Deaths from liver disease are surging, and drinking is to blame

 

Deaths from liver disease have risen sharply in the U.S., and doctors say the biggest factor is drinking —especially among young adults.

A study published Wednesday found a 65 percent increase in deaths from cirrhosis of the liver since 1999. The biggest increase is among millennials: the team found that deaths from cirrhosis are rising 10 percent a year among people aged 25 to 34.

People so young might not even realize that they can drink themselves to death so quickly, but they can, said liver specialist Dr. Haripriya Maddur of Northwestern Memorial Hospital in Chicago.

“Surprisingly, it only takes about 10 years of heavy drinking to actually lead to cirrhosis,” said Maddur, who was not involved in the study.

“So when people start drinking in college and they start binge drinking, that can actually lead to end-stage liver disease at a much earlier age,” Maddur told NBC News.

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11 things your itchy skin can reveal about your health
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11 things your itchy skin can reveal about your health

Kidney disease

An intense itch all over the body often occurs in people with late stage kidney disease or who suffer from chronic renal failure. In fact, one study showed that 42 percent of dialysis patients suffered from moderate to extreme renal itch. “Some people describe it as a nuisance,” says Anthony M. Rossi, MD, assistant attending at Memorial Sloan Kettering Cancer Center and New York Presbyterian Hospital.  “[The itch] is so intense that people wake up in the middle of the night scratching.” Science has yet to uncover why kidney disease causes itchiness, but doctors suspect it has to do with the build up of toxins in your body when your kidneys are unable to remove the waste from your bloodstream. Aside from treating the disease, a doctor may prescribe medications like gabapentin, an anti-seizure medicine that’s been FDA-approved for off-label use to quell renal itch. Here are 9 more little body changes that could signal much bigger health problems.

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Liver disease

Itching all over could also be a silent sign of liver disease. Where incessant itchiness shows up late-stage in kidney disease, it can be an early symptom of liver disease. “If your liver is not functioning properly to detoxify the body, byproducts like bile acids back up,” says Dr. Kathleen Cook Suozzi, MD, assistant professor in the Department of Dermatology at Yale School of Medicine. “The primary goal is to treat the underlying liver disease and prescribe medications that can eliminate the bile acids.” Doctors will typically prescribe medications that can inhibit your body’s uptake of bile acids or help reduce the amount of bile acid returning to the liver. Don't miss these  9 signs your liver is in big trouble.

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Spinal disease

A chronically itchy upper middle of the back (without a rash) can be a hallmark of neuropathic itch, a symptom of nerve malfunction. Before providing treatment, doctors will first rule out spinal cord disease as a cause. Research has shown that spinal disease, whether due to age or injury, can apply pressure on the nerve and pinch it, which results in an itchy sensation on the skin. Neuropathic itches can occur on one side of the body or both, but it's a big red flag if scratching brings no relief. “People with eczema get a good sensation from scratching,” says Dr. Rossi. “But [nerve itch] doesn’t improve with scratching. The itch intensifies most of the time.” Some people say it feels like insects are crawling on them. Once spinal cord disease or other health conditions have been ruled out, neuropathic itches can be treated with capsaicin cream, which is derived from hot peppers, to burn out the nerves that are firing irregularly on the skin. Make sure you know what muscle spasms can reveal about your health

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Celiac disease

Extremely itchy bumps or blisters on knees, elbows, buttocks, and/or hairline are signs of dermatitis herpetiformis (DH), a skin manifestation of celiac disease. “When a person with celiac disease consumes gluten, the mucosal immune system in the intestine responds by producing a type of antibody called immunoglobulin A (IgA),” John Zone, MD, Celiac Disease Foundation medical advisory board member told celiac.org. These IgA antibodies travel to and bind with the skin cells to trigger an itchy response. The prescription Dapsone can provide short-term itch relief for the skin, but the intestinal damage is serious and patients have to adopt a strict gluten-free diet for life. If they continue to eat gluten, celiac patients can develop malnutrition, anemia, bone loss, ulcerative colitis, and even cancer. Here are 11 celiac signs you need to pay attention to.

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Lymphoma

“The other thing that you want to rule out are blood disorders,” says Dr. Suozzi. “Anywhere from five to 30 percent of lymphomas such as Hodgkin’s and non-Hodgkin’s can present with itch.” Itchiness with or without a rash can be the first symptom of Hodgkin’s disease—likely caused by cytokines, cell signal molecules that trigger inflammation in response to infection. If your doctor suspects lymphoma, she may order a chest X-ray to eliminate the possibility. If you're diagnosed with the disease, the itching will cease soon after starting chemotherapy or radiation therapy. 

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Thyroid disease

“Thyroid disease, whether it’s overactive or underactive can cause weird sensations in the skin,” says Cameron Rokhsar, MD, associate clinical professor of dermatology at Mount Sinai Hospital and dermatologist and cosmetic surgeon at New York Cosmetic, Skin & Laser Surgery Center. “No one knows the association but it may be that the changes in the sweat glands can cause skin dryness.” Itchy, dry skin is more common in people who have hypothyroid, because skin tissue contains thyroid hormone receptors that are seeing diminished cellular activity in the absence of thyroid hormone.

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Allergies

Allergies are one of the most common chronic health conditions in the world. In fact, many skin allergies are classified under the umbrella term contact dermatitis, the itchy rash on your skin that you get when you come into contact with an allergen. Poison ivy, nickel, or compounds found in personal care items like baby wipes and makeup are just a few of the allergens that can cause contact dermatitis. Your dermatologist may stick patches on your skin with different compounds that are correlated to the most common allergens to pinpoint the root cause of your allergies. “It’s like a treasure hunt when we’re trying to look into all the products that people use,” says Dr. Suozzi. A strong topical steroid is prescribed for relief. Don't miss these 8 signs your skin products are secretly damaging your face.

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Menopause 

If you’ve finally hit menopause, you may have noticed a sudden change in your appearance—including dry skin. The loss of estrogen, an essential building block for collagen production, leads to thinner, itchier skin due to a diminished supply of natural oils that keep your skin’s moisture intact. Maintain your fountain of youth with Aloe Vera gel or calamine lotion, which help hold water in your skin’s outermost layer to alleviate drying and itching.

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Breast cancer

Paget’s disease of the nipple is an incredibly rare form of breast cancer where cancer cells collect in or around the nipple. According to the National Cancer Institute, Paget’s disease of the nipple accounts for less than 5 percent of all breast cancer cases in the United States. The first sign is scaly, red, itchy patches around the nipple and areola. “Sometimes it's misdiagnosed as eczema of the nipple,” says Dr. Suozzi. “But when it's breast cancer-associated it's unilateral.” Itchy skin isn't the only sign of disease; here are the 10 subtle signs of disease that your feet can show

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You're pregnant 

The American Pregnancy Association states that 1 in 150 women will develop pruritic urticarial papules and plaques (PUPP), an outbreak of itchy red rashes commonly seen on the abdomen, though they can also appear on your legs and arms. Most women can’t do much about the itch because the rash typically doesn’t develop until late into the third trimester when most medications are off limits. “It’s not proven but some people say [PUPP] can happen with multiple gestations like twins,” says Dr. Rossi. “And some people think it’s because the skin gets stretched out.” Fortunately, it’s harmless and goes away after pregnancy.

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Dermatographia

If after lightly scratching your skin, your fingernails leave thin, raised red welts on your skin that take 15 to 30 minutes to disappear, you may suspect dermatographia. Although the cause of this condition is unclear, the Mayo Clinic says it could be triggered by stress, infections, allergens, or medications like penicillin. “It’s an extreme skin condition, where your skin is sensitive to touch and releases too much histamine,” says Dr. Rokhsar. Areas of touch and clothing are the most susceptible to dermatographic flare-ups. It’s easy to diagnose but often goes undiagnosed because it’s not severe or bothersome enough for people to make an appointment with their dermatologist. If the itch becomes severe, your doctor can prescribe an antihistamine to relieve the inflammation. If this becomes a regular occurrence, ask your doctor if you might have histamine intolerance or even mast cell activation syndrome—both are conditions where the body fails to process histamine properly.

And should your itch not be due to one of these conditions, check out the 7 bug bites you should never ignore.

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For the study, Dr. Elliot Tapper and Dr. Neehar Parikh at the University of Michigan and the Veterans Affairs hospital in Ann Arbor, Michigan, looked at federal data taken from death certificates and the U.S. Census Bureau.

“From 1999 to 2016 in the U.S., annual deaths from cirrhosis increased by 65 percent, to 34,174, while annual deaths from hepatocellular carcinoma (liver cancer) doubled to 11,073,” they wrote in their report, published in the British Medical Journal.

Earlier this week, the National Center for Health Statistics reported a 43 percent increase in death rates from liver cancer between 2000 and 2015. The increase made liver cancer the sixth-leading cause of cancer death in 2016, up from the ninth-leading cause in 2000.

The biggest increase was among baby boomers, people aged 55 to 64. The Centers for Disease Control and Prevention says hepatitis B and C are most likely a major cause of liver cancer in this older age group.

“Unfortunately, many people are unaware they are infected with viral hepatitis since the disease often causes no symptoms,” the CDC says. “For reasons that are not entirely understood, people born from 1945 to 1965 are five times more likely to have hepatitis C than other age groups.”

There’s a vaccine to prevent hepatitis B, and drugs can cure most cases of hepatitis C.

Obesity and drinking too much alcohol can also cause liver cancer, as well as liver cirrhosis, and those two factors seem to be driving the rise in deaths among younger adults.

“I think it's because millennials are drinking more, and they're drinking different types of liquor that is actually harder and more potent,” Maddur said.

One 2013 study found that even one drink a day raises a person’s risk of dying from cancer — not just liver cancer, but also breast cancer and cancers of the mouth and throat.

A lot of my patients will say, ‘Oh I don't drink every day,’ but they're binge drinking, which is just as bad, if not worse, for the liver,” Maddur said.

The CDC defines binge drinking as downing five or more standard drinks in a couple of hours for a man, or four for a woman.

People really need to take it easy on the alcohol, Maddur said.

“So, for a woman, no more than one alcoholic drink in a day and for a man no more than two drinks in a day is safe,” she said. “Anything exceeding that can actually lead to end-stage liver disease.”

The federal government has been cautioning about the dangers of alcohol for years. Tapper and Parikh said it may take more action to discourage boozing.

“In this regard, forthcoming data from Scotland will prove instructive,” they wrote. There, officials have mandated a minimum price for alcoholic beverages in the hope of reducing consumption.

Scotland’s alcohol consumption is among the highest in the world, according to World Health Organization data.

“The impact of this program on Scottish public health should be eagerly awaited by American policy makers, Tapper and Parikh wrote.

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