You who often read the medical code must know this truth:
Just drink and you'll hurt!
Other words. The "safe dose" for drinking alcohol is 0.
From the point of view of physical health, we always recommend that you do not stick to alcohol.
However, it is really, really too hard to do!
Whether it's an occasional drink or a social outping that can't be pushed off, if you must drink alcohol, how can you minimize the damage of alcohol to the liver?
This article is for you who "occasionally drink and drink".
The first thing to state is that the safe dose of alcohol is 0.
The famous medical journal "Lancet" pointed out in 2018 that drinking alcohol does not bring any health benefits, and the argument that moderate drinking is beneficial does not exist at all [1]!
In 2016, alcohol consumption was the seventh leading risk factor for death and disability-adjusted life years (DALYs), accounting for 2.2% of deaths in women and 6.8% of deaths in men. And for people aged 15 to 49 years old, it is the number one cause of disability and death [1].
But in today's life, the vast majority of people are difficult to drink without sticking, if you are difficult to completely eliminate drinking in life, then you can drink less and drink less.
The less alcohol is drunk, the less damage alcohol can do to the liver.
The liver is the organ that relieves alcohol and is also the organ that is most harmed by alcohol.
After alcohol enters the liver, the metabolic process increases the production of phosphoglycerol, which binds to fatty acids and becomes triglycerides, and excessive accumulation in the liver becomes fatty liver.
Persistent alcohol consumption also activates the immune system, causing interleukins to attack liver cells with the help of neutrophils, eventually even becoming "alcoholic hepatitis."
Persistent liver damage can lead to irreversible liver damage [2].
Studies have found that long-term intake of more than 30 grams of anhydrous alcohol per day increases the risk of developing alcoholic liver disease; drinking more than 80 grams of anhydrous alcohol per day is almost certain to develop liver disease.
In Chinese populations, the ethanol risk threshold (warning line) for developing alcoholic liver disease (ALD) is 20 grams per day, and the risk increases with daily intake [3].
In a world without alcohol, there can be at least half as many people with cirrhosis [4].
Speaking of abstinence from alcohol, someone will definitely refute you: The old king next door has been drinking for decades, is it not a little nothing? Here's the answer: Why do some of the drinkers get liver disease early, while others are very healthy?
Everyone drinks different amounts and types of alcohol, and everyone's physical resistance is also different, and it may be that for a very few lucky people, long-term drinking is still very healthy (this is also in their lifetime), but for the vast majority of people, the harm of alcohol is unquestionable.
The harm of alcohol to the human body is affected by these factors [5,6]:
Drinking patterns: For example, drinking alcohol on an empty stomach hurts the liver more than drinking alcohol during meals.
Gender: Women are more vulnerable to alcohol than men. Studies have shown that women have a lower ability to oxidize ethanol in their intestines than men, and that women have a lower proportion of water in their bodies compared to men of the same weight, and women have higher concentrations of alcohol in their blood than men when they consume the same amount of alcohol.
Age: The liver of the elderly is more susceptible to alcohol than the younger ones.
Heredity: Also known as personal susceptibility, people with certain genetic mutations have a weakened ability to metabolize alcohol and are more likely to be harmed.
Obesity: Obese people are more vulnerable.
Smoking: Smoking itself can also affect liver function and increase the risk of alcohol-induced cirrhosis in humans.
If you are used to drinking on an empty stomach, alcohol will hurt you more, so it is best to eat something before drinking;
If you are a woman, older, more likely to be attacked by alcohol than others, try not to drink;
If you are obese (BMI greater than or equal to 25), it is best to quit alcohol completely. Not only alcohol can damage your liver, but alcohol itself is not low in calories and will aggravate obesity, which is a risk factor for many cardiovascular diseases and cancers;
If you smoke, it's best to quit smoking and also quit drinking. Studies have shown that tobacco and alcohol have a synergistic effect on liver function, and that drinking and smoking at the same time have a greater effect on liver function than any single one [7].
If you drink alcohol regularly, be sure to pay attention to the effects of nutritional supplementation.
Alcohol itself affects appetite and nutrient absorption, such as vitamin B1 deficiency caused by chronic alcohol; alcohol can affect nutrient metabolism, such as vitamin A deficiency caused by long-term alcohol consumption, and can also lead to protein deficiency in the body [8].
People with alcoholic liver disease often have malnutrition.
Malnutrition often indicates that patients with alcoholic liver disease may have a bad outcome, so once alcoholic liver disease is found, it is necessary to supplement nutrition reasonably, supplement protein, and if the family has liver disease itself, try not to drink more.
Since alcohol hurts the liver, can taking some liver protection pills "offset" the harm of alcohol?
The answer may disappoint you, there is no conclusive data to prove that a certain class of liver protection drugs can reduce the harm of alcohol to the body.
Commonly used hepatic drugs, such as compound glycyrrhizic acid, have anti-inflammatory and antioxidant activities, and have only been found in animal experiments [9]; for example, reduced glutathione has a strong reducing effect, but its protective effect when drinking alcohol has only been verified in animal experiments [10]. These are prescription drugs that should not be used haphazardly and may instead lead to drug-induced liver damage.
The best way to prevent alcohol damage is to quit drinking.
There is no safe dose of alcohol, and drinking it can cause harm.
People at different stages are advised to adopt different coping methods.
1. Alcoholic fatty liver: quit drinking! temperance! Or quit drinking!
Most patients with simple alcoholic steatosis are asymptomatic, but may experience nausea, anorexia, and vomiting.
Abstinence from alcohol is sufficient for treatment, and abstinence from alcohol is the method that should be followed by all patients with alcoholic liver disease.
About 90% of heavy drinkers develop alcoholic fatty liver or simple steatosis (usually large vesicles) and may occur within 2 weeks of heavy and regular alcohol intake.
After complete abstinence from alcohol, liver steatosis resolves rapidly [11].
2. Alcoholic hepatitis: abstain from alcohol and supplement nutrition
Treatment is based on the doctor's recommendations.
All patients with alcoholic hepatitis should abstain from alcohol and pay attention to nutritional supplementation, such as protein, zinc, B-complex vitamins, etc. [11].
3. Alcoholic cirrhosis
All patients with alcoholic cirrhosis should abstain from alcohol and pay attention to nutritional supplementation [11].
Liver transplantation may be considered for cirrhosis and end-stage liver disease [11].
4. Liver cancer
Patients with alcoholic cirrhosis should have an ultrasound every six months, with or without alpha-fetoprotein testing, to screen for liver cancer [11].
After the discovery of liver cancer, it can be removed in time in the early stage, and the middle and advanced stages can be combined with interventional therapy, radiotherapy, chemotherapy, and targeted therapy.
Having said all this, in fact, what we want to tell you most is:
The damage of alcohol to the liver is irreversible.
The so-called minimization of alcohol damage can only be "as little as possible", and there is no way to completely offset it.
As long as you drink alcohol, the damage of alcohol to the liver will occur.
There is no safe dose of alcohol, you can drink less, you can drink less, if you can not drink, do not drink!
Review expert: Jiang Weimin
Executive Director of the Department of Infectious Diseases, Huashan Hospital, Fudan University
bibliography
[1] Burton R, Sheron N. No level of alcohol consumption improves health. Lancet. 2018;392(10152):987-988.
[2] Patel R, Mueller M. Alcoholic Liver Disease. [Updated 2021 Nov 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546632/
[3] Bruha R, Dvorak K, Petrtyl J. Alcoholic liver disease. World J Hepatol. 2012;4(3):81-90.
[4] Roerecke M, Vafaei A, Hasan OSM, et al. Alcohol Consumption and Risk of Liver Cirrhosis: A Systematic Review and Meta-Analysis. Am J Gastroenterol. 2019;114(10):1574-1586.
[5] Osna NA, Donohue TM Jr, Kharbanda KK. Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Res. 2017;38(2):147-161.
[6] Lu XL, Luo JY, Tao M, et al. Risk factors for alcoholic liver disease in China. World J Gastroenterol. 2004;10(16):2423-2426.
[7] Zhang Z, Ma L, Geng H, et al. Effects of Smoking, and Drinking on Serum Gamma-Glutamyl Transferase Levels Using Physical Examination Data: A Cross-Sectional Study in Northwest China. Int J Gen Med. 2021;14:1301-1309. Published 2021 Apr 15. doi:10.2147/IJGM. S301900
[8] Kamran U, Towey J, Khanna A, et al. Nutrition in alcohol-related liver disease: Physiopathology and management. World J Gastroenterol. 2020;26(22):2916-2930.
[9] Kharbanda KK, Ronis MJJ, Shearn CT, et al. Role of Nutrition in Alcoholic Liver Disease: Summary of the Symposium at the ESBRA 2017 Congress. Biomolecules. 2018;8( 2):16.
[10] Huo X, Sun X, Cao Z, et al. Optimal ratio of 18α- and 18β-glycyrrhizic acid for preventing alcoholic hepatitis in rats. Exp Ther Med. 2019;18(1):172-178.
2018;1032:37-53.
[11] Singal AK, Bataller R, Ahn J, et al. ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol. 2018;113(2):175-194.
Editors: Zhang Xiaoyi, Di Hao, Wang Yan
Proofreading: Wu Yihe | Typesetting: Li Yongmin
Operation: Han Ningning | Coordinator: Zhao Yanan