Recently I saw a post from a patient who was cured of hepatitis C, only to find out that he had fatty liver disease. I felt badly for him, since now he has another liver disease to contend with, but then I thought it over. Fatty liver disease can be fixed, and the cure may help more than his liver—it may help him live longer and feel better.
Non-alcoholic fatty liver disease (NAFLD) is a metabolic disease that generally occurs in overweight patients. It may also occur in patients whose weight is normal, but because of prior excess weight, they developed insulin resistance, diabetes, or fat in the liver area, called visceral fat. NAFLD may also arise in people who eat a high fat, low-nutrition diet.
NAFLD is the most common liver disease, and it is increasing in prevalence and severity. Since fat impairs liver regeneration, NAFLD can lead to fibrosis and cirrhosis. NAFLD is the third most common risk factor for primary hepatocellular carcinoma. The American diet is so harmful, that children are developing NAFLD. If we keep on this course, NAFLD may overtake hepatitis C as the single most common reason for liver transplantation. Tragically, the prevalence of NAFLD is so great, that there has been a decrease in the number of viable livers that can be used for transplantation.
Hepatitis C appears to increase the risk of NAFLD. However, before blaming hepatitis C for fatty liver disease, keep in mind that the prevalence of hepatitis C in the U.S. is less than 2 percent, whereas the prevalence of NAFLD is 30 percent. This makes it hard for hepatitis C to be the sole link to NAFLD. An exception is in genotype 3, where there is clearly a higher risk for NAFLD.
As I stated, fatty liver disease can be fixed. You probably already figured out that good nutrition and maintaining a healthy weight is important, but did you know that physical activity could improve NAFLD? Exercise also improves insulin resistance as well as cardiovascular health. A few studies bear this out, but the question some of us have is, “What kind of exercise, how much, and how often?”
Let me state this in a way that I can relate to, “What is the least amount of exercise in both time and intensity that I can get away with, and still look my doctor in the eye and say I am a regular exerciser?”
In a retrospective analysis of obese middle-aged men (Hepatology April 2015), Sechang Oh and colleagues reported that moderate to vigorous physical activity had a dramatic effect. Those who engaged in ≥ 250 minutes a week of moderate to vigorous physical activity had the most improvement of NAFLD.
That is more than four hours of exercise weekly. Surprisingly, the exercise seemed to improve liver health, regardless of weight loss. Other research shows similar benefits. When it came to liver health, aerobic activity showed more improvement than resistance training.
What is moderate to vigorous physical activity?
There are various was to measure intensity. I prefer the concept of relative intensity. Using this method, people pay attention to how physical activity affects their heart rate and breathing. Intensity level is subjective. What may be intense for one person may be less intense for someone else. For instance, I don’t play tennis, but if I were to try, I would probably be huffing and puffing after the first serve. On the other hand, I do aerobic dance, and it takes me a bit of effort to raise my heart rate.
In general, if you are doing moderate-intensity activity you can talk, but not sing, during the activity. If you are engaged in vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath.
According to the Centers for Disease Control and Prevention, examples of moderate-intensity activity are:
- Walking briskly (3 miles per hour or faster, but not race-walking)
- Water aerobics
- Bicycling slower than 10 miles per hour
- Tennis (doubles)
- Ballroom dancing
Examples of vigorous-intensity activity are:
- Race walking, jogging, or running
- Swimming laps
- Tennis (singles)
- Aerobic dancing
- Bicycling 10 miles per hour or faster
- Jumping rope
- Heavy gardening (continuous digging or hoeing)
- Hiking uphill or with a heavy backpack
Then there is the concept of duration. Perhaps 250 minutes a week is too much for you. Before you throw in the towel, bear in mind that any exercise is better than none. I don’t care if you are walking once around the table, it is better than sitting all the time. In fact, prolonged sitting is very unhealthy.
Prolonged sitting (eight to 12+ hours per day) increases risk of developing type 2 diabetes by 90 percent. It is also associated with increased premature death from cardiovascular conditions and cancer. The World Health Organization lists physical inactivity as the fourth-leading risk factor for death for people all around the world. It ranks up there with smoking.
When I first heard this, I thought, “I am screwed.” Writers sit a lot. Yes, I exercise every day, but I also sit a lot. After I was done whining, I set about to solve my sitting problem. I bought a stand-up desk, and set a timer to remind me to walk every hour. In addition to my regular workout, I added in a longer walk after dinner. I set a goal to stand during phone calls and commercials.
There are many other benefits of adding more physical activity in to your life. Last month, I talked about hepatitis C and the value of exercise for reducing chronic pain. Exercise helped alleviate arthritic and inflammatory pain, fibromyalgia, migraine headaches and back pain. Being active improves our sleep and our moods. We live longer, and the quality of our lives is better.
If you are new to exercise, be sure to talk to your medical provider before starting. Start slow and only do what feels comfortable. Most of all, do it. Find ways to battle every excuse. Make exercise a non-negotiable part of your life. It may be hard, but it is worth it.
- Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity
- Medline Plus’s Exercise and Physical Fitness
Lucinda K. Porter, RN, is the author of Free from Hepatitis C and Hepatitis C One Step at a Time.
This article is reprinted with permission from the August 2015 HCV Advocate
Hivi karibuni, nilipata barua kutoka kwa mgonjwa aliyepona ugonjwa wa ini la C, lakini alipata ugonjwa wa ini la mafuta. Nilimhurumia sana kwa sababu sasa alikuwa na ugonjwa mwingine wa ini, lakini baadaye nilifikiria jambo hilo. Ugonjwa wa ini la mafuta unaweza kurekebishwa, na tiba inaweza kusaidia zaidi ya ini lake - inaweza kumsaidia kuishi muda mrefu na kujisikia vizuri. Ugonjwa wa ini lisilo la pombe (NAFLD) ni ugonjwa wa kimetaboliki ambao kwa ujumla hutokea kwa wagonjwa wenye uzito wa ziada. Pia inaweza kutokea kwa wagonjwa ambao uzito ni kawaida, lakini kwa sababu ya uzito wa ziada kabla, wao maendeleo insulini upinzani, kisukari, au mafuta katika eneo la ini, aitwaye visceral mafuta. NAFLD inaweza pia kutokea kwa watu ambao kula mafuta mengi, lishe ya chini. NAFLD ni ugonjwa wa ini unaoenea zaidi, na unaongezeka kwa kuenea na ukali. Kwa kuwa mafuta huzuia ini lisibadilike, NAFLD yaweza kusababisha fibrosis na cirrhosis. NAFLD ni sababu ya tatu ya kawaida ya hatari ya kansa ya hepatocellular ya msingi. Chakula cha Marekani ni hatari sana, kwamba watoto wanapata NAFLD. Kwa hivyo, ikiwa utaendelea na mchakato huu, NAFLD inaweza kuchukua nafasi ya ugonjwa wa ini C kama sababu ya kawaida ya kupandikiza ini. Kwa bahati mbaya, idadi ya watu wenye ugonjwa wa NAFLD imepungua sana, na idadi ya ini zinazoweza kutumiwa kwa ajili ya upandikizaji imepungua. Inaonekana kwamba ugonjwa wa ini aina ya C huongeza hatari ya kupatwa na ugonjwa wa NAFLD. Hata hivyo, kabla ya kulaumu ugonjwa wa ini la mafuta, kumbuka kwamba kuenea kwa ugonjwa wa ini la mafuta nchini Marekani ni chini ya asilimia 2, wakati kuenea kwa NAFLD ni asilimia 30. Hii inafanya kuwa vigumu kwa ugonjwa wa ini C kuwa kiungo pekee kwa NAFLD. Kwa mfano, kwa watu wenye genotype 3, hatari ya NAFLD ni kubwa. Kama nilivyosema, ugonjwa wa ini lenye mafuta unaweza kurekebishwa. Kama unavyojua, kula vizuri na kudumisha uzito mzuri ni muhimu, lakini je, unajua kwamba mazoezi ya mwili yanaweza kuboresha NAFLD? Mazoezi pia huboresha upinzani wa insulini na afya ya moyo na mishipa ya damu. "Hii ni moja ya masomo ya kawaida ambayo yamefanywa na wataalamu wa afya, lakini kwa nini ""mfano wa mazoezi ya mwili"" haujulikani? - Uchunguzi wa kawaida wa wanaume wenye uzito wa wastani, uliofanywa na Seung-Hee na wenzake, ulionyesha kuwa mazoezi ya mwili ya wastani na ya wastani yana athari kubwa." Wale waliofanya mazoezi ya mwili kwa muda wa dakika 250 au zaidi kwa wiki walipata uponyaji mkubwa zaidi wa NAFLD. Hiyo ni zaidi ya saa nne za mazoezi ya mwili kila juma. Kwa kushangaza, mazoezi hayo yalionekana kuboresha afya ya ini, bila kujali kupoteza uzito. Utafiti mwingine unaonyesha faida kama hizo. Kwa habari ya afya ya ini, mazoezi ya mazoezi ya mwili yalionyesha uboreshaji zaidi kuliko mazoezi ya nguvu. Ni nini utendaji wa kimwili wa kadiri hadi wenye nguvu? Kuna mbalimbali ilikuwa kupima nguvu. Ninapendelea dhana ya nguvu ya jamaa. Kwa kutumia njia hii, watu huangalia jinsi utendaji wa kimwili unavyoathiri mpigo wa moyo na kupumua kwao. Kiwango cha nguvu ni subjective. Jambo ambalo linaweza kuwa gumu kwa mtu mmoja huenda lisiwe gumu sana kwa mtu mwingine. Kwa mfano, mimi si kucheza tenisi, lakini kama mimi walikuwa kujaribu, mimi pengine itakuwa huffing na puffing baada ya huduma ya kwanza. Kwa upande mwingine, mimi hucheza dansi ya aerobiki, na inanichukua jitihada kidogo kuinua mpigo wa moyo wangu. Kwa ujumla, ikiwa unafanya shughuli ya nguvu za wastani unaweza kuzungumza, lakini si kuimba, wakati wa shughuli hiyo. Ikiwa unafanya kazi ya nguvu, huwezi kusema maneno mengi bila kupumua. Kulingana na Kituo cha Kudhibiti na Kuzuia Magonjwa, mfano wa shughuli za nguvu za wastani ni: kutembea kwa kasi (maili 3 kwa saa au kwa kasi zaidi, lakini si mbio za mbio) - Aerobics ya maji - Baiskeli ya polepole zaidi ya maili 10 kwa saa - Tennis (mara mbili) - Dansi ya Balozi - Mfano wa shughuli za nguvu - Tennis ya mbio - Kuteleza - Kuogelea - Kupanda - Kupanda - Kuendesha baiskeli - Maili 10 kwa saa au kwa kasi zaidi - Kupanda kamba - Bustani (kuchimba au kuchimba) - Hiking up. Labda dakika 250 kwa wiki ni kupita kiasi kwako. Kabla ya kuacha, kumbuka kwamba mazoezi yoyote ni bora kuliko kutofanya mazoezi yoyote. Mimi sijali kama wewe ni kutembea mara moja kuzunguka meza, ni bora kuliko kukaa wakati wote. Kwa kweli, kukaa kwa muda mrefu si jambo la afya. Kukaa kwa muda mrefu (kwa masaa 8 hadi 12 kwa siku) huongeza hatari ya kuambukizwa ugonjwa wa kisukari wa aina ya 2 kwa asilimia 90. Pia huhusianishwa na ongezeko la vifo vya mapema kutokana na magonjwa ya moyo na mishipa ya damu na kansa. Shirika la Afya Ulimwenguni (WHO) limesema kuwa kutofanya mazoezi ni sababu ya nne ya vifo duniani. Inashikamana na uvutaji sigareti. Niliposikia hili kwa mara ya kwanza, nilifikiri, "Nimechoshwa". Waandishi huketi sana. Ndiyo, mimi hufanya mazoezi kila siku, lakini pia mimi huketi sana. Baada ya kumaliza kulalamika, nilianza kutatua tatizo langu la kuketi. Nilinunua dawati la kusimama, na kuweka kipima-wakati ili kunikumbusha kutembea kila saa. Kwa kuongezea mazoezi yangu ya kawaida, niliongeza kutembea kwa muda mrefu baada ya chakula cha jioni. Nilijitolea kusimama wakati wa simu na matangazo ya biashara. Kuna faida nyingi za kuongeza mazoezi ya mwili katika maisha yako. Mwezi uliopita, nilizungumza juu ya ugonjwa wa ini C na thamani ya mazoezi ya mwili kwa kupunguza maumivu ya muda mrefu. Mazoezi yalisaidia kupunguza maumivu ya arthritic na ya uvimbe, fibromyalgia, maumivu ya kichwa ya migraine na maumivu ya mgongo. Kuwa na shughuli nyingi kunaboresha usingizi wetu na hali yetu ya moyo. Tunaishi muda mrefu zaidi na maisha yetu ni bora zaidi. Ikiwa ni mpya kwa mazoezi, hakikisha kuzungumza na mtoa huduma wako wa matibabu kabla ya kuanza. Anza polepole na fanya tu kile unachohisi ni vizuri. Zaidi ya yote, fanya hivyo. Tafuta njia za kupigana na kila udhuru. Fanya mazoezi ya mwili kuwa sehemu ya maisha yako ambayo hayawezi kujadiliwa. Huenda ikawa vigumu, lakini inafaa kufanya hivyo. "Center for Disease Control and Prevention's Division of Nutrition, Physical Activity, and Obesity, Medline Plus, Inc. ""Mwanamke mwenye umri wa miaka 18 na zaidi, Lucinda K. Porter, RN, ni mwandishi wa kitabu Free from Hepatitis C and Hepatitis C One Step at a Time." Makala hii imechapishwa tena kwa ruhusa ya HCV Advocate ya Agosti 2015.