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Fatty liver disease (FLD) is a condition whereby fat builds up in the liver. FLD can either be alcoholic or non-alcoholic. As the name suggests, non-alcoholic fatty liver disease (NAFLD) isn’t caused by heavy alcohol use. The condition doesn’t cause liver cell damage or serious inflammation. However, it results in fat build up in the liver.
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Alcoholic fatty liver disease (or alcoholic steatohepatitis) is caused by excessive alcohol consumption over prolonged periods. The risk of suffering from alcoholic steatohepatitis is highest among heavy drinkers.
Obese women are the most susceptible to the condition. The condition also affects individuals with certain genetic mutations.
Alcoholic FLD exhibits little to no symptoms. It may be accompanied by some tiredness or aches experienced in the abdomen (upper right side). Severe cases result in alcoholic hepatitis and liver cirrhosis.
Heavy drinkers who develop symptoms start experiencing them in their 30s/40s. Severe problems develop a decade or more after the initial symptoms. As alcoholic FLD progresses, symptoms range from fever and jaundice to tiredness and an enlarged, tender and painful liver.
Other symptoms include tightening palms that cause the fingers to curl, and muscles to waste away. Pancreatitis and nutritional deficiencies leading to many other health problems can also occur.
As with any progressive condition, there are different stages of liver disease. This depends on the amount of alcohol one has consumed, and for how long they have been abusing it. Below we describe the stages:
This liver disease is asymptomatic in the initial stage. Mild symptoms are depicted as gastrointestinal problems. If a person quits drinking, he/she can recover fully from FLD.
Alcoholic hepatitis is caused by liver inflammation. If a person continues drinking it can cause severe liver damage and death. Alcoholic hepatitis means scar tissue in the liver, which interferes with blood flow and detoxification, resulting in kidney problems, among other related issues.
Liver cirrhosis is characterised by irreversible liver scarring, which eventually results in liver failure. Liver cirrhosis symptoms appear at an advanced stage. While quitting alcohol can help i.e., increase the life expectancy of a person, a liver transplant is inevitable to save cirrhosis patients.
Although the liver is the main detoxification organ in the body, and it is capable of regenerating, excessive alcohol consumption hinders its work and inflicts damage. Excessive consumption of alcohol regularly causes fat build-up, given alcohol damages the liver on a cellular level.
Mitochondria damage in the liver compromises the liver’s ability to breakdown fat, which causes triglycerides and lipid molecules to start accumulating. This marks the onset of fatty liver disease.
Yes. The initial stage of alcohol-related FLD is reversible. You just need to quit drinking for two or more weeks to allow your liver enough time to recover and breakdown fat deposits.
If you can’t stop drinking alcohol, drink 14 units of alcohol weekly or less, not more than 3 days consecutively. Moderate drinking, coupled with alcohol-free days, will allow the liver enough time to recover.
If you quit alcohol early enough, you can reverse the effects of alcoholic FLD. While healing may begin days after quitting alcohol, effects such as liver damage will take several months to reverse. In some cases, long-term effects may be irreversible.
Susceptibility to FLD is dictated by many things. The first critical factor is the quantity of alcohol consumed. In America, one standard drink is 14g, which is 5 Fl oz of wine, 1.5 Fl oz of hard liquor, or 12 Fl oz of beer. 
If you consume 6 beers daily with an average alcohol content of 5%, this translates to 84g of alcohol, which is excessive after years of drinking for men. Women who drink 20g of alcohol daily increase their risk of getting fibrosis and hepatitis by 47% and 7%, respectively. 
The drinking pattern is another risk factor. Drinking during meal times is less risky. Drinking outside this period increases the risk of ALD threefold. 
Gender is another factor with women at higher risk (twice as susceptible) to ALD than men, even with a shorter drinking duration and doses of alcohol. Fat absorption changes caused by the menstrual cycle may be to blame. Some infections i.e., hepatitis C that accelerates liver injury, are also notable risk factors. 
Fatty liver disease also has a genetic component. Predisposition to alcoholism, iron overload, and malnutrition are other notable risk factors.
Alcoholic fatty liver disease is challenging to diagnose since most people don’t exhibit symptoms. However, doctors are still able to diagnose using a person’s health history combined with a physical exam, blood tests, imaging tests, and a liver biopsy.
When using a person’s health history as a basis for diagnosis, doctors look for nutritional information, current medication, and past/existing health conditions.
Physical exams check for jaundice, enlarged liver, and other signs of liver issues. Blood tests that show high levels of ALT and AST (liver enzymes) are an indication of liver problems. Imaging tests such as ultrasound and magnetic resonance imaging detect fat in the liver. A liver biopsy (which is rarely done) reveals liver complications like cirrhosis.
Alcohol-related liver disease or ARLD can result in several serious complications like:
Liver cirrhosis causes portal hypertension. The complication occurs when blood pressure increases to potentially serious levels. When the liver is scarred severely, blood can’t circulate effectively, resulting in increased blood pressure around the intestines.
When the pressure becomes unbearable, it causes the varices walls to split and start bleeding. Prolonged bleeding can cause other problems like anaemia.
Hypertension can cause fluid build-up in the abdomen, a condition referred to as ascites. While ascites can be treated using diuretics, the problem may require paracentesis – a procedure that drains fluid build-up using a long thin tube under the skin. Ascites can cause serious complications such as spontaneous bacterial peritonitis linked to kidney failure and death.
When the liver can’t perform its detoxification functions, the level of toxins in the body increases sharply, causing hepatic encephalopathy. This condition has symptoms like confusion, disorientation, agitations, muscle tremors, speech difficulties, muscle stiffness, and coma (in severe cases).
Heavy drinking over many years can cause liver damage that increases susceptibility to liver cancer. In fact, liver cancer rates in the UK have increased sharply because of increasing alcohol misuse. 
You should see a specialist and go through the above diagnosis methods to establish if you have the disease. A specialist scan (fibro scan) can be done to assess your susceptibility to FLD.
Once diagnosed, your doctor should refer you to specialists to offer the required treatment. If you can’t stop drinking on your own, you may require rehab treatment with detox to flush out toxins and therapy like cognitive behavioural therapy to help you deal with the underlying causes of alcohol addiction.
As discussed above, abstinence can reverse fatty liver disease in its early stages. If abstinence isn’t possible, reducing alcohol consumption can still help. Two drinks and one drink daily for men and women respectively can give the liver some much needed time to recover.
Lifestyle changes like maintaining a healthy diet can reverse alcohol-related liver disease related to malnutrition.
You may be required to use supplements or seek the assistance of a nutritionist if you can’t get adequate amounts of nutrients in your diet. Exercising regularly is also important for reducing fat levels in the liver.
Vaccination is also recommended to reduce susceptibility to FLD. Medication is also important when treating related conditions like alcoholic hepatitis.
In such instances, medication can reduce liver inflammation. If rehab is required, benzodiazepines can be used to eliminate withdrawal symptoms experienced by individuals who quit alcohol.
Fatty liver disease is a serious condition when left untreated. If you consume alcohol frequently, you are at risk. If you suspect you have the condition or are susceptible to it, you should see a doctor.
Here are some examples of questions you can ask:
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