Beer And Fatty Liver: Is It Safe To Drink?

Alcohol-related liver disease (ARLD) is caused by heavy alcohol use and is one of the most common causes of death in the UK. The liver is one of the most complex organs in the body, and it can become damaged when alcohol consumption surpasses its ability to process it. This can lead to a build-up of fat inside the liver cells, resulting in an enlarged liver. ARLD typically doesn't cause any symptoms until the liver has been severely damaged. However, once the damage is extensive, symptoms can include jaundice, swelling in the ankles and tummy, confusion or drowsiness, and vomiting blood or passing blood in stools.

The first stage of ARLD is alcoholic fatty liver disease, which is reversible if alcohol consumption is stopped. The subsequent stages are alcoholic hepatitis and cirrhosis, which can be life-threatening.

While the type of alcohol doesn't make a difference, the amount consumed does. The safe limit for men and women is 14 units of alcohol per week, which is roughly half a pint of normal-strength lager or a pub measure of spirits per day.

A study on mice suggests that hops, an ingredient in bitter beers, may protect the liver by guarding against the build-up of liver fat. However, it's important to note that the study was conducted on mice and may not have the same effect on humans.

Alcohol worsens fatty liver disease, increasing mortality in high-risk patients

Alcohol is known to worsen fatty liver disease, increasing mortality in high-risk patients. Fatty liver disease is a common condition affecting about 30% of the global population. It is caused by a build-up of fat in the liver, exceeding 5% of the liver's weight, which can lead to inflammation, cirrhosis, and liver cancer. While some people with fatty liver disease may not experience any symptoms, the condition can progress and cause severe health issues.

Alcohol consumption is a significant risk factor for fatty liver disease, especially when consumed in excess of safe limits. The safe limit for men and women is 14 units of alcohol per week, which corresponds to approximately half a pint of beer per day. Excessive alcohol intake can lead to alcoholic fatty liver disease (AFLD), which is characterised by fat accumulation in the liver and can progress to inflammation, fibrosis, and cirrhosis. Therefore, it is generally recommended that people with fatty liver disease avoid alcohol consumption to prevent further damage to the liver.

However, there is ongoing debate about the effects of moderate alcohol consumption on people with non-alcoholic fatty liver disease (NAFLD). Some studies suggest that moderate alcohol intake may have a protective effect, lowering the risk of liver disease progression and improving cardiovascular health. In contrast, other studies indicate that even moderate alcohol consumption can increase the risk of liver disease progression and cancer development, especially in women.

While the specific mechanisms are not fully understood, several factors may contribute to the conflicting findings. These include the assessment tools used to measure alcohol intake, the definition of "safe" alcohol consumption, and potential confounders such as socioeconomic status and physical activity levels.

Overall, the current consensus is that abstinence from alcohol is the best approach for people with fatty liver disease, particularly in high-risk patients, to prevent further liver damage and improve health outcomes.

Alcohol introduces fat to the liver, causing inflammation and destruction

Alcohol consumption can lead to a range of adverse health effects, with alcohol use disorders being among the most common substance use disorders worldwide. Alcohol is a major preventable cause of death, with 95,000 people dying annually in the US from alcohol-related causes. Excessive alcohol consumption can significantly affect the liver, contributing to three types of liver disease: fatty liver (or hepatic steatosis), alcoholic hepatitis, and alcohol-related cirrhosis.

Alcoholic fatty liver disease is caused by alcohol introducing fat to the liver, which then causes inflammation and destruction. Alcohol abuse and chronic alcohol consumption can lead to a high rate of morbidity and mortality due to alcohol-induced liver disease (ALD). ALD is a preventable yet potentially fatal condition that results from drinking more alcohol than the liver can process, damaging the organ. The liver breaks down alcohol, and this chemical reaction releases toxins that damage liver cells. If this process occurs repeatedly over time, even without the person getting drunk, liver damage can begin.

The original biochemical explanation for alcoholic fatty liver centred on ethanol metabolism shifting the redox state of the liver and inhibiting fatty acid oxidation. Subsequent studies found that ethanol metabolism increases the levels of the mature sterol regulatory element-binding protein 1 (SREBP-1), which enhances hepatic lipogenesis and leads to the development of fatty liver. Ethanol also impairs the secretion of very-low-density lipoproteins (VLDL) from the liver, which can result in the accumulation of triglycerides in hepatocytes and the development of fatty liver.

The total amount of fat in the liver depends on fatty acid synthesis and its oxidation. Alcohol-induced fatty liver is based on the combination of increased glycerolipid synthesis and decreased fatty acid oxidation in mitochondria. Ethanol influences the activity of peroxisome proliferator-activated receptor-alpha (PPAR-α), which is responsible for fatty acid oxidation. Alcohol inhibits PPAR-α activity, both in vitro and in vivo. This inhibition of PPAR-α leads to reduced capacity for fatty acid oxidation, resulting in an increased hepatic lipid synthesis and decreased fatty acid oxidation.

In summary, ethanol metabolism leads to excessive generation of reducing equivalents, inhibiting fatty acid oxidation and stimulating lipogenesis. The effects of ethanol on lipid metabolism result from inhibition of PPAR-α and stimulation of SREBP-1, causing metabolic remodelling of the liver towards a fat-storing, rather than a fat-oxidising, organ. These alterations contribute to alcohol-induced fatty liver, causing inflammation and destruction.

Alcohol consumption is a risk factor for the development of type 2 diabetes

The American Diabetes Association (ADA) states that a drink or two may improve insulin sensitivity and sugar management. However, heavy alcohol consumption and zero consumption increase the risk of developing type 2 diabetes. A 2015 meta-analysis of 38 cohort studies found that moderate consumption appeared to offer some protection against the condition in women and Asian populations, while heavy consumption raised the risk in almost all groups.

Alcohol can cause blood glucose levels to rise or fall, depending on how much you drink. Some diabetes pills (including sulfonylureas and meglitinides) also lower blood glucose levels by stimulating the pancreas to make more insulin. Combining the blood-sugar-lowering effects of the medication with alcohol can lead to hypoglycemia or "insulin shock," which is a medical emergency.

The liver is responsible for breaking down alcohol, and when it is busy doing this, it cannot release stored carbohydrates to maintain blood sugar, potentially causing blood sugar levels to drop to dangerous levels. This is why experts advise people with diabetes not to drink alcohol if their blood sugar is already low.

In addition, alcohol consumption is a risk factor for the development of type 2 diabetes, and it increases the risk of heart disease, high blood pressure, nerve damage, and eye problems, all of which are complications of the condition.

Therefore, while moderate alcohol consumption may have some protective effects against type 2 diabetes, heavy consumption is clearly harmful and increases the risk of developing the disease.

Avoiding alcohol can reverse alcoholic fatty liver disease and prevent it from progressing into more severe liver conditions

Alcoholic fatty liver disease (AFLD) is caused by drinking a lot of alcohol, which causes fatty acids to collect in the liver. Avoiding alcohol can reverse the damage of AFLD and prevent it from progressing into more severe liver conditions such as alcoholic hepatitis, fibrosis, and cirrhosis.

Non-alcoholic fatty liver disease (NAFLD) occurs in people who do not drink a lot of alcohol. However, alcohol can worsen the symptoms of NAFLD, leading to further liver damage. Therefore, it is strongly advised that people with NAFLD avoid alcohol altogether.

A 2020 review found that alcohol use probably increases the risk of liver disease progression in people with NAFLD. Alcohol use, even when moderate, can cause the liver to accumulate additional fat, which damages the liver.

A study on mice found that the compound in hops may have a protective antioxidant effect that helps minimize cell damage in the liver. Therefore, bitter beers like India Pale Ales (IPAs) and Extra Special Bitters (ESBs), which have an abundance of hops, may be better for the liver than other types of beer.

Alcohol use increases the risk of liver disease progression in people with non-alcoholic fatty liver disease

Alcohol consumption can indeed cause fatty liver disease. However, this is not the only cause of the disease, and it is possible to have non-alcoholic fatty liver disease (NAFLD). While it is generally recommended that people with fatty liver disease avoid alcohol, there is some debate as to whether moderate alcohol consumption may be safe or even beneficial for people with NAFLD.

Alcohol and Fatty Liver Disease

Fatty liver disease is characterised by a build-up of fat in the liver, which can lead to inflammation and liver cell damage. There are two types of fatty liver disease: alcoholic fatty liver disease (AFLD), caused by excessive alcohol consumption, and non-alcoholic fatty liver disease (NAFLD), which occurs in people who do not drink a lot of alcohol. People with fatty liver disease typically do not experience any symptoms, but left untreated, it can increase the risk of more serious conditions, including cirrhosis, liver disease, and liver cancer.

Alcohol and NAFLD

While NAFLD occurs in people who do not drink a lot of alcohol, it is still recommended that those diagnosed with the disease avoid alcohol altogether. This is because alcohol use, even when moderate, can cause the liver to accumulate additional fat, which damages the liver and can lead to further health complications. Indeed, a 2020 review found that alcohol use probably increases the risk of liver disease progression in people with NAFLD.

However, some studies have suggested that moderate alcohol consumption may be safe, or even beneficial, for people with NAFLD. For example, a 2012 review of studies on the effects of alcohol on people with NAFLD found a reduced prevalence of altered liver enzymes in older and younger age groups who consumed light to moderate amounts of alcohol. Similarly, a 2019 study found that patients with NAFLD who drank a maximum of half a can of beer or half a glass of wine daily (less than 7.4 g of alcohol per day) did not have a higher mortality rate or risk of disease progression.

Nevertheless, given the potential risks associated with alcohol consumption for people with NAFLD, doctors highly recommend that these patients avoid alcohol altogether.

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