Statistics often feel unrelated to everyday life, however the recent BMJ report on the increasing incidence of alcohol related liver disease in our younger population mirrors my real life experiences in clinical practice. In the last few months alone, I have seen an increase in young adults being admitted for alcohol related liver injury.
Many of these young people struggle with depression or addiction and often use alcohol as a coping mechanism. While most recognize they’re drinking, they don’t realize how dangerous their habit has become until they present with jaundice, malnutrition and multi-organ failure. Unfortunately, what is often accompanied with the progression of liver disease, several of these young patients have died.
As both a parent and a physician, it is a challenge to care for these young patients who should have a long life in ahead of them. But instead, I find myself speaking with their families about hospice and end of life arrangements. From my point of view, this means there is an urgent need for physicians to speak with their patients, especially those who are younger, about alcohol consumption. Alcohol is ever-present in our society, from advertising to social events, it’s around every turn. Meaning it is our responsibility to discuss what safe alcohol consumption really looks like with our patients and discuss it often.
This conversation is especially important in light of the BMJ study that uncovered a concerning trend in rising mortality among those aged 25-34 due to excessive alcohol consumption. While obesity and hepatitis C infection may contribute, the rise in liver disease among young Americans due to alcohol is particularly troubling.
The data points to a larger health crisis that I also see play out in my daily rounds – the societal norms of excessive drinking. As most of us specializing in liver treatment know, binge drinking is consuming five or more standard drinks in a couple of hours for a man, or four for a woman. With the recent findings in mind, it’s likely many young people surpass this benchmark on a regular basis. Moreover, most people don’t know what “healthy” or “moderate” drinking looks like. According to the CDC, it’s one drink per day for women, and up to two for men.
Speaking with patients about a “safe” amount of alcohol is difficult due to a number of factors. Especially given new trends like the rising craft beer and wine scenes, “a drink” can have many different interpretations. It’s important we remind patients that one standard drink is about 12 ounces of regular beer, 5 ounces of wine or 1/5 ounces of spirits. I find it helpful to share resources and tools with patients to help them grasp this concept, such as the chart above.
However, when offering advice to patients on alcohol intake we must consider that the beer and wine our parents’ generation drank was likely much lower in alcohol by volume (ABV). Many beer drinkers these days, particularly those in younger generations, prefer craft beers over regular beer. A craft IPA (India Pale Ale) can have alcohol concentrations as high as 9.7%. Meaning an IPA drinker can consume two standard drinks in the same volume as one regular beer without even knowing it. Bringing these kinds of nuances to our patients’ attention enables them to make informed decisions after leaving our office, and maybe even change their drinking behavior in the future.
Informing patients about safe consumption is important for both their near- and long-term health. This is especially true because most people don’t know that excessive drinking has long-term health consequences well beyond today’s drink. For instance, most patients who walk into our exam rooms don’t always grasp that liver disease is often symptomless and can advance undetected for years. Physicians must ask questions and speak candidly with patients about alcohol consumption to help define their risk.
We cannot discuss excessive drinking in younger generations without emphasizing other contributing factors such as the increasing rates of addiction, depression and suicide. Alcohol has long been used as a surrogate for an antidepressant, especially given that mental health issues are still stigmatized. To truly address this rising health crisis, we must also consider potential underlying causes for the self-destructive behavior. We must take these critical factors into consideration if we want to tackle this issue at its foundation across younger patient populations.
Another barrier to tackling this trend is education. Many know the liver can regenerate but have no idea the complexity of the hundreds of vital functions the liver accomplishes every day. Simply defining how the liver breaks down alcohol when it enters the bloodstream can be helpful to many patients. Also, clarifying that the liver can only process about one drink per hour may be enough for patients to change their drinking behavior.
Understanding what’s healthy, reducing alcohol consumption and education are important prevention strategies for the long-term liver health and wellness of our patients. There are steps we can take to assess or curb a patient’s risk of liver damage from alcohol, such as asking about their family history and educating them on “safe” portion sizes. We must continue to speak with our patients about the impact of alcohol on the liver and actions they can take to safeguard their health now and in the future.
I’m not here to spoil the party with scary statistics, rather I hope to enable young Americans to make informed decisions about their health.
Nancy Reau, MD, is the section chief of hepatology and associate director of organ transplantation at Rush University Medical Center. She serves as a member of the American Liver Foundation’s National Medical Advisory Committee.