Hep C and Alcohol

How Alcohol Affects Your Liver

The liver is one of the largest organs in the body. It weighs 3.3 pounds.

It performs many roles, including:

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

The liver is also responsible for alcohol metabolism.

When a person drinks alcohol, an enzyme called alcohol dehydrogenase (ADH) converts 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 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, the liver cannot break down the substance quickly enough. This can lead to a build-up of acetaldehyde in the body. It is one of many reasons that people suffer hangover effects after heavy alcohol intake. 

Drinking alcohol in large quantities can cause liver damage. This can potentially lead 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. It is 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 occurs within six months of exposure to the virus. People 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. Chronic HCV infection can cause liver injury, liver failure, cirrhosis, liver cancer, or death in more severe cases.

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 people with HCV do not seek medical attention. The CDC estimates that the actual number of cases is underreported and reaches approximately 50,300. 

Vital Signs: Newly Reported Acute and Chronic Hepatitis C Cases ― United States, 2009–2018, CDC

Alcohol use can worsen a hepatitis C virus infection. However, it will never cause the medical condition itself.

If a doctor diagnoses someone with HCV, the patient will be advised to stop drinking.

Continual drinking, despite a doctor’s recommendation, can further damage liver cells and affect HCV treatment. 

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What is Alcoholic Hepatitis?

Alcoholic hepatitis refers to inflammation of the liver due to alcohol consumption.

The disease tends to occur in people who drink heavily over an extended period. However, there is still a risk for those who consume moderate quantities of alcohol.

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
• Low-grade fever 
• Tenderness in the abdomen 

In more severe cases, symptoms may include:

• Collection 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. Consuming alcohol can further cause inflammation of the organ.

Alcohol can also affect the body’s immune system. This makes it difficult for the viral load to reduce. 

The combination of hepatitis C and alcohol increases the risk of cirrhosis. This leads to the quickened development of hepatocellular carcinoma (primary liver cancer).

How Much Alcohol Is Safe?

A person diagnosed with hepatitis C which continues to drink alcohol will soon discover that the damage has worsened. The disease will progress faster.

There is no "safe" alcohol level for people with hep C. It is best to avoid alcohol altogether.

Patients with chronic hepatitis C infection who are also heavy drinkers are most likely to develop cirrhosis.

Those diagnosed with hep C 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 part of a treatment plan for people suffering from chronic HCV. This especially refers to those with compensated or decompensated cirrhosis.

Compensated cirrhosis refers to when you do not have any symptoms of the disease.

Decompensated cirrhosis is when the condition has progressed to the point that the liver is having problems functioning. When you begin having symptoms of the disease, you have 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 is a medicine used to treat hepatitis C and B. The medicine is sold under the brand name Pegasys (among others).

Patients should also avoid drinking alcohol for at least six months following therapy.

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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 common in women as 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 linked with an increased risk of the disease.
• Binge drinking — the risk increases for men who consume five or more drinks within two hours and women who consume four or more within the same time frame. 
• Malnutrition  — heavy drinking is linked with malnourishment. This is typically 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 includes eight to 12 weeks of oral medication (pills).

The treatment program is effective. It cures more than 95% of cases with minimal side effects.⁸ 

If patients 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 quicken the disease progression of hepatitis C. This can 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 is suffering from alcohol abuse, it is best to seek 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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