Alcohol And Your Liver – Understanding Alcoholic Liver Disease

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There is a close relationship between alcohol and your liver.

Unfortunately, it is not a good one. Actually, it is a complex one.

Alcohol is widely available these days, and this has only made health problems from alcohol worse. While alcohol in moderation might be beneficial for the heart, once you cross a limit it can take a toll on your health.

Today, I will be discuss the complex relationship between alcohol and your liver. I will also discuss how much alcohol is bad for you, what type of alcohol is the worst kind and how you could get over your alcohol addiction.

So grab a drink (coffee or juice, not a beer!!!) and let’s get going…..

Alcohol And Your Liver

Lets first take a look at the liver.

The liver is a large organ located under the rib cage on the right side of your abdomen. It weighs around 1.5 to 1.7 kg. It consists of 2 lobes – the left and the right lobe.

The liver possesses the unique property of the power of regeneration.

This means that if a part of the liver is removed, it can regrow.

The liver filters all the bad toxins from the blood stream. In addition to this, it is a storehouse for essential minerals such as iron.


1. Removal of harmful toxins from the blood stream

2. Release of enzymes to help food digestion

3. Storage of nutrients such as iron and vitamins for times of need

4. Regulating blood sugar and cholesterol levels

5. Body’s defense against infections

When we drink alcohol, it is broken down in the liver cells by an enzyme. This enzyme is called alcohol dehydrogenase, or ADH.

There are other elements that also help break down alcohol, but I will not go into too much detail regarding this.

When you drink excess amount of alcohol, it begins to overwhelm the breakdown process. It begins to generate harmful free radicals, which can damage the liver cells.

Not just that, it also results in the generation of excessive amounts of fatty acids and compounds called ‘adducts’. An adduct is a compound that alters the immunity in the liver and makes it heavily inflamed.

The inflammation results in the release of harmful toxins that further damage the liver cells. This leads to a condition called alcoholic liver disease, or ALD.

One of the toxins that is released is called ‘acetaldehyde’. This toxins can potentially kill the liver cells, or damage them in an irreversible fashion.

In addition to this, the toxins can also reduce the amount of oxygen the liver receives.

As you can see, there is a complex relationship between alcohol and your liver.

There are many more mechanisms that I have not discussed here. All of them result in damage to the liver cells.

How Much Alcohol Is Bad For You?

I mentioned previously that alcohol in moderation is good for health.

But there is a fine line between moderation and excess.

Once you cross over to excess intake, you risk damaging your liver.

Binge drinking is also a bad thing. This is because the alcohol ‘hit’ can put too much stress on the kidneys and the heart

So how do we know if what we are drinking falls in the ‘moderate’ category?

Well, there are 2 ways of looking at it.

We can quantify alcohol in ‘units’ or in ‘grams’.

Units is a measure of ‘pure’ alcohol content in a drink. One unit is 8 grams of alcohol (or 10 ml of pure alcohol). It takes the liver about an hour to breakdown this quantity of alcohol in most people.

According to, one unit of alcohol is equal to 76 ml of wine, half a pint (250 ml) of 4% strength beer or 1 bottle of a drink like Bacardia Breezer (alcopops).

The image below will explain more.

alcohol and your heart

Anything above 14 units consumed over a week is considered excess.

Remember that this does not mean 14 units a day!! It refers to alcohol intake distributed over a week that amounts to a total of 14 units.

Men who drink more than 60 grams per day and women who drink more than 20 grams a day increase their chances of developing liver damage, or cirrhosis.

Stages Of Alcohol Related Liver Disease

There are 3 stages in the development of alcohol related liver disease.

Stage 1 – Fatty Liver

Fatty liver can be a common finding on a routine ultrasound scan. This is usually nothing to worry about.

However, in those who drink more than the recommended alcohol every day, fatty liver could indicate early damage to the liver.

fatty liver alcohol liver disease
Fatty liver – As you can see, the liver surface is completely covered in yellow fat deposits.

This is because the liver turns glucose into fat. Alcohol does not allow this fat to be distributed evenly through the body. As a result, this fat accumulates on the liver.

Furthermore, it does not cause any symptoms and is only detected on a scan.

In fact, fatty liver is the only stage in alcoholic liver disease that is reversible. By stopping alcohol, you can reverse fatty liver in 1 to 2 weeks.

Stage 2 – Alcoholic Hepatitis

In this stage, the liver begins to become inflamed and red. It is the first point at which a patient may realise that alcohol is affecting the liver.

Usually, there are no symptoms. However, some may feel generally unwell.

The good news is that by stopping alcohol intake completely, you could reverse the liver damage to a great extent.

Stage 3 – Cirrhosis

This is the irreversible stage of liver damage from alcohol. Once it reaches this stage, even stopping alcohol will not help.

In cirrhosis, the liver becomes shrunken and fails to function.

In alcoholic liver disease, the liver becomes shrunken and dark. Image courtesy Vecteezy .

This leads to toxin build up in the blood stream. This in turn can affect the vital tissues, including the brain.

Liver disease that affects the brain is called hepatic encephalopathy. Here, toxins affect the brain, preventing it from functioning normally. Patients can become deeply jaundiced and drowsy. It is a potentially fatal condition.

Stopping alcohol at this stage will not reverse the problem. It may just help slow down worsening of the problem.

Symptoms Of Alcoholic Liver Disease

In the early stages, you may not feel anything at all. You may feel completely normal.

However, as the disease progresses, you may feel excessively tired and nauseous. Abdominal pain and vomiting may occur.

In advanced stages, you may notice jaundice. Water accumulation in the body can lead to distention of the abdomen and fluid accumulation in the body.

As the liver is responsible for the synthesis of clotting factors, liver disease from alcohol can affect this.

This means the blood can become too thin. This can lead to bruising and sometimes serious bleeding.

If the condition progresses to end stage liver disease, it is fatal. Some may also develop liver cancer from alcoholic liver disease.

Treating Alcohol Related Liver Disease

I will not go into too much detail here.

However, you must know that the first step is the stop drinking completely.

If there is any evidence of liver disease, you may be started on liver enzyme tablets to aid digestion.

If there is any bleeding or bruising, this will be treated appropriately.

Nutritional supplements may be needed to aid recovery. Salt restricted diets may need to be followed.

In advanced cases of liver cirrhosis, liver transplant may be recommended. There are specific criteria to be met for this, and only a few of them are suitable for transplantation.

Lowering Your Risk

If you someone who enjoys alcohol, then here are some tips to reduce your risk of developing alcohol related liver disease.

1. Eat before you drink

If you eat a meal before you drink, you are likely to consume less alcohol as your stomach is already full.

Also, the fat content in the food will help prevent rapid absorption of alcohol, reducing your chances of getting ‘hammered’.

2. Spread out your drinking

Avoid binge drinking. Instead, spread out your alcohol intake evenly over the week.

Just make sure you do not cross the 14 units a week that is recommended.

3. Stay hydrated

Alcohol makes you pass a lot of urine, and can make you dehydrated. Drink plenty of water in between drinks to avoid this.

4. Don’t mix your drinks

Mixing your drinks can make you ill and irritate your stomach. Instead, choose your favorite and stick to your limit. Don’t buckle to peer pressure.

Closing Remarks

Alcohol and your liver are enemies. Make sure you stick to your limit if you partake. If you don’t, then avoid finding reasons to start now.

Dr Vivek Baliga B
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10 thoughts on “Alcohol And Your Liver – Understanding Alcoholic Liver Disease”

  1. Sai Ram Thanks a lot Dr.Baliga, for a very useful and informative article on alcohol.

    Fortunately, I am a teetotaller and my weakness is drinking about 4 to 5 cups of coffee ,Kindly let me know whether this will have an adverse impact on my liver.Looking forward to your response and with my regards .

    1. Dr Vivek Baliga

      Thank you for your comment Sir! Coffee as such will not affect your liver. Some people find coffee an indulgence. I don’t think it will cause too much trouble for you!

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