HR post on exercise?

[jamimapuddle]

I keep hearing about an HR post on exhaustive exercise and the effects on the liver.  I can't find it.
I have a problem being reasonable (I do everything in excess). I used to do drugs in excess, now I am into exercise. I'm not sure I'm doing it in excess though. I'm 31 and on tx and still exercise 4 or 5 days a week. I'll stay in the cardio zone (145 to 165bpm) for at least an hour, sometimes an hour and a half per workout. I don't feel like I'm pushing myself, I love it and I'm having fun. Is this exhaustive?

[H20Lover]

Ah....thanks for the tip.  One learns so much here!

[jamimapuddle]

I've heard that ALT can rise after exercise, but it's not something to worry about since it was released by your muscles and not your liver so therefore not an indicator of liver stress.  You should avoid exercise 24 hours before testing your enzymes.

[H20Lover]

Ah.....now it makes sense.  I realize having just a little bit of info can truly be dangerous.

I have to tell you though I was literally laughing my A** off after the visual you gave me.  

Laughter is truly the best medicine.

Thanks for you encouragement as well.  My personal battle is my age (52) and a high VL (>5 mil) but I am going to give it my very best shot.  

I hate the idea of having this.  It really ticks me off and I want to do all I can to beat it.

Thanks again for your time.  

[mremeet]

I couldn't take rescue drugs during the first 12 weeks of my treatment because I was in a drug trial (telaprevir or VX950) and they were not allowed during that timeframe. Otherwise I could have taken neupogen which boosts neuts (which fight infection), and could have avoided an IFN dose reduction that way. The reason I ran up and down the flights of stairs while anemic, was because my doctor told me that neutrophils are commonly trapped or "resting" in bodily tissues, they aren't always circulating in your blood. He said if you were to measure a person's neutrophils (also called ANC's) who had been relatively sedentary for a few days (or weeks) and then that person ran a marathon and his/her blood was sampled again at the end of the marathon, their neutrophils would measure much higher than before the race. The reason this would happen is because the extensive muscle contractions/use and greatly increased blood flow would shake many of the "resting" neutrophils loose and return them to the bloodstream. Basically, intense aerobic exercise "gets your juices flowing", and apparently when it comes to ANC's, that's exactly what it does. Anyway, that's what my reputable doctor told me after me probing what could be done about my ever lowering ANC's (knowing that an IFN reduction may be in the cards for me), and I think he told me as a sort of hinting way that I could employ to help avoid an IFN reduction. If my ANC's fell below 500 he was required by the study guidelines (and perhaps for liability reasons) to lower my IFN dose. I wanted none of that (especially knowing that otherwise healthy HCV patients usually can tolerate ANC's down to the 200-ish level), so I read between the lines of his neutrophil story and made sure that I ran the flights of stairs just prior to blood sampling. The only downside is that the poor lady that sampled my blood undoubtably thought I was some kind of freakish junkie wired out on something, being that I was always coming in breathing so heavily and sweaty and pale and grayish blue and hairless and without eyebrows (which I scratched off) with a gnarly rash...and I had llama lashes on top of all that. She must have thought I was one freaked out junkie dude...and I WAS! But hey, my neuts did jump up a bit, so I was spared the dreaded IFN dose reduction.

Anyway for you it should be much less dramatic. You're not in a trial, you have a much easier to treat genotype, and you're allowed neupogen if you need it. So god luck, I'm sure your tx will work out fine. Just be grateful you dont have geno 1, things are much more troublesome when you're type 1.

[H20Lover]

Thanks for writing back.

My routine consists of 30 minutes on an elliptical 3 days a week and 2 days of strength training (max 20 lbs).  I get my heart up to 150-160 or so.  I can only dream of doing what you described with or without this virus so I am probably OK.  I ran it by the doc and he said as long as my body i agreeable to go for it.  When I work out I fantasize about killing the virus and it is a great motivator.

My plan is to keep it up as long as I can.  I have only had 2 shots so far and am doing 24 (geno 2).

I have not yet had to deal with the HGB or neutrophil problem.  It is my understanding from my Dr. though that he would use helper drugs before reducing dosage.  Would what you did not give the doc a false idea of what your levels really are?  I am a little confused by that.

[mremeet]

Oops I think I made a boo boo. I didn't realize jam said she was on treatment. Um, no I wouldn't say the amount of exercise I mentioned previously would be appropriate for someone on tx. I mean, I wouldn't say it would be terrible, but 40-60 min of intense aerobics 3-4 times a week? I don't think that would be optimum, that could run you down and possibly lower your immune responses. I (mistakenly) was speaking for someone who was not on tx, sorry about the confusion. If someone were on tx, I would think brisk walks lasting maybe 30 minutes or so 3-4 times a week would be better. Yoga and flexibility stuff would be good too. But really it's listen to your body time. If you've got bad anemia (anything under 11 in my book) and feel like sh!t I wouldn't do any aerobics. I didn't exercise a lick during my treatment and I didn't feel guilty about it either. The only exercise I did was just prior to gettijng my blood sampled, I'd run up and down the hospital staircase (5 stories) a few times until I almost passed out (HGB around 10 at the time). The reason I did that was to temporarily increase my neutrophil blood counts so that I would not be hit with an IFN dose reduction. Other than that, I didn't do any exercise. Besides my skin was irritated and itchy, I couldn't stand to agitate it any further with any chafey/sweaty exercise.

[H20Lover]

I hope you are right....I have made exercise a big part of my life of late (last 14 months) but I do not want to do anything to jeapordize my chances of successfull tx.  I was thinking increased blood flow was a good thing and I need to lose about 10 more lbs to not have a BMI in the overweight range.  

It's interesting though what Jim said.  Before I started exercising I never had a high ALT.  Probably a coincidence, but who will ever know because I don't know how long I have had this nasty virus.  Obviously exercise does not cause it so eventually it would have shown up anyway.  I just found it interesting because I wonder what may have precipitated the elevation.

Thanks!

[mremeet]

I'd say a good moderate exercise program would involve intense aerobic activity (be it running,cycling, aerobics etc) about 40-60 minutes a day 3-4 times a week. And throw in some flexibility/strength exercises like a little weight training (with light weights) or yoga (which is probably better). If you did all that, I'd say that would be both moderate and very good for you. It would be interesting to see if HR thinks this is ok too.

[jamimapuddle]

What is exercise in moderation? I am a healthy, very fit 31 year old on tx. How much should I be exercising? I really don't know.

[jmjm530]

actually, while I phrased my fasting question on the "hep c or SVR" liver -- in fact, my liver is probably not my biggest problem now -- the metabolic issues are. So I should have framed the question as wht do you think about occ fasting in terms of the metabolic syndrome -- pushing liver issues aside. I did read somewhere that varying ones caloric intake can snap the metabolic system out of thinking one is in a dieting (fast) mode where it holds onto fat. In other words, I would then think that periodic caloric variance (including a fast) might result in losing some fat stores which I would think is good.

[working dog]

about 8 years ago i was riding my bike for about an hour and a half every other day ...i wore a heart rate monitor and kept my heart rate at between 145 and 175...most of the ride it was 155....in the winter i would ride inside on a stationary bike...anyway...i started getting sx back then(after about 5 years of this exercise)...i think i pushed too hard...i can't seem to do anything like i used to....i know i'm getting older but i'm quite sure the hep-c is really doing it's thing...i haven't been on tx yet but when my life is set up a little better i will tx...and if i was treating i wouldn't take the chance of heavy exercise..good luck...billy.

[jmjm530]

So are you saying then that I should go the fridge and eat a drumstick now? So far today, just a cup of coffee and water, but I figured I had enough fuel from last night to last awhile :) Hope you had a good Turkey or whatever you ate yesterday.

-- Jim

[Hepatitis Researcher]

When you fast intensely for any prologned time, sure as clockwork your liver enzymes will rise as if you had acute hepatitis. The ALT of our Zero diet patients in the metabolic ward were typically higher than the ones of our hepatitis patients.

So first you beat the cow metabolically, then you starve the cow - which is also beating its overstressed hepatocytes in other ways. Good cow!

Generally speaking, metabolic rollercoaster rides for prestressed livers are not recommended.

I day of occasional water only fasts are probably ok. But: You DO force the liver into a change of gene expression - switching it over to another metabolic mode - and that means a lot of opening of DNA and transcribing new sets of genes - in an atmosphere rich with/full of reactive oxidative species  = DNA damage = one small step further down the road towards liver cancer....

[jmjm530]

Quick time sensitive (post thanksgiving day) question.

What is your opinion on fasting for the HCV or SVR liver? I'll define fasting as water only for a period ranging from 1 to 3 days.

35 years ago, I went to a Yoga camp and fasted for six days, water only. Don't remember enzymes before or after, but not sure if I did my liver any good.

But what about occasional 1 or 2 day water-only fasts?

-- Jim

[Hepatitis Researcher]

Thats why too much stress is bad for many things. In moderation it is stimulatory. In excess it starts to reduce immune functionality and many other physiological processes.

[Hepatitis Researcher]

We do not know if this zig/zag behavior is not present in quite a few. You need a study for that, and it probbly already exists somewhere in the over sixtythousand abstracts that I have, in small print, in the abstract books of the AASLD, the EASL and the DDW since 1994, sitting in a shelf behind me..  One has to pragmatically focus on the ones that really matter, copy/print them and collect them in a topic specific binder. Exercise and HCV has not yet made the climb to a binder worthy topic.

[pigeonca]

Production of too much cortisol and adrenalin - wouldn't that be the same thing as taking prednisone, only self-produced rather than purchased at the pharmacy?

[jmjm530]

Makes sense but my understanding is that what happened to me is very unusual -- several acute bouts within a few years of exposure? But in any event, what is your thinking why all of a sudden that pattern stopped? I did the equivalent energy expenditure of a marathon a few years prior to treatment and no acute relapse. Nor have I seen anyone here ever post that exercise caused any sort of acute HCV reaction. No one, except my own story early-on in the process.

-- Jim

[Hepatitis Researcher]

Jim:
it was exercise in my case although no real explanation why was given, nor was it probably asked back then. Maybe HR has a theory why I went in and out of what appeared to be an acute stage at least three times in the 2-5 years following exposure."

It seems wise to keep that stress level within moderation, otherwise too much adrenalin and cortisol will be produced, with potential adverse effects on the antiviral mechanisms that are in place in a chronic HCv hepatitis patient that keep his viral load/replicative activity at a lower level. Temporary supression of immune function will give rise to an increase in the intensity of viral replication and, in the backlash,  the immune response will lead to another  " acute bout".

[jmjm530]

not normal enzymes, but slightly elevated enzymes , as opposed to enzymes over 1000 if I remember correctly.

[jmjm530]

To be more specific, first "relapse" was within a month of first acute reaction. Second relapse was around 8 months later. Then I think there was another, but can't remember.
I define a "relapse" as the set of symptons described above occuring after a period of no symptons, including normal enzymes.

[jmjm530]

Not directly related to you situation -- but for the first several years after contracting hepc, vigorous and extended exercise did cause several "relapses".

I'm using the word "relapse" in the following sense -- I had a symptomatic acute stage of hep c consisting of the classical sky high enzymes, yellow skin, yellow eyes, white stools, dark urine, EXTREME fatigue, etc.

During 2-5 or so years after my first acute episode, I "relapsed several times back into the acute stage. It was always following a period of vigorous exercise. Then, all of a sudden, that pattern stopped and I could exercise to my hearts content with no "relapse.

Did discuss with one of the leading hepatologists of the day (this was around 30 years ago) and he concurred it was exercise in my case although no real explanation why was given, nor was it probably asked back then. Maybe HR has a theory why I went in and out of what appeared to be an acute stage at least three times in the 2-5 years following exposure.

-- Jim

[CMcH]

It's actually nice to hear that someone is exercising on TX. I am a very active person and will be starting TX probably in JAN., just had my biopsy last Friday. I used to run 6x's a week and was running marathons. I think I might have over stressed my body and lowered its resistance to allow my Hep C to raise it's ugly head. I was worn down and didn't seem to be healing from falls then the stiff joints with RA factor showing up made me decide to TX.
I backed down with the running to 3 x a week and started doing Pilates and Zumba. I like staying strong and in shape because I have a very physical job. I have been very concerned about going into TX because it seems most people have such bad sides that they can hardly walk. So it's nice to hear that some people can still exercise, it's just finding the balance between staying as healthy as possible without  overdoing it. I guess you just have to monitor how your body
responds to it. I would imagine keeping the blood flowing would be good, just knowing when to stop when you have an addictive personality is the tricky part. I would love to hear from others on TX  that can exercise. I've wondered if perhaps the people without so many sides wouldn't be posting to  much because they don't have as much need for support?

[Hepatitis Researcher]

Nobody can anser the question with certainty, if exhaustive exercise while on tx will lessen your chance of SVR, by causing too much stress that in turn will reduce the efficacy of viral elimination.

It seems wise to keep that stress level within moderation, otherwise too much adrenalin and cortisol will be produced, with potential adverse effects on the antiviral mechanisms meant to be enhanced by tx.