From the Guidelines
Binge drinking can significantly affect liver enzymes, particularly Alanine Transaminase (ALT) and Aspartate Transaminase (AST), leading to liver cell damage and potentially serious liver disease. The most recent and highest quality study, published in 2022 1, defines binge drinking as the consumption of 4–5 standard drinks, depending on sex, and generally in under 2 hours. This study highlights the risks associated with binge drinking, including the development of chronic liver disease with liver decompensation.
Key points to consider:
- Binge drinking can cause elevations in AST and ALT, indicating liver cell damage, and may create an AST:ALT ratio greater than 2:1, which can be a clinical indicator of alcoholic liver disease 1.
- Regular binge drinking can lead to chronic elevation of these enzymes and eventually more serious forms of liver damage, including alcoholic hepatitis, fatty liver disease, and cirrhosis 1.
- The liver has remarkable regenerative capacity, so enzyme levels often normalize after a period of abstinence from alcohol, typically within 2-6 weeks depending on the extent of damage.
- Continued binge drinking prevents this recovery and leads to progressive liver injury.
- Host-related factors, such as female gender, and environmental factors, such as obesity and viral hepatitis, can influence the risk of developing alcoholic liver disease and modify its progression 1.
In terms of management, early detection and treatment of binge drinking are recommended, and promotion of abstinence is strongly encouraged, especially in individuals with chronic infection with HCV, HBV, or HIV 1.
From the Research
Binge Drinking and Liver Enzymes
Binge drinking can have significant effects on liver enzymes, including Alanine Transaminase (ALT) and Aspartate Transaminase (AST).
- The relationship between binge drinking and liver enzyme levels is supported by studies that have investigated the impact of binge drinking on liver health 2, 3.
- A study published in 2019 found that binge drinking was associated with increased levels of ALT and AST in both men and women, even in those with low-risk overall alcohol consumption 2.
- Another study published in 2017 found that binge drinking increased the risk of liver disease, including decompensated liver disease, independently of average alcohol intake and other confounders 3.
Liver Enzyme Markers
ALT and AST are commonly used biomarkers for liver damage.
- ALT is considered a more specific marker for liver damage, as it is primarily found in liver tissue 4.
- AST, on the other hand, is also present in cardiac and skeletal muscle and in erythrocytes, making it a less specific marker for liver damage 4.
- The ratio of AST to ALT (AST/ALT) can be used to help diagnose the underlying cause of liver disease, with a ratio greater than 2.0 often indicating alcoholic liver disease and a ratio less than 1.0 indicating chronic hepatitis or chronic cholestatic syndromes 5.
Clinical Implications
The findings of these studies have important clinical implications for the diagnosis and management of liver disease.
- Binge drinking should be considered a risk factor for liver disease, and patients who engage in binge drinking should be monitored for signs of liver damage 2, 3.
- The use of ALT and AST as biomarkers for liver damage can help clinicians diagnose and manage liver disease, but the results should be interpreted in the context of the patient's overall clinical presentation and medical history 4, 5.