A Guide to Liver Damage From Alcohol Abuse

Gillian May

Photo byImage by brgfx in Freepik.com

My father died of liver failure six and a half years ago. I thought I knew a lot about the liver being a nurse for almost 20 years, but it turns out the liver is more complex than what I had learned. I didn’t realize that liver damage was so insidious, confusing, and caused symptoms everywhere else except the liver. In fact, I didn’t realize that my father had been showing signs of liver damage for many years before his death.

When my father was admitted to the hospital with jaundice, swelling, bleeding, and an inability to eat, I didn’t realize that he was actively dying and we would lose him in only 3 weeks.

In that time, I educated myself further about the diagnosis, treatment, test results, symptoms, and progression of liver disease. I vowed to use my nursing knowledge and personal experience to pass on vital information to the general public.

There’s much you may not know about alcohol and liver damage. In fact, there’s much you may not know about the liver. Consider this article a comprehensive guide to liver damage specific to alcohol abuse.

There are over 100 diseases that can cause liver damage; alcoholism is only one of them. But the nature of alcohol intake and how it affects the liver may mask and confuse this deadly problem.

Unfortunately, alcoholism is already a masked issue. The nature of addiction is such that even the alcoholic is unaware of how their health is changing due to their addiction. Often times, liver damage from alcoholism is diagnosed too late. And if it is found and diagnosed, usually it’s covered up or minimized by the alcoholic.

The liver is a highly forgiving organ that can take an awful lot of hits before it finally gives out. Compared to other organs such as the heart or stomach, the liver doesn’t show clear symptoms that follow a specific path.

The liver is responsible for several vital functions including digestion, removing toxins and waste products, processing medications, managing blood sugar, and synthesizing proteins for blood production and coagulation.

The fact that the liver has the power to regenerate itself is often what doctors pass on to patients to help them feel less frightened. It’s also a way to help them take responsibility for changing their lifestyle to help prolong and maintain the health of this vital organ.

Unfortunately, many alcoholics (including my father), hear “the liver can regenerate,” and they may take this as permission to keep going so long as they “take it easy.” In fact, that’s exactly what my father said he would do five years before his death.

He had started drinking again after many years of sobriety. He was told he had liver issues years before, which prompted him to quit. When he resumed drinking, he said, “the doctor told me my liver is in perfect health now, so I just have to take it easy. I promise I will only have a glass of wine once a day.”

Unfortunately, alcoholics can’t have one drink per day. Within half a year, my fathers drinking went from one glass of wine per day to 5–6 glasses per day. On top of that, he had begun mixing regular wine with port wine, which contains twice the amount of alcohol.

But it wasn’t just those 5 years of port-mixed glasses of wine that killed my father — it was 40 years of heavy drinking prior to that paved the way towards his death. Although the liver can regenerate, once enough liver cells have been killed off, it’s difficult to come back from that. And there’s no test that can exactly determine how many healthy cells are left.

What is liver damage, and how does it work?

If you drink heavily and frequently, you may already have liver damage that can result in alcoholic fatty liver disease. Most people who drink heavily for a prolonged amount of time have some degree of fatty liver damage. Fatty liver itself doesn’t kill us, instead, it’s the first stage of liver damage and it’s important to understand how it works. This process is quite similar for all the different liver diseases. But this article is only addressing liver damage specific to alcoholism.

Here’s how it works. Think back to the worst hangover you’ve ever had. The horrible headache, the pins and needles, the vomiting, spinning, inability to think or manage external stimuli. If you were to get a blood test at that moment, it may reveal elevated liver enzymes.

An elevation of liver enzymes is always a result of acute liver damage. However, due to how well our liver works at repairing and maintaining balance, these enzymes don’t end up being elevated for very long.

Many people think that if their liver enzymes are normal, this means that their liver is in perfect health. This is false.

What is a fatty liver, and does it mean my liver is failing?

After acute damage, the liver does some impressive work to clean things up. It labors tirelessly to fix the damage while performing the rest of its normal functions.

Unfortunately, although some cells can repair, some cells don’t make it, and they turn into fat. A fatty liver means that many liver cells have been damaged and turned into fat and you can actually see it on an imaging scan.

A fatty liver does not mean liver failure is imminent, but it does mean that if a person continues to bombard the liver with toxic substances, more and more cells will turn to fat as well.

How is cirrhosis different from fatty liver?

Over time, fatty liver cells can turn into scars, which create hardened areas of the liver that never return to normal. This is called cirrhosis, and it’s the last and most severe stage of liver disease. Many people with cirrhosis go on to develop liver failure if they don’t quit drinking.

Survival depends on how severe the cirrhosis is and whether the person can change their drinking and lifestyle habits. If a person quits drinking, they can have what is known as compensating cirrhosis. This means that even though much of the liver is destroyed, the remaining healthy liver cells can do a good enough job to keep the body in balance.

People with compensating cirrhosis have a good chance of long-term survival only if they quit drinking. And only if they don’t do anything else to damage the remaining part of the functioning liver. However, they often have ongoing health symptoms and challenges, so they need to be vigilant.

After my father’s death, the doctor told me that he likely had compensating cirrhosis and not just a fatty liver when he began drinking again.

Compensating cirrhosis is manageable, but adding alcohol, drugs, or other toxic substances can often push people into decompensating cirrhosis. Once a person gets to decompensating cirrhosis, death is usually imminent. This is what happened to my father in the months before his death.

Decompensating cirrhosis means that the remaining liver tissue is not making up for the rest of the damaged liver and is therefore not keeping the body in balance anymore.

Once this happens, it sets off a series of events that causes widespread organ failure and toxicity that results in death.

Is it true that my liver can regenerate after it’s been damaged?

Under healthy circumstances, the liver can produce new cells, thus regenerating itself. Experts say that regeneration is a highly complicated process that is not well understood. It’s important to know that the degree of regeneration is highly dependent on the person, their complex health history, and how well they adhere to their treatment plan.

Alcoholics with fatty liver disease can only benefit from the forgiving nature of the liver if they quit drinking. Also, they need to limit certain medications, fatty food, and other substances that put stress on the liver.

It takes several months to a year for the liver to regenerate or find a healthy balance after it’s been significantly damaged. If the liver never gets to repair itself, those damaged cells become hardened and turn into cirrhosis.

The confusing part is that many blood tests taken during this recovery period may show normal results. The liver does a great job when it comes to maintaining balance in the body while working on repairing itself. Unfortunately, normal results may give a false perception that the liver is healthy and able to take more abuse through drinking, medications, unhealthy food, and so on.

By adding toxic substances to a liver that’s trying to repair itself is like shooting ourselves in the foot, except we don’t see the damage until the foot has fallen off.

I drink more than I should, how do I know if I have liver disease?

If you drink a lot and are concerned about the health of your liver, it’s best to tell your doctor how much you actually drink every day. Many people are afraid of being stigmatized by their doctor because of their heavy drinking, but not knowing the state of your liver can make things much worse for you. If your doctor doesn’t know how much you drink, then he or she can’t help you. Also, doctors need this vital information to help direct them toward more advanced testing. Without that, signs of liver damage get confused with other illnesses.

Knowing where you are in the health of your liver will help you make decisions about your drinking and lifestyle habits that contribute to liver damage. Many people opt to reduce their drinking rather than quit.

If you’re able to do this, then that’s great news for you and your liver. If not, there’s help available to deal with addiction and lifestyle habits that may be harming your liver.

I’m afraid to talk about my drinking and my liver health, are there signs that my liver is in trouble?

There are some clear signs that the liver is struggling or working really hard to keep up. Most people don’t know that these signs indicate liver issues as they can signal many other health issues as well. These signs happen well before a liver becomes too damaged to work anymore. Once a person develops cirrhosis, these signs change and become much worse.

If you’re a heavy drinker and have some of these signs, it might be a good idea to talk with your doctor and consider getting help to reduce or quit your drinking. These signs are evident in both mild acute liver damage as well as fatty liver disease.

  • Frequent issues with digestion such as heartburn, pain, diarrhea or constipation, or slow digestion.
  • Problems with fat metabolism, such as feeling nauseated or having diarrhea after eating high-fat foods.
  • Decreased appetite, especially for fat and protein.
  • Type 2 diabetes — If you’ve been diagnosed recently and are a heavy drinker, you should get your liver checked.
  • Metabolic syndrome — insulin resistance, obesity, hormone-related disorders, high blood pressure, and cholesterol issues. This has been linked to heavy drinking and related to liver issues.
  • Extreme fatigue and feeling unwell, especially in the morning, can indicate problems as well. Liver damage and the repair process can feel like recovering from a cold or flu. These symptoms are often worse in the morning but can happen during the day as well.
  • Neuropathy — pain, and tingling in the hands and feet have been linked with liver damage and alcohol toxicity.
  • Redness and tiny blood vessels around the face — these symptoms show up more in men than women and are highly related to liver disease.
  • Swollen face and stomach — this is an effect of the inflammation that heavy drinking creates in the body. This is not the same as ascites which happens in cirrhosis where the belly and legs swell with fluid.
  • Tremors or “the shakes” — this is often a sign of alcohol withdrawal. If you’re getting the shakes a lot, it’s a tell-tale sign that your liver is also struggling.
  • Confusion or brain fog — this is a sign of inflammation and/or a liver that is struggling to repair itself. It’s also a prominent sign as liver disease progresses.
  • Evidence of thiamine deficiency due to alcoholism — double vision or nystagmus (eyes shaking back and forth for a few seconds), confusion, personality changes, cracked reddened mouth, neuropathy. Thiamine deficiency is very common in alcoholism and can indicate that the liver is also struggling.
  • Becoming noticeably ill after taking medications, food, or other substances that are toxic to the liver and combining them with alcohol (especially if you’ve been doing this for a while and never got sick before). This is a sign that the liver isn’t able to manage the load as it once did.

The liver is very forgiving, but unfortunately, it can only take so much over time. Knowing the signs of a struggling liver can be confusing as they’re related to many other health issues, but it can give you clues to help you make decisions about your health.

My father had many signs that his liver was struggling. These signs plagued him for his whole life. As a nurse, even though I knew about liver pathology, I didn’t realize that these subtle signs are significant clues about how well the liver is functioning.

Taking control of our health starts with knowledge first.

Here are the links to research I used to inform this article.

Liver Regeneration
How Does The Liver Work?
Liver cirrhosis and diabetes: Risk factors, pathophysiology, clinical implications and management
Elevated Liver Enzymes
Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease
Metabolic Syndrome
The Role of Thiamine Deficiency in Alcoholic Brain Disease

Comments / 12

Published by

I'm a former nurse turned freelance writer. I have extensive experience in administration, frontline care, and education in mental health, public health, and geriatrics. However, after 20 years, I needed a change and always wanted to write. I have personal and family experience in mental health and addictions, so I'm passionate about advocacy and education in those areas. I'm also a traveler, photographer, and artist. I funnel all my various expertise into my writing and hope to provide valuable content that is entertaining and educational.


More from Gillian May

Comments / 0