The average liver can process the equivalent of about one small drink an hour. When you drink heavily, it puts a strain on your liver and disrupts how your liver processes the alcohol. Alcoholism can lead to three primary liver conditions: fatty liver, hepatitis and cirrhosis.
The sooner a person stops drinking, the better off their body will be in the long run. Once the liver undergoes fibrotic changes, it cannot be fully repaired.
Table of Contents
How Does Alcohol Affect the Liver?
Alcohol is known to cause long-term impairment and damage to the liver, especially in those who use alcohol over a long period of time or drink large amounts. Alcohol damages the liver initially by accumulating fat in the liver. This stage is called alcoholic fatty liver disease. This condition leads to alcoholic hepatitis, or inflammation and irritation in the liver. That inflammation causes irreversible scarring of the liver or cirrhosis. While fat accumulation and inflammation are reversible, the scarring they eventually cause is not. A scarred liver has irreparable liver damage with long-term health effects that may be fatal.
What is Alcoholic Fatty Liver Disease (AFLD)?
Alcoholic fatty liver disease (AFLD) is the first stage of liver disease. In AFLD, fat gets deposited in the liver cells, harming them. Most people who drink heavily over a long time will develop AFLD. There are two types of fatty liver disease:
- Non-alcoholic fatty liver disease, or NAFLD: Of the two conditions, NAFLD is not thought to be linked to alcohol use. However, doctors are currently unsure of what causes the condition. Although sometimes NAFLD is mild, it can progress in some patients. Studies have not clearly shown whether small amounts of alcohol are safe to consume if you have NAFLD. Therefore, it is crucial to talk to your doctor about your particular circumstances to see if moderate drinking is safe for you or not. Heavy drinking should be avoided with NAFLD.
- Alcoholic fatty liver disease, or alcoholic steatosis: When you have alcoholic fatty liver disease, the cells in your liver start to build up with too much fat. Drinking alcohol causes your body to make fat, and also prevents your body from getting rid of some of the fat you have. All of this extra fat is then deposited inside your liver cells, where it can do damage. Some fat can even move from other areas of your body to your liver after you drink.
Signs & Symptoms of AFLD
Unfortunately, AFLD itself has very few symptoms. The main AFLD symptoms include:
- Feeling tired
- Having discomfort in your upper right abdomen
- Yellow coloration of the skin or whites of the eyes
Because there are so few symptoms, it can be hard for doctors to make a diagnosis for AFLD in the early stages. The disease is often found if you need to have imaging done, or if you have a blood test that comes back showing problems with the chemicals in your liver. Sometimes, doctors are not able to find alcoholic fatty liver disease until it progresses into a more dangerous condition like cirrhosis.
Treatment of AFLD
Alcoholic fatty liver treatment mainly relies on changes to your lifestyle. These changes can include:
- Quitting alcohol completely
- Eating a healthy diet
- Weight loss, if you are overweight
- Exercise, which may reduce the amount of fat in the liver
Getting vaccinations such as hepatitis A, hepatitis B, pneumonia, and your yearly influenza (flu) shot will not treat AFLD but may help prevent more serious conditions from occurring later. It is also important to talk to your doctor before taking any vitamins, herbs or supplements. Some products can further damage your liver.
What is Alcoholic Hepatitis?
Alcoholic hepatitis is inflammation of the liver, and regular use of alcohol can promote its development. The inflammation disrupts the liver’s normal functions and can lead to several distressing and potentially deadly symptoms.
Symptoms & Causes of Alcoholic Hepatitis
Some cases of acute alcoholic hepatitis may not cause symptoms, and people who are developing alcoholic hepatitis may not know until it becomes more advanced. These symptoms may include:
- Confusion, due to the buildup of the toxin ammonia
- Swelling in the abdomen caused when the liver does not make enough of a protein called albumin
- Bleeding that may be severe because the liver does not produce enough of the proteins needed for blood clotting
- Bleeding in the throat caused by weakened blood vessels that occur with hepatitis
- Yellowing of the skin and whites of the eyes, also called jaundice, occurs when the liver cannot break down a substance called bilirubin. The jaundice alcoholic hepatitis causes is not dangerous in and of itself. However, it indicates that other dangerous liver conditions are likely present. People who experience jaundice should seek immediate medical care.
Scientists are not entirely certain what it is about alcohol that causes alcoholic hepatitis. However, heavy alcohol use plays an important role. Without alcohol use, there is virtually no risk at all for developing alcoholic hepatitis. When alcohol use is stopped, the inflammation from alcoholic hepatitis may eventually go away completely.
Several other risk factors may, when combined with alcohol misuse, make the risk of developing alcoholic hepatitis greater. These risk factors include:
- Poor nutrition
- Immune system disorders or diseases
- Viral illnesses, especially hepatitis B or hepatitis C
- Use of Tylenol, especially over a prolonged period of time
- Age over 55
- Female gender
Treating Alcoholic Hepatitis
Alcoholic hepatitis treatment involves stopping the use of alcohol and supporting the liver as it heals. Alcohol cessation is the crucial part of the initial treatment because as long as alcohol is used, there will be more inflammation. The good news is that, over time, the inflammation of the liver can subside once alcohol use is stopped.
Medications may be used to stop or reduce inflammation. The primary medication used to treat alcoholic hepatitis is steroids. These medications reduce inflammation and suppress the body’s immune system. Steroids may also help to reduce recovery time.
While malnutrition plays a smaller role, following a healthy and nutritious diet while maintaining a healthy weight has been shown sometimes to improve the symptoms of alcoholic hepatitis.
Unfortunately, the inflammation can lead to scarring, also called alcoholic cirrhosis. This scarring cannot be reversed and will have more permanent, long-term effects.
What is Cirrhosis?
When you drink excessively, particularly over long periods, the healthy tissue of your liver is replaced with scar tissue. Cirrhosis is the scarring of the liver. Cells in the affected areas do not function effectively or stop functioning altogether. The more you drink, the more scar tissue develops and the more cirrhosis progresses. Eventually, your liver stops functioning the way it’s supposed to. Not every person who misuses alcohol gets cirrhosis. For those who do, this disease will have serious repercussions and lifelong effects.
Causes & Symptoms of Alcoholic Cirrhosis
Cirrhosis can lead to several symptoms that can range from irritating to potentially deadly. The most serious of these symptoms are yellowing of the skin and eyes, increased bleeding and swelling.
- Yellowing of the skin and eyes: Increased yellowing of the skin and the whites of the eyes (also called jaundice) is a serious symptom of alcoholic cirrhosis. Jaundice indicates a malfunctioning liver, leading to a buildup of toxins that could eventually become deadly. Someone who experiences jaundice should seek emergency medical help.
- Increased bruising or bleeding: Increased bleeding occurs because the liver stops making enough of the components needed for blood clotting. It can also cause a person to bruise easier than they used to. This side effect is dangerous: even a minor source of bleeding can cause significant blood loss because the bleeding cannot be stopped easily. If you notice that you have increased bleeding, you should seek medical help as soon as possible.
- Swelling in the abdomen, feet, legs or ankles: The last important symptom of alcoholic cirrhosis is swelling, especially within the abdomen. This swelling, also called ascites, occurs when the liver no longer makes proteins that keep water within the veins. This indicates that the liver is not functioning as it should. Buildup of fluid in the abdomen can lead to serious health problems.
Other symptoms may include: confusion, weakness and fatigue, decreased appetite, weight loss, muscle atrophy, nausea and vomiting, pain and tenderness in the upper right abdomen, an increased amount of small, visible blood vessels on the skin, itchy skin, hair loss or fever.
The development of alcoholic cirrhosis is a progression of liver damage, typically beginning as fatty liver disease, which leads to inflammation and eventually scarring in the liver. Up to 35% of heavy drinkers develop alcoholic hepatitis, greatly increasing the risk of alcoholic cirrhosis.
Treating Alcoholic Cirrhosis
The scarring that cirrhosis causes is typically irreversible, but will continue to worsen as more alcohol is consumed. Stopping the use of alcohol is vital to stopping the progression of alcoholic cirrhosis.
Treating any underlying medical conditions affecting the liver will also be important. Diseases such as hepatitis or an autoimmune disorder may worsen alcoholic cirrhosis. Maintaining a high-protein, high-calorie diet will typically be recommended by medical professionals, along with maintaining a healthy level of exercise. This activity will help to optimize the remaining function of the liver.
Treating the complications that occur from cirrhosis will also be an essential part of treatment. As cirrhosis cannot be reversed, its effects must be treated as they arise.
Ultimately, the only way to fully recover from alcoholic cirrhosis is through a liver transplant. While a transplant can result in a full recovery, this option is not readily available to most people. To be eligible for a liver transplant for alcoholic cirrhosis, applicants will need to show a significant period of sobriety to ensure that the new liver will not undergo the same stresses that initially caused the cirrhosis.
How Do You Repair Liver Damage from Alcohol?
There are several things you can do to help reverse the effects of alcohol on your liver, such as:
- Stop Drinking: If you have been told you have an unhealthy liver, the first and most important thing you can do is stop drinking alcohol.
- Make Other Healthy Lifestyle Changes: This means no more smoking and maintaining a healthy weight. Next to alcoholism, obesity is a leading cause of liver disease, while cigarettes contain toxins that worsen liver damage.
- Watch What You Put Into Your Body: When you are not eating many processed foods, sugars and saturated fat, the liver does not have to work as hard to filter what comes through it. A healthy diet can lead to a healthier liver.
- Get Your Workout In: Apart from helping to avoid obesity, exercising can aid the liver in other ways. Regular exercise improves the immune system and reduces the risk of liver cancer.
- Pay Attention to Medications You Are Taking: Even some over-the-counter medications can be harmful for the liver when taken in excess, such as acetaminophen.
- Don’t Let Unnecessary Toxins In: Avoiding other substances like illicit or abused prescription drugs can help keep the liver healthy. This also means taking extra precautions, such as using a mask when dealing with aerosol sprays, spray paints, spray insecticides, spray fungicides and any other form of sprayed chemical. Be aware of what chemicals could come into contact with your skin and wear gloves if needed.
Liver Disease & Pancreatitis
Along with looking at the impact of alcohol on the liver, it’s also relevant to consider how alcoholism causes pancreatitis. There is acute pancreatitis and chronic pancreatitis.
The pancreas is a gland behind the stomach responsible for releasing digestive enzymes and works with the liver to process substances. An inflamed pancreas is called pancreatitis.
Acute pancreatitis is sudden onset inflammation that’s short-lived. The results of the condition range significantly, from being mildly uncomfortable to fatal, but most people recover. Chronic pancreatitis has symptoms similar to acute, but there’s frequent pain, weight loss and the potential for diabetes to develop.
In the majority of cases, alcohol causes acute pancreatitis, although other causes may include trauma, metabolic conditions or infections. Heavy, long-time alcohol use accounts for about 60-90% of chronic pancreatitis cases.
Having chronic pancreatitis puts you at risk for other serious illnesses, including cancer and diabetes. Stopping alcohol use significantly increases your chances of recovering from pancreatitis.
- How much alcohol causes liver damage?
Binge drinking is known to increase the levels of chemicals that doctors think are involved in alcoholic liver disease. Studies have also found that binge drinking, especially when done repeatedly and often, is linked to a high risk of liver damage. Doctors think this is especially true when the person already has other risk factors for liver disease, such as obesity. It’s not just heavy drinkers who get cirrhosis. Some people have damage to their liver and cirrhosis from only two to four drinks per day. Even a small amount of alcohol still requires the liver to work and may add to scarring.
- Why does alcohol abuse affect the liver more so than other body parts?
The liver takes the brunt of the damage because the liver is the main organ that processes alcohol to remove it from your body. Research shows if you keep drinking over time, alcohol activates chemicals that make your liver store fat in the cells rather than use it up, which can be a toxic change. This accumulation of fat leads to inflammation and, eventually, a scarred liver.
- How long does it take for the liver to heal? Can it repair itself?
The liver can repair itself over time from alcoholic fatty liver disease and hepatitis. However, the liver will not be able to heal itself from the scars of cirrhosis. The length of time needed for the liver to recover depends on many factors, but primarily on alcohol usage. It may take months or even years for a heavy drinker’s liver to recover to a near-normal state.
- Are women or men more at risk of developing alcoholic fatty liver disease (AFLD)?
Women are more at risk for AFLD than men because they have less of the enzymes needed to break down alcohol. Fewer enzymes allow more alcohol to reach the liver and create the scar tissue that develops into cirrhosis.
- What other risk factors exist for developing alcoholic fatty liver disease (AFLD)?
Increased weight increases your risk of developing alcoholic cirrhosis. This factor can be a more prevalent risk than most people initially realize, as heavy alcohol use will typically lead to increased weight. Underlying medical conditions, especially hepatitis, can also lead to an increased risk of alcoholic cirrhosis developing.
U.S. National Library of Medicine. “Fatty Liver Disease.” MedlinePlus, November 19, 2019. Accessed April 21, 2020.
Ajmera, Veeral H; Terrault, Norah A, Harrison, Stephen A. “Is Moderate Alcohol Use in Non-Alcoholic Fatty Liver Disease Good or Bad? A Critical Review.” Hepatology, June 2017. Accessed April 21, 2020.
Rasineni, Karuna; Casey, Carol A. “Molecular Mechanism of Alcoholic Fatty Liver.” Indian Journal of Pharmacology, May-June 2012. Accessed April 21, 2020.
Wolf, David C. “Cirrhosis.” Medscape, July 30, 2018. Accessed April 21, 2020.
American Liver Foundation. “Alcohol-Related Liver Disease.” 2017. Accessed April 21, 2020.
Menachery, John; Duseja, Ajay. “Treatment of Decompensated Alcoholic Liver Disease.” International Journal of Hepatology, July 2011. Accessed April 21, 2020.
Naveau, Sylvie et al. “Excess Weight Risk Factor for Alcoholic Liver Disease.” Hepatology, 1997. Accessed April 21, 2020.
Ventura-Cots Meritxell, Watts, Ariel E, Bataller, Ramon. “Binge Drinking as a Risk Factor for Advanced Alcoholic Liver Disease.” PMC, September 1, 2018. Accessed April 21, 2020.
Griffith, Christopher M; Schenker, Steven. “The Role of Nutritional Therapy in Alcoholic Liver Disease.” Alcohol Research & Health, 2006. Accessed April 21, 2020.
National Organization for Rare Disorders. “Hepatic Encephalopathy.” 2011. Accessed April 21, 2020.
Tholey, Danielle. “Ascites.” Merck Manual, October 2019. Accessed April 21, 2020.
Tholey, Danielle. “Jaundice.” Merck Manual, October 2019. Accessed April 21, 2020.
Blonski, W, Siropaides, T, & Reddy, KR. “Coagulopathy in Liver Disease.” Current Treatment Options in Gastroenterology, December 2007. Accessed April 21, 2020.
Mallet, Maxime; Rudler, Marika; and Thabut, Dominique. “Variceal Bleeding in Cirrhotic Patients.” Gastroenterology Report, August 20f17. Accessed April 21, 2020.
Orfanidis, Nicholas T. “Alcoholic Liver Disease.” Merck Manual, July 2019. Accessed April 21, 2020.
Chowdhury, Parimal; Gupta, Priya. “Pathophysiology of alcoholic pancreatitis: An overview.” World Journal of Gastroenterol, December 14, 2006. Accessed April 21, 2020.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.