With the beginning of the year, comes the usual rush of consults to my office for abnormal liver tests. Perhaps it’s a coincidence, but my suspicion is that these visits are related to the many holiday parties and their associated excessive drink and dietary indiscretions—which brings me to the topic of alcohol.
How much alcohol is too much? This question has long been debated by researchers (and home microbrewers). Until recently, the standard answer has been 14 drinks per week for men and 7 drinks per week for women. In reality, this recommendation is likely only acceptable to those with BMIs of less than 25 and no other medical comorbidities.
The true answer to the question of “how much alcohol is too much?” is largely dependent on an individual’s physiology, daily medications, and drinking behaviors (e.g. binge drinking versus a glass of wine a night). However, I know you need a specific number to give your patients. Thankfully, a study published in the Lancet Journal in April 2018 does just that.
The researchers analyzed just under 600,000 people who drink 0 to more than 350 g of alcohol per week. The study found that people who drink more than 100 g of alcohol per week, or the equivalent of about seven glasses of wine or seven 12 oz beers, have a definite increased risk of cardiovascular and liver disease. If you are interested in learning more, I encourage you to look up the article: Risk threshold for alcohol consumption: “Combined analysis of individual participant data for 599 912,000 current drinkers and 83 prospective studies,” Lancet Journal, volume 391, issue 10129, P1513-1523, April 14, 2018.
“We clearly need to do more to fight the worsening epidemic of alcohol abuse and alcoholism in our communities.”
As practitioners, we clearly need to do more to fight the worsening epidemic of alcohol abuse and alcoholism in our communities. My approach to dealing with the subject of alcohol has evolved over my career. I find that the “doctor knows best” tactic typically goes nowhere and only serves to alienate and shame my patients. However, ignoring or skirting around the problem also does little good. Alcoholic cirrhosis-related deaths have increased dramatically over the past decade and the prevalence of alcoholrelated liver disease is estimated at around two percent in the general population.
Of course, patients generally expect a discussion about alcohol with a hepatologist. The subject is more complicated for general practitioners due to time constraints and their many other priorities. However, there are several screening tools that are effective, quick and easy. I often use the tried and true CAGE questionnaire to screen potential problems with alcohol abuse.
A second screening test which is effective and easy is the Alcohol Use Disorders Test, or AUDIT-C, which is comprised of three questions and recommended by the United States Preventive Services Task Force. Either one of the tests can be administered and scored by your nurse or medical assistant.
Finally, let’s discuss a lighter topic—coffee! Recent studies suggest that medium bodied coffee may have beneficial effects on the liver. I will admit that the data is not strong and has not been published in leading medical journals, but is still interesting as reference (check out: “Coffee: The magical bean for liver disease,” World J Hepatol. 2017 May 28; 9(15): 689-696).
Caffeine is obviously the main ingredient, but coffee also has more than 1000 different chemicals, one of which– paraxanthine–may slow the growth of scar tissue involved in fibrosis. Some research also finds that coffee may decrease the risk of alcohol-related cirrhosis, nonalcoholic-cirrhosis related to fatty liver disease, and liver cancer.
Please check out the American Association of the Study of Liver Disease (www.AALSD.org) and the National Institute on Alcohol Abuse and Alcoholism (www.niaaa.nih.org) websites for more information on alcohol abuse and alcohol-related liver disease.