Why alcohol hurts women’s livers more than men’s
By A.J. Hostetler
Women may drink alcohol less than men, but research shows that alcohol seems to hurt their livers, and their lives, more than it does to men.
In a recent editorial, a VCU hepatologist and colleagues from Chile and California looked at trends in drinking among women in Latin America and the United States to try to understand why that is. Is there something about women’s bodies that put them at greater risk?
Heavy drinking is one of the main causes of long-term disease, disability and even early death. One of the most serious problems linked to alcohol is alcohol-associated liver disease, or ALD, which has become a major public health concern in those countries.
For example, about half of all cirrhosis cases in Mexico come from long-term alcohol use. And in the United States, ALD has risen sharply. From 2000 to 2021, the number of Americans living with ALD increased by more than one-third, and deaths nearly doubled. These numbers show that alcohol-associated liver disease is becoming a serious threat to public health in both nations.
Women face higher risks
One study the authors noted suggests that women are getting sicker and dying younger from alcohol-associated liver disease than men, even though they drink less.
That study looked at 192 adults with cirrhosis caused by alcohol who were treated at a major hospital in Mexico City. The researchers wanted to understand how much patients drank, how their drinking habits differed and whether men and women faced different risks.
The results were striking. Women in the study had a much higher risk of dying from ALD-related cirrhosis than men. About 62 percent of the women died, compared with about 39 percent of the men. Women also died at younger ages. On average, women died at about age 34, while men died around age 37.
Women are more vulnerable even with less alcohol
This is especially worrisome because the women in the study did not drink as much as the men. They started drinking later in life, drank for fewer years and drank smaller amounts both on heavy-drinking days and during binge drinking episodes.
“Even with this lower alcohol exposure, women still had worse outcomes,” said co-author Juan Pablo Arab, M.D., the director of alcohol sciences at VCU’s Stravitz-Sanyal Institute for Liver Disease and Metabolic Health. “This suggests that women’s bodies may be more sensitive to alcohol and more easily harmed by it.”
Research from the United States supports this idea. A large review of nine studies, which included more than 2.6 million people, found that women who drank even one alcoholic drink per day had a higher risk of developing cirrhosis than women who did not drink. This increased risk was not seen in men. When women drank heavily, five or more drinks a day, their risk rose much more quickly than men’s risk did.
Why women’s bodies react differently
There may be several biological reasons for this difference. Women have lower levels of a stomach enzyme that helps break down alcohol before it enters the bloodstream. This means more alcohol reaches the liver.
Women also tend to have smaller bodies and more body fat, which affects how alcohol is absorbed and increases stress on the liver. Female hormones, especially estrogen, may make liver cells more vulnerable to damage. Women may also have a stronger immune response to changes in gut bacteria that happen with drinking, leading to more inflammation in the liver, which can cause scarring, which in turn can lead to cirrhosis.
The study also shows how difficult it can be to measure alcohol use accurately. Many people underestimate how much they drink because they feel embarrassed or don’t remember clearly. Some people also cut back on drinking when they start feeling sick, which can make it harder to understand their past drinking habits. Researchers say that future studies should use more reliable tools, such as detailed drinking questionnaires and lab tests that can detect alcohol in the blood, to get a clearer picture.
Alcohol use among women is rising
This new research highlights a larger trend seen in both the United States and Mexico: alcohol use among women is rising quickly. In the U.S., heavy drinking among women went up by 80 percent over a recent decade. In Mexico, national surveys show more girls and young women are drinking heavily than in past years.
What does this mean for women
The authors say these finding send a clear warning to women: even non-heavy drinking can be more harmful to women than men. If you are a woman who drinks alcohol, it’s important to understand that your liver may be more vulnerable, and that drinking less or not at all can significantly reduce your risk of serious liver disease.