Why do I get so tired? Even when I don't feel sick I am sooo tired.

Is there anything I can do? It just seems so hopeless.

OK, lets take a look at this.  Fatigue is common to a lot of problems, but with liver disease it makes everything much harder.  These comments will apply to a lot of fatigue issues but I'll refer to liver in this discussion.

When you think about energy you have to forget that you like to imagine yourself as a "person".  You have to understand that at the core of your problem you are a bunch of mitochondria.  These are small, self contained structures that float inside of your cells.  They are the focus of this discussion because they are the power source of the cell.  There is a vast and very complex chemistry that does its magic to allow you to live but at the root of everything is energy.  You eat to get fuel for your body but ask yourself just when does that fuel turn to the energy?  What the heck is energy anyway?  Ah, there you have it. That is the nut isn't it? when you feel fatigue, even when you eat good food, why doesn't it work for you?

At the end of a very  complex stew of chemical reactions sit the mitochondria and what happens is deceptively simple.  The mitochondria takes two molecules from glucose or a fatty acid and transfers two electrons from them to allow carbon and oxygen to join as carbon dioxide.  In the process a bit of extra energy is left over which powers the rest of the cellular operation.  You cannot feel good or even live if the transfer of those two electrons does not happen.

Ok, what is critical to that process? Well clearly the number of mitochondria is important and it is important to know that each cell has several and that number can change with time or as a result of various cellular events and the efficiency of the way each of them transfers those two little electrons will matter a lot.

The Mayo clinic recently reported a study about exercise.  Mayo Clinic discovers high-intensity aerobic training can reverse aging processes in adults You have no doubt been told to exercise and you likely have tried.  Very few of us really maintain a healthy exercise practice as we get older.  Our society makes it so easy to be sedentary and most of us do that and as we gain weight over time we compromise our liver which changes our bio-chemistry in ways that aren't good and so our bodies become less efficient.  The double whammy is that as we age we naturally lose mitochondria.  It doesn't take much creativity to imagine that a result of those things is a shortage of energy or fatigue.  As our body continues to become a damaged bag of not great chemical processes the fatigue becomes soul crushing.

Mayo researchers compared high-intensity interval training, resistance training and combined training. All training types improved lean body mass and insulin sensitivity, but only high-intensity and combined training improved aerobic capacity and mitochondrial function for skeletal muscle. Decline in mitochondrial content and function are common in older adults.

High-intensity intervals also improved muscle protein content that not only enhanced energetic functions, but also caused muscle enlargement, especially in older adults. The researchers emphasized an important finding: Exercise training significantly enhanced the cellular machinery responsible for making new proteins. That contributes to protein synthesis, thus reversing a major adverse effect of aging. However, adding resistance training is important to achieve significant muscle strength.

What does that mean.  You have to sweat in a nutshell.  Strength training is good but doesn't affect your mitochondria much.  This is further documented in athletic practice where studies associated with runners increased the mitochondria by working longer but maximum strength exercises didn't help total mitochondria.

If you think about how the body works this is an intuitive answer.  When you ask the body for more work it has to process more of those electrons to make carbon dioxide.  If it needs more the body responds by making more of the tools it needs to meet your demands so it makes more mitochondria.

There is a second critical piece to the puzzle.  The efficiency of the mitochondria is critical so if there are foods that help them do their job you should make sure to eat plenty of them.  The research on this is clear as I've reported in an earlier post. Oleic acid stimulated complete oxidation of fatty acids.  Oleic acid is an Omega 9 fatty acid which is the main ingredient in olive oil. You can read about the study here,

Nothing is ever as simple as this and the situation that each of us faces is different, however, this message is clear.  A way to combat fatigue where it lives is to move.  It really is a life or death decision particularly for a liver disease patient.  If you hope to slow or reverse the process.  You must support the energy engines that your body must have to live.  No matter how small a start you can manage, and any progress is helpful, you must take those first steps and build from there.  It is a lifestyle choice and everyone tells you to exercise but rarely tell you why.  Now that you know you will have to decide whether the fight is worth it. It isn't easy but if the bag of bio-chemistry that is you has enough value for you to make this fight real. It is vital to consider trying to build a new foundation for all of the other operations your body must do for you to live and go find yourself a way to sweat.