Drinking too much alcohol? Could you be damaging your liver?

Do you know what happens to your body when you consume too much alcohol? The answer could be more serious than you think. Consumption of alcohol for a long period, even if just one or two alcoholic drinks, can have an impact on your liver health. In this blog post, we will discuss the damaging effects that high amounts of alcohol can have on your liver. We’ll explain how alcohol affects your liver, the different types of liver diseases related to excessive consumption and explain the diagnostic tests such as ultrasound and MRI. So if you’re wondering whether or not drinking too much could be detrimental to your health – keep reading!

What is Alcohol Liver Disease?

Alcohol liver disease refers to liver damage caused by excess alcohol intake. Excessive alcohol consumption is a global healthcare problem with enormous social, economic, and clinical consequences, accounting for millions of deaths each year worldwide. Excessive drinking over decades damages nearly every organ in the body. However, the liver sustains the earliest and the greatest degree of damage from excessive drinking because it is the main site for alcohol metabolism.

Heavy alcohol consumption produces a wide spectrum of liver diseases, such as fatty liver (steatosis), hepatitis, and fibrosis/cirrhosis

What is a unit of alcohol?

One unit equals 10ml or 8g of pure alcohol, which is around the amount of alcohol the average adult can process in an hour.

To keep health risks from alcohol to a low level, men and women are advised not to drink more than 14 units a week on a regular basis. Spread your drinking over 3 or more days if you regularly drink as much as 14 units a week. If you want to cut down, try to have several drink-free days each week.

14 units is equivalent to 6 pints of average-strength beer or 10 small glasses of lower-strength wine.

What liver diseases can heavy alcohol consumption cause?


Fatty liver (hepatosteatosis)

Fatty liver/steatosis is the deposition of fat in the cells of the liver as part of how the liver metabolises alcohol.

It is the most common effect of alcohol, found in 90% of problem drinkers who consume 4 to 5 units per day over decades.

However, steatosis also develops after binge drinking, defined as drinking 6+ units (women) or 8+ units (men) in a single session.

Fatty liver disease rarely causes any symptoms, but it’s an important warning sign that you’re drinking at a harmful level.

If the affected individual ceases drinking, steatosis is a reversible condition with a good prognosis.

Steatosis was formerly considered a harmless consequence of alcohol abuse. However, patients with long term steatosis are more susceptible to fibrotic liver disease/cirrhosis, because the continued presence of fat in liver cells can damage them.

Alcoholic hepatitis

Alcoholic hepatitis, is a potentially serious condition that can be caused by alcohol misuse over a longer period. This is where the alcohol causes inflammation of liver cells, that can lead to liver cell damage and death.

When this develops, it may be the first time a person is aware they’re damaging their liver through alcohol.

Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).

The liver damage associated with mild alcoholic hepatitis is usually reversible if you stop drinking permanently.

Severe alcoholic hepatitis can be a serious and life-threatening illness. Many people die from the condition each year in the UK.


Fibrosis and its terminal or late stage, cirrhosis, refers to scarring in the liver. As your liver becomes more damaged, you may feel very tired and weak, sick (nausea), lose your appetite, lose weight and muscle mass. There may be skin changes, such as red patches on your palms and small, spider-like blood vessels on your skin (spider angiomas) above waist level.

If cirrhosis gets worse, some of the symptoms and complications include yellowing of the skin and whites of the eyes (jaundice), vomiting blood, itchy skin, bleeding or bruising easily, swollen legs (oedema) or tummy (ascites) from a build-up of fluid and loss of sex drive (libido)

It’s generally not reversible, but stopping drinking alcohol immediately can prevent further damage and significantly increase your life expectancy.

How is alcohol liver disease diagnosed?


Blood tests

Blood tests that look at liver function or the blood cells may identify that the liver is functioning abnormally. For example, there may be a rise in liver markers such as serum transaminase levels or a drop in the number of platelets cells in the blood.

Imaging tests

Current widely available imaging tests for the liver include ultrasonography (US) and magnetic resonance imaging (MRI). Imaging studies are useful for determining the presence of underlying liver disease. Imaging studies can also excluding other causes of abnormal liver tests in patients, such as obstructive biliary pathology and neoplastic diseases of the liver. Imaging can also aid in the diagnosis of cirrhosis and can be used to screen for and identify hepatocellular carcinoma.

Ultrasound (US) is a non-invasive test that is routinely used in the initial evaluation of liver. The appearance of fat in the liver is highly variable on US, however, in general, a fatty liver will have a bright appearance.

Hepatic steatosis is more easily detected by MRI techniques in which water and fat are imaged in and out of phase.

On imaging tests, patients with fibrosis may have a coarsened echo pattern to their liver and patients with cirrhosis may have a nodular liver contour. In patients with cirrhosis, there may be shrinking of the right lobe of the liver, growth of the liver caudate lobe, nodularity of the liver, spleen enlargement and free fluid in the abdomen (ascites).

Liver biopsy

A liver biopsy is not necessary for the diagnosis of ALD in most patients. Clinical findings in patients with chronically elevated characteristic blood test liver enzymes, together with a history of significant alcohol use, can be diagnostic for alcoholic liver disease.  A liver biopsy may be useful for establishing the diagnosis in some patients if the diagnosis of ALD is not clear,  especially in patients in whom the clinician suspects more than one type of underlying liver disease.

If you have concerns about whether you are damaging your liver by drinking too much alcohol, see your doctor and arrange diagnostic tests. Don’t leave it too late as liver changes can be reversible in the early stages, but may be irreversible if liver scarring sets in.

Dr. Khalid Enver

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