Questioning How Much Alcohol Is Safe
It is well acknowledged that a person with chronic hepatitis C and a history of heavy alcohol abuse has an increased chance of developing advanced liver disease, including cirrhosis and hepatocellular carcinoma . Both of these conditions work together to effectively promote the development, progression, and severity of liver disease.
On its own, heavy alcohol intake can lead to a form of non-viral hepatitis called alcoholic hepatitis. When paired with viral hepatitis , the impact on the liver can be exponentially increased.
Hepatitis C has also been found to be more common in people with a history of alcohol abuse than among non-drinkers. While the reasons for this are not entirely clear, we do know two things:
- That alcohol and injecting drug use are strongly linked, and
- That injecting drug use remains the predominant mode of hepatitis C transmission in the U.S.
These associations highlight the need to address alcohol intake in all persons with chronic hepatitis C, whether symptomatic or not, as well as the need to address alcohol use whenever embarking upon a hepatitis C virus prevention strategy, particularly among injecting drug users and other high-risk groups.
Learn more about the risks associated with alcohol use and hepatitis C below.
Who Is At Risk For Alcoholic Hepatitis
Both women and men can have alcoholic hepatitis. Most people who are diagnosed with alcoholic hepatitis are between 40 and 60 years old. Patients at highest risk for alcoholic hepatitis typically drink more than 100 grams of alcohol a day for many years. Those who have a family history of alcoholism may also be at risk for the disease.
Hepatitis C Infection: Disease Characteristics Testing And Treatment
The symptoms and course of hepatitis C vary greatly. Many people who are infected with the virus show no symptoms , whereas some people may experience fatigue, weakness, fever, nausea, abdominal pain, poor appetite, muscle and joint pain, or yellowing of the skin and eyes . About 75 percent of patients who are infected with HCV develop chronic infection . Between 10 and 40 percent of HCV patients develop cirrhosis within 20 to 40 years, and 1 to 3 percent develop liver cancer.
Many patients who develop cirrhosis show no symptoms of the disease and can expect longterm survival . Data from a cohort of European patients with cirrhosis followed for an average of 5 years showed that only 7 percent developed hepatocellular carcinoma, and 18 percent experienced symptomatic liver failure . There currently is no vaccine for hepatitis C.
Testing and Treatment
Blood tests can diagnose HCV infection, either by detecting antibodies to the virus or by detecting the presence and quantity of the viruss genetic material itself . Liver biopsy is quite helpful for evaluating the diseases severity prior to initiating treatment. Liver enzymes have little value in predicting fibrosis.
There are six known genetic variants of HCV, which vary geographically in their rate of occurrence. Genotypes 1 , 2, and 3 constitute the majority of genotypes in the United States.
Eugene R. Schiff and Nuri Ozden
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Abstention Before Interferon Treatment
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Questions To Ask Your Doctor
- What’s the most likely cause of my symptoms? Are there other possible causes?
- What tests do I need? How do I need to prepare for them?
- Is my condition temporary or chronic?
- What treatments are available? Which one do you recommend?
- I have other health problems. How can I best manage these conditions together?
Don’t hesitate to ask other questions.
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Important Things To Remember
Here are some important recommendations that your doctor may make about hep C, treatment, and alcohol.2,3,7 As always, ask your doctor what’s best for you.
- Dont drink if you have an active hepatitis C infection
- Dont drink if you are receiving interferon treatment for hepatitis or cancer
- Dont drink if you have cirrhosis
- Dont drink if you are on the liver transplant list
From Steatosis To Cirrhosis
Alcoholic Liver Disease includes three conditions: Fatty liver, alcoholic hepatitis, and cirrhosis. Heavy drinking for as little as a few days can lead to “fatty” liver, or steatosis-the earliest stage of alcoholic liver disease and the most common alcohol-induced liver disorder.
Steatosis is marked by an excessive buildup of fat inside liver cells. This condition can be reversed, however, when drinking stops.
Drinking heavily for longer periods may lead to a more severe, and potentially fatal condition, alcoholic hepatitis-an inflammation of the liver. Symptoms include nausea, lack of appetite, vomiting, fever, abdominal pain and tenderness, jaundice, and, sometimes, mental confusion. Scientists believe that if drinking continues, in some patients this inflammation eventually leads to alcoholic cirrhosis, in which healthy liver cells are replaced by scar tissue , leaving the liver unable to perform its vital functions.
The presence of alcoholic hepatitis is a red flag that cirrhosis may soon follow: Up to 70 percent of all alcoholic hepatitis patients eventually may go on to develop cirrhosis. Patients with alcoholic hepatitis who stop drinking may have a complete recovery from liver disease, or they still may develop cirrhosis.
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Medications To Reduce Liver Inflammation
If you have severe alcoholic hepatitis, your doctor might recommend:
- Corticosteroids. These medications have shown some short-term benefit in increasing the survival of certain people with severe alcoholic hepatitis. However, corticosteroids have serious side effects and generally aren’t prescribed if you have failing kidneys, gastrointestinal bleeding or an infection.
- Pentoxifylline.Your doctor might recommend this anti-inflammatory medication if you can’t take corticosteroids. The benefit of pentoxifylline for alcoholic hepatitis isn’t clear. Study results are inconsistent.
How Alcohol Affects Treatment
Hep C is a virus that can not only be treated, but also cured.1,8 Antiviral therapy is used to treat hepatitis infections.1,5,7 There are new hepatitis drugs on the market that have high cure rates. Physicians prescribe the drugs that are the best match for each individuals particular type of hepatitis.1
Many doctors wont start antiviral treatment if their patients are still drinking.1 They believe consuming any alcohol risks further liver damage, despite treatment. Some doctors may disagree as to whether it is safe to ever have a drink, especially when it comes to patients with a history of alcohol abuse. Further, it is a myth that beer or wine is considered less harmful than hard liquors . All forms of alcohol are potentially damaging to the liver.3,6
Your doctor will continue to send you for lab work while treating hepatitis. If test results are virus free after 3 months, the treatment will be considered successful, or “cured”.2 However, being cured doesnt mean it is OK to resume drinking. Even after hep C and treatment, liver disease may already be present, and any alcohol may continue to make that condition worse. Always talk to your doctor to get recommendations based on your own personal health status and medical condition.
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Increased Risk Of Cirrhosis
There is little doubt that people with chronic hepatitis C who drink alcohol have a higher chance of developing cirrhosis. From an epidemiological point of view, more than 90% of heavy drinkers will develop fatty liver disease, of which as many as 20% will develop liver cirrhosis within 10 to 20 years.
Hepatitis C infection runs a similar course, with 75% of infected persons developing chronic disease, while 15-20% will progress to advanced disease within 10 to 30 years.
The combination of these two factors speeds the process dramatically, as well as increasing the severity of liver damageby some estimates, by as much as 200-300%. Furthermore, heavy alcohol users with HCV have a nearly 11-fold greater risk of developing cirrhosis than non-drinkers with HCV.
Treatment Programs And Support
Doctors may recommend alcohol treatment programs for people who find it difficult to cut out alcohol. Programs are available both in and out of hospital, depending on the severity of the dependence.
These programs can help people to reduce and eventually stop consuming alcohol.
Here are some examples:
Not everyone who consumes large amounts of alcohol will develop alcoholic hepatitis.
More research is necessary to confirm why some people who drink in excess develop the disease while others do not.
It is also important to note that alcoholic hepatitis can also occur in moderate drinkers, although the risk is far lower.
According to the Liver Foundation, up to 35 percent of people who consume alcohol heavily develop alcoholic hepatitis. Of these, 55 percent already have cirrhosis.
Alcohol can have a wide range of harmful effects on the body. People who consume alcohol should do so in moderation.
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Key Points About Alcoholic Hepatitis
- Hepatitis is inflammation of the liver that leads to liver cell damage and cell death.
- Alcoholic hepatitis is caused by drinking too much alcohol. The liver breaks down alcohol and if, over time, you drink more alcohol than the liver can process, it can become seriously damaged.
- Alcoholic hepatitis usually develops over time with continued drinking. Severe alcoholic hepatitis can develop suddenly and quickly lead to liver failure and death.
- You must completely stop drinking alcohol and may need an alcohol treatment program. Sometimes diet changes are recommended, too. Treatment involves reducing the symptoms and halting the progression of the disease.
Antiviral Medication For Hepatitis B
Doctors may recommend antiviral medication for people with chronic hepatitis B, which occurs when the virus stays in your body for more than six months.
Antiviral medication prevents the virus from replicating, or creating copies of itself, and may prevent progressive liver damage. Currently available medications can treat hepatitis B with a low risk of serious side effects.
NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus is very likely to damage the liver over time. People with chronic hepatitis B may need to take antiviral medication for the rest of their lives to prevent liver damage.
There are many different types of antiviral medications available, and your doctor recommends the right type for you based on your symptoms, your overall health, and the results of diagnostic tests. A doctor may take a wait-and-see approach with a person who has a healthy liver and whose blood tests indicate a low viral load, the number of copies of the hepatitis B virus in your bloodstream.
Someone with HIV infection or AIDS may have a weakened immune system and is therefore more likely to develop liver damage. The U.S. Centers for Disease Control and Prevention strongly recommends that people with HIV infection who are diagnosed with hepatitis B immediately begin treatment with antiviral medication.
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How Does Alcohol Affect Cirrhosis
Alcohol increases the damage done to the liver and speeds up the development of cirrhosis. For example, after about 25 years of hepatitis C infection, heavy drinkers show more than twice the scarring of light drinkers or non-drinkers. After 40 years of infection and heavy drinking, most heavy drinkers have developed cirrhosis.
Tips For Cutting Back On Drinking
The National Institutes of Health offers the following tips to help people cut back on drinking:
Watch it at home.
Keep only a small amount or no alcohol at home. Don’t keep temptations around.
When you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink water or non-alcoholic drinks after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.
Take a break from alcohol.
Pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.
Learn how to say NO.
You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.
What would you like to do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a movie, or go for a walk.
Cutting down on your drinking may be difficult at times. Ask your family and friends for support to help you reach your goal. Talk to your doctor if you are having trouble cutting down. Get the help you need to reach your goal.
Watch out for temptations.
Do not give up!
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How To Help Prevent Liver Damage
Studies have shown that taking N-Acetyl-Cysteine NAC for hangover prevention can contribute to avoiding damage to your liver . NAC works by helping to increase glutathione production which helps break down acetaldehyde. NAC hangover drink is so effective that it is even used with patients that overdose on Acetaminophens. An example is when someone overdoses on Tylenol. If they are given NAC in time, it is almost 100% hepatoprotective when it is given within 8 hours after an acute acetaminophen ingestion . Similar results have been shown for rats that consume NAC alcohol drink. The liver cells of the rats given NAC showed tiny change and appeared almost normal . This is compared to the rats that ingested ethanol and showed liver damage.
How Is Ah Diagnosed
Your healthcare provider will ask how much alcohol you drink at one time. He will ask how much you drink each day and how often you drink each week. He will ask how long you have been drinking alcohol. He may also ask if you have ever been treated for alcohol addiction.
- Blood tests are used to check your liver function.
- CT or ultrasound pictures may show liver damage or enlargement.
- A biopsy is a procedure used to take a sample of your liver to be tested. A liver biopsy is done if other tests do not show what is causing your symptoms.
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Is Alcoholic Hepatitis Reversible
Alcoholic hepatitis is sometimes reversible. If the condition isnt severe, individuals can recover from liver damage caused by alcohol abuse. It is clear that the condition will continue to worsen if a person continues to drink. Drinking alcohol also increases the risk of developing cirrhosis, a liver condition that can be deadly.
Medical conditions that commonly occur alongside alcoholic hepatitis, such as infections, pneumonia, tuberculosis, internal bleeding, diabetes, pancreatitis and cancer, may be irreversible.
Alcohol addiction is a common contributor to alcoholic hepatitis. Alcoholics, the common term for people with alcoholism, usually have to receive treatment for alcoholism to increase the likelihood of successfully reversing alcoholic hepatitis.
Demographic And Biochemical Data
There was no difference in the age of all male patients in the alcohol and alcohol-free groups . The median alcohol intake for Groups A and D was similar and was considered indicative of heavy alcohol consumption. The median alcohol intake for Group C was 65 g/day and this was considered as a group of moderate alcohol consumption. The AST/ALT ratio was > 1 for Group A, but was < 1 for the other groups. We did not find any significant difference in the serum levels of other biochemical parameters in these four groups except gamma-glutamyl transpeptidase and leucine aminopeptidase , which showed a higher value in Group A compared to the other groups .
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Is Ald Progression Reversible
Stopping alcohol consumption may completely reverse steatosis. It is known that advanced ALD prognosis is poor, with a survival rate of 23% at 5 years and of 7% at 10 years. An important issue is whether there is reversibility in the case of steatohepatitis/steatofibrosis: Diehl affirms that alcohol-induced steatohepatitis appears to be the rate-limiting step” in the pathogenesis of alcohol-induced cirrhosis because almost 40% of the patients with the lesions develop cirrhosis within 5 years. Moreover, he declares that the evolution of more advanced stages of ALD depends on the balance between the degree of exposure to alcohol and the presence of other host attributes or confounding conditions .
A past experience demonstrated how, in abstainer patients, the reversibility of alcoholic hepatitis is possible and it is confirmed by the return to an essentially normal architecture even in cases in which the alcoholic steatohepatitis was severe or was observed repeatedly for 3-5 years .
HSC are known to synthesize the excess matrix that characterizes liver fibrosis and cirrhosis.
It is possible, in case of ethanol abstinence and in association with an exercise program, adequate nutrition and pharmacological treatment , to reverse the morphology of activated HSC to the quiescent phenotype, before irreversible fibrotic changes occur .
How Is Alcoholic Hepatitis Treated
The goal of treatment is to restore some or all normal functioning to the liver.
You will need to stop drinking alcohol. To do thi, you may need to be in an alcohol treatment program. Sometimes you may also need to change your diet. Scarring of the liver is permanent. But the liver is often able to repair some of the damage caused by alcohol so you can live a normal life.
You may be admitted to the hospital or treated on an outpatient basis. There is no medicine to cure alcoholic hepatitis. Treatment involves easing the symptoms and keeping the disease from getting worse.
Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.
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