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Do all kinds of alcohol increase the risk of liver disease in a similar way? Or is an alcoholic beverage that is higher in alcohol by volume (e.g. scotch - ~60% and up) more harmful than those lower in alcohol by volume (e.g. red wine - 12%)?

michaelpri
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Victor
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1 Answers1

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The only difference it makes to the liver how alcohol is consumed is how high the blood alcohol content becomes and for how long - the other particulars of the beverage will be filtered out by the digestion process. Beverages containing a higher alcohol content will tend to cause a higher peak blood alcohol content because they can be consumed more quickly than the same amount of alcohol in a larger volume, and the more concentrated alcohol will be absorbed from the stomach more quickly. The liver is limited in its capacity to process alcohol. Low blood concentrations of alcohol are efficiently converted into acetate and metabolized, but at high concentrations some of the alcohol is converted into toxic acetaldehyde. Acetaldehyde is thought to cause hangover symptoms and also contribute to liver cell death through oxidative stress (Min, JA; Lee, K; Ki, D. June 2010. The application of minerals in managing alcohol hangover: a preliminary review. Current Drug Abuse Reviews, 3(2): 110-115). Replacement of these cells leads over time to enlargement of the liver, accumulation of scar tissue (cirrhosis) and cancer. So avoiding hangover by consuming alcohol in moderation may help avoid liver damage if alcohol is consumed. It is also very important to avoid consumption of acetaminophen with alcohol because processing the alcohol prevents the liver from properly eliminating the acetaminophen, which can cause severe liver damage.

Like the liver, the brain is also only concerned with the concentration of alcohol in the blood and how long it has been that way, in terms of how intoxication is experienced. It will take more alcohol as beer to produce the same level of intoxication as vodka because more of it will have had time to metabolize before the peak blood concentration is reached. The brain also becomes more tolerant to the effects of alcohol as time passes, so that the blood concentration has to be increased over time to maintain the same level of intoxication. So having more drinks to maintain the same experience will be harder on the liver than the initial drinks.

Chris Jenks
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  • Got it, I will stick to my one glass of wine. – Victor Jul 10 '15 at 19:15
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    " Low blood concentrations of alcohol are efficiently converted into acetate and excreted" ... this is incorrect. Acetate is never excreted. It enters the TCA cycle and is metabolized into CO2, water, and reduced nucleotides. It may also participate in de novo fatty acid synthesis. – scottb Jul 10 '15 at 21:29
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    "but at high concentrations some of the alcohol is converted into acetaldehyde which is toxic and may lead to liver cell death and replacement, " ... this is misleading. The mechanisms of hepatic toxicity from alcohol are complex. There is an important role of redox state change and gluathione depletion and a consequent inability to protect against oxidative stress. – scottb Jul 10 '15 at 21:40
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    "This "cell death" leads to the release of toxins from the cells which may contribute to the experience of hangover. " ... you'll need to provide a reference for this. The mechanisms of a "hangover" are complex but are not known to be related to hepatic cellular necrosis. – scottb Jul 10 '15 at 21:42
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    @scottb: Thank you for your helpful corrections. – Chris Jenks Jul 10 '15 at 23:08
  • @TFD - Be nice. – anongoodnurse Jul 12 '15 at 21:00
  • Surely it is not just how high the blood alcohol level gets. Surely the type of alcohol matters. For example pthis page](http://homedistiller.org/intro/methanol/methanol) suggests that scotch contains 0.2-0.3% methanol, vs wine containing only 0.1% methanol. Methanol being much worse than you than regular ethanol, suggests that there would be a difference based on the type of alchol rather than simply the concentration. – Frames Catherine White Jul 14 '15 at 14:34
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    I'm surprised that the methanol content is that high. I imagine the methanol content of scotch is higher than for wine because scotch is distilled, concentrating both the ethanol and the methanol. But I would still argue that this methanol is not toxicologically significant for a few reasons: At 0.1%, a liter of wine contains only 1 mL of methanol - less than the amount produced from metabolism of a kilo of apples (https://en.wikipedia.org/wiki/Methanol). Second, ethanol metabolism inhibits methanol metabolism (and is used as an antidote), making the methanol in these beverages less toxic. – Chris Jenks Jul 14 '15 at 17:55
  • Are you sure that alcohol slows down metabolism of acetaminophen? Chronic alcohol consumption will induce the cytochrome systems in the liver, which may cause more rapid breakdown of various chemicals. I'm not sure whether acetaminophen is in that group. This induction of cytochromes is responsible for the widely known phenomenon mentioned, that it takes more alcohol to get you drunk if you are a chronic drinker. – Iron Pillow Jul 18 '15 at 09:03
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    The absolute concentration of alcohol may not make a difference to the liver, but it may make a difference to other tissues, especially those of the upper aerodigestive tract that physically come in contact with the liquid. See, for example, this study, which showed an elevated risk of oral cancer in users of hard liquor: http://aje.oxfordjournals.org/content/157/10/881.long -- it's apparently a retrospective case-control study. – Iron Pillow Jul 18 '15 at 09:17
  • @Iron Pillow: I didn't write that alcohol slows the metabolism of acetaminophen, I wrote that it interferes with it. Alcohol metabolism depletes the glutathione which would allow elimination of the toxic acetaminophen metabolite, N-acetyl-p-benzoquinone imine. Glutathione depletion is also what makes acetaminophen overdose deadly, but concurrent alcohol consumption lowers the amount necessary. I found a good account of this at https://en.wikipedia.org/wiki/NAPQI – Chris Jenks Jul 27 '15 at 22:13