The liver, that quiet workhorse of the human body, serves as both filtration system and metabolic powerhouse. Yet for many in the African American community, this vital organ faces disproportionate threats. In a recent conversation with Rolling Out Health IQ, Dr. Makeda Dawkins, a gastroenterology fellow, shared insights about liver health disparities that receive far too little attention in both medical literature and community discussions.
“When it comes to liver disease, there are many reasons to have problems with your liver,” Dr. Dawkins explains, her voice carrying the measured cadence of someone who has delivered difficult news to patients. “Those reasons can range from heavy and consistent alcohol use to side effects from certain medications to autoimmune disease to obesity.”
The twin epidemics at the core of liver disease
According to Dr. Dawkins, two factors stand prominently in the current literature as primary drivers of liver disease: obesity and alcohol use. For African Americans, these risk factors often operate within a complex web of social determinants that compound their effects.
“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,” she notes. This environmental reality makes some more susceptible to fatty liver disease, a condition once considered relatively benign but now recognized as potentially serious.
What’s particularly concerning is what Dr. Dawkins describes as a “two-hit risk factor” affecting many patients. “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. So they have basically a kind of two-hit risk factor going on for developing liver disease.”
The implications extend beyond merely developing the disease. “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,” Dr. Dawkins states, highlighting how disparities persist throughout the care continuum.
Recognizing the early warning signs
Most liver disease develops silently, with symptoms appearing only after significant damage has occurred. For alcohol-related liver disease, Dr. Dawkins suggests that social habits often provide the first warning signs before physical symptoms emerge.
“If you’re someone that commonly is going out on the weekend, and you’re having five or seven 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. I think it’s maybe just a social activity. They do it once a week, but if you’re going out once a week and having five, seven, eight drinks, that’s binge drinking,” she explains.
Over time, these habits can manifest as inflammation in liver enzyme tests, or more visibly as jaundice (yellowing of the eyes or skin) or fluid accumulation in the abdomen or legs. For obesity-related liver disease, the signs can be even more subtle and easily missed without regular medical screenings.
Dr. Dawkins points to central adiposity, fat concentrated around the midsection, as a key physical indicator of potential liver issues, especially when accompanied by other metabolic syndrome markers like high blood pressure or diabetes.
“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,” she observes.
Prevention strategies that actually work
When asked about protective measures, Dr. Dawkins outlines three primary approaches:
1. Vaccination and screening. “Vaccination is very important,” she emphasizes, particularly for hepatitis B, which now has a CDC recommendation that all adults over 18 be fully vaccinated. Similarly, testing for hepatitis C is recommended through a simple blood test, though no vaccine currently exists for this form of viral hepatitis.
2. Regular medical monitoring. “Another thing to do is when you’re checking with your doctor, your regular screening, so 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,” Dr. Dawkins explains.
3. Alcohol moderation. Here, Dr. Dawkins treads carefully but firmly into cultural territory. “I think that in our culture sometimes alcohol use is normalized and it’s accepted largely when you look at people at parties and clubs and things like that, but oftentimes, if you’re doing that Friday, Saturday, you’re going to a day party on a Sunday, now you’re talking about three days of very heavy alcohol use more than twice a month. So those things kind of accumulate with time and can affect your liver.”
Perhaps most surprising in Dr. Dawkins’ insights is her firm rejection of the “liver detox” trend that has swept through social media and supplement aisles. “This is the biggest thing that comes up,” she notes with a hint of frustration. “The vitamins and the minerals and the tablets that are sometimes advertised in certain places are not FDA approved. They’re not FDA regulated.”
Even more concerning, she warns that many herbal supplements marketed for digestive health can actually harm the liver. “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, you read that that can affect your liver.”
She also cautions against the widespread belief that the liver’s regenerative capacity makes it impervious to long-term damage. “The idea that whatever you do, the liver’s going to regenerate, and you’ll be fine. I’ve heard this so many times,” she says. “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.”
As our conversation concludes, Dr. Dawkins shares a perspective that extends beyond liver health to a philosophy of overall wellbeing. “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, and they say, ‘Oh, if I knew this, and if I knew that.’ 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.”
In a medical landscape where liver health often takes a back seat to more visible concerns like heart disease or diabetes, Dr. Dawkins’ insights serve as both warning and roadmap for a community already navigating health disparities on multiple fronts. Her message is clear, the liver speaks quietly until it can’t, and prevention remains our most powerful medicine.
