Fatigue can be described as a sense of excessive tiredness, lack of energy or total body give out. The majority of people who have hepatitis C may at some stage experience fatigue although it must be stressed that it is not unusual for many people to experience periods of extreme tiredness which may relate to a busy lifestyle, stress or other factors. The term fatigue is commonly used for any symptom associated with tiredness. Fatigue specific to hepatitis C is not associated with the clinical entity known as Chronic Fatigue Syndrome (CFS).
Fatigue may or may not be associated with over exertion or lack of rest, and may or may not be alleviated by rest. There is a wide clinical spectrum of fatigue. The mildest forms are where fatigue is experienced only through over-exertion or lack of rest, and responds well to rest. In its severe form, fatigue is not the result of either over-exertion or lack of rest, and in turn does mot respond to rest.
Factors contributing to fatigue:
- Liver dysfunction
- Chronic activation
- Impaired liver function through alcohol, poor diet and other toxic substances
- Poor sleep and lack of rest
- Drug use
- Stress, distress and other situational problems
- Medical treatments such as interferon
Why Hepatitis C causes fatigue
Fatigue does tend to be intermittent and mild, and in general, patients with more advanced chronic active hepatitis and raised liver function tests, (specifically higher ALT levels), tend to experience more severe symptoms of fatigue. This however, is not the rule and fatigue is not a reliable indicator or measure of disease progression or severity. Many people with hepatitis C experience some sort of fatigue and it is the most common single symptom.
The cause of the fatigue experienced in hepatitis C has not been fully determined. There are probably multiple contribution factors towards this symptom and no one single factor can easily be studied without the influence of other factors. Also, the mechanism of how a disease state causes fatigue is not clearly understood. There are two possibilities that could be contributing factors to the fatigue experienced in hepatitis C.
1. The immune system
The major factor in chronic hepatitis C that may contribute significantly to fatigue symptoms is the continuing and long-term response of the immune system to the virus. It is generally accepted that the virus is both directly damaging to liver cells (the direct effect on other cells of the body has not been established) and indirectly damaging to the cells of the liver via the activity of the body’s immune response to the virus.
In other viral conditions such as measles, flu or hepatitis A for example, the response of the immune system rapidly produces antibodies, which eventually defeat the virus. The immune system, after clearing a virus such as measles returns to a less active state. In the majority of patients with hepatitis C (probably up to 90%), the immune system fails to have any impact.
2. The metabolic process of the liver
The liver is the largest organ in the abdomen and is the centre of all the metabolic processes that occur in the body. Liver disease if any kind interferes with the normal biochemical processes in the liver. The liver effectively acts as a filter for any toxic and unnecessary substance in the blood that may interfere with metabolic processes. It has a great deal to do with all substances that enter the body and a large proportion of the chemicals that are produced by other organs. This is why alcohol and certain other drugs are thought to have a strong bearing on the rate of disease progression in the liver.
In chronic hepatitis any number of metabolic processes could be interfered with, resulting in the escape of toxic substances into the body. This has not been proven but fatigue symptoms have been seen to respond favourably to diets and herbal treatments, which address this sort of toxic overload.
The immune system is an intricate and complex part of the whole individual and is intimately related to individual health. With the continuous and ongoing activity of the immune system and the related activity of certain chemicals and molecules as part of the immune response, there is understandably an ongoing effect on the wellbeing of the individual. The intermittent nature and unpredictability of this system could possibly be reflected by the individual nature of each person’s immune response to the virus.
While most people with hepatitis C are aware of Interferon as a drug treatment for hepatitis C, they may not be aware that this drug has been synthesised to match one of the naturally occurring interferon’s in the body. These are proteins produced by special cells, which are made when the body recognizes a foreign substance entering it. It acts as part of the protection mechanism against infection and is stimulated by a viral attack such as the flu virus. Interferon is actually the substance that seems to be the major factor in the flu-like symptoms and fatigue with hepatitis C.
In anyone who has hepatitis C, validation of fatigue symptoms is very important. An explanation to why fatigue is experienced often relieves the stress caused by it to a certain degree. It is also important to be informed about the detrimental effects of alcohol, drug use, poor rest and poor lifestyle on liver function that will in turn contribute to increased fatigue. All of these lifestyle factors probably have major impact on the immune system in addition to the virus itself.
As well as adopting changes in behaviour and lifestyle which would maximise individual wellbeing and health, there are a number of tips to best manage the fatigue state so that the normal activities of daily living can be achieved without as much effort. Experiencing fatigue over a period of time can impact in many areas of life such as relationships, work or other activities. The management of fatigue may require some readjustment and professional help. In some cases it is important to consider some type of counselling support to assist in managing the fatigue, which can cause people to feel quite depressed.
Chinese and herbal medicines have been used with some success in the treatment of hepatitis C, and the Traditional Chinese Medicine CH100 has been shown to significantly reduce the symptoms associated with hepatitis C including fatigue. Some formal trials have been done and certain combinations of herbs have been used in China, apparently successfully, for many years. When using herbals and liver tonics, it is recommended that you consult a certified herbalist or naturopath.
- Balancing your daily activities is very important. Try not overloading your day, work at the time of the day when you feel your best and arrange to do things then;
- If it takes you a while to get going in the morning, schedule your appointments for a later time so that you don’t have to rush;
- Sit down to iron or shower for example, so you are not having to support yourself;
- Use equipment if it helps conserve energy, eg use a washing trolley instead of carrying the wash;
- Have the most commonly used items out in the kitchen or at waist height so you don’t have to bend or reach which takes more energy;
- Rather than trying to sleep when you are fatigued, rest or do a lighter, easier activity as you will regain more energy from this sort of break;
- Pace yourself, give yourself timeout and regular breaks in your day;
- Prioritise your activities into what you need to do over what you think you have to do;
- Ask someone else to help you if you are too tired;
- Fatigue does not mean you cannot or should not exercise. Exercise can be invigorating and strengthening. Consult with a physiotherapist or GP to assist with an appropriate regime for you;
- Avoid big heavy meals, take smaller meals without rushing and give your body time to concentrate on the digestive process before undertaking any activity;
- Try not to have very hot showers, as this can be tiring. Also make sure the room is well ventilated otherwise the steamy humid environment can contribute to fatigue;
- Use the escalator - every little thing helps;
- Try to establish a pre-sleep routine at night. For example, instigate a quiet time, a warm drink, wind down and prepare your body for sleep;
- Your occupational therapist can help you with more ideas.
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