What should I do if I have alcohol-related liver disease?
For all types of liver disease caused by alcohol, you should stop drinking alcohol completely. Also, you may be referred to a dietician to review your diet. This is because many people who drink heavily do not eat properly and need advice on getting back into eating a healthy diet. Vitamin supplements may be prescribed for a while.
- If you have fatty liver, or alcoholic hepatitis which is not severe, you should fully recover from these conditions if you stop drinking alcohol.
- If you have severe hepatitis and require hospital admission, you may require intensive care treatment. Some people with severe hepatitis will die.
- If you have 'scarring' of the liver (cirrhosis), stopping drinking alcohol can improve your outlook. It depends on how severe the cirrhosis has become. If cirrhosis is diagnosed when it is not too advanced and you stop drinking alcohol, the cirrhosis is unlikely to progress. However, the cirrhosis and symptoms will almost certainly get worse if you continue to drink alcohol. In severe cases where the scarring is extensive and the liver can barely function, a liver transplant may be the only option.
You are very unlikely to develop liver problems caused by alcohol if you drink within the recommended safe limits. That is:
- Men and women should drink no more than 14 units of alcohol per week, spread evenly over several days and with at least two alcohol-free days a week.
- Pregnant women. The Chief Medical Officer's latest guideline for women is that if you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk. The risk of harm to the baby is likely to be low if a woman drank only small amounts of alcohol before she knew she was pregnant or during pregnancy. Women who find out they are pregnant after already having drunk during early pregnancy, should avoid further drinking, but should be aware that it is unlikely in most cases that their baby has been affected. If you are worried about how much you have been drinking when pregnant, talk to your doctor or midwife.
Where do these recommendations come from?
- New guidelines from the UK Chief Medical Officer for both men and women state that you are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level. If you do drink as much as 14 units per week, it is best to spread this evenly over three days or more - if you have one or two heavy drinking sessions, you increase your risks of death from long-term illnesses and from accidents and injuries. The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis. If you wish to cut down the amount you're drinking, a good way to help achieve this is to have several drink-free days each week.
- The Royal College of Physicians (RCP) advises no more than 14 units per week for men and 14 units per week for women. They also recommend having 2-3 alcohol-free days a week to allow the liver time to recover after drinking anything but the smallest amount of alcohol. A quote from the RCP: "In addition to quantity, safe alcohol limits must also take into account frequency. There is an increased risk of liver disease for those who drink daily or near daily compared with those who drink periodically or intermittently."
- The House of Commons Science and Technology Committee advises that people should have at least two alcohol-free days a week.
- Some would argue that the upper limits of the recommendations are too high. For example, one study found that drinking more than two units a day for men and more than one unit a day for women significantly increases the risk of developing certain cancers.
In general, the more you drink above the upper recommended limits, the more harmful alcohol is likely to be.
And remember, binge drinking can be harmful even though the weekly total may not seem too high. For example, if you only drink alcohol once or twice a week but when you do you drink 4-5 pints of beer each time, or a bottle of wine each time, this is a risk to your health.
One unit of alcohol is 10 ml (1 cl) by volume, or 8 g by weight, of pure alcohol. For example:
- One unit of alcohol is about equal to:
- Half a pint of ordinary strength beer or cider (3-4% alcohol by volume); or
- A small pub measure (25 ml) of spirits (40% alcohol by volume); or
- A standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume).
- There are one and a half units of alcohol in:
- A small glass (125 ml) of ordinary strength wine (12% alcohol by volume); or
- A standard pub measure (35 ml) of spirits (40% alcohol by volume).
But remember, many wines and beers are stronger than the more traditional ordinary strengths. A more accurate way of calculating units is as follows. The percentage alcohol by volume (% abv) of a drink equals the number of units in one litre of that drink. For example:
- Strong beer at 6% alcohol by volume (abv) has six units in one litre. If you drink half a litre (500 ml) - just under a pint - then you have had three units.
- Wine at 14% abv has 14 units in one litre. If you drink a quarter of a litre (250 ml) - two small glasses - then you have had three and a half units.
Some other examples
Three pints of beer, three times per week, is at least 18-20 units per week. A drinking session of three pints is at least six units, which is more than the safe limit advised for any one day. Another example: a 750 ml bottle of 12% wine contains nine units. If you drink two bottles of 12% wine over a week, that is 18 units. These are above the upper safe limits for men and women.
However, you should not drink alcohol at all if:
- You have already developed early 'scarring' of the liver (cirrhosis).
- You have chronic hepatitis or certain other liver problems. Your doctor will advise for each specific condition.
Do you need help to stop drinking?
Help and treatment are available if you find that you cannot stop drinking alcohol. Counselling and support from a doctor, nurse, or counsellor are often all that is needed. A detoxification treatment may be advised if you are alcohol-dependent. Referral for specialist help may be best for some people. If you feel that you need, or a relative or friend needs, help about alcohol then speak with your doctor.
Did you find this information useful?
- House of Commons Science and Technology Committee - Alcohol Guidelines (Eleventh Report); UK Parliament, December 2011
- Schutze M, Boeing H, Pischon T, et al; Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ. 2011 Apr 7 342:d1584. doi: 10.1136/bmj.d1584.
- I J Beckingham and S D Ryder; ABC of diseases of liver, pancreas, and biliary system: Investigation of liver and biliary disease. BMJ 2001 322:33-36.
- The Government's Alcohol Strategy (proposals to cut 'binge drinking', alcohol-fuelled violence, and number of people drinking to damaging levels); HM Government, 2012
- Antenatal care for uncomplicated pregnancies; NICE Clinical Guideline (March 2008, updated 2017)
- UK Chief Medical Officers' Alcohol Guidelines Review, Summary of the proposed new guidelines; Dept of Health, January 2016
- Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence; NICE Clinical Guideline (February 2011)
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.