Daniel Robles is very interested in how precision medicine can shed light on questions about liver disease and liver cancer among military veterans.

Robles, a senior research coordinator at the UC Davis Comprehensive Cancer Center, served in the U.S. Marine Corps from 1988 to 1993 — including months in the active combat theater during 1991’s Persian Gulf War.

During a workup for headaches a couple of years after his discharge, doctors noticed chronic liver inflammation. A few years later, Robles — who doesn’t drink alcohol — was diagnosed with non-alcoholic fatty liver disease or NAFLD, a common precursor to liver damage and cancer.

He wasn’t the only one. Robles is heavily involved in a large veterans' organization, and has noticed many NAFLD questions on web forums. But so far, he’s found no formal advice published by the Veterans Administration.

"People are looking for answers, and right now there are just none," he said.

NAFLD is often seen in patients with diabetes, obesity, alcohol use, or occasionally inherited predisposition. But many military personnel also develop NAFLD and consequent liver problems without known predisposition.

Many veterans suffer from anxiety or post-traumatic stress disorder (PTSD), Robles said, which can lead to self-medication with food or alcohol. "You tend to hunker down with what’s comfortable, and that can include poor food choices," he said.

But while mental health support for veterans is crucial, Robles said there’s also speculation and suspicion that environmental exposures play a role in the liver issues as well. Specialists told Robles that while no studies currently show formal correlation between liver problems and the Gulf War, there’s other empirical evidence linking the two — possibly involving depleted uranium in ammunition.

"I do worry," Robles said. "When I look at my life today and see loose patterns of empirical evidence pointing to the Gulf War, that concerns me. However, the best approach for now is to make better choices about fitness, diet and lifestyle."