The liver directly processes the toxins in alcohol. Limits on how much is safe to drink take into account how much the liver can process. For example, binge drinking involves drinking four or five servings of alcohol in two hours, leading to rapid intoxication, since the liver can only process one serving of alcohol in an hour. Drinking heavily – one or two drinks per day, every day of the week – leads to chronic health issues, including heart disease, ulcers, excessive weight gain, and liver damage, including fatty liver disease and cirrhosis.
Fatty liver disease (FLD) has many potential root causes, but alcoholic liver disease can be diagnosed if fatty liver disease develops first. For many people, FLD is the first sign of a potentially larger problem with the organ.
What Is Fatty Liver Disease?
Fatty liver disease, called hepatic steatosis in medical literature, describes the buildup of fat on the liver. Having a little fat on the liver is normal and even healthy, but when the total weight of the organ is 5-10 percent fat, or more, it is a sign of FLD. Unfortunately, because of eating and drinking habits among most people in the United States, FLD is a common condition, affecting as many as 10-20 percent of the adult population. Most instances of fatty liver occur in adults between 40 and 60 years old.
There are many potential causes of fatty liver disease, including:
- Hyperlipidemia, or having high levels of fat (lipids) in the blood
- Rapid weight loss
- Some medications that harm the liver, including acetaminophen, tamoxifen, and tetracycline
- Abusing alcohol
The most common cause of fatty liver is drinking too much, and as Americans drink more alcohol, they are at greater risk of developing this problem. One of the first ways doctors recommend to stop the progression of fatty liver is to stop drinking alcohol completely.
The liver is the second largest organ in the body, and its cells can regenerate themselves if damaged. However, with too much damage, the organ will not be able to keep up. It can suffer problems leading to reduced ability to filter toxins out of the blood. Permanent scarring of the liver, caused by too much damage, is called cirrhosis.
Damage to the liver is preventable, and if it is detected early enough, problems like fatty liver are reversible. However, people who struggle with alcohol abuse are less likely to seek medical treatment and will have a hard time stopping compulsive behaviors around alcohol, so they may suffer ongoing damage to their liver, leading to liver failure, if they do not get help.
Symptoms of fatty liver disease include:
- Poor appetite
- Unintentional weight loss, even in people who are obese
- Abdominal pain
When FLD progresses to liver failure, symptoms include:
- Jaundice, or yellowing of the skin or eyes because of toxins in the blood
- Easier bleeding and reduced clotting
- Extreme confusion
- Enlarged, fluid-filled abdomen
Alcoholic Fatty Liver and Further Harm from Alcohol Abuse
A subcategory of fatty liver disease is alcoholic fatty liver (AFL). This disease is the first stage of liver damage caused by alcohol abuse. When heavy drinking leads to cell damage, the liver is less able to process most toxins, including fats. When the liver no longer breaks down fats, the cells collect in the blood and around the organ itself. After AFL develops, and the person does not get treatment for any symptoms or fails to get regular checkups that may spot the problem, cirrhosis will develop, followed by alcoholic hepatitis, and eventual liver failure.
Women are more at risk for alcoholic fatty liver than men, but anyone who drinks heavily (more than 15 alcoholic beverages per week) for months or years puts themselves at risk for this condition. The problem is exacerbated in those with poor diets, who eat a lot of processed food, who do not exercise enough, or who choose to drink rather than eat meals. Those who have pre-existing health conditions, like hepatitis C, who are obese, or who have too much iron in their blood are also at risk of developing AFL if they drink excessively.
Fortunately, alcoholic fatty liver is very easy to treat and even reverse. Since the liver regenerates cells, it can recover from fatty liver if the cause is alcohol. You must stop drinking, and within six weeks, the fat around your liver will be gone. You will be at risk for developing AFL again, though, if you go back to drinking. Quitting then relapsing means you are at risk of alcohol poisoning, which can be fatal.
Ending Fatty Liver and Quitting Alcohol Abuse
Quitting alcohol is not as simple as it sounds. While the numerous health benefits may seem like an obvious reason to stop drinking, for too many people, the compulsive behaviors associated with addiction mean that they cannot stop. Heavy drinkers are often physically dependent on alcohol to feel normal. Both people struggling with alcohol use disorder (AUD) and heavy drinking are at risk of experiencing withdrawal symptoms, which can be life-threatening. On average, about 8.5 percent of adults in the US struggle with AUD, which does not include regular binge drinking or heavy drinking. These people need medical oversight to safely detox, which will help them stop drinking and heal their livers.
To diagnose fatty liver, your doctor will conduct a physical exam to see if your abdomen is enlarged. Then, they will run blood tests to find your liver enzyme level. If liver enzymes are high, this indicates the liver is suffering damage but does not conclude that the cause is fatty liver. You will also receive a questionnaire about your drinking habits, and your family or friends may be questioned about how much you drink in a week. An ultrasound will detect how much fat is in your liver by producing images of the organ, or a liver biopsy may be conducted to determine how much fat has gathered.
If your doctor determines that you have fatty liver, whether you struggle with alcohol abuse or not, you will likely have lifestyle changes recommended, including:
- Controlling how much alcohol you drink
- Managing cholesterol in foods and beverages
- Losing weight
- Exercising more
- Controlling blood sugar
If your physician determines that fatty liver has been caused by how much alcohol you drink, you may be referred to a detox program, followed by comprehensive addiction treatment. Completing this process is important, not just to save your liver from further harm, but to end an addiction to a dangerous, deadly substance.