Episodic Binge Drinking Could Triple Your Risk of Liver Disease
Frat-party style drinking days are hopefully in the rearview mirror for most people. That hangover isn’t worth it. While several people believe that binge drinking now and then is harmless if they usually drink moderately, a new study finds that this thinking may be quite harmful.
A large US research study found that individuals with MASLD (metabolic dysfunction-associated steatosis liver disease), a disease impacting roughly one in three adults, have a significantly higher risk of serious scarring of the liver if they drink heavily, even just once a month.
Binge drinking infrequently can dramatically raise the risk of harmful liver damage, especially in those with underlying metabolic conditions such as diabetes or hypertension. Drinking moderate amounts of alcohol over time is far less damaging than drinking the same amount in one sitting.
The study was published in April in Clinical Gastroenterology and Hepatology. Researchers found that those with metabolic dysfunction–linked steatotic liver disease (MASLD) have a much higher risk of liver fibrosis, or dangerous scarring of the liver, if they periodically drink heavily. What’s considered episodic heavy drinking is four or more drinks in one day for women and five or more drinks in one day for men, at least once a month.
People who drink large amounts of alcohol in one day at least once per month are three times more likely to develop advanced liver fibrosis than those who spread out the same total alcohol intake over time, according to the research.
Men and younger adults were more likely to disclose episodic heavy drinking, and the more alcohol they consumed at one time, the more liver fibrosis was noted.
“This study is a huge wake-up call because traditionally, physicians have tended to look at the total amount of alcohol consumed, not how it is consumed, when determining the risk to the liver,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study. “Our research suggests that the public needs to be much more aware of the danger of occasional heavy drinking and should avoid it even if they drink moderately the rest of the time.”
How the research was done
Data was used from the nationally representative National Health and Nutrition Examination Survey, a long-running health survey of the United States population. Dr. Lee and colleagues combined data from over 8,000 adults, collected between 2017 and 2023. Particularly, they evaluated the link between episodic heavy drinking and advanced liver fibrosis to understand how drinking habits — not just total drinks consumed — may lead to harm even to moderate drinkers, which is defined as seven drinks a week for women and 14 or fewer for men.
MASLD is prevalent among Americans and on the rise. It impacts people with excess weight, obesity, or other metabolic conditions, including Type 2 diabetes, high blood pressure or high cholesterol. In addition, while MASLD is not defined as alcohol-related, Lee and his team wanted to examine if alcohol played some role in the condition.
Over one-half of the adults in the study disclosed episodic heavy drinking, and nearly 16% of patients with MASLD were episodic heavy drinkers.
People with MASLD were compared with the same age, sex, and average weekly alcohol consumption, separating some as episodic heavy drinkers and others as non-episodic heavy drinkers, to discover that episodic heavy drinkers with MASLD had practically three times higher odds of experiencing advanced liver fibrosis.
Lee suspects that episodic heavy drinking can hurt the liver both directly and indirectly. Consuming large quantities of alcohol at one time can overwhelm the liver and increase inflammation, leading to scarring and damage.
Those with MASLD may be especially at risk, as Lee’s previous research indicates that obesity, hypertension, nd other diseases associated with MASLD can more than double liver disease risk.
In the past two decades, alcohol-related liver disease has more than doubled, according to Lee. He suspects this trend is fueled by pandemic-era bumps in drinking and an increase in people with risk factors for MASLD, such as obesity and diabetes.
“Although this study focused on patients with MASLD, these findings may also be pertinent to a broader patient population,” said Lee. “With more than half of adults reporting some episodic heavy drinking, this issue deserves further attention from both physicians and researchers to help better understand, prevent, and treat liver disease.”
Below are tips to reduce your risk of MASLD:
· If you drink, do so in moderation. Bachelor party drinking isn’t cool anymore.
· Embrace that cup of joe. Coffee has hepatoprotective effects. Skip the extra sugar and heavy creamers. 2
· Cut out sugar-sweetened beverages and foods containing excess sugar and high-fructose corn syrup. These have been linked with fatty liver disease. 3
· Lose weight if you’re overweight or obese. Even a small loss may reduce the risk of metabolic conditions, such as diabetes. 4
· Reduce high-fat foods, including fast food, full-fat dairy products, fried foods, heavy sauces, red meat, and ultra-processed red meat. 5
· Increase your fiber intake. A high-fiber diet is beneficial in reducing the risk of fatty liver. Add beans or lentils to salads, sides, and soups. 6
· Get off the couch. Regular physical activity improves blood sugar, blood pressure, weight management, and cholesterol.
· Enjoy green tea. The catechins in green tea have antioxidant and anti-inflammatory properties that may protect against fatty liver disease. 7
· Avoid acetaminophen (Tylenol) and alcohol. The combination may harm your liver.
· Discuss the use of “liver detoxifying” supplements with your doctor or pharmacist before purchasing. Supplements are not regulated by the FDA, and could be harmful to your delicate liver. 8
Lisa Andrews, MEd, RD, LD
References:
Yinan Su, Jennifer L. Dodge, Brian P. Lee. Episodic Heavy Drinking and Implications for Steatotic Liver Disease Nomenclature: A National Cross-Sectional Study. Clinical Gastroenterology and Hepatology, 2026; DOI: 10.1016/j.cgh.2026.03.004
Ungvari Z, Kunutsor SK. Coffee consumption and cardiometabolic health: a comprehensive review of the evidence. Geroscience. 2024 Dec;46(6):6473-6510. doi: 10.1007/s11357-024-01262-5. Epub 2024 Jul 4. PMID: 38963648; PMCID: PMC11493900.
Zhao L, Zhang X, Coday M, Garcia DO, Li X, Mossavar-Rahmani Y, Naughton MJ, Lopez-Pentecost M, Saquib N, Shadyab AH, Simon MS, Snetselaar LG, Tabung FK, Tobias DK, VoPham T, McGlynn KA, Sesso HD, Giovannucci E, Manson JE, Hu FB, Tinker LF, Zhang X. Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality. JAMA. 2023 Aug 8;330(6):537-546. doi: 10.1001/jama.2023.12618. PMID: 37552302; PMCID: PMC10410478.
Kanbour S, Ageeb RA, Malik RA, Abu-Raddad LJ. Impact of bodyweight loss on type 2 diabetes remission: a systematic review and meta-regression analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2025 Apr;13(4):294-306. doi: 10.1016/S2213-8587(24)00346-2. Epub 2025 Feb 26. PMID: 40023186.
Zeng XF, Varady KA, Wang XD, Targher G, Byrne CD, Tayyem R, Latella G, Bergheim I, Valenzuela R, George J, Newberry C, Zheng JS, George ES, Spearman CW, Kontogianni MD, Ristic-Medic D, Peres WAF, Depboylu GY, Yang W, Chen X, Rosqvist F, Mantzoros CS, Valenti L, Yki-Järvinen H, Mosca A, Sookoian S, Misra A, Yilmaz Y, Kim W, Fouad Y, Sebastiani G, Wong VW, Åberg F, Wong YJ, Zhang P, Bermúdez-Silva FJ, Ni Y, Lupsor-Platon M, Chan WK, Méndez-Sánchez N, de Knegt RJ, Alam S, Treeprasertsuk S, Wang L, Du M, Zhang T, Yu ML, Zhang H, Qi X, Liu X, Pinyopornpanish K, Fan YC, Niu K, Jimenez-Chillaron JC, Zheng MH. The role of dietary modification in the prevention and management of metabolic dysfunction-associated fatty liver disease: An international multidisciplinary expert consensus. Metabolism. 2024 Dec;161:156028. doi: 10.1016/j.metabol.2024.156028. Epub 2024 Sep 11. PMID: 39270816.
Zhu Y, Yang H, Zhang Y, Rao S, Mo Y, Zhang H, Liang S, Zhang Z, Yang W. Dietary fiber intake and non-alcoholic fatty liver disease: The mediating role of obesity. Front Public Health. 2023 Jan 6;10:1038435. doi:10.3389/fpubh.2022.1038435. PMID: 36684870; PMCID: PMC9853067.
James A, Wang K, Wang Y. Therapeutic Activity of Green Tea Epigallocatechin-3-Gallate on Metabolic Diseases and Non-Alcoholic Fatty Liver Diseases: The Current Updates. Nutrients. 2023 Jul 3;15(13):3022. doi: 10.3390/nu15133022. PMID: 37447347; PMCID: PMC10346988.
8. Office of Dietary Supplements (ODS)