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  • Writer's pictureNick Allen

Alcohol and liver health

Last week the World Heart Federation put out a policy brief stating that “no amount of alcohol is good for the heart.” This sparked some controversy, upsetting many who hold the belief that moderate consumption of alcohol has health benefits. I personally don’t think there’s enough evidence to firmly stand on either side, but I would err on the side of less alcohol consumption, and certainly wouldn’t drink more alcohol in pursuit of health benefits.


This is because the risks associated with overconsumption far outweigh any risk associated with underconsumption (if this risk even exists). The evidence we do have has made it abundantly clear that significant alcohol consumption is damaging to organs and overall health. Excess alcohol consumption is a risk factor for nearly every disease process, from infection to diabetes to cancer.


Particularly evident is the harm that alcohol can do to your liver. Those who saw our Instagram post yesterday will be familiar with the first two images in Figure 1. The first represents healthy liver tissue, whereas the second is from a liver with steatosis, or fat buildup. Those white bubbles you see are fat, and it can get there in a few different ways. This post will just focus on one of those ways — alcohol consumption.


Figure 1: These images show both a microscopic and macroscopic view of a healthy liver (first panel), fatty liver (second panel), and cirrhotic liver (third panel). Images courtesy of histologyguide.com, BMJ, Mayo Clinic.


It’s thought that significant liver steatosis can result from just 4 or 5 drinks, although at this stage it can still be reversed if alcohol intake is limited. People who drink sparingly may have minor fat deposits that come and go. Why does alcohol cause this fat buildup? Firstly, ethanol metabolism leads to NADH buildup, which favors fatty acid synthesis and storage. It is also thought that alcohol consumption leads to the inactivation of PPAR-ɑ, a protein which is key for fatty acid oxidation (breakdown). This impairment of breakdown contributes to an increase in overall fat storage.


While any amount of steatosis can impair liver function, usually this stage is not accompanied by life-threatening dysfunction. If alcohol consumption remains at high levels chronically, however, fatty liver can evolve into the liver cirrhosis shown in the third panel of Figure 1. At this point, the damage is irreversible and can lead to serious health consequences. For example, the liver’s inability to remove toxins from the blood can lead to yellowing of the skin and mental impairment. In many cases, patients with a cirrhotic liver are placed on a waiting list for a liver transplant.


Liver damage is not exclusively caused by alcohol — things like chronic hepatitis B/C infection, certain genetic conditions, and diet (stay tuned for an upcoming post on NAFLD) can also lead to cirrhosis. That being said, alcohol consumption is a major cause of liver injury that can be avoided. This is not to say that you need to avoid alcohol entirely, and there’s definitely something to be said for the relaxation and enjoyment that some people find from sharing a drink with others. Once you find yourself going beyond one drink per day, however, you may want to keep in mind the trade-off you are making with your health.


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