Lifestyle Taboos for High Cholesterol: Fatty Liver, Morning Exercise, Common Misconceptions about Birth Control Pills and Discontinuation

Don't ignore fatty liver

Fatty liver disease occurs when excessive fat accumulates in the liver for some reason, exceeding 5% of the liver's weight (fat normally accounts for 2% to 4% of the liver's weight).

Fatty liver and high blood lipids are like brothers. High blood lipids are a systemic lipid metabolism disorder that easily affects the liver. The liver is the main site of lipid metabolism, and fatty liver can also affect lipid metabolism throughout the body, causing abnormal blood lipids.

Fatty liver is classified into alcoholic fatty liver and non-alcoholic fatty liver. Studies show that 90% of people who frequently drink excessively will develop fatty liver, and 12% of those with alcoholic fatty liver will develop cirrhosis. It has been observed that the amount and duration of alcohol consumption are directly related to the occurrence of alcoholic fatty liver; there is a positive correlation between them.

Studies have shown that individuals meeting the following criteria are more prone to fatty liver disease: those with high cholesterol; those with diabetes; those with abdominal fat accumulation; those who drink heavily for a long time; those who are obese; those with viral hepatitis; and those exposed to drugs or toxins over a long period.

So, why are people with the above conditions prone to fatty liver?

For example, obese individuals, especially those with abdominal fat accumulation, are highly susceptible to fatty liver disease because their bodies have a relative excess of nutrients, which tend to accumulate in the liver. Between 21% and 78% of diabetic patients also develop fatty liver disease. This is because insufficient insulin or insulin resistance leads to endocrine and metabolic disorders, resulting in abnormal blood lipids and blood sugar levels, causing excessive fat accumulation in the liver. Thus, fatty liver disease creeps up on them insidiously. Most of them do not experience any symptoms and are often only discovered during physical examinations or when seeking medical attention for other illnesses. As the disease progresses, it manifests as hepatomegaly, liver area distension and pain, loss of appetite, and elevated transaminase levels. A few may develop mild jaundice and splenomegaly. Approximately 35% of adults with elevated transaminase levels during physical examinations have fatty liver disease.

Fatty liver disease has very serious consequences; it can easily progress to cirrhosis, leading to symptoms such as jaundice and ascites, and in severe cases, it can be life-threatening. Therefore, the prevention and treatment of fatty liver disease are crucial for preventing the progression of chronic liver disease and improving prognosis.

Avoid strenuous exercise in the morning

Morning exercise is beneficial, but it shouldn't be too strenuous. Early morning is a high-risk time for cardiovascular diseases because the body's sympathetic nervous system is more active then. This activity causes small blood vessels to constrict, leading to increased blood pressure and, in severe cases, myocardial ischemia. Furthermore, blood viscosity is higher in the morning, increasing the risk of blood clots. Strenuous exercise at this time can accelerate this process, thus promoting the development of coronary heart disease and other cardiovascular complications. Therefore, moderate exercise is recommended.

Avoid long-term use of birth control pills

Long-term use of birth control pills can cause some adverse reactions. For example, oral contraceptives can affect blood lipids. Birth control pills are synthetic preparations made from different types of estrogen and progesterone in varying proportions. Recent studies have concluded that oral contraceptives can increase blood cholesterol, triglycerides, and low- and very low-density lipoprotein cholesterol levels, leading to an increased risk of arteriosclerosis and coronary atherosclerosis. A follow-up study of 2,606 white women in the United States showed that, compared to those who did not use oral contraceptives, those using oral contraceptives had significantly increased levels of low-density lipoprotein cholesterol and triglycerides. The ratio of estrogen to progesterone in these drugs is a significant factor affecting high-density lipoprotein cholesterol levels. Higher estrogen levels lead to a more significant increase in high-density lipoprotein cholesterol, while the opposite is true for progesterone. Therefore, birth control pills should not be chosen arbitrarily but selectively. Experimental studies have shown that formulations containing low doses of estrogen and 18-methylnorethindrone have no effect on blood lipids and are quite effective.

Do not stop taking medication without consulting a doctor.

People often think that blood lipids only refer to triglycerides, but blood lipids actually include cholesterol. Cholesterol plays a more significant role in the development of cardiovascular and cerebrovascular diseases. Cholesterol is mainly found in low-density lipoprotein (LDL), which acts like silt in a pond, entering blood vessels and adhering to the vessel walls to form atherosclerotic plaques, causing narrowing or blockage of blood vessels. Even more frightening is that the "fibrous cap" on the surface of these plaques can rupture, causing the plaque contents to react with the blood, forming a blood clot in a short time. This can suddenly block the major blood vessels in the heart (coronary arteries), leading to sudden death without any symptoms.

In conclusion, actively lowering cholesterol is the most crucial and fundamental treatment for atherosclerosis-related myocardial infarction and stroke.

People often believe that lipid-lowering treatment only requires one course of therapy, that the disease isn't that serious, and that medication can be stopped once blood lipids are lowered. In reality, atherosclerosis is a chronic disease that develops over a long period and requires long-term treatment-a fact that even some medical professionals are not fully aware of.

When blood lipids drop to near the desired level, the medication dosage should be appropriately reduced for long-term maintenance therapy at a low dose, rather than stopping medication immediately. This is because high blood lipids are caused not only by external factors such as diet and exercise, but also by internal metabolic and genetic factors, which have a long-term impact on blood lipids. For example, cholesterol is mainly produced from the small intestine, skin, and liver (about 80%), with only 20% provided by food. Therefore, metabolic factors are very important.

Many patients stop medication after achieving their treatment goals, while others continue treatment intermittently. This is detrimental to the treatment of this condition. Similar to the treatment of hypertension, current lipid-lowering methods only treat the symptoms, not the root cause. While lowering blood lipids does not require lifelong treatment, prematurely stopping medication after achieving the target levels can cause blood lipid levels to rise again. After achieving the target levels, a long-term treatment plan should be developed under the guidance of a doctor to effectively control blood lipids and maintain them at normal levels. It is crucial to avoid inconsistent treatment.

Avoid blindly lowering cholesterol

Because lipid-lowering drugs are metabolized in the liver, they can worsen liver damage. Therefore, patients with active hepatitis are not suitable for taking cholesterol-lowering drugs.

Atherosclerosis is a relatively slow process, and the negative long-term effects of discontinuing lipid-lowering drugs for a certain period on the treatment of primary hypercholesterolemia are negligible. Furthermore, cholesterol and other products of its biosynthesis are essential components for fetal development, including steroid and cell membrane synthesis. It is worth noting that statins, while reducing cholesterol biosynthesis, also reduce other products of the cholesterol biosynthesis pathway; therefore, pregnant women taking these lipid-lowering drugs may potentially harm the fetus. Thus, pregnant or breastfeeding women should not take cholesterol-lowering drugs; discontinuing their use is far more beneficial than harmful.

Whether lipid-lowering drugs and their metabolites are secreted in human breast milk is currently lacking research, and there is no sufficient theoretical or evidentiary support to prove it. Given that many drugs are secreted in human breast milk, and considering the potential side effects of lipid-lowering drugs, breastfeeding women are generally not suitable to take these medications.

It is obvious that not all patients with coronary heart disease are suitable for cholesterol-lowering treatment. For elderly patients in their seventies, those with chronic congestive heart failure, dementia, advanced cerebrovascular disease, or active malignant tumors, lipid-lowering treatment has significant drawbacks.