Everyone complains now and then of being tired. Perhaps you were up all night cramming for a final exam, caring for an ill family member, or maybe you just could not fall asleep. We experience many situations that result in decreased energy levels, but a night or two of good sleep usually puts us back on track. But what if you woke up every morning feeling as if you never got a moment of rest? What if you could not function at work, at home, or socially because you were just too tired? That is what most healthcare practitioners would consider chronic fatigue.

Chronic fatigue can be peripheral or central. Peripheral is muscle or physical fatigue, whereas central fatigue comes from the central nervous system, and is associated with difficulty in performing physical and mental activities that require self-motivation. Whether physical or mental, it is difficult to cope while in a constant state of fatigue.

Fatigue is a symptom commonly described by people with liver disease (hepatitis), regardless of whether the hepatitis is caused by a virus, excess alcohol or fat consumption, or an inherited disease. The associated fatigue may be intermittent or constant, mild or debilitating. There is no relationship between the severity of liver disease and the severity of the fatigue. Those with minimal liver disease may experience total exhaustion while those with severe liver disease may not feel tired at all, or vice versa.

Since fatigue can be caused by a variety of other health problems, such as anemia, depression, sleep disorders, poor diet, dehydration, or lack of exercise, it may be difficult to determine whether it is caused by the liver disease, secondary conditions, or a combination of both.

There is no magic medication, vitamin, or dietary change that will alleviate fatigue completely. Unfortunately, for most who suffer from chronic hepatitis, it is something with which they must learn to cope. That being said, there are certain strategies that may make the fatigue more bearable:

  • Management (or treatment, if possible) of the cause of hepatitis, if it is present. This depends greatly on the type of hepatitis (see our hepatitis article for more information).
  • Treatment of secondary conditions such as anemia, sleep disorders, thyroid dysfunction, and depression. When properly monitored by a physician, these conditions will not contribute to the level of fatigue.
  • Ask for help from family and friends. Activities such as housework, laundry, and shopping can be divided up easily and spread throughout the week.
  • Alternative therapies, such as acupuncture, relaxation, meditation, and massage, may help alleviate pain and diminish fatigue.
  • Get adequate sleep. Wind down before bed; avoid caffeine, alcohol, and tobacco in the evening; and maintain a regular routine (i.e., go to bed every night at the same time and get up each morning at the same time).
  • Eat a well-balanced diet that includes fruit, vegetables, whole grains, and protein. Avoid foods that are high in fat, sugar, and salt (sodium).
  • Ensure an adequate water intake by drinking fluids throughout the day. Avoid caffeinated beverages, such as pop, tea, and coffee, as they deplete the body of required fluids.
  • Regular exercise done more than 2 hours before bed promotes better quality sleep. Try different kinds of exercise, such as walking, biking, dancing, gardening, swimming, Tai Chi, or yoga.
  • A positive attitude can be a very powerful ally when it comes to minimizing the symptoms of fatigue. It may help you cope more easily with the daily grind of life and the many obstacles that can often occur in life.



Fatigue is not something any of us would choose to experience on a daily basis. Unfortunately, we do not always get the option. Learning to manage fatigue, and not letting it rule your life, will allow you to enjoy the activities of everyday life.

Lori Lee Walston, RN
First published in the Inside Tract® newsletter issue 176 – 2010