Understanding the Causes of Fatigue in Inflammatory Bowel Disease (IBD
Crohn's Disease and Ulcerative Colitis are well-known for their impact on the digestive system. However, one of the most common and debilitating symptoms experienced by individuals with IBD outside of the gut is fatigue, with over 50% of patients experiencing this. Unlike ordinary tiredness, fatigue in IBD can be overwhelming, affecting our quality of life significantly. This blog explores the different causes of fatigue in IBD to help you understand and work with your medical team to manage this challenging symptom:
1. Chronic Inflammation during disease flares
Persistent inflammation not only affects the digestive system - the inflammatory molecules released during a flare can also alter brain function and energy levels, leading to fatigue (1). When the disease is active the body uses more energy that usual leading to fatigue.
2. Nutritional Deficiencies and Increased Energy Needs
Nutrient deficiency is common in IBD for several reasons including food restriction, absorption issues (e.g with Crohns in the small intestine) and nutrient losses (e.g. blood loss in UC causing iron deficiency anaemia). Common nutrient deficiencies in IBD include iron, vitamin B12, folate, and vitamin D and deficiency in any of these nutrients can cause and contribute to fatigue. Our energy requirements increase during a flare but we often restrict our food intake during this time but this, put simply, just means there is often not enough fuel in the tank which can cause fatigue (1).
3. Medications and Treatments
Many IBD treatments, including corticosteroids, immunosuppressants, and biologics, come with side effects that can contribute to fatigue. Corticosteroids, for example, can cause insomnia and mood swings, which in turn, lead to increased fatigue (1).
4. Sleep Disturbances
Sleep disturbances are common among IBD patients. The need to frequently use the bathroom during the night, abdominal pain, and anxiety about disease flares can disrupt sleep patterns. Poor quality sleep or insufficient sleep can directly cause fatigue, and the cycle of poor sleep and chronic tiredness can be difficult to break (2).
5. Psychological Factors
Living with a chronic illness like IBD is emotionally draining. Anxiety, depression, and stress are very common in those of us with IBD and these can lead to mental and physical fatigue (3).
7. Dehydration and Electrolyte Imbalance
A common symptom during an IBD flare is diarrhea, which can result in dehydration and electrolyte imbalances. Dehydration causes fatigue (1).
Managing Fatigue in IBD
Due to the number of different causes of fatigue in IBD, addressing it involves a multidimensional approach:
Medical management to keep disease under control: Regular monitoring and treatment adjustments by IBD teams to manage and resolve inflammation during flares and maintain remission for as long as possible.
Nutritional Support: support from an IBD specialist Nutritionist/Dietitian to assess for nutrient deficiencies, ensure adequate intake nutrients to support consistent energy, to support patients to expand diet and remove food fear to reduce dietary restriction, and advise on appropriate supplementation, if needed.
Sleep Hygiene: Developing good sleep habits and addressing any sleep disturbances with medical support when needed.
Mental Health Support: Therapy, counseling, and support groups to help manage the psychological burden.
Lifestyle Adjustments: Incorporating regular, moderate exercise, staying hydrated, and balancing activity with rest.
Understanding the causes of fatigue in IBD is the first step toward managing it effectively. The cause of fatigue will be different in each IBD patient and it may be caused by one or a combination of different factors in each individual. So by assessing then addressing these different factors, collectively they may have big impact on improving energy levels and overall quality of life with IBD.
If you feel fatigued and you would like more personalised support from an IBD specialist clinic we can help you.
We are a nutrition and dietetics clinic specialising providing exceptional care to improve the quality of life of people living with IBD. We bring clarity around food and IBD and remove uncertainty and fear around food.
Our IBD specialist Nutritionist (Clemmie) and specialist gastroenterology and IBD Dietician (Jess) both have IBD too so ‘get it’ and are so passionate about helping others with IBD.
If you would like support with your IBD please book a free initial call via the button below so we can find out more about you, discuss how we can help and take you through our appointment options.
References
1. Nocerino A, Nguyen A, Agrawal M, Mone A, Lakhani K, Swaminath A. Fatigue in Inflammatory Bowel Diseases: Etiologies and Management. Adv Ther. 2020 Jan;37(1):97-112. doi: 10.1007/s12325-019-01151-w. Epub 2019 Nov 23. PMID: 31760611; PMCID: PMC6979464.
2. Alex Barnes, Réme Mountifield, Justin Baker, Paul Spizzo, Peter Bampton, Jane M Andrews, Robert J Fraser, Sutapa Mukherjee, A systematic review and meta-analysis of the prevalence of poor sleep in inflammatory bowel disease, SLEEP Advances, Volume 3, Issue 1, 2022, zpac025, https://doi.org/10.1093/sleepadvances/zpac025
3. Uhlir V, Stallmach A, Grunert PC. Fatigue in patients with inflammatory bowel disease-strongly influenced by depression and not identifiable through laboratory testing: a cross-sectional survey study. BMC Gastroenterol. 2023 Aug 22;23(1):288. doi: 10.1186/s12876-023-02906-0. PMID: 37608313; PMCID: PMC10463723.
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We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.