The liver condition metabolic dysfunction–associated steatohepatitis (MASH), which was once called nonalcoholic steatohepatitis (NASH), is not caused by alcohol use. But alcohol is directly toxic to the liver, and drinking can be a significant health hazard to people with MASH.
Alcohol can inflame the liver and cause additional fat buildup, which could make MASH worse and accelerate the progression to more severe forms of liver disease. Experts say that some people with MASH may safely drink small amounts, but it will depend on your health, the progression of your liver disease, and your diet and other lifestyle habits.
MASH occurs when fat builds up in your liver and causes inflammation. Several health problems contribute to MASH, including:
When your liver is already injured, adding alcohol adds trouble.
“Alcohol directly hurts liver cells, causing inflammation,” says Zhaoping Li, MD, PhD, professor of medicine and chief of the division of clinical nutrition at the University of California, Los Angeles. “If the liver is ‘on fire’ because of the excess fat, alcohol can add more fuel and make the fire worse.”
In addition, alcohol has little to no nutritional value and supplies extra calories.Alcohol contains 7 calories per gram (g), more than protein and carbohydrates, and nearly as much as a gram of fat. One alcoholic drink may contain anywhere from 100 to 250 calories or more.
“If the body doesn’t need more energy, it will convert excess calories to fat, which could also contribute to fatty liver,” Dr. Li says.
Alcohol and MASH With Fibrosis
Alcohol consumption is more dangerous with more severe levels of liver disease. MASH can cause liver scarring, known as fibrosis, which can eventually lead to cirrhosis and increase your risk of liver cancer.
“Unless you know the degree of fibrosis, then you really do not know what your current and future risks will be for the ultimate development of cirrhosis,” says Joe Galati, MD, founder of Liver Specialists of Texas in Houston and author of Eating Yourself Sick.
Your medical team can use a variety of tests to tell you what level of fibrosis you have, from stage 0 (lowest) to stage 4 (highest). In stage 0 or 1, limited alcohol intake may be okay, Dr. Galati says. Li adds that if you do drink, it’s wise to couple this with healthy lifestyle choices, such as daily physical activity, a balanced diet, and adequate sleep.
At higher stages of fibrosis, alcohol damage is even more of a concern.
“Personally, I’d tell [those] patients not to consume alcohol,” Galati says. “You want to preserve every liver cell you can.”
It is also possible to have MASH and alcoholic liver disease at the same time. This condition is called metabolic dysfunction and alcohol-associated/-related liver disease (MetALD).
If you have stage 2 or 3 liver fibrosis, you may be prescribed resmetirom (Reziffra) to reverse scarring. This drug may interact with alcohol.
“I’d completely avoid alcohol if taking these drugs,” Galati says. “At stages 2 and 3 of fibrosis, you are inherently at a higher risk of liver disease progression.”
Your healthcare provider also may prescribe GLP-1 medications like liraglutide (Saxenda, Victoza) semaglutide (Ozempic, Wegovy), and tirzepatide (Mounjaro, Zepbound) to reduce liver fat and inflammation. Alcohol may enhance these medications’ side effects, which may include nausea and diarrhea.
If you have diabetes in addition to MASH, you have more complications to worry about. Using alcohol with diabetes medications like insulin, sulfonylureas, or metformin also can cause side effects, such as dangerously low blood-sugar levels, nausea, and weakness.
Consult your healthcare provider or a pharmacist to ask about how your specific medications may interact with alcohol.
No. Galati says that the advice to avoid alcohol when you have MASH applies to beer, wine, distilled alcohol, hard lemonades and teas, seltzers, and so on.
Li adds that although wine and similar alcoholic drinks have compounds like resveratrol that may reduce inflammation, that does not make them safer for MASH. It’s still alcohol, and the added calories only worsen MASH. Although research previously said that regular, moderate alcohol consumption may be good for your heart or longevity, public health authorities increasingly say that no amount of alcohol is good for your health.
First, if you don’t drink alcohol, there is no reason to start drinking. If you do drink and are considering continuing after a MASH diagnosis, follow these guidelines on how to do so safely.
Speak to Your Doctor First If you have a liver condition like MASH, you shouldn’t drink a drop of alcohol until you confirm with your doctor that it is safe.
Consume Alcohol in Moderation Although moderate alcohol drinking is usually defined as one or fewer drinks per day for females, two or fewer for males, Galati says that these levels are likely too high for someone who has MASH. He recommends that women and men consume the equivalent of less than one standard drink per day.
Drink Alongside a Healthy Meal Eating a fatty steak, mashed potatoes, and a slice of chocolate cake is different than having a piece of fish with vegetables when you are drinking, Li says. Consider meals that are low in saturated fat and calories, which can help support cardiometabolic health and a healthy weight when you have MASH.
Consider Nonalcoholic Alternatives Nonalcoholic liquor, beer, and wine options are increasingly available, as are flavored carbonated waters and prebiotic and probiotic sodas. Check the added sugar and calorie counts to make sure they align with your goals.
Monitor Yourself for Reactions Your body may process alcohol differently. If you notice your MASH symptoms worsening with alcohol, or you experience side effects, consider discontinuing alcohol use and contacting your doctor.
Keep in mind that research increasingly shows that there is no safe level of alcohol, and not drinking is always the safest approach.
Although alcohol use does not directly cause MASH, drinking can inflame the liver and make your condition worse.
Ask your doctor if, based on your condition and overall health, you can drink alcohol when you have MASH.
