Why am I Always so Tired with Crohn's or UC?
We recently asked the community to submit questions about IBD. We received a range of great questions that Dr. Nandi is now answering! This post answers questions related to tiredness/fatigue and IBD. Questions asked included:
"Why am I always so tired with my IBD?"
"When does it ever get better? I have Crohn’s disease... I am tired."
Inflammation from IBD contributes to lack of energy
Did you know? Inflammation alone from your intestinal ulceration can zap all of your energy. Of course, if you have Crohn's or UC, you are well aware of its debilitating signs and symptoms that contribute to this fatigue.
Indeed, some of the most common and obvious nutrient deficiencies in many IBD patients is that of iron deficiency anemia (IDA) from slow, chronic, microscopic or overt losses of blood from intestinal ulcers.
Other patients, depending on the location, extent, and duration of inflammation in their bowels may manifest with B12 deficiencies (ileal disease in Crohn’s) or deficiencies of other nutrients (zinc, selenium, vitamin D) to name a few.
Nutritional deficiencies from Crohn's or UC have an impact on fatigue
If you have significant fatigue, I recommend reviewing your history with your GI physician. Supplements exist to correct deficiencies. Deficiencies may suggest active disease that was not previously recognized and may prompt your physician to adjust your therapy to provide better healing.
In the long run, recognition of a nutritional deficiency can lead to a proactive change in your treatment and prevent long-term consequences of uncontrolled inflammation (stricture, perforation, cancer). Being proactive and reviewing with your doctor can make all the difference.
Can fatigue with Crohn's or UC get better?
In answer to the questions on, ‘does it ever get better?’ The answer for most patients is that it can indeed get better. I encourage both physicians and patients to question the prescribed treatment plan and to proactively assess and re-assess symptoms and what proof there exists that one’s IBD is in remission.
If endoscopy, labs, and imaging (eg, MRE, CTE) demonstrate no inflammation, then the fatigue may be from another etiology altogether (eg, sleep apnea, late-night smartphone addiction, or lack of adequate hours of sleep). If, however, there is evidence of active disease, then a treatment change is absolutely mandated.
Optimizing current therapy or changing medications
Optimizing one’s current therapy may be accomplished by checking your biologic drug levels and antibody to that drug as well. This is known as therapeutic drug monitoring (TDM) and exists via various companies for: infliximab, adalimumab, vedolizumab, ustekinumab, and also immunomodulators such as azathioprine or 6-mercaptopurine.
If your current drug therapy is already optimized, but you are not responding, then changing the way your drug works (mechanism of action) may be necessary to change to a different drug class that works by a different mechanism of action.
As of 2019, there are several different classes of mechanism of action (anti-TNF, anti-integrin, anti-IL-12/23, and a small molecule class known as JAK inhibitors).
Be proactive about your treatment with your doctor
Being proactive and changing medications may help your healing better than no change at all. While this may seem quite obvious, it is not uncommon for IBD-ologist’s to observe the contrary phenomena in clinical practice.
It may take an adamant patient advocate (YOU!) to emphasize just how intolerable your health status may be if not clinically beknownst to your doctor!
What is your comfort level disclosing your IBD to your employer?