How alcohol contributes to MASH and other types of liver disease

Summers in Utah, where I grew up, meant hot days spent boating and swimming in lakes. For my friends and me, they also meant drinking more alcohol than was ever good for us.

By the time I left Utah, however, I had resolved never to allow any substance, including alcohol, to cloud my judgment or damage my health. That changed many years later, after my divorce in Maryland.

Alcohol had never played much of a role in my life until my 30s. When I became single again, I bleached my hair a convincing shade of blond, saw live music whenever I wanted, and started drinking more. I was trying to repair a life that had not gone according to plan. Being social seemed like the answer, and alcohol made me feel more comfortable in my own skin.

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For a while, it was fun. Then it started to feel more like self-medication. Booze was a necessary ingredient for a good time, and I began to notice occasional sharp pains on my right side after drinking fancy cocktails.

I got scared.

After a visit to my doctor, I learned that my fatty liver disease had progressed to metabolic dysfunction-associated steatohepatitis, or MASH. My doctor warned me that alcohol was not helping and urged me to consider quitting. It took a little time, but eventually I did.

It was not a brave act. I simply did not want to get any sicker.

Then I did.

Not long after I stopped drinking, I developed symptoms I had never experienced before. I regularly felt nauseated. My skin was dry. My eyes began to take on a slightly yellow cast. Nearly two years passed before I learned that I had MASH and cirrhosis, a terrifying degree of liver scarring.

I was grateful alcohol was no longer adding to the damage, because I needed all the help I could get.

To be fair, I had not changed my diet. I behaved a little like someone who orders a diet soda with a cheeseburger and fries and thinks, “Well, at least I skipped the sugary drink.”

Giving up alcohol mattered, but it was not a magic trapdoor out of liver disease. I was still consuming plenty of foods that worked against my metabolic health: candy, sugary soda, rich desserts, and fried foods. Alcohol did not need to carry my liver across the finish line by itself. It had a group of misfit friends hanging out by the dumpster on their smoke break, waiting to beat up nerdy livers like mine.

I am still glad I stopped drinking. I do not miss it, although I understand why some people would. Alcohol can feel like social lubrication for the shy, a pain reliever for people in distress, or a temporary eraser when life becomes too difficult to stare at directly.

But it is a lousy friend to your liver.

The risks of alcohol

The Cleveland Clinic advises people with MASH not to drink alcohol at all, calling it “adding fuel to the fire.” The risks do not end with liver disease. The U.S. Centers for Disease Control and Prevention says all alcoholic drinks increase the risk of developing several types of cancer, including breast cancer in women. The National Cancer Institute also notes that even light drinking can increase the risk of certain cancers.

Alcohol use can also change how a person’s liver disease is classified. In 2023, liver experts introduced the term MetALD for people who have metabolic dysfunction-associated steatotic liver disease (MASLD) and consume higher amounts of alcohol. It is not simply a more advanced stage of MASH. It is a reminder that metabolic risk factors and alcohol can overlap, with damaging results. Recent research has also linked episodic heavy drinking in people with MASLD to higher odds of advanced liver scarring.

I hate to be a killjoy, but it may be time to reevaluate your relationship with alcohol. If you drink heavily or think you may be dependent on alcohol, do not quit abruptly without talking to a medical professional. Withdrawal can be dangerous.

There are plenty of reasons to try an alcohol-free life. I would argue that your life is the best reason of all.

Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.