The liver is one of the most resilient organs in the body, with an impressive and unique ability to actually regenerate new, healthy tissue to replace damaged tissue.
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And we’re lucky it can do that, because the liver plays an important role in removing toxins from the bloodstream and turning food into energy.
But accumulation of certain toxins, including alcohol, can get in the way of the liver’s ability to do its job. And that’s a problem for a growing number of young people who are drinking alcohol in excess for long periods of time.
An alarming new study calls attention to an uptick in both the number deaths from liver disease and the number of young adults age 25 to 34 who died from alcohol-related cirrhosis – the latest stage of liver damage – between 1999 and 2016.
Hepatologist Christina Lindenmeyer, MD, says a trend toward diagnosing alcohol-use disorders more in young people is something she and her colleagues have observed in practice, too.
“It used to be a diagnosis that we didn’t make until people were in their 40s or 50s,” she says.
One of those increasingly common diagnoses is severe alcoholic hepatitis. The impact of alcohol on liver health varies from person to person, but people are generally at risk for severe alcoholic hepatitis when they drink at least 80 grams of alcohol a day for at least five years.
“You have this profound inflammation of the liver that carries extremely high mortality,” Dr. Lindenmeyer says. “We used to say it took 10 to 20 years of drinking 80 grams of alcohol a day, but in this younger group of patients we’re seeing a shorter time to development of severe acute liver disease.”
What’s going on?
David Streem, MD, psychiatrist and Medical Director for the Alcohol and Drug Recovery Center, hasn’t noticed a significant change in the number of young people seeking behavioral treatment for alcohol addiction, but notes that alcohol use disorders are the most common problem for which people request treatment. “Despite great variability in percentages of heavy drinking and binge drinking across the country, as a nation, Americans drink too much,” he says.
And the rise of craft beer, wine clubs that deliver bottles to your doorstep each month, and bottomless mimosa brunches make an abundance of alcohol readily available today.
Another factor contributing to overconsumption may be a lack of education around or attention to what one serving of alcohol (14 grams of pure alcohol) actually looks like. Dr. Lindenmeyer explains that sometimes, patients show up with severe liver disease and don’t even realize that they have been drinking too much.
“We say we should have no more than two drinks a day for men and no more than one per day for women, but when you ask people what they’re drinking, they might say they drank one 40-ounce beer,” she explains. “They also don’t take into account that they might be drinking a beer with 12 percent alcohol.”
This is also a problem with wine, as Dr. Streem points out. “Wine is typically served in portions that are unmarked and often much larger than the 5 ounce standard drink measurement,” he says. “In most restaurants, if you ordered a glass of wine and received a 5-ounce pour, you’d conclude that someone at your table had upset the waiter. So that can mislead people as to how much they’re drinking.”
In the United States, a standard drink contains about 14 grams of pure alcohol, which is the equivalent of:
- 12 ounces of beer with about 5 percent alcohol content
- 5 ounces of wine with about 12 percent alcohol content
- 1.5 ounces of distilled spirits with about 40 percent alcohol content
Dr. Lindenmeyer adds that often, patients who show up with liver problems have been longtime drinkers but have also experienced something in their life that’s caused an uptick in their recent alcohol use – maybe a stressful event, for example. Along those lines, the authors of the cirrhosis study point to The Great Recession as a potential trigger for financial stress that could have led young people to take up drinking in the last decade.
When to worry
For most people, moderate drinking will not cause liver disease. We’re talking about years of repeated overuse.
The first signs of liver disease tend to be yellowing of the skin and development of fluid overload in the abdomen or in the legs, Dr. Lindenmeyer says. Some people experience blood in the stool or even vomiting blood.
The optimistic news is that damage caused by inflammation to the liver can be repaired – at least to a certain extent. “We do know that the longer people are abstinent from alcohol, the better their livers get, even up to a year after stopping alcohol,” Dr. Lindenmeyer says. “It may not improve to be a completely normal liver, but it can improve to the point where they may not have complications related to their liver disease.”
If you are concerned about the drinking habits and health of someone you know, Dr. Streem suggests starting with online resources from the National Institute of Alcohol Abuse and Alcoholism about how to talk to loved ones about alcohol and how to find help.