If you’ve been drinking more alcohol lately and starting to worry about the long-term effects on your health, such as the potential for alcoholic liver disease, you’re not alone.

According to the Centers for Disease Control, excessive alcohol use is the leading preventable cause of death in the United States. It is responsible for 140,000 deaths in the United States each year and is the cause of one in five deaths among adults ages 20 to 49.

Americans were already drinking at high levels prior to the start of the COVID-19 pandemic, when the large-scale lockdowns and closures led to a spike in alcohol sales and consumption.

Health officials are concerned about the long-term impact of all this drinking, particularly when it comes to increasing rates of alcoholic liver disease (ALD)—a severe complication of excess alcohol consumption that impairs the function of the liver and is essentially untreatable.

Jay Luther, MD

“There is data showing that the incidence of ALD is on the rise globally, says Jay Luther, MD, director of the Massachusetts General Hospital Alcohol Liver Center. “Our group has also generated data showing the type of cases we’re seeing post-COVID are more severe and are happening to younger people.”

While there are evidence-based medications for alcohol use disorder (AUD), a 2022 study by researchers at Yale University found that due to stigma and other systemic factors, only one percent of eligible patients are taking them.

Could exercise help to protect against alcoholic liver disease in this vulnerable and growing population?

That’s the question being investigated by researchers from the Alcohol Liver Center, who recently published their findings in the journal Alcohol and Alcoholism.

The team, which was led by Dr. Luther and Jessica Shay, MD, PhD, studied the long-term outcomes of 2,000 patients with AUD from the Mass General Brigham Biobank.

Looking at health outcomes over an average of 10 years, they found that AUD patients who reported engaging in 2.5 hours of moderate-high exercise each week had a lower risk of developing alcoholic liver disease compared to those who did not exercise—and that each additional hour of exercise performed per week added to this protective effect.

Notably, the team also saw a protective effect in those who performed less than 2.5 hours of moderate-high intensity exercise per week, suggesting that even some exercise is better than none.

Those patients who reported no moderate-high intensity exercise each week were more likely to develop alcoholic liver disease, the team found.

There were no reported differences in alcohol use comparing patients reporting more than 2.5H of moderate-high intensity exercise per week, less than 2.5H or no exercise, suggesting that the beneficial effects of exercise occur independently of alcohol consumption.

“While we’re not recommending that people drink as much as they want and just exercise, I think it is an important finding that can be used to supplement education on the risks of alcohol consumption,” says Shay, a physician-scientist in the Division of Gastroenterology and Hepatology at Massachusetts General Hospital and the first author of the study.

The team’s findings have some limitations, including the possibility that there are other influences on alcoholic liver disease risk that were not captured in the team’s assessment. Those who performed at least 2.5 hours of moderate-high intensity exercise tended to have a lower BMI than those in the non-exercise group, which could have also affected the results.

Randomized clinical trials will be needed to better detail the association between exercise and reduced ALD risk, the researchers say.

In the meantime, care providers may want to encourage their patients with AUD to engage in regular exercise as a strategy to prevent the development or progression of ALD.

The team’s findings also tie into a larger clinical and research efforts by the Alcohol Liver Center to reduce the growing health impact of alcoholic liver disease through early intervention and treatment.

This includes the creation of an Inpatient Alcohol Liver Service that meets with every Mass General inpatient with a diagnosis of AUD (regardless of why they were admitted) in an effort to improve early detection of liver disease.

“The reason our group has decided to catch the disease before it starts is because ALD is one of the unique diseases in which there really is no cure,” Luther explains. “Once you diagnose it, there is in some ways no turning back. You can try to manage it, but you can’t cure it.”