Tuesday 20 November 2018

What really happens to your body when you give up booze?

Thousands of Irish people are having a 'Dry January' and abstaining from alcohol after the excesses of Christmas. But does four weeks without a drink really have any health benefits, or are we kidding ourselves? Liver specialist Professor Suzanne Norris has the answers

The fact that the liver has a unique ability to repair and regenerate is well-established
The fact that the liver has a unique ability to repair and regenerate is well-established
Professor Suzanne Norris

We are often told that too much alcohol is bad for us. While the liver can cope with drinking a small amount of alcohol at any given time, drinking too quickly or drinking too much over a short period of time can result in the liver struggling to process it. Most of us are familiar with the idea of giving up alcohol for Lent. More recently the concept of a 'Dry January' has gained prominence when we give up alcohol for the month in an attempt to make up for the excesses of the Christmas period.

It's a concept gaining popularity with the medical profession which has warned that Ireland is in the grip of an alcohol epidemic. According to a report by the World Health Organisation in 2014, 39pc of Irish people are heavy drinkers which is defined as having more than 35 units (three and a half bottles of wine) a week for women, or more than 50 units a week for men. Drinking more than six standard drinks on any one occasion is regarded as binge drinking.

The recommended maximum levels of alcohol intake are 11 units a week for a woman or 17 units a week for a man (1 unit is equivalent to a half pint of beer, one pub measure of spirits, or one small glass (125mls) of wine).

Alcohol effects on the liver

Professor Suzanne Norris
Professor Suzanne Norris

The hangover is the most obvious warning sign that one has consumed excessive alcohol as alcohol acts as a diuretic resulting in dehydration causing the hangover headache. But it is important to keep in mind that alcohol can have varying effects. When alcohol reaches the liver, it produces a toxic enzyme called acetaldehyde which can damage liver cells causing permanent scarring (liver disease). Depending on your age, gender, mental health, drug use and medical conditions, regular and heavy drinking over time, can affect the way alcohol is metabolised within the body, which can lead to alcoholic liver disease. If you continue to drink excessively, either through binge drinking or by having multiple drinks on a daily basis, the consequences include destruction of liver cells, a build-up of fat deposits in your liver (fatty liver disease), or liver inflammation (alcoholic hepatitis), permanent scarring (cirrhosis) or even liver cancer.

Alcohol effects on other areas of the body

Exceeding limits is easily done - for example, a large glass of wine can equal a third of a bottle - and drinking at this level can leave you with more than just a hangover. Not only is alcohol high in calories, contributing to weight gain, but heavy drinking contributes to high blood pressure, high cholesterol, and increases blood sugar levels through insulin resistance, increasing the risk of type 2 diabetes. In addition, other tissues such as the stomach lining are injured causing gastritis or peptic ulcer disease, or inflammation to the pancreas (pancreatitis).

Recent evidence published in the scientific journal Addiction in 2017 reported a link between alcohol consumption and cancers of the oropharynx (mouth), larynx (throat), oesophagus, liver, colon, rectum and breast, and concluded that there is more than simply a link or statistical association between alcohol and cancer that could be explained by something else. Growing evidence suggests that alcohol is also likely to cause skin, prostate and pancreatic cancer. However, communication of these findings beyond the medical and scientific community has been poor. A recent Cancer Research UK study found that when people were shown a list of different cancers, only one in five knew that breast cancer could be caused by drinking, compared to four out of five people who knew that alcohol could cause liver cancer.

Prof Dame Sally Davies, the chief medical officer for England, caused a stir last year by warning women that drinking alcohol could cause breast cancer. She told a parliamentary hearing: "Do as I do when I reach for my glass of wine. Think: do I want the glass of wine or do I want to raise my own risk of breast cancer? I take a decision each time I have a glass."

But can a Dry January really reverse the impact of alcohol and reduce the risk of developing life-threatening illnesses and disease? Research from University College London and the Royal Free Hospital in London suggests the answer to that question is a definite yes. A total of 102 relatively healthy men and women in their forties who took part in the Dry January campaign in the UK for four weeks saw benefits in liver function, blood pressure and cholesterol levels and were also at lower risk of developing diabetes and liver disease. Those who took part in the month of abstinence lost as much as 6lbs in weight and reported improvements in concentration and sleeping. This is not surprising as regular drinkers often have impaired sleep because they are more likely to snore or wake more frequently during the night as a consequence of their poor breathing, leading to poorer concentration during the day.

The female patients had been drinking an average of 29 units of alcohol a week, equivalent to more than four units a day, while the male patients were typically drinking more than 31 units, both above UK government guideline levels. After four weeks, their "liver stiffness" scores (Fibroscan test) - an indication of liver damage and scarring - had reduced by 12.5pc, and insulin resistance - a measurement of diabetes risk - had reduced by 28pc.

This important study shows the benefit from a month's abstinence from alcohol. What is unknown, however, is how durable those benefits are and whether the benefits are sustained over time and if the benefits accrued would be greater if the abstinence period was extended from one month to two or three months. The fact that the liver has a unique ability to repair and regenerate is well established. Liver specialists have observed for several years the significant benefits of weight loss on liver inflammation and liver scarring (fibrosis) in patients with fatty liver disease due to type 2 diabetes or obesity. Several scientific studies have reported that 7-10pc loss in body weight in patients with proven non-alcohol fatty liver disease is associated with up to 90pc reduction in liver inflammation and more than 50pc improvement in liver scarring. In Ireland, approximately 43pc of Irish over 50 year olds are overweight (BMI≥25 kg/m2), with a further 36pc classified as obese (BMI ≥ 30 kg/m2); just 21pc have a normal BMI.

Detection and treatment for liver disease

In December 2016, in response to the growing incidence of liver damage, the National Institute for Health and Care Excellence (NICE) in the UK recommended non-invasive liver scans such as fibroscan assessments for women drinking more than 35 units per week and men who drink more than 50 units per week. Fibroscan testing is a non-invasive ultrasound-based technology which measures liver stiffness and is correlated with liver fibrosis (scarring). From the patient's perspective, the procedure is painless, quick and easy to repeat over time. Unfortunately, many people with liver disease do not show symptoms and early detection of liver disease is critically important to both prevent and halt the damage that drinking too much alcohol can do. If it is tackled at an early stage, simple lifestyle changes can be enough for the liver to recover. A Dry January campaign may be the first step!

• Professor Suzanne Norris is a consultant hepatologist/gastroenterologist at Beacon Consultants Clinic beaconhospital.ie She operates the Liver Wellness clinic. For more on alcohol-related liver disease and top tips for a healthy liver, visit liverwellness.ie/ald

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