The Current - More young women with alcohol-related liver failure, study warns

Episode Date: April 8, 2025

Samantha Harasemchuk was 27 when she was diagnosed with cirrhosis, the beginning of liver failure linked to heavy alcohol consumption. Now, a new study suggests the problem is rising sharply among teens and young adults — and women are most at risk.

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4 F1 cirrhosis. That's the beginning of liver failure. Samantha's diagnosis was linked to heavy alcohol consumption. She's part of a troubling trend identified in a new study. Life-threatening liver disease linked to alcohol is rising sharply among teens and young adults, and women are most at risk. In a moment, we'll hear more about this trend, but first, I'm joined by Samantha. Good morning.

Hi, how are you? I'm doing well. How are you doing? I'm good. Thank you for asking. Okay, and thank you for being with us here this morning. We'll get to your diagnosis in a bit, but tell us first about your drinking history.

When did you first start drinking? Just like most people do in high school, a couple of drinks here and there. I was a pretty good student in high school, so I didn't really partake that much. And then you move away to college and you start drinking a bit more. But it was my early 20s, I would say 21, 22,

is when I started heavily consuming alcohol. Yeah, and describe that to me. What did that heavy alcohol consumption look like? Drinking every day, for sure. Hard liquor most days. There wasn't much of a break with my drinking. On weekends, on weekdays, there was a point where I went a few years without having a day off from drinking at all. Mm-hmm. And what was that doing to you? What, physically, how did, how were you feeling? Physically, I never noticed at first. I just kept, I held down a steady job. I was going to school. Sure, I was drinking a lot, but from the outside looking in, my life was fairly normal. I didn't seem sick.

It wasn't until when I was 27, so about five years into heavily drinking, when I started to notice sickness and I brought myself to the hospital. And you were told that you had cirrhosis. Yes. Yes, it took a long time to get that diagnosis. Okay, and when you got that diagnosis, tell me about the impact of hearing that, especially at the age of 27. It was shocking, devastating, heartbreaking. I was scared. I was confused. When I was first told, my doctor kind of told me as a matter of fact, and then I left her

office and I sat in the parking lot in my car and cried for half an hour. I didn't know what else to do with myself. What was I supposed to call my mom? Was I supposed to call my family? How bad was it? At that point, my initial diagnosis was only from my family doctor. It took over six months to get an official diagnosis from a gastroenterologist. And that's a long time to wait

when you don't know how serious you are, how ill you are. Am I gonna die next year? Do I need a liver transplant? There was every scary scenario running through my head that you could imagine. I can't imagine what you were going through for those months. You mentioned at the outset though, when you got the diagnosis that you could imagine. I can't imagine what you were going through for those months.

You mentioned at the outset though when you got the diagnosis that you were surprised. Why surprised? Cirrhosis has always been known to be like an old man's disease. If you're, you don't expect a young person, I never would have expected someone such as myself to get such a severe diagnosis. Of course, I was abusing alcohol and I was drinking too much and not living the healthiest lifestyle, but a fatal liver disease at 27 was not what I was anticipating. And those six months, you know, as you're waiting to get that official diagnosis and as you're mentioning, everything's going through your mind. How were you informing yourself?

What were you learning about what you needed to do or what your life was going to be like moving forward? So one of the most surprising parts about this was the lack of information that's given to you. My family doctor failed to provide even a website, a pamphlet, a piece of paper with a little bit more information, I was 100% left to my own devices, which can be scary. If you type that into Google, you don't often get the happiest results. So scaring myself with Google, I knew wasn't the best option.

I reached out to the Canadian Liver Foundation. I went to their website and I found an email for someone and I emailed her. And I said, listen, I'm young, I'm scared, I want somebody to talk to, I don't know what to do. And she connected me with my cirrhosis pen pals. I called them, a couple of other women in Ontario who were also diagnosed with cirrhosis. And we emailed back and forth and that really helped me solidify the feeling, okay, there is a community out here. I can find people in similar situations.

Then I went online. I live in a small town in Northern Ontario, so there's not a lot of resources. So I knew online would be my best option. I went online and I found support groups on Reddit of all places. And I have found many women similar age to me, similar diagnosis, similar life story, and they're just as stunned as I am. Wow. We'll get to that, the new research on this, but now this was materializing before your eyes. So now you realize you're not alone, especially

as a young woman, you're not alone. And what were those stories with your pen pals? What were the stories that you were sharing with each other? Similar to mine, some women drank longer than I did. Some drank a little bit less. One woman I spoke with did not have alcohol induced cirrhosis, but we suffered a lot of the same doctor and medical hurdles. So I found that to be the biggest similarity was the medical hurdles that you have to go through, the weighting, the how sick am I? Am I going to make it to 40? Am I going to be able to have kids?

There are so many different things running through your head. And those women all share feelings very similar. You got sober, which is an important part of this conversation, obviously, for you as you try to rebuild your life. What prompted you to get sober? Getting sick definitely prompted me to be sober. I hadn't realized how sick I was. I was just living my day-to-day life, and then all of a sudden I was ill. I wasn't feeling well, I couldn't eat,

and I didn't even notice the yellow tinge to my skin. I had a family member point it out to me, and that's what prompted, okay, something is wrong. I need to go to the hospital. Did you deal with a certain stigma? As you mentioned before, you think that this is an old guy disease, this cirrhosis or condition. Did you feel a certain stigma and shame as a young woman?

Yes and no. I think I was a shocking case to the first set of doctors that I met in the ER. One, the doctors that see me when I first entered the ER, it was a group of doctors, there was three of them. Two were the doctors in charge and one was a student. The two doctors in charge wanted to discharge me. They wanted me to go home, they told me not to drink and they wanted to discharge me and have me follow up with my family doctor. The student doctor who was a young woman in her late 20s early 30s saw me and said no no this girl does not need to go home. If

she goes home, she is going to die. That young woman doctor advocated for me and got me into the that young woman doctor advocated for me and got me into the addictions management unit at Science North in Sudbury. And I stayed there for nine days and it saved my life. It changed my life. She saw me as a person and those other doctors did not see me as a person. They saw me as a problem and wanted me to go home and contact my family doctor. And I don't know if I would be here today if I would be here today if I listened to that advice. Wow, yeah, I can imagine that is actually stunning. And at least there was a voice there

and a voice that other Canadians are listening to now today as we talk about this. How has this, having cirrhosis, what kind of impact has it had on your life now? It has initiated a large lifestyle change. I've already been sober a long time. This year will be four years I'll have been sober. So I've already made a lot of positive life changes.

Thank you. And I continue to make those changes. My fiance and I are getting married this year. We are trying to get pregnant. We just bought a house last year. So I am still living my life to the fullest and trucking forward while keeping an eye on my health. I go for checkups every six months.

I'm always talking with the gastroenterologist specialist in Sudbury every six months. I follow up with my family doctor every six months just to ensure that my disease is stable right now because I am otherwise a young healthy person. And you are you're at that stage right now where you are maintaining your you're living well and your body reflects that? Yes so there's compensated and decompensated cirrhosis. I'm compensated despite the disease and despite the heavy scarring I have my

body is compensating my liver is compensating despite the disease and despite the heavy scarring I have. My body is compensating, my liver is compensating despite the damage it has. Now that switches, it can switch very quickly and I've read a lot of stories and talked with many people whose stories flip really quickly. So we're staying on top of it and maintaining a healthy lifestyle and maintaining our medical workups and going from there. Samantha, what advice do you have for someone listening who may be a young woman in her twenties who might be concerned hearing your story? Don't reach for the sugary drinks.

Reaching for a heavily sugared alcoholic beverage is like running your liver over and then throwing the car in reverse and reversing right over it. High sugar content has just as much damage to your liver as alcohol does, so mixing the both is a ticking time bomb. And the fact that that's not more well aware is very concerning. Hmm. Samantha, it's a powerful story. Thank you so much for sharing it with us.

Yes, thank you very much. Samantha Harris-Emchuk was diagnosed with stage four cirrhosis when she was 27 years old linked to heavy drinking. She was in Espanola, Ontario, just outside of Sudbury. I'm Zing Zing. And I'm Simon Jack. And together we host Good, Bad, Billionaire. The podcast exploring the lives of some of the world's richest people.

In the new season, we're setting our sights on some big names. Yep, LeBron James and Martha Stewart to name just a few. And as always, Simon and I are trying to decide whether we think they're good, bad, or just another billionaire. That's Good, Bad, Billionaire from the BBC World Service. Find it on bbc.com or wherever you get your BBC podcasts. Jennifer Fleming is the lead author on the study I mentioned earlier that highlights a spike in alcohol-related liver disease in young people. She's also an associate professor of medicine and public health sciences at Queen's University

and a practicing clinical hepatologist. Jennifer, good morning. Good morning. You've been listening in to Samantha's story. Tell us your thoughts. I mean, unfortunately, it's a familiar story to me, becoming more and more familiar, which is why we wanted to look into this and actually study it. I think 15 years ago when I was training in residency, it would be relatively rare to have such a young female coming in with signs of advanced liver disease or liver failure.

And now, unfortunately, we're seeing it regularly in the hospitals, in the clinic. And so I wish I could say I hadn't heard this story before, but I've heard it many times. And when you say regularly, how often are you seeing this? I mean, I would say we get referrals, we get referrals for similar stories, at least weekly at our institution. And I know not only, you know, in Ontario, in Canada, my colleagues in the United States, other places in the world, you know, everybody is seeing this. So tell us more about that.

Your study looked at the incidence of alcohol-associated liver disease in teens and young adults, as well as the outcomes. What were you seeing in your clinical practice that made you want to look at it? Was it just that there was more of it? Was it the severity? Why were the alarm bells going off for you? That we were seeing it more often and we were seeing it in young females. Like Samantha said, we think that classically cirrhosis is a disease of middle-aged or older

men and then to see all of these young women suffering from this and having it become more prevalent in kind of our daily practice made us want to figure out, you know, is this just something that's happening locally? Is this more widespread? So what we particularly looked at in this study was a type of alcohol-associated liver disease called alcohol-associated hepatitis. And so when I try and describe this to people, it's kind of like your liver gets in a car crash.

So with very heavy, regular alcohol ingestion, you can very rapidly deteriorate the function of your liver and you can go directly into liver failure, sometimes without even having cirrhosis. And so this is what we were seeing. So what we did was we actually just described it and said, you know, are the numbers going up? And it showed that it was increasing by 8% per year over the past decade and it was going up faster among females than males.

So it kind of confirmed what we were seeing. Okay, lots to unpack there. Let's start with the increase. What do you attribute this increase to? Oh, I think there's so many things. I mean, Samantha hit on one thing. I think that, you know, if you look at the proportion of young people who are consuming alcohol,

the proportion is actually going down. So it's not actually that there's more people consuming alcohol and that's why we're seeing it more. I think it's the way that people are using alcohol. And like Samantha said, there's been this increase in alcoholic beverages that combine alcohol with sugar. And the two are toxic to the liver, both of them. And so I think that that potentially is one thing, that the things that people are drinking, and maybe that demographic of young females

where marketing is targeting young women and saying, oh, look at this pink fruity drink, let's sell it to women. And then it has a double whammy, right? Because it has the alcohol and it has the sugar. I think that's one thing. The culture of alcohol use among women has changed. So historically, say, you know, 50 years ago, it was very clear that males consumed more

alcohol than women. But now that gender gap has closed. And so men and women are drinking similar amounts of alcohol. And we know biologically women are predisposed to higher degrees of liver damage for the same amount of alcohol consumed compared to men due to multiple factors. One is their ability to process alcohol. They have less of the enzyme that breaks down alcohol. They have less body water, just physically smaller, and so the concentration of alcohol gets higher among women than it does in men. And then

I think that, you know, like she said, there's a lot of lack of information and knowledge about liver disease. You know, liver candidate did a survey and nine out of ten people weren't concerned about their liver health. And so I think that there's this kind of lack of awareness of the ability for alcohol to damage your liver even at a young age. Okay. Well, let's drill down into that. When we talk about alcohol-associated hepatitis, just how serious is it, the risks once you

have this? So it's the most severe form of alcohol-associated liver disease and depending on how severe it is at the time you actually present for medical attention, between 30 and 50% of people can die within 30 to 90 days. So it's very severe. In our study, we saw that among these young people, the average age was in their 30s. After they presented, 20% of them had died within five years. So this is a very serious liver injury. But like Samantha said,

the ability of the liver to repair itself and regenerate is one of the things that makes treating these individuals so very rewarding because you can see somebody who's very sick and on the verge of dying and they can completely turn around. I have seen people do it time and time again and you would see these people one, two years later you wouldn't even recognize them. So I think that it's very treatable if you can identify it early, but you want to identify it early enough so that you get the opportunity to intervene before you run into these complications. So given that, when you're listening to Samantha's story about, you know, sort of being cut adrift

for waiting six months to be able to see a specialist, and the fact that there was just a lack of information that she was given after her first diagnosis, I mean, this just seems to be a recipe for more failure in the system. Yes, I agree. I mean, there are a lack of specialists who specialize in liver disease. There's a growing population in Canada

who have chronic liver diseases, not just related to alcohol, but metabolic-associated liver diseases. There are so many people living with liver disease right now that it's very difficult sometimes to get in to see a specialist. So I have seen that happen with patients waiting to see us. Depending on the severity of your liver disease and how many other people need to see us, it can take months and months to actually see a specialist who might be able to convey that information.

And I agree there is a lack of information out available for the public. And I think it relates to what you mentioned earlier about stigma. And people, you know, assuming that individuals who have alcohol associated liver disease did this to themselves and it's their own fault, and that's not the case. Most of the time, this is related to alcohol use disorder, which is a disease, which needs to be identified and it needs to be treated. And then, you know, trying to blame and shame individuals for this just increases the stigma. People don't talk about it. Many patients I see do not talk to their friends and family about what's going on for fear

that they're going to be stigmatized. And so I think we really need to change the conversation in Canada about liver disease because it's more common and we need more information. And I guess there's a component to this, of course, which is prevention. I mean, obviously, don't drink whatsoever would be one approach. But if you are, I mean, how much does someone have to drink to damage their liver? Perhaps that they just need to know what the stakes are out there.

Yeah, so this is very difficult to kind of pinpoint an exact amount. I mean, there's lots of things we've estimated. Obviously, if you don't use alcohol, you won't have any alcohol-related complications. That's an easy answer. But, you know, you can have two individuals who consume the exact same amount of alcohol and somebody will develop liver failure and someone will be totally fine. There's other things that come into play. There's genetics, there's your environment, there's the types of alcohol that you're drinking, whether or not you have any other underlying liver disease. So when in general, when we, you know, if I'm in

clinic and I'm taking a history of somebody's alcohol use to try and determine, you know, are you at risk of developing liver disease? We would typically say if you're a man who consumes more than three drinks per day or a woman who consumes more than two drinks per day, that will put you at risk of liver disease. The problem is is that people don't know how to quantify their alcohol consumption. We don't label alcohol in Canada, right? If you go and you buy something from the grocery store, you know exactly how much protein and carbohydrates and sugar are in whatever you're eating, but you go pick up a bottle of alcohol

and you try and figure out how much alcohol you're drinking, you're not going to be able to know. So we convey this information, but we don't actually empower people to use it because we don't actually label the contents of alcohol. I'm sensing a little frustration in your voice, Jennifer, as you talk about this. I know you're very passionate about it, of course. But do you feel the frustration that you're shouting from the rooftops and perhaps people aren't listening?

I do feel that. You know, and again, I think it relates to stigma, right? Or people not thinking that it applies to them. But if you actually talk to people, more people are affected by liver disease, whether, you know, it's somebody in their family, somebody you know. When you actually start talking to people, it's very prevalent. Like we would say that 25% of people walking around Canada have some form of chronic liver disease, whether that's alcohol related or not. Well we're giving you the platform today and it's an

important platform but with everything that you've seen and considering your research, what is your message to teens, young adults and their parents about alcohol use? I mean I think knowledge is power. I think we need to empower people to make their own decisions and to have the information to make those decisions. You know, it's very challenging with alcohol because alcohol is embedded in so much

social cultural things that we do. But I think that step number one is having knowledge. So understanding that there are risks associated with alcohol consumption, even at a young age is having knowledge. So understanding that there are risks associated with alcohol consumption, even at a young age, is step one. And then providing people with the information so that they can make decisions about how they want to take risks and things like that. Everybody's a bit different.

Jennifer, I'm glad we had this conversation. Thank you for your work, and thank you for your time. I really appreciate it. Thank you so much. Jennifer Fleming is an associate professor of medicine and public health sciences at Queen's University.