While we have been discussing the microbiome, we have a golden opportunity to show how it can influence the development of other types of diseases and in this article, the focus will be the liver. I want to discuss a major health problem in the US called Non-Alcoholic Fatty Liver Disease, usually abbreviated NAFLD.
To understand what NAFLD is and how it develops, we need to first understand what the liver actually does. There’s a reason it’s the largest internal organ. It has many important functions and I’ll just touch on a few major activities. It is a key organ that regulates how our bodies process and utilize the nutrients that result from digestion of food. It can store and release energy sources as needed and can make new energy units when necessary.
The energy required for all our body functions mainly comes from carbohydrates and fats. Carbohydrates are broken down into sugars, fats are broken down into fatty acids and triglycerides. These are the fuels our bodies run on that are produced as our food is digested. These nutrients are absorbed from the intestine and enter the bloodstream going directly to the liver. The liver can store carbohydrates and release them as sugars when needed.
It can also make new sugar for use as fuel. It can take fatty acids from the dietary fats and package it into triglyceride-rich particles, the form that fats are transported in the body as an energy source. It can remove cholesterol from the circulation and use it to produce bile, an important chemical we need to be able to digest fats. This just the tip of the iceberg of what the liver does, but these functions are important to causes and effects of fatty liver disease.
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Non-alcoholic fatty liver disease is named such to indicate that this disease process is different from the damage that alcohol abuse and dependency causes in the liver, but the outcomes may be similar. In the US, it is estimated that there are 80-100 million people with NAFLD.
One of the key features of this disease is the accumulation of fat globules in the liver cells. Other features include obesity, high levels of triglycerides circulating in the blood, high blood pressure and the early stages of diabetes, referred to as insulin resistance (you can find articles on all these medical problems on the blackdoctor.org website).
Collectively, we call this condition Metabolic Syndrome. The problem is that the fat accumulation can trigger an immune response and inflammation in the liver which can progress to cirrhosis, liver failure and potentially, liver cancer.
So what causes NAFLD? It can be seen as one of the consequences of this metabolic syndrome where the body is in crisis over the intake and utilization of fuels (carbohydrates, fats) and other nutrients. Poor diet (intake) and insufficient physical activity (utilization) set off a cascade of events that could result in NAFLD and it’s more serious outcomes.
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At the center of this process is the intestinal microbiome. Many studies have shown that our diets affect the microbiome. Recall that the intestinal bacteria are essential inbreaking down the foods we ingest and these digested products go to the liver.
Two things happen. First, by eating a poor diet, a diet high in saturated fats, simple carbohydrates, low in plant fiber, high in processed foods, the digested products going to the liver are not optimal. But, secondly, this poor diet produces a change in the microbiome. It is a change from bacteria that can produce products of good nutritional value to bacteria that may produce compounds that are actually harmful. And where do these products end up? That’s right, the liver!
Now, let’s talk NAFLD and HIV. Recall in the article on HIV and the Gut microbiome that HIV disease by itself can cause a shift in the microbiome from the “good” bacteria to the “not so good” bacteria. I also described how HIV infection produces a low-grade type of inflammation. So all the ingredients for developing NAFLD are already in place! Therefore, it was no surprise when a large study last year found that over one-third of people with HIV disease had NAFLD. HIV disease doubles the risk of developing NAFLD.
Some of the older drugs used to treat HIV could cause fat in the liver but these drugs are almost never used anymore. African-Americans suffer from the double whammy of metabolic syndrome and HIV at very high rates. I have worked to help patients manage these problems for over two decades.
Over that period, liver disease has steadily increased to be among the top 2-3 causes of death in this era of effective HIV therapy. The fact that many people with HIV disease also have Hepatitis C and Hepatitis B makes this even worse. Work with your medical providers and nutritionists to change your diet and increase physical activity. There are dozens of great articles on the blackdoctor.org website on how to prepare nutritious meals that are delicious and all sorts of ways to increase physical fitness.
Dr. Crawford has over 25 years of experience in the treatment of HIV. While at Howard University School of Medicine, he worked in two HIV-specialty clinics at Howard University Hospital. He then did clinical research as a visiting scientist with the AIDS Clinical Trials Group (ACTG) at Johns Hopkins University School of Medicine. He served as the Assistant Chief of Public Health Research with the Military HIV Research Program where he managed research studies under the President’s Emergency Plan for AID Relief (PEPFAR) in four African countries.
He is currently working in the Division of AIDS in the National Institutes of Health. He has published research in the leading infectious diseases journals and serves on the Editorial Board of the journal AIDS. Any views and perspectives in his articles on blackdoctor.org are not representative of any agency or organization but a reflection of his personal views.
