Why is Alcohol Harmful for People with Hepatitis?

Avoiding alcohol is the most important lifestyle change you should make after a viral hepatitis diagnosis. Why? Because drinking alcohol accelerates the rate of progression of the liver disease.

When the alcohol gets into the body, 95% of it will be metabolized in the liver. Inside the liver cells, alcohol turns to acetaldehyde, which is even more toxic to the liver than the original form of alcohol. The alcohol and its metabolite intoxication cause the liver to inflame and long-term drinking causes the inflammation to be persistent. This onset of inflammation leads to an over-production of free radicals that can further damage liver cells and impair their functions.

Alcohol also reduces the production of antioxidants, which are the body's natural defenses against free radicals. When these harmful effects are added to the strain of the liver inflammation caused by the HBV or HCV infection, the progression of fibrosis can accelerate dramatically.

On top of exacerbating inflammation, Acetaldehyde can also cause fibrosis directly. One of the mechanisms that alcohol promotes disease progression directly is by increasing the amount of certain cytokines such as TGFb1 (transforming growth factor-beta 1), PDGF (platelet delivered growth factor), and PAI (Plasminogen activator inhibitor). This increase activates the stellate cells of the liver and causes the cells to loss their vitamin A content, which then begins to produce scar tissue. (See previous column articles about fibrosis.) The activated stellate cells can also constrict blood vessels, reducing the blood infusion to the liver cells and decreasing the oxygen and nutrition supply of the liver cells.

As you can see, alcohol can promote fibrosis in more ways than one and can increase the chances of progression to cirrhosis. Although many hepatitis patients try to "negotiate" with their doctors about alcohol use in limited amounts, it is my belief that they should avoid it altogether. Since there are no studies that have determined what is a “safe” amount of alcohol to drink for a patient with chronic liver diseases, the safest route is to not drink. 

Thus, if you have hepatitis B or C, I strongly recommend that you eliminate alcohol from your life. You will live better and longer!