How Alcohol Affects the Liver

The liver performs hundreds of critical functions. It creates essential proteins and produces a fluid called bile that helps digest fats. It helps regulate blood sugar levels and is a key part of the natural immune system. The liver also filters the blood, removing waste and harmful substances — such as alcohol. If alcohol use is excessive, the liver can be damaged.

How much alcohol is considered “excessive?” In general, the maximum number of drinks per week should be three for a woman and five for a man. It doesn’t matter what type of alcohol you drink — beer, wine, hard liquor and other types of alcohol all have the same effect on the liver.

“The difference is the amount of alcohol that's in different types of drinks,” explains Adam Deising, DO, a gastroenterologist and hepatologist at Scripps Clinic Torrey Pines, who specializes in treating people with acute and chronic liver disease. “There can be a higher concentration of alcohol in hard liquor as compared to certain beers, for example. However, I always tell people that alcohol is alcohol and that it does the same damage. The liver does not discriminate.”

In addition, those who have had bariatric surgery (such as Roux-en-Y bypass or gastric sleeve) need to be very cautious with how much alcohol they consume. The altered anatomy influences how alcohol is metabolized in the body and people with a history of bariatric surgery may be at increased risk of developing severe liver disease with less amounts of alcohol as compared to the general population.

Damage to the liver develops in several ways. Excessive alcohol intake can cause the liver to become very fatty, which may trigger a chain of events that lead to chronic liver inflammation. That inflammation can cause the liver to form scar tissue, a process called fibrosis. Over time, if the person continues drinking, fibrosis can progress to cirrhosis of the liver, which is defined as end-stage liver disease and can be fatal in many individuals.

Alcoholic hepatitis is a very severe form alcohol related liver inflammation. It develops when the liver is frequently exposed to too much alcohol either in a very short period or over a long amount of time, causing so much inflammation that the liver stops working properly.

Alcohol-related liver damage often has no symptoms until the damage is quite advanced. Alcohol hepatitis may present with jaundice, abdominal pain and swelling, edema, low-grade fever, nausea, anorexia and fatigue. In addition, patients may have low muscle mass, especially in the arms and legs and they may develop ascites (fluid in the abdomen). 

Finally, patients may not clear toxins from the liver very well, and these toxins build up and affect brain function, leading to confusion and other cognitive changes. Those who have cirrhosis of the liver may have similar symptoms and sometimes it can be challenging to differentiate the two conditions. Unfortunately, many people who have alcoholic hepatitis may also have underlying cirrhosis. 

Diagnostic tests for liver disease usually include blood work to check for elevated liver enzymes, low protein levels and other indications of liver issues. Imaging studies such as ultrasound or CT scan may show damage to the liver. Your doctor can also refer you to a liver specialist where an in-office procedure called vibration-controlled elastography can be performed. This test is non-invasive, quick and gives an approximate estimate as to how much liver damage someone may have.

If liver disease is found, the best immediate “treatments” are to permanently stop drinking alcohol and take steps to improve nutrition. A diet rich in protein is key. The liver needs a great deal of energy to function properly; if it is not getting the nutrients it needs, it will pull them from the muscles and other parts of the body, causing illness and weakness.

Many people who use alcohol may also need additional resources to help them stop drinking. There are many programs in the area that offer both in-person and on-line abstinence support services. Referral to a specialist who has experience in treating patients with addiction is required for some, in addition to treating any other underlying mental-health conditions that can act as triggers to drinking alcohol.

In cases where the disease is not advanced, the liver may recover with treatment.

“I like to think of the liver as a rubber band. When you stretch a rubber band and think of the tension on it as whatever is causing the liver injury, and you take away that tension, sometimes the rubber band goes back to its original shape,” says Dr. Deising. “If the liver is not already too damaged and you stop drinking, the liver can actually regain a lot of its function, and some of that inflammation and scar tissue can even reverse.”

Unfortunately, severely damaged livers may not recover. In such cases, a liver transplant may be necessary.

Liver disease related to alcohol use has become one of the leading causes of severe liver injury in the U.S. and is even being diagnosed in people in their 20s and 30s. Fortunately, it can be prevented.

“Many individuals don't even realize that the amount that they drink is causing liver damage,” says Dr. Deising. “I recommend that people be very aware of how much alcohol they're consuming. Just like the brain or the heart, we only have one liver and it's extremely important that we take excellent care of it.”