Sharp, ‘Off The Charts’ Rise In Alcoholic Liver Disease Among Young Women
Speaker 1: 00:00 What do people do when they're shut up in their homes, anxious about a deadly disease, stressed out about kids, not in the school and jobs on the line. Well, for many people during the pandemic, the answer is drink last fall around research corporation study found that consumption of alcohol in the U S was up 14% last year with a big 41% increase among women and doctors are starting to see the results of increased drinking as those soothing cocktails and bottles of wine turn into serious health problems. Joining me is Dr. Rohit Loomba, who specializes in gastroenterology and liver diseases at UC San Diego health. Dr. Loomba, welcome to the program. Speaker 2: 00:45 Thank you, Maureen. Glad to be here. Speaker 1: 00:47 Have you experienced an increase in patients with alcoholic liver disease during the pending? Speaker 2: 00:53 Yes. Um, we have a group of eight hepatologist at UC San Diego and, uh, we are definitely seeing a big increase in patients who are excessively consuming alcohol and then the severe form of it, including alcoholic, hepatitis, uh, acute pancreatitis related to excessive alcohol use. And then those patients who have a decompensated liver disease that need liver transplantation. So those rates are increasing nationally. And, uh, particularly in San Diego Speaker 1: 01:25 Seen a change then in the age or circumstances of the people who are coming in with liver problems. Speaker 2: 01:32 Yes. So what we've observed, and these are anecdotal experiences, but confirmed by national studies, as you just mentioned that now we are seeing patients who, you know, used to have a normal life, maybe consumed, you know, one to two drinks every day, but suddenly because of the pandemic lost a job or a family member, some major life event happened that caused a trigger for these, you know, normal individual who then start increasing their consumption of alcohol and then get into trouble without really realizing that this could be harmful to them. And this is the particular section of the society that I think is increasing, where they had no idea that they could be in trouble because of alcohol. And now they need, um, admission to the hospital they're having GI bleed or need a liver transplantation. Speaker 1: 02:22 The, the people that you're seeing perhaps younger or are, are they skewing female or anything of that nature? Speaker 2: 02:29 Yeah, we definitely seeing, um, alcoholic hepatitis, uh, to be happening in younger and younger age groups. Um, we're seeing individuals in their late twenties, early thirties and forties who are presenting with acute alcoholic hepatitis and this, I think it has been rising even before the pandemic and then just pandemic added fuel to the fire. We're also seeing increased number of women presenting with, uh, alcoholic hepatitis, but in San Diego, we're seeing it across the board. And it's particularly important here, uh, because of, uh, Hispanic ethnicity being a risk factor for fatty liver disease. Speaker 1: 03:11 I think lots of people wonder how much alcohol puts their health at risk. Does that amount differ from person to person? Speaker 2: 03:19 This is an important question. And there are many ways of looking into it. If you ask a liver doctor that what is the risk of liver related mortality, then, you know, daily consumption of alcohol increases your risk for liver related mortality. Although just lightly, what is particularly damaging is something called us binge drinking. This is really something to be completely avoided. It's harmful across the board, particularly harmful in those patients or individuals who are overweight and obese. What is binge drinking? It is consuming six drinks for men within four to six hours and four drinks for women within four to six hours. And so that's really bad for the liver and general health. And that absolutely must be awarded. Speaker 1: 04:09 And doctor, what does too much alcohol do to the liver? Speaker 2: 04:12 You drink excessively portrayed in the liver cells start dying. They secrete inflammatory cytokines leading to scarring in the liver, leading to cirrhosis liver. If it continues unabated long-term, is there any way to reverse the damage? Absolutely. There are many ways of reversing the damage, but one thing that definitely works, even in the setting of cirrhosis, if you completely quit or abstain from alcohol, you can reverse the disease and you can reduce the risk of complications as well as decompensation. So number one is completely abstaining from alcohol. If you get in trouble, how do you do that? I think really identifying issues related to excessive alcohol use, they might be related to depression, anxiety, certain triggers in life, and potentially could be improved with therapy, alcohol anonymous, as well as family and psychosocial support. There are also treatments available for alcohol use disorder, because particularly that's where if you have difficulty in maintaining the moderate amount of alcohol intake and you have excessive alcohol use, then you probably want to see a D addiction psychiatrist who can help you reduce your alcohol consumption. And that way you can reduce the risk of end organ damage. That's what we call when you develop cirrhosis of the liver or pancreatitis and inflammation in the pancreas. So treatment of alcohol use disorders would be important, and that is available where you could be offered psychotherapy or certain medications that will reduce your risk for excessive drinking. Speaker 1: 05:52 And what are the consequences to a person's health of not the issue and not getting help to stop drinking? Speaker 2: 06:00 I think there are a lot of consequences. Yeah. In terms of liver disease, you know, development of cirrhosis or something called us alcoholic hepatitis when patients develop jaundice, which is yellow color of the eye and skin, they may develop confusion may come into the hospital with vomiting of blood. And sometimes, you know, patients develop life-threatening infections and may die. Once you develop alcoholic hepatitis, the risk of mortality goes up to about 50% over 90 days. So it's a fatal disease, unless you stop drinking alcohol completely and you can get supportive, nutritional care. Other adverse health effects include acute pancreatitis as well as chronic pancreatitis where patients develop severe abdominal pain related to excessive alcohol use leading to inflammation in the pancreas. And that can also be life-threatening in some individuals. And then we know that alcohol use also causes certain kinds of cancers, including liver cancer. Speaker 1: 07:02 And don't some people actually need liver transplants. Speaker 2: 07:05 Yes, we have seen nationally and especially here in San Diego, number of patients presenting need for liver transplantation has increased, especially related to alcoholic liver disease and alcoholic hepatitis. Speaker 1: 07:21 You expect to see more patients with liver disease finally come in for treatment as the pandemic threat continues to decline. Speaker 2: 07:28 Absolutely. We're already seeing this and we've started some outreach in South Bay, as well as in impaired County know central. Cause we really think that if you see liver disease, mortality rates are significantly higher in San Diego and Imperial County. Also liver cancer rates are also about two times higher in San Diego and Imperial County than an average County in the United States. Why is that? And I think it may be because of a Hispanic ethnicity predominantly in our two counties, as well as rampant, diabetes, obesity, and on top of it, uh, potentially alcohol use combined with, uh, the risk of liver disease due to diabetes. And all of these metabolic problems with alcohol use is, uh, you know, adding fuel to the fire and leading to excessive liver disease related morbidity and mortality. So I do expect more and more patients to come. Speaker 1: 08:27 I've been speaking with Dr. Rohit Loomba. He specializes in gastroenterology and liver diseases at UC San Diego health. Dr. Lumumba, thank you so much for speaking with us. Speaker 2: 08:37 Thank you so much, Maureen, as my pleasure, appreciate you doing this program.