Many of those who live with chronic hepatitis C virus (HCV) infection are all too familiar with one of its major side effects—fatigue. In fact, fatigue is the most common hep C complaint. I refer to it as the other F word, although I have been known to use the two F words together. What is this thing we call fatigue and what can we do about it?

Fatigue sucks. It can feel like you are pushing your body through sludge while wearing waders and a fifty pound pack. It’s relentless and it casts a shadow on everything. Well-meaning people would tell me that if I exercised, I’d have more energy. It may be true, but how was I going to exercise if I was too tired? That’s like telling a double amputee that you could walk if you got up out of the chair.

There are thousands of causes of fatigue. Some common ones are: diseases, jet lag, inadequate sleep, anemia, alcohol, supplements, drugs (prescription and non-prescription), inactivity, pregnancy, boredom, excess iron, stress, too much exertion, dehydration, depression, poor nutrition, pain, thyroid abnormalities, low testosterone or other hormones, diabetes, and off course, hepatitis C.

Since there are so many causes of fatigue, the dilemma is figuring out if you are experiencing HCV-related fatigue, or if there is another cause. After years of debilitating fatigue, I asked myself that very question. It took a year of detective work, but I was able to figure out that my fatigue was not solely HCV-related. Now I am like the Energizer Bunny. Perhaps Energizer Turtle is a better comparison. I am slow, but I make it to the finish line with energy to spare.

If you figure out the contributors to fatigue, you may be able to fix or reduce the problem. Examine the common causes of fatigue mentioned in paragraph 3, and ask yourself if they could be contributing to your symptoms. Your medical provider is an essential part of the process, and will want to rule out the notorious energy-busters, such as anemia, thyroid abnormalities, sleep problems, diabetes, depression, dehydration and allergies.  A thorough and honest look at alcohol, substance use, and excessive caffeine is essential. Your medical provider will also want to look at all medications, supplements and herbs that you take. 

Determining the cause of fatigue is more a process of elimination than anything else. There are some clear connections between liver disease and chronic fatigue. Anemia may accompany liver disease. Some of the medication used to treat hepatitis cause fatigue. The liver may have an iron storage problem, which can cause tiredness. Fatty liver or autoimmune diseases that lead to hepatitis may cause fatigue. Some patients with liver disease experience a disruption of sleep patterns known as sleep reversal, which causes daytime fatigue.

Facing Fatigue

Part of your fatigue assessment will be lifestyle questions. Do you exercise, and if so, what do you do, how often and for how long?  What does your diet look like? Do you smoke? Is there a lot of stress in your life? Do you have any fun?

If you tell me that the only vegetables you eat are French fries and the only greens in your diet are lime jelly beans, there may be a problem. If the only exercise you get is pointing the remote at the TV, then there may be a big problem—a problem with a solution.

I don’t judge people about their lifestyle. I used to smoke, drink, sit, and eat chips as if these activities were a national sport. Not only will I not judge you, I urge you to not chastise yourself. Being critical doesn’t solve problems—it just makes us feel bad about ourselves. Feeling crappy about ourselves may lead us deeper into the activities that make us tired.

Be honest, but not harsh. Ask this: What could be changed, even if you have no idea of how to make this change? Don’t censor or judge your answers. For instance, you may think some exercise would be help helpful, but you have a broken leg. You can’t find a solution without identifying the problem.

Fixing Fatigue

Since fatigue is a tough problem to overcome, it can be difficult to figure out where to start. Here is what I did:

  1. First, I stopped fighting fatigue. In fact, I learned to embrace it. I started to watch how I related to fatigue. I was treating it like a huge monster, fighting it every step of the way. This fight was using up valuable mental energy that I was already short on.
  2. I changed my attitude.  I read about a study of people with chronic fatigue. After interviewing them, it was noted that people often said to themselves and others, “I am tired.” The study subjects were divided into two groups. One group was instructed not to do anything differently. The other group was instructed to substitute the phrase, “I am getting my energy back” every time they felt tired. The outcome was that the people who told themselves they were getting their energy back reported significantly reduced fatigue. I practiced this regularly.
  3. I stopped blaming hepatitis C as the sole cause of how I felt and became open to the possibility that other factors may have been contributing to how I felt. This was pivotal because it opened the door to slowly making significant lifestyle changes, which lead to more energy.

What are these changes? I sleep better because I wear ear plugs to block out my husband’s snoring. I exercise and meditate regularly and eat a mostly Mediterranean diet. I don’t smoke any longer, or drink alcohol. Remember, I wasn’t always like this. It was a slow process. If nothing else, drink a lot of water. Not only will you stay hydrated, you’ll get some exercise running to the lavatory. However, watch the water intake before bedtime so you don’t disrupt your sleep with bathroom visits.

After you have addressed all the possible factors that may cause fatigue, in the end it may still come down to hepatitis C. There is still much to be learned about this virus. Join a support group if you haven’t already. There is no substitute for being in a group with others who know what it is like to have hep C. At the very least, it’s one place you can go where no one will be offended if you fall asleep while others are talking.