It is never too late to stop drinking alcohol, even in end-stage liver disease.
In advanced liver disease, abstaining from alcohol can reduce ongoing oxidative damage, stabilise metabolic pathways, and improve the efficacy of medical interventions. It may not reverse cirrhosis, but it can slow further deterioration, reduce complications, and enhance quality of life.
The body’s capacity for repair is remarkable and removing alcohol restores the biochemical conditions necessary for healing. In this context, choosing sobriety is not just a lifestyle change; it is a scientifically supported act of metabolic restoration.
Perfect conclusion to this article, Dr. Hunter. As always, your contributions are priceless. Thank you for the thoughtful comments here, and the message to all that it is truly never too late to stop drinking.
In my clinic and in my own life, I have learned that prevention works best when people feel supported, not judged. We can talk honestly about alcohol risk and still enjoy our lives, our friendships, and our celebrations without guilt.
Loved how clearly you drew the line between “normalization” and physiology. From a physician-scientist lens, the most evidence-anchored framing is: alcohol isn’t a health food at any dose, but it’s a dose-dependent toxin, and for cancer risk there isn’t a true “safe threshold.” WHO/IARC classify alcohol as a Group 1 carcinogen, and the risk signal extends into “light” drinking for several cancers (notably breast and colorectal). 
Where I think your post is especially valuable is that it pushes readers to stop thinking in binary (“red wine is good!” vs “alcohol is fine if it’s moderate”) and instead think in benefit–risk. The old “cardioprotective” story has been increasingly challenged by confounding, while we have very consistent data on harms: blood pressure, atrial fibrillation/arrhythmias (including binge-related “holiday heart”), sleep disruption, and liver/pancreas risk in susceptible people. 
Practical clinical nuance I’d add for readers: if someone chooses to drink, the most protective version is less, not daily, and never binge and it should be off the table for many (pregnancy/trying, history of AUD, liver disease, pancreatitis, uncontrolled HTN, AF, interacting meds). For everyone else, I like your implied message: treat alcohol as an occasional indulgence, not a wellness strategy and build the “stress relief” habit stack (sleep, movement, connection) somewhere else.
Thank you for taking the time to articulate this from a physician's perspective. The challenge we face in lifestyle medicine is 1) presenting prescriptive information in a digestible way that 2) motivates behavior change to support a patient's unique health/disease scenario. And you did this beautifully for readers.
Absolutely. No moral judgment here. Lord knows I’ve enjoyed enough beer and wine and whiskey in my day. It’s just super bad for our livers and brains at almost any dose :)
I stopped drinking entirely six years ago. It’s been an enlightening journey…developing the skills to hold to my preferences under social pressure (the hardest part!), handling the discomfort of others (their problem not mine), finding ways to celebrate, relax or have fun without alcohol, and knowing with certainty that it’s never the alcohol speaking or acting. Although I serve it when I host (no judgment) I absolutely see it as toxic poison. I was barely even a moderate drinker but being a teetotaler makes a difference and my body thanks me every day for that choice. Most people, when they learn I don’t drink not due to alcoholism or for medical reasons state with certainty, “Oh I could never do that.” To experiment with something different requires an open mind.
This really resonated. I've been thinking a lot lately about the hidden costs we don't put on the ledger — the ones that show up the next morning as foggier focus, shorter patience, and a version of ourselves that's running at seventy percent. I explored this idea recently through a conversation with an attorney who reframed alcohol not as a moral question but as an economic one: every drink borrows from tomorrow, and the bill always comes due.
Everyone will in fact die. That is indisputable. We have, however, the power of choice in how we show up in the life we have. When we choose gratitude and happiness, sleep and rest, community and friendships, good food over fast food, our bodies have an opportunity to thrive. And it is in this physical state that we get to experience a high quality of life for a longer period of time instead of being riddled with illness and unable to participate in or enjoy the parts of life that bring us true joy.
It is never too late to stop drinking alcohol, even in end-stage liver disease.
In advanced liver disease, abstaining from alcohol can reduce ongoing oxidative damage, stabilise metabolic pathways, and improve the efficacy of medical interventions. It may not reverse cirrhosis, but it can slow further deterioration, reduce complications, and enhance quality of life.
The body’s capacity for repair is remarkable and removing alcohol restores the biochemical conditions necessary for healing. In this context, choosing sobriety is not just a lifestyle change; it is a scientifically supported act of metabolic restoration.
Perfect conclusion to this article, Dr. Hunter. As always, your contributions are priceless. Thank you for the thoughtful comments here, and the message to all that it is truly never too late to stop drinking.
In my clinic and in my own life, I have learned that prevention works best when people feel supported, not judged. We can talk honestly about alcohol risk and still enjoy our lives, our friendships, and our celebrations without guilt.
Absolutely. No judgement here ☺️
ER physician here. Yet another example of the importance of scientific literacy, critical thinking, and unlearning in health and medicine. Thank you.
Loved how clearly you drew the line between “normalization” and physiology. From a physician-scientist lens, the most evidence-anchored framing is: alcohol isn’t a health food at any dose, but it’s a dose-dependent toxin, and for cancer risk there isn’t a true “safe threshold.” WHO/IARC classify alcohol as a Group 1 carcinogen, and the risk signal extends into “light” drinking for several cancers (notably breast and colorectal). 
Where I think your post is especially valuable is that it pushes readers to stop thinking in binary (“red wine is good!” vs “alcohol is fine if it’s moderate”) and instead think in benefit–risk. The old “cardioprotective” story has been increasingly challenged by confounding, while we have very consistent data on harms: blood pressure, atrial fibrillation/arrhythmias (including binge-related “holiday heart”), sleep disruption, and liver/pancreas risk in susceptible people. 
Practical clinical nuance I’d add for readers: if someone chooses to drink, the most protective version is less, not daily, and never binge and it should be off the table for many (pregnancy/trying, history of AUD, liver disease, pancreatitis, uncontrolled HTN, AF, interacting meds). For everyone else, I like your implied message: treat alcohol as an occasional indulgence, not a wellness strategy and build the “stress relief” habit stack (sleep, movement, connection) somewhere else.
Thank you for taking the time to articulate this from a physician's perspective. The challenge we face in lifestyle medicine is 1) presenting prescriptive information in a digestible way that 2) motivates behavior change to support a patient's unique health/disease scenario. And you did this beautifully for readers.
Great writing, one drop of alcohol is enough to tip the balance of metabolism.
Well said :)
I’m told that Jesus, on orders from his mother, turned water into wine.
Absolutely. No moral judgment here. Lord knows I’ve enjoyed enough beer and wine and whiskey in my day. It’s just super bad for our livers and brains at almost any dose :)
I stopped drinking entirely six years ago. It’s been an enlightening journey…developing the skills to hold to my preferences under social pressure (the hardest part!), handling the discomfort of others (their problem not mine), finding ways to celebrate, relax or have fun without alcohol, and knowing with certainty that it’s never the alcohol speaking or acting. Although I serve it when I host (no judgment) I absolutely see it as toxic poison. I was barely even a moderate drinker but being a teetotaler makes a difference and my body thanks me every day for that choice. Most people, when they learn I don’t drink not due to alcoholism or for medical reasons state with certainty, “Oh I could never do that.” To experiment with something different requires an open mind.
This really resonated. I've been thinking a lot lately about the hidden costs we don't put on the ledger — the ones that show up the next morning as foggier focus, shorter patience, and a version of ourselves that's running at seventy percent. I explored this idea recently through a conversation with an attorney who reframed alcohol not as a moral question but as an economic one: every drink borrows from tomorrow, and the bill always comes due.
https://thecaseforpodcast.substack.com/p/the-case-for-not-borrowing-from-tomorrow
everyone will die
Everyone will in fact die. That is indisputable. We have, however, the power of choice in how we show up in the life we have. When we choose gratitude and happiness, sleep and rest, community and friendships, good food over fast food, our bodies have an opportunity to thrive. And it is in this physical state that we get to experience a high quality of life for a longer period of time instead of being riddled with illness and unable to participate in or enjoy the parts of life that bring us true joy.
Balance and moderation in all things in life - no need for extremes