Ask the doctor: I drink eight bottles of wine a week and I want to quit. Should I cut down gradually or go cold turkey?

By | March 29, 2021

Q: I drink a lot, far more than the recommended amount and have done so for about 10 years. I would easily put away eight bottles of wine a week, in addition to a couple of beers here and there and the odd whiskey. I have promised my wife I will address it but she wants me to just quit. I think it is safer to cut down gradually, but she says this is just me procrastinating. Am I right about quitting cold turkey?

: Much like quitting cigarettes, people often ask if it’s best to cut down and wean off or go cold turkey. There is no right or wrong way, once you get to where you need to be. Unfortunately your current level of consumption is anything but safe. Judging by your current eight bottles of wine per week, you are drinking at least 60 standard units of alcohol per week.

For men, it is recommended to drink less than 17 standard units of alcohol per week. Drinking six or more units in one day is considered binge drinking. An important question is, can you go two or three consecutive days alcohol-free? This allows the liver to recover somewhat. Have you have tried to quit or go cold turkey in the past, and if so, did you experience any alcohol-withdrawal symptoms?

The liver is considered the engine room of the body. It is responsible for the storage of vitamins, minerals and sugar, the removal of bacteria and toxins (including alcohol), the breakdown of nutrients from food and the production of bile, protein and blood clotting factors. Alcohol causes liver damage in two ways. Firstly, by producing a toxic enzyme called acetaldehyde that can damage liver cells. Secondly, by causing dehydration as the liver needs lots of water to function properly. Prolonged heavy alcohol consumption in certain people can lead to severe liver damage.

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Some people are more at risk than others. Factors such as age, gender, genetics and your pattern of drinking come into play. The only way to know if you are at risk of liver disease is to attend your doctor for an assessment and get liver bloods checked. Typically, in alcohol abuse we see an increase in gamma glutamyl transferase and the alkaline phosphatase. This will prompt a referral for a special liver ultrasound scan called a liver fibroscan.

Occasionally, an enlarged liver or other stigmata of liver disease can be found on clinical examination and will prompt a more urgent referral. There are three types of primary alcohol-induced liver disease: fatty liver disease, alcoholic hepatitis and alcoholic cirrhosis. Essentially mild, moderate and severe liver disease respectively. These processes frequently overlap.

The first type, fatty liver disease, is the most common and most reversible. The underlying cause is typically multifactorial with alcohol, high cholesterol and sometimes obesity contributing to the development of fatty liver disease. Generally once dietary, lifestyle and alcohol factors are addressed, the disease changes reverse.

The second type is alcoholic hepatitis (meaning inflammation of the liver) and is much more serious. You may notice jaundice (yellowing of the skin or whites of the eyes), general fatigue, anorexia, fevers, nausea or right-upper quadrant abdominal pain. Patients are often between 40 and 50 years of age, with the majority presenting before 60. The final stage is called alcoholic cirrhosis and has a poor prognosis. Cirrhosis of the liver involves the destruction of normal liver tissue, leaving permanent scar tissue.

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The end stage complications of liver cirrhosis cause portal hypertension (increased resistance to blood flow through the liver), an enlarged spleen, abdominal ascites, confusion, and in some cases even liver cancer. I strongly encourage you to reduce down to less than two bottles of wine per week and consider attending your doctor for a clinical examination.

Dr Jennifer Grant is a GP with Beacon HealthCheck

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