Alcohol-Related Liver Disease vs. Non-Alcohol-Related Liver Disease

Written by Brigid Galloway Greenwood
Medically Reviewed by Jennifer Robinson, MD on December 19, 2024
10 min read

Your liver is a hardworking organ and gland that performs more than 500 functions in your body. It fights infections. It cleans your blood of waste and harmful substances. And it transforms fats, proteins, and carbohydrates into energy and nutrients. Your liver is essential to maintaining your body’s overall wellness. But all that cleaning and processing also puts this vital organ at risk of developing various types of liver disease, including alcohol-related liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD). 

Both ALD and NAFLD happen when a person's liver becomes damaged and can no longer process the fat cells that it would typically turn into energy, nutrients, and waste. Excess fat buildup in the liver can cause the liver become inflamed (swollen and irritated). Over time, this inflammation may lead to scarring that limits liver function. 

Non-alcoholic fatty liver disease 

Doctors now refer to NAFLD as metabolic dysfunction-associated steatotic liver disease (MASLD). It often goes hand in hand with obesity and conditions related to obesity, like type 2 diabetes. A recent study found that NAFLD is the world’s leading cause of liver disease. Almost 1 in 3 adults around the globe has it. In the U.S., it’s the most common chronic (long-term) liver condition. 

There are two basic stages of NAFLD: simple fatty liver and metabolic dysfunction-associated steatohepatitis (MASH). If your liver’s weight is more than 5% fat, you are considered to have simple fatty liver. Only 1 in 5 adults with simple fatty liver disease will progress to MASH. At this stage, there is swelling in the liver, which can lead to further damage. 

If you are overweight, you have a greater risk of developing NAFLD. Research shows that up to 75% of people who are overweight and more than 90% of people with severe obesity (weighing 100 pounds over their ideal body weight) have NAFLD. Likewise, more than a third of people with type 2 diabetes develop this form of liver disease. 

Doctors who specialize in the treatment of the liver (called hepatologists) recommend testing for NAFLD if you are overweight or have type 2 diabetes. This test is done through a simple blood test. 

Alcoholic liver disease

ALD is caused when the liver becomes damaged through the excessive consumption of ethanol, the substance in alcoholic beverages that makes you feel tipsy or drunk. After you drink an alcoholic beverage, it's broken down (metabolized) in your liver. This process turns alcohol into toxins, including a chemical called acetaldehyde, which must be processed and eliminated from your body. This process is bad for the liver because every time your liver filters alcohol, some liver cells die. Although a healthy liver can generate new cells, if you drink heavily over time, your liver can be permanently damaged.

Although everyone is different, in general, men who have more than 14 drinks per week and women who have more than seven drinks per week are considered “heavy drinkers” and are most at risk for ALD. According to the CDC, one alcoholic drink may be a 12-ounce beer, a five-ounce glass of wine, or a 1.5-ounce “shot” of liquor, such as vodka, tequila, or whiskey. 

It can take 10 or more years for ALD to progress from fatty liver disease to chronic liver failure. Symptoms often go undiagnosed until you begin experiencing advanced scarring (cirrhosis) of your liver and liver cells can't regrow. 

If you are a heavy drinker, experts recommend having specific blood tests that can determine if your liver is functioning normally. Other noninvasive tests may also be ordered, such as an ultrasound of your liver, to further evaluate its condition.

If you’re at risk for fatty liver disease

If you're overweight, have been diagnosed with type 2 diabetes, or regularly drink more alcoholic beverages than recommended, you may be at risk for fatty liver disease. Talking with your doctor is important because damage to your liver can be reversed — if it’s caught in the early stages. Unless you are under the care of a liver specialist, don’t assume that your doctor will screen you for liver disease. If you think you're at risk, it’s important to bring up your concerns and any symptoms you may be having.

Here are some key questions to get the conversation started with your doctor:

  • Could fatty liver disease be the cause of any of my recent health problems?
  • I’m concerned that I’m at risk. What tests can you run to find out if I have fatty liver disease?
  • What steps can I take to treat or reverse the damage of fatty liver disease? 
  • Beyond modifying my lifestyle and diet, are there treatments for fatty liver disease? 
  • Can my liver recover from fatty liver disease if I stop drinking and/or lose weight?
  • How can you monitor the progression or improvement of my fatty liver disease? 

On the surface, ALD and NAFLD may seem very similar, but the way each disease damages the liver can be distinct. Research shows that NAFLD may lead to greater fatty buildup in the liver than ALD. Inflammation and scarring are more common in ALD.   

In the early stages, you may have ALD or NAFLD and not have — or recognize — the symptoms. Since both conditions impact your liver in the same basic manner, the outward symptoms can be the same. Fatigue and belly pain may be the initial warning signs of both ALD and NAFLD. But if you have ALD you may have other symptoms sooner, such as: 

  • Nausea

  • Decreased appetite and weight loss

  • Small, red, spider-like veins on your skin

In later stages of both diseases, symptoms include: 

  • Yellowing skin (called jaundice)

  • Itchy skin 

  • Fluid buildup or swelling of the legs (called edema) and abdomen (ascites)

  • Gastrointestinal bleeding

  • Confusion

ALD and NAFLD don’t happen overnight. Over time, both of these liver diseases can get worse. There are four distinct stages of liver disease that researchers have identified.

Stage 1: Fat deposits build up in your liver typically with few outward symptoms. 

Stage 2: Inflammation of the liver is present. 

Stage 3: Inflammation causes scarring in your liver called fibrosis.

Stage 4: If this scar tissue continues to build up, your liver becomes less able to create healthy tissue and repair itself. Inflammation gets worse as blood flow and oxygen become limited by increased scar tissue build-up (called cirrhosis). 

 

Since these two liver diseases are very similar, it can be difficult for your doctor to make a diagnosis. There are various lab tests to evaluate the condition of your liver, which will provide clues. But one of the first ways your doctor will gather those clues is through taking your medical history. Specifically, you may be asked about your typical diet and alcohol intake. 

Your doctor may also perform a physical exam to determine if your liver or spleen is enlarged if your abdomen is swollen, if your skin is yellow (jaundice), or if you have spider veins. In men, excess breast tissue or small testicles could also be signs of ALD.

Finally, your doctor will likely order blood tests to see exactly how your liver is functioning. The results will provide important information about the health of your liver. Your doctor may also order an ultrasound, MRI, CT scan, or a Fibroscan to gain more information to make an accurate diagnosis. In advanced cases, a liver biopsy may also be done to determine how far the disease has advanced. 

ALD and NAFLD are serious health conditions. Being diagnosed with either one may leave you feeling upset or overwhelmed, but once you know why your liver is not functioning as it should, there are steps you can take to improve the health of your liver and your overall well-being. 

There is no specific therapy to magically improve the function of your liver. The primary treatment for ALD and NAFLD is the same: healthy lifestyle changes. 

In the treatment of ALD, the most important step is to stop drinking alcohol. Of course, that may not be as easy as it sounds. If you are among the estimated 400 million people age 15 and above who have an alcohol use disorder, stopping is often a process that requires professional help. You may also need to change other aspects of your lifestyle and create new healthy habits. If you are a heavy drinker, it’s important to talk with your doctor, since getting sober often requires medical supervision.

Beyond this important lifestyle change, depending upon your symptoms, your doctor may also recommend a low-sodium diet (to decrease water retention) or prescribe diuretics (medication that help remove water from the body).

Treatment of NAFLD is similar to ALD. Lifestyle change is key. If you are overweight, embracing a healthy diet that is low in fat and sodium, limiting alcohol consumption, and getting regular exercise will likely be your doctor’s recommendation. 

Maintaining a healthy weight through nutrition and exercise may help improve your liver function and improve your overall feeling of well-being. You may want to work with a nutritionist and a fitness coach to establish a monitored wellness program that yields the most successful results for you. Always talk with your doctor before starting a new nutrition and exercise plan. 

Depending on your diagnosis, your doctor may also prescribe medications to help you manage high blood pressure, high cholesterol, and diabetes. Always take medications as directed and inform your doctor of all treatments you are taking, including herbs, vitamins, supplements, and over-the-counter medications.  

When your liver can no longer perform its functions to nourish the body and get rid of toxins, you can have serious health problems. This is true for both ALD and NAFLD. The complications may include: 

  • Bleeding in your esophagus, stomach, or intestines

  • Behavioral changes

  • Confusion and general mental impairment

  • Blood flow issues

  • Infection

  • Liver cancer

Advanced-stage liver disease is called liver failure and may require a liver transplant if you meet specific requirements.

There are many ways to reduce your chances of getting NAFLD and ALD. The primary way to embrace a healthy diet and lifestyle. Experts recommend the following strategies to safeguard yourself against these forms of liver disease:

  • Maintain a healthy weight
  • Eat a low-fat healthy diet that features fresh fruits, vegetables, whole grains, and healthy fats
  • Avoid alcoholic beverages 
  • Exercise regularly and maintain an active lifestyle
  • Only take medications that you need and carefully follow dosing recommendations
  • Ask your doctor to perform annual blood tests that measure the health of your liver

If you are overweight, talk with your doctor before starting a new diet or exercise plan.

Non-alcohol fatty liver disease is the leading cause of liver disease worldwide. Although similar to alcoholic liver disease, it is typically caused by being overweight or having type 2 diabetes. Alcoholic liver disease is caused by drinking alcohol. If left unchecked, ALD and NAFLD can lead to liver failure. But if caught early, your liver can recover its function. Embracing a healthy lifestyle, eating nutritious food, staying active, as well as limiting or cutting out alcoholic beverages can prevent or even halt the progression of these liver diseases. Talk to your doctor if you have any concerns about your liver health. 

Can both alcohol-related liver disease and non-alcoholic fatty liver disease be reversed?

In their early stages, the damage to the liver from ALD and NAFLD can be reversed. For ALD, this typically means stopping drinking alcohol and generally embracing a lifestyle that includes a healthy diet and regular exercise. For NAFLD, reversal of the initial buildup of fat in the liver typically calls for losing excess weight through a healthy diet and exercise plan. Once ALD or NAFLD progresses to the point where liver cells can no longer grow back because of extensive scarring, the damage cannot be reversed. 

Can you drink alcohol if you have non-alcohol-related fatty liver?

Experts recommend that people who have been diagnosed with NAFLD stop drinking or greatly limit their intake of alcohol. 

How fast do ALD and NAFLD progress?

It typically takes many years, and a variety of factors can affect the progression.  For NAFLD it can take 30 years for simple fatty liver to form damaging scar tissue, while ALD may take only 10 years to progress from stage 1 to stage 4. 

Does everyone who drinks heavily get liver disease?

No, not everyone who drinks heavily will develop liver disease. Some experts think there may be genetic reasons why some heavy drinkers do not get liver disease, but there is no research to back that up. Heavy drinkers who have obesity, type 2 diabetes, a poor diet, or who already have another form of liver disease (such as hepatitis C), are thought to have a higher chance of developing ALD.