Liver Health and Signs of Liver Damage from Alcohol Abuse

My father died of liver failure from heavy alcohol abuse three and a half years ago.

I was a nurse for 20 years; I thought I knew a lot about liver health and the signs of liver damage. My father had quit drinking for six years before relapsing just four years prior to his death. I didn’t realize that he had been showing signs of alcoholic liver damage in the two years before his death.

These signs eluded even my father, who erroneously thought that he had repaired his liver in those six years that he was sober.

When my father was admitted to the hospital with jaundice, swelling (ascites), bleeding, and an inability to eat, I didn’t realize that he was in decompensating liver failure and we would lose him in only 3 weeks.

During his hospitalization, I educated myself further about the diagnosis, treatment, test results, symptoms, and progression of liver disease. I vowed to use my nursing knowledge and personal experience to pass on vital information to the general public.

Many people don't know about alcohol and liver damage. In fact, most people don't even know what the liver does and how it works.

There are over 100 diseases that can cause liver damage; alcoholism is only one of them. But the nature of alcohol intake and how it affects the liver may mask and confuse this deadly problem.

Unfortunately, alcoholism is already a masked and controversial issue. The nature of addiction is such that even the alcoholic is unaware of how their health is changing due to their addiction. Often times, liver damage from alcoholism is diagnosed too late. And if it is found and diagnosed, usually it’s covered up or minimized.

This does not happen in other non-alcoholic liver diseases. People with liver disease, not attributed to alcohol, get extensive follow-up and are put on strict diets and have their medications reviewed carefully.

The liver is a highly forgiving organ that can take an awful lot of hits before it finally gives out. Compared to other organs such as the heart or stomach, the liver doesn’t show clear symptoms that follow a specific path.

The liver is responsible for several vital functions including digestion, removing toxins and waste products, processing medications, managing blood sugar and synthesizing proteins for blood production and coagulation.

The fact that the liver has the power to regenerate itself is often what doctors pass on to patients to help them feel less frightened. It’s also a way to help them take responsibility for changing their lifestyle to help prolong and maintain the health of this vital organ.

Unfortunately, many alcoholics (including my father) hear words like “the liver can regenerate” and take this as permission to keep going so long as they “take it easy.” In fact, that’s exactly what my father said he would do in the years before his death.

When he relapsed, he said, “The doctor told me my liver is in perfect health now, so I just have to take it easy. I promise I will only have a glass of wine once a day.”

Unfortunately, alcoholics can’t have one drink per day. Within half a year, my fathers drinking went from one glass of wine per day to fix to six glasses per day. On top of that, he had begun mixing regular wine with port wine, which contains twice the amount of alcohol.

But it wasn’t those few years of port-mixed glasses of wine that killed my father—it was 40 years of heavy drinking and slowly progressing liver disease, which advanced to liver failure, that killed my father.

Common questions about liver health and illness

I'd like to answer some common questions about liver health and illness. These were also questions my family and I had when we learned that my father was dying from alcoholic cirrhosis. Some of these answers pertain to overall liver health and some points are specific to alcoholic liver damage.

Many people with alcoholic liver issues can go on to live healthy lives, but only after they’ve successfully reduced or quit drinking. The lack of education about alcohol for both alcoholics and the general public is mind-boggling. I aim to change that.

1. What is liver damage, and how does it work?

If you drink heavily and frequently, you may already have liver damage that can result in alcoholic fatty liver disease. Not everyone gets a fatty liver from alcohol, but most people who drink heavily have some form of liver damage.

Here’s how it works. Think back to the worst hangover you’ve ever had. The horrible headache, the pins and needles, the vomiting, spinning, inability to think or manage external stimuli. If you were to get a blood test at that moment, it may have revealed elevated liver enzymes.

An elevation in liver enzymes is always the result of acute liver damage. However, due to how well our liver works at repairing and maintaining balance, these enzymes don’t end up being elevated for very long.

Many people think that if their liver enzymes are normal, this means that their liver is in perfect health. This is false. It just means you didn't do the bloodwork when active inflammation was present. These levels rise and fall fairly rapidly.

2. What is a fatty liver, and does it mean my liver is failing?

After acute damage, the liver does some impressive work to clean things up. It labors tirelessly to fix the damage while performing the rest of its normal functions.

Unfortunately, after the damaged cells are fixed by the liver, some cells don’t make it, and they turn into fat. A fatty liver means that many liver cells have been damaged and turned into fat and you can actually see it on an imaging scan.

A fatty liver does not mean liver failure is imminent, but it does mean that if a person continues to bombard the liver with toxic substances, it will not be able to keep up its functions for the long term.

3. How is cirrhosis different from fatty liver?

Over time, fatty liver cells can turn into scars which create hardened areas of the liver that never return to normal. This is called cirrhosis, and it can be a severe stage of liver disease. Many people with alcoholic cirrhosis go on to develop liver failure if they don’t quit drinking.

Survival depends on how severe the cirrhosis is and whether the person can change their drinking and lifestyle habits.

If a person quits drinking, they can have what is known as compensating cirrhosis. This means that even though much of the liver is destroyed, the remaining liver can do a good enough job to keep the body in balance.

People with compensating cirrhosis have a good chance of long term survival only if they quit drinking. And only if they don’t do anything else to damage the remaining part of functioning liver. However, they often have ongoing health symptoms and challenges, so they need to be vigilant.

After my father’s death, the doctor told me that he likely had compensating cirrhosis and not just a fatty liver when he began drinking again.

Compensating cirrhosis is manageable, but adding alcohol, drugs, or other toxic substances can often push people into decompensating cirrhosis. Once a person gets to decompensating cirrhosis, they will need a liver transplant or they will die.

This is what happened to my father in the months before his death. And you should know, alcoholics don't receive a liver transplant unless they are alcohol-free for six months and in good enough shape for the transplant. My father didn't fit the bill and so he died.

Decompensating cirrhosis means that the remaining liver tissue is not making up for the rest of the damaged liver and is therefore not keeping the body in balance anymore.

Once this happens, it sets off a series of events that causes widespread organ failure and toxicity resulting in death.

4. Is it true that my liver can regenerate after it’s been damaged?

Under healthy circumstances, the liver can produce new cells, thus regenerating itself. Experts say that regeneration is a highly complicated process that is not well understood.

It’s important to know that the degree of regeneration is highly dependent on the person, their complex health history, and whether they have a resilient liver.

Alcoholics with fatty liver disease can only benefit from the forgiving nature of the liver if they quit drinking. Also, they need to limit certain medications, fatty food, and other substances that put stress on this vital organ.

It takes several months to a year for the liver to regenerate or find a healthy balance after it’s been significantly damaged. If the liver never gets to repair itself, those damaged cells may become hardened and turn into cirrhosis.

The confusing part is that many blood tests taken during this recovery period may show normal results. The liver does a great job when it comes to maintaining balance in the body while working on repairing itself.

Unfortunately, normal results may give us a false perception that the liver is healthy and able to take more abuse through drinking, medications, unhealthy food, and so on.

Adding toxic substances to a liver that’s trying to repair itself is like shooting ourselves in the foot, except we don’t see the damage until the foot has fallen off.

5. I drink more than I should, how do I know if I have liver disease?

If you drink a lot and are concerned about the health of your liver, it’s best to tell your doctor how much you actually drink every day.

Many people are afraid of being stigmatized by their doctor because of their heavy drinking but not knowing the state of your liver can make things much worse for you. If your doctor doesn’t know how much you drink, then he or she can’t help you.

Knowing where you are in the health of your liver will help you make decisions about your drinking and lifestyle habits that contribute to liver damage.

Many people opt to reduce their drinking rather than quit. If you’re able to do this, then that’s great news for you and your liver. Unfortunately, most alcoholics do not succeed at reducing their drinking for the long-term.

6. I’m afraid to talk to my doctor about my drinking, but are there signs that can help me know if my liver is in trouble?

There are some clear signs that the liver is struggling or working really hard. Most people don’t know that these signs indicate liver issues as they can signal many other health issues as well. These signs happen well before a liver becomes too damaged to work anymore. Once a person develops cirrhosis, these signs change and become much worse.

If you’re a heavy drinker and have some of these signs, it might help you to make some decisions about your health. These signs are evident in both mild acute liver damage as well as fatty liver disease. These conditions exist long before liver damage becomes life-threatening.

• Frequent issues with digestion such as heartburn, pain, diarrhea or constipation, or slow digestion.
• Problems with fat metabolism, such as feeling nauseated or having diarrhea after eating high-fat foods.
• Decreased appetite, especially for fat and protein.
• Type 2 diabetes—If you’ve been diagnosed recently and are a heavy drinker, you should get your liver checked.
• Metabolic syndrome—which refers to insulin resistance, obesity, hormone-related disorders, high blood pressure, and cholesterol issues. This has been linked to heavy drinking and liver issues.
• Extreme fatigue and feeling unwell, especially in the morning. Liver damage and the repair process can feel like recovering from a cold or flu. These symptoms are often worse in the morning but can happen during the day as well.
• Neuropathic pain—decreased movement with pain and tingling in the hands and feet has been linked with liver damage and alcohol toxicity.
• Redness and tiny blood vessels around the face—these symptoms show up more in men than women and is highly related to liver disease. These become more prominent as liver damage gets worse.
• Swollen face and stomach—this is an effect of the inflammation that heavy drinking creates in the body. This is not the same as ascites which happens in end-stage cirrhosis where the belly and legs swell with fluid.
• Tremors or “the shakes”—this is often a sign of alcohol withdrawal. If you’re getting the shakes more frequently, it’s a tell-tale sign that your liver is also struggling.
• Confusion or brain fog—this is a sign of inflammation and/or a liver that is struggling to repair itself.
• Evidence of thiamine (vitamin B1) deficiency due to alcoholism—double vision or nystagmus (eyes shaking back and forth for a few seconds), confusion, personality changes, cracked reddened mouth, neuropathy. Thiamine deficiency is very common in alcoholism and can indicate that the liver is also struggling. This is a serious issue that is absolutely not talked about enough.
• Becoming noticeably ill after taking medications, food, or other substances (that are hard on the liver) and combining them with alcohol (especially if you’ve been doing this for a while and never got sick before). This is a sign that the liver isn’t able to manage the load as it once did.

The liver is very forgiving, but unfortunately, it can only take so much over time.

Many people have signs of a struggling liver after they’ve put too many toxic substances in their body. It’s good to know these signs so we can be more aware of our liver and how to take care of it.

There are ways to improve and protect your liver if you are a heavy drinker. It begins by knowing how the liver responds to alcohol over time. I highly encourage anyone who drinks heavily to ask their doctor for testing and assessment of their liver. You can't fix what you don't know.

Lastly, knowing the signs of a struggling liver can be confusing as they’re related to many other health issues, but it can give you clues to help you make decisions about your liver health.

My father had many signs that his liver was struggling. These signs plagued him for his whole life. As a nurse, even though I knew about liver pathology, I didn’t realize that these subtle signs are significant clues about how well the liver is functioning.

Taking control of our health starts with knowledge first.

Here are some links to the research I used to inform this article. You can read them if you want more information and education.

Liver Regeneration

How Does The Liver Work?

Liver cirrhosis and diabetes: Risk factors, pathophysiology, clinical implications and management

Elevated Liver Enzymes

Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease

Metabolic Syndrome

The Role of Thiamine Deficiency in Alcoholic Brain Disease