When it comes to liver health, it’s pretty well-established that drinking alcohol isn’t good for you. So why are so many millennials suffering from alcohol-related liver disease (ALD)? That’s the question posed by a recent study in BMJ, which has found that ALD is on the rise among young people across the county, Self reports.

Conducted by researchers at the University of Michigan, the study analyzed death certificate data collected between 1999 and 2016 from the Vital Statistics Cooperative and data from the Census Bureau collected as part of the Centers for Disease Control and Prevention’s WONDER online data portal. They found that annual deaths from cirrhosis, or liver scarring, in the United States increased 65 percent during that time period. Among those deaths, 765 were among young people between ages 25 and 34.

That means there was a 10.5 percent annual increase in cirrhosis-related deaths among millennials. The vast majority of these deaths, the study found, were precipitated by alcohol. In fact, study authors said they began the study because they noticed an increase in the number of young patients dying of ALD-related cirrhosis.

“The only way to do that in your 20s is with incredible alcohol abuse,” said lead study author Elliot B. Tapper, MD, an assistant professor of gastroenterology at the University of Michigan. “In order to die of alcoholic cirrhosis, you have to drink an amount of alcohol that is so far beyond what you would call risky drinking…. This is not someone who accidentally had three drinks a night when they should have had less.”

Although the study didn’t examine why so many more millennials are dying of ALD-related complications, there are some theories. One is that the type of alcohol young people are drinking—for instance, craft beers and IPAs—may have a higher alcohol content than other forms that have been abused in the past. A growing binge-drinking culture among millennials may also play a role, rendering many young people unaware that they might have a problem. Researchers also noted that the increase in ALD-related cirrhosis appeared after the 2008 recession, which could suggest that career stress could be a factor. 

Symptoms of cirrhosis include fatigue, bruising, bleeding easily, itchy skin, jaundice, loss of appetite, nausea, swelling in the legs or abdomen, weight loss, spider veins and redness in the palms of the hands. Complicating matters is the fact that not only are these symptoms relatively vague but also doctors say many young people who present with symptoms aren’t upfront about their drinking, which can delay diagnosis. While the disease isn’t reversible, lifestyle changes can help stop or reduce further damage.