But you can get fatty liver disease, even if you don’t drink a lot of alcohol.
Alcohol-Related Fatty Liver Disease
You might hear this called “ALD.”
Some people don’t have any symptoms. But if your liver becomes enlarged, you may develop pain or discomfort on the upper right side of your belly.
ALD is preventable. It usually gets better when you stop drinking alcohol.
If you keep drinking, ALD can cause serious problems. These include:
Alcoholic cirrhosis. This is a buildup of scar tissue in your liver. It can cause the same symptoms as alcoholic hepatitis plus:
- High blood pressure in the liver
- Bleeding in your body
- Confusion and changes in behavior
- Enlarged spleen
- Liver failure, which can be fatal
Fatty liver disease usually comes first. It can then get worse and becomes alcoholic hepatitis. Over time, it may turn into alcoholic cirrhosis.
If you drink heavily, talk with your doctor. It’s confidential, and it can help you get your drinking under control to save your health.
Nonalcoholic Fatty Liver Disease (NAFLD)
Like the name says, alcohol isn’t involved in this condition. There are different types of NAFLD.
Simple fatty liver means you have fat in your liver, but you may not have any inflammation in your liver or damage to your liver cells. It usually doesn’t get worse or cause problems with your liver. Most people with NAFLD have simple fatty liver.
Non-alcoholic steatohepatitis (NASH) is another type. It’s much worse than simple fatty liver. NASH means you have inflammation in your liver. You may also have damage to your liver cells. The inflammation and liver cell damage that happen with NASH can cause serious problems such as:
- Fibrosis: scarring of the liver
- Cirrhosis: lots of scarring in the liver, which can lead to liver failure and death
- Liver cancer
About 20% of people with NAFLD have NASH.
For ALD, the cause is too much alcohol. You may be even more likely to get it if you drink a lot and
NAFLD is more likely if:
- You’re overweight or obese
- Your body doesn’t respond to insulin as it should (called insulin resistance)
- You have high levels of triglycerides or “bad” (LDL) cholesterol, or low levels of “good” (HDL) cholesterol
- You have type 2 diabetes
- You have metabolic syndrome. This is a mix of conditions that make you more likely to get type 2 diabetes and heart disease.
With metabolic syndrome, you may have any three of these conditions:
- Large waist size
- High triglycerides
- Low levels of HDL (good) cholesterol
- High blood pressure
- High blood sugar levels
NAFLD may also be due to certain genes that make the condition more likely.
The reason why some people with NAFLD have simple fatty liver and others develop NASH isn’t known. It’s possible that genes may be a reason. You may be more likely to have NASH if you:
- Are obese
- Have high blood pressure
- Have high triglycerides or abnormal cholesterol levels
- Have type 2 diabetes
- Have metabolic syndrome
There are also some less common reasons why you may develop NAFLD or NASH. They include:
- Medical conditions that affect how your body uses or stores fat
- Hepatitis C or other infections
- Fast weight loss
- Taking certain medicines such as glucocorticoids, methotrexate (Rheumatrex, Trexall), synthetic estrogen, tamoxifen (Nolvadex, Soltamox), and others
- Gallbladder removal. Some people who have surgery to remove their gallbladder are more likely to have NAFLD.
With ALD and NAFLD, there are usually no symptoms. Some people may develop signs such as tiredness or pain in the upper right side of the abdomen where your liver is located.
If you have NASH or develop cirrhosis, you may have symptoms such as:
Your doctor may use different tests to find out if you have fatty liver disease. There’s no test that can show whether the fat in your liver is due to alcohol or not, so your doctor will ask about your alcohol use. This information can help your doctor tell if you have ALD or NAFLD.
Some of the tests your doctor may use to diagnose fatty liver disease are:
Blood tests. These can show if you have high levels of liver enzymes such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). If so, there could be a problem with your liver.
Imaging tests. You may get ultrasound, computerized tomography (CT) scans, or magnetic resonance imaging (MRI). These tests can help show if there’s any fat in your liver. But they can’t tell whether you have simple fatty liver or NASH.
Liver biopsy. A doctor removes a sample of tissue from your liver and sends it to a lab to see if you have liver inflammation or damage. You’ll get this done at a hospital or outpatient surgery center. Before the procedure, you’ll get medicine to help you relax or control pain.
For the biopsy, your doctor numbs the area and uses a special needle to take a small piece of tissue from your liver. A liver biopsy is the only way for doctors to diagnose NASH.
Not everyone with NAFLD needs to have a liver biopsy. Your doctor may recommend a liver biopsy if you’re at risk for NASH or if other tests show that you may have NASH complications such as cirrhosis.
If you have ALD, the best thing you can do is quit drinking. It’s the only way you can keep liver damage from getting worse. You may even be able to undo some of the liver damage that’s already happened. Talk to your doctor about how you can get help. You may need a medically supervised detox program to safely quit drinking and manage withdrawal symptoms.
For NAFLD, weight loss is one of the best treatments. Weight loss helps reduce fat, inflammation, and scarring in your liver. Losing just 3% to 5% of your body weight can cut down on how much fat is in your liver.
No medications are approved to treat NAFLD.
If you have complications due to NASH, such as cirrhosis or liver failure, you may need to have a liver transplant. In general, people with NASH who get a liver transplant do very well.