The Difference Between Alcoholic and Non-Alcoholic Fatty Liver Disease

I’m a former nurse and recovering alcoholic, and I also lost my father to alcoholic liver disease (ALD). I have been focusing my educational writing efforts on helping people better understand alcoholic liver disease, as it’s a very sneaky condition with horrible outcomes that often happen too late….CONTINUE READING

One concern that readers have been raising with me lately is understanding the difference between alcoholic and non-alcoholic fatty liver disease (NAFLD).

NAFLD refers to liver damage resulting from metabolic-related

issues such as diabetes, obesity, high cholesterol, and hyperlipidemia. ALD refers to liver damage due to the toxic effects of alcohol on liver cells and metabolic processes.

While these conditions are fairly similar, it’s important to know the key differences in their presentation and diagnosis. Mainly because the nature of alcoholism can really put a veil over this condition, making it even more dangerous and sneaky. I mean that NAFLD tends to be diagnosed and treated earlier, while ALD often goes under the radar.

The reason for this is obvious — most alcoholics hide their drinking

or don’t tell their doctors how much they actually drink. And without other clear metabolic indicators, doctors don’t often think to test someone’s liver. However, with NAFLD, the person will have metabolic issues (i.e., diabetes or high cholesterol), which often point toward potential liver damage.

In this way, doctors are more apt to promptly test the functioning of the liver to see what’s happening.

This means that the key difference between diagnosing these conditions is whether the doctor has clear evidence that will alert them to potential liver problems.

So while NAFLD is more likely to be diagnosed, ALD is not. That is, unless the patient divulges their drinking history. Nonetheless, ALD often begins and progresses to a dangerous level before a diagnosis is made, which is why ALD is highly fatal.

After reviewing the research, it seems that the major difference in presentation is that ALD usually has a malnutrition

component, whereas NAFLD presents with over-nutrition

(i.e., evidence of obesity, increased visceral fat, and other metabolic issues due to excessive food intake).

For those with ALD, alcohol often suppresses appetite , and over time, the toxic effects of alcohol make food intake more unpleasant .

Also, food intake often dampens the “high” of alcohol, especially for heavy drinkers whose nervous systems always develop ever-increasing tolerance levels. Lastly, heavy drinking reduces the ability to absorb several important nutrients

leading to malnutrition.

Below are some bullet points outlining other minor differences between ALD and NAFLD:

Now for the most important educational issue concerning NAFLD and ALD. Clear evidence shows that both conditions can often occur together

. And when they do, the potential damage to the liver often doubles. This means that if someone has metabolic risk factors like diabetes, high cholesterol, and obesity, they should be instructed to cut their alcohol intake or completely remove it altogether. And it should be known that for those with actual alcohol abuse issues, the risk of developing liver disease is quite high.

Indeed, one review

looking deeper into the co-occurrence of NAFLD and ALD says that “alcohol use is a significant risk factor for the progression of liver disease in these individuals, eventually impacting a mortality in those patients with NAFLD and MetS (metabolic syndrome).”

Given that NAFLD affects about 25–30% of adults worldwide , it should be standard practice to advise people not to drink alcohol if they suffer from risk factors that cause NAFLD. Likely some doctors do provide this important advice. However, this is not education that is widely known to the general public, and it should be.

Indeed, a 2020 review says that it’s imperative to improve the clinical understanding of liver disease in patients with both alcohol and metabolic issues, as it likely presents in higher numbers among these patients….CONTINUE READING