LisAmArie monAco’s Life wiTH iBD is riDdled with ups and downs. One of the most challenging complications over the last 20 years, she says, has been bouts of fatigue.
“When there’s a flare or a treatment isn’t working well, it can be debilitating, and that’s very difficult to address,” says Monaco, 50, who lives in Georgia. “You simply don’t have the energy to do anything. All you feel is exhaustion.”
Monaco is far from alone in battling fatigue as a major part of her condition. Crohn’s disease and ulcerative colitis—both of which fall under the umbrella of inflammatory bowel disease (IBD)—often lead to lack of energy. Research in a 2023 issue of BMC Gastroenterology noted that as many as 80% of people with IBD have fatigue when the disease is active, and about 60% of those in remission experience fatigue. Most study participants said fatigue had an impact on their lives more than diarrhea or pain—and that this deep sense of exhaustion wasn’t alleviated by rest or sleep.
Another study, in Clinical Gastroenterology and Hepatology, found that fatigue can increase over time, particularly if it’s unaddressed. If that happens, it can become chronic and lead to more frequent, and more serious, IBD symptoms.
So what exactly is causing this fatigue? There are several factors at play, according to the Crohn’s & Colitis Foundation, including the body’s response to inflammation, medication side effects, and sleep disruption caused by gastrointestinal problems and anxiety. Because those factors are so complex, patients often need to test out multiple strategies until they find one that works for them. Doctors suggest considering these as a starting point:
ADDRESS THE EMOTIONAL IMPACTPeoPle with iBD often exPerience conDition- related stress, worry, depression, and anxiety. IBD can also lead to a poor self-image, which makes the need for better support crucial. A 2022 study in the journal Inflammatory Bowel Diseases found that nearly a third of people with IBD show symptoms of post-traumatic stress disorder.
Robert Frank, who was diagnosed with ulcerative colitis in 2021, says living with the disease causes a unique mental fatigue. The 44-year-old from New Jersey went from being deeply interested in health and fitness to wanting to stay in bed all day because his symptoms felt so overwhelming. The problem was that the more he “rested,” the worse he felt in both body and mind. “I’ve never felt fatigue on so many levels like that. I was absolutely drained, and it took everything I had to complete even simple tasks,” he recalls.
Frank started addressing his emotional health by talking about his feelings openly on social media and making connections with other people with the condition, creating a community of support. That proved more effective than pushing himself to exercise: Within just a few weeks, Frank discovered he had much more energy to tackle all the everyday tasks that once seemed insurmountable.
EXPLORE GENTLE MOVEMENT OPTIONS if you’re experiencing significAnT fATigue due to IBD, the mere thought of working out might make you feel much worse.
But exercise doesn’t have to be intense to be effective—and in fact, gentle movement is more likely to alleviate fatigue than a more rigorous exercise routine, says Dr. Rudolph Bedford, a gastroenterologist at Providence Saint John’s Health Center in Santa Monica, Calif.
“The importance of physical activity for alleviating IBD symptoms can’t be overstated. It should be a foundational part of your IBD management,” he says. “Many people think that means they need to go work out at the gym multiple days per week, for hours at a time, but the idea really is to just get more movement every day.”
That’s because any type of activity has been shown to help reduce inflammation in the body— a major benefit when dealing with an inflammatory disease like IBD, he says, adding that exercise can also help with bowel motility and better blood flow in the intestinal tract. When you add enjoyment into the mix, it can provide a mental boost as well as physical benefits, which means it addresses fatigue in multiple ways. A 2022 study in Crohns Colitis 360, for example, found that yoga can improve quality of life for those with IBD by alleviating stress and providing accessible movement. Other options include swimming, Tai Chi, bicycling, paddleboarding, walking, easy jogging, and even lighter-intensity movement like gardening.
In addition to helping combat fatigue, this type of movement can improve disease progression. A 2022 research review in the journal PLOS ONE examined how structured exercise affected those with IBD, and found that strength training helped reduce frequency and intensity of flares. Simply walking regularly can provide a substantial decrease in disease-related symptoms, including fatigue, according to the Crohn’s & Colitis Foundation.
REVIEW YOUR MEDICATIONS AT your nexT cHeckup, Ask your docTor To talk through your medications, keeping an eye out for any that might have a high risk of fatigue.
“This is a fairly common side effect, not just for IBD medications, but for several types of drugs that address multiple kinds of conditions,” Bedford says. For example, 2020 research in Advances in Therapy found that two IBD medications—vedolizumab and infliximab—lead to fatigue in 6% and 9% of patients, respectively. Long-term use of steroids, which are often used to control inflammation, can also lead to fatigue, as can tapering off the drugs.
Other common medications that aren’t specific to IBD could intensify these side effects, says pharmacist Daniel Breisch, who works at Mountain View Pharmacy in Utah. The list includes muscle relaxants, anti-anxiety medicines, antidepressants, statins, and pain management medications.
“This is why having a medication review with your doctor or pharmacist is so important,” he says. “Some of your meds may be interacting in ways that increase your fatigue or cause other negative side effects.”
TALK TO A NUTRITION PROFESSIONAL NutritioNal deficieNcies could also be driving IBD patients’ fatigue. It’s especially common to get too little iron, vitamin D, vitamin C, and zinc, says Dr. Dale Young Lee, medical director of clinical nutrition at Seattle Children’s Hospital. Having low levels of these, as well as other vitamins and minerals, can lead to lack of energy and tiredness. People with IBD, particularly Crohn’s disease, may also struggle to get enough protein, which can increase fatigue.
There are a few reasons why people with IBD are at risk of nutritional deficiencies, Lee says, including malabsorption. The disease can change how well you absorb macronutrients, vitamins, and minerals. Plus, symptoms like stomach pain may cause you to eat less than normal.
Undiagnosed food sensitivity could also be increasing your fatigue levels, says Dr. Bindiya Gandhi, a Georgia-based functional medicine physician. Food allergies tend to be easier to detect since they cause more notable symptoms, such as nausea, itching, wheezing, and dizziness. Food sensitivities can be more subtle, and, over time, worsen symptoms like fatigue. “Pay attention to how you feel right after you eat, but also hours later,” she says. “An initial inflammation response might be mild, but as your body works to digest that food, it could become more noticeable.” Keeping a food diary and talking with a clinical dietitian can be a good way to modify eating habits in a way that reduces fatigue, Gandhi adds.
Marianne Sarcich, 56, was put on the low-FODMAP diet when she was diagnosed with IBD. The approach involved eliminating many foods and then adding them back into her diet, which made it clear which foods triggered symptoms. Adjusting her diet helped reduce her levels of fatigue, and she now has more energy than she did in the past. “You have to see changes like this as a long-term investment in improving your IBD,” she says. “If you can reduce your fatigue, it helps with so many other aspects of IBD management, including your emotional well-being.”
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