High cholesterol and liver disease

Specialist’s Corner

Dr  Deepak K Agarwal

The writer is senior consultant  gastroenterologist, hepatologist & endoscopist and is running a successful medical Centre in Lucknow

When it comes to managing cholesterol in your body, your liver is key. Your liver makes cholesterol and sends it to other parts of your body where you need it. Your liver makes lipoproteins that carry cholesterol and other lipids through the bloodstream. Your liver is also important for getting rid of cholesterol through a fluid called bile. If high cholesterol runs in your family, it’s likely because your liver isn’t able to keep up with recycling or getting rid of cholesterol the way it should. As a result, cholesterol gets too high.

You’ve probably heard that eating too much cholesterol is bad for your heart. But it may be even worse for your liver. One of the functions of the liver is to break down cholesterol. If the liver is not working properly, it can cause cholesterol to build up in the body. The cholesterol in your blood comes from two sources: the foods you eat and your liver. Your liver makes all the cholesterol your body needs. Cholesterol and other fats are carried in your bloodstream as spherical particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL or “bad" cholesterol can contribute to the formation of plaque buildup in the arteries (atherosclerosis). This is linked to higher risk for heart attack and stroke. Cholesterol from food mostly ends up in the liver. If you are getting too much, this can increase your risk for fatty liver disease. High cholesterol also can turn fatty liver disease (steatosis) into a more serious and sometimes fatal condition known as nonalcoholic steatohepatitis (NASH).

When fatty liver disease turns into NASH, it can lead to other liver problems including: Liver inflammation; Scarring (cirrhosis); Liver failure; Liver cancer. Changes in lipids including cholesterol also may play a role in other chronic liver diseases, including: Alcoholic liver disease; Hepatitis C; Hepatitis B; Cholestatic liver disease; Cirrhosis. If you have high cholesterol and concerns about your liver, there’s a lot you can do to reduce your risks and protect your liver. These steps include: Getting regular aerobic exercise; Eating less saturated or trans-fat; Eating more fiber; Eating fewer carbohydrates; Maintaining a healthy weight. Studies have shown that a Mediterranean diet is good for your liver. A Mediterranean diet includes lower amounts of red meat and dairy and is rich in: Vegetables; Fruits; Whole grains; Beans; Nuts and seeds. If you have liver disease and diet and exercise aren’t enough to lower your cholesterol, your doctor may suggest you take a cholesterol-lowering medicine. If you have high cholesterol and think your liver may be at risk, talk to your doctor about steps you can take to lower your risks.

A diet can create fat around the liver if it is high in cholesterol. This scenario can lead liver damage in the long-term and can increase the risk of health problems, such as a stroke or diabetes. If the condition is found and treated at an early stage, it is often possible to stop it from getting worse. A person can also reduce the amount of fat in their liver at an early stage. Usually, high cholesterol does not cause any symptoms. But a simple blood test measures cholesterol level. A doctor may recommend a cholesterol test if a person has a family history of heart disease, a medical condition such as diabetes, or if they are overweight. A liver biopsy or liver function test is usually used to diagnose liver disease. A biopsy will remove a tiny piece of liver tissue to test for disease. A liver function test is a blood test that can measure proteins and enzymes in the blood.

For people who have plaque in their arteries or who have other factors that put them at risk for cardiovascular disease, doctors recommend an ideal LDL level well below 70 mg/dl. For those without risk factors who have an LDL level at or above 190 mg/dl, the recommendation is to get this level down to below 100 mg/dl. People age 40 to 75 who are living with diabetes and whose LDL is at 70 or above may need medication. Treatment may include: Addressing risk factors. Some risk factors that can be changed include lack of exercise and poor eating habits. Cholesterol-lowering medicines. Medicines are used to lower fats in the blood, particularly LDL cholesterol. The most common group of medicines is statins, which a person needs to take for life. Statins are drugs that block a chemical in the liver that makes cholesterol. The two most effective types are atorvastatin and rosuvastatin. Other medicines that lower cholesterol levels are ezetimibe and PCSK9 inhibitors. High cholesterol levels early in life may play a role in developing atherosclerosis as an adult.

A person can make lifestyle changes and sometimes take medication to treat high cholesterol. Usually, they will be encouraged to make changes to diet and exercise first. If they are overweight, they may be advised to lose weight. A doctor may prescribe medication if these changes do not lower cholesterol after a few months. Treatment for liver disease depends on what type of liver disease a person is experiencing. It will usually involve lifestyle changes, medication, or sometimes, a liver transplant if the liver is too damaged to function. Diet can help to cut the risk of developing liver disease and may reduce its impact. Keeping to a healthy weight is an essential way to maintain good overall health. What a person is recommended to eat or drink may be different for each specific liver disease. A doctor will be able to advise on diet and exercise. A person who has alcohol-related liver disease will usually be advised to stop drinking alcohol. Eating enough protein and carbohydrates as part of a balanced diet can help maintain a healthy weight. Cutting down on fatty foods may reduce the impact of a fatty liver or NAFLD. Eating plenty of fruits and vegetables, and foods such as bread and potatoes that release energy slowly can help. A diet with plenty of protein is a way of obtaining adequate energy supplies without eating high-cholesterol foods. Eggs, nuts, chicken breast, and pulses are excellent sources of protein. Eating regularly and snacking between meals can be a healthful way for a person to get enough fuel. A person can help prevent health problems, such as damage to the liver, by reducing high levels of LDL cholesterol. They can lower cholesterol by eating a healthful diet, with plenty of fruits and vegetables. Saturated fats contain a high level of cholesterol. Many fast foods, cakes, butter, fatty meats such as sausages, full-fat cheese, and cream contain saturated fats. Taking regular exercise can help to lower a person’s cholesterol. Giving up smoking can also be beneficial. Making changes to diet and exercise are ways a person can manage high cholesterol. And they will need to maintain these changes to avoid high cholesterol returning. The liver can repair itself up to a certain point. This means that someone may be able to reduce the damage that has been done if they discover liver disease at an early stage. Losing weight if needed, eating a healthful diet, exercising, and cutting down on alcohol can help to reduce the impact of liver disease.