Alcohol-related liver disease slams younger people
INDIANAPOLIS – Although Rachel Martin would never deny she had a drinking problem, she figured years would pass before it would take a toll on her health. After all, she had not yet hit 40 and she had managed to eke out two years of complete sobriety about a decade ago.
Even when she was drinking, she would hit the bottle hard for three weeks but then go cold turkey for a week.
So when Martin started feeling off about a year and a half ago, she tried to ignore the symptoms. She lost her appetite, her skin itched, and as she put it, she lost her waist as fluid accumulated in her abdomen. For four months she continued to drink, but in mid-March 2019, she decided she was done.
The next day she finally went to the doctor and found out she had cirrhosis of the liver, something that did not surprise her, given her internet-aided selfdiagnosis. What did surprise her, however, was what her doctor said: If she did not stop drinking she might die within a month. Even if she did quit, she might not make it three months.
“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,’ ” said the Bloomington resident, who is now 39. “I know people that drink more than I do, and they’re fine. I have years before I have to worry about this.”
Doctors are seeing more patients like Martin, people in their 20s and 30s with symptoms of acute liver disease related to alcohol consumption. The National Institute on Alcohol Abuse and Alcoholism published a study in January that found that from 1999 to 2017 the number of alcohol-related deaths per year doubled, rising from 35,914 to 72,558. Just under a third of those resulted from liver disease. Similarly, a study in the British Medical Journal published in 2018 also noted a dramatic increase in deaths in the United States from cirrhosis from 1999 to 2016. In that time period, people ages 25 to 34 saw the highest increase.
“There is an epidemic of alcoholism and alcohol use disorder that I think is hiding behind the opioid crisis,” said Dr. Naga Chalasani, head of hepatology at Indiana University Health. “Alcohol consumption has risen in this country.”
Many of those who wind up requiring care do not fit the stereotypical image of an alcoholic. They may be highly productive individuals who work and have families until suddenly they find themselves facing an acute health crisis brought on by alcohol-related liver disease, such as acute hepatitis or cirrhosis. The trend is particularly pronounced in middle-aged women, where studies suggest that high-risk drinking is the highest it has ever been, Chalasani said. A 2019 study by University of Michigan researchers that looked at more than 100 million Americans with private insurance found a 50% increase in the prevalence of alcohol-related cirrhosis in women from 2009 to 2015.
How much alcohol is too much
Several factors likely contribute, experts say. The alcohol industry invests heavily in marketing. Many who drink in college continue into young adulthood and beyond. Many social events incorporate alcohol consumption.
Doctors are seeing more patients with alcoholic-related liver disease who have no trouble functioning day to day.
“They are people who consume alcohol on a moderate basis chronically enough to be harmful to them, and they didn’t really expect it to be that harmful,” said Dr. Mazen Alsatie, a gastroenterologist and hepatologist with Ascension St. Vincent.
Some can drink, some can’t
Jordon Mattingly admits in retrospect he probably drank too much, but it was an occupational hazard. For the past three years he has tended bar. Rarely did he wind up so inebriated he couldn’t drive, but he did down more than half of a fifth of vodka a day.
In October he started having acute stomach pains, and he went to the hospital in Evansville, where he lives. The doctors diagnosed him with alcoholic liver hepatitis and cirrhosis.
Eventually he grew so sick that the southern Indiana hospital that was treating him transferred him to IU Health University Hospital. In three and a half weeks, he lost 40 pounds and was deathly ill when he arrived in Indianapolis.
Now 28, Mattingly never thought his drinking could jeopardize his health. His doctors explained to him that everyone’s liver handles alcohol differently.
“Some people can handle it; some people can’t,” he said. “But I guess I’m one that can’t.”
In the early stages of liver disease, the condition can be reversed as long as the person stops drinking completely. An ultrasound of the liver can reveal how much damage a person’s liver has sustained, Alsatie said.
If there is minimal to moderate damage, stopping drinking will allow the liver to recover.
But many people have no clue of the damage they are doing until the disease has advanced and they develop symptoms such as jaundice, nausea, vomiting, or abdominal pain and swelling.
“That’s the trickiest part about the liver. It is a dumb organ,” Yoder said. “It doesn’t complain about anything until it’s too late.”