Alcoholic liver disease, which arises from the overconsumption of alcohol, is the main cause of liver disease in Western nations. Viral hepatitis continues to be the major cause of liver disease in Asian countries, and several others. Experts say a considerable number of heavy, regular drinkers never develop liver damage - they do not fully understand why this is so and how exactly alcohol damages the liver.
We know that acetaldehyde damages the liver. Acetaldehyde is a toxic chemical produced by alcohol. It seems to affect some regular heavy drinkers' livers more severely than others. It takes a long time for any liver damage to become noticeable. The liver is amazingly good at regenerating and repairing itself. Even if three-quarters of a patient's liver is damaged, it is able to continue to function virtually normally.
Eventually, long-term heavy drinking takes its toll, resulting in liver scarring - cirrhosis or end-stage alcoholic liver disease.
The following factors increase the risk of developing alcoholic liver disease:
- Beer and liquor (spirits), compared to other alcoholic beverages
- Sex - women metabolize alcohol more slowly than men, and are thus more susceptible to developing the disease
- Hepatitis C. Regular drinkers who have had any type of hepatitis have a greater risk of developing the disease
- Changes in the genetic profiles of some enzymes which are key to alcohol metabolism, such as ADH, ALDH, CYP4502E1
- Some vitamin deficiencies, such as a lack of vitamins E and A
- Diet - many alcoholics eat poorly
- Iron overload
After the brain, the liver is the most complex organ in the human body, with over 500 functions. Some examples of liver functions include:
- Fighting infection and disease
- Filtering out blood toxins
- Manufacturing hormones, proteins and other vital chemicals
- Regulating our levels of blood cholesterol
- Storing energy
Alcoholic liver disease has three main stages:
- Alcoholic fatty liver disease - heavy drinking can result in an accumulation of fatty acids in the liver. Sometimes, the heavy drinking need only have occurred daily over a period of than less than a week. This usually asymptomatic (no symptoms) stage is reversible if the individual abstains from alcohol for a couple of weeks.
If the accumulation of fatty acids in the liver is severe, the patient may experience weakness, nausea, abdominal pain, loss of appetite, and malaise (generally feeling unwell).
- Alcoholic hepatitis - hepatitis means inflammation (swelling) of the liver from any cause. In this case it means swelling because of alcohol. After many years of heavy drinking the liver can swell. In rarer occasions alcoholic hepatitis can affect individuals involved in binge drinking - heavy drinking over a relatively short period. If the patient abstains from alcohol for some months, alcoholic hepatitis is usually reversible. In some cases abstention has to go on for years.
Symptoms may include pain or tenderness in the abdomen, jaundice (yellowing of skin and whites of the eyes), spider-like veins appear on the skin, general tiredness, fever, nausea and loss of appetite.
- Cirrhosis - the liver has been inflamed for a long time, causing scarring and loss of function. This can be a life-threatening condition. Cirrhosis damage is irreversible and the best the patient can do is prevent any further damage by stopping drinking. A long period of abstention will improve liver function. If the damage is severe, the patient may need a liver transplant to survive.
During the early stage the patient will feel tired and weak, their palms may be blotchy and red, they lose more weight, have itchy skin, insomnia, abdominal pain and/or tenderness, and loss of appetite.
During what is termed the end stage there will be hair loss, jaundice, dark urine, black or pale stools, dizziness, fatigue, loss of libido, bleeding gums and/or nose, the skin will easily bruise, edema, vomiting (with blood in vomit), muscle cramps, irregular breathing, accelerated heartbeat, personality changes, walking problems (staggering), and weight loss. As the liver no longer processes toxins properly there will be heightened sensitivity to medications and alcohol.
According to the NHS (National Health Service), UK, alcoholic fatty liver disease affects between 90% to 100% of heavy drinkers, approximately one in every four heavy drinkers eventually develops alcoholic hepatitis, and one in five of those with fatty liver disease will go on to suffer from cirrhosis.