal organ. Dealing with the alcohol you drink is just one of its many jobs. If you are drinking too much, your liver has to literally soak up the excess and with few nerve endings to signal pain, you won t know anything is wrong. 2
If you re drinking on a regular basis, the chances are that you won t feel anything happening until the damage to your liver is so severe that it could even be fatal. It is 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 and taking a few minutes to read this leaflet will help you understand the effect alcohol has on you and your liver. If you keep track of how much you drink, you should stay in better shape and be around for longer to enjoy it! What is alcohol? Alcohol is a drug produced by the fermentation of sugar in yeast. The main psychoactive ingredient in alcoholic drinks is ethanol or ethyl alcohol. Ethanol dissolves quickly in water and is 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. 3
Drinking more alcohol starts to affect the balance and 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 intestine (gut) and into your blood stream. The higher the concentration of alcohol, the faster it will be absorbed (e.g. whisky will be absorbed faster than beer). From the intestine, the alcohol is carried to your liver as well as other organs and body tissues. 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 processes about 90 per cent of the alcohol you drink to eliminate it from your body and it breaks down the alcohol into water, gas (carbon dioxide) and fat. 4
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 (1 unit per hour). If you re 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 and this is what causes hangovers. Acetaldehyde is then 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. 5
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 drink too much, you increase the chances of damaging your liver as it receives fat from both food and alcohol. Fatty livers return to normal if you drink within sensible limits. If you carry on drinking above that limit, you run the risk of more serious damage. Alcoholic hepatitis If you have a fatty liver and continue to drink, you have up to a 1 in 3 three chance of developing alcoholic hepatitis. 6
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 This is scar tissue that is generated to protect injured tissue from further damage which would usually disappear in a healthy liver. When the liver is damaged through excessive alcohol use, the scarring may keep building up and lead to fibrosis. Cirrhosis The final stage of alcoholic liver disease is cirrhosis which is usually the result of long-term, continuous damage to the liver. Irregular bumps, (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 and can lead to complete liver failure. 7
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 1 in 10 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 and each year, a small percentage of people with cirrhosis will develop liver cancer. Can I avoid liver damage? Everyone reacts to alcohol in different ways so it s difficult to tell in advance who is most likely to suffer liver damage. However, research shows that three groups may be more at risk than most: Women, partly because of their smaller body size and build People who are overweight People who inherit genes that don t allow proper metabolism of alcohol 8
How much can I drink? If you are healthy and eat a balanced diet then sensible drinking should not give you problems. But what is sensible drinking? The Department of Health currently offers the following guidelines for sensible drinking: Women should not regularly drink more than 2 to 3 units of alcohol in a single day (no more than 14 units in a week) Men should not regularly drink more than 3 to 4 units of alcohol in a single day (no more than 21 units in a week) After an episode of heavy drinking it is advisable to stop drinking for 48 hours to allow your body to recover. If you have alcoholic liver damage, cutting down will only reduce the rate of damage The symptoms of liver damage may disappear when you cut down the amount you drink, but this does not mean that damage is not taking place. Cirrhosis can develop even after drinking just a little too much over the years, with possibly no early warning signs of disease. Treatments are available that will alleviate the symptoms of cirrhosis but they cannot reverse it. 9
Stop drinking The most effective way to treat alcoholic liver disease is to stop drinking. For most people with fatty liver and alcoholic hepatitis the liver will recover and heal itself if they stop drinking. Even if you have cirrhosis, you will reduce any further damage to your liver and increase your chances of survival if you stop drinking. If you cannot stop, try contacting one of the organisations listed at the end of this leaflet. Diet Drinking alcohol can lead to malnutrition. The consumption of empty calories, a loss of appetite and poor absorption of food nutrients caused by alcohol s toxic effect on the gut can all play a part in this. Eating well is important in helping your liver recover. If you have alcoholic liver damage, it is likely that you lack vitamins, in particular thiamine, a B vitamin that helps the body convert carbohydrates into energy. Your doctor may prescribe vitamin supplements and it is important that you take them as prescribed. 10
Contacts Please see list of contacts for further information, advice or support The Alcohol Liaison Nurse Service 01536 491785 Monday to Friday 9am - 5pm Help with drinking All services are free and confidential Substance 2 Solutions (CRI) 01604 211304 www.cri.org.uk Rutland and Leicestershire Swanswell Charity: 0300 303 5000 Drinkline the national alcohol helpline available 24hrs/day 0800 917 8282 Reference: Information from the British Liver Trust http://www.britishlivertrust.org.uk 11
If you need this information in another format or language, please telephone 01536 492510. Further information about the Trust is available on the following websites: KGH - www.kgh.nhs.uk NHS Choices - www.nhs.uk Ref: PI.170 April 2014 Review: January 2016