From fatty liver to cirrhosis: Why doctors are worried about India’s drinking habits

Alcohol consumption is on the rise — so much so that India now ranks among the highest in heavy episodic drinking globally, after Europe, America and China, as per the World Health Organization (WHO). Experts are calling it a significant public health concern, as tendencies of binge drinking among teens increase, and more and more working age professionals indulge in heavy drinking episodes as well. According to Dr Yogesh Batra, senior consultant, gastroenterologist, Indraprastha Apollo Hospitals, New Delhi, alcohol is a major health hazard and affects nearly every system of the body, even though the predominant injury is to the liver.

“Many individuals are not aware when drinking shifts from low-risk to harmful levels,” says Dr Ameet Mandot, director, hepatology, Gleneagles Hospital, Lower Parel, Mumbai, adding, “Higher risk patterns are often seen among working-age adults (20-50 years), urban populations, and high-stress occupations.”

“Regular drinking leads to fatty liver (steatosis), which is reversible, but continued intake may progress to alcoholic hepatitis (inflammation) and eventually cirrhosis, where permanent scarring affects liver function. Over time, this condition will lead to liver failure while simultaneously increasing the probability of developing liver cancer,” says Dr Vinay Kumar BR, consultant, hepatology, Fortis Hospital Bannerghatta Road, Bengaluru. “Beyond the liver, metabolic disorders such as diabetes become worse through alcohol consumption because the substance affects blood sugar control mechanisms in the body.”

Multiorgan risks

Dr Vinay confirms that a vast majority of liver cirrhosis cases in India are indeed linked to alcohol. He elaborates, “Alcohol consumption on a regular basis interrupts the body’s normal liver functions and causes fat to build up inside liver cells, which leads to the condition known as fatty liver disease. The condition progresses to alcoholic hepatitis after people continue drinking, which results in liver cell damage and inflammation,” he explains. “The process of ongoing injury and recovery results in fibrosis, which eventually develops into cirrhosis, an irreversible medical condition that causes extensive structural and functional damage to the liver.”

Further, the process of alcohol metabolism creates harmful substances such as acetaldehyde and reactive oxygen species, which result in oxidative stress that causes additional harm to liver cells. “The consumption of alcohol decreases the liver’s capacity to regenerate while compromising immune functions, which increases the risk of developing infections,” says Dr Vinay.

“In terms of disease progression, among heavy drinkers, nearly 90% may develop fatty liver, about 10-35% may progress to alcoholic hepatitis, and around 10-20% eventually develop cirrhosis. Overall, roughly one-third of patients with serious liver disease have alcohol as a contributing factor, though this varies by population,” he adds.

However, experts hold that the liver is not the only organ bearing damage as a result of excessive alcohol consumption. Dr Batra says alcohol can cause brain degeneration and psychosis as well. “It can affect the heart causing cardiomyopathy; kidney involvement can result in chronic kidney disease; other gastrointestinal organs can get involved resulting in acute and chronic pancreatitis, peptic ulcer, or gastritis. The incidence of cancers, infertility and reproductive abnormalities are much more in alcohol consumers.”

“Excessive alcohol can also damage the brain, causing memory problems, poor coordination, depression, and addiction,” provides Dr Mandot. He further shares that in his experience, “Around 20-25 patients aged 30-65 years come with liver cirrhosis and failure linked to alcohol consumption in a year. Alcohol consumption is common in youngsters as well as the older population.”

Symptoms and safe limits

Dr Mandot says that some visible symptoms from continued alcohol abuse can look like “jaundice, weight loss, tremors, poor coordination, mood changes, and frequent gastrointestinal problems”. “But liver cirrhosis, liver failure, pancreatitis, and alcohol-related brain damage can mean alcohol abuse for a long time.”

According to Dr Batra, nearly 30% of his patients have ailments related to alcohol intake. “Decrease in sleep, abnormal social behaviour, new aggression are early signs of drinking,” he says, adding, “As disease sets in pain in the upper abdomen, swelling of feet and jaundice are early signs of liver disease.”

“In my clinical practice, alcohol-related liver disease is quite common. Broadly, in India, around 20-40% of chronic liver disease (CLD) patients may have alcohol as the primary or major contributing cause, though this varies by region and healthcare setting,” says Dr Vinay. He further expounds the volume of patients with alcohol intake related issues. “In a typical outpatient (OPD) setting, for every ten patients with chronic liver disease, approximately two to four patients may have significant alcohol contribution. In inpatient wards, especially among those admitted with decompensated cirrhosis, the burden is higher — around three to five out of every ten admissions may be alcohol-related.” He says that in tertiary referral centres and liver transplant units, this proportion can be even higher, with 30-50% of advanced cirrhosis or liver failure cases linked to alcohol use, highlighting the significant clinical burden.

“Many individuals are not fully aware when their consumption crosses safe limits, as social drinking is often normalised,” stresses Dr Vinay. “Young to middle-aged adults who live in urban areas, particularly in high-stress environments and easy alcohol access, show higher drinking problems across different income levels.”

“Contrary to what was believed earlier, there is no safe limit for alcohol. Even a small amount of alcohol can cause disease. Invariably once people start drinking they end up drinking in excess,” observes Dr Batra. “If one has to drink then one should drink only to the point there is no apparent social, physical, or mental issue to self or any harm to those nearby — that is, responsible drinking,” he advises.

Dr Vinay, however, points out, “What often goes unnoticed is that even amounts perceived as ‘social’ can become harmful over time, particularly when combined with underlying conditions like fatty liver, diabetes, or obesity.” “People who have existing health risks should either limit their alcohol consumption or completely avoid drinking alcohol. It is equally important to avoid binge drinking, as consuming large quantities over a short period can cause acute liver stress and accelerate long-term damage,” he adds.

While some doctors advocate responsible drinking and to watch out for symptoms, or to indulge in a glass or two of branded alcohol every four to five weeks, Dr Mandot holds, “There is no completely ‘safe’ level of alcohol — limiting intake to one small glass per day for women and men is essential. However, it is best to quit alcohol. The course of treatment for a patient who is suffering complications from alcohol intake is complete abstinence, medical management of affected organs, nutritional support, and structured de-addiction therapy.”