Prof. Dooley, many people want to avoid alcohol after New Year's Eve. For example, an alcohol-free January is popular. Why?
Alcohol is harmful to the body and health. Many people are aware of this. Such a decision is a sign that they believe they have consumed too much alcohol in the past. Otherwise you wouldn't have to decide to give up alcohol. So the consciousness is there. All the more so, of course, because the Christmas holidays and New Year's Eve are still very present - days when people usually look a little deeper into the glass.
The crucial question is: Does giving up something bring anything – or can you leave it as it is?
The answer here is very clear: every renunciation is sensible and important. Alcohol is a poison and stresses the body's cells, especially liver cells that are responsible for metabolism. The liver is the organ that metabolizes and breaks down alcohol. Every single alcohol molecule damages the affected liver cell.
Prof. Dr. Steven Dooley works as a professor of molecular hepatology at the Mannheim Medical Faculty (Heidelberg University). Dooley researches the effects of alcohol on the liver.
Every single molecule?
Yes, exactly. When each individual alcohol molecule breaks down, degradation products are created that put liver cells under stress. If too many molecules arrive at the same time, the liver cell is so badly damaged that it dies. Cell death occurs. This creates a wound that can scar. This is comparable to a cut in the skin. The problem is chronicity. This means: Unlike a cut in the skin, the influence that causes the wound, for example chronic alcohol abuse, comes back again and again and the organ scars over time.
What does this mean in relation to the liver?
The organ is increasingly no longer able to carry out its actual task: building up, breaking down and excreting metabolic products. Cirrhosis develops and, in the worst case, there is a risk of acute liver failure. If the liver is already severely damaged, the risk of liver cancer is also increased.
But that certainly only applies to heavy drinkers.
Not exclusively. The liver can also be seriously damaged by hepatitis pathogens, poisons, an unhealthy diet or medication abuse. Alcoholic cirrhosis is the result of continuous, progressive damage and most commonly occurs with regular, risky alcohol consumption. But some occasional drinkers are also particularly at risk, even with moderate consumption.
Why is that?
There are personal risk factors that multiply the damaging effects of alcohol. An example of this is a hepatitis C virus infection. If this is the case, the risk of developing liver cancer after drinking alcohol is increased many times over. Research is currently being conducted into other possible risk factors. These include, for example, inflammatory messengers or a genetic predisposition.
Watch the video as author Susanne Kaloff talks about her self-experiment: What was it like living without alcohol for a year?
How long should you avoid alcohol for at least so that the liver benefits from it?
There is no general answer to this. I would advise against consuming alcohol continuously for six months and then taking a four-week break, kind of like a cure. Instead, I recommend: behave consciously, pay attention to your well-being, stop drinking alcohol every now and then for a certain period of time and prove to yourself that you can do it. It is certainly helpful to always drink at least the same amount of water when consuming alcohol. Otherwise, the rules for moderate consumption apply: men should not drink more than 20 grams of alcohol a day. This corresponds to about a quarter liter of wine or half a liter of beer. For women, half is considered acceptable. You should also stay alcohol-free for at least two to three days a week. However, these guidelines must also be carefully considered with regard to the risk factors mentioned above. There are situations where this is already too much, such as a pre-existing hepatitis C infection.
What is cirrhosis of the liver?
In cirrhosis of the liver, the liver tissue is destroyed and transformed into connective tissue. As the disease progresses, the liver can no longer properly detoxify the blood. Cirrhosis increases the risk of liver cancer.
What risk factors are known?
Liver cirrhosis is preceded by chronic liver disease. It can last for years or decades. Viruses, toxins and metabolic diseases damage the liver and attract inflammatory cells from the blood. They settle in the organ and cause further damage. Experts estimate that around 60 percent of cases of illness are caused by excessive alcohol consumption.
What are the symptoms?
Liver cirrhosis is often diagnosed accidentally - through an ultrasound examination or abnormal liver values during a blood test. The reason: Liver cirrhosis only becomes noticeable in an advanced stage. Those affected are often tired, exhausted and not as productive as before. Some patients also complain of a feeling of pressure in the upper abdomen, flatulence and nausea. If large parts of the liver have already been destroyed, patients develop jaundice, are short of breath and develop water retention in the stomach and legs.
How common is cirrhosis?
Every year, around 250 out of 100,000 people develop liver cirrhosis. Men are affected about twice as often as women.
Is it curable?
No. However, the doctor can prevent the disease from progressing if he knows the causes of the underlying disease. In the case of alcohol-related cirrhosis, it is important that patients consistently avoid alcohol. In severe cases, a liver transplant is the only chance for a cure.
Is abstinence better than moderate consumption over a longer period of time?
Even if this waiver is only temporary, say for a few months?
Then it's better than not doing without for these few months. That is beyond question.
Some people report feeling better without alcohol. Is it just placebo?
Certainly not. Those who avoid alcohol sleep better and more deeply and therefore feel fitter and better recovered. But this only applies to people who are not addicted to alcohol. Addicts can even experience life-threatening side effects if they stop drinking overnight. A doctor should be consulted here.
Alcohol damages the liver, we've already talked about that. Where else does alcohol cause harm?
There are around 200 illnesses that are caused by alcohol. High-percentage alcohol, for example, can cause mechanical damage to the surface of the throat and throat area. Consumed regularly, it increases the risk of cancerous tumors in this area. And of course we shouldn't forget the many hospital stays that are indirectly attributable to alcohol: car accidents, falls, fights.
How do those affected notice that they are drinking too much alcohol?
You often only notice it physically when it is too late and the liver has suffered irreversible damage. It can be helpful to critically question your own consumption: How do I see my drinking behavior? Are friends and family perhaps worried? Can I give up alcohol for a long time without it becoming difficult? There are also questionnaires online that can make self-assessment easier.
Is there such a thing as a healthy glass of wine in the evening?
That doesn't exist - for one simple reason: alcohol is a poison, and a poison cannot inherently be healthy. Of course the situation is more complex. A little wine in the evening can also contribute to the quality of life and support well-being. This has nothing to do with escaping everyday life, but rather with enjoyment. And that in turn can be good for your health. When we talk about the "healthy glass of wine", there are two different poles: on the one hand, conscious, beneficial enjoyment, and on the other hand, biochemical stress. If you only consider the latter, you have to say it quite clearly: alcohol is toxic.
How do you feel about alcohol yourself?
Every now and then I drink a glass with my meal. Or open a bottle of wine on the weekend and drink it with my wife. Spread over the weekend. I largely avoid hard liquor. For me, the focus is on taste, quality and enjoyment. Not the level.
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