Alcohol has been enjoyed by humans since early civilisation. It is often consumed in celebrations such as weddings, anniversaries and banquets. While mild to moderate drinking is delightful, excessive drinking can be serious and potentially fatal.
Excessive alcohol leads to excessive fatty acid synthesis in the liver, leading to accumulation of excessive fat in liver. Alcohol also leads to oxidative damage in the liver, causing inflammation and cell death.
When the liver is inflamed, fibrosis (scarring of the liver tissue) may occur. If the inflammation continues, the patient may develop liver cirrhosis (hardening of the liver) and liver cancer.
Unfortunately, liver disease is often a silent killer – there are usually no signs or symptoms in the early stages of liver damage. By the time a patient shows symptoms, it is often too late.
Patients with liver damage experience feelings of tiredness, abdominal discomfort, and weight loss. Patients with more serious liver damage will have more serious symptoms like abdominal swelling, leg swelling, mental confusion due to accumulation of toxins in blood, recurrent infection, and even vomiting of blood.
Risk of liver cirrhosis increases proportionally with daily alcohol consumption. While prevalence of cirrhosis is about 1% in patients drinking 30 – 60g of alcohol a day, the risk increases drastically to 5.7% in those consuming 120g daily.
One can of beer containing 5% alcohol has about 15g of alcohol, which is equivalent to one glass of red or white wine (which contains about 12 – 15% of alcohol), or one shot of hard liquor.
In layman terms, the safety limit of daily alcohol consumption is about 2 cans of beer, 2 glasses of wine, or 2 shots of hard liquor.
Women who consume alcohol tend to have a higher risk for alcohol liver damage due to their generally smaller body size and the slower rate at which the female body breaks down alcohol.
Binge drinking is particularly harmful as the body is not accustomed to breaking down such large amounts of alcohol at one go. The overload on the liver from binge drinking can be even more harmful than that from consuming alcohol regularly.
Abstinence is the cornerstone in treating alcoholic liver disease.
As alcohol addiction has psychological and physiological components, I usually manage my patients who have alcoholic problems with a counsellor or a psychiatrist.
Family and social support are also very important.
It is a fine balance between being gentle to an alcoholic patient and being firm in denying them further alcohol intake.
Adequate nutrition is another important aspect in management of liver disease. Alcoholics tend to be malnourished as their body metabolic rate tends to be higher. In these cases, shifting to a healthier diet and adding nutritional supplements can help manage the condition.
There are also specific medications/supplements for alcoholic liver damage which would require a doctor's prescription. With abstinence, a healthy diet and medication, even patients with a moderate degree of liver damage can see improvement after time.
I have witnessed many alcoholic patients reversing their liver damage 3 – 6 months after they start abstaining from alcohol and receiving appropriate specialist care.
However, there is a point of no return where a patient's liver is so badly damaged that their liver functions continue to deteriorate despite optimal medical care. For such patients, liver transplant would be necessary.
Drinking is enjoyable, but only within limit. Those who regularly consume alcohol should consult a specialist for medical evaluation. For those with serious liver damage caused by alcohol, a multidisciplinary team approach led by a liver specialist and consisting of psychiatrists, counsellors and dietitians would provide the best chance of reversing the liver damage.