I am Dr G.S. Lamba, Gastroenterology and Hepatology. Now we all know that consumption of alcohol has been there in the mankind from time immemorial. So people have been drinking alcohol and there has always been a concern about the ill effects of alcohol on our health. Now what is happening is the data shows that the consumption of alcohol is increasing in the society more and more people are taking alcohol, people have started taking alcohol at a much earlier age and also people have started consuming alcohol in much larger amount as compared to before. Now, this definitely causes lot of concern because alcohol can damage various organs in the body be it brain or heart or kidney or pancreas or bladder but one organ which bears the maximum burnt of alcohol is liver. So liver is one organ which is very vulnerable to alcohol induced damage and it has been now clearly established that alcohol can cause very serious and irreversible damage to the liver. So today we would be talking about alcohol and its effect on the liver.
Now what I have seen among my patients and friends and generally in society is that people carry lot of misconceptions in your mind about alcohol, there are a lot of myths, people gather knowledge from their friends, they gather knowledge from some unverified sources on the net or unverified literature so there are a lot of wrong notions in everybody's mind about alcohol and its ill effects on the body, especially when it pertains to liver so I get a lot of queries from my patients about this aspect and so the aim of today's talk is to clarify some of these myths and misconceptions, which are there about alcohol so that we can have more clarity on this issue. Now if I have to talk about alcohol and it's damage on liver, broadly the liver damage occurs in three stages, the first stage is what is known as stage of fatty liver disease. In this stage anybody who takes alcohol in large amounts starts developing fat in liver cells so fat starts to accumulate in the liver cells, the liver cells start expanding and becomes swollen and the liver size becomes enlarged, now at this stage generally there are no symptoms the patient is absolutely healthy otherwise or if at all there are symptoms, symptoms are very vague and non-specific, he or she may have just some amount of loss of appetite or a dull aching pain in the right side of the upper abdomen where the liver is located. So at this stage there are no symptoms and this stage is usually recognised when person goes for a general health check up or if he undergoes an ultrasound or some other investigation due to some other reason.
So there it is picked up that he has fatty liver disease and then it is diagnosed that it is probably because of alcohol. Now it is very important to recognise this stage because this is a stage which is luckily reversible. If a person stops taking alcohol this fat will gradually melt from his liver cells and his liver cells will come to the normal shape and size and they will function normally so there will be no health issues there, if you stop alcohol at this stage but if a person continues to take alcohol in large quantities after this stage has reached so there will be a progressive damage to the liver cells and the second stage then occurs which is known as a stage of alcoholic hepatitis. In this stage what is happening is because of the accumulation of this fat a lot of inflammation starts to occur in the liver. There are a lot of inflammatory cells which from the blood they go and enter into the liver and they cause a lot of damage there to liver cells and because of this damage a lot of signs and symptoms starts to come at this stage, the stage of alcoholic hepatitis and this is a serious stage.
At this stage a person may have symptoms like obviously loss of appetite would be there, a person may have weakness, easy fatigability and then the cardinal symptoms of jaundice comes when he starts appearing yellow from the eyes, so this stage is a serious stage because a lot of advanced damage has occurred to the liver cells and much of this damage will be reversible at this stage and if this stage progresses, a person may go into total liver failure which may occur gradually or sometimes it may take a very prominent course and very rapidly the liver functions may come down and it may be a serious threat to life so this is serious stage needs to be recognised and then obviously one needs to be under the supervision of the liver specialist and whatever interventions are possible they should be taken but the first and foremost step is to stop alcohol in totality.
Now if the liver injury progresses beyond this and alcohol is still continues to go inside the body and its is damaging the liver then the person goes into the third stage of liver damage which is known as cirrhosis of the liver, now in this stage what is happening is that the lots of liver cells start dying and they are being replaced by a bland fibrous tissue which does not serve any useful function, the whole liver architecture sort of starts to collapse and the whole functioning of the liver is seriously impaired and at this stage lot of complications start to come and these complications are one is jaundice which may be there sometimes it is not there but there are issues with other functions of the liver which are very important for the survival of life and liver damage may start affecting the brain of the patient, which may come in the form of insomnia, confusion, lack of concentration which may lead on to semi-consciousness or unconsciousness or full coma and other complications maybe start accumulating fluids in the body which may initially manifest as swelling in the feet but then they go on to involve the whole body and then starts to develop fluid in his abdomen and which is known as ascites and this ascites starts gradually to increase and abdomen swells so this is also very serious complication, then he may develop bleeding diathesis, clotting mechanism may get affected so he may start bleeding and this bleeding maybe in form of bruises on the body, it may be in the form of bleeding gums or bleeding piles and the more serious is when he starts to vomit blood, so this is a very serious condition beside this immunity starts to fall person becomes prone to infection, his other organs also start malfunctioning like kidney and heart and lungs which are dependent on the liver for their good health so this is a stage which is very serious stage is known as cirrhosis and this is unfortunately irreversible stage when nothing much can be done and it is not only irreversible it may have a progressive downhill course and ultimately a person goes into a total liver failure when survival of life is not possible and probably he might require liver transplant or new liver for him to continue with his life. So these are the 3 stages and what we need to know is the initial stage of fatty liver which is reversible and needs to be recognised early and intervention has to start there because as the liver damage increases, things become more and more irreversible and unfortunately the medical science is yet not advanced enough to repair a damaged liver which is damaged to a great extent, so this is about the stages of liver injury caused by alcohol.
Now coming to some of the misconceptions which people have, first and foremost the question which is very frequently asked to me is how much alcohol and for how much duration will cause damage to the liver? this is one question which cannot be answered and the scientists are not able to find out the exact answer to this question because how much alcohol for how much duration is not defined yet because basic reason is everybody’s liver is different, everybody's body is different, everybody metabolizes alcohol in a different way, the genetic makeup and the resistance of the liver to the alcohol induced damage in different individual is different so it is very difficult to fix a particular amount, but usually if the person is taking alcohol in large amounts it takes about 10 years or so to go into a stage of cirrhosis but this is again not an absolute number some people may develop cirrhosis in a very short duration, so one has to be careful from the very beginning you cannot continue to think that it will take very long for alcohol to damage my liver so I should keep on drinking for 5, 10 years and then my liver is going to damage and I may stop then, but this is not true because there is no absolute amount or duration which has been defined till now.
Now second very important confusion among people's minds is which I have seen is people think that light alcoholic beverages are safe by light alcoholic beverages usually they mean beer or some time even Gin is referred to as ladies drink or wine is referred to as light drink. Now again I will caution here that it is not the type of beverage which affects which is responsible for the liver damage but it is the amount of alcohol which is going in liver so if somebody is having beer which says it has got 5% alcohol and if he takes it in a large quantity then his liver is going to get damaged as much as a person who is drinking a similar amount of alcohol in the form of whisky which is about 42% alcohol so it is not the light drink or hard drink it is the amount of alcohol which is going in which is causing the liver damage so this should also be very clear that beer drinking is not safe if it is taken in large amounts and it should be very clear with everybody.
Third important misconception is about drinking habits, there are people who think that alcohol taken along with water maybe safer than alcohol which is taken along with fizzy beverages like soda or alcohol which is taken as neat is more harmful than alcohol which is taken mixed with water or alcohol taken at room temperature is better as compared to alcohol taken with ice or something so these are all misconception which has no scientific basis again it is the amount of alcohol which is important rather than the way it is taken whether with this beverage or that beverage that may just affect your taste or it may affect the rapidity of getting inebriated or something that may be different but damage that occurs in the body because of alcohol remains the same so this should also be very clear.
Then there are a lot of misconceptions about dietary habits and alcohol intake, now it has been seen that people who are badly addicted to alcohol we have seen so many patients, they badly diet also and they are very malnourished and it has been seen the people who are malnourished obviously suffer much more liver damage and they fare much more than people who maintain good health and nutrition, so it is very important to have a balanced diet if you are taking alcohol because malnourishment causes more damage to the liver than if you are well-nourished.
So when we are treating liver disease patients our first aim is to maintain his nutrition and bring him back to good nutritional status because that is going to help him, so definitely a good diet is somehow protective against alcohol induced damage to the liver. Then again now a days I got a lot of queries about gender variability and the effect of alcohol as you all know that the incidence of female consuming alcohol in society is increasing, so naturally there is a question does alcohol affect the male and female liver in the same way? now unfortunately this is not so and what data shows females probably develop liver damage at a much earlier stage and at lesser amounts as compared to the male counterparts, now female liver is more susceptible to alcohol induced injury then the corresponding male liver, there are some scientific reasons behind it, which I will not go into detail but there are some reasons behind it why the the female liver is more affected by alcohol and so I think females need to be slightly more careful on that account, then there are many more misconceptions about alcohol which we can talk about but I think I cannot cover all of them here in this talk, but these are some of the popular ones which people do ask me so I just wanted to address these issues.
So coming to now some of the do's and don'ts which we have to do about alcohol, number one if someone can avoids the alcohol that is the best there is nothing like it, but if somebody wants to take alcohol it should always be in moderation, regular continuous drinking should be avoided at all cost, daily habitual drinking is not something which is advisable it causes damage to the liver so should be avoided and similarly there are people who go on binge drinking, they will go and drink heavily for 4-5 days and then they will have abstinence period of 2 to 3 weeks and again then will have a binge, now this binge drinking is also as harmful as daily drinking so this should also be avoided at all cost and very heavy drinking and binges is not something which is recommended by a liver specialist, so this should be avoided, yes good nutrition should be taken if you want to keep your liver healthy otherwise also, good nutrition is there and it should always be one of the primary things which needs to be done. Then what we have to know is that in the early stage there are no symptoms of liver disease so when the symptoms comes most of the time disease is very advanced and not much therapeutic interventions can be done at that stage so it is very important to recognise the symptoms of liver disease at the early stage and if there are no symptoms which is better, if there any doubts or a person goes for a regular health check up and regular periodic check up of his liver functions.
I think that is advisable specially if he is taking alcohol and if liver disease is recognised once it is diagnosed with investigations then obviously that calls for an end to the alcohol and no more further alcohol intake should be done because the liver damage can be progressive and reach irreversible stage and it is not difficult to diagnose liver disease because they are diagnosed with very easily available investigations, there are few blood test and ultrasound or Fibroscan, very easily available investigations which can tell us about liver health, so I think periodically we should get our liver health checked and go in for these things, so I think these are some of the measures which we can take and special caution to patients who are obese, obese person has got anyway a compromised liver because there is lot of fat in the liver so he should be more careful and always do regular exercise and try to maintain your weight because that is affecting your liver and if anybody has got liver disease due to some other pause say hepatitis b or c or any cause which is causing damage to his liver, if this person takes alcohol then the two things become additive and there is accumulative damage to the liver so in that case, one has to be very careful about alcohol, if there is any other underlying liver disease because one and one can become additive and they cause more damage. So this is my message today to everybody and thanks for this patient listening.