Are moderate drinking of alcohol and liver disease connected? Drinking in moderation is not a risk factor for any liver disease. That is, it doesn’t increase the chance of getting any liver disease. On the other hand, drinking in moderation reduces the risk of non-alcoholic fatty liver disease.
- Liver Diseases
- Liver-Related Death
I. Liver Diseases
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the developed world. It effects about one-third of the total population of the U.S.
NAFLD is a major risk factor for cardiovascular disease. That’s the major cause of death in most countries around the world. And it’s also a major cause of hepatic dysfunction among children.
Non-alcoholic fatty liver disease is the build up of too much fat in liver cells. When alcohol abuse doesn’t cause it, it’s non-alcoholic. The liver normally contains some fat. But, if more than five to ten percent of the liver’s weight is fat, it’s a fatty liver.
Some things increase the risk of non-alcoholic fatty liver disease.
• Being overweight
• Diabetes (type 2 or adult-onset)
• Dangerous cholesterol levels
• High triglycerides
• Poor diet
• Sleep apnea
• Metabolic syndrome
• Underactive thyroid
• Underactive pituitary gland
• Gastric bypass surgery
• Polycystic ovary syndrome
Non-alcoholic fatty liver disease usually has no signs. When it does, they may include fatigue, pain in the upper right of the abdomen, and unwanted rapid weight loss.
A team of researchers at the University of Buenos Aires in Argentina analyzed the results of eight studies. Each study examined the consumption of alcohol and the risk of non-alcoholic fatty liver disease. In total, the studies included 43,175 men and women in different countries.
The results? Moderate drinkers had a 31% lower risk of non-alcoholic fatty liver disease than alcohol abstainers.
Moderate drinkers also had a fifty percent lower risk of developing an advanced stage of NAFLD. That’s a very big large drop in risk.1
The take away message? Drinking alcoholic beverages in moderation greatly reduces the risk of non-alcoholic fatty liver disease.
Other researchers examined alcohol and liver disease. In this case, it was moderate drinking and non-alcoholic steatohepatitis (NASH).
That’s liver inflammation from a buildup of fat in the organ. The disease can get worse causing. When it does, it causes scarring of the liver (cirrhosis). NASH is a major feature of non-alcoholic fatty liver disease.
Researchers studied participants in the U.S. National Institute of Health’s NASH Clinical Research Network. They looked at those who had non-alcoholic fatty liver disease. Then they compared lifelong non-drinkers to moderate drinkers. The risk of NASH dropped as the consumption of alcohol increased. It did so up to the highest levels of moderate consumption.
Moderate drinkers also had a significantly lower risk of suffering from fibrosis. And also from ballooning hepatocellular injury than lifetime alcohol abstainers.2
Drinking Frequently is Helpful
The frequent and moderate consumption of alcohol reduces the risk of fatty liver disease. For example, a large study of men in Japan reported this. This finding is consistent with other research.3
It’s logical that frequent drinking would be especially helpful. For example, the effects of an aspirin wear off as the body metabolizes it. Similarly, the beneficial effects of alcohol wear off because of metabolism.
It is important to know relative risks. People with either NAFLD or NASH are much more likely to die of cardiovascular disease than of liver disease. And moderate drinking reduces the risk of death from cardiovascular disease by almost half.
C. Liver Cancer
Drinking alcohol in moderation is not a risk factor for liver cancer.4 However, alcohol abuse over a period of many years is one of the causes of alcohol cirrhosis.5 Others are hepatitis B and hepatitis C virus.6 It is the liver cirrhosis itself that is one of the risk factors for liver cancer.7
The usual setting is an individual with alcoholic cirrhosis who has stopped drinking for ten years, and then develops liver cancer. It is somewhat unusual for an actively drinking alcoholic to develop liver cancer. What happens is that when the drinking is stopped, the liver cells try to heal by regenerating (reproducing). It is during this active regeneration that a cancer-producing genetic change (mutation) can occur. This explains the occurrence of liver cancer after the drinking has been stopped.8
Drinking alcohol in moderation is clearly not a risk factor for developing liver cancer. On the other hand, the moderate consumption of alcohol is associated with better health and greater longevity. That’s in comparison to either abstaining from alcohol or drinking abusively.
Dr. Gerald Minuk is head of the University of Manitoba Liver Diseases Group. He found in animal studies that moderate drinking helps heal damaged livers. However, both heavy consumption and lack of alcohol hinder liver healing.9
Coffee Reduces the Risk of Liver Cirrhosis
Researchers made a study of 125,580 people for 24 years. They found that drinking one cup of coffee per day cut the risk of cirrhosis by one-fifth. Drinking four cups per day reduced the risk by 80%. This relationship held for both men and women of different racial categories.10
Cirrhosis from all causes, including Hepatitis C and some inherited diseases, causes over 27,000 deaths annually in the U.S. It also causes nearly 400,000 hospital admissions.
Drinking coffee reduces the risk of alcoholic cirrhosis. But drinking alcohol in moderation or abstaining are better ways.
II. Liver-Related Death
Many people think that heavy drinkers usually die as a result of liver disease. However, researchers conducted an 18-year-long study in the Netherlands. They used participants in the well known Rotterdam Study. The researchers found that only one percent (1%) died because of liver related causes.
The analyses adjusted for age, gender hypertension (high blood pressure), cholesterol, body mass index (BMI), diabetes, smoking, and education level.
Compared to abstainers or non-drinkerss, light and moderate drinkers experienced and average 15% reduced risk of mortality. Although heavy drinkers experienced a 5% reduction in risk of death during the 18 years, such drinking is not desirable.11
III. Resources on Alcohol and Liver Disease
- Abou-Alfa, G. and DeMatteo, R. 100 Questions and Answers about Liver Cancer. Sudbury, MA: Jones and Bartlett, 2006.
- Chalasani, N., and Szabo, G. Alcoholic and Non-alcoholic Fatty Liver Disease. Cham: Springer, 2016.
- Farrell, G., et al. Non-alcoholic Fatty Liver Disease. Chichester, Eng: Wiley-Blackwell, 2013.
- Friedman, L., and Keeffe, E. Handbook of Liver Disease. Philadelphia: Elsevier, 2012.
- Lake-Bakaar, G. Alcohol and the Liver. NY: Nova 2016.
- Neuberger, J., and DiMartini, A. Alcohol Abuse and Liver Disease. Hoboken: Wiley, 2015.
- Dunn, W., et al. Modest wine drinking and decreased prevalence of nonalcoholic fatty liver disease. Hepat, 2009, 47, 1947-1954.
- Hart, C., et al. Effect of body mass index and alcohol consumption on liver disease. Analysis of data from two prospective cohort studies. Brit Med J, 2010, 340, 1240-1245.
- Kwon, H., et al. Effect of lifetime alcohol consumption on the histological severity of non-alcoholic fatty liver disease. Liver Inter, 2014, 34(1), 129-35.
- LaVecchia, C. Alcohol and liver cancer. Euro J Can Prev, 2007, 16(6), 495-497.
- National Institute on Alcohol Abuse and Alcoholism. Alcohol and Liver Disease. Washington: The Institute, 1998. Alcohol Alert #42.
- Sogabe, M., et al. Light alcohol consumption plays a protective role against non-alcoholic fatty liver disease. Liver Inter, 2015, 35(6), 1707-1714.
- Szabo G. Moderate drinking, inflammation, and liver disease. Annal Epidem, 2007, 17(Suppl.), S49-S54.
- Xiaobin, F., et al. Alcohol consumption might be beneficial for the patients with resectable liver cancer. Med Hypoth, 2009, 73(2), 207.
References for Alcohol and Liver Disease
- Sookoian, S., et al. Modest alcohol consumption decreases risk of non-alcoholic fatty liver disease. A meta-analysis of 43,175 individuals. Gut, 2014, 63(3), 530-532.
- Dunn, W., et al. Modest alcohol intake and less inflammation among patients with non-alcoholic fatty liver disease (NAFLD). J Hepat, 2012, 57(2), 384–391.
- Hiramine, Y., et al. Alcohol drinking patterns and the risk of fatty liver in Japanese men. J Gastro, 2011, 46, 519–528.
- Liver Cancer Risk Factors and Prevention (American Society of Clinical Oncology)
- Risk Factors for Liver Cancer (American Cancer Society).
- Liver Cancer Risk Factors (Mayo Clinic).
- Liver Cancer Causes and Risk Factors (CancerAbout.com.)
- Liver Cancer. (Mydochub.com.)
- Minuk, G. Annual meeting of the American Association for the Study of Liver Disease, Dallas, 2000. Zhang, M., et al. Gastro, (November, 2001). Finkel, H. Drink a little, eat a little, and nurture your liver. AIM Digest, 2001, 10(3), 8.
- Klatsky, A. et al. Coffee, cirrhosis, and transaminase enzymes. Arch Int Med, 2006, 166, 1190-1195.
- Am Assn Study Liver Diseases. Annual meeting, 2010. Liver disease, cancer and cardiovascular disease as a cause of death in heavy drinking. AIM Digest, Dec, 2011, p. 3.