April 1, 2020

Why are more young adults getting alcohol-related liver disease?

Daily Briefing

    Rachel Martin, 39, didn't realize the toll her drinking was taking on her health until she was diagnosed with acute liver disease in 2019—and experts say Martin's case highlights the surprising increase of young, U.S. adults who have developed acute liver disease related to alcohol consumption, Sahri Rudavsky writes for USA Today.

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    Martin's story

    According to Rudavsky, Martin knew she had a drinking problem. Martin started out as a social drinker who would "hit the bottle hard" for a few weeks, detox for a week, and then repeat the cycle, Rudavsky writes. "I knew it was affecting my life, but it's a really easy pattern to fall into," Martin said.

    But in her mid-20s, Martin began turning to alcohol as a coping mechanism, and at one point a few years ago, Martin suffered a loss that caused her to start drinking heavily. However, as a woman under 40 years old, Martin assumed she had a few more years before the habit began affecting her body, Rudavsky writes.

    Unfortunately, that wasn't the case. About a year and a half ago, Martin started experiencing some strange symptoms, including loss of appetite, fluid in her abdomen, and itchy skin. She continued to drink for four months, but decided to quit drinking alcohol in March 2019.  

    The day after she quit, Martin saw a doctor and was diagnosed with cirrhosis of the liver. According to Rudavsky, the diagnosis didn't surprise Martin because she had done some research on the internet and made a similar self-diagnosis. But the doctor then told Martin something that did come as a shock, Rudavsky writes: If Martin didn't stop drinking, she could die within one month. And, even if she did quit, she could still die within three months.

    After the visit, Martin was in and out of the hospital for the next five months. Her liver became so damaged that her kidneys shut down and she had to go on dialysis. She was in desperate need of a liver transplant, which she received in August 2019.

    Martin hasn't consumed alcohol since her transplant, but she is still recovering from the news of her initial diagnosis. "You know it's bad for you, you know it's not healthy at all whatsoever, but you think, 'Oh, I have no family history of this.' … I know people that drink more than I do, and they're fine. I have years before I have to worry about this," Martin said.

    And once you receive a diagnosis of alcohol-related liver disease, it's difficult to tell others about the condition, Martin said. "The thing about alcohol-related liver disease, it's a dirty little secret. It's embarrassing because you have done this to yourself."

    Martin's case highlights an unsettling trend

    But experts say cases like Martin's are becoming increasingly common in the United States.

    The National Institute on Alcohol Abuse and Alcoholism in a study published last month found the number of alcohol-related deaths in the United States doubled from 35,914 in 1999 to 72,558 in 2017, and almost one third of the deaths were due to liver disease.

    "Alcohol consumption has risen in this country," said Naga Chalasani, head of hepatology at Indiana University Health. "There are more people drinking, and the people who drink are drinking more."

    But, according to Rudavsky, "[t]he people getting sick are not necessarily the people you might expect."

    A 2018 study published in the British Medical Journal found a large increase in U.S. deaths from cirrhosis of the liver between 1999 and 2016, with the highest increase occurring among adults between the ages of 25 and 34. Additional research showed a major uptick in high-risk drinking and alcohol-related liver disease among patients in their 20s and 30s, and particularly among middle-aged women, Rudavsky reports. For example, a 2019 University of Michigan study found a 50% increase in the prevalence of alcohol-related cirrhosis in women with private insurance between 2009 and 2015.

    Rudavsky also notes that many patients with alcohol-related liver disease are high-functioning, like Martin, who are surprised to learn their drinking habits damaged their livers.

    "They think it's an older, white guy who has cirrhosis, he's been sitting around in a bar after work for decades," said Lindsay Yoder, a physician assistant at IU Health. But she added, "I see a really high percentage of patients in that clinic that are young. ... It's just devastating."

    What's behind the trend?

    There are a lot of factors that have contributed to the uptick in alcohol-related liver disease among U.S. adults in their 20s and 30s.

    For instance, Rudavsky notes a shift in the drinking culture among younger adults is one factor. According to Rudavsky, many people start drinking in college and continue to drink consistently into adulthood, both at social and work events and at home.

    In addition, there was a time when moderate drinking—which traditionally has been defined as drinking between one and two glasses of alcohol per day for women and up to three glasses of alcohol per day for men—was thought to have health benefits. However, "a controversial" study published in The Lancet in 2018 "suggested that no amount alcohol is safe," Rudavsky writes, and some "experts have started to dial back … endorsements of alcohol" as good for one's health.

    Currently, CDC recommends that women consume no more than one alcoholic drink per day and men consume no more than two alcoholic drink per day.

    As Mazen Alsatie, a gastroenterologist and hepatologist with Ascension St. Vincent, warned, "An almost daily basis of a moderate amount of alcohol can be much more harmful than a binge drinker who drinks once a month and then quits."

    And although liver damage caused by alcohol consumption typically can be reversed in younger patients if caught and addressed early, in many cases, liver disease is often "silent," or without symptoms like vomiting, pain, and jaundice. As a result, it's often not discovered until it's too late, Rudavsky writes (Rudavsky, USA Today, 2/20).

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