Sobering facts about wine, women and liver disease

If you missed the chance to join the popular "Dry January" challenge, it's not too late to take a break from wine, beer or liquor. If you completed the challenge, congratulations and keep going.

"Although one month doesn't sound like a big deal, research suggests that decreasing alcohol use for a month gives us insight into our overall alcohol use," said RUSH hepatologist Nancy Reau, MD. "That insight can help lessen future problematic drinking."

From better sleep and more energy to improved blood pressure and weight loss, your body can experience immediate short-term benefits by going without alcohol for 30 days. You may enjoy the benefits enough to cut back or eliminate alcohol entirely.

That's a trend Reau and other liver specialists would like to see catch on.

As a specialist in transplant hepatology, Reau has watched the number of liver disease cases and deaths rise steadily, particularly among women. For example:

• Last year, the number of patients hospitalized for alcoholic cirrhosis of the liver rose 23%.
• From 1999 to 2017, the number of women's deaths involving alcohol increased 85%, while men's deaths related to alcohol increased 35%, according to National Institutes of Health data.
• Alcohol use disorder among women rose 84% from 2001 to 2013, while high-risk drinking among women—defined as more than three drinks in a day or more than seven in a week—jumped 58% over the same time period.

More women are drinking more alcohol

The increase in alcohol-related illness and deaths among women parallels women's increased consumption of alcohol.

At the same time, a "Mommy Wine" culture has taken hold with the message that raising children is taxing and drinking wine will make it easier to cope. From social media memes to T-shirts and tchotchkes, the slogans are hard to miss: It's Wine O'clock Somewhere. Mama Needs Wine. Mom's Sippy Cup.

What starts as an occasional drink can become a daily routine. In a culture that normalizes excessive drinking and binge drinking, people start thinking it's what everyone does, and that can contribute to addiction and health problems, Reau said.

Of particular concern to Reau is the increasing number of younger women hospitalized for alcoholic hepatitis.

"During the pandemic, one of the most frequent hospitalizations among younger people was alcoholic hepatitis," she said. "Unfortunately, when people are found to have alcoholic hepatitis, a large share of them will already have cirrhosis—meaning the liver has been damaged by scarring."

How alcohol hurts your liver

Cirrhosis develops as healthy tissue is replaced by dead scar tissue when the liver tries to recover from injury by alcohol, illness or other causes. Cirrhosis usually develops over a long period of time, but with alcoholic hepatitis, the damage can come on rapidly. The disease usually doesn't show symptoms until it has progressed to a severe stage.

"We already were seeing an increase in alcoholic hepatitis and alcohol-related liver disease in women before COVID-19," Reau said. "It just was exacerbated by the pandemic."

Reau cites a combination of unhealthy trends that have been rising for many years:

• Sedentary lifestyles and the resulting increase in obesity
• Fatty liver disease, which makes the liver more easily damaged by alcohol
• Higher rates of drinking by women
• Excessive and pathologic drinking (using alcohol to relieve emotional tension or stress)

Using alcohol to self-sedate can lead to high-risk drinking or to alcohol use disorder, and alcohol may further contribute to depression, emotional issues and relationship problems. The health risks of alcohol are difficult to predict, Reau said.

"Moderation is always going to be the buzzword," she said. "The CDC offers guidelines for 'safe' alcohol use, and that is good advice for most people. But if you have alcohol dependence, liver disease or certain other health conditions, any alcohol use could be dangerous."

Understanding moderate alcohol use

The CDC describes moderate drinking as one alcoholic beverage a day for women, two for men. They define one drink as a 12-ounce glass of beer, 1.5-ounce shot of distilled spirits, such as whiskey, or a 5-ounce glass of wine.

That may surprise anyone who's used to filling a 10-ounce or 20-ounce wine glass to the brim.

In fact, a woman consuming 20 ounces of wine in a day would meet the CDC's criteria for high-risk drinking and, if it's a pattern, binge drinking, both of which carry serious health risks.

The health risks of drinking

"While there are people who drink on a regular basis and seem to avoid health consequences, several studies suggest that any alcohol use increases health problems," Reau said.

The CDC notes that drinking within the recommended limits still may increase the overall risk of death from various causes, such as from breast cancer and other cancers and heart and vascular diseases. For some types of cancer, the risk increases even when drinking less than one drink in a day, according to the CDC.

"Alcohol consumption can cause damage to the liver, heart, and pancreas, it's linked to several types of cancers and it can weaken the immune system or worsen depression and anxiety," Reau said. And the impact is worsened when combined with other health issues, including obesity.

"It's most important to look at your own personal health 'report card,' and realize that if you have any medical conditions, trying to find a safe zone for alcohol is going to be challenging," said Reau, who is the Richard B. Capps chair of hepatology and a professor at RUSH Medical College.

Most importantly, she added, is that patients and physicians understand that there are effective behavioral therapies and medications for alcohol use disorder or to address unhealthy drinking habits.

"If someone tries to cut out alcohol for a month or longer and struggles, your doctor can help you find effective treatment," she said.