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How Alcohol Affects Your Liver

The liver stands as one of the largest organs in the body, weighing 3.3 pounds. It performs many roles, including:

  • Filtering circulating blood
  • Eliminating toxic substances
  • Secreting bile into the small intestine for fat digestion and easier absorption 
  • Regulating blood-clotting mechanisms 
  • Converting products of protein metabolism into urea

The liver is also responsible for alcohol metabolism. When an individual consumes alcohol, an enzyme called alcohol dehydrogenase (ADH) begins to convert the ethanol in alcohol into acetaldehyde.

Acetaldehyde can be toxic to the body, even in low concentrations.

However, another enzyme called aldehyde dehydrogenase (ALDH) and an antioxidant called glutathione (GSH) convert the chemical compound into non-toxic acetate. Most of the acetate then circulates through the bloodstream to enter other energy- or molecule-producing metabolic cycles. 

When alcohol consumption is high, though, the liver cannot break down the substance quickly enough. This inability can lead to a build-up of acetaldehyde in the body and is one of many reasons that people suffer hangover effects after heavy alcohol intake. 

In other terms, drinking alcohol in large quantities, whether periodically or chronically, can cause liver damage, potentially leading to alcoholic liver disease. Extensive and chronic inflammation of the liver can result in three different types of liver disease:

  • Fatty liver disease
  • Alcoholic hepatitis 
  • Alcoholic cirrhosis 

Fatty liver disease and alcoholic hepatitis are reversible. Alcoholic cirrhosis, however, is permanent and usually fatal. 

Alcohol use can also worsen medical conditions like viral hepatitis responsible for the hepatitis C virus (HCV). When mixed, hepatitis C and alcohol use may contribute to liver fibrosis (scarring) and/or other health risks. 

Hep C and Alcohol

Hepatitis C is an inflammation of the liver caused by the hepatitis C virus. Unlike hepatitis A and hepatitis B, there is no current preventative vaccine available for the general population. There is treatment available, though.

There are two types of hepatitis C infection:

  • Acute hepatitis C arises within six months of exposure to the virus. Individuals may report mild symptoms like lack of appetite or jaundice (yellow skin or eyes) lasting a few weeks. 
  • Chronic hepatitis C develops in more than half of those who become infected with acute hepatitis C. In more severe cases, chronic HCV infection can cause liver injury, liver failure, cirrhosis, liver cancer, or death. 

In 2018, the CDC reported a total of 3,621 cases of acute hepatitis C in the United States. However, because initial infection does not often present with symptoms, many of those with HCV do not seek medical attention. The CDC estimates that the actual number of cases is underreported and reaches approximately 50,300. 

While alcohol use can worsen a hepatitis C virus infection, it will never cause the medical condition itself. If a doctor diagnoses an individual with HCV, the patient will be advised to stop drinking. Continual drinking, despite a doctor’s recommendation, can further damage liver cells and interact with HCV treatment. 

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How Much Alcohol Is Safe?

A person diagnosed with hepatitis C and continues to drink alcohol will soon discover that the damage has worsened and the disease has progressed faster. There is no "safe" alcohol level for people with hep C. The best thing to do is to completely avoid alcohol.

Patients with chronic hepatitis C infection who are also heavy drinkers are most likely to develop cirrhosis. However, those diagnosed with hep C and who do not drink alcohol have a lower risk of developing severe liver disease.

It is unclear how long an individual must abstain from alcohol use before the adverse effects of alcohol reverse. Because of this, quitting alcohol use should be explored as part of a treatment plan for people suffering from chronic HCV, especially those with compensated or decompensated cirrhosis. Patients should also avoid any illicit drug use.

Additionally, people who require peginterferon should abstain from alcohol for at least six months before beginning treatment. Peginterferon, sold under the brand name Pegasys (among others), is a medicine used to treat hepatitis C and B. Patients should also avoid drinking alcohol for at least six months following the completion of therapy.

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What is Alcoholic Hepatitis?

Alcoholic hepatitis refers to inflammation of the liver due to alcohol consumption. While the disease tends to occur in people who drink heavily over an extended period, there is still a risk for those who consume moderate quantities of the beverage. However, not all heavy drinkers will have alcoholic hepatitis. 

Common symptoms of alcoholic hepatitis include:

  • Fatigue and weakness 
  • Jaundice 
  • Lack of appetite
  • Nausea and vomiting
  • Usually low-grade fever 
  • Tenderness in the abdomen 

In more severe cases, symptoms may include:

  • Accumulation of fluid in the abdomen 
  • Changes in behavior or confusion 
  • Kidney failure
  • Permanent scarring of the liver (cirrhosis)

Those with hepatitis C are at a higher risk of developing alcoholic hepatitis. When left untreated, HCV places the liver under a great deal of stress, and consuming alcohol can further cause inflammation of the organ. Alcohol can also impair aspects of the body’s immune system, making it difficult for the viral load to decrease. 

The combination of hepatitis C and alcohol increases the risk of cirrhosis and consequently, the accelerated development of hepatocellular carcinoma (primary liver cancer). In one study, more than half of alcoholic patients with HCV developed the cancerous disease. 

Other Risk Factors of Drinking with Hepatitis C

Apart from alcohol consumption and HCV, other risk factors contribute to alcoholic hepatitis. These examples include:

  • Sex — alcoholic hepatitis poses a higher risk to women than to men. The primary liver enzyme responsible for breaking down alcohol is not as prevalent in women as it is in men. This means that women face more difficulty in metabolizing the substance.
  • Obesity — heavy drinkers who are overweight face a higher likelihood of alcoholic hepatitis and cirrhosis. 
  • Race and Ethnicity — Blacks and Hispanics have been associated with an increased risk of the disease.
  • Binge drinking — the risk increases for men who consume five or more drinks within two hours and for women who consume four or more within the same time frame. 
  • Malnutrition  — heavy drinking is associated with malnourishment due to either poor eating habits or the body’s inability to absorb nutrients. Alcohol and its byproducts can prevent nutrient absorption and result in liver cell damage. 

Treatment for Hepatitis C

To treat chronic liver disease, doctors will prescribe antiviral therapy. Hepatitis C treatment comprises 8 to 12 weeks of oral medication (pills). The treatment program is effective, curing more than 90% of cases with minimal side effects. 

If individuals decide to drink during treatment, the alcohol may interact with medication and worsen side effects. It is also important to remember that alcohol consumption can accelerate the disease progression of hepatitis C and result in permanent liver scarring. 

Can I Drink Alcohol After Treatment?

Healthcare professionals recommend not drinking alcohol after treatment. Even if cured of the disease, there may be liver scarring caused by the viral infection. Alcohol may increase that scarring. 

Similarly, alcohol use after hepatitis C treatment has been associated with the risk of liver cancer.

If you believe that you or a loved one are suffering from alcohol abuse, it is recommended to seek out professional medical help. Your healthcare specialist can provide you with a treatment plan that can guide you in your path to recovery. 

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Alcoholic Hepatitis,” Mayo Clinic, Mayo Foundation for Medical Education and Research, 30 Nov. 2018.

Hepatitis C Questions and Answers for the Public,” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 28 July 2020.

Lieber, Charles S. “Alcohol and Hepatitis C,” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services.

Mahler, Jacquelyn J. "Exploring Alcohol’s Effects on Liver Function", National Institute on Alcohol Abuse and Alcoholism, 1997.

Rizza, Stacey A. “Drinking after Hepatitis C Cure: Is It Safe?,” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Dec. 2019.

"What Is Viral Hepatitis?," National Institute of Diabetes and Digestive and Kidney Diseases (NIH), May 2017.

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