Alcohol-Related Complications

Alcohol-Related Complications

Alcohol is the most common substance consumed by Canadians. Like all substances, alcohol can damage your body, especially if consumed in large amounts.

The term alcohol refers to any fermented or distilled beverages which contain an organic chemical compound called ethanol. Fermented alcoholic beverages such as beer and wine contain lower amounts of alcohol, typically between 2% and 20% alcohol by volume, while distilled alcoholic beverages such as spirits and liqueurs contain 20% or more. 

What happens when someone has a drink?

Alcohol affects everyone. When a person has a drink, the alcohol is absorbed directly through the wall of the stomach and intestine into the bloodstream, where it is distributed rapidly throughout the body. The alcohol changes the function of each cell that it enters. Each time your liver filters alcohol, some liver cells are destroyed. 

Only a certain quantity of alcohol can be detoxified over a period of time. Your liver has the ability to develop new cells, however binge drinking as well as consuming too much alcohol over many years can reduce your liver’s ability to regenerate. This can result in permanent damage to your liver. Excess alcohol affects the brain, heart, muscles and other tissues of the body.

How does alcohol affect the liver?

Alcohol affects your body in many ways. Some side effects are immediate and last only a short time; others can occur over time may significantly affect your health and quality of life.

When the liver has too much alcohol to handle, normal liver function may be interrupted leading to a chemical imbalance. If the liver is required to detoxify alcohol continuously, liver cells may be destroyed or altered resulting in fat deposits, called fatty liver, and more seriously, either inflammation (alcoholic hepatitis), and/or permanent scarring (cirrhosis). Liver cancer can also result from alcohol-induced liver disease.

How much alcohol is safe?

In small amounts, alcohol may be low-risk, but when consumed in large quantities over a long period of time, it can lead to significant liver issues. How much harm alcohol can cause to your liver, depends on how much you drink and your pattern of drinking. Your body composition, age, drinking experience, genetics, and social factors all play a part as well. For example, women absorb more alcohol from each drink than do men and tend to be more susceptible to alcohol-related liver damage.

A standard drink is a measure of how much pure alcohol you are drinking. It varies based on the concentration of alcohol in a beverage. One standard drink is the equivalent of either:

• 12 oz. (341 ml) of beer
• 12 oz. (341 ml) of a cider or cooler
• 5 oz. (142 ml) of wine
• 1 ½ oz. (43 ml) of spirits

Each of the these has the same effect on the liver whether taken alone or diluted. It is the amount of alcohol present in a drink that matters, not the type of drink. 

The Canadian Liver Foundation supports the level of alcohol consumption proposed in Canada’s Low Risk Alcohol Drinking Guidelines:

  • For women, no more than 2 drinks a day or 10 standard drinks a week.
  • For men, no more than 3 drinks a day or 15 standard drinks a week.
  • For pregnant women, the safest amount is no alcohol at all.  

How does alcohol interact with medication?

Mixing alcohol and medications may damage the liver. Alcohol should not be taken with drugs such as acetaminophen. Many prescribed and over – the – counter medications interact with alcohol, thereby altering the metabolism or effects of alcohol and/or the medication. Examples of these medications include antibiotics, antidepressants, antihistamines, barbiturates, benzodiazepines, muscle relaxants, pain and anti-inflammatory medications. Please consult with your healthcare provider or pharmacist.

How do I know if my liver has been damaged by alcohol?

Your liver is a resilient organ. It often doesn’t show any symptoms early on. More than three quarters of liver cells may be nonfunctioning before you notice any symptoms, but by then it may be too late to do anything about it.

Early detection of alcohol-related liver disease can be challenging, and signs and symptoms are often mild in the early stages. If your doctor suspects potential damage to your liver due to alcohol, they will typically arrange blood tests and an ultrasound to check on how well your liver is working. Your doctor will also discuss with you your alcohol consumption. It’s important to be honest about how much and how often you drink alcohol to avoid further unnecessary testing, but to also prevent delays in receiving potential treatment.

Along with blood work and an ultrasound, your doctor may also recommend other tests such as a CT scans, an MRI, or a liver biopsy. All these tests may be helpful in examining your liver for potential injury or damage, and to rule out other causes of liver disease.

If your liver is not properly performing its many functions, the rest of your body may soon be affected by the lack of nutrients and excess waste products present in the blood. Symptoms and complications from liver damage include:

• Fatigue
• Loss of appetite
• Yellowing of the skin and eyes – called jaundice 
• Swelling of the abdomen
• Internal bleeding
• Confusion
• Kidney failure

These symptoms may vary depending on the stage of your alcohol-related liver disease. Continuous damage to your liver can lead to serious liver scarring called cirrhosis, put you at risk for liver cancer, and potentially in need of a liver transplant. 

What are the stages of alcohol-related liver disease?

Alcohol-related liver disease can be broken down into stages, although that there can be overlap of the stages. It’s important to address the condition early as this may prevent further liver damage.

The earliest and most common stage of alcohol-related liver disease is called fatty liver, or steatosis. Fatty liver refers to an excess buildup of fat inside the liver cells, which makes it harder for your liver to function. In this early stage, there are often very few symptoms, however some people may experience general fatigue and weakness. This build-up of fat inside the liver cells can also result in an enlarged liver, called hepatomegaly, which may cause pain or discomfort in the upper right side of the belly. Anyone who consumes alcohol in excess can develop fatty liver. Typically, the fat in the liver will lessen once you stop drinking.

Stage two of alcohol-related liver disease refers to inflammation or swelling of the liver, and liver cell damage – known as alcoholic hepatitis and alcoholic steatohepatitis. Abdominal pain, fever, weakness, nausea, vomiting, loss of appetite, and the yellowing of the skin and eyes are common symptoms. Alcoholic hepatitis can be mild or severe. In its severe form, the disease may occur suddenly, for example after binge drinking, and can quickly lead to life-threatening complications.

Severe alcoholic hepatitis and alcohol-related cirrhosis are considered the most serious stages of alcohol-related liver disease. Anything that damages the liver over many years can lead to the development of scar tissue in the liver. Fibrosis is the first stage of liver scarring. When scar tissue builds up significantly and takes over most of the liver, it is referred to as cirrhosis. Symptoms of cirrhosis include high pressure in the portal vein, an enlarged spleen, fluid build-up in the belly, internal bleeding, confusion, as well as being high risk for liver cancer. Once you develop significant symptoms of cirrhosis, you may require a liver transplant.

How does alcohol affect other forms of liver disease?

Alcohol consumption has been shown to increase the rate of liver damage and risk of cirrhosis in people who already have liver disease. Therefore, it is strongly recommended that if you are living with any form of liver disease, to not drink alcohol. It is important to speak with your doctor about alcohol consumption and what you can do to prevent further liver damage.

Can alcohol-related liver damage be reversed or cured?

An illustration of the human body showing the location of the liver, gallbladder, stomach, colon and small intestine. Image used with permission from Mayo Clinic.
Used with permission from Mayo Clinic. All rights reserved

If you’ve been diagnosed with alcohol-related liver disease, the single most important thing you can do for yourself is to stop drinking. Eliminating alcohol, also known as abstinence, can reverse slight liver damage, or in more serious cases, preventing it from becoming worse.

Your doctor might also suggest additional treatment options and services including, alcohol counselling, psychosocial therapy, or an alcohol treatment program. For instance, if you are physically addicted to alcohol, a medically supervised detoxification program may be needed to safely reduce your alcohol levels, as it can be dangerous to eliminate all alcohol immediately. Your doctor may also suggest that you slowly reduce the amount of alcohol that you are drinking to keep it from shocking your system too fast. A rapid reduction in alcohol can lead to withdrawal symptoms including tremors, anxiety, agitation, nausea, hallucinations, and seizures. It’s important to understand that alcohol withdrawal is different for every person. Medications can also be prescribed to help with withdrawal symptoms and alcohol cravings. Your doctor can recommend programs, services and prescribe medications that best meets your needs.

Nutritional deficiencies are common in people with alcohol-related liver disease. Your doctor may refer you to a registered dietitian who can assist you with food planning. In this case, your doctor or dietitian could recommend a special diet, as well as vitamin and nutritional supplements, to combat the effects of malnutrition and help you gain weight if needed. If you have trouble eating enough to get the vitamins and nutrients you need, your doctor and registered dietitian may talk to you about other ways what you need to meet your nutrient needs.

Depending on the severity of your disease, your doctor may recommend medications to help reduce liver inflammation in acute alcoholic hepatitis. These medications have shown some short-term benefit in increasing the survival of certain people with severe alcoholic hepatitis. Corticosteroids such as prednisone is usually the first treatment given. If you can’t take corticosteroids, then your doctor may recommend some anti-inflammatory medications. Both corticosteroids and other anti-inflammatory medications can have side effects. Your doctor will help you choose the medication most suitable for you.

For those with severe alcohol-related liver disease, such as alcohol-related cirrhosis, the risk of life-threatening health problems is high, and the only treatment option may be a liver transplant. Historically, those with severe alcohol-related liver disease had to wait six months before being considered eligible for a liver transplant. The reasoning? The possibility that liver disease could improve with abstinence, and to prove the liver recipient could remain abstinent of alcohol and not return to harmful drinking after their transplant. 

Over the recent years, there have been some changes in the transplant assessment pathway in Canada. As such, people with severe alcohol-related liver disease may now be eligible for liver transplantation without having to wait six months, only after they have been carefully assessed by a multidisciplinary transplant team. Recent studies also suggest that carefully selected people with severe alcohol-related liver disease have similar survival rates following their transplant as those who received a liver transplant due to other types of liver disease not caused by alcohol.

What is the outlook for people with alcohol-related liver disease? 

Your liver has a tremendous capacity to regenerate itself. Minimal liver damage starts to repair itself once alcohol is removed from your system.

Improvements in liver function takes time. However, if your liver condition is severe, the damage may be irreversible. Despite complete abstinence, however, up to one third of people with severe alcohol-related liver disease will continue to have ongoing liver damage.

Canada’s Low-Risk Alcohol Drinking Guidelines can support you in making informed choices about alcohol consumption, reduce your risk, and maintain healthy liver function.

Look after your liver and if you choose to drink alcohol, less alcohol is best. Drinking alcohol in moderation can help to lower your risks of alcohol-related liver disease. If you already have a liver disease, it is highly recommended that you do not drink any alcohol.

Things to remember:
• Alcohol-related harms are prevalent worldwide and on the rise.
• Drinking alcohol every day, as well as binge drinking (drinking four or more drinks at one time) can be harmful to your liver.
• Do not drink and drive.
• Mixing alcohol and medications may damage the liver. Alcohol should not be taken with drugs such as acetaminophen.
• If you have a liver disease, the safest amount of alcohol is no alcohol at all
• Abstinence is the only proven therapy for alcohol-related liver disease.

Support & Resources

National Help Line:
This support resource gives you and your loved one somewhere to turn for answers after diagnosis, helps you understand your disease, and provides you with the resources you need.  You can call 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST, or send us an email at CLF@liver.ca 

The National Peer Support Network:
This is a national network of people living with liver disease that have offered to share their experiences with others. It was developed by the Canadian Liver Foundation as a means to link Canadians like you who have a family member who has liver disease, who care for someone who suffers from liver disease, or who have been diagnosed with a liver disease, to talk about your concerns with a peer in a similar situation.

If you would like to be connected with a Peer Supporter in your area, or would like to join the Peer Support Network, please fill out the Peer Support Network Sign-up Form.

Canadian Centre for Substance Use and Addiction: 
The CCSA is a non-governmental organization that provides national leadership on substance use and to advance solutions to address alcohol- and other drug-related harms. Some of their resources include: 

The Canadian Mental Health Association: 
The CMHA provides advocacy, programs and resources that help to prevent mental health problems and illnesses, support recovery and resilience, and enable all Canadians to flourish and thrive. For more information, please visit www.cmha.ca.  

Health Canada: 
Information about alcohol, health effects and risks, a standard drink, how to reduce short-term and long-term health risks, and trends in alcohol use among Canadians. For more information, please click here.

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