Alcohol

Key messages

  • Drinking any alcohol makes your liver work harder
  • Drinking heavily can cause liver damage
  • Liver damage from alcohol can happen very suddenly after a binge, or over many years
  • Heavy drinking can lead to very serious liver problems
  • If you’ve been drinking heavily, it’s a good idea to get your liver checked out
  • If you have any sort of liver disease, it’s best not to drink any alcohol

What happens in the body when you have an alcoholic drink?

Alcohol – like beer, wine or spirits – is made up of lots of different chemicals. These include water, sugar and alcohol.

The chemical that makes you feel relaxed or drunk is called ethanol. Ethanol is created when yeasts ferment the sugar in fruits, vegetables or grains.

Because ethanol is a toxin (poison), your body tries to break it down and get rid of it. This happens in the liver.

Every time you have an alcoholic drink, several chemical processes take place to get rid of the ethanol from the body.

  1. First, a small amount of alcohol is absorbed from the mouth and by the tongue into the bloodstream
  2. The rest of the drink travels down into the stomach where it’s digested like food
  3. The sugars are broken down and then travel into the intestine
  4. The alcohol moves directly from the stomach into the bloodstream
  5. Once the alcohol is in the bloodstream, it travels throughout the body effecting different tissues, like the brain
  6. The blood passes through the liver, where there is a chemical process to get rid of the ethanol

Your liver can only process alcohol at a certain rate. If your liver can’t keep up, the ethanol and other chemicals build up in the blood. That’s what makes you drunk.


How does alcohol affect the liver?

When you drink alcohol, your liver has to work very hard to get rid of the toxins. This is on top of all its other jobs.

If you keep on asking the liver to do this process by drinking large amounts of alcohol, it is more likely to get damaged.

Even if you are not drinking heavily or your liver disease hasn’t been caused by alcohol, drinking alcohol is giving your liver extra work.


Why does drinking alcohol increase the risk of liver disease?

Drinking alcohol can increase the risk of liver disease. It can also increase things like overweight or obesity, which also puts you more at risk of liver disease.

Drinking heavily affects how your body absorbs nutrients like vitamins and minerals. Over time, this can cause damage to liver cells.

If you have another form of liver disease, drinking alcohol puts more strain on the liver.


How much alcohol is safe to drink?

To reduce the risk of harm from alcohol, the Australian Government recommends that healthy men and women should drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol.

It is best if children under 18 and women who are pregnant or breastfeeding do not drink any alcohol at all.

A standard drink contains 10 grams of pure alcohol. It could be:

  • Light beer 425 mL
  • Full strength beer 285 mL
  • Sparkling wine 100 mL
  • Wine 100 mL
  • Spirits e.g. vodka, gin, rum, whiskey 30 mL

Read more about Australia’s alcohol guidelines

Read some tips for cutting down

If you have been diagnosed with advanced liver disease or cirrhosis, you should stop drinking alcohol completely. Even a small amount of alcohol can increase the risk of the disease getting worse or complications developing.

Alcohol and liver disease

Drinking a lot of alcohol over time can damage your liver. Alcohol-related liver disease is common, but it can be prevented and reversed by stopping drinking.

You are more at risk of alcohol-related liver disease if:

  • You are a woman
  • You drink heavily
  • You binge drink
  • You are overweight or obese
  • You have diabetes
  • You have another liver condition like hepatitis C 

There are different stages of liver disease caused by alcohol.

Fatty liver

The first stage is fatty liver disease. It means too much fat is in the liver cells. The liver gets swollen and it can’t work properly.

Anyone who drinks more alcohol than recommended can develop fatty liver disease. More than 5 million Australians have fatty liver disease caused by alcohol.

There might be no symptoms of fatty liver disease, though you might feel tired and weak.

Alcoholic hepatitis

The second stage of alcohol-related liver disease is alcoholic hepatitis. Hepatitis means swelling of the liver. It can happen over time or suddenly, after binge drinking.

Symptoms of alcoholic hepatitis include:

  • pain in the belly
  • fever
  • weakness
  • nausea
  • vomiting
  • loss of appetite
  • yellowing skin and eyes (jaundice)

Alcoholic hepatitis is also called alcoholic steatohepatitis.

It can be mild or severe. If it’s severe, it can quickly become life threatening.

Alcohol-related cirrhosis

Over time, drinking a lot of alcohol can cause scarring of the liver (fibrosis). This can eventually lead to cirrhosis, when the scarring covers most of the liver.

Around 1 to 2 people in every 10 heavy drinkers will develop cirrhosis, usually after 10 or more years of drinking.

Symptoms of cirrhosis include:

  • yellowing skin and eyes (jaundice)
  • low energy
  • poor appetite
  • weight loss
  • depression
  • itching
  • loss of sexual function

It can cause serious complications like:

  • enlarged veins in the stomach or food pipe (varices)
  • internal bleeding
  • high blood pressure in the portal vein (a vein in the belly)
  • build-up of fluid in the belly (ascites)
  • enlarged spleen
  • confusion
  • liver cancer

How is alcohol-related liver disease diagnosed?

If you have been drinking more than the recommended amount for a few months, it’s a good idea to get your liver checked out.

Your doctor will talk to you about how much you drink. They will order blood tests to look for signs of liver damage and rule out other causes of liver disease.

You might have a liver scan such as an ultrasound to see how much damage has been done to the liver. Sometimes a liver biopsy is needed.

It’s really important to be honest with your doctor. The earlier you find out about any liver damage, the better your chances of reversing it.

How is alcohol-related liver disease treated?

People with liver disease caused by alcohol often have malnutrition – they don’t have the right vitamins and minerals in their body. Your doctor might recommend a special diet. A dietitian can help you with this.

You might need medicine to reduce swelling in the liver. For example, you might need a corticosteroid such as prednisone, or an anti-inflammatory medicine.

People with cirrhosis might have damage that can’t be reversed. In this case, they need a liver transplant.


Can I drink alcohol if I have liver disease?

Anyone with alcohol-related liver disease will have better health and a better future if they stop drinking.

Stopping drinking can often reverse the liver damage. If the damage is severe, stopping drinking will prevent it from getting even worse.

If you have fatty liver disease, you may be able to drink a little alcohol once your liver recovers. But you will need to stop drinking for several months while your liver repairs itself.

People with alcoholic hepatitis or alcoholic cirrhosis should stop drinking completely. If they don’t, they are likely to develop life-threatening health problems.


How can I reduce the impact of alcohol on my liver?

The first step is to talk to your doctor. There is plenty they can do to help you stop drinking. Treatments might include:

  • medicine to help with the cravings
  • counselling
  • an alcohol treatment program
If you are struggling with cutting down on alcohol or want to learn more about striking the right balance with alcohol for your liver, talk to your doctor. They are there to help.

Information and support

Alcohol and Drug Foundation 1300 85 85 84

Alcohol and Drug Information Service (ADIS)

Alcoholics Anonymous 1300 222 222

Counselling Online

Foundation for Alcohol Research & Education

Hello Sunday Morning

Lifeline

National Alcohol and Other Drug Hotline 1800 250 015

SMART Recovery

Turning Point 1800 888 236 (Victoria)

 

References

Adams LA, Roberts SK, Strasser SI, Mahady SE, Powell E, Estes C, Razavi H, George J. Nonalcoholic fatty liver disease burden: Australia, 2019-2030. J Gastroenterol Hepatol. 2020 Sep;35(9):1628-1635. doi: 10.1111/jgh.15009. Epub 2020 Feb 26. PMID: 32048317; PMCID: PMC7540570.

American Liver Foundation. Alcohol-related liver disease.

British Liver Trust. Alcohol-related liver disease (ARLD)

Canadian Liver Foundation. Alcohol-Related Complications.

Healthline. Alcohol-related liver disease

NHMRC. Alcohol

Reviewed November 2022

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