Commentary: Singaporeans risking serious liver damage if pandemic-drinking trend continues
If a person drinks four to five times a week, they would be considered a regular drinker and ought to keep two to three alcohol free days to allow the liver to recover. Drinking less frequently yet in high quantities can be equally harmful for liver health, and such drinkers should limit alcohol consumption per session.
Amid employment worries, burnout and boredom during Covid-19, more people around the globe turned to “pandemic-drinking” to cope with the stressors.
Nearly one in four adults in the United States reported drinking more alcohol to relieve stress, according to the American Psychological Association’s latest poll.
Singapore was no exception. Though no formal study exists on drinking patterns during the circuit breaker period, I noticed an interesting trend among my patients.
Some were ploughing through their wine cabinets, while others indulged in frequent home delivery of alcohol as a coping mechanism.
A local market forecast report by Fitch Solutions showed that the Singapore alcoholic beverages market increased by 4.8 per cent year-on-year from 2020 to 2021.
Now, with the return of late-night parties in full force alongside the easing of measures, social drinkers who, during pandemic restrictions, drank less than usual without company, are now falling off the wagon.
If the pandemic-drinking trend is not reversed, Singaporeans are unwittingly putting themselves in danger, and risking serious damage to their liver health.
SERIOUS IMPACT OF ALCOHOL ON LIVER HEALTH
Drinking alcohol in large quantities can cause damage to healthy liver cells and lead to fatty liver, or the buildup of fat inside the liver cells.
Alcoholic hepatitis, or the inflammation of the liver due to heavy drinking, is often followed by permanent scarring. Cirrhosis, or the hardening or scarring of the liver, often typically occurs after many years of drinking.
Liver cirrhosis is not worth the shot. According to a Singapore Burden of Disease Survey, nearly 28 per cent of hospitalised cases of liver cirrhosis found the cause to be alcohol-related.
Alcoholic liver disease can be prevented by practising drinking in moderation.
So, how much is too much? One standard drink contains 10 grams of alcohol, which is equivalent to a can of beer, or 100 millilitres of wine or about 30 millilitres of whisky.
At most, medical professionals advise sticking to two standard drinks a day for men and one standard drink a day for women.
It goes without saying that pregnant women and those with other serious medical conditions should avoid alcohol altogether.
Next, comes frequency of alcohol consumption. If a person drinks four to five times a week, they would be considered a regular drinker and ought to keep two to three alcohol free days to allow the liver to recover.
Social drinkers, who primarily drink with company, tend to drink more during a single session.
Drinking less frequently yet in high quantities can be equally harmful for liver health, and such drinkers should limit alcohol consumption per session.
HEPATITIS B OR C ALSO CAUSE LIVER DISEASE
Of course, not all heavy drinkers will end up with liver damage, but the likelihood remains high with about 20-40 per cent who are at risk.
Aside from heavy alcohol consumption, liver disease can also be caused by viral hepatitis B or C, or non-alcoholic fatty liver disease (NAFLD). NAFLD is associated with chronic conditions such as obesity, cholesterol and diabetes.
These causes have varying impacts on liver disease progression and severity. Hepatitis C infections and NAFLD tend to lead to more gradual liver inflammation, with risk of cirrhosis developing over a few years to a few decades in the case of NAFLD.
In comparison, progression of alcohol-related liver disease can vary from gradual liver inflammation or alcoholic steatosis, to rapid, severe form of inflammation, or alcoholic hepatitis.
Those who drink more than 10 units of alcohol per day over time are at risk of severe liver disease with a fatality rate of up to 50 per cent.
Similarly, hepatitis B infections could result in either gradual or rapid liver inflammation. In Singapore, chronic viral hepatitis B is currently the leading cause of liver cancer.
The good news is that progression of liver disease can be slowed and is reversible when detected in the early stages, through treatment and lifestyle changes.
SIGNS OF LIVER DAMAGE
The silent nature of liver disease means it is not often discovered until it is too late, when complications develop.
Symptoms in early stages may be hard to attribute to the liver. Feelings of tiredness, weight loss, and abdominal discomfort can all be written off as by-products of everyday stress.
The earlier liver disease is diagnosed, the higher the success of treatment. The liver has a remarkable ability to regenerate and if it is not fully hardened yet, treatment may be able to heal the scar tissue and soften the organ.
In cases of mild inflammation, the liver can return to health within a few weeks but for those with severe alcoholic hepatitis, inflammation can persist even after giving up alcohol.
Liver cirrhosis due to drinking can take years to show improvement and soften. For patients with severe scarring, it sometimes becomes impossible to reverse the damage and only a liver transplant may save life.
IMPORTANCE OF LIVER HEALTH SCREENING
On World Hepatitis Day on Thursday (July 28), let us take this chance to pay closer attention to our lifestyle choices and liver health.
It can be as simple as going to your general practitioner for a health screening, especially since liver disease is asymptomatic in early stages and most viral hepatitis carriers are unaware of their condition.
Individuals are recommended to get checked every one to two years, or as advised by a physician, based on family history and other risk factors.
Those born in Singapore from 1987 onwards are vaccinated against hepatitis B as part of the Singapore National Childhood Immunisation Schedule.
Living a healthy life goes beyond controlling what we eat and drink or how much we exercise.
Fundamentally, it is how we take responsibility for our own health — from knowing disease severity, to understanding risk factors and seeking treatment.
ABOUT THE AUTHOR
Dr Tan Poh Seng is a gastroenterologist at Mount Elizabeth Hospital.