Why we’re launching the Liver Habits Score™

100 million Americans are at risk for later-stage liver disease. Heavy drinkers are especially at risk—but so are moderate drinkers. Cheers® is working to reduce the risks of disease for all drinkers.

In 2020, my wife and I moved into a new home on a golf course. We couldn’t pass up the record low mortgage rates combined with the (then) low costs of housing. After moving in, I played in the golf club championship as the neighborhood revolves around the local country club and my wife and I figured it would be a good way to meet people.

The joke in the community is that it’s a “drinking town with a golfing problem.” My kind of place.

After the championship, I got to drinking at the bar with a number of the other players. I was the new guy, and as most conversations go, it got around to what I did for a living. I explained that I was the founder of Cheers, which is an “alcohol-related health company” where “we sell anything from daily liver supplements to products designed to make you feel better the day after drinking.” Of course, I have been in the Cheers game long enough to know to carry around samples, and so I pulled out a handful of Cheers Restore single serves from my bag and handed them around.

Mission accomplished: This definitely started making me very popular with the new group of people. People hate hangovers almost as much as they love alcohol.

However, once all the discussion of “hangover pills” was coming to an end, the conversation turned more serious than I was expecting. The guys (mostly in their 30s-40s) began telling me about one of their friends who had recently passed away from liver cirrhosis at the age of 36. They said it all happened so quickly. Evidently, a few months prior, a doctor told him he should drink less because his lab tests showed biomarkers of liver disease… then at some point after that he started throwing up blood, and then few days later he went in for surgery to never wake up again. This was a young man that had been playing golf, drinking beers, walking around outside without any concerns just a few weeks prior. The liver disease was so silent that no one knew anything was wrong, including himself, until it was too late.

It was a shock to the whole neighborhood. There’s now a freshly planted tree with a plaque beside it in his honor on the 7th hole, right next to a par 5 tee box. While I never met him… I think about his story every time I play the hole and wonder how I might be able to do something about preventing stories like this in the future.

All of us in the company have similar stories to this. Whether it be a friend, an uncle, a co-worker, a child, or a parent.

In our first 3 years of business, Cheers already has 300,000+ regular customers, has sold 10+ million doses, has reached 50+ million unique Americans reached with advertisements an average of 10 times each on Facebook/Instagram alone, and has 2+ million website visitors each year. These numbers continue to grow rapidly year after year.

As a startup focused on alcohol-related health, and dealing with people (such as ourselves) who are drinkers, we don’t believe there is a company better situated to tackle the habits and risk factors surrounding liver health.

• Our mission (what we strive for every day) is to: “Promote fun, responsible, and health-conscious alcohol consumption.”
• Our vision (the end goal we hope to achieve) is: “A world where everyone can enjoy alcohol throughout a long, healthy, and happy life.”

As can be seen in our mission & vision statements, it’s important not only that our customers are able to have a good time, but that they are healthy, so that they continue to have a good time throughout a long life. The fact of the matter is that liver disease is very preventable with a number of easily implementable best practices.

The liver is an incredible organ. It’s the only organ that can regenerate itself as long as enough healthy tissue remains to make the process occur—something that even the greeks knew two millennia ago as told in the tale of Prometheus.

So even if you believe you have already damaged your liver too much throughout the years… the fact of the matter is that it is basically never too late to start. The liver is extremely resilient in its ability to heal itself after years of abuse once best practices are adopted.

25% of Americans are “heavy drinkers”… this is about 65 million people.

If you look at the United States as a whole based on alcohol consumption, it can really be broken down into 3 groups:

• 1) “Drinkers” (30% of Americans)
• 2) “Special Occasion-ers” (30% of Americans)
• 3) “Never Drinkers” (40% of Americans)

The US CDC defines “heavy drinking” as 2 drinks a day for men and 1 drink a week for women. If taken to its max, this ends up “allowing” for 14 drinks a week for men and 7 drinks a week for women. After that, the CDC, your doctor, etc. are going to consider you a “heavy drinker”.

If you’re a Special Occasion-er or a Never Drinker, then 7–14 drinks a week likely sounds like a lot. “Who could drink that much every week?”

If you’re a Drinker, 7–14 drinks a week typically sounds like pretty light. “Who doesn’t have at least that many drinks every week?”

It’s typically a binary: you’re either a drinker or you’re not.

The chart above shows the average number of drinks for each decile, and the chart is not controlled for male/females. The eighth decile shows an average drinks per week of 6.25, however, the top of that decile is likely over 7 drinks a week. Between the eighth and ninth decile, there are plenty of women included. In total, this means that about 25% of Americans are classified as “heavy drinkers”.

While 25% of Americans are “heavy drinkers”, there’s truthfully not that many people that regularly drink alcohol who aren’t heavy drinkers. It’s only about 5% of people. After this 30% of Americans, it drops off quite aggressively, and the remaining people that drink only do so on special occasions, such as a drink or two on weekends, or at a birthday party or some other event.

Therefore, as far as the American populace goes, 30% of people are “drinkers” and the rest barely touch the stuff.

It should be obvious, but we have found that our customer base almost entirely resides within these 30% of drinking Americans. Besides an alcohol company itself, which would never do something like a Liver Habits Score™, there’s likely no other company in the world with a more fine tuned reach into American drinkers as Cheers.

For what it’s worth. I’m likely within the 87–93 percentile of Americans in terms of alcohol consumption. I am very much a “drinker”. I also scored a -19 on the Liver Habits™—which is funny, because I invented it. This article is not about drinkers being “bad”, it’s about bringing awareness to the activities we choose to partake in and the ways we can reduce our risk factors.

Fatty Liver Disease (FLD) is the first step—and nearly 100m Americans already have it.

In another article, we discuss how all liver disease starts with liver fat percentage. Fatty liver disease (often called “non-alcoholic (NAFLD)” or “alcoholic (AFLD)”) can come from two sources: metabolic disorders (e.g., being overweight), alcohol (drinking too much), or some combination thereof.

The definition of fatty liver disease is quite simple. It’s simply when your liver consists of 5% of fat or more. About 90% of “heavy drinkers” have fatty liver disease, and north of 75% of obese people have fatty liver disease. If you’re both overweight and consume more than 7–14 drinks a week, you can almost be 100% certain that you have fatty liver disease.

There’s a small subset of drinkers that don’t have fatty liver disease, but it’s pretty rare. For example, Brad Pitt was a self described alcoholic, and yet, for most of his life has had an impeccable diet and workout routine. He could potentially be an example of a heavy drinker that doesn’t have any major fat accumulation in his liver. Chances are that if you’re a drinker and don’t look like Brad Pitt in most of his films, you have fatty liver disease, the first step towards structural changes in your liver.

Liver disease is on the rise, both from alcohol and non-alcohol reasons.

• From 1999 to 2016 in the US annual deaths from cirrhosis increased by 65%, to 34,174, while annual deaths from hepatocellular carcinoma doubled to 11,073.
• The cirrhosis disease itself increased by even more and deaths due to cirrhosis are expected to triple by 2030.
• Projected increases in the burden of cirrhosis are thought to be driven primarily by the increasing prevalence of alcoholic liver disease and non-alcoholic fatty liver disease.
• While alcohol itself is a major risk for liver disease, its risks significantly compound when combined with other comorbidities such as: obesity, metabolic disorders, lack of exercise, and lack of proper nutrients in diet.
• Based on alcohol consumption and obesity rates, it’s estimated that between 80–100 million Americans already have fatty liver disease.

These numbers should sound scary—because they are. One of the downsides of the liver being such a resilient organ is that its problems often don’t easily present themselves until it’s too late.

As mentioned before, the good news is that liver disease is very easily preventable/reversible with knowledge about best practices for keeping your liver healthy, which is the whole intent of the Liver Habits Score™.

My Liver Habits Score™ was a -19 before I began implementing best practices to reduce my long-term risks for developing irreversible liver disease. While my Liver Habits Score™ changes from month to month, I now consistently have a positive score around a +10.

Introducing the Liver Habits Score™

In the article Understanding the Liver Habits Score™ we outline the “how” and “what” of the score: how the score works, its methodology, what each score means, the research behind it, and more.

However here, the goal is to help you understand the “why” of the score and our motivation behind it.

The score is quite simple. Through a series of questions that a person answers (similar in format to the Myers-Briggs Personality Test), we get at the liver-related habits that someone has in their life and then assign them a total score that’s intent is to help someone understand whether they are at more or less risk over time to develop liver disease than the average not drinking adult at normal bodyweight.

We then present how this score can be improved through a results page that is easy to understand. These areas for improvement are broken into categories that make it easy for the user to see where they are doing poorly and where they can improve.

Overall, there are 10 categories ranging from alcohol-related questions (such as # of drinking days per week) to other health-related questions (such as minutes of exercise per week). Each category is weighed differently based on a best understanding of how it affects liver health. Each category has written content to give drinkers an understanding of how that habit affects their overall liver health.

For example, if Brad Pitt were to take the test, he’d understand that while he’s nailing the diet and exercise side of things, the areas of improvement for him would be concentrated around alcohol consumption. Even if he’s unwilling to drink less, there are still strategies he could use to reduce the risk of his drinking habits. For example, a series of large scale studies have revealed evidence that # of drinking days per week is its own risk factor, and that by merely reducing your # of drinking days per week from everyday to 5 days per week can have very significant reductions in risk for liver disease. We deal with this topic in an article titled: “How Reducing Your # of Drinking Days per Week is a Low Hanging Fruit for Overall Liver Health”.

The idea behind our Liver Habits Score™ is quite simple. We don’t want people to unknowing develop liver disease. By taking our test they not only will be able to see if they are at risk, but they will also be given information about how they can improve. While our Liver Habits Test™ is not an excuse to deny seeing a doctor, it can help raise awareness for a very important, and yet unappreciated topic.

The long-term vision for Cheers’ role in liver health:

There are two ways to get at someone’s liver health: 1) reviewing their habits and 2) looking at their liver-related biomarkers.

When it comes to liver-related biomarkers, the way that doctors typically do this is through something called a “liver panel”, which is a blood test that captures various biomarkers including: Alanine transaminase (ALT), Aspartate transaminase (AST), Alkaline phosphatase (ALP), Albumin and total protein, Bilirubin, and others. These biomarkers have normal ranges, and when something is outside of these ranges, it could mean that something is going wrong with your liver and that you should definitely see a doctor.

Many Americans don’t have insurance or do regular doctor visits. And even people of significant financial means often don’t do regular doctor visits due to inconvenience—I’m often one of them. Since the liver often does give any visible warning signs until it’s too late, we’re trying to preempt this problem by enabling you keep tabs on your liver health through helping you track both your 1) liver-related habits and 2) your liver biomarkers over time.

The Liver Habits Score™ test is meant to be taken monthly. And we are currently partnering with at-home lab test providers to be able to offer a quarterly service where you can test your liver-related biomarkers through an at-home (or close by) liver panel blood test.

Altogether, our goal is threefold: 1) to help people see from month-to-month how their liver health is trending, 2) to ensure negative liver health does not surprise anyone before it’s too late, and 3) to offer best practices to help people reduce their liver-related risks and improve overall liver health.

This is all part of our vision of creating a world where everyone can enjoy alcohol throughout a long, healthy, and happy life.

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