Fatty liver, also known as hepatic steatosis, is a condition where excess fat builds up in the liver. It’s normal to have some fat in your liver, but more than 5-10% of your liver weight as fat is considered fatty liver. Fatty liver is commonly associated with heavy alcohol consumption, but you can also get fatty liver from being overweight or obese, having diabetes, or other causes. If you’ve been diagnosed with fatty liver, one of the first recommendations from your doctor may be to avoid alcohol completely. But does fatty liver always mean you cannot drink alcohol? Here is a quick overview of the relationship between fatty liver and alcohol.
What causes fatty liver?
There are two main types of fatty liver:
Alcoholic fatty liver disease
This type is caused by drinking excessive amounts of alcohol. Alcoholic fatty liver disease (also called alcoholic steatosis) is the earliest stage of alcohol-related liver disease. Heavy drinking overworks the liver and prevents it from processing fat properly, leading to a buildup of fat.
Nonalcoholic fatty liver disease
Nonalcoholic fatty liver disease (NAFLD) occurs in people who drink little to no alcohol. The most common causes include:
- Metabolic syndrome
- High blood sugar and diabetes
- High cholesterol and triglycerides
- Rapid weight loss
- Certain medications
- Autoimmune diseases
- Inherited diseases
NAFLD is increasingly common due to growing rates of obesity and type 2 diabetes. Over time, NAFLD can progress to more serious liver conditions like NASH (nonalcoholic steatohepatitis), cirrhosis, and liver cancer.
What are the symptoms of fatty liver?
Fatty liver often has no signs or symptoms, especially in the early stages. People may feel fatigue or have vague abdominal discomfort. As the disease progresses, symptoms may include:
- Enlarged liver
- Abdominal swelling
- Leg swelling
- Confusion and impaired brain function
- Bleeding disorders
However, severe symptoms only tend to appear once the liver has been severely damaged. That’s why fatty liver is often diagnosed incidentally when screening for other conditions. Blood tests can check for high liver enzyme levels that may indicate liver problems. An ultrasound, CT scan, or MRI can confirm fat buildup in your liver.
Can you drink any alcohol with a fatty liver?
If you’ve been diagnosed with alcoholic fatty liver disease, it’s essential to stop drinking alcohol completely. Continuing to drink can lead to alcoholic hepatitis, fibrosis, cirrhosis, and eventual liver failure.
But what if you have NAFLD or nonalcoholic steatohepatitis (NASH)? In these cases, recommendations on alcohol tend to be less black-and-white. Moderate, occasional drinking may be okay for some people with NAFLD. However, any amount of alcohol may be risky for certain individuals. Here are some factors to consider:
Severity of liver disease
People with advanced liver fibrosis or cirrhosis should avoid all alcohol, even if their condition is not alcohol-related. Alcohol can worsen liver inflammation and function.
Weight and diet
Being overweight and unhealthy eating habits contribute to NAFLD. Even light to moderate drinking can add excess calories and affect the liver. Losing weight through diet and exercise is very important for NAFLD management.
Other health problems
People with obesity, diabetes, hypertriglyceridemia or other metabolic disorders have higher NAFLD risks. Alcohol can exacerbate these conditions. Carefully monitoring your blood sugar and triglyceride levels is important.
Some medications like acetaminophen are broken down by the liver. Alcohol increases the toxic byproducts. Avoid alcohol if you regularly take medications that affect the liver.
Certain genetic mutations like PNPLA3 can increase NAFLD risk, even with little alcohol intake. People with a family history of NAFLD may need to be more cautious with alcohol.
Is moderate drinking ok with NAFLD/NASH?
Moderate alcohol use is often defined as 1 drink per day for women and 2 drinks per day for men. A drink is:
- 12 oz regular beer
- 5 oz wine
- 1.5 oz distilled spirits
While an occasional drink may be harmless for some people with mild NAFLD, most experts recommend erring on the side of caution and avoiding alcohol. Here’s why:
- Alcohol can contribute to insulin resistance, obesity, and liver inflammation – main factors underlying NAFLD.
- There are no standardized recommendations for “safe” alcohol limits in NAFLD/NASH patients.
- Any alcohol consumption could potentially progress liver damage and fibrosis.
- Alcohol patterns like binge drinking are clearly unsafe, butconsistently drinking light-moderate levels may also be damaging long-term.
- Given lack of evidence on safe alcohol thresholds, recommending zero alcohol is cautious advice for most NAFLD patients.
Speak to your hepatologist about your specific risks. They may approve light drinking if you have mild, stable liver disease without worsening factors. But no amount of alcohol is considered completely safe if you have NASH or advanced NAFLD-related fibrosis.
Tips on alcohol if you have fatty liver disease
Here are some tips if you choose to drink alcohol occasionally with NAFLD/NASH:
- Limit to 1 drink daily or less for women, and 1-2 drinks daily or less for men.
- Drink slowly – avoid binge drinking completely.
- Drink with food – this slows alcohol absorption.
- Avoid liquor and stick to lighter drinks like regular beer and wine.
- Monitor liver enzymes and signs of worsening liver function.
- Stay hydrated by drinking water before, during, and after alcohol intake.
- Maintain a healthy diet and active lifestyle.
- Don’t drink alcohol if you are unable to limit intake or have alcohol disorder issues.
Pay attention to how you feel when drinking alcohol. Signs like fatigue, stomach pain, nausea may indicate alcohol worsening your condition. Inform your doctor about your alcohol habits at each visit. You may need to cut back or quit alcohol if there are signs of liver disease progression.
Can the liver heal after quitting alcohol?
Liver damage from heavy alcohol use can be reversed if you stop drinking completely.
- Fatty liver: Fatty liver from alcohol can be reversed if you abstain from alcohol for 2 weeks to several months. Liver enzymes usually return to normal levels with alcohol cessation.
- Alcoholic hepatitis: Stopping alcohol use can help resolve inflammation. But severe alcoholic hepatitis has a high short-term mortality risk even with abstinence.
- Cirrhosis: Alcohol abstinence stops progression of fibrosis and cirrhosis. But significant scar tissue cannot be reversed, which is why early intervention is key.
Quitting alcohol also reduces your risk of long-term complications like liver cancer. That said, once advanced cirrhosis develops, complications may continue even if you quit drinking.
Along with alcohol abstinence, good nutrition, medications, and lifestyle changes can help stabilize liver function. Losing weight if obese or diabetic is also important. Speak to your hepatologist about additional ways to support your liver health.
Fatty liver disease has two main types – alcoholic fatty liver caused by alcohol abuse, and NAFLD/NASH triggered by obesity, diabetes and other factors. If you have alcoholic fatty liver, abstaining from alcohol is critical, as any amount can worsen disease progression. With NAFLD or NASH, light drinking may be deemed safe for some individuals, but avoiding alcohol is often recommended to be cautious. Speak to your doctor about your specific risks. If you do choose to occasionally drink alcohol with NAFLD or NASH, strict moderation is key, along with close monitoring for any signs of worsening liver function.