What Is Zieve's Syndrome?

You wake up groggy one morning after yet another big night out. But today, it’s not just the usual headache and nausea that accompanies a night of heavy drinking. As you drag yourself to the bathroom to freshen up, you feel a pang in your stomach. When you catch your reflection in the mirror, you do a double take. Your skin and the whites of your eyes have taken on a yellowish hue as if there’s a filter on the image staring back at you. Confused and alarmed, you wonder, “What’s happening to me?”

Excessive drinking for an extended period of time doesn’t come without consequence. Meet Zieve’s syndrome, an often overlooked condition that occurs in those of us with a history of heavy drinking. Unlike typical liver disease, Zieve’s syndrome combines multiple complications, making it a unique and challenging condition to understand and manage. Let’s further explore what Zieve’s syndrome is to learn what we can do to prevent or address it. 

Understanding Zieve’s Syndrome: An Underreported Cause of Alcohol-Induced Anemia 

Zieve’s syndrome is a complication of alcohol-related liver injury that stems from excessive drinking. It was first described by Dr. Leslie Zieve in 1957 when he noticed that many patients with alcohol-related liver injury shared three common issues. The three signs of Zieve’s syndrome are yellowing of the skin and eyes (jaundice), abnormal breakdown of red blood cells (hemolytic anemia), and high levels of lipids such as cholesterol and triglycerides in the blood (hyperlipidemia). This trio causes a range of symptoms associated with Zieve’s syndrome.

Jaundice is one of the big three signs. We can identify jaundice in four ways:

• Yellowing of skin, eyes, and other mucous membranes
• Dark-colored urine
• Pale stools
• Itchy skin

Anemia is a condition that occurs when our blood doesn’t have enough healthy red blood cells or proteins (hemoglobin), which carry oxygen to the rest of the body. If our body doesn’t get enough oxygen, we may experience a range of symptoms: 

• Weakness
• Dizziness
• Confusion 
• Pale skin
• Increased heart rate
• Fever

Hyperlipidemia (or high levels of fat particles in the blood) isn’t associated with any specific symptoms. But when this condition combines with jaundice and anemia, the result may be:

• Abdominal pain
• Nausea
• Vomiting
• Fatigue
• Low-grade fever 

Now that we understand what to look out for, let’s get to know why Zieve’s syndrome occurs.

What Causes Zieve’s Syndrome?

Zieve’s syndrome occurs due to liver injury from excessive drinking. Since our liver is the main organ that breaks down alcohol, it’s consistently exposed to toxins that destroy its cells. Over time, damage to our liver cells leads to inflammation, scarring, and liver dysfunction. While our liver is in charge of breaking down toxins, it also plays a key role in regulating the lipids in our blood. When our liver isn’t functioning properly, fat builds up, leading to hyperlipidemia. Our liver also struggles to remove bilirubin, a yellowing pigment that is a waste product of our blood, leading to jaundice. 

Jaundice can also be caused by hemolytic anemia, another component of Zieve’s syndrome. Hemolytic anemia is a disorder where red blood cells are destroyed faster than they can be produced. While we know hemolytic anemia in Zieve’s syndrome can contribute to jaundice, the cause of hemolytic anemia isn’t completely understood. 

Researchers believe that Zieve’s syndrome can be a combination of several different factors. First, elevated levels of lipids in our body can disrupt the red blood cell membrane and cause it to break down (hemolysis). Additionally, vitamin E, which plays a vital role in red blood cell metabolism, can be depleted by alcohol, contributing to hemolysis. Lastly, acetaldehyde, the toxic compound in alcohol, impairs red blood cell enzymes, which can make red blood cells more susceptible to injury. While it seems like Zieve’s syndrome can be caused by many different elements, the underlying factor is alcohol-related liver injury. In short, damage to our liver from excessive drinking can lead to Zieve’s syndrome. To fully grasp who is most vulnerable, let’s delve into the specific risk factors that increase the likelihood of its onset. 

Zieve’s Syndrome Risk Factors 

As we’ve learned, Zieve’s syndrome occurs due to alcohol-related liver damage, and the risk factor for alcohol-related liver damage is excessive drinking. According to the CDC, excessive drinking is outlined by the following criteria:

• 14 standard drinks per week for men
• 7 standard drinks per week for women 
• 4 drinks in one sitting for men
• 3 drinks in one sitting for women 

One standard drink refers to 14 grams of pure alcohol. This looks different depending on the type of alcoholic beverage. For example,14 grams of pure alcohol is found in roughly 12 oz of 5% beer or 1.5 oz of distilled spirits. When evaluating our drinking habits, it’s important to ensure we’re using standard drink measurements, as one drink we order at the bar can easily be two or three standard drinks. 

To understand the direct link between excessive drinking and liver damage, let’s take a look at some sobering facts. Research on alcoholic liver disease published by the National Library of Medicine outlines the following findings:

• Consumption of 30-50 grams of alcohol per day or about 2-4 standard drinks a day for 5 years can lead to alcohol-related liver disease.
• Cirrhosis or permanent liver scarring occurs in 30% of those with a history of heavy drinking (40 grams per day).
• Steatosis (fatty liver disease) occurs in 90% of those who drink more than 60 grams of alcohol per day.
• Quantity and duration of alcohol consumption are the highest risk factors for the development of liver disease.

Zieve’s syndrome, which is caused by alcohol-related liver damage, shares the same risk factors and helps us understand why it develops. While excessive drinking is the primary risk factor for Zieve’s syndrome, treating it isn’t as simple as not drinking excessively. 

Treatment for Zieve’s Syndrome

A core component of treating Zieve’s syndrome is avoiding alcohol. Research shows that patients with Zieve’s syndrome can recover 4 to 6 weeks after abstinence from alcohol. Continuing to drink, even below the criteria for excessive drinking, can lead to severe liver damage and cirrhosis. Cirrhosis is permanent liver scarring that leads to liver failure. Oftentimes, the only treatment for chronic liver failure is a liver transplant.

Aside from lifestyle changes, the other main treatments for Zieve’s syndrome are blood transfusions. Normal blood transfusions can increase our red blood cell count, combating jaundice and anemia. Plasmapheresis helps treat hyperlipidemia by removing the triglycerides (fatty acids) from the plasma in our blood. Together, these treatments address each component of Zieve’s syndrome and help us improve our liver health. By prioritizing liver health, we can more effectively prevent Zieve’s syndrome. Let’s talk strategy. 

Tips for Preventing Zieve’s Syndrome

Although Zieve’s syndrome manifests through a triad of conditions (and even more symptoms), preventing it is much less complicated. It’s centered around mindful drinking, which we can practice in the following ways: 

• Set limits. Follow moderation guidelines or track your consumption, then develop attainable goals to cut back. 
• Choose alternatives. Better yet, choose alcohol-free alternatives to avoid alcohol altogether. Since alcohol is toxic to our liver, avoiding alcohol is beneficial for it. 
• Manage liver health. Aside from eliminating toxic substances like alcohol, eating a liver-healthy diet, getting adequate sleep, and participating in daily exercise help improve the function of our liver (more on this in the next section).
• Catch it early. This goes for both negative drinking habits and alcohol-related liver damage. Early intervention helps prevent further damage from alcohol. Look out for early signs of alcohol misuse to stop it in its tracks to help prevent adverse health effects such as liver damage.
• Get support for quitting or cutting back. The way alcohol hijacks our brain’s reward system can make quitting or cutting back not always as easy as it sounds. Luckily, we have a range of support options to explore including behavioral treatments, psychological therapy, and support groups like the Reframe community.

Improving and maintaining the health of our liver is a crucial aspect of preventing and treating Zieve’s syndrome. Let’s dive into more detail on ways we can boost the well-being of our liver.

Leveling Up Your Liver

To level up our health, it’s crucial to not only prevent conditions like Zieve’s syndrome, but also to enhance our liver function. The liver is in charge of many major functions in our body including detoxification, supporting metabolism, and more. We can prioritize our liver health by implementing these strategies:

• Steer clear of toxins. In addition to alcohol, pesticides and other toxins can damage our liver. Take care when washing produce and read warning labels on chemicals before use. 
• Check your supplements. Research shows that some herbal and dietary supplements account for 20% of liver injury in the US. Be sure to check if the supplements you’re taking are on the National Institutes of Health database of toxic substances or consult with your doctor for individual medical advice. 
• Maintain a healthy weight. Having a sustainable exercise routine helps us stay active and avoid excess fat buildup in our liver which can lead to dysfunction. Find enjoyable ways to move your body such as going for a hike or taking a dance or exercise class. Eating a balanced diet can also help us maintain a healthy weight and liver. The American Liver Foundation recommends avoiding foods high in fat, sugar, and salt. 
• Use medications properly. Taking too much or taking them for extended periods of time can be harmful to our liver. Make sure to follow directions for all prescribed medications. 
• Prevent hepatitis A, B, and C. Hepatitis A and B are viral diseases and can be prevented through vaccinations. While the vaccinations are now recommended for children, some adults have not gotten them. Talk to your doctor to see if it’s recommended. For hepatitis C, there’s no vaccination. This virus is spread through blood and can lead to permanent liver damage if left untreated. Practice safe use and disposal of needles and look out for signs of hepatitis C including stomach pain, joint pain, dry mouth, fatigue, loss of appetite, and yellowing of the skin or eyes (jaundice).

Taking care of our liver health ultimately improves our overall health and well-being. 

From Awareness to Action

Zieve’s syndrome is a complication of alcohol-related liver damage that leads to a treacherous trio of jaundice, anemia, and hyperlipidemia. Now that we understand how it works and what causes it, we can better treat and prevent it by prioritizing our liver health! Quit or cut back on alcohol, load up liver-friendly foods, and steer clear of toxins to give your liver a reprieve and avoid Zieve’s!