Fatigue is a common symptom in inflammatory bowel diseases (IBD), occurring in up to 50% of those in remission and 80% with active disease, although it is more common in Crohn’s disease than in ulcerative colitis.
Fatigue can have a significant impact on quality of life. It is more than just feeling tired – it is a profound and persistent sense of exhaustion that can significantly interfere with daily activities and it is not helped by getting more sleep. Although the exact cause of fatigue in IBD is unknown, it is likely due to a combination of factors, including inflammation, anemia, medication side effects, and psychological stress.
Why does IBD cause fatigue?
Biologically, fatigue is an adaptive physiological process that helps us recover from physical and mental exertion. The reduction of effort often results from perceived exertion and motivational factors. It is, essentially, a signal that the body needs rest so it can redirect resources toward fighting infection or illness.
In IBD, fatigue is generally caused by the inflammation itself. The chemical signals produced during inflammation can directly affect the brain, causing fatigue and lack of energy. Side effects of medications for IBD can also contribute to fatigue. In addition, IBD can lead to nutritional deficiencies or anemia, which can also contribute to fatigue.
If you are experiencing fatigue, it is important to talk to your doctor to determine the cause and find the best treatment options.
Common causes of fatigue in IBD:
- Inflammation: Chemical signals produced during inflammation directly act on the brain to cause tiredness and lack of energy.
- Nutritional deficiencies: IBD can cause malabsorption of minerals and vitamins is common for IBD, with low iron, Vitamin B12, and folate deficiency linked to weakness and fatigue.
- Medication side-effects: Fatigue can be a direct adverse effect of medication, especially corticosteroids.
- Arthritis: Inflamed and painful joints can lead to fatigue.
- Anemia: Low iron causes fatigue, as well as blood loss from the intestines, though this is more common for UC than CD.
- Poor sleep quality: If anxiety or symptoms interrupt your regular sleep cycle, this can contribute to fatigue.
Why does inflammation cause fatigue?
Fatigue appears highly associated with acute or chronic inflammatory conditions. This is due to the impact of inflammatory cytokines on the central nervous system, which can cause changes in behavior, including fatigue.
When the immune system activates, immune cells produce pro and anti-inflammatory cytokines. These cytokines are signaling molecules that coordinate the body’s defense against pathogens. The cytokines reach the brain through various pathways, consequently modifying our monoaminergic neurotransmitters and neuroendocrine systems (such as the hypothalamic–pituitary–adrenal axis). This in turn leads to behavioral changes.
Fatigue can also be caused when enzymes interfere with serotonin and dopamine biosynthesis. According to the research, an increase in the “central ratio” of serotonin and dopamine is linked to lethargy and tiredness, leading to flat-out fatigue.
What does IBD-related fatigue feel like?
Fatigue can, unfortunately, cause a decrease in quality of life. The lack of energy or focus makes it difficult to think clearly and be productive. You may feel tired all the time, even after sleep or rest. This constant exhaustion can get in the way of doing what you love, like activities with friends, hobbies, family time, and school or work.
Fatigue can also impact mental function, affecting motivation, mood, emotions, concentration, and alertness. This causes what many call ‘Brain Fog’.
Does IBD cause brain fog?
IBD patients commonly report frequent bouts of difficulty in concentration, cloudy thoughts, and lapses in memory.
A 2016 study observed cognitive response time in Crohn’s patients compared to people over the legal drink drive limit in EU countries. Crohn’s patients had a response time 10% slower than normal and were even slower than those over the drink limit. The slow cognitive response ‘significantly’ correlated with symptoms of inflammation, such as abdominal pain and fatigue. The results show that brain fog is a very real and valid concern for IBD patients.
Can IBD cause muscle weakness?
While IBD itself doesn’t wear away muscle strength, certain factors involved can contribute to muscle weakness. Many lose strength from malnourishment, nutritional deficiencies, undereating, and a general lack of energy.
IBD & Fatigue after eating
You may feel especially fatigued after eating. First of all, it’s common to feel tired after a meal, especially one heavy in carbohydrates and protein. It takes the body up to 40 minutes to digest food, which involves no small degree of effort. This can be especially exhausting with IBD, causing bloating and heaviness. Digestion can also take a toll on sleep quality.
How do I combat fatigue with IBD?
If you’re managing fatigue from IBD, you’ll want to work with your doctor to find ways to reduce the exhaustion. This may involve changing your diet, lifestyle habits, your medication, and integrating some simple stress relief tools into your daily routine.
Simple ways to combat fatigue:
- Ask your doctor about adjusting doses or switching medications at lower dosages
- Talk to your dietician or nutritionist to ensure you’re absorbing enough nutrients to regulate your energy levels (especially iron!)
- Meditation or massages help the body regulate stress and sleep quality so you’re more rested
- Staying hydrated can help you release more toxins and feel less sluggish during the day
- Regular physical activity improves and regulates energy levels
- Avoid smoking, as cigarettes can worsen symptoms like fatigue
Fatigue is, at the end of the day, a sign your body needs rest. Try not to push or overexert yourself when your energy is low. It also helps to cultivate a healthy bedtime routine, as high-quality sleep can reduce fatigue and help your body recover from a flare or the long-term damage from IBD.
- Try to move a little bit once a day, even just a stroll or gentle yoga
- Avoid large meals, caffeine, and alcohol in the afternoon/evening
- Drink chamomile tea or a ‘sleepytime’ brew instead
- Go to bed at the same time every night
- Put away phones and laptops an hour before bed
- Keep your bedroom cool and dark
Whatever the cause of your fatigue may be, you should always discuss it with your healthcare team to find the solutions that work best for your body, your condition, and your lifestyle.