5 Things You Need to Know about Alcohol and Your Liver

By Jeanene Swanson 01/05/15

The risk factors and techniques to prevent cirrhosis.

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While many people have complained of their “liver hurting” after a night of binge drinking, most won’t go on to develop alcoholic liver disease. “Probably about anywhere from 8 to 20% of chronic alcoholics will end up developing cirrhosis,” says Dr. Tim Pawlik, an expert on liver cancer at Johns Hopkins. While we still don’t understand why only a proportion of moderate to heavy drinkers get liver cirrhosis, what we do know is that if you continue to drink, you up your odds markedly. However, there are other risk factors that come into play besides alcoholic drinking—lending hope to the possibility of improved treatments.

Risk factors

There are different stages of alcoholic liver disease: fatty liver, alcoholic hepatitis (inflammation of the liver), and cirrhosis (fibrosis, or scarring, of the liver). Dr. Pam Peeke, who is the senior science advisor to Elements Behavioral Health and author of “The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction,” says that while fatty liver and alcoholic hepatitis are “fairly prevalent,” cirrhosis is “a whole different ballgame.”

While there are some reversible elements of cirrhosis, there has to be 100% abstinence in order to be able to achieve that.

“One in five people who are alcoholics develop [alcoholic] hepatitis, and one in four develop cirrhosis,” Peeke says. “You'll be at higher risk if you also have fatty liver—it’s those people who tend to be at higher risk for cirrhosis if they continue to drink.”

In fact, one study says that fatty liver will develop in about 90% of heavy drinkers, alcoholic hepatitis in 10 to 35%, and cirrhosis in about 10 to 20%. While there are some reversible elements of cirrhosis, “there has to be 100% abstinence in order to be able to achieve that,” Peeke says.

Amount of alcohol

While alcoholic liver disease typically occurs after years of heavy drinking—and the longer and more you drink, the more your chances increase—not all alcoholics get it. Drinking constantly puts someone at a higher risk than binge drinking on the weekends, or drinking irregularly throughout the week. “It seems like steady daily drinking versus binge drinking can be more harmful,” Peeke says.

“Research has found that five drinks or more per day raised the risk of developing cirrhosis,” says Kristie Moore, a registered dietitian nutritionist with Los Angeles-based Nutrition in Recovery. In fact, a daily intake of 60g or more in men per day for 20 years or more, and 20g per day for women significantly increases the risk of both hepatitis and cirrhosis. 

Gender

Women may be more likely to get it than men. The damage caused by alcohol happens more acutely in women: more severe, faster, and with less alcohol. Women are much more susceptible to alcoholic liver disease for a variety of reasons, including that they secrete less alcohol dehydrogenase (which breaks down alcohol), have a greater proportion of body fat (alcohol is soluble in water), and experience changes in fat absorption due to their menstrual cycles. 

Immune system

If a person’s immune system is already compromised, this increases the risk, too. “Current research has found that people who are infected with HIV or hepatitis C, or both, have an increased risk of advanced liver disease,” Moore says. “The reason behind this is not clear; however, it is known that these diseases increase liver cell death, and excessive alcohol intake possibly accelerates that process.” Other risk factors are age of infection and being male.

Pawlik warns that anything that makes the body work even harder to maintain its health is going to increase risk among drinkers for developing liver disease, including obesity and diabetes. “All the things that can affect your liver, if you have those other things and you drink on top of it, it’s like pouring gas on fire,” he says.

Genetics

“We’ve just now begun to understand the role of genetics, which is very strong,” Peeke says. Gene mutations that predispose someone to both developing alcoholism and alcoholic liver disease have to do with individual differences in the metabolism of alcohol. Mutations in genes such as ADH (alcohol dehydrogenase), ALDH (aldehyde dehydrogenase), and CYP4502E1 (one of the many cytochrome P450 enzymes) may partly explain this genetic link.

The importance of nutrition

A key problem for many alcoholics is a poor diet, which can both lead to malnutrition and exacerbate it. New frontiers in research are just beginning to discover how gut bacteria—or the gut microbiome—is affected by alcohol, which can change gut permeability and lead to problems absorbing and digesting food. “Several studies have demonstrated the importance of gut-liver axis,” says the abstract of a recent paper in the World Journal of Gastroenterology, with new treatments focusing on antibiotics, prebiotics, probiotics, and synbiotics.

“Malnutrition also increases oxidative stress, which is known to promote liver disease by the depletion of circulating antioxidants, including vitamins A, C, and E, and glutathione,” Moore says. “Altered fat metabolism leads to the increased production triglycerides that are deposited in the liver, contributing to fatty liver. Those suffering from malnutrition are also at higher risks of infection due to a suppressed immune system due to an altered protein status.”

When AA tells you to go and have a cookie, or when, at a meeting, your home group surprises you with a cake for your “soberversary,” the best thing you can do is not eat it. (That is, if you can resist!) Consuming refined carbohydrates and other junk food not only doesn’t help your sobriety, it undermines it, Peeke says. Simple sugars and other processed goodies can cause mood swings, putting recovering alcoholics at an increased risk of relapse. Their lack of nutritional value also contributes to the deficit that many malnourished alcoholics are suffering from. Most nutritionists interviewed instruct their patients in recovery from alcoholism and other substance use disorders to eat whole grains, proteins, and good fats.

In addition to loading up on high-quality proteins, healthy carbohydrates are key as well. “You’re striving to consume primarily 40% to 50% as vegetables and then adding high quality grains,” Peeke says. “Try to stay away from any refined, processed, simple foods, especially sugars. From 30 to 35% should be healthy fat, preferably unsaturated and/or essential fats. Vitamins B and D, omega fatty acids, and magnesium and zinc should all be included. "It's important to work with a registered dietitian who can make certain you're eating an optimal recovery diet."

“With oxidative stress playing an important role in the progression of [alcoholic liver disease], antioxidant therapy is important to the healing process,” Moore says. “Research has found that an important antioxidant, glutathione (GSH) is decreased in patients with fatty liver and hepatitis, leading to increased oxidative stress.” Supplementing with S-adenosylmethionine (SAMe), the precursor to GSH, could help reduce progression of liver disease in alcoholics.

Improper nutrition can undermine one’s recovery in another way: sugar addiction is real. By instructing alcoholics in recovery to essentially switch one drug, alcohol, for another, sugar, is simply encouraging the development of cross addiction, Peeke says.

In addition to abstinence, regular physical activity, and meditation, a critical component in the treatment of a recovering liver—and in general, a recovering alcoholic—is nutrition. “You can’t just stop alcohol and eat trash,” Peeke says. “Among alcoholics, their go-to high when alcohol is no longer available is refined sugar. [However] if you continue to eat trash, and you don’t get your micro- and macronutrients, then your recovery will never be optimized.”

Jeanene Swanson is a regular contributor to The Fix. She last wrote about substituting addictions and addiction among Hispanics.

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Jeanene Swanson is a science journalist who specializes in mental health and addiction. As a science writer with a background in biotechnology, she enjoys turning complex subjects into stories that everyone can understand—and apply to their lives. You can find Jeanene on Linkedin.

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