Dr. Makeda Dawkins, a Board-Certified Internal Medicine Physician and Gastroenterology Fellow at Westchester Medical Center, recently shared her insights on liver health and how liver disease specifically impacts the Black community. In this informative interview, Dr. Dawkins discusses common liver conditions affecting African Americans, early warning signs to watch for, and practical prevention strategies to maintain optimal liver health.
What are some common liver diseases affecting African Americans?
There are many reasons to have problems with your liver, and those reasons can range from heavy and consistent alcohol use to side effects from certain medications to autoimmune disease to obesity. The things that are documented mostly in the literature now are obesity as a cause of liver disease, and unfortunately, liver cancer and alcohol use. Those are number one and number two reasons to have liver disease.
What symptoms should people watch for in early stages?
When it comes to alcohol, usually the social habits that people have should be the first kind of concern. If you’re someone that commonly is going out on the weekend, and you’re having 5 or 7 drinks, and you’re kind of binge drinking, I know it doesn’t seem that way to a lot of people when they think about it, but if you’re going out once a week and having 5, 7, 8 drinks, that’s binge drinking. If you’re doing that over the span of months or years that can have an effect on your liver with time.
Sometimes it’ll range from just going to the doctor for your annual, and you’re seeing that some of your AST/ALT, which are numbers that show inflammation in the liver, may be a little bit high, or sometimes you may physically start seeing and feeling the effects. If you have signs of more advanced liver disease, your eyes or your skin might start turning yellow, you might start having fluid in your stomach or fluid in your legs, and those are the signs that some of your social habits are now impacting your liver health.
When it comes to things like obesity, it’s difficult to tell, because now there is so much more information and more advertising about what we call fatty liver disease, and now there’s data to show that actually, fatty liver disease can cause cancer. You’re talking about patients who may be overweight, who may also have high blood pressure, may also have diabetes, and may also have coronary artery disease, or signs of metabolic syndrome. The biggest thing for that is going to your doctor regularly and completing your routine screenings.
When you’re going to the doctor, and they tell you that your BMI is 35, or 40, taking that seriously. Yes, sometimes the BMI is not the best predictor in people of minority and African American descent, just because of the proportion of fat on the body, but when you’re talking about central adiposity, that’s the biggest sign or symptom that you do have some extra weight on the body.
There is no definitive recommendation for liver cancer screening in someone who has no risk factors, however, sometimes what we find is that when patients go to the emergency room for one reason, oftentimes you get a CAT scan. It’ll show that you have some fatty infiltration of the liver, from there, there are certain scoring systems that we use based on your labs to show the likelihood of having stiffening or hardening of your liver, which we call fibrosis, and based off the fibrosis scale that’ll determine how aggressive you should be with treatment and what your likelihood is of developing complications from that liver disease.
For the obesity portion, the most important things to look for are how your weight is distributed, what you’re eating on a daily basis, what your protein intake is, what your fat to protein ratio is of your body, and then your overall health as well, because usually when you have fatty liver disease, you also have other things going on outside of that.
Are African Americans at a higher risk for conditions like fatty liver disease, cirrhosis, or hepatitis?
There’s a lot of social data that goes into determining if African Americans are more at risk for liver disease because of things like food deserts. The fast food density or concentration in certain African American communities sometimes makes you more susceptible to having things like fatty infiltration of the liver and fatty liver disease, but also you can have a combination of the two.
A lot of patients who live in these areas and don’t have the best intake and diet also have a heavier use of alcohol, they have basically a kind of two-hit risk factor going on for developing liver disease. Overall, it’s your social habits that determine your risk. However, when it comes to recommendations and referral for transplant, there’s a lot of data to show that African Americans are not referred for liver transplant within the same time period as other populations, and I think that’s the most concerning thing.
What steps can African Americans take to protect their liver health and prevent liver disease?
Vaccination is very important, when we talk about hepatitis, there are many types of viral hepatitis, because the term hepatitis means inflammation of your liver. Commonly what we talk about is hepatitis B and hepatitis C. Hepatitis B is largely preventable because there is a 2-series and 3-series vaccine that is available. The CDC recommends that every person over the age of 18 should be fully vaccinated for hepatitis B.
Make sure you’re up to date with your screening, testing for hepatitis C is recommended as well. It’s a blood test that can be done and basically shows you if you ever had an exposure, because there currently is no vaccine for hepatitis C.
Another thing to do is when you’re checking with your doctor, your lipid panel to test if you have high cholesterol, your A1C to make sure you don’t have diabetes, getting your blood pressure checked, all of those things go into your pretest probability of developing fatty liver disease. We talk about metabolic syndrome as a risk factor for developing fatty liver disease, it’s your whole body system, and the liver is just a reflection of that.
Limiting your alcohol intake, making sure you’re not binge drinking, if you have any complications of alcohol intake or any complications of alcoholism, make sure you’re getting treatment for that and being honest about it with your family and friends. In our culture sometimes alcohol use is normalized and it’s accepted largely when you look at people at parties and clubs, but oftentimes, if you’re doing that Friday, Saturday, and going to a day party on a Sunday, now you’re talking about 3 days of very heavy alcohol use more than twice a month, those things accumulate with time and can affect your liver.
Are there any myths about liver disease that you’d like to debunk?
Detoxing, this is the biggest thing that comes up with our patients. The vitamins and the minerals and the tablets that are sometimes advertised in certain places are not FDA approved, they’re not FDA regulated. A lot of the times you’re finding things on social media that may or may not have any scientific backing or input in them.
It’s very important to always read the ingredients, and it’s very important to always run these things by your physician, because anything can be harmful even though you think it’s going to be helpful. A lot of the herbal supplements are actually documented to cause liver disease and liver irritation, inflammation. So if you’re someone who’s taking turmeric every day because you think it helps your digestion, that can affect your liver.
A lot of herbal supplements also have side effects that are outside of the liver that can affect you negatively as well. So that’s one thing I want to point out, the idea about a liver detox and the care that needs to be taken when you’re taking some of these supplements, especially if you’re on other medications, because sometimes they can hasten the metabolism, meaning that you don’t get the full effect, and sometimes they can decrease your metabolism, meaning that you’re getting more of effect than you should have.
Two, the idea that whatever you do, the liver is going to regenerate, and you’ll be fine. I’ve heard this so many times, people say, “Oh, but the liver regenerates. It’s a special organ.” It is a very special organ, it’s my favorite organ, however, there’s always a limit, everything has a limit.
It’s true that you don’t necessarily need 100% of your liver to survive, because some people do live donor transplants where part of your liver is transplanted to someone else, and you live a healthy life, but there’s always a limit to these things, and you don’t want to be in a situation where you’re pushing the limit, and you’ve passed the limit.
Making sure you’re consulting with a board certified physician, or someone who has the degree and the backing to give you input is very important, and don’t ever think that your questions are too small for your doctor, because that’s what they’re there for.
I think oftentimes the patients that I see are generally in the hospital, and once you’re in a state where you require an inpatient stay, the conversation is a little bit different, but the one thing that they always take for granted is the effort they put into maintaining their health. There are a lot of things that can be replaced in life and health is not one of them, it’s a one and done, it’s your only opportunity. You only get one body, and you need to make sure you take the best care of it as possible.
