Fatigue: Hep C’s Partner in Crime

How people living with the virus can root out the causes of fatigue and find ways to cope.


Hepatitis C virus (HCV) is infamous for its stealth, often remaining undetected in the body for decades. But one symptom above all others tends to rise to the surface to rear its ugly head. Ask a different expert and you’ll get a different estimate on its prevalence, but most will agree that fatigue is highly common in the hepatitis C population and often poses a major challenge to their overall quality of life.

Fatigue is a notoriously tricky beast—highly subjective and hard to define. Beneath its wide umbrella are symptoms such as sleepiness, a lack of physical energy or stamina, an inability to concentrate, trouble with memory, and the ever-nebulous “brain fog.”

For people with hepatitis C in particular, it may be impossible to ever fully understand where such physical and mental symptoms come from, because there are so many overlapping potential causes. To wit: research on this topic is often contradictory and inconclusive, or just plain non-existent. 

The virus itself may cause fatigue, perhaps by increasing the presence of the body’s cytokines, a key part of the immune response, which can then lead to fatigue in the same way a flu would. Those with cirrhosis of the liver from any cause are also known to struggle with fatigue.

Non-viral contributing factors tend to be better understood and may in fact be a bigger part of the problem. Because drug and alcohol use is so prevalent among the hep C population, both are possible culprits, as are psychological illnesses such as depression and anxiety. It should come as no huge surprise to anyone who has grappled with a hepatitis diagnosis that simply knowing one has the disease may cause depression, which can lead to fatigue. And of course, until therapies for the virus improve in the coming years, treatment means taking interferon, which causes fatigue in just about everyone. 

It may require various levels of sleuthing before you can begin to identify why you’re not feeling well. Such an understanding will hopefully lead to ways to mitigate your symptoms. But even if such success ultimately proves out of reach, at the very least you can learn coping strategies to better manage life with fatigue.

Start a Dialogue With Your Doctor

An important first step is to have a comprehensive medical exam, during which you communicate your symptoms with your clinician. Start this process with a hepatologist or your primary care physician. The doctor can figure out what tests will help rule out contributing conditions outside of hep C and can decide on any other specialists you should see. 

Tell your care provider about any medications you are taking, as these may have side effects that make you tired. Also, you should discuss your sleep patterns. Be honest about any drug or alcohol use. 

Your physician may refer you to either an internist or endocrinologist to check for conditions such as thyroid disease, which is relatively common among the hep C population. You might also visit a sleep specialist to detect problems such as sleep apnea that may be seriously interfering with sleep patterns. A psychiatrist or psychotherapist can help treat issues like depression and anxiety. And in the event that you are presenting symptoms of the pain condition fibromyalgia, which often goes hand-in-hand with chronic fatigue syndrome, you might see a rheumatologist.

Lifestyle Changes

“It’s very important to maintain an ideal body weight,” says Zobair Younossi, MD, MPH, chairman of the department of medicine at Inova Fairfax Medical Campus in Virginia, suggesting a diet that cuts out excessive fats and carbohydrates.

Obesity, as it happens, is yet another cause of fatigue, as is consuming alcohol, which physicians tend to advise those with hep C avoid entirely because it can damage the liver. Smoking—be it tobacco or marijuana—can also zap your energy.

Exercise, of course, is another important component of healthy living and weight control and it can help fight fatigue. Younossi recommends a baseline regimen of 30 to 45 minutes of aerobic exercise at least three times a week. 

If this proves impossible, don’t despair. And don’t let a lack of energy lock you to the couch. One recent study found that simply walking can be highly beneficial. People with hepatitis C who hit 10,000 strides, or about five cumulative miles, three days out of the week saw significant improvements in fatigue levels. Try using a pedometer to keep track of your strides.

Then there’s the old stand-by, caffeine, which research suggests may actually help with more than just short-tern alertness.

“I think two or three cups of coffee is fine,” Younossi says, “and it may even help liver fibrosis.”

Those who have trouble sleeping, however, may want to consider a more conservative approach to caffeinated beverages.

“Sleep is key in everything,” says Diana Blank, MD, a staff psychiatrist at Toronto Western Hospital and a member of the hospital’s comprehensive hepatitis C team. So if the sleep pattern changes, then that’s enough to screw up someone’s life and have them become chronically fatigued.”

Outside of speaking to a doctor about medical solutions, some classic behavioral techniques for improving sleep include going to bed and getting up at the same time every day, only using your bed for sleep, establishing a relaxing routine at bedtime, making sure you have a comfortable, dark, quiet and cool sleeping environment, and avoiding both caffeine later in the day and food before bed.

Source: hepmag.com

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