Liver experts: abstain from alcohol at least three days in a row every week

Hepatologists call for less consumption, advertising restrictions, and higher prices for alcohol

Pablo Linde
British Liver Trust
Scanning a patient's liver at the International Liver Congress held in June in London.Steve Forrest/EASL

Hepatologists (liver, gallbladder, bile ducts, and pancreas specialists) say the healthiest amount of alcohol to consume is none at all, but acknowledge that this is unrealistic for most people. Instead, the world’s leading experts at the 2022 International Liver Congress in London have some advice for those who are unwilling to give up drinking altogether: be kind to your liver and abstain from alcohol at least three days in a row every week. And don’t go on a binge the rest of the week – always practice moderation and good nutrition.

The warning was prompted by some concerning epidemiological evidence. Europe has the world’s highest rate of alcohol consumption, and more than half of all end-stage liver diseases are related to drinking, according to a joint report by the European Association for the Study of the Liver (EASL) and The Lancet medical journal. Every year 287,000 Europeans die from mostly preventable liver disease, a 25% increase over the number of deaths in 1990.

Liver disease differs from other conditions in that it has a substantial impact on young and middle-aged individuals, especially the most socially vulnerable population. “This contrasts with mortality from smoking-related and other obesity-related illnesses, such as lung cancer or type 2 diabetes, for which deaths typically occur in the 60s and 70s,” said the EASL/Lancet study. Data from the World Health Organization (WHO) shows that liver disease is now second only to coronary heart disease as the leading cause of years of working life lost in Europe.

This reality led Aleksander Krag, EASL’s vice-secretary, to call for a significant reduction in consumption, advertising restrictions, and higher prices for alcoholic beverages. “We’re not telling people to stop drinking altogether,” said Krag. “Just follow a few sensible rules: go three days in a row every week with no alcohol, never consume more than five units of alcohol in one sitting, and no more than 10 a week.” One unit is not equal to one drink: a full glass of wine equals three units; a 12-ounce can of beer equals 1.5 units; and a shot of hard liquor equals one unit.

Krag clarifies that the liver can tolerate this amount of alcohol consumption without becoming diseased because the organ has a high regenerative capacity. But it’s not recommended. “You should drink wine because you like it, not because you think it’s healthy for you,” he said.

Any amount of alcohol consumption is associated with an increased risk for certain cancers. Alcohol is toxic, as well as addictive. This is why many medical professionals are adamantly opposed to recommending anything other than – try to drink as little as possible. And if you don’t drink at all, so much the better.

Food and health consultant Juan Revenga said, “Obviously, it’s better to drink less,” and to abstain for three days. He also believes that promoting “moderate consumption” is an “entelechy,” in that it realizes or makes actual what is otherwise merely potential. “It’s true that a daily beer or glass of wine won’t damage your liver, but there are other risks. Alcohol is addictive and gives you a feeling of wellbeing. As soon as you drink a little, you tend to want a little more. It’s also habit-forming because you need more and more to achieve the same feeling. With alcohol, the best amount is none at all,” he said.

Although there are differences of opinion as to how encourage less alcohol consumption, experts unanimously agree that it needs to happen. There are two very effective tools for reducing consumption: raising prices and restricting advertising. “It’s well documented that the price of alcohol matters. When they established minimum prices for alcohol in Wales and Scotland, consumption dropped overnight,” said Krag. He thinks that similar measures should be applied to unhealthy foods, and wants politicians to establish distinct tax rates for different foods. “We know vegetables are healthy, but many of our patients can’t afford them and go straight to fast food,” he said.

Another way to modify behavior is regulating the advertising of alcohol and unhealthy foods. “There’s a reason why companies have huge advertising budgets. But why is it legal to advertise alcohol?” asks Krag. He compares it to tobacco advertising which has been banned in almost all every Western country for years. Tobacco packaging also carries mandatory warnings about the health hazards of smoking. “Why not implement these simple measures? The alcohol industry won’t like it, but it’s about protecting the public,” said Krag.

The silent disease

One of the problems with liver disease is that there are often no symptoms or warning signs until it is too late. “Most people with undiagnosed cirrhosis have normal blood tests,” said the EASL/Lancet report.

At the EASL congress attended by EL PAÍS reporters, a WHO presentation recommended a new, prevention-focused strategy to fight liver disease. “We need to bring diagnosis and treatment closer to the community. We need to use mobile units to make [liver] scans and blood tests more accessible,” said Philippa Easterbrook, a hepatitis expert with the WHO. They want to facilitate early detection of liver problems in local health centers or mobile units, and avoid specialist and hospital visits.

The British Liver Trust (BLT), a non-governmental organization in the UK that focuses on liver disease has been taking this approach for the past five years. Its mobile units go into neighborhoods and conduct liver scans that provide a highly accurate picture of an individual’s liver health. The machine used for the liver scans was adapted from a device invented 30 years ago to monitor cheese aging. It measures whether the cheese is still soft inside and therefore needs more aging. The liver scanner can calculate the degree of organ fibrosis, indicating the need for further diagnosis if the fibrosis exceeds a certain level.

The BLT has conducted over 300,000 tests in various UK population centers, finding sub-optimal conditions in 20% of the people tested. They say it is not a diagnostic method, but an easy, fast, and cheap way to assess the general health of a person’s liver.

“There are two things that increase the risk of liver disease, 90% of which is preventable – alcohol and the metabolic risks associated with being overweight and type 2 diabetes,” said BLT spokesperson Vanessa Hebditch. “We know that if we detect disease early on, then we can prevent further damage and sometimes even reverse it.”

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