Are you drinking heavily? You may be at greater risk of liver disease

CBC

3 days ago

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The rate of serious liver disease among heavy drinkers has more than doubled over the last 20 years as the demographics around who is consuming more alcohol shift, a new study suggests.
The research, published Wednesday in American medical journal Clinical Gastroenterology and Hepatology, found that heavy alcohol use is up among women, older adults, lower-income individuals and people with metabolic syndromes like obesity, high blood pressure and high blood sugar.
These groups tend to already be at a higher risk for liver disease, and excessive drinking only makes that worse, doctors say.
"Liver disease is real, it's surging, and your risk is much higher than you might think," said Dr. Brian Lee, a study author and a transplant hepatologist who treats liver transplant patients in the U.S.
WATCH | Research suggests heavy drinking is shifting and liver disease is up:
Who's drinking heavily is shifting and liver disease is up, research finds
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A study published in Clinical Gastroenterology and Hepatology shows that rates of serious liver scarring more than doubled over the last 20 years among heavy drinkers as the demographics of drinkers shift to include older adults and women.
Liver disease is a leading cause of alcohol-related deaths in Canada and the United States. Severe forms of the illness, which has three main stages, leads to cirrhosis. That's when the liver has experienced irreversible damage and is significantly scarred.
"Alcohol causes fat to deposit in the liver, that fat then causes inflammation, the inflammation then causes scarring and the scarring is what causes the long-term complications of liver disease," said Lee.
Until it gets to the later stages, there aren't usually many obvious symptoms related to alcohol-related liver disease. And there's also not any specific treatment that can help.
People are often advised to stop drinking or make other lifestyle changes, but in severe cases where the liver has stopped working, a liver transplant might be necessary.
Rate of liver disease doubled: study
The new research followed more than 44,600 American adults who were 20 years or older from 1999 to 2020.
Over that 20-year period, the study found that among heavy drinkers, the rate of serious liver disease increased from 1.8 per cent in 1999 to 2004, to 4.3 per cent in 2013 to 2020.
That increase was mostly in women, older people and those living in poverty.
Even though the research included only people in the United States, experts say this is a global trend.
In Canada, recent research has also shown that alcohol-related illnesses are on the rise and that women are increasingly impacted.
Better consumption guidelines needed: Expert
"One thing that we need to really try as a population is to better educate our population on how much alcohol they're actually consuming," said Dr. Jennifer Flemming, an associate professor in medicine and public health at Queen's University in Kingston, Ont.
Flemming says many people don't understand what constitutes a standard drink.
Experts blame this uncertainty on a mishmash of alcohol consumption guidelines and little transparency on the amount of alcohol in a standard drink.
For example, Flemming says in the United States, 14 grams of pure alcohol is considered a standard drink, compared to 10 grams of pure alcohol in the United Kingdom.
Meanwhile, in Canada, the national health department says a standard drink is 13.45 grams of pure alcohol, which includes a 12 ounce bottle of beer at five per cent alcohol, or a five ounce glass of wine at 12 per cent alcohol.
Warning labels may help, study suggests
But labels on alcohol products in many parts of the world don't actually specify how many grams the alcohol contains, which Flemming says can make it hard for people to know.
Though research is limited, some studies suggest that placing warning labels on alcohol can decrease consumption.
A study published in 2020 examined the effect of warning labels on alcohol in the Yukon. The researchers found that sales of alcohol with warning labels decreased and concluded that these labels resulted in reduced consumption.
"When people noticed the warnings, they changed their beliefs," said one of the researchers Tim Stockwell, who is a scientist at the Canadian Institute for Substance Use Research at the University of Victoria in B.C.
"Those people who increased their awareness of the cancer risk expressed intentions to cut down their drinking.
Which consumption guidelines should Canadians follow?
The Canadian Centre for Substance Use and Addiction (CCSA) released new alcohol consumption guidelines in 2023. They stated that no amount of alcohol is safe and recommended no more than two drinks a week for men and women.
Despite receiving funding from Health Canada to create these new guidelines, the federal health department has not adopted them, and its website features different recommendations.
In an email, a Health Canada spokesperson told CBC News the CCSA's work is "ongoing" and said "the Health Canada website will be updated after this work is completed."
As for adding warning labels that better define the risks and serving size, Health Canada says it is "monitoring the situation and will continue to inform the public about the harms of alcohol."
But experts say more needs to be done to better protect people. At this time, Stockwell says the best guidance for Canadians is to follow the recommendations by the CCSA.
"The pressure is mounting," said Stockwell, though he noted how challenging it is given the power of large commercial alcohol companies.
People more aware of health risks: Expert
The new research doesn't account for increased alcohol consumption during the COVID-19 pandemic, but research in Canada found that alcohol-related illnesses did significantly increase during that time.
It also doesn't account for early suggestions that people have been drinking less post-pandemic, says Stockwell.
"There's been a shift in the awareness out there in the public … about the health impacts," he said.
That's why he expects future research to show a drop in alcohol-related illnesses, like liver disease.
He says this is also partly due to inflation.