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Stage 4 HCV and fatigue
Melissa Palmer, MD posted:
One of the most common, relentless, and debilitating symptoms experienced by people with liver disease is fatigue. The symptom of fatigue is universal to liver disease. Some people do not experience fatigue until several years after they have been diagnosed with liver disease. In others, fatigue is the primary reason that they seek medical attention. Fatigue does not correlate with either the duration or the severity of the disease, so it may be as debilitating to a person in the early stages of liver disease as it is in a person with advanced cirrhosis. Fatigue is particularly common in people with chronic hepatitis C, especially in stage 4 disease.
Successfully treating fatigue can be a challenge. In attempting to combat fatigue, all of the possible causes of a person's fatigue should be looked into. Some causes are easily managed. Some occur commonly in people with liver disease. The potential causes of, and/or contributors to, fatigue include the following:
? Thyroid disease (may be primary cause of, or contribute to, fatigue).
? Anemia (may be primary cause of, or contribute to, fatigue).
? Disorders of other organs, including the heart (for example, congestive heart failure) or the brain (for example, brain tumors).
? Nutritional deficiencies (for example, a lack of iron or a lack of protein).
? Disturbances in fluid and electrolyte balance (for example, a low sodium level).
? Depression
? Some medications and drugs (a doctor should review all prescription and over-the-counter medications that a patient is taking. If possible, those that cause fatigue should be discontinued).
? Excessive use of caffeine.
? Excessive use of alcohol.
? Emotional stress.
? Lack of exercise.
? Lack of sleep.
? Overwork.

rmccloskey001 responded:
you mentioned excessive caffeine use. I posted as to my new diagnosis and an article i found on the internet and the benefits of caffeine use in hepatitis c patients. can you illuminate?
Melissa Palmer, MD responded:
The hepatoprotective effect of caffeine, particularly caffeinated
coffee, on patients with chronic liver disease
has been demonstrated in many studies. Analysis of the
baseline characteristics of 766 patients in the HALT-C
trial concluded that higher coffee consumption was
associated with less hepatic steatosis, lower serum
aspartate (AST)/alanine aminotransferase (ALT) ratio
and lower alpha-feto protein (AFP) levels. Follow-up
evaluation approximately 4 years later revealed that
patients who drank three or more cups of coffee/day had
a lower incidence of disease progression compared to
those who ingested less than three cups of coffee/day
(43). This finding was confirmed in a study by Modi
and colleagues who found that HCV patients consuming
between 2—3 cups of regular coffee/day had less fibrosis
on histologic evaluation, compared to patients who
drank less than this daily amount (44). Similar results
were not seen in patients who consumed caffeine from
other sources or who consumed decaffeinated coffee.
Costentin and colleagues in France found that HCV
patients who consumed more than 408 mg of caffeine/
day—approximately 3 cups of a caffeinated beverage/
day, had less histologic inflammation compared
with those HCV patients who drank less than this daily
amount of caffeinated beverages/day, although no correlation
with degree of fibrosis was found (45).
While the exact amount of coffee consumption
necessary to obtain beneficial results is unclear, it
appears reasonable for patients with HCV to drink two
-to -four cups of caffeinated coffee/day. Caffeine may
also reduce fatigue that is often associated with HCV,
although higher amounts of caffeine may cause irritability,
restlessness, and insomnia. This should be
taken into consideration for people undergoing HCV
treatment, as side effects of PI plus RBV may also
include anxiety and insomnia. Finally, it should also be
kept in mind that coffee is also risk factor for the
development of osteoporosis, which as noted above
occurs, with increased frequency in people with
chronic liver disease.
billm57 replied to Melissa Palmer, MD's response:
it seems the more we know - the less we know - lol

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