British Liver Trust
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Cholesterol and Liver Damage

I have liver fibrosis and found out this week that my cholesterol is high at 8.7. My GP wants to put me straight onto statins and said it is high enough to admit me to hospital if I don't comply. I am worried the statins will damage my liver even more but the pharmacist said I will be okay. I would appreciate other's thoughts on this. Thanks.

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I’m interested in this. My cholesterol is 6.7 so not quite so high but am considering statins. I haven’t been diagnosed with fibrosis but I suspect I have it as my ggt is on the low 90s from fatty liver. Depends on your age and other factors I guess. Maybe exercise and diet will help?

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exercise and diet can only be good, personally I'm out on the statins and have refused them but that's not to say I'm right! I did take them for a week and my numbers dropped significantly.

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I had high cholesterol about 12 years ago which was thought to be familial hypercholesterolemia but statins didn't agree with me causing quite a few side effects so I was taken off them when my levels dropped. I am on a lot of other meds for heart failure and I also have hypothyroidism so statins will only add to all the other side effects which are bad enough.

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Statins aren't generally considered as drugs that adversely affect the liver for most people although they can have numerous unpleasant side effects.

There's a lot you can do to get your cholesterol down. Do a Google search for the McDougall diet. It's too extreme for my liking but the success stories reported by people that tried it including lowering cholesterol are impressive. Personally I'd still eat a small amount of lean meat on the diet occasionally (maybe once a week) but follow the rest of it as close as I could to see if it lowered cholesterol. It's a very low fat diet & if your cholesterol didn't drop significantly I'd be very surprised.

Your GP is rightly concerned & is doing the right thing in urging you to go on statins. My father had massively high cholesterol (his was over 12) & he suffered a stroke after ignoring warnings. He lost the use of his left arm as a result of the stroke. It could have been much worse.

I'd take the statins but also try lifestyle changes like diet to lower cholesterol & depending on the results the statin dose could be lowered or even stopped if a low fat diet worked. While taking the statin you could have liver function tests every couple of months to see if the statin caused a rise in liver enzymes.

The other alternative is to try diet first & see how successful it was & if cholesterol didn't come down significantly then take statins.

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I will have a look for the McDougall diet and give it a try.

I am sorry to hear about your dad. I do have heart problems but they are not connected to clogged arteries.

My liver enzymes are already high and I have some liver damage which is why I was concerned. I have heard statins can cause liver damage and I am concerned because my liver already has problems with metabolising drugs so the statins will add extra pressure on it. I think I will have to weigh the pros and cons and try to make an informed decision.

I did ask my GP if I could try lowering my cholesterol levels by diet but he wouldn't hear of it and that was when he said it is high enough for me to be admitted to hospital which quite surprised me. The test was done 3 weeks ago but I had to wait that long before I could get an appointment which made me think it can't have been that urgent.

I had another cholesterol test on Thursday in the hope that it may have gone down since then and I am hoping it hasn't gone even higher.

Thanks for your advise.

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the doctors probably saying that because the levels are too high-it can take a long time to reduce cholesterol by diet alone which is placing you at risk. I think Edwards approach is sensible. I'm seeing the GP in a few weeks and i'll let you know what I'm going to do-in my case losing 10kgs and getting fitter will probably help the ggt levels and Cholesterol levels. I may opt for a low dose statin to see what impact that has....I'm coming to the conclusion that I have a higher risk of stroke/heart attack with elevated GGT and high cholesterol than serious liver damage casued by statins. It's all a risk game...

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sensible approach

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Yes, I agree Edward's approach is sensible and I am going to go back and see the doctor again next week to see if I can have my liver function checked again first. I am waiting also to hear from the Hepatologist and hopefully she can advise me too and I will be able to take the statins. The highest my GGT levels have been is 145 but I also have high ALT and AST. I do believe most of the liver damage was caused by the other meds I am on.

Last summer I managed to lose quite a bit of weight through a low carb, no sugar diet and I was able to exercise and I have to say I felt a lot better. My cholesterol was 5.7 at that time which is still high but not too bad.

My GP wants me to start on 40mg Atorvastatin and I think he may want to put it up to 80mg, so it is quite a high dose on one of the high intensity statins.

Do please let me know how you get on once you have had your appointment.

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yep will do-meantime all the best

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Thanks and good luck with your appointment.

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I can understand why you are concerned. I would be too if I was in your situation. Statins can have all sorts of side effects that aren't pleasant & I'd want to avoid them if possible. Before my previous reply I checked online & in a book 'Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease' that I bought & read when I had acute hepatitis. It's a little out of date now but probably the most comprehensive book on liver disease ever written for the lay person & I could find no reference to statins causing significant problems for the liver for most people including people with liver disease.

I had high cholesterol some years back when I was overweight, my diet was poor & I had become sedentary. My cholesterol was around 7 & my GP suggested I go on statins & I refused. I laughed when he made me sign a waiver absolving him of any responsibility if I had a stroke or heart attack! I then did the McDougall diet for around 6 weeks before having a blood test & my cholesterol dropped massively. I also exercised daily & lost weight however.

By all means give diet, exercise & losing weight (if you are overweight) a try & if your cholesterol doesn't come down a lot statins may be the only way to get it down because your fibrotic liver may not be able to regulate cholesterol the way a normal liver can.

I live in Australia & I take a capsule daily called 'Blackmores Cholesterol Health' containing plant sterols that lowers cholesterol that I buy at a pharmacy. It lowers cholesterol by up to 10%.

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I have read the information leaflet that comes with my statins and it states not to be taken by people who have ever had a disease which affects the liver or if they have abnormal blood tests for liver function (which I have). Also under warnings and precautions it states to talk to a doctor if you have an underactive thyroid or unexplained muscle pains (I have both). Unfortunately my GP doesn't always check interactions or the effects on other conditions so this is a worry. I think I am going to have to make another appointment before I go ahead and start on the statins because it says blood tests should be carried out first to predict the risk of muscle related side effects.

I was surprised to hear you had to sign a waiver but I suppose your doctor was protecting himself. I could do with losing some weight but at the moment I am getting angina attacks and breathlessness which prevent me from exercising, even walking more than a few metres is difficult. The McDougall diet does sound do-able so I will give it a go. I am not sure about plant sterols so it is something I will have to look into.

Thanks again for your time and advise.

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The doctor that made me sign a waiver was from overseas & newly qualified in Australia. He was being super cautious to protect his new job by covering his arse. I got rid of him after signing his waiver because I thought he was an idiot for making me sign it. My cholesterol of 7 was fixable through diet & lifestyle changes & I knew it. Also both my parents lived into their 70s despite being far less healthy than me & neither died of a heart attack.

If I was in your situation I'd take statins despite the warnings you mentioned while at the same time trying the McDougall diet. At 8.7 and with angina symptoms your cholesterol is too high to risk just relying on lifestyle changes to get it down. Your doctor won't agree to you relying solely on diet to get it down & I wouldn't blame him.

The McDougall diet if followed strictly could fix a lot of your problems. If you read some of the testimonials at his website you are the sort of person that his diet has helped. On his diet people have seen their angina go away as a result of their heart disease reversing.

I hope everything goes well for you whatever you decide.

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Your parents both lived quite long lives and you should too. My mum was very healthy until she was diagnosed with lung cancer and died at the age of 73. My father lived until 77 despite having heart problems but it was heart failure that killed him.

You are right about the statins so I am going to start on them tonight. I got very excited over the McDougall diet but when I checked the food list I realised it is going to be very limiting for me as a lot of the food from the starch category are a big no for me. I have Hashimoto's which is an autoimmune disease and unfortunately foods such as grains, legumes, rice and pasta can cause a bad flare-up. I will see if I can manage it without those foods but if I can't I may go back on the low carb, no sugar diet as that was very effective for me last year.

Thanks again for your help.

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Starches are a mainstay of the McDougall diet for energy. I'd experiment & see what foods he recommends that agree with you. Fruit as a source of energy is healthy because of the fibre and I eat a few oranges every day.

Given how his diet has seen many people reverse their heart disease and other conditions your best bet is to experiment & see which of the McDougall diet foods your body can tolerate. You might even find that the conditions you suffer from improve as a result of following his diet like many people have reported.

A low carb no sugar diet as an alternative to the McDougall diet leads to the question of where you would get your energy from. You can't rely on fat for energy given your heart problems. With your heart condition I'd avoid meat because even when you strip away the visible fat it will contain fat marbled in it. Both fasting & a high protein diet makes the liver more susceptible to damage from hepatotoxic drugs according to hepatologist Melissa Palmer.

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I could see from the list of foods that starches form a large part of it but I will experiment and see what works for me.

The low carb no sugar diet I was on last summer was actually a ketogenic diet which is frowned upon by some because it does mean eating fat. Usually the body uses sugar for energy and unused sugar is converted to fat. With a keto diet with the body not having any sugar it burns fat for energy. It worked quite well for me last year and I lost 30lbs in two months, had more energy than I've ever had and a lot of the symptoms due to my health conditions cleared up. Also my cholesterol and liver levels went down despite eating fat so it must have been doing some good. I did stray off it after going on holiday and I was going to go back on it this year but lack of motivation and feeling unwell has delayed me. I will try the McDougall diet first and if that doesn't suit me I will go back on the keto one.

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You could try the 5:2 diet as well -I’ve found that very effective for weight loss

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I haven't tried the 5:2 but I did try a 16:8 diet. I am the sort who doesn't have much of an appetite until late afternoon so that worked very nicely for me especially when combined with the keto diet.

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Do whatever you feel works best for you.

I've done a keto diet a number of times to lose weight & it worked but at my age (66) my days of trying diets like that are over. I belong to a forum called Overclockers Australia where dieting has been extensively discussed & many people there are into eating low carb, burning fat for energy, doing keto etc & when I told them about what people in the 'Blue Zones' around the world eat & I showed them the findings of a documentary called Forks Over Knives they turned on me. One guy became incensed & attempted to mock me by posting a photo of people who were all blue & I retaliated by saying that he suffered from 'tunnel vision' & I posted a photo of a guy with his head up his arse so he understood what I meant by tunnel vision!

Blue Zones are places around the world where people live unusually long disease free lives. People in the Blue Zones tend to eat a diet like the McDougall diet but maybe with a little meat added (apart from the Seventh Day Adventists). Meat tends to be an occasional treat & fat is avoided. The documentary Forks Over Knives was based on a huge long term study done on the Chinese population looking at things like cancer & heart disease rates etc. They found that the heart disease & cancer hot spots were where people ate more meat & fat.

There was one guy on the Overclockers Australia forum who had beat leukemia & had lost 30 kg doing keto & he used to show photos of his breakfast of sausages wrapped in bacon etc & he boasted about how his blood test results had all improved including cholesterol. He hated me when I showed him a place on the net where he could watch the documentary Forks Over Knives for free & when he watched it he learned that people who ate his way had a much greater chance of getting heart disease, cancer etc. & dying prematurely.

My keto days are over. When you lose weight on it you tend to put it back on if you stop. I avoid fat as much as possible by buying skim milk, not using spreads like butter or margarine on sandwiches etc. I like meat but I strip all fat off it & I am eating less of it as I get older.

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