How does your liver affect cholesterol?
It makes most of it. About 80% of your cholesterol is made in your liver, not eaten. Your liver clears it from your blood too. When clearing is weak, eating well may not be enough.
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Does the liver make cholesterol?
Yes. HEART UK says about 80% is made in the liver. The rest comes from food.
Your body needs some. The NHS says cholesterol helps make vitamin D and some of your hormones.
Think of your liver as a bakery. It bakes most of the bread, sends it out in vans and takes some back.
If it bakes too much or takes too little back, bread piles up. In your body, that means a higher blood level.
Your liver makes cholesterol, ships it out and takes some back
- 1
Make
Your liver makes about 80% of your cholesterol.
- 2
Pack
It packs cholesterol and other fats into parcels called lipoproteins.
- 3
Deliver
LDL carries cholesterol from the liver to cells round your body.
- 4
Return
HDL brings spare cholesterol back to the liver to be broken down.
If the liver makes too much, or takes too little back out of your blood, your blood level rises. Too much can stick to artery walls and can lead to a heart attack or stroke.
A cholesterol test shows the result, not which step is off. Start with what your cholesterol results mean.
How does the liver get rid of cholesterol?
It turns it into bile. Bile is a juice that helps you break down the fats in food.
A little bile leaves in your poo. Most is soaked back up and returned to the liver to use again.
| Parcel | Which way it goes | What it carries |
|---|---|---|
| LDL | From the liver out to your cells | Cholesterol. Too much is called bad cholesterol. |
| VLDL | From the liver out round your body | Triglycerides (another type of fat in your blood), plus some cholesterol. |
| HDL | From your cells back to the liver | Spare cholesterol. Often called good cholesterol. |
Some cholesterol medicines use the bile loop. They stop bile being soaked back up, so the liver takes more cholesterol out of your blood to make more.
Ezetimibe works on the same loop. It blocks some cholesterol from your gut, so your liver cells make more catchers, called LDL receptors. These pull LDL out of your blood.
Ask your GP or pharmacist which of these suits you. Never stop or change a prescribed medicine without your prescriber.
Why is my cholesterol high if I eat well?
Your plate is only part of it. The cholesterol in eggs and prawns does not have much effect for most people. See eggs and cholesterol.
| Reason | What the sources say |
|---|---|
| Saturated fat | The NHS says cut down on fatty food, especially saturated fat. |
| Familial hypercholesterolaemia (FH) | An inherited gene change makes the liver less able to remove LDL. |
| Other conditions | Liver disease, kidney disease, type 2 diabetes and an underactive thyroid. |
| Lifestyle | Not being active enough, smoking and extra weight, especially round the middle. |
One cause of weak clearing is FH, an inherited condition. It affects about 1 in 250 people. If a parent has it, you have a 1 in 2 chance of having it too.
The BHF says FH cannot be treated through diet alone. It is usually treated with statins, but eating well and staying active still help.
Before a specialist referral, NICE says your GP should rule out other causes, such as too much alcohol, liver disease or an underactive thyroid. See thyroid and cholesterol.
Is fatty liver linked to high cholesterol?
Yes. The NHS says you are more likely to get fatty liver if you have high cholesterol or high blood pressure. That’s a link, not proof that one causes the other.
Fatty liver, also called MASLD, means fat has built up in your liver. It does not usually cause symptoms. It is often found by a blood test or scan done for another reason.
The same habits help both. The NHS says they can cut liver fat and lower the risk of heart and blood vessel disease.
Habits that help your liver and your cholesterol
- Eat a healthy, balanced diet, and cut down on fatty food high in saturated fat.
- Exercise regularly, aiming for at least 150 minutes a week.
- Lose weight if you are overweight.
- Drink no more than 14 units of alcohol a week.
- Do not smoke.
Sources: NHS: fatty liver; NHS: lower your cholesterol
For meals, see how to lower cholesterol.
Are statins bad for your liver?
Most people can take them safely.
Statins work in the liver. HEART UK says they slow how much LDL the liver makes. The liver then takes cholesterol out of your blood to make bile.
The NHS says not to if you have severe liver disease or are pregnant. The same goes if you’re trying to get pregnant, or could and aren’t using contraception.
Mildly raised liver tests don’t usually rule you out. NICE says don’t routinely rule out a statin for people whose liver levels are raised but less than 3 times the upper limit of normal.
Liver tests NICE advises around a statin
- 1
Before
A liver test (ALT or AST) before you start.
- 2
2 to 3 months
Liver and full cholesterol tests after starting or changing treatment.
- 3
12 months
One more liver test, then only if there’s a reason.
Source: NICE NG238
Never stop or change a prescribed medicine without your prescriber. See blood tests on statins and the liver function test.
When to speak to a GP
Most people with high cholesterol have no symptoms, and fatty liver does not usually cause any. Book an appointment if:
- You think you could have fatty liver, or you have a higher risk of getting it. Some people feel very tired or unwell, or have pain under the right side of the ribs.
- A parent has FH, or you notice signs of FH: lumps on your knuckles, knees or the back of your ankle, a pale ring round the coloured part of your eye, or yellow patches round your eyes.
- You take a statin and want to stop or change it. The NHS says talk to a doctor or pharmacist first.