Nonalcoholic Fatty Liver Disease: Causes, Symptoms and Treatment

It’s well-known that alcohol can damage our liver, but in the case of nonalcoholic fatty liver disease (NAFLD), the consequences seem less clear. Just like how we shouldn’t judge a book by its cover, we shouldn’t see the word “nonalcoholic” and assume that alcohol doesn’t affect NAFLD. 

To determine where alcohol fits into nonalcoholic fatty liver disease, let’s first understand what it is and what can cause it. We’ll then get into effective strategies to manage NAFLD or prevent it from developing. Let’s filter out common misconceptions to better understand NAFLD.

What Is Nonalcoholic Fatty Liver Disease (NAFLD)?

Non-alcoholic fatty liver disease, NAFLD for short, is a buildup of fat that can affect normal functioning of our liver. As the name suggests, NAFLD is not caused by excessive consumption of alcohol. Although, excessive drinking can increase the risk of developing NAFLD (more on that later!).

NAFLD is broken up into four different stages, distinguished by severity:

• Simple fatty liver (steatosis). The first stage of NAFLD is steatosis, which is a buildup of fat in the liver. Steatosis doesn’t always show symptoms; in fact, it’s usually only detected by liver function tests or other imaging.
• Non-alcoholic steatohepatitis (NASH). The next stage of NAFLD is NASH, which is characterized by inflammation of the liver. This stage isn’t commonly associated with severe or visible symptoms either. 
• Fibrosis. Fibrosis occurs when inflammation causes scar tissue to form around the liver and its surrounding blood vessels. This stage affects the functioning of the liver and is commonly accompanied by unpleasant side effects.
• Cirrhosis. This is the most severe stage of NAFLD. During cirrhosis, the liver shrinks from severe scarring, which leads to liver failure and liver cancer.

Nonalcoholic fatty liver disease is distinguished from alcohol-related liver disease because it’s not primarily caused by alcohol consumption. So what causes NAFLD?

Risk Factors for Nonalcoholic Fatty Liver Disease

NAFLD develops for many reasons; however, some of us may be more prone to developing it. Several risk factors can lead to the development of NAFLD:

• Obesity. Excess body fat can increase the chance of fat buildup in our liver. 
• Type 2 diabetes. NAFLD and type 2 diabetes are common co-occurring conditions. Type 2 diabetes is marked by insulin resistance, which increases the risk of fat accumulation. 
• High cholesterol. Cholesterol is a fatty substance that can overload our liver. High cholesterol can aggravate NAFLD by contributing to liver scarring and immune cell dysfunction. 
• High blood pressure. Hypertension is associated with many factors that contribute to NAFLD. These include insulin resistance, obesity, raised liver enzymes, and more.
• Prediabetes. Prediabetes is also marked by decreased insulin sensitivity. This can impact our ability to maintain a healthy body weight and ability to lose excess body fat.
• High triglycerides. Triglycerides are a type of fat in our blood that contributes to hardening or thickening of our artery walls. High triglycerides create an imbalance between lipid uptake and removal — contributing to liver damage. 
• Bowel disease. Systemic inflammation associated with irritable bowel disease is linked to an increased risk of developing NAFLD. 
• Poor diet. An unhealthy diet puts us at greater risk of gaining excess weight — leading to a buildup of fat in our liver.
• Certain medications. Since our liver processes drugs, certain medications and drug misuse may increase the risk of developing NAFLD. 

While some of us may be at a higher risk of developing NAFLD, it can affect any of us. NAFLD can also affect us differently. Let’s take a look at common symptoms associated with NAFLD.

Symptoms of Nonalcoholic Fatty Liver Disease

Symptoms of NAFLD can vary depending on the person and development of the disease. Less severe stages of NAFLD may not have any visible symptoms but can include weakness or pain in the upper right abdomen. More severe stages of NAFLD significantly impact liver function and may include the following symptoms:

• Fatigue
• Loss of appetite
• Nausea or vomiting
• Jaundice
• Intense itching
• Fluid buildup in the legs/abdomen
• GI bleeding
• Mental confusion 

Liver scarring and dysfunction from NAFLD manifests in a variety of symptoms. Does alcohol-related liver disease manifest in the same way?

Comparing Nonalcoholic Fatty Liver Disease and Alcohol-Related Liver Disease

NAFLD and alcohol-related liver disease (ALD) are similar in many ways. Both conditions are caused by a buildup of fat in the liver and both have comparable stages of progression. While similar, NAFLD and ALD are distinctive. 

Unlike NAFLD, ALD is directly caused by excessive alcohol consumption. A study published in the World Journal of Gastoenterology explains the clinical differences between NAFLD and ALD:

• Fatty degeneration of liver cells is more severe in NAFLD than in ALD. 
• Inflammatory cell infiltration occurs to a greater degree in ALD than in NAFLD.
• Perivenular fibrosis (fat buildup around hepatic veins), phlebosclerosis (hardening of the walls of our veins), and lymphocytic phlebitis (inflammation of the veins) are more common in ALD.

Since the differences are subtle, the conditions are mostly distinguishable by their primary causes — ALD is directly related to alcohol, and NAFLD isn’t. That being said, is it a good idea to drink alcohol with NAFLD?

Can You Drink Alcohol With Nonalcoholic Fatty Liver Disease?

While alcohol isn’t the direct cause of NAFLD, it’s not recommended to drink when diagnosed with the condition. Alcohol can further harm our liver and lead to more disease.

A 2020 study reviewing the effects of moderate drinking on NAFLD, noted that although previous studies showed varied results, concerns for an increase in mortality make it questionable whether even moderate consumption of alcohol is safe for patients with NAFLD. Similarly, a systematic review found that any level of alcohol may be harmful to liver health — negatively impacting NAFLD. 

Alcohol may have a negative influence on NAFLD, but will quitting or cutting back on alcohol be beneficial?

Benefits of Avoiding Alcohol on Fatty Liver Disease

Since NAFLD is not directly caused by alcohol, quitting or cutting back is only a small piece of the solution. There is currently no cure for NAFLD, so management is crucial. Some benefits of quitting or cutting back on alcohol include the following effects: 

• Reduce liver inflammation. Since alcohol causes liver inflammation, cutting back on alcohol can directly reduce inflammation and the progression of NAFLD. 
• Prevent additional liver damage. NAFLD makes our liver highly susceptible to damage from toxic substances like alcohol. By cutting back on alcohol, we can prevent further damage. 
• Improve metabolic health. Metabolic conditions including obesity, metabolic syndrome, and insulin resistance are closely linked with NAFLD. Cutting back on alcohol helps to improve our metabolic health — reducing the progression or risk of NAFLD.
• Overall liver health. By cutting back on alcohol, we can limit additional stress on our liver. With other healthy lifestyle changes, we can reduce fat buildup and inflammation — improving overall liver function.

Avoiding toxic substances such as alcohol is an integral aspect of treating NAFLD, but let’s explore some additional treatment options.

Treatment for Nonalcoholic Fatty Liver Disease

Everyone has certain expectations when it comes to different types Although there’s no specific cure or medication for NAFLD, treatment for associated conditions such as diabetes, high cholesterol, and high blood pressure may be explored to help reduce progression. In severe cases of liver failure, a liver transplant may be needed. 

While medication can treat co-occurring or associated conditions, the most common treatment for NAFLD is making healthy lifestyle changes: 

• Maintain a healthy diet. A balanced diet improves our overall systemic function and prevents excess fat buildup. 
• Choose water over sugary drinks. Calories from sugary drinks can quickly add up — increasing our blood sugar and increasing the risk of excess weight gain.
• Exercise regularly. An active lifestyle helps to diminish markers such as high blood pressure, high cholesterol, and excess weight, which are all risk factors for NAFLD. 
• Reduce toxic substances. Toxic substances such as alcohol and tobacco can damage our liver. By limiting these harmful substances, we set ourselves up for the best chance of limiting and reversing the progression of NAFLD.

Healthy lifestyle choices also help prevent NAFLD or minimize the progression of the condition.

Preventing Fatty Liver Disease

Early intervention through lifestyle choices is the most effective way to prevent or reverse fat buildup in our liver. Similar to how we can manage NAFLD, we can prevent disease or dysfunction by practicing healthy lifestyle choices:

• Maintain a healthy weight. Excess weight can contribute to many risk factors that lead to NAFLD. We can lower the risk of NAFLD by maintaining a healthy weight through proper nutrition and regular exercise.
• Adhere to a healthy diet. A liver-friendly balanced diet of complex carbohydrates, healthy fats, and lean proteins helps our body function optimally and prevents excess body fat. Limiting high-sugar and high-fat food and drinks minimizes the risk factors of NAFLD.
• Stay active. Frequent activity throughout the day helps us maintain a healthy body weight. If you don’t enjoy hitting the gym and lifting weights, consider other activities like gardening, cleaning, sports, walking, etc. You’re more likely to be consistent if you do something you enjoy. The National Health Service (NHS) recommends aiming for at least 150 minutes a week of moderate-intensity movement. 
• Use medication properly. According to the American College of Gastroenterology, drugs such as common OTC pain medications and cholesterol-reducing medications can increase the risk of liver injury. It’s important to limit the use of OTC medications and consult with a doctor regarding personal recommendations.
• Limit alcohol consumption. Alcohol puts a significant damper on our liver health. Reduce the stress on your liver by reducing alcohol intake. Strategies such as tracking consumption, setting limits, and finding alternatives can help you quit or cut back on alcohol.

Although alcohol may not directly cause NAFLD, quitting or cutting back on alcohol is a part of maintaining a healthy liver and improving our overall well-being.

All Things Considered

Though nonalcoholic fatty liver disease is distinguished by not being alcohol-associated, alcohol plays a significant role. Drinking alcohol can contribute to the risk of developing NAFLD and increasing the progression of the condition. Adding alcohol to NAFLD is like adding fuel to a fire. Since lifestyle changes are crucial to limiting and reversing the progression of NAFLD, quitting or cutting back on alcohol can help manage and prevent the condition and give your liver its best chance for a long, healthy life.