I Heart Liver —Lucinda Porter, RN
Sometimes it takes a hepatitis C diagnosis for us to pay attention to the fact that we each have a liver. We learn where the liver is, what it does, and how essential it is. However, the hepatitis C virus (HCV) affects more than just the liver. HCV affects the entire body, particularly the heart and cardiovascular system. Since February is American Heart Month, it is a perfect time to discuss the relationship between the liver and its neighbor, the heart. In particular, we will explore ways to improve cardiovascular health. This information is good for everyone, with or without hepatitis C.
Over the years, many studies have shown that people with hepatitis C have higher rates of heart disease and stroke. It makes sense, because hepatitis C is an inflammatory disease, and the cardiac system does not like excess inflammation. That said, keep in mind that the association between hepatitis C and cardiovascular disease does not prove that the virus causes the heart disease; it merely indicates a strong relationship.
Huh? If studies show that people with hepatitis C have a higher risk of heart disease and stroke, why doesn’t that mean that the virus causes cardiovascular disease? There could be other factors at play here. It could be that people with hepatitis C don’t exercise as much because they are too tired; or that they take medication that increases their risk.
What we do know is that when people successfully respond to hepatitis C treatment, their stroke and heart disease risk decreases. Is this because the virus is gone or is it because people feel better and are more active? We don’t know.
Although research on the link between hepatitis C and cardiovascular disease isn’t entirely conclusive, we do have evidence that taking care of your heart and health has multiple benefits. Physical activity and diet are strongly correlated with health, whether looking only at the liver, the heart, or another organ or system.
Let’s start with some basic facts about heart disease:
- Heart disease is the leading cause of death for men and women.
- Someone has a heart attack every 40 seconds in the United States; someone dies from a heart disease-related event every minute in this country.
- Younger adults are at risk. In the United States, the rate of heart disease deaths are declining more slowly than they have in the past, especially among adults ages 35 to 64. In some parts of the country, death rates are increasing among adults in this age group. This age group also has seen a rise in risk factors related to heart disease, such as physical inactivity, tobacco use and high blood pressure.
- Heart disease and stroke are largely preventable conditions.
About half of the adult population in the United States has at least one of the three top risk factors for heart disease. These are:
- High blood pressure
- High LDL cholesterol
Other significant risk factors include:
- Overweight and obesity
- Poor diet
- Physical inactivity
- Excessive alcohol use
To this list, I’d add liver disease, whether it is hepatitis C, fatty liver disease or cirrhosis of any cause.
In 2018, the U.S. Department of Health and Human Services (HHS) published the second edition of the Physical Activity Guidelines for Americans. The updates include more evidence, and thus incentive, showing the benefits of physical activity. There are also changes to the recommendations for physical activity for children.
Here are the HHS recommendations for adults: “To attain the most health benefits from physical activity, adults need at least 150 to 300 minutes of moderate-intensity aerobic activity, like brisk walking or fast dancing, each week. Adults also need muscle-strengthening activity, like lifting weights or doing push-ups, at least 2 days each week.”
A word to those who are overwhelmed or discouraged by the notion of exercise or other physical activity. I know that this sounds monumentally difficult. Please stick with me to the end of this article and read, “Let’s Get Practical.”
Adults with Chronic Health
Conditions or Disabilities
HHS developed recommendations for adults with chronic health conditions or disabilities. Be sure to be under the care of a health care provider.
- If you are able, do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.
- If able, do muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.
- If unable to meet the above key guidelines, engage in regular physical activity according to their abilities and avoid inactivity.
Any amount of physical activity has some health benefits. If you do a small amount of moderate-to-vigorous physical activity throughout the day, your health may profit. According to HHS, the first edition of the Physical Activity Guidelines for Americans stated that only 10-minute bouts of physical activity counted toward meeting the guidelines. The second edition removes this requirement to encourage Americans to move more frequently throughout the day as they work toward meeting the guidelines.
The latest studies show that physical activity has immediate health benefits. For example, physical activity can reduce anxiety and blood pressure and improve quality of sleep and insulin sensitivity. Do this more consistently, in time you may experience even more long-term health benefits.
Other benefits of physical activity include:
- Reduces risk of excessive weight gain and helps people maintain a healthy weight.
- Helps prevent 8 types of cancer (bladder, breast, colon, endometrium, esophagus, kidney, stomach, and lung).
- Decreases risk of dementia (including Alzheimer’s disease).
- Reduces risk of all-cause mortality, heart disease, stroke, high blood pressure, type 2 diabetes, and depression.
- Improves bone health, physical function, and quality of life.
- Lowers the risk of falls and injuries from falls in older adults.
HHS states, “New evidence shows that physical activity can help manage more health conditions that Americans already have. For example, physical activity can decrease pain for those with osteoarthritis, reduce disease progression for hypertension and type 2 diabetes, reduce symptoms of anxiety and depression, and improve cognition for those with dementia, multiple sclerosis, ADHD, and Parkinson’s disease.”
Let’s Get Practical
Hear me out if you think that you can’t meet the exercise guidelines. I am 65 years old. I am not, nor have I ever been athletic. The truth is, I don’t particularly like exercise and if I could skip it, I would. However, I love the benefits of exercise so much, that I endure the effort. These benefits include improved sleep, low blood pressure, strength, endurance, feeling energetic, no depression, and no diabetes.
Please don’t get the impression that I follow these guidelines all the time or do them perfectly. That is certainly not the case. However, I am devoted to the process, and when I fall off the exercise wagon, I get back on. I’ve been a regular exerciser for more than 30 years, so now it is a habit. I started out very slowly, which I highly recommend.
If you are just starting out, here are some tips:
- Talk to your doctor. It’s always a good idea to be sure you don’t have a medical reason that could be worsened by certain physical activities.
- Move more and sit less. Walking around a room every hour is better than sitting for 8 hours straight.
- Start where you are. If you can only walk a minute, then walk a minute. If you do this several times a day, you may be able to increase your endurance to 2 minutes.
- Start low, go slow. The goal is to succeed without ending up never wanting to exercise again. If you do too much, your physical fitness career may end abruptly. The purpose of this is to improve your health, and not to torture yourself. Increase duration and/or intensity gradually.
- Make it fun. Personally, I think that walking in a beautiful setting is more interesting than a treadmill. However, if poor weather forces me indoors, music or an audiobook will keep me on the treadmill.
- Be an encouraging self-coach. Never, ever berate yourself for anything, most especially for anything fitness-related.
- Find ways around the obstacles. Every night, I set out my workout clothes, shoes, water bottle and earphones. In the morning, I put them on and by then, I am committed enough to keep going. I don’t think I’ve ever put on this attire without actually completing a workout.
- Never give up. If I am not meeting a workout goal, it is probably because I haven’t figured out how to. By trying something different, my commitment stays firm, and in time, I discover ways to meet my goals.
The Bottom Line:
If you have hepatitis C and want to improve your chances for survival, get treated. However, that is only a small part of good health. To maximize your chances of living a long and healthy life, be sure you are physically active for as long and as often as you can. And keep doing this for as long as you are able to.
For more information about heart disease, visit the CDC’s website at www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm
For information about physical activity, check out https://health.gov/paguidelines
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