Exhausted Every Day? Here’s What May Help

This is probably not news to you, but fatigue—unusual, unrelenting tiredness—is one of the most common symptoms of primary biliary cholangitis (PBC). It can be the first symptom some people with PBC notice—and its effects are no joke. PBC fatigue can cause brain fog and impact your mental health, your overall well-being, and your ability to “do it all.”  

So, how do you deal with it?

Give yourself some credit—and ask for support

Acknowledge all that you can do, for starters. And explain to your family and friends that you’re doing the best you can. A recipient of the American Liver Foundation’s Fund for the Cure Award says, “Educating your loved ones on your symptoms and how they impact you on a daily basis may be helpful. A supportive environment can improve your sense of well-being and may help you develop modifications to accommodate the burden of fatigue.” Modifications can mean asking others to take on responsibilities you used to handle on a regular basis. The recipient also mentioned that engaging in social activities, as difficult as that can be when you’re fatigued, is another helpful strategy.

Learn to pace yourself

An occupational health specialist in the UK suggests that people with fatigue practice pacing themselves. She says, “It’s about understanding your own units of energy. So rather than working flat out all day and then needing 2 days to recover, you may need to work for 2 hours a day for 5 days.”

This is also known as the spoon theory—having a certain number of “spoons” of energy available each day. Every time you do something, you remove a spoon. This can help you plan ahead for how to use your spoons. You can also use this as a tool when talking to friends and family—letting them know you only have 2 spoons left for the day, so you may need to recharge and take a nap before committing to a social outing or doing chores. After a while, you will learn how many spoons, or units of energy, a task takes, and you can plan your time accordingly.  

Practice good sleep habits

When you have multiple responsibilities inside and outside the home, your sleep quality and schedule could take a hit. This only adds to the problem of fatigue.  

Here are a few tips on how to maintain good sleep habits:  

• Avoid daytime naps lasting 2 or more hours

• Go to bed at the same time each day

• Get out of bed at the same time each day

• Ban TVs and computers from your bedroom

• Avoid using your smartphone before bed

• Keep your room cool and dark at night

• Avoid caffeine and alcohol

• Have a relaxing bath about 2 hours before bed

You might also try to keep a sleep diary for a few weeks, which can help your doctor spot any patterns or triggers and recommend helpful solutions. 

Consider lifestyle changes

While exercise may seem impossible when you’re exhausted, it’s been shown to release hormones called endorphins that can actually help relieve fatigue. If you can, try to take advantage of days when you feel up to it to exercise, and rest on the days when you need it.

Adjusting your diet can also make a difference. While there is no one diet proven to fight fatigue, adding foods that fight inflammation can help—as can avoiding foods that could add to it. The Mediterranean diet is often recommended for its abundance of healthy, anti-inflammatory foods.

Here are some foods that help fight inflammation:

• Tomatoes
• Olive oil
• Green, leafy vegetables (spinach, kale, collard greens)
• Nuts (almonds, walnuts)
• Fatty fish (salmon, mackerel, sardines)
• Fruits (blueberries, strawberries, cherries, oranges)

And here are some foods to limit:

• Refined carbohydrates, like white bread and pastries

• French fries and other fried foods

• Soda and other sugar-sweetened drinks

• Red meat (hamburgers, steaks)

• Processed meats (hot dogs, sausages)

• Margarine, shortening, and lard

• Alcohol

Treat other health conditions

Besides talking to your doctor about overall fatigue, it makes sense to take care of treatable conditions that could coexist with PBC and could be adding to your exhaustion. Seek help with testing for and treating health concerns, like:

• Thyroid problems

• Anemia

• Vitamin D deficiency

• Sleep apnea

• Depression or anxiety

• Toxic mold exposure, which has been shown to be a trigger in people with autoimmune disease

It’s also a good idea to ask your doctor whether your use of certain medications could be contributing to your fatigue. As always, talk to your doctor and care team about any of these tips, and update them on your progress.