The three main stages of alcohol-related liver disease are fatty liver, hepatitis and cirrhosis. These conditions can occur at the same time.
See your doctor or practice nurse if you are drinking above the safe limits and are finding it difficult to cut down.
What are the recommended safe limits of alcohol?
- Men and women should drink no more than 14 units of alcohol per week, no more than three units in any one day and have at least two alcohol-free days a week.
- Pregnant women. Advice from the Department of Health states that: "Pregnant women or women trying to conceive should not drink alcohol at all. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk."
Your liver processes alcohol. It can only cope with so much at a time. Drinking more alcohol than the liver can cope with can damage liver cells and produce toxic by-product chemicals.
The more you drink and especially above the recommended limits, the greater the risk of developing serious problems. And remember, binge drinking can be harmful even though the weekly total may not seem too high. For example, if you only drink 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. Also, even one or two units can be dangerous if you drive, you operate machinery, or you take some types of medication.
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What is a unit of alcohol?
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, lager, 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% 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.
- 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. This is above the upper safe limit for both men and women.
Isn't alcohol good for you?
For men aged over 40 and for women past the menopause, it is thought that drinking a small amount of alcohol helps to protect against heart disease and stroke. The exact amount is not clear but it is a small amount. So, do not exceed the recommended amount of alcohol as described above in a mistaken belief that it may be good for the heart.
Do you know how much you are drinking?
When asked "How much do you drink?" many people give a much lower figure than the true amount. It is not that people usually lie about this but it is easy not to realise your true alcohol intake. To give an honest answer to this question, try making a drinking diary for a couple of weeks or so. Jot down every drink that you have. Remember, it is a pub measure of spirits that equals one unit. A home measure is often a double.
If you are drinking more than the safe limits, you should aim to cut down your drinking.
Further reading and references
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 7342: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 2001322:33-36.
Antenatal care for uncomplicated pregnancies; NICE Clinical Guideline (March 2008 - updated February 2019)
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)