Can You Drink Alcohol When You Have MASH?

Note: While research on alcohol is evolving, the World Health Organization says drinking less or not at all is better for your health.

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.

• Being overweight
• Type 2 diabetes
• High cholesterol
• Elevated levels of triglycerides, a type of fat
• High blood pressure
• Insulin resistance

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.”

“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

“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.”

“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.”

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.

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.

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  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.

• 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.
• Not drinking alcohol is always the safest option.