Is Alcohol Safe if You Have MASH?
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Can You Drink Alcohol When You Have MASH?

Can You Drink Alcohol When You Have MASH?
Everyday Health
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Published on August 1, 2025
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While research on alcohol is evolving, the Centers for Disease Control and Prevention 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.

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.

How Alcohol Affects MASH

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).

Does Alcohol Interact With MASH Medications?

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.

Are Some Alcoholic Drinks Safer for MASH Than Others?

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.

Safe Drinking Practices for People With MASH

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.

The Takeaway

  • 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.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Nonalcoholic Fatty Liver Disease. Mayo Clinic. April 4, 2024.
  2. Babuta M et al. Combined Insults of a MASH Diet and Alcohol Binges Activate Intercellular Communication and Neutrophil Recruitment via the NLRP3-IL-1β Axis in the Liver. Cells. June 1, 2024.
  3. Metabolic Dysfunction-Associated Steatophepatitis (MASH). Cleveland Clinic. May 5, 2025.
  4. Alcohol Calorie Calculator. World Cancer Research Fund.
  5. Cirrhosis. Mayo Clinic. February 22, 2025.
  6. Leal-Lassalle H et al. Metabolic and Alcohol-Associated Liver Disease (MetALD): A Representation of Duality. npj Gut and Liver. January 10, 2025.
  7. Gorgojo-Martínez JJ et al. Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated With Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus. Journal of Clinical Medicine. December 24, 2022.
  8. Alcohol and Diabetes. American Diabetes Association.
  9. Alcohol and Diabetes. Kaiser Permanente. January 31, 2023.
  10. Meng T et al. Anti-Inflammatory Action and Mechanisms of Resveratrol. Molecules. January 5, 2021.
  11. No Level of Alcohol Consumption Is Safe for Our Health. World Health Organization. January 4, 2023.
  12. Understanding Alcohol Drinking Patterns. National Institute on Alcohol Abuse and Alcoholism. February 2025.
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Waseem Ahmed, MD

Medical Reviewer

Waseem Ahmed, MD, is an assistant professor of medicine in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai Medical Center in Los Angeles and serves as Director, Advanced Inflammatory Bowel Disease Fellowship and Education within the F. Widjaja Inflammatory Bowel Disease Institute.

He received his undergraduate degree from the University of Michigan and attended medical school at Indiana University. He then completed an internal medicine residency at New York University, followed by a fellowship in gastroenterology and hepatology at Indiana University, and an advanced fellowship in inflammatory bowel disease at the Jill Roberts Center for Inflammatory Bowel Disease at New York-Presbyterian Hospital/Weill Cornell Medicine. Prior to his current role, Dr. Ahmed served as an assistant professor of medicine within the Crohn’s and Colitis Center at the University of Colorado from 2021-2024.

Dr. Ahmed is passionate about providing innovative, comprehensive, and compassionate care for all patients with inflammatory bowel disease (IBD). His research interests include IBD medical education for patients, providers, and trainees; clinical trials; acute severe ulcerative colitis; and the use of combined advanced targeted therapy in high-risk IBD.

He enjoys spending time with his wife and dog, is an avid follower of professional tennis, and enjoys fine dining.

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