The Liver and Cholesterol: What You Should Know

Introduction and overview

Balanced cholesterol levels are important to maintaining good health. The liver is an underrecognized part of that effort.

The liver is the largest gland in the body, located in the upper right part of the belly. It is the body’s master detoxer of drugs and other foreign substances. It stores glycogen, which the body uses for energy. It’s also important in metabolizing fat, carbohydrates, and proteins. A healthy liver does all this unnoticed.

An important function of the liver is to produce and clear cholesterol in the body. Most of the attention focused on cholesterol describes its potential for harmful health effects. But cholesterol is necessary for the creation of hormones, vitamin D, and enzymes needed for digestion.

Bundles called lipoproteins carry cholesterol throughout the body. Two important types are high-density lipoproteins (HDL) and low-density lipoproteins (LDL). “High” and “low” refer to the relative proportion of protein to fat in the bundle. The body needs both types in regulated proportions.

Healthy levels of cholesterol in the body

It’s important to know the levels of HDL (“good” cholesterol), LDL (“bad” cholesterol), and total cholesterol in your body. A rough estimate of total cholesterol is HDL, plus LDL, plus one-fifth of a third type of fat called triglyceride.

The National Heart, Lung, and Blood Institute recommends the following levels:

HDL levels of at least 40 milligrams per deciliter (mg/dL) of blood. Anything less than that increases your risk of heart disease. A level of at least 60 mg/dL helps lower your risk for heart disease.

LDL cholesterol levels
Less than 100 mg/dL	optimal
100-129 mg/dL	near optimal/above optimal
130-159 mg/dL	borderline high
160-189 mg/dL	high

Total cholesterol
Less than 200 mg/dL	desirable
200-239 mg/dL	borderline high
240 mg/dL and above	high

Liver function complications

Liver function complications can hinder the organ’s ability to produce or clear cholesterol. Both conditions can create a spike in cholesterol and affect a person’s health. The following conditions can affect the liver in a way that causes cholesterol levels to be abnormal.

Nonalcoholic fatty liver disease

The most common form of liver malfunction is nonalcoholic fatty liver disease (NAFLD). It affects approximately one-quarter of the population. It’s often seen among people who are overweight or have diabetes.

NAFLD is associated with dyslipidemia, abnormal levels of cholesterol and similar compounds in the blood. NAFLD also can trigger lipodystrophy, irregularities in how the body distributes fat.

NAFLD covers a spectrum of conditions. Within NAFLD is the more serious non-alcoholic steatohepatitis (NASH). A diagnosis of NASH often leads to cirrhosis, liver failure, and hepatocellular carcinoma.

Cirrhosis

Cirrhosis can cause scarring and prevent the liver from carrying out basic metabolic functions. The condition is a reaction to long-term injury to the organ. The injury can include inflammation from a disease such a hepatitis C. After hepatitis C, long-term alcohol abuse is the most common cause of cirrhosis in the United States.

Drugs

Another significant cause of liver problems is damage from drugs. The liver’s job is to metabolize chemicals in the body. That makes it susceptible to injury from prescription, over-the-counter, or recreational drugs.

Common drug-induced liver injuries and the drugs associated with these conditions include:

Acute hepatitis

Associated drugs:

• acetaminophen
• bromfenac
• isoniazid
• nevirapine
• ritonavir
• troglitazone

Chronic hepatitis

Associated drugs:

• dantrolene
• diclofenac
• methyldopa
• minocycline
• nitrofurantoin

Mixed pattern or atypical hepatitis

Associated drugs:

• ACE inhibitors
• amoxicillin-clavulanic acid
• chlorpromazine
• erythromycin
• sulindac

Nonalcoholic steatohepatitis

Associated drugs:

• amiodarone
• tamoxifen

Microvesicular steatosis

Associated drugs:

• NRTIs
• valproic acid

Veno-occlusive disease

Associated drugs:

• busulfan
• cyclophosphamide

After discontinuing the drug, liver damage is typically not severe and often subsides. In rare cases, the damage can be severe or permanent.

The effects of high cholesterol

High levels of LDL cholesterol increase the risk of fatty deposits on vessels that bring blood to the heart. Too-low levels of HDL cholesterol suggest the body may not be able to clear plaques and other fatty deposits from the body. Both conditions create a risk for heart disease and heart attack.

When to see a doctor

Liver damage can progress for months or years with no symptoms. By the time symptoms appear, liver damage often is extensive. Some symptoms warrant a visit to the doctor. These include:

• jaundice (yellow skin and eyes)
• fatigue
• weakness
• loss of appetite
• accumulation of fluid within the abdomen
• tendency to bruise easily

Diagnosis

A doctor may be able to diagnose liver problems by observing your symptoms and completing a medical history. You may also undergo tests of your liver function. These tests include

Liver enzyme test: Common enzymes in this panel are alanine transaminase, aspartate transaminase, alkaline phosphatase, and gamma-glutamyl transpeptidase. High levels of any of these enzymes may indicate damage.

Liver protein test: Low levels of the proteins globulin and albumin can show a loss of liver function. Prothrombin is a liver protein needed for clotting. A common test measures how long it takes for your blood to clot. Slow clotting time can mean a lack of prothrombin and liver damage.

Bilirubin test: The blood transports bilirubin to the liver and gallbladder. Then it’s excreted in the stool. Blood in the urine or excess bilirubin in the blood can show liver damage.

Single lipoprotein panel: The panel tests blood cholesterol and tryglycerides together. Blood typically is drawn after fasting.

Treatment

Treatment of liver disorders often starts with addressing the underlying condition. Different liver conditions call for specific dietary changes, but the American Liver Foundation has some general tips.

Do's

• Eat grains, fruits, vegetables, meat and beans, milk, and oil in proportion. Fiber-rich foods are key.
• Stay hydrated.

Avoid

• foods high in fat, sugar, and salt
• raw or undercooked shellfish
• alcohol

Treatment of high cholesterol includes dietary guidelines like those for liver disease. Medical treatment of high cholesterol also often includes a class of drugs called statins. Researchers have looked at whether statins are safe for people with liver disease to use.

“In general, statins are safe in patients with liver disease,” says David Bernstein, MD, FACG, chief of hepatology at Northwell Health, and professor of medicine at Hofstra Northwell School of Medicine in Hempstead, NY. “Patients who have decompensated cirrhosis should be monitored very closely, but in general, they are safe.”

“Is there a risk? Yes, but it’s a very small risk and patients are monitored in the first three to six months,” says Bernstein.

Outlook

Therapeutic interventions promise more effective control of cholesterol, even among people with liver disease. But lifestyle changes and dietary control remain important and effective parts of a complete approach to cholesterol control with liver involvement.

Prevention

The National Heart, Lung, and Blood Institute suggests how to control high levels of blood cholesterol with diet and lifestyle changes:

Bernstein suggests these lifestyle guidelines are good advice for anyone trying to keep cholesterol in check, including those with the added challenge of underlying liver disease.

What does the liver have to do with cholesterol?

Are you concerned about your cholesterol level? Have you tried unsuccessfully to lower it by watching your diet? Did you know that the vast majority of the cholesterol in your body was made by your liver?

On the whole, cholesterol is a beneficial substance in your body. It is so essential in fact that every cell of your body requires it. Having too much cholesterol in your bloodstream can be problematic though; particularly if you have other risk factors for cardiovascular disease, such as high blood pressure and abdominal obesity.

If you want to achieve a healthy cholesterol level, it is vital to improve the health of your liver.

The types of fats that are found in your bloodstream include:

·        HDL cholesterol (often referred to as good cholesterol)

·        LDL cholesterol (often referred to as bad cholesterol, but is only bad if the particle sizes are small and dense)

·        Triglycerides (these are very unhealthy if excess amounts are present). Triglycerides are made in the liver from dietary carbohydrates, sugar and alcohol.

The liver plays a central role in the metabolism of fats and if it is working efficiently the liver makes more of the good cholesterol (HDL cholesterol) and less of the bad cholesterol (LDL cholesterol). If you have a fatty liver this healthy state of affairs becomes reversed and you end up with excess levels of LDL cholesterol floating around in your circulation and this can lead to blocked and hardened arteries. Even more dangerous is the build up of triglyceride fats in the bloodstream that occurs in most people with a fatty liver. Triglycerides are sticky fats and make your blood too thick; this can cause poor circulation and blood clots.

Natural ways to improve your blood fats:

Drink more healthy beverages – water, tea, herbal tea and raw vegetable juices

Take one tablespoon of apple cider vinegar mixed in water – sip this during your main meal and it will also improve digestion

Take a fiber mixture daily- mix the following

·        2 tablespoons of psyllium husks

·        1 to 2 tablespoon of ground LSA (Linseed, Sunflower seeds & Almonds)

·        2 teaspoons of Fibertone powder

·        3 tablespoons of coconut milk

·        Eat this like a porridge or add it to your cereal or smoothie

Garlic can influence the liver’s ability to produce cholesterol. It is thought that garlic is able to reduce the production of the liver enzyme, HMG-CoA, which is responsible for the production of cholesterol. It seems garlic works in the same way as cholesterol-lowering statin drugs, however without the side effects.

Previous studies have supported this finding and have concluded that garlic is capable of lowering harmful LDL cholesterol and raising beneficial HDL cholesterol. A recent study completed at Pennsylvania State University found that the active ingredient in mature garlic (known as S-allyl cysteine) inhibits unhealthy LDL cholesterol. Other studies have also shown that garlic is able to reduce other risk factors associated with cardiovascular disease by enhancing circulation, reducing homocysteine levels (an amino acid which increases the risk of coronary heart disease, stroke and fatty deposits in arteries) and reduce blood clotting.

I am not a believer in the modern day practice of giving everyone with risk factors for heart disease cholesterol lowering drugs, irrespective of their cholesterol levels. I have seen many patients with extremely low cholesterol levels induced by years of these types of drugs and they live in fear of their cholesterol levels rising back to normal levels.

High doses of cholesterol-lowering drugs can cause side effects such as:

·        Liver inflammation

·        Memory impairment

·        Muscle inflammation, muscle pain, muscle weakness and cramps

·        Weakening of the tendons and ligaments

·        Inflammation and weakening of the heart muscle (cardiomyopathy)

·        Mental and physical fatigue

·        Deficiency of co enzyme Q10

Your body manufactures co enzyme Q10 via the same metabolic pathway as cholesterol. That means a drug that reduces your cholesterol level will also reduce your co enzyme Q10 level. This is a problem because CoQ10 is very important for a healthy heart. It helps to bring blood and oxygen to the heart muscle, reducing the risk of heart attacks. It also helps to strengthen the heart muscle and reduce the risk of heart failure. Lastly, co enzyme Q10 assists energy production in the body, therefore helps to improve energy, endurance and stamina. If you are taking a cholesterol lowering drug, a co enzyme Q10 supplement can reduce many of the side effects.

The practice of starting older patients on cholesterol lowering drugs is to be questioned unless they have very elevated levels of small dense LDL cholesterol. Slight elevation of cholesterol in older patients, and indeed in any patients responds to natural therapies, a liver tonic and increased dietary fiber. Often older patients are already on too many prescribed drugs – such as drugs for gastric reflux, pain, arthritis, osteoporosis, high blood pressure, depression, fluid retention etc – the last thing they need is another drug! When the liver has to break down 4 or 5 different drugs, it must work very hard, indeed much much harder than normal. This can cause a higher risk of liver damage and drug interaction side effects.

I have also found that when patients are prescribed too many drugs at one time we get a tendency to weight gain, as there are less energy reserves left in the liver to burn fat. Yes the practice of prescribing too many drugs (polypharmacy) can lead to weight gain as well as serious health problems. Is it normal for a 75 year old to have extremely low levels of cholesterol? I do not think so!

What does the body use cholesterol for?

·        Cholesterol is the raw material that the body uses to manufacture the following –

·        Vitamin D

·        Sex hormones and steroid hormones – such as testosterone, estrogen, progesterone, cortisol

·        Bile salts

·        Production of the myelin sheath which insulates nerve pathways

Just the other day I had a patient who came to visit me with her daughter. She was a woman aged 74 years and had been made to feel seriously ill by taking an ever increasing number of prescribed drugs. She was taking drugs for osteoporosis, high blood pressure, acid reflux and high cholesterol. This polypharmacy had made her feel like “a toxic stew” she said. The diuretics she had been taking had caused her blood electrolytes to become seriously deranged.

Her daughter, being a nurse, had taken her off all the medication, except for her blood pressure tablets. She had made her mother raw vegetable juices and within a week, her mother felt human again and could walk without falling over.

Is the theory that everyone with any risk factors for cardiovascular disease (and isn’t that 90% of us?), should have a very low cholesterol level, a conspiracy theory? I think it is.

There are forces that encourage Western governments to subsidise the use of cholesterol lowering drugs for the majority of its older population – is that natural? I don’t think so.

Share :

Tweet

✚

Related Post