Recent research has shown a dramatic increase in liver diseases. Alcohol consumption is causing health problems, even at previously “moderate” levels.
In my role as an alcohol epidemiologist and internal medicine physician, I am interested in how alcohol consumption and liver disease are related in patients and the population at large. These topics have surprising connections, as it turns out.
Humans need the liver to survive. The liver is essential for metabolism, food storage and blood clotting. It also plays an important role in our immune system.
Alcohol is toxic at the cellular levels and is broken down mainly in the liver. Alcohol can cause liver damage and inflammation when consumed in excess.
Cirrhosis or liver dysfunction can result from severe scarring or inflamed cells. Cirrhosis is a serious condition that can lead to cancer of the liver.
What is the role of alcohol in liver disease?
Alcohol-related liver diseases or ALD are the old names for liver disease that is caused by drinking alcohol. Alcohol use disorders (AUD) and cirrhosis can be developed by heavy drinkers.
Alcohol-related liver diseases do not affect only people who drink heavily or AUD. Evidence is growing that chronic alcohol consumption at low levels can also affect liver function and cause disease. This applies to those who have other liver risk factors.
Even those who don’t drink much alcohol in general should be aware of the patterns of their alcohol consumption. Binge drinking, for example (defined as men drinking five drinks or more per occasion or women drinking four drinks) can be very harmful to the liver due to its high blood alcohol levels.
Even people with alcohol abuse disorders or who drink less than average can suffer liver damage from binge drinking.
What causes the increase in liver diseases?
In Canada and the United States, liver diseases have increased dramatically over the last 20 years. Alcohol consumption increased during this time period but has decreased in recent years. Canadian liver-related deaths increased 22 percent between 2016 and 2022.
Alcohol is not the only factor that contributes to liver diseases. Another is the rise of a condition called metabolic dysfunction-associated steatotic liver disease, or MASLD.
Alcohol is toxic at the cell level and is broken down primarily by the liver.
THE CANADIAN PRESS/Chris Young
MASLD, despite its complicated name is a form of liver disease caused by metabolic disturbances. These are the same ones that accompany the increase in obesity and overweight coupled with an inadequate amount of physical activity. These are the same risk factors which have contributed to an increase in diabetes. One can think of MASLD, then, as being the liver’s equivalent to diabetes.
Hepatitis C is also a major contributor to liver diseases and cirrhosis. It is a viral blood infection which can be contracted through the use of injection drugs and sharing needles.
Even though alcohol has been used to differentiate between non-alcohol liver diseases and alcohol-related liver disorders, it contributes towards the progression of non-alcoholic liver diseases such as hepatitis B and MASLD.
We studied patients from the Framingham Heart Study in America who had MASLD. Even among those who don’t drink heavily, we found a relationship between alcohol consumption and liver inflammation or fibrosis.
Even low-level alcohol consumption can accelerate the development of liver cancer in those who have hepatitis C. Research has found that each additional drink per day increases risk by 11 percent.
Alcohol and liver damage: Preventing or reducing the harm caused by alcohol
In order to improve the overall health of patients, it is important that steps are taken in advance. This includes screening for alcohol consumption in primary care and counselling for people with drinking problems. For this to work, more resources are needed for these interventions.
However, treating individual alcohol abusers does not solve the problem of public health. Instead, measures must be taken to reduce the consumption rate at the population-level.
It is the cornerstone to preventing liver disease, its disability and hospitalizations. Alcohol control policies are the best way to cut down on alcohol consumption.
- Increase the price of alcohol (for instance, by increasing alcohol taxes or minimum prices);
- Alcohol is less available, either because of restrictions (such as the hours or locations where alcohol can be purchased),
- Socially less desirable (such as limiting advertising, marketing and sports sponsorships).
Previous research has shown that states with stronger alcohol policies or those more restrictive by 10 percent had lower ALD rates. Moreover, even states with a five-percent increase in restrictiveness showed a reduction in ALD.
Alcohol-induced liver damage is a problem of public health. We all need to do our part to protect the liver by reducing alcohol consumption.
