LIVER DISEASE

ALCOHOL AND ITS EFFECTS ON HEPATITIS C

SHOULD YOU DRINK ALCOHOL WITH HEPATITIS C?

Because of the recent widespread press regarding the benefit of consuming "red wine" and heart disease protection, many hepatitis C individuals have asked if they, too, could drink socially. Most people in the United States who drink socially are used to having a glass of wine with dinner, or, perhaps, a mixed drink at a party. Unfortunately, if you have hepatitis C, any consumption of alcohol can potentially be deadly for your liver. And it does not matter whether alcohol is consumed in a drink, in a non-prescription product, or in cough syrup. If you have hepatitis C, alcohol in any form should be completely and totally avoided.

IS IT JUST THE ALCOHOL?

OR SOMETHING IN THE ALCOHOL?

Regardless of the alcoholic beverage consumed, it is the alcohol, itself, that is the culprit in liver damage. Expensive drinks are just as damaging as cheap ones. A one-shot glass of whiskey has the same alcoholic content as a 4 ounce glass of wine, or a 12 ounce can of beer. So…why is alcohol such an enemy to people with hepatitis C?

As the primary organ of detoxification in the body, the liver breaks down most of the alcohol a person drinks. As the liver breaks down alcohol, certain deadly by-products are formed which can be more toxic to the body than the alcohol itself. One of those products is acetaldehyde. This by-product can actually cause liver scarring without inflammation. In most cases, this happens by the interaction of specialized cells produced in the liver to fight infection. For example, cytokines are produced by liver cells and the immune system in response to infection or cell damage. Alcohol use increases the number of cytokines produced. These cytokines often go on a collision course with another type of specialized liver cells, known as stellate cells.

In a normal liver, stellate cells function as storage depots for vitamin A. If activated by cytokines, stellate cells divide rapidly to increase their numbers. Activated stellate cells lose their vitamin A stores and begin to constrict blood vessels that normally deliver oxygen to liver cells. The result is the production of liver scarring without inflammation. This is the primary pathway taken in alcoholic liver cirrhosis.

Long term use of alcohol also increases the inflammatory process itself, a natural body response to tissue damage or infection. This leads to the overproduction of free radicals, molecules that can destroy healthy liver tissue and interfere with important functions such as energy production. Alcohol also interferes with the body's production of natural defenses against these damaging free radicals (i.e. anti-oxidants). Thus, the combination of free radical production and alcohol can lead to liver damage.

A number of studies have shown that alcohol abuse (over 4 drinks per day) accelerates the progression of liver damage. In a person with hepatitis C, this damage is associated with fibrosis and may double the risk of developing cirrhosis of the liver. Other research has clearly shown that the severity of liver disease and the potential for liver cancer in alcoholics versus non-alcoholics increases in the presence of HCV.

Recent studies on HCV viral replication have indicated that the amount of HCV in the blood rises in proportion to increasing alcohol consumption, and drops when alcohol is avoided. This finding may explain why alcoholics generally have a lower response rate to antiviral therapy than non-alcoholics. Other studies have demonstrated a decreased rate of viral clearance from the body among people who drank alcohol, compared to those who did not drink at all. And this decrease in response rate continues for up to six months after stopping all alcohol intake.

Alcohol has also been implicated in the liver's inability to regenerate and to repair itself, a reduced ability of the immune system to fight off viruses, the stimulation of excessive fibrosis in the liver, and an increased absorption and deposition of iron in the liver.

THE BOTTOM LINE - SHOULD YOU OR SHOULDN'T YOU DRINK?

For those with hepatitis C, there are no studies that show conclusively that there is a safe amount of alcohol to drink. Some studies indicate that there is increased liver damage in people with hepatitis C who have had more than 4 drinks of alcohol per day. Other studies demonstrate liver damage can occur with as little as one drink of alcohol per day. Women appear to be more susceptible than men to the damaging effects of alcohol. Women have a lower body mass than men, and they accumulate a higher concentration of alcohol in their blood after consuming the same number of alcoholic drinks. Women's livers also appear to metabolize alcohol at a faster rate than do men's, and their greater estrogen levels appear to add to the effects of alcohol accumulating in their livers. The bottom line…Since no amount of alcohol has been proven to be safe in persons affected with the HCV virus, it is strongly recommended that people with hepatitis C virus…should not drink ANY alcohol at all.

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