Occasional Drinking? 3x Risk Of Liver Scarring

Fun thought for the day in 3 parts:

1. “Occasional drinking” is often seen as healthy
2. Binge-drinking often comes in the form of “occasional drinking”
3. The Threshold For Binge-Drinking Is Lower Than Most Think

…and as we wrote in the above-linked article:

The term “binge-drinking” typically conjures images of people in the 18–22 age range (general figure; if we get geographic about it, then perhaps 21–25 in the US, or 15–21 in Europe) swinging around lampposts while very drunk, very loud, minimally-clothed, and liable to waking up somewhere new and exciting that they’ve never seen before.

But in fact, while definitions do vary a bit, a prevailing and representative scientific definition is:

❝consuming four or more standard drinks on one occasion for women and five or more standard drinks on one occasion for men❞

Learn more: Heterogeneity of definitions and measurements of binge drinking in research on adolescents and young adults

Now, that paper’s looking at research on adolescents and younger adults because that’s where most of the research is, but it doesn’t mean older adults are magically immune—quite the opposite!

One other quick thing…

Note that that “four standard drinks” is often only two drinks where each drink is a “double measure”, such as a double-shot of spirits or a large glass of wine.

This gets particularly relevant for those who “only drink on special occasions”, but then have several drinks.

Here’s a good example of that: You’d Better Watch Out: Why More Cardiac Deaths Happen On Dec 25 Than Any Other Day

So what’s this about liver scarring?

“Alcohol is bad for your liver” is something most people know, but often the actual mechanism at hand can remain a mystery. So, let’s demystify it a bit:

The liver is a remarkably self-regenerating organ; we wrote about it here: How To Unfatty A Fatty Liver

…but there’s more to it than that. Liver tissue is remarkably regenerative (cut away 49% of an otherwise healthy liver, and it’ll just regrow itself), but large alcohol doses (again, by the above definitions, not just by what most people think are large doses) at once can overwhelm your liver, increasing inflammation and accelerating fibrosis (scarring), particularly in already metabolically stressed livers.

Scar tissue is different from regular tissue in its structure and composition, and the same is true for scarred liver tissue, and that makes a difference, greatly reducing, if not outright halting, its regenerative ability.

Recent research (linked below) has found that even once-a-month binge-drinking (≥4 drinks for women or ≥5 for men in one day) was linked to a 3× higher risk of advanced liver fibrosis in people with metabolic dysfunction–associated steatotic liver disease (MASLD)*

^{*Formerly known as Non-Alcoholic Fatty Liver Disease (NAFLD), now it’s MASLD instead. Attentive readers may have noticed that there appears to be a D missing from the new acronym. We noticed that too, and were not able to find any explanation of why it’s not MDASLD However, you can read about why the change was made, and how the decision was agreed upon, here: A multisociety Delphi consensus statement on new fatty liver disease nomenclature}

In any case, about 1 in 3 adults have MASLD, and over half of adults reported episodic heavy drinking.

This is a problem, because many guidelines focus on total weekly alcohol, but this study shows how you drink matters as much as how much you drink, with large single-session intake posing greater risk than spreading drinks out; indeed, in this case, people consuming the same total alcohol per week had worse liver outcomes when intake was concentrated into sessions of 4+ drinks.

You can find the paper itself, here: Episodic Heavy Drinking and Implications for Steatotic Liver Disease Nomenclature: A National Cross-Sectional Study

What to do about it?

First of all, know that it’s not too late:

What Happens To Your Body When You Stop Drinking Alcohol ← a realistic timeline of recovery

If you’d like to give your liver a helping hand, consider:

N-Acetyl Cysteine For The Liver & More

Take care!