Different Stages of alcohol-related liver disease
Alcohol-related liver disease can be broken down into stages. Addressing the condition early may prevent it progressing and possibly leading to a liver transplant or death.
The first stage is a result of a build-up of fat in your liver. When alcohol is metabolised it results in overproduction of fat in the liver. A healthy liver should have little or no fat but if you drink more than your liver can cope with, fat can build up, leading to fatty liver disease.
If you have a fatty liver, and don’t stop or reduce your intake of alcohol, you are at a high risk of developing alcohol-related hepatitis. This is a condition where your liver becomes inflamed, swollen and tender. Alcohol-related hepatitis can occur at an early stage or after many years of harmful drinking.
The final and irreversible stage of alcohol-related liver disease is cirrhosis. This is usually the result of long-term, continuous damage to the liver. Irregular bumps, known as nodules, replace the smooth liver tissue and the liver becomes stiffer due to the accumulation of scar tissue. As a result, the shape of the liver becomes distorted. This can lead to complete liver failure as there are too few cells left to carry out normal liver functions.
About one in 10 people who drink harmful amounts will develop cirrhosis.
Is it possible to stop my alcohol-related liver disease getting worse?
The first stage of alcohol-related liver disease, alcohol-related fatty liver disease, is reversible.
Stopping drinking alcohol completely for two weeks gives the liver time to recover, reduce fatty deposits and stop the inflammation. If, after this, you do continue to drink alcohol, try to stick to the Government guidelines, which advise that both men and women should drink no more than 14 units a week, spread over several days, with two or three consecutive alcohol-free days to give the liver a
chance to recover.
If you have a more serious form of alcohol-related liver disease, such as alcohol-related hepatitis or cirrhosis, stopping drinking completely (lifelong abstinence) is the only way to prevent liver damage getting worse and progressing to liver failure and loss of life.
Alcohol provides 7 kcal/g, meaning that a bottle of spirit can provide 1,500
kcals. There is different advice on diet and nutrition depending on your weight and whether you are malnourished.
If you have been regularly consuming very large amounts of alcohol you may be advised to follow a high-protein, high-calorie diet to compensate for the energy lost when you stop drinking alcohol. You will also need to be given a high dose of thiamine (vitamin B1) as you will be prone to thiamine deficiency. Unless corrected, this can lead to the development of the Wernicke-Korsakoff syndrome, which has devastating effects on neurological and memory function.
Some people with alcohol-related liver damage may neglect their diet or eat a very unbalanced diet. As a result, they may lose weight and become malnourished. If this is the case, you will be advised to follow a well balanced diet and may be given multivitamin supplements. Find out more about eating a well balanced diet here.
Some people with alcohol-related liver disease are overweight, as they continue to eat as normal whilst also drinking large amounts of alcohol. If this is the case, you will usually be advised to eat a calorie-restricted, high-protein diet, and should also receive multivitamin supplements.
Approximately 15-20% of people drinking excessively will develop cirrhosis, and should follow the advice to eat a high protein and high calorie diet. Read more about diet and cirrhosis here.
What should I do next?
If you have alcohol-related fatty liver disease, your GP should now assess you to see how likely it is you have fibrosis or cirrhosis using a blood test score. In some cases, you may also be given a specialist scan (for example, a fibroscan). If this indicates a low risk, you should receive advice on your lifestyle as above and be re-checked for risk of fibrosis every three-five years.
If you are diagnosed with advanced alcohol-related liver disease, your GP should now refer you to a specialist team. This should either be a gastroenterologist (a doctor who specialises in diseases relating to the digestive tract with a liver specialism) or a hepatologist (a doctor who specialises in liver disease). They will be able to assess further the extent of the damage to the liver and decide on the best way to treat it.
If you need help to stay in control around alcohol, or stop drinking altogether, see your doctor, who can advise on local support groups, types of therapy that can help (such as cognitive behavioural therapy, or CBT) and managing withdrawal symptoms. If you have drunk a lot of alcohol over a long period of time, you may need medical assistance to help your body cope without alcohol to start with.
If you are in the early stages of alcohol-related liver disease, as well as stopping drinking, you may be advised to book regular appointments with your doctor so they can check your liver function and keep an eye on any new symptoms that may develop.
Please visit the support section of our website for information on Support groups in your area.
Call our helpline or visit our online forum.Visit
Where to find support if you are worried or have been diagnosed with ARLD?
A diagnosis of any kind of liver disease can be worrying and you may have a lot of questions.
Talk to your doctor about anything you don’t understand. You can also call the British Liver Trust’s
helpline on 0800 652 7330 to speak with a liver nurse specialist. Alternatively, email us at
Where to find support if you need help to stop drinking alcohol?
Cutting down on drinking alcohol, or stopping drinking altogether, can be very difficult and a lot of people need help with this – as many as 70% of people with alcohol-related liver disease are alcohol-dependent. Ask your doctor about alcohol services in your area, and remember that support groups such as Alcoholics Anonymous (AA) are available throughout the UK, free of
Useful contacts include:
- Alcoholics Anonymous (AA) – support to stop drinking available UK-wide. Call free on 0800 9177 650 or visit www.alcoholics-anonymous.org.uk.
- Drinkline – a national alcohol helpline. Calls are free and completely confidential. Call 0300 123 1110 (weekdays 9am-8pm and weekends 11am-4pm).
- Smart Recovery – a charity that promotes addiction recovery through meetings and online resources, including online meetings. Visit www.smartrecovery.org.uk