Drinking with liver disease not caused... - British Liver Trust

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Drinking with liver disease not caused by alcohol

Interesting information for those with liver disease NOT caused by alcohol who believe this means they can continue to drink. From the New England Journal of Medicine.

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Thank you for sharing Jim. Can you email it to me and the source reference?

Best wishes.

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Done

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Thanks Jim!

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I was always under the impression that any diagnosis of liver disease meant no alcohol. As a diseased or fatty liver cannot function correctly to process alcohol putting it under further stress is surely equivalent to self harm

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You are absolutely correct.

However, there are some who may mistakenly rationalise drinking, because their illness was not caused by alcohol it somehow doesn't apply to them.

My post was really just a reminder, especially with the festive season looming.

Jim

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I was diagnosed with liver cancer 10 years and have never been told to stop drinking or limit my alcohol...so not everyone with liver issues needs to give up drinking.

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Doctors have varying opinions and that was the purpose behind why I posted the link below.

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I was diagnosed with Hepatitis B, D then cirrhosis, not once was I told anything about drinking. I only found out I had to stop after doing my own research. Just because your doctor/consultant hasn't mentioned anything, it doesn't mean any further damage from alcohol won't occur.

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My hepatoligist and liver surgeon have both said no need to make any life style changes..and as I'm still alive and well 10 years after a diagnosis of primary liver cancer I think they know what they are talking about ..only thing they advise against is hormonal birth control..

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Nice one Jim. I think there's a greater need for awareness especially at this time of year.

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Not my opinion personally but just a bit of devils advocate on the topic...

hepatitis.va.gov/provider/c...

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I post this only as it seems that anytime I talk to a doctor or my hepotologist about this the facts remains the same. 1) alcoholics can never drink for risk of relapse. 2) heavy alcohol continuation will definatly progress disease. 3) that light social drinking is not concretely proven to show disease progression as an absolute and much of that variable remains unknown and uncertain. The unknown will make most doctors advise against it but as seen here that is not always the case as quantity is a key factor it seems.

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Glad its got a debate going. To reinforce what you say, In the link you posted, it states;

"Patients with chronic hepatitis C cirrhosis who have not had a history of alcohol dependency should be clearly advised to avoid heavy or daily drinking, but there is still debate among experts about whether light, occasional drinking is harmful."

Further, in the New England journal (NEJM) article " No safe level of alcohol consumption has been determined for patients with HCV, and even those who drink moderate amounts of alcohol can have progressive liver fibrosis. compensated liver disease was 2.3 times as high among patients with HCV who drank alcohol as the risk among abstainers."

And for those who collect facts; in the NEJM article it states "The causal association between alcohol intake and alcoholic liver disease has been well documented, yet liver cirrhosis develops in only 10 to 20% of heavy drinkers" That shouldn't be taken as a green light to drink heavily, just an interesting fact. Who wants to take part in a lottery when the prize is a potentially fatal illness ?

Jim

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Noone said it was a greenlight to drink heavy . Again I never said it was my belief to drink while having cirrhosis. This was merely a point in the other direction. Your initial post is written as if its concrete and it is not. Any publicly posted comment or claim becomes fair game to be commented on by anyone reading it.

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In fact not sure where anywhere I said anything about greenlighting anyone to drink heavy

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Sorry if I wasn't clear. I was referring to the statistic in the article about 10 - 20% possibly misleading some into believing the chance of harm was lower than you might think.

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Oh I agree fully. There are many who see the " low risk" of it all as seemingly safe gamble to continue drinking. I disagree fully with that mindset but that being said any and all drinking is risky on that front even in those who dont have disease. I was simply trying to shed light on the fact that there seems to be not a ton of info out there on occasional drinking after disease in comparison to engaging in heavy drinking habits. Even the word moderation seems to have a very loose interpretation amongst different countries and doctors regardless of the standards set out. Also most who think they are within guidelines are usually off the mark by overeserving themselves or being over served. In a discussion with my hepotologist and with my GI doctor before her they both seem to agree that the odd glass of wine will likely do nothing to further progression if it was truly in fact kept to occassion such as a glass of champagne on a new years toast or a proper poured glass of wine on an anniversary dinner. Though they will not say go ahead and do it some doctors will say it's fine to do so. Though this was said I personally still do not engage myself. But again to each his own in his or her free will.

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Hi LAJ123,

Thank you for posting this.

My husband's liver disease was decided to be alcohol related and so his liver doctor asked him to abstain, which he has - although now is allowed non-alcoholic beer. We like his liver doctor who is informative and also in charge of the transplant department where we go. The doctor told us that once the liver is damaged any alcohol would increase the damage or at best slow any possible improvements. I would think not all doctors make this a big point when talking to their patients, so putting the information out is good.

Best wishes,

Mary

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Do you know why he is allowed non alcoholic beer? The clinic where my husband goes are very strict about it & you would not be allowed a transplant if you drink it. I feel very sad for my husband when I see the stats that only 10-20% of heavy drinkers get cirrhosis. He did drink over the units, & didn't give his liver a break but I've spoken to people recently who know people who've had spirits & been drinking all day for years & not got it. In fact, apart from a very brief conversation noone has ever really spoke to him about his drinking habits. He gave up drinking immediately, no problems but is not even allowed an occasional 0% beer.

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I was a bit surprised by alcohol free being tolerated as well.

As someone who had a transplant with alcohol related liver disease as the reason, I know a bit about this.

The thinking is, before being considered as a suitable candidate for a transplant, anyone with alcohol related liver disease would be expected to conform to certain expectations.

These are, to totally abstain from alcohol for a minimum of six months and engage with a substance abuse agency in a meaningful way. This means to have a lifelong commitment to remain alcohol free pre and post transplant. This commitment has to include changing not just the behaviour but the thinking and attitude underpinning the problem with drinking. Drinking alcohol free beers or wines could be seen as evidence that there is still a desire or need for alcohol. If there is any doubt in the minds of the transplant team, drinking alcohol free could be the tipping point for being denied a transplant.

Seems a bit severe, but being listed and given a transplant is a huge investment in time, effort, money and the need to ensure that the public know that a donated organ goes only to those who will respect and care for the gift of, in this case, a liver. An unfortunate truth is that some are unsure about donating if their organs are going to be given to someone who will not respect that gift.

Jim

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Hi Supportinghubby,

We live in the USA, so I'm not sure if it is that or just his liver doctor's opinion.

At most of his liver doctor appointments he would ask the doctor why drinking, even occasionally, was not allowed and the doctor told him the main reason is because once you start drinking, even occasionally, it will, most likely, start the whole cycle again, for those, very few, with live disease most probably caused by alcohol. I also think that many doctors fear that even non-alcoholic beer will make many go back to the "real" thing, since they don't really taste or give the same result as real beer. We sampled a whole bunch to find some he liked and he got used to the taste and is fine with them.

Hubby did not have anything, even non-alcoholic, for over a year, even though every 6 month check up he'd ask about it. The doctor told him that once the liver is in cirrhosis alcohol will either continue to damage it or best not allow it to heal. He did however give the okay for non-alcoholic brews. We think mostly because my husband's blood work and ultrasounds continue to improve a little bit each time we see the doctor. I'd guess that if he stops improving or gets worse the doctor will go back to the no drinking anything with even a minute amount in it. But that is just my thought. Hubby did ask about transplants and drinking and was told that a new liver would probably not change the fact that he is one of those whose body reacts poorly to alcohol and one drink could just start the whole process over again and the drugs used for keeping a transplant viable require no alcohol to work right.

Transplant was not mentioned during my husband's hospitalization or after and his doctor believes that his life expectancy is pretty much back on a normal [?] schedule. The recurring appointments are to keep an eye out for liver cancer because cirrhosis increases the chances of it, and also to make sure his liver is doing relatively okay. Should a transplant be suggested and dropping even the n/a was required hubby would do that as he has proven to his doctor that he can.

So in essence, his doctor was okay with it because my husband is improving even 3 years after his liver failure.

Other doctors might not have okayed this, but his did and hubby has abided by it so, for now, we're good.

Best wishes,

Mary

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I have progressed form NA fatty liver to cirrhosis. I went off alcohol after contracting a virus. Fatty liver is now at epidemic proportions in the western world, US and UK especially. I was told to lose some weight and did over 3 years I dropped 2 stone. Slow but sure and reduced my portions and only ate when I felt hungry. Now comes the BUT and the relevance to drinking alcohol. Carbs cause liver fat. The sugar in alcohol is hidden , but it is there, sometimes in high levels. I was told clearly by a Hep. Professor the only way to help my liver is to reduce the fat. To get the body to burn off fat it has to have fat as its energy source. ie LO/NO CARBS. Being told to just lose some weight has seen me progress from fatty liver,fibrosis,severe fibrosis and cirrhosis. Obesity is at an all time high and with it comes a high risk of not just diabetes but cirrhosis, which is given no publicity.Its not a way of eating you can just wake up and decide, it is something that requires a massive effort on preparation . Even eating clean has pitfalls it seems. Many fruits are high in carbs. Due to the low fat we have been convinced of, often foods low fat are packed with carbs. It has taken me over a week to prepare and I am awaiting ketostix to be delivered. Bought a BP monitor as a lo carb diet reduces BP. The good news I received from this Prof. was I can expect to still be around in 20 years time if I can change my body to burning fat instead of carbs. Alcohol is is off the agenda , even without being addicted, it can damage the liver , adding fat from the carbs. If cirrhosis is advanced then none of this applies. Then it is much more complex and needs medical supervision . sorry for the essay but there is no simple way I could think of to highlight this.

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Hi

I'm not a qualified nutritionist but have learned a lot on diet and nutrition from my line of work. Avoiding carbs is one of the worst things you can do to yourself. Yes you may lose some weight but it's not sustainable and you'll likely be feeling sluggish and miserable all the time. The body needs carbs for energy. Not all carbs are created equal so you should avoid simple carbs like most sugars, pretty much all processed foods and sugary drinks including fruit juice. Focus instead on complex carbs like Whole grains, starchy vegetables, non-starchy vegetables, and legumes. Fresh and frozen fruit (not dried) is also great and due to the high fibre content is digested slowly making it more like complex carbs despite the sugar content. The same cannot be said about fruit juice due to the lack of fibre. Low fat foods are loaded with sugar making them much worse than the full fat versions. Certain fats are actually essential for a healthy diet like olive oil, avocado, nuts, oily fish and cheese. Having a good muscle mass helps the body break down sugar and alcohol more efficiently. Obviously both are a big no no if you have liver problems. Ultimately, other than watching what you eat, it comes down to the calorie deficit or surplus. If you burn more calories than you take in, you will lose fat, it is that simple. No need for extreme diets or starving yourself.

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I was told to do this by a Professor only last week at my liver clinic. I have lost weight in the past by following this diet and now if I want to take care of my liver and prevent cirrhosis from causing further damage, the only way is to virtually remove carbs from my diet. Just as not drinking has to become a way of life for alcohol dependents, and I know from working with people who had serious drug and or alcohol dependence this is a massive challenge, I admire all those who manage to stop and stay that way. Carbs are what caused fat in my liver! If the body is stopped from using carbs as the energy source it then depends on converting fat to energy. Dark green vegetables are best but I have lost 2 stone by allegedly reducing portion sizes, only eating when hungry etc. reduced my calorie intake. I will definitely not be starving whatsoever! Meat, with fat in or on, Eggs,cheese, seafood,fish, butter and dairy produce are allowed, The animal fat argument has been totally debunked. Butter is healthier than say Flora. Our bodies relied totally on a carnivore diet since inhabiting the planet. I have spent a lot of time researching and I dont mean on forums and chat sites! medical research and qualified dieticians. Yes it will be tough, however when I did this before on an Atkins style, I found after a few weeks that carb foods like bread,chips,biscuits,rice and pasta were bland and my palate changed. Due to other health conditions I cannot exercise. Many people are in this situation. ME and fibromyalgia are just 2 of my ailments. Methotrexate is toxic, it worked amazingly well on my psoriasis and psor. arthritis. This was prescribed injections, it does say there is a small chance of liver damage. Stopping however does not reverse the damage. Psoriasis too can cause fibrosis. I didnt just decide this is the best way to lose fat, I was told by a Hep. Professor. at a major Teaching Hospital that has a dedicated Liver Centre. I do have an ology in nutrition and food so have a good understanding of it. however as we age our bodies change. Middle age spread is a fact for most people. Fat seems to go straight to the tum. Of course I will have cravings, but its no different than someone stopping drinking. If I want to stay well and not get to severe cirrhosis then I have good reason to sustain this way of eating.

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As someone said, opinions in the topic vary. Alcohol is never good for you even when you have a perfectly fine liver. There was a study recently published in Lancet concluding that something like moderation doesn't exist when it comes to alcohol. Which makes units a bit pointless but still some sort of guidance. So, I suppose it's an informed choice you have to make yourself and shouldn't be judged for.

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Hi

I was DIY with nafld 2.5 years ago and Nash with fibrosis just over 2 years ago. This was caused by meds from my drs. I last had a drink 3 years this Christmas and I do t intend to drink again not that I drank much anyway. I will been given some very good advice on this forum to which it fully appreciate. Love and hugs to you all Lynne xxxx

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