In the US, approximately 2/3 of the population drinks alcohol. Just over 7% of this number regularly abuse it. While all sorts of societal and personal problems stem from alcohol abuse, so do significant health issues. The liver is particularly affected by alcohol overindulgence.

Formally known as hepatic steatosis, fatty liver disease (FLD) occurs as fat builds up in this vital organ and alcohol contributes to this accumulation. The good news is that, caught early, FLD is treatable – and reversible. However, because FLD symptoms are often vague, many people are not diagnosed until the disease reaches a stage where treatment is more difficult, and the liver has already suffered serious damage.

What Is Fatty Liver Disease?

FLD occurs when there is too much fat in the liver. When more than 5-6% of normal liver tissue is replaced by fat, the person has FLD. While alcohol abuse is responsible for many FLD cases, there are multiple types of FLD, and not all these varieties are caused by drinking.

These include:

  • Non-alcoholic FLD

    Also known simply as fatty liver but, unlike FLD, there is no cell damage or inflammation. Non-alcoholic FLD does not usually get worse with time, or cause serious health issues in the majority of those diagnosed.

  • Non-alcoholic steatohepatitis (NASH)

    Those with NASH experience liver inflammation. About 20% of those with Non-alcoholic FLD will develop NASH. The damage done to the liver by inflammation may lead to cirrhosis, fibrosis, or cancer.

How Does Alcohol Cause Fatty Liver Disease?

The liver serves as the body’s filter, removing toxins, aiding digestion, and helping to combat infection. Being the most resilient organ, the liver is capable of regeneration. When it must filter alcohol, however, liver cells die off. New cells develop, but heavy drinking inhibits the organ’s ability to regenerate.

Consuming large amounts of alcohol on a regular basis can lead to fat buildup in the cells. This is because, as excessive drinking causes damage on the cellular and mitochondrial level to the liver, it loses its ability to break down fats, causing lipid molecules and triglycerides to start accumulating and triggering the onset of FLD.

What are the Symptoms of FLD?

Early symptoms of FLD include:

  • Abdominal pain
  • Appetite loss
  • Diarrhea
  • Nausea
  • Vomiting

Many of these symptoms mimic other intestinal disorders, and those suffering from them may dismiss them as a stomach bug. However, if the individual continues drinking, symptoms become more distinctive, and worse.

Later stage FLD symptoms include:

  • Ascites - abdominal fluid buildup
  • Blood in the stool
  • Clubbing - extensively curving fingernails
  • Extreme itching
  • Fatigue
  • Fever
  • Frequent bruising or bleeding
  • Jaundice – yellowing of the skin and whites of the eyes
  • Muscle wasting
  • Shivering
  • Swelling of the legs and feet
  • Weakness
  • Weight loss

Those with FLD may find themselves becoming more sensitive to the effects of alcohol and drugs on their bodies. After two weeks’ abstention from alcohol, people diagnosed with early stage FLD may find the liver beginning to return to normal, provided they do not start drinking again.

Stages of Alcohol-Related Liver Disease (ARLD)

Alcoholic Fatty Liver Disease

In the early stage, those affected are often asymptomatic. Mild symptoms are often mistaken for gastrointestinal problems. If the person stops drinking alcohol, he or she will usually recover completely from FLD. If heavy drinking continues, ARLD may progress to a more serious and less treatable stage.

Alcoholic Hepatitis

Once the liver becomes inflamed, resulting in alcoholic hepatitis, failure to stop drinking results in severe liver damage or death. Scar tissue begins forming, reducing blood flow throughout the organ. This also spurs the continuing buildup of toxins in the body. Blood flow reduction may affect the kidneys.


Cirrhosis is generally not reversible. It refers to the scarring of the liver, and eventual liver failure. Symptoms may not appear until the cirrhosis is quite advanced. Quitting alcohol can prolong the lives of those diagnosed with cirrhosis but continuing to drink lessens life expectancy considerably. Liver transplants are one option for cirrhosis patients, however, because your disease was self-inflicted, you will be a less promising transplant candidate than someone suffering from a less avoidable disease.


If you suspect you may suffer from FLD, see a doctor as soon as possible for a diagnosis. Testing for FLD involves a thorough review of your medical history and performing a physical exam, along with blood samples so that doctors can evaluate your liver function and enzyme levels. Urine testing will show whether bilirubin levels are high (this is the substance that causes jaundice and is usually broken down in the liver).

Some doctors may order additional tests, such as:

  • Abdominal ultrasound : evaluates blood flow and liver shape and size
  • Abdominal computed tomography scan : enables viewing of liver damage
  • Magnetic resonance imaging : calculates liver fat levels
  • Magnetic resonance elastography : tests for liver fibrosis

In some cases, the patient may require a liver biopsy. During this minimally invasive, image-guided procedure, a needle removes a small amount of liver tissue. Under microscopic examination, the sample is viewed for signs of fibrosis, inflammation, and other problems. The test is also used for ruling out other diseases.


While various FLD treatment options exist, the patient must stop consuming alcohol for them to be effective. Those diagnosed in the early stages of FLD may reverse the disease entirely by simply abstaining from alcohol for a period of time and significantly reducing their intake afterwards. Of course, for many people, that is easier said than done, and they may need to seek help from a chemical dependency treatment professional to assist them in quitting.

Patients suffering from diabetes or high cholesterol must manage these conditions with the help of their healthcare providers. Because malnutrition affects virtually all alcohol hepatitis patients, good nutrition is an essential part of treatment. These patients may also benefit from the use of corticosteroids.

In a worst-case scenario, the person may require a liver transplant. While alcoholic cirrhosis has long been one of the leading reasons for such transplantations, some hospitals performing liver transplants require a certain period of sobriety for patients to qualify.


The best way to prevent FLD is via alcohol avoidance, or at least limited consumption. Never take any medications with alcohol, either prescription or over-the-counter, without reading all warning labels. Protect yourself against hepatitis C, which increases the odds of cirrhosis in those with the virus, by getting a vaccination. Avoid eating too much fat. As with excessive alcohol consumption, excess fat in the diet contributes to FLD development because there are more lipids for the liver to work to break down.

Since obesity can aggravate FLD, a strict diet and exercise program for weight loss can help prevent this condition. Many seriously overweight people have tried various ways to lose weight to little avail. Such individuals may want to discuss options with their physicians. Even if obesity is not an issue, consuming a healthy diet and partaking in regular exercise can help prevent FLD and keep the body healthier overall.

Risk Factors

While anyone who drinks to excess is vulnerable to FLD development, some populations are more likely to suffer from FLD than others. For example, men of Hispanic, Native American, and Inuit ancestry are more likely to succumb to cirrhosis than white males. Overall, men are more likely to develop FLD than women, but men also tend to drink more. Females who consume large amounts of alcohol on a steady basis run twice the risk of coming down with alcohol-related liver disease than males.

Genetics play a role, and those with one specific gene, PNPLA3, usually get sicker and are more likely to die from liver disease than those lacking gene. As noted, obese individuals are also at greater risk of FLD than those with a normal body mass index. So are diabetics and people with high cholesterol. Those undergoing certain types of chemotherapy for cancer treatment or taking steroids for other conditions raise their risk of FLD development.

Certain medications can cause or exacerbate FLD, so inform your healthcare provider about your FLD risk factors when they are determining drugs for treatment of other diseases. Rapid weight loss may predispose people to FLD, as can high blood pressure. Metabolic disorders also contribute to FLD risk. Virtually any heavy drinker has excess fat in the liver, but not all such drinkers develop FLD. Even moderate drinking is a risk, as 40% of those consuming alcohol daily experience some liver changes. If you are concerned about FLD, limiting alcohol intake is imperative.