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Liver Disease And Chronic Fatigue Syndrome

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Why Do You Think That Medications The Help Pbc

Fatigue and Sleep Disorders in Patients with Chronic Liver Disease

This is probably in part because fatigue is so complex, and we dont know exactly what leads to its development. Many factors are likely involved, such as changes to the central nervous system, the autonomic nervous system, and the muscle metabolism. Many changes that are related to fatigue can be observed in patients with PBC, including memory changes, difficulty concentrating, sleep disturbances, mood changes, and impaired physical activity. Because fatigue can limit a persons ability to work and perform their daily activities, and affects their mood and quality of life, treatment of fatigue is identified as a priority for research for patients with PBC. We need to continue to study new strategies to help address the debilitating symptoms that can accompany the disease which is where this study comes in.

Clinical Assessment Of Fatigue

Understanding and then managing fatigue in CLD is dependent on our ability to quantify what is a complex and difficult to vocalise symptom in a way that is both valid and reproducible. There are three broad approaches to the assessment of any symptom. These are the use of subjective measures , objective measures and impact measures . In the context of fatigue in CLD the three categories are: fatigue impact scores, physical activity monitoring, and higher QOL or functional status assessment tools. In terms of fatigue assessment tools, the Fatigue Impact Score has been validated for patient self-completion and is widely used., This approach has the advantage of allowing cross-disease comparison. Disease-specific measures such as the PBC-40 may offer greater sensitivity but are limited in terms of their availability.

Objective measurement of physical activity is in reality an indirect measure of fatigue. It must be remembered that there are confounding factors in chronic disease which are unrelated to fatigue but which cause reduced activity. Perceived fatigue levels can be very high in motivated patients who strive to keep active and thus retain high levels of activity, a scenario that can lead to under-estimation of their symptoms. Physical activity monitoring has been done in PBC and NASH and correlates well with perceived fatigue,, but has limited application other than in the clinical trial setting when objective outcome measures have a particular value.

Enhancing Healthcare Team Outcomes

An interprofessional team that provides a holistic and integrated approach is needed for a patient with chronic liver disease to achieve the best possible outcomes. The earlier signs and symptoms of a complication are identified, the better is the prognosis and outcome. The team consists of primary care physicians, gastroenterologists/hepatologists, dieticians as needed, and a social worker and community nurses who can monitor the patient and make referrals as necessary to prevent the development of complications. Routine labs and endoscopy and the ultrasound as appropriate are required. The liver transplant team should closely monitor patients who are transplant candidates.

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Liver Disease & Fatigue

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 , 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.

Deterrence And Patient Education


Patient education is one of the critical factors that can play a pivotal role in the prevention of chronic liver disease. Most of the causative factors of chronic liver disease damage the liver over a long period therefore, it is necessary to stop its progression to avoid cirrhosis and its complications.

Recommendations for Preventive Care in Chronic Liver Disease

  • Avoid various types of alcohol .
  • Regular screening for hepatitis B and hepatitis C
  • Vaccination against hepatitis A and B
  • Avoid iron supplementation unless there is an iron deficiency.
  • Avoid over-the-counter painkillers and other hepatotoxic drugs.
  • Maintain a good lipid profile to avoid metabolic syndrome and NAFLD.

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Fatigue In Chronic Liver Disease: New Insights And Therapeutic Approaches

Calgary Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada


Calgary Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada


This work was supported by Abbott Laboratories GmbH.

Handling Editor: Espen Melum

List Of Abnormal Findings In Chronic Fatigue Syndrome And Myalgic Encephalomyelitis

Myalgic encephalomyelitis/chronic fatigue syndrome is a complex multi-system disease and biological abnormalities in patients have been found affecting multiple bodily systems. No single biomarker-based diagnostic test has been validated but patients have a range abnormal physical findings affecting multiple bodily systems. The CDC states that diagnosing ME/CFS relies on a physical and psychiatric assessment, observations, medical history, clinical interview, and results from a mix of blood and urine tests.

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Causes Of Chronic Fatigue Syndrome

There is no clear explanation for why people develop chronic fatigue syndrome. There are a number of theories about what could be happening:

  • It may be a faulty immune system response that leads to inflammation of the immune system.
  • It has also been suggested that the symptoms are caused by a virus although no virus has yet been identified. Likely candidates include Epstein-Barr virus or human herpes virus-6.

There are also a number of contributing factors that are believed to increase the likelihood of developing CFS including:

  • A family history of the condition. There may be a genetic component to chronic fatigue syndrome.
  • Environmental factors.
  • If people are dealing with excessive stress they may be more at risk of developing the condition.
  • Poor diet choices.
  • Those people who are socially isolated seem to be more likely to develop CFS.
  • Lack of exercise or excessive exercise.
  • Traumatic events.
  • History of viral infections such as glandular fever.
  • History of depression.

Chronic Fatigue Syndrome Is In Your Gut Not Your Head

Diagnosing HCC in Chronic Liver Disease
Cornell University
Physicians have been mystified by chronic fatigue syndrome, a condition where normal exertion leads to debilitating fatigue that isn’t alleviated by rest. There are no known triggers, and diagnosis requires lengthy tests administered by an expert. Now, for the first time, researchers report they have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood.

Physicians have been mystified by chronic fatigue syndrome, a condition where normal exertion leads to debilitating fatigue that isn’t alleviated by rest. There are no known triggers, and diagnosis requires lengthy tests administered by an expert.

Now, for the first time, Cornell University researchers report they have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood.

In a study published June 23 in the journal Microbiome, the team describes how they correctly diagnosed myalgic encephalomyeletis/chronic fatigue syndrome in 83 percent of patients through stool samples and blood work, offering a noninvasive diagnosis and a step toward understanding the cause of the disease.

In the study, Ithaca campus researchers collaborated with Dr. Susan Levine, an ME/CFS specialist in New York City, who recruited 48 people diagnosed with ME/CFS and 39 healthy controls to provide stool and blood samples.

Bacteria in the blood will trigger an immune response, which could worsen symptoms.

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Glutathione And Long Covid/chronic Fatigue Syndrome


COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, which has been at the forefront of peoples minds since its emergence in late 2019. It is fair to say that the pandemic it unleashed throughout the world will resonate with us for many years. The arrival of successful vaccines has tilted the pandemic in our favour, but there is a sinister side to this story.

Not long after COVID-19 became synonymous with the collapse of tourism, businesses and overburdened health systems, reports of people surfaced who suffered from a condition that became known as Long Covid. In essence, Long Covid is a lingering illness in people who have contracted COVID-19 and then presumably recovered because the virus was no longer detectable. Regardless of how severe the initial onset of COVID-19 manifested itself, a significant proportion of patients report debilitating symptoms long after the virus has been eliminated from their body .

An Irish study found that over 50% of patients with COVID-19 reported persistent fatigue more than 10 weeks after initial symptoms . Likewise, researchers in Italy confirmed troublesome symptoms sixty days after initial onset . The US Centers for Disease Control and Prevention similarly concluded ongoing symptoms such as fatigue and cough. They found this to be more prevalent in older people or those suffering from chronic diseases.


Liver Biopsy And Serum Biochemistry

All patients underwent percutaneous liver biopsy guided by ultrasonography. Liver biopsy was performed using 16-G Tru-Cut biopsy needles . The specimens were fixed, paraffin-embedded, and stained with hematoxylin and eosin. A minimum of 1.5cm of liver tissue with at least 9 portal tracts was required for appropriate diagnosis. All liver biopsies were reviewed by one pathologist , who had no knowledge of the clinical characteristics of the study subjects. Liver fibrosis was evaluated according to METAVIR scoring system.

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Management Of Fatigue In Practice

Significant challenges remain with regard to the management of fatigue in CLD in clinical practice. In particular, we lack evidence-based specific therapies with the result that the main approach to management in practice is supportive. Recent advances in understanding the mechanistic basis of fatigue in CLD outlined above have the potential to lead to specific therapies in the near future, although the evaluation of those in the clinical trial setting will be challenging.

Depression Can Play A Role In Fatigue

Liver Disease Fatigue Treatment

Anyone with a long-lasting illness can get depressed. Hepatitis C is no different. You may be angry, anxious, or sad about your health or the changes you’ve had to make in your life.

Your doctor can help. Tell them how you’re feeling. They may prescribe an antidepressant.

They can also help you find a therapist or support group, where you can talk to others who are facing the same problems as you.

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Reduced Butyrate Levels A Seminal Gut Finding In Me/cfs

Fatigue was certainly the byword in this study as lower butyrate levels were associated with more fatigue and both general and/or physical fatigue were particularly associated with reduced levels of F. prausnitz, Coprococcus, and a few other bacteria.

Butyrates becoming a pretty big deal in ME/CFS gut studies. Its the primary energy source for the endothelial cells lining the gut an interesting finding given all the focus on the endothelial cells lining the blood vessels in ME/CFS and long COVID. Given the strong possibility that leaky gut is present in ME/CFS, its intriguing that butyrate protects the gut lining. Its support of regulatory T-cells and its anti-inflammatory activity helps keep the immune system in check as well.

Dramatically reduced butyrate levels in ME/CFS patients compared to healthy controls.

Reduced butyrate levels in ME/CFS then, could result in an inflammatory state in the gut and a weakened gut barrier to boot which is perhaps just the right combination to spark an inflammatory response that ranges from the gut all the way to the brain.

The butyrate connection got even stronger when the authors found reduced levels of a substance called acetate. Because butyrate-producing bacteria need acetate to produce butyrate, the acetate deficiency fit the bill.

The Gist

  • Coming up increasing acetate and butyrate levels in the gut for better health

What Is Causing My Chronic Fatigue

Wouldnt it be nice to know whats causing your chronic fatigue syndrome? Chronic fatigue syndrome is characterized by extreme fatigue that persists for more than six months. The fatigue often gets worse with physical or mental activity, and resting more does not seem to make a profound change. While it would be nice and easy if there was only one culprit responsible for causing chronic fatigue syndrome, we know this is not the case. If you struggle with Chronic fatigue, you should consider working with a doctor who is certified in Functional Medicine and one who can put these pieces of your health puzzle together.

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Drug And Alternative Therapies

Specific chronic fatigue syndrome symptoms such as pain, depression, and poor sleep are treated.

Many different drugs and alternative therapies have been tried to relieve the chronic fatigue itself. Although many treatments, such as antidepressants and corticosteroids, seem to make a few people feel better, none are clearly effective for all. It can be hard for people and doctors to tell which treatments work because symptoms are different in different people and because symptoms may come and go on their own.

Controlled clinical trials The Science of Medicine Doctors have been treating people for many thousands of years. The earliest written description of medical treatment is from ancient Egypt and is over 3,500 years old. Even before that, healers… read more , which compare the benefits of a drug to those of a placebo , are the best way to test therapies, and no drug therapy has been shown to be effective for the treatment of chronic fatigue syndrome in controlled trials. A number of treatments directed at possible causes, including use of interferons, intravenous injections of immune globulin, and antiviral drugs, have been mostly disappointing and potentially dangerous. Dietary supplements, such as evening primrose oil, fish oil supplements, and high-dose vitamins, are commonly used, but their benefits remain unproved. Other alternative treatments have also been ineffective. Treatments that have no proven benefits are best avoided because they can have side effects.

Learning To Deal With Extreme Fatigue

CBD Oil And Liver Cirrhosis Fatigue Liver Cirrhosis Vlog

Feeling extreme tiredness with liver disease is a common symptom. Many people with advanced liver disease feel very tired and have low energy levels. This can be due to your medical condition, external stresses or a combination of the two. Fatigue affects people differently and can come and go. One day you may feel able to live normally and the next you may have difficulty getting the energy and strength to do even the smallest tasks.

Planning your day and the week ahead is very important if you experience fatigue.

  • Plan in time to rest during the day.
  • Think about which things are the highest priorities for you and your family, and make sure these get done first.
  • Be realistic about what you can do and dont try to do too much.
  • Ask for help, not just from your family, but think about which tasks a friend or neighbour might be able to do for you.
  • Explain to people that you need to be flexible, so that you can leave early from a party or social engagement.

Some people experience sleep problems. This can mean that you need to sleep during the day, or perhaps that you have difficulty sleeping through the night. Plan your day to suit your bodys needs, taking naps during the day if you need to.

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Elevated Liver Enzymes Causes

Hepatitis, nonalcoholic fatty liver disease, obesity and alcohol abuse typically cause elevated liver enzymes 2. Liver cancer, cirrhosis and liver scarring also cause an elevation in liver enzymes. Elevated liver enzymes are often noted during a liver function test consult your doctor for interpretation of your test results and treatment options 2.

Fatigue And Liver Disease

Fatigue is the most common symptom of liver disease, according to a study published in the March 2006 issue of the Canadian Journal of Gastroenterology. The study pointed out that although there is now a greater understanding of the processes that cause fatigue, but an insufficient understanding of the underlying cause of fatigue associated with liver disease 1. The results of the study suggest that fatigue very likely occurs because of changes in your brains neurotransmission. Further research is needed to more fully understand the processes that affect liver disease-associated fatigue, as well as the effects on liver enzyme levels.

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A Less Diverse Ecosystem

Having IBS made a real difference. Specifically, the differences in the alpha diversity of the gut bacteria largely reflected whether one had IBS or not. Alpha diversity is a term borrowed from ecology that measures the richness or diversity of complex ecosystems . Like a forest, the higher the species richness or alpha diversity of the bacteria in the gut the more resilient, healthy, and productive the gut should be

The bacteria in our guts form an ecosystem. This study suggests that some ME/CFS patients gut ecosystems are less diverse and less resilient

Alpha diversity isnt the only measure of gut health but it is an important one. One Ph.D. student reported that High gut alpha diversity has been linked to a healthy state in so many studies that it has become common knowledge in microbiome circles.

Having IBS had a dramatic influence on alpha diversity with only the ME/CFS +IBS having a reduced alpha diversity compared to healthy controls.

Beta diversity can also be used to assess gut health. The beta diversity test compared the difference between the microbiome species found in the presumably healthier guts of the healthy controls with the ME/CFS patients with and without IBS. In contrast to the alpha diversity finding, both ME/CFS cohorts , had altered beta diversity i.e. whether they had IBS or not, the flora in the ME/CFS patients guts was markedly different than the flora found in the healthy controls guts.

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