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A Good Balanced Nutritional Diet Can Help Your Liver
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Dear Reader,

Below are a collection of some articles & website links
off the internet that we think may be helpful for you.


How does the use of alcohol damage the liver?

 

Heavy and chronic drinking cause the liver to become fatty and this fat infiltration chokes off the supply of blood that delivers oxygen and other nutrients to liver cells causing them to eventually die. They are replaced with connective or scar tissue and this is called cirrhosis. This results in a drinker's reduced ability to tolerate the drug because there are progressively fewer liver cells to metabolize it. Genetic make-up plays a big role in one's susceptibility to this condition. Some alcohol users develop symptoms of cirrhosis after just a few years of consuming 3-4 drinks a day, while other heavy drinkers never suffer from this potential killer.

The liver performs so many vital functions that we cannot live without it. It is the largest single organ in the body and it handles the majority of the blood that flows from the intestinal tract back to the heart; stores glycogen, the body's storage form of sugar for energy; and breaks down toxic compounds that occur with the body's metabolism It is very important to "take care of your liver!"

Warning signs of cirrhosis include jaundice (yellowing of the skin and whites of the eyes) and the back-up of fluid in the abdomen and lower extremities. At university health services, physicians have seen cirrhosis in men as young as 19-20 who started drinking heavily in their early teens. Here are some healthy drinking guidelines designed to reduce alcohol-related problems:

 

  • 1) know that if your family has a history of alcohol and other drug use, you may be more susceptible to abuse;

     

  • 2) limit your alcohol intake to no more than two drinks per day; and,

     

  • 3) drink for positive reasons like a celebration, instead of relying on alcohol to relieve stress and depression.

The National Clearinghouse for Alcohol and Drug Information [(301)-468-2600] has free information and resources about alcohol-related health topics including disease and abuse prevention.

More Information About Alcoholism & Alcohol Liver Disease

He knew the only way to save his life was to quit drinking, but he just couldn't stop, no matter how he tried.

His name was Bobby. He wasn't my best friend; he was more like everybody's best friend. Everybody enjoyed his company, his sense of humor and his incessant teasing. I don't remember anyone who disliked Bobby. He was one of those people that you immediately felt comfortable around.

Everybody loved Bobby.

I don't ever remember seeing Bobby drunk, but I never saw him sober either. You know what I mean: he could drink all day and you could never tell it by the way he looked, acted or talked. I suppose that was because he drank constantly. Nobody could tell the difference.

On the way to work in the mornings, he would pull into the backyard of one of his friends, pop the trunk, get his bottle of whiskey and take a long swig right out of the bottle. He'd get back into the car and drive off to work. Every morning.

That's when he was still able to work. When he began having health problems, the doctor immediately diagnosed him with cirrhosis of the liver or alcohol liver disease. They told him to quit drinking or he was going to die.

God knows he tried to quit. He tried to work the 12-step program again and again, and saw the inside of more than one alcohol treatment center. After 28 days of no alcohol, a balanced diet, and megadoses of vitamins, Bobby would feel a lot better. He'd celebrate by having a drink -- the minute he was released.

Later came the medical hospitals. When jaundice set in he was forced into having a complete blood transfusion, which helped for a while. Six weeks later, Bobby would be back needing another transfusion.

After his second trip to the hospital and second transfusion, Bobby came to me looking for work. He'd been fired from every auto dealership and mobile home lot in town at least once and had few options. Since he swore to me he was not drinking and because, with his great personality he was a great salesman, I got him a position in our sales department. He seemed to be doing a lot better.

One morning a few weeks later I was at work before anyone else. I was upstairs in the break room fixing a pot of decaf and glanced out the window to see Bobby pull into the back alley parking area. He got out of the car, popped the trunk, got his bottle and turned it up.

Nothing had changed. He was just trying to hide it now, even from his oldest friends.

The last time I saw Bobby he was in the hospital again. His skin was completely yellow and his eyes were sunken into his head. "Bobby, you need to hurry up and get out of this place, I want to go fishing!" I told my friend of more than 30 years. Then I placed my hand on his weary head and told him I loved him and God loved him too. I knew I was saying goodbye.

When I left the room I called all of his old friends: "If you want to see Bobby again, you better get on over to the hospital. Quickly." Most of them were able to get there in time.

We buried him four days later. He was in his mid-40s. Survivors included a four-year-old daughter.

Bobby was one of the 10-15 percent of drinkers whose livers cannot process alcohol properly. Or perhaps there was just too much alcohol for far too long. An estimated 25,000 people a year die as a result of alcohol liver disease.

Alcohol abuse can cause a condition called "fatty liver" or another called "alcohol hepatitis" -- both of which can be treated, but only if alcohol consumption is stopped. If drinking continues, these conditions will cause cirrhosis of the liver.

What happens is the liver begins to harden. Scar tissue develops in the body's largest organ which hinders its ability to filter blood. When the scar tissue develops to a certain point, the liver can no longer do its work.

The problem is the liver performs more than 1,500 functions for the body, including more than 300 life-saving procedures. If the liver stops doing its job, all kinds of health problems develop quickly and death can come rapidly.

The liver detoxifies poisons, both those produced by the body and those from outside; filters bacteria from the blood; regulates fat metabolism; stores and manufactures vitamins; regulates and manufactures cholesterol and fats; synthesizes proteins; maintains the body's water and salt balance; secretes bile for the digestion of fat; stores energy (in the form of glycogen); helps regulate overall body metabolism; transforms the highly toxic ammonia (produced by exercise and by metabolism of proteins) into urea which is eliminated in the urine; manufactures lipoproteins for fat and cholesterol transport; and metabolizes alcohol.

If the liver stops doing any of these jobs, or numerous others it does constantly, the result is fatal.

Here is more information about the liver and alcohol liver diseases:

 

 

The Yellow Man
The story of the last days of Willie Duncan from a medical point of view.

Risk factors for premature death in alcoholics
Years of heavy drinking put alcoholics at risk for a host of health problems ranging from poor nutrition to heart disease and cirrhosis of the liver.

Vitamin C - Beneficial Effects
It has been used to treat everything from poison ivy to cirrhosis of the liver.

Health Issues
Long-term alcohol abuse can bring about a myriad of other health problems.


 

Alcoholic Liver Disease

By Howard J. Worman, M. D.

Alcohol abuse is a leading cause of morbidity and mortality throughout the world. It is estimated that in the United States as many as 10 % of men and 3 % of women may suffer from persistent problems related to the use of alcohol. The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association divides alcohol use disorders into "alcohol dependence" and "alcohol abuse." Alcohol dependence is indicated by evidence of tolerance and/or symptoms of withdrawal such as delirium tremens (DTs) or alcohol withdrawal seizures (rum fits) upon cessation of drinking. Alcohol abuse is characterized by recurrent performance problems at school or on the job that result either from the after effects of drinking alcohol or from intoxication on the job or at school. In addition, patients with alcohol abuse disorders may use alcohol in physically adverse circumstances (e.g. while driving) and may miss work or school or neglect child care or household responsibilities because of alcohol use. Legal difficulties related to alcohol use are also common. Patients with alcohol abuse disorders often continue to consume alcohol despite the knowledge that continued consumption poses significant social or interpersonal problems for them. People with alcohol use disorders often consume alcohol despite knowing that they suffer from alcohol-related medical problems such as liver disease.

Alcohol affects many organ systems of the body, but perhaps most notably affected are the central nervous system and the liver. Almost all ingested alcohol is metabolized in the liver and excessive alcohol use can lead to acute and chronic liver disease. Liver cirrhosis resulting from alcohol abuse is one of the ten leading causes of death in the United States.

From data obtained in autopsy studies, it appears that between 10 % and 15 % of alcoholics have cirrhosis at the time of death. It is unknown why some alcoholics develop liver disease while others do not. One possibility is that there are genetic factors that predispose some alcoholics to liver disease. Some data also suggest that co-factors such as chronic infection with hepatitis C virus may increase the risk of the development of cirrhosis in an alcoholic. In general, women who drink an equal amount of alcohol are at higher risk than men for the development of liver disease, possibly because of decreased metabolism of alcohol in the stomach prior to absorption.

REMEMBER, LIVER DISEASE IS NOT THE ONLY LIFE-THREATENING COMPLICATION OF ALCOHOL USE DISORDERS. ALL ALCOHOLICS MUST ABSTAIN FROM DRINKING AS NUMEROUS OTHER ALCOHOL-RELATED MEDICAL, SOCIAL AND PSYCHOLOGICAL PROBLEMS CAN LEAD TO MORBIDITY AND MORTALITY.

Alcohol abuse generally leads to three pathologically distinct liver diseases. In clinical practice, any or all of these three conditions can occur together, at the same time, in the same patient. These three conditions are:

Fatty Liver (Steatosis)
Alcohol abuse can lead to the accumulation of fat within hepatocytes, the predominant cell type in the liver. A similar condition can also be seen in some obese people who are not alcohol abusers. Fatty liver is reversible if the patient stops drinking, however, fatty liver can lead to steatohepatitis. Steatohepatitis is fatty liver accompanied by inflammation and this condition can lead to scarring of the liver and cirrhosis. Click to see a microscopic section of a NORMAL LIVER LOBULE and an example of FATTY LIVER in an alcoholic. (Images are part of WebPath and are copyrighted by the Pathology Department of the University of Utah Health Sciences Center. Link with permission of Edward C. Klatt, M. D.)
Hepatitis
Alcohol can cause acute and chronic hepatitis. The patient who presents with alcoholic hepatitis is usually a chronic drinker with a recent episode of exceptionally heavy consumption. Other presentations are also possible. Alcoholic hepatitis can range from a mild hepatitis, with abnormal laboratory tests being the only indication of disease, to severe liver dysfunction with complications such as jaundice (yellow skin caused by bilirubin retention), hepatic encephalopathy (neurological dysfunction caused by liver failure), ascites (fluid accumulation in the abdomen), bleeding esophageal varices (varicose veins in the esophagus), abnormal blood clotting and coma. Histologically, alcoholic hepatitis has a characteristic appearance with ballooning degeneration of hepatocytes, inflammation with neutrophils and sometimes Mallory bodies (abnormal aggregations of cellular intermediate filament proteins). Click to see a microscopic section of a NORMAL LIVER LOBULE and an example of a liver with ALCOHOLIC HEPATITIS. (Images are part of WebPath and are copyrighted by the Pathology Department of the University of Utah Health Sciences Center. Link with permission of Edward C. Klatt, M. D.) Alcoholic hepatitis is reversible if the patient stops drinking, but it usually takes several months to resolve. Alcoholic hepatitis can lead to liver scarring and cirrhosis, and very frequently occurs in alcoholics who already have cirrhosis of the liver.
Cirrhosis
Cirrhosis is characterized anatomically by widespread nodules in the liver combined with fibrosis. In the United States, alcohol abuse is the leading cause of liver cirrhosis. Anatomically, alcoholic cirrhosis is almost always micronodular (i.e. the regenerating liver nodules are small). You can click to see a microscopic section of a liver with MICRONODULAR CIRRHOSIS AND FATTY LIVER and a NORMAL SECTION for comparison. (Images are part of WebPath and are copyrighted by the Pathology Department of the University of Utah Health Sciences Center. Link with permission of Edward C. Klatt, M. D.) Cirrhosis can result from many causes other than alcohol such as chronic viral hepatitis, metabolic and biliary diseases. The co-existence of another chronic liver disease in a patient who abuses alcohol likely increases the risk of developing cirrhosis (eg. an alcoholic with chronic viral hepatitis C). Alcoholic cirrhosis can occur in patients who have never had evidence of alcoholic hepatitis. Cirrhosis can lead to end-stage liver disease. Some of the complications of cirrhosis are jaundice, ascites, edema, bleeding esophageal varices, blood coagulation abnormalities, coma and death. You can click to read more about CIRRHOSIS AND ITS COMPLICATIONS.

Treatment

The most important measure in the treatment of alcoholic liver disease is to ensure the total and immediate abstinence from alcohol. This will sometimes require admission to an in-patient medical ward for prophylactic treatment of withdrawal symptoms such as delirium tremens and seizures. Treatment of other associated neurological conditions may also be required. Chronic alcohol abusers often need treatment with vitamins, especially thiamin, to correct the deficiencies that may have resulted from chronic alcohol abuse. Intensive medical treatment of the complications of acute alcoholic hepatitis or cirrhosis is also sometimes necessary, as is the treatment of concurrent infectious and/or metabolic disorders.

Once the patient is medically stable, he/she should receive on-going treatment to ensure abstinence from alcohol. This often includes a period of in-patient alcohol rehabilitation followed by subsequent long-term participation in support groups such as Alcoholics Anonymous and possibly continuous out-patient psychiatric care. Cessation of alcohol use will reverse fatty liver and alcoholic hepatitis. Although cirrhosis is irreversible, alcohol abusers who stop drinking will often have a good prognosis in that progressive liver deterioration can be avoided.

There are several sites on the Internet with information about alcohol-related disorders and recovery programs for alcohol abusers. Here is a list of links, some of which will also lead to other sites:

Click here to return to Diseases of the Liver home page.

Click here to go to COLUMBIA UNIVERSITY GASTROENTEROLOGY WEB.

 

Copyright, 1995, 1998, Howard J. Worman, M. D. All rights reserved. Printing or other reproduction is prohibited without the written authorization of Howard J. Worman.

 

Alcoholic Liver Disease/Howard J. Worman, M. D./hjw14@columbia.edu
 

 


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