Does being a lightweight drinker have anything to do with my liver?

Dear Not worried, just curious, 

Here’s something that might lift your spirits—you build alcohol tolerance through regular drinking, rather than inheriting it. You can, however, inherit alcohol sensitivity and certain types of liver diseases. Yet, there doesn’t seem to be a link between liver function and alcohol tolerance. All of that said, lots of factors affect how your body responds to boozy brews. 

What happens in your body when you drink alcohol? 

When you drink alcohol, your stomach and small intestine break some of the alcohol down. However, the liver processes most of it. In the liver, enzymes break the alcohol down until it becomes acetate. This eventually leaves your body as carbon dioxide and water.  

Your body can only process approximately one standard drink of alcohol per hour (12 ounces (oz) of beer, 5 oz of wine, or 1.5 oz of hard liquor). If you drink faster than your liver can break it down, the level of alcohol in your blood will rise and you may start to feel intoxicated.  

Why do some people have a higher alcohol tolerance than others? 

Many factors affect how your body processes alcohol. These include:  

• Stomach content: Food in the stomach, particularly carbohydrates, slows the rate of alcohol absorption into the bloodstream. 
• Carbonated beverages: Bubbly drinks like champagne, soda, or tonic water are absorbed more rapidly. When they contain or are mixed with alcohol, they can cause the alcohol to enter the bloodstream much faster.  
• Amount of alcohol: Drinks will a higher concentration of alcohol will increase your blood alcohol content (BAC) quicker. You can estimate your BAC using a BAC calculator. 
• Speed of consumption: Downing a drink over a shorter time will raise your BAC more quickly. 
• Size and body build: Your body distributes alcohol through the water in your bloodstream. From here, it can enter muscles and tissues. Smaller people have less “room” for alcohol to spread out, leading to higher BAC. 
• Gender: People assigned female at birth (AFAB) often have lower levels of some of the enzymes in the stomach, so less alcohol can be broken down before it’s absorbed into the bloodstream. AFAB people also tend to have lower blood volume and higher percentage of body fat. As such, there is less lean body mass to distribute alcohol throughout the body. 
• Drugs and medications: Certain medications can interact with alcohol and change the way your body metabolizes it. Nicotine, a chemical found in cigarettes, can also reduce alcohol’s sedative effects and enhance the stimulating effects.  
• Age: Older people may feel the effects of alcohol more strongly due to decreased activity of liver enzymes involved in alcohol metabolism.  
• Environment: Emerging research suggests that individuals tend to lose inhibitions more when drinking in unfamiliar environments. 

Do genes affect how you react to alcohol? 

Genes can affect how your liver processes alcohol. In people with alcohol intolerance, two genetic mutations make it harder for their bodies to process alcohol. The combination of these two genetic variants causes toxic acetaldehyde to build up in the bloodstream. This leads to side effects like facial flushing, headaches, and nausea. People of East Asian and Polynesian descent are more likely to inherit these mutations. These genes, however, have no relation to functional alcohol tolerance, or how you build up tolerance over time.  

How is alcohol consumption related to liver disease? 

While liver disease can be caused by various infections or diseases, long-term alcohol use is also a common cause. Moderate to heavy alcohol use can increase the risk of developing liver disease. As such, drinking in moderation (up to one drink per day for AFAB people and two drinks a day for people assigned male as birth (AMAB) people) can lower the likelihood of developing liver disease. 

If you’re concerned about your liver health, you might consider speaking with a health care provider. They can help to assess your risk factors and suggest ways to reduce or reverse your risk of developing liver disease.  

Drink safely, and liver life to the fullest!