The recent report into life on the liver ward makes sobering reading. John has alcohol-induced dementia (Korsakoff’s syndrome) and doesn’t know where he is. Rita has cirrhosis of the liver and is homeless. Her life has spiralled downwards as a wine habit segued into damaging dependence. It’s easy to feel sorry for the Johns and Ritas, though most of us think it’ll never happen to us.
But will it? Are we becoming a nation of drinkers and drunks? The UK death rate from liver disease has increased fourfold in the past 30 years as cheap alcohol has flooded our shores and our gullets. Alcohol-related emergencies resulted in over a quarter of a million admissions in 2013/14, most of whom were 45-64-year-olds, who see themselves as regular rather than binge drinkers. Jackie Ballard, the chief executive of Alcohol Concern, says “Alcohol is linked to over 60 medical conditions including cancer, diabetes and high blood pressure.” And the chief medical officer, Sally Davies is so concerned that she has published new and controversial guidelines on safe drinking.
The good news is that the tide seems to be turning against alcohol use in the UK. The percentage of men drinking alcohol in a typical week fell from 72% in 2005 to 64% in 2012 (in women the fall was from 57% to 52%). Frequent drinking has also been reported to be in decline.
Most of us who drink alcohol won’t die of liver disease, just as many smokers don’t die of lung cancer. It’s a question of weighing the risks against the benefit that alcohol gives us. It’s my drug of choice but I wouldn’t pretend that it’s harmless.
How much alcohol is too much? Some can probably safely drink more than others; your size, genetics, lifestyle and state of your liver make a difference. But in general, less than 14 units, spread over at least three days a week should be OK. That’s just under a bottle-and-a-half of wine (ABV 13.5%), or an average of one 175ml glass per day. For beer drinkers, that’s less than five pints of higher strength beer (ABV 5.2%) a week.
The liver is a resilient and vital organ. With the kidneys, it acts as a waste-disposal system, filtering our blood of toxins. The liver plays a key role in digestion and also produces hormones, bile to digest fats and proteins for blood clotting. We have two kidneys, which is handy if one fails, but only one liver. Luckily, it can withstand a tremendous battering and still recover. We can survive on a liver that is only 30% operational; after that it gets critical.
Viruses, drugs, chemicals, toxins and some genetic conditions can take their toll on even the youngest and meatiest of livers. At first, these irritants cause inflammation, which is reversible. But long-standing damage causes cirrhosis, which is irreversible thickening (fibrosis) that stops the liver from functioning. We can’t live without a liver, so a transplant becomes the only option.
Liver disease kills more of us than diabetes and road deaths combined and is the fifth-biggest killer now after heart attacks, cancer, strokes and lung diseases. It is the only major cause of death in the UK that is still increasing year on year. The hope is that as awareness rises and alcohol intake falls, the crowded NHS liver wards will become a thing of the past.
