Dr Manav Wadhawan– Sr. Director - Gastroenterology & Hepatology, BLK-Max Institute for Digestive & Liver Diseases
India contributes to a major share in the burden of liver related ailments in the world. We currently rank in the top ten list alcohol consuming nations in the world (according to WHO). Alcoholic induced liver disease has always been the most common cause of advanced liver disease in India, but till recently it was mostly seen in men. The incidence of alcohol induced liver disease has been rising among women in recent years (especially in urban areas). Since the pandemic, there has also been a sharp increase in the frequency of binge drinking episodes among the ‘new gen women’.
Liver is the most resilient organ that regenerates its dead cells after a while, but excessive consumption of alcohol for years may tend to prevent this regeneration process and result in cirrhosis and ultimately liver failure.
.jpg "Alcohol and liver health in women")
There are 3 main stages of alcohol related liver damage, although there is often an overlap between these stages. These stages are:
1) Alcoholic fatty liver disease- Drinking a large amount of alcohol, even for just a few days, can lead to a build-up of fat in the liver. This is called alcohol induced fatty liver disease and is the first stage of ALD. Fatty liver disease generally does not cause any symptoms, but it's an important warning sign that you're drinking at a harmful level. Fatty liver disease is reversible if you stop drinking alcohol.
2) Alcoholic hepatitis- It is a potentially serious condition that can be caused by alcohol misuse over a longer period. Patients usually develop jaundice when this develops. The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking alcohol. Severe alcoholic hepatitis, however, is life-threatening, and needs hospitalization and ICU treatment.
3) Cirrhosis- It is the stage where the liver develops scarring. It's generally not reversible but stopping alcohol can prevent further damage and significantly increase your life expectancy. A person who has alcohol-related cirrhosis and does not stop drinking has a less than 50% chance of survival over the next 5 years.
The alcohol metabolism by liver
Having over 500 functions, Liver is one of the most complex organs in the human body. Some of its salient functions include filtering out blood toxins, storing energy, synthesizing hormones and proteins, and regulating cholesterol and blood sugar.
As alcohol is broken down in the liver, several potentially dangerous by-products are generated, such as acetaldehyde and highly reactive molecules called free radicals. Perhaps more so than alcohol itself, these products contribute to alcohol-induced liver damage. Each time the liver filters alcohol, some of the liver cells die. Although the liver is capable of regenerating itself, prolonged alcohol abuse over years can reduce its ability to regenerate.
Alcoholic Liver Disease (ALD) is the commonest cause of cirrhosis in india. The damage is more profound among women because of various reasons. Women absorb more alcohol relative to their body size than men. Also the enzyme which detoxifies alcohol is expressed at lower levels in women than in men. It is estimated that despite consuming half the quantity of alcohol, women are twice as likely to damage their liver compared to men. Yet, the damage is highly preventable by avoiding or minimizing consumption of alcohol.
Alcoholic Liver disease has become common in women, and it is widely underdiagnosed. By keeping alcohol intake low, maintaining a healthy diet and exercising regularly, women can significantly reduce their chance of developing some of the most common types of liver diseases as well.
More importantly, there is a genetic predisposition towards alcoholism, and certain HLA phenotypes pose twice the increased risk of alcohol induced liver damage among women.
Drinking in Safe limits!
Although safe limits of alcohol drinking have been described, the best way is not to consume alcohol at all. The most effective way to prevent alcohol induced liver damage is to stop drinking or stick to the recommended limits of alcohol consumption: Women with a healthy liver should not drink more than 1 alcoholic beverage a day (or 7 drinks in 1 week). Men with a healthy liver should not drink more than 2 drinks a day (or 14 drinks in 1 week). Also, to be noted, the type of alcohol (Beer, Whisky, Wine) do not matter in liver diseases, but the amount of alcohol one consumes is important, and not the kind.
It is important to understand that for patients who have a pre-existing liver disease (eg: fatty liver, hepatitis B or C, uncontrolled diabetes), there is no safe limit of alcohol. Alcohol is a direct hepatotoxic agent and those who have pre-existing liver diseases are more prone to its toxic effects. Complete abstinence from alcohol is the only way to avoid liver disease in these patients.
Also it must be stressed that binge drinking (more than 3 drinks at a time) is as harmful as regular drinking. If a lady drinks occasionally but takes more than 3 drinks at one time, it can be equally harmful.
I urge all the readers to save your livers by either quitting alcohol or sticking to the safe limits as suggested above. Please remember that a healthy liver leads to a healthy body & better life.
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