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Why am I Always so Tired?

Editors note:
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 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 IBD, you are well aware of its debilitating signs and symptoms that contribute to this fatigue. Abdominal pain, dehydration, diarrhea, nausea, vomiting, not to mention severe debilitating fatigue, lethargy and malaise are some of the symptoms and consequences of uncontrolled IBD. Lack of hydration and malnutrition can lead to nutrient deficiencies and poor quality sleep manifesting with 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.

Talk to your doctor about nutritional deficiencies

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.

Fatigue with IBD can 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, vedoluzimab, 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).

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!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • PK more Moore Moo
    5 months ago

    Recently changed Drs has made all the difference.

  • Neilanjan Nandi, MD, FACP author
    4 months ago

    I am happy to hear that you advocated yourself by changing clinicians. Have to find the right fit for you !

  • thedancingcrohnie moderator
    5 months ago

    This is such a great article! Thank you for all of the thorough information. I love that you end with patient advocacy!

    It is so important for us IBDrs, to remember to push for tests and change in treatment when we are not feeling well. We must always advocate for ourselves and make it known to our doctors.

    Always dancing,
    Elizabeth (team member)

  • Neilanjan Nandi, MD, FACP author
    4 months ago

    I couldn’t agree with you more !

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