Alcohol and Liver Disease: Effects of Drinking May Surprise

Are moderate drinking of alcohol and liver disease linked? Drinking in moderation is not a risk factor for any liver disease. That is, it doesn’t increase the chance of getting any liver disease. On the other hand, drinking in moderation reduces the risk of non-alcoholic fatty liver disease.


          1. Liver Diseases
            1. NAFLD
            2. NASH
            3. Cancer
          2. Liver-Related Death
          3. Resources

I. Liver Diseases


Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the developed world. It effects about one-third of the total population of the US.

NAFLD is a major risk factor for cardiovascular disease. That’s the major cause of death in most countries around the world. And it’s also a major cause of hepatic dysfunction among children.

alcohol and liverAgain, the risk of NAFLD is lower among moderate drinkers.

NAFLD is the build up of too much fat in liver cells. When alcohol abuse doesn’t cause it, it’s non-alcoholic. The liver normally contains some fat. But, if more than five to ten percent of the liver’s weight is fat, it’s a fatty liver.

     Risk Factors

Some things increase the risk of NAFLD.

• Being overweight.
• Type 2 or adult-onset diabetes.
• Dangerous cholesterol levels.
• High triglycerides.
• Poor diet.
• Sleep apnea.
• Metabolic syndrome.
• Under active thyroid.
• Under active pituitary gland.
• Gastric bypass surgery.
• Polycystic ovary syndrome.

NAFLD usually has no signs. When it does, they may include fatigue, pain in the upper right of the abdomen, and unwanted rapid weight loss.

     Alcohol Protective

drinking in American lifeA team of researchers at the University of Buenos Aires analyzed the results of eight studies. Each study examined the consumption of alcohol and the risk of NAFLD. In total, the studies included 43,175 people in different countries.

The results?  Moderate drinkers had a 31% lower risk of NAFLD. That’s compared to alcohol abstainers.

Moderate drinkers also had a fifty percent lower risk of developing an advanced stage of NAFLD. That’s a very big large drop in risk.1

The take away message? Drinking in moderation greatly reduces the risk of non-alcoholic fatty liver disease.


Other researchers examined alcohol and liver disease. In this case, it was moderate drinking and non-alcoholic steatohepatitis (NASH).

That’s liver inflammation from a buildup of fat in the organ. The disease can get worse. When it does, it causes scarring of the liver (cirrhosis). NASH is a major form of non-alcoholic fatty liver disease.

     Alcohol Protective

alcohol and liverResearchers studied those in the US National Institute of Health’s NASH Clinical Research Network. They looked at  those who had non-alcoholic fatty liver disease. Then they compared lifelong non-drinkers to moderate drinkers. The risk of NASH dropped as the consumption of alcohol increased. It did so up to the highest levels of moderate consumption.

Moderate drinkers also had a much lower risk of having fibrosis. And also from ballooning hepatocellular injury than lifetime alcohol abstainers.2

     Drinking Frequently is Helpful

Frequent and moderate drinking reduces the risk of fatty liver disease. For example, a large study of men in Japan found this. This finding is consistent with other research.3

It’s logical that frequent drinking would be especially helpful. For example, the effects of an aspirin wear off as the body metabolizes it. Similarly, the beneficial effects of alcohol wear off because of metabolism.

     Relative Risks

alcohol and healthIt is important to know relative risks. People with either NAFLD or NASH are much more likely to die of cardiovascular disease (CVD) than of liver disease. And moderate drinking reduces the risk of death from CVD by almost half.

C. Liver Cancer

Drinking alcohol in moderation is not a risk factor for liver cancer.4 But alcohol abuse over a period of many years is one of the causes of alcohol cirrhosis.5 Others are hepatitis B and hepatitis C virus.6 It is the liver cirrhosis itself that is one of the risk factors for liver cancer.7

The usual setting is an individual with alcoholic cirrhosis who has stopped drinking for ten years, and then develops liver cancer. It is somewhat unusual for an actively drinking alcoholic to develop liver cancer. What happens is that when the drinking is stopped, the liver cells try to heal by regenerating (reproducing). It is during this active regeneration that a cancer-producing genetic change (mutation) can occur. This explains the occurrence of liver cancer after the drinking has been stopped.8

Drinking alcohol in moderation is not a risk factor for liver cancer. On the other hand, the moderate drinking is linked with better health and longer life. That’s compared to either abstaining from alcohol or abusing it.

     Damaged Livers

Dr. Gerald Minuk is head of the University of Manitoba Liver Diseases Group. He found in animal studies that moderate drinking helps heal damaged livers. Yet both heavy consumption and lack of alcohol hinder liver healing.9

     Coffee Reduces the Risk of Liver Cirrhosis

Researchers made a study of 125,580 people for 24 years. They found that drinking one cup of coffee per day cut the risk of cirrhosis by one-fifth. Drinking four cups per day reduced the risk by 80%. This relationship held for both men and women of different racial groups.10

alcohol and liverThese findings build on earlier research reporting that drinking coffee reduces the risk of liver cancer. Cirrhosis is the major cause of liver cancer.

Cirrhosis from all causes, including Hepatitis C and some inherited diseases, causes over 27,000 deaths annually in the US. And it also causes nearly 400,000 hospital admissions.

Drinking coffee reduces the risk of alcoholic cirrhosis. But drinking alcohol in moderation or abstaining are better ways.

II. Liver-Related Death

Many people think that heavy drinkers usually die as a result of liver disease. But researchers conducted a study for 18 years in The Netherlands. They used those in the well known Rotterdam Study. The researchers found that only one percent (1%) died because of liver related causes.

The analyses adjusted for age, gender, high blood pressure, cholesterol, body mass index (BMI), diabetes, smoking, and education level.

Compared to abstainers, light and moderate drinkers had and average 15% reduced risk of death. Heavy drinkers had a 5% lower risk of death during the 18 years. But such drinking is not good for many reasons.11

III. Resources on Alcohol and Liver Disease

Popular Books
    1. Sookoian, S., et al.  Modest alcohol consumption decreases risk of non-alcoholic fatty liver disease. Gut, 63(3), 530-532.
    2. Dunn, W., et al. Modest alcohol intake and less inflammation among patients with non-alcoholic fatty liver disease (NAFLD). J Hepat, 57(2), 384–391.
    3. Hiramine, Y., et al. Alcohol drinking patterns and the risk of fatty liver in Japanese men. J Gastro, 46, 519–528.
    4. Liver Cancer Risk Factors and Prevention (Am Soc Clin Oncol)
    5. Risk Factors for Liver Cancer (Am Cancer Soc).
    6. Liver Cancer Risk Factors (Mayo Clin).
    7. Cancer of the Liver. Causes and Risk Factors (
    8. Liver Cancer. (
    9. Finkel, H. Drink a little, eat a little, and nurture your liver. AIM Digest, 10(3), 8.
    10. Klatsky, A. et al. Coffee, cirrhosis, and enzymes. Arch Int Med, 166, 1190-1195.
    11. Am Assn Study Liver Dis. Liver disease, cancer and cardiovascular disease as a cause of death in heavy drinking. AIM Digest, p. 3.
    • This site gives no advice. Please see your doctor with alcohol and liver questions.