Excessive alcohol consumption can have a wide range of harmful effects on your health. But how much is too much alcohol to increase your risk for serious health conditions?

“I think it’s important that we practice prevention and not drink that much to begin with,” says gastroenterologist and transplant hepatologist Nathalie Khoury, MD. “But I think a lot of people don’t know what is considered harmful when it comes to alcohol consumption.”

What is considered heavy drinking?

For men, consuming 15 or more drinks per week qualifies as excessive, while for women, it is eight or more. Binge drinking is defined as consuming more than five drinks on a single occasion for men and more than four for women.

A non-harmful amount of alcohol for individuals without underlying liver disease is two drinks or less per day for men and one drink or less per day for women. This is not cumulative; a person can’t “bank” their daily amounts and drink them all on the weekend. A person with underlying liver disease, including metabolic dysfunction-associated liver disease (also known as a fatty liver), should abstain from alcohol altogether.

“It’s also important to know that it is the quantity of the alcohol, not the type,” Dr. Khoury says. “People will tell me, ‘I don’t drink hard liquor,’ but what matters is the amount you drink.”

The following amounts are considered one serving:

• 12 ounces of 5% alcoholic beer
• 8 ounces of 7% malt liquor
• 5 ounces of 12% wine
• 1.5 ounces of 40% distilled spirit

Impact on the GI tract

Excessive alcohol consumption can have detrimental effects on the entire GI tract. This includes:

1. Esophagus. The esophagus may suffer from inflammation and irritation, leading to conditions such as acid reflux, Barrett’s esophagus, and an increased risk of esophageal cancer.
2. Stomach. Inflammation of the stomach lining can occur, causing nausea, vomiting, and pain. It can also lead to ulcers, and anemia, and increase your risk of stomach cancer.
3. Bowels. Alcohol can disrupt the normal functioning of the bowels, leading to ulcers, malabsorption, and pain. It can create an imbalance of good and bad bacteria that can cause bloating and diarrhea. It can also increase your risk of colon cancer.
4. Pancreas. The pancreas can be severely affected by alcohol misuse. Excessive alcohol use can lead to pancreatitis, a painful inflammation of the pancreas. This condition can result in long-term damage and increase the risk of developing pancreatic cancer.
5. Liver. Excessive alcohol use can lead to liver inflammation and scarring, known respectively as alcohol-related hepatitis and cirrhosis.

Cirrhosis

The liver metabolizes about 80% of alcohol consumed and is perhaps the organ most impacted by excessive alcohol use. Cirrhosis is characterized by replacing healthy liver tissue with scar tissue, resulting in impaired liver function. Scarring happens over time and the staging of scarring ranges from stage 1 to stage 4, with stage 4 being cirrhosis.

“I tell my patients the good news is that, when you come in early, scarring that is stage 3 and below can be reversed or improved with alcohol abstinence,” Dr. Khoury says. “Your liver doesn’t get enough credit. It’s got a great ability to regenerate within about six months if you don’t push it too far.”

After six months of abstaining from alcohol, a diagnostic tool called a Fibroscan can determine the extent of liver scarring. This can help doctors understand your risk of becoming more ill and how closely you need to be monitored.

Liver disease can be silent

If you drink regularly, routine monitoring is crucial, as liver disease may not present noticeable symptoms until it is very advanced.

“Very often, I have patients who come in with cirrhosis and severe symptoms,” Dr. Khoury says. “They say, ‘But I didn't know about it.’ Liver disease can be silent for years until it has progressed.”

Dr. Khoury recommends patients visit their primary care provider annually and have regular bloodwork done to detect the warning signs of liver disease as soon as possible. “If we catch it early, we can still repair or reverse the damage. If the damage is advanced to the point it’s not reversible or manageable, the only cure is transplant, which we can offer to carefully selected patients.”

Medication and alcohol

Close to half of commonly prescribed and over-the-counter medicines can have harmful interactions with alcohol, rendering the medications ineffective or toxic. Alcohol can also increase the risk of liver damage when combined with certain medications such as acetaminophen.

Resources and support

If you are unsure whether your drinking is problematic, Dr. Khoury suggests seeking assistance.

“If you are unable to limit your consumption or have had medical, social, professional, or relationship problems related to alcohol, or if people around you are concerned about you, then it might be a good idea to talk to a physician about the possibility of having alcohol use disorder,” she says.

For individuals with alcohol use disorder, support is available:

• Behavioral Health Connection is a free program for adults in the metro area, connecting individuals with substance abuse disorders to local resources.
• Nebraska Medicine Addiction Services offers comprehensive treatment of co-occurring psychiatric and substance use disorders.
• Alcoholics Anonymous is a support group that provides community and a structured program for recovery.
• SMART Recovery offers an alternative to traditional 12-step programs, providing evidence-based techniques and tools for overcoming addiction.