Hepatitis C can wear you out. There’s no getting around it. Of the estimated 3.5 million people in the U.S. who have the virus, at least half say fatigue is one of their symptoms.
But the link between the virus and feeling so tired isn't always clear.
Nancy Reau, MD, section chief of hepatology at Rush University Medical Center in Chicago, says that studies have shown that if you can stop the virus from reproducing so much, people feel more energetic.
"When the hep C is no longer measurable,” she says, "people are less tired.”
Still, not everyone with hepatitis C feels run down all the time.
“I think it’s important to recognize that fatigue is a pretty common problem anyway,” says Reau, a member of the American Liver Foundation’s National Medical Advisory Committee. “Sometimes it’s the virus. Sometimes it’s not the virus.”
There's a more direct link between fatigue and problems like cirrhosis (scarring on the liver) that are more serious. So when faced with someone who has hepatitis C, doctors will try to manage liver disease before dealing with the fatigue.
If there’s no disease, doctors will look at other possible reasons you're tired that aren't directly related to the virus.
Those could be psychological. Some of that run-down feeling can come from the emotions and stress that come with a chronic disease. Whatever it is, fatigue can stop those with hep C in their tracks.
“People sometimes do get a mistaken sense from doctors that, ‘It’s all in your head,’” says Andrew Muir, MD, a hepatologist at Duke Clinical Research Institute in Durham, NC. “But it’s real. The key is, is it related to the liver disease or not?”
What can you do about that always-tired feeling?
Talk to Your Doctor
The first step with any medical issue is to talk to your care team and follow your treatment plan.
As you’re fighting off that fatigue, remember that hepatitis C is curable. With proper treatment, doctors can rid you of the virus. And, maybe, the fatigue, too.
“Usually [if they don't have cirrhosis] once we treat them, cure them, and they know that their hepatitis C is gone, their quality of life is better, subjectively better,” says Victor Machicao, MD, a gastroenterologist with McGovern Medical School at UTHealth-Houston.
“They don’t worry much about their fatigue, or maybe they have fatigue that’s not as bad as before,” he says.
Even before you’re cured, your medical team may be able to spot other causes for your fatigue and help you find ways to combat them.
Get Your Sleep
If you’re always tired, sleep problems become common. These will make your more tired. More than 35% of adults get what the CDC calls “short sleep,” or less than the 7 hours a night (at least) that experts recommend. That could lead to all sorts of chronic diseases, including obesity, cardiovascular disease, diabetes, and depression.
“I cannot tell you how many times I see somebody who has posted on the [hepatitis C] forum, ‘I can’t sleep, I didn’t sleep at all’ … and they’re on the Internet posting at 2 a.m. or 3 a.m.,” says Lucinda Porter, a nurse and hepatitis C advocate who has written two books on the subject.
Porter got hep C after a 1988 transfusion, but she's now virus-free. “Turn off those devices an hour before sleep time, and give yourself a good 8 hours of sleep.”
You can take steps to ensure a good night’s sleep, including:
- Cut out alcohol and caffeine before you sleep.
- Go to bed and get up about the same time each day.
- Keep smartphones, laptops, TVs, etc. out of your bedroom.
- Make sure where you sleep is dark and quiet.
And if you still feel tired during the day, it’s OK to take a nap. Really. It’s OK.
“If you’re tired, take that, like, 10-minute power nap. There’s lot of things out there that suggest that’s a very healthy strategy,” Reau says. “Now, taking a 5-hour nap in the middle of the day probably isn’t ideal. But resting when you need to is very appropriate.”
Watch Your Diet
Yes, as always, what you eat is critical. An unhealthy diet can lead to fatigue. Muir often fields questions about a “hepatitis C diet.”
“There’s no specific diet that we would say that is related to hepatitis C. You do want it to be a diet that keeps you healthy. Particularly we worry about people gaining weight,” says Muir, a member of the American Liver Foundation’s National Medical Advisory Committee. “So, a healthy diet that keeps your weight under control, balanced with exercise.”
You know: fruits, vegetables, grains, proteins, and a little dairy. Reau suggests talking to a nutritionist if you have questions.
Avoid alcohol, too. That can lead to trouble sleeping and other health problems.
“When I talk to [people] about fatigue, figuring out whether they’re tired or out of shape can be challenging,” Muir says. “If you are out of shape, all that activity will be hard until you get back in shape.”
It’s nearly impossible to think about exercise when you’re so fatigued all the time. But often it’s a vicious loop. Maybe you’re tired because you’re not exercising enough. If that’s the case, the answer is simple.
“I’m not saying get out there and run a marathon. If you’re housebound, and you’re not used to exercising, walk around the house. Maybe next day, get out of your house and walk as far as you can. Then the next day, walk to the end of the block,” Porter says. “Start building up your strength.
"You need your strength to battle fatigue.”
Have a Cup of Coffee
Your morning java is a stimulant that can help stave off that run-down feeling. It's also liver-friendly. It’s a surprise to many of the people who come to see Muir.
“Every time I ask them, ‘Do you smoke, do you drink, do you drink coffee?’ they’re kind of sheepish about all that,” he says. “But I tell them, ‘Enjoy your coffee.’ I feel like as a doctor, I take away so much stuff from people. It’s nice to be able to tell them that coffee is fine.”
A few cups a day to keep you alert seems to be fine, Reau says. Still, you want to avoid too much too close to bedtime.
One sign of dehydration is fatigue. Water, which is full of health benefits, keeps you hydrated. (How much to drink? Eight glasses a day is only a guideline. It varies by person.)
“It was pure, it didn’t have any artificial sweetener. It didn’t have any toxins in it. Tea and water, and coffee. I lived off that,” says Stella Armstrong, a member of the National Patient Advisory Committee for the American Liver Foundation.
Manage Your Stress
Dealing with hepatitis C, as with other chronic diseases, can be stressful, and that can lead to some sleepless nights and restless days. That can bring on fatigue that happens over and over again.
“The nature of stress is very fatiguing,” says Porter, who writes about hepatitis C on hepmag.com and hcvadvocate.org. “It uses up your muscle strength, it uses up some of your oxygen. And it’s very hard to let go of.”
Some people find meditation helpful. Some need their alone time. Some enjoy watching TV, or knitting, or bowling, or whatever. The key is finding your whatever.
Lean on Others
Find someone you trust -- a family member, someone else with the virus, a member of the clergy, your doctor, a support group in person or online, a psychologist -- who will help you through the depression and emotions many people face. Holding all that stuff in can be exhausting.
And find someone who will push you when you need it.
“Look for kind of like the life Sherpa,” Reau says. “Do you have a friend that will go with you to the gym when you really don’t want to go? Or that will every day at 10 o’clock give you a phone call to force you to get dressed and go out and do something? A regimen is really important. Go to bed early. Take your naps.
"Give into it when you have to. But don’t let it rule your life.”