The Quality of Life Depends upon the Liver
Ben - While we're talking about alcohol it's very important to remember that alcohol-related illness is a massive killer here in the UK and worldwide. And so to chat a bit more about that I've come to the Flying Pig pub and we're out in the beer garden I'm with Mike Allison of Addenbrooke's hospital. Hi Mike!
Mike - Hiya.
Ben - So Mike, how big a problem is alcohol-related disease in the UK?
Mike - It's a huge problem and it's an increasing problem. Our concern, particularly from the liver point of view is the trend for rapidly increasing amounts of alcohol consumption in the young with the binge drinking culture. There's evidence that this can continue with people into their early 20s moving onto consistent heavy drinking, which can result in severe liver damage.
Ben - So, when people are drinking responsibly, such as right now I'm enjoying a nice pint of bitter, what is it that actually happens to the alcohol after I've taken a swig?
Mike - It obviously goes down your gullet and into your stomach. There's a variable rate of absorption from the stomach and it enters the blood system, draining to the liver, where it is metabolised. A lot of aspects of damage that alcohol can cause is through its metabolism.
Ben - So it's the metabolites of the alcohol rather than the alcohol itself that does the damage? What does alcohol get broken down into?
Mike - It's broken down, in particular, to acetaldehyde. This is particularly toxic to cells. It can change the number of cellular constituents, affect protein, the cell wall and a number of ways in which the cell works.
Ben - So when the liver breaks alcohol down into these fairly toxic components, does that directly damage the liver?
Mike - The metabolites can damage the liver but the liver has a capacity to deal with these in a safe manner. The problem can arise, however, the system is swamped. Then the metabolites can't be degraded down a safe route. Then you do get cellular damage, which over the course of time, can lead to aggressive liver damage.
Ben - And is it the damaged liver that leads to the hangover that some of us are far too familiar with?
Mike - I think that's multi-factorial. I don't know that it's necessarily solely the liver. I think that you do get an alcohol-related gastritis and that contribute to the nausea and generally feeling awful. The neurological effects of the hangover, in terms of alcohol, will also be the dehydration one sees. Hence the advice to always drink some water before you go to bed. I think that's very sensible advice. It's multi-factorial and not solely related to the liver.
Ben - So once you've damaged your liver through the presence of these metabolites, what can this lead to?
Mike - In the long term, excessive alcohol consumption can lead to cirrhosis. You get scar tissue in the liver which is joined up and leads to architectural disruption. This leads to an increased risk of liver cancer, you can have exsanguination or bleeding from the gut. You might get fluid accumulation in the abdomen. In addition to that, what we see and what accounts for a large proportion of people turning up in hospital with liver disease is when someone has alcoholic hepatitis. That is when someone becomes jaundiced: yellow eyes, yellow skin, often with distension of the tummy - with fluid in the abdomen. This can be a very sever illness and in severe cases around 40-50% of people do not survive to get out of hospital. A worrying thing from our point of view is that we're seeing people coming in with this condition in their 20s now. It used to be people in their 40s.
Ben - So is there any way to go out, get a bit drunk, have a big night out and then not do damage to your liver?
Mike - Any night out such as that will damage the liver. It may not do so in a way that will be reflected three months later if it's a one-off. Certainly it will stress the liver. If it's done on an on-going basis or it's done nightly or regularly then you may start to see progression to what may be irreversible liver damage.
Ben - And are there ways to slow down the process of getting drunk? You hear rumours that drinking milk before you go out will line your stomach. Perhaps eating a meal before you go out?
Mike - Certainly it's the case that if you have a full stomach, if you drink with meals then that can reduce the risk of liver damage. That's not to say it's reasonable. 'If you get drunk with a decent meal that's fine for the liver' - that's not the case. But the body's tolerance of sensible amounts of alcohol with food is better than on an empty stomach.
Ben - And one other rumour that we often hear is that if you have very expensive tastes and perhaps you're celebrating if you drink some champagne, people say that fizzy alcohol goes straight to the head. Is there any truth in that?
Mike - I'm not aware of any evidence that that's the case!
Ben - Well thank you ever so much for coming to speak to me and cheers!
Mike - Cheers!