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How does alcohol affect the liver?

vinayakhingane - October 20, 2020 - 0 comments

There may be a few skeptics but there is a general consensus that alcohol in excess is bad for the liver. However, very few know the science behind it. Read along if you are interested in learning; I will also discuss in brief about how to identify different types of liver diseases associated with alcohol.

We often come across terms like ‘hepatitis’ or ‘cirrhosis’ in the news when it describes the demise of a popular person with alcohol related problems. In colloquial terms, we refer to it as jaundice or simply, as liver problems.  Alcohol in excess is notorious for damaging many organs but it damages liver the most. Liver is a crucial organ that is often neglected. Liver disorders can not only ruin one’s health but can also prove fatal.

Alcohol here signifies the active ingredient “Ethanol” in the alcoholic beverages. Each beverage has different amount of ethanol in it. It is this ethanol that gets absorbed in the bloodstream when one drinks an alcoholic beverage. As the level of ethanol rises in the blood, one starts feeling a “high”. This feelgood effect is the reason why people like to drink alcohol and it lasts for some time. Once alcohol (ethanol) levels in the blood start declining, the influence of alcohol (the “high”) declines as well.

Just like any other food, alcohol is broken down into its by-products in our body. Alcohol that is absorbed in the blood goes to the liver where it gets converted to another chemical known as “acetaldehyde”. This is an aldehyde and it acts like fuel. Our cells use aldehydes to produce energy which is then stored as fat. Obviously this is not good for people who already have an excess of fat in their internal organs. However there are far more bigger problems to simple excesses of calories and fat. 

Problems of an explosive fuel:

Let us imagine that our liver is a kitchen that has fire for cooking meals. We need this fire to be controlled effectively to be able to cook perfect meals instead of ending up with undercooked or charred meals. We also need a fire extinguisher or enough water to douse the fire in case of accidents. Our body`s metabolism is like this fire. Whenever there is a potent fuel like aldehyde, there is a higher risk of injury to cells due to higher production of free oxygen radicals.  More aldehyde implies more ‘oxidative’ or ‘burning’ stress on the liver cells.

There is a system in our body which routinely counteracts free oxygen radicals and protects our cells from injury. This is the “fire extinguisher system” in our cells. In situations where there is a lot of stress due to free radicals, this system gets fatigued. The fire extinguishers are all used up and cells become vulnerable to burns due to free radicals. This is what happens when there is a large amount of aldehyde acting on the liver cells.

Imagine this injury being inflicted on the liver every time a person drinks large amount of alcohol. If this is frequent enough, the liver does not get a chance to recover.

Other effects of Aldehyde:

Aldehyde can prove noxious in larger quantities. They attack our cell proteins and genes. This leads to a diffuse injury to the cells which in excess causes cancers. They also trigger wide spread inflammation that affects various organs in the body. These effects are especially prominent in the long run and are called as chronic effects in medical jargon. There are some acute or immediate effects as well

Hangover – After an intake of a significant amount of alcohol, there is a sudden increase in aldehyde levels which is perceived as headache, nausea and an uncomfortable feeling generally called as hangover. The pleasant effects of alcohol wean off as the blood alcohol levels drop before being replaced by the unpleasant effects of acetaldehyde. Acetaldehydes are an important factor for causing hangovers. Eventually the aldehydes are burnt off as fuel and the hangover passes on. People with lower ability to burn off aldehydes tend to suffer more. On the other hand, habitual drinkers develop an accessory pathway with the help of enzymes to efficiently burn off the aldehydes.

An interesting mechanism is observed in certain individuals who have an inherent inability to efficiently dispose off aldehyde. These individuals develop flushing of their face, nausea, vomiting, sweating and marked discomfort after drinking alcohol. They have defective enzymatic pathways that are needed to process aldehydes. They also have a very low risk of developing alcohol addiction! Similar reactions are seen with the drug “Disulfiram” which is used to treat alcohol addiction by experts.

As you can see there are multiple ways in which alcohol affects the liver by causing repeated injuries. These effects on liver manifest in different stages. Let’s have a look at these stages.

The stages of liver injury:

Alcohol related fatty liver: The initial stage is known as fatty liver. Fat accumulation can be seen in liver on ultrasound examination. The blood tests show a mild elevation of liver enzymes. The individual may not have any symptoms but this stage should be taken seriously as a ‘ warning sign ‘. Abstinence can help to revert all these changes and liver can become normal again.

Hepatitis: Hepatitis means inflammation or swelling of the liver. In this stage, there are multiple injuries to liver cells. Blood results show significant increase in liver enzymes and bilirubin. The individual may look jaundiced. He may have symptoms such as fatigue, nausea, vomiting, tummy ache etc . This is a potentially serious condition. If the injury is diffuse, then the person may land up in serious complications. It demands abstinence and medical treatment.

Cirrhosis: The multiple repetitive injuries leave the liver scarred. It shrinks and hardens. Only a few working cells remain in the liver and the rest is just scar tissue. Liver function is compromised and the individual may experience various complications such as accumulation of fluid in tummy and lung causing shortness of breath, disturbance in the brain function, bleeding tendency and recurrent infections. This is an extreme end of the spectrum. It requires significant medical treatment and sometimes even a liver transplant. It is best to avoid ending up in this stage.

Liver is as important as heart or kidney for our health. Unfortunately there isn’t enough awareness about it. Liver problems can prove to be critical.

Let me enumerate the functions of liver

  • Liver processes absorbed food and stores it
  • It manages cholesterol levels
  • Filters out the waste products
  • It processes and makes proteins
  • Helps to build immunity
  • Helps in blood clotting
  • Helps in managing blood cells
  • Filters out toxins
  • Processes drugs and medicine.

If liver cells fail to work, there are serious consequences and even death! That’s why healthy liver matters! There are other factors and diseases which affect liver. Similarly alcohol affects other body parts adversely as well. Let’s talk about those issues some other time.  Till then, take care!

Dr Renuka Hingane & Dr Vinayak Hingane

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