New Clues to Help People with Liver Disease Stay Off Alcohol
By A.J. Hostetler, Communications Director
Stravitz-Sanyal Institute for Liver Disease and Metabolic Health
Researchers who study alcohol’s impact on the liver are now looking more broadly at how alcohol affects the entire body, an avenue of research that may lead to better ways to treat alcohol use disorder and alcohol-associated liver disease.
AUD affects about 10% of people 12 and older in the United States, according to the National Institute on Alcohol Abuse and Alcoholism. People with this disorder struggle to stop drinking even when alcohol is harming their health. One of the most common effects of heavy drinking is liver damage, known as ALD.
In a recent review in the journal Hepatology, Institute investigators Juan Pablo Arab, M.D., Jasmohan Bajaj, M.D., and colleagues discuss the molecular basis of alcohol abstinence and relapse in alcohol-associated liver disease research and why the gut and its microbiome could be attractive targets for treatment.
“Alcohol-use disorder and alcohol-associated liver disease have a significant burden on individuals, families and society worldwide,” Arab said. “It has dramatic consequences for people, including mental disorders, chronic liver disease, cancer and cardiovascular disease.” Currently, limited therapeutic options, but fortunately, thanks to research, new therapeutic options are on the pipeline.”
How Alcohol Harms the Body
Alcohol affects many parts of the body, but two of the most important are the liver and the brain. In the brain, alcohol triggers chemicals that make people feel good. Over time, the brain changes and starts to rely on alcohol, leading people to drink again and again, even when they know it’s bad for them.
In the liver, alcohol causes inflammation and damages cells. If not halted, the damage can lead to liver fat buildup, scarring, and eventually liver failure. Some people may develop alcohol-associated hepatitis, a serious condition that causes sudden and severe liver inflammation.
Alcohol also harms the gut. Normally, the gut keeps harmful bacteria and toxins from entering the bloodstream. But alcohol weakens this barrier, allowing these harmful substances to leak into the body. They travel to the liver and brain, causing even more damage and inflammation.
The Gut-Liver-Brain Connection
Scientists who study alcohol use disorder are focusing what’s called the gut-liver-brain axis. When alcohol harms the gut, it can trigger problems in both the liver and the brain.
One major discovery is that alcohol changes the balance of bacteria in the gut. People with AUD often have fewer helpful bacteria and more harmful ones. This imbalance, called dysbiosis, can lead to increased cravings for alcohol and more inflammation in the liver.
Researchers are testing ways to restore healthy gut bacteria. One method is using probiotics, which are live bacteria that are good for your gut. Another method is fecal microbiota transplant (FMT), which transfers healthy bacteria from a donor’s stool to the patient. Early studies, including those led by VCU’s Bajaj, show these treatments may reduce cravings and help protect the liver.
Alcohol and the Immune System
The immune system helps the body fight infections and remove harmful substances. But alcohol can confuse the immune system, making it attack healthy tissue by mistake.
In the liver, special immune cells get activated when alcohol and gut toxins are present. These cells cause inflammation, which leads to more liver damage. In the brain, alcohol also triggers immune responses that may lead to mental health issues like anxiety, depression and memory loss, causing a condition called hepatic encephalopathy.
New Treatments for AUD
Currently, only three drugs are approved in the United States to treat AUD: naltrexone, acamprosate, and disulfiram. But not all of them are safe for people with liver disease. For example, disulfiram can cause liver injury.
Scientists are testing other treatments that may be safer and more effective, especially for people with ALD. These include:
- Spironolactone, a common medicine for liver disease that may also reduce alcohol use.
- Apremilast, used to treat inflammation, it lowered drinking levels in a small clinical trial.
- Semaglutide, a drug for diabetes and weight loss, may help reduce cravings.
- Ghrelin blockers, which target a hunger hormone linked to alcohol desire.
- Probiotics and FMT, which aim to restore healthy gut bacteria.
In studies with animals and people, these treatments helped lower alcohol cravings and protect the liver. More clinical trials are underway to confirm these results.
Rethinking Liver Transplant Rules
For people with severe liver damage, a transplant may be the only hope. Many transplant programs, but not VCU’s Hume-Lee Transplant Center, require patients to be alcohol-free for six months before they are eligible. But some doctors believe this rule is too strict and not supported by evidence.
Some people are so sick they won’t survive six months. But new studies show that, with strong support and the right care, some patients can do well with a transplant even if they haven’t remained sober for that long.
Still, sobriety after a transplant is very important. People who return to drinking are more likely to damage their new liver and have serious health problems. That’s why many transplant centers, including VCU’s, work closely with addiction specialists to help patients stay on track.
One Size Doesn’t Fit All
One reason AUD is hard to treat is that it affects people in different ways. Some have mental health issues. Others have a genetic risk. Some people have strong support systems.
More personalized health care can help by offering treatments based on each person’s background, health, and needs.
There’s also a growing effort to screen people earlier for alcohol problems, especially in communities that don’t have easy access to health care. Right now, only a small number of people with AUD ever receive treatment.
What’s Next?
With newer tools to understand and treat alcohol use disorder, researchers now know that alcohol affects not just the brain and liver, but also the gut and immune system.
New drugs, changes in gut bacteria, and better support systems are all showing promise in helping people recover. Combining medical treatment with counseling and support from family and health care teams can improve the chances of long-term recovery.