Crohns disease and fatigue

6 Reasons Crohn’s Disease is Sapping Your Energy and How to Stop It

6 Reasons You May Be Experiencing Crohn’s-Related Fatigue

Quality sleep is important for keeping Crohn’s disease under control. Research from a cohort study undertaken by the Crohn’s and Colitis Foundation on sleep disturbance and IBD found that Crohn’s disease patients who were in remission and reported impaired sleep had a two-fold increase risk of developing active disease 6 months later.

You may have fatigue from a variety of sleep and non-sleep related issues, including:

  • The need for nocturnal bowel movements. Crohn’s diseases can cause sudden, frequent bowel movements, even in the middle of the night, which will prevent you from getting a restful night’s sleep.
  • The persistence of symptoms such as abdominal pain. Cramping and bloating can make it hard to fall asleep. “Sometime it’s just a matter of trying to get comfortable enough to fall asleep and stay asleep throughout the night,” Domilici says.
  • Blood loss. Slow continuous blood loss from lesions in the small or large intestine can lead to anemia, which causes fatigue explains Cuckoo Choudhary, MD, an associate professor of gastroenterology in practice at Jefferson University Hospitals in Philadelphia. One telltale sign of Crohn’s-related anemia is blood in the stool — call your physician right away if this happens.
  • Nutrient deficiency. As with many digestive conditions, Crohn’s disease can keep patients from properly absorbing key nutrients, such as iron, particularly when the small bowel is affected. A research review published in February 2015 in BioMed Research International maintains that low vitamin D levels (a vitamin that comes from sunlight and food sources) is associated with Crohn’s disease, and that vitamin D supplementation may have a therapeutic role.
  • Medication side effects. In addition to her symptom-related fatigue, Domilici remembers one particular medication that worsened the problem. “I felt like I’d been run over by a truck,” she recalls. Unable to get up for work in the mornings, she called her doctor for a switch. “Some medications can make patients anemic,” Choudhary says. If this is the case, you doctor may stop or switch your medications to address this problem or recommend supplements.
  • Depression. Like many others with chronic illnesses, people with Crohn’s disease symptoms are at increased risk for depression. This may be particularly problematic when people are first diagnosed, says Domilici, adding that living with Crohn’s for 31 years has helped her to gain some perspective and discover strategies to cope with the emotional and psychological challenges.

9 Ways to Fight Crohn’s Fatigue

It’s true that your exhaustion could be due to sleepless nights, stress, and even situations unrelated to Crohn’s, but sometimes medical intervention may be needed. Work with your doctor to rule out or address what’s causing your fatigue and make lifestyle changes to cope. Here’s where to start:

  • Assess anemia. A blood test can determine whether or not you’re anemic. At its most severe, anemia is life-threatening. Occasionally, people with Crohn’s may need blood transfusions to improve their blood and then take other steps to address or prevent anemia.
  • Take a supplement. You might need iron or additional folic acid. Choudhary says she often recommends that patients take a multivitamin and have frequent blood tests. Talk to your doctor before taking any additional medications.
  • Treat flare-ups. Make sure you’re taking all of the necessary steps to avoid and treat your Crohn’s flares. This means taking prescribed medication according to your doctor’s instructions in addition to maintaining a healthy diet and exercise plan.
  • Switch medications. If fatigue is a side effect of one of your medications, you might need to switch. Do so only with your doctor’s supervision.
  • Manage sleep. Americans, even those without a chronic medical condition, are notoriously short on sleep. Talk with your doctor about ways to improve life with Crohn’s so you can get some shut-eye, especially if Crohn’s disease symptoms are keeping you up at night. Also review your entire sleep routine to make sure you’re giving yourself a chance to get enough good-quality sleep.
  • Manage stress. Yes, Crohn’s is stressful. Stress in itself is tiring and can keep you up at night. A warm bath, meditation or a warm cup of herbal tea are all great ways to help you relax before bedtime.
  • Eat well. You probably know what foods and beverages to avoid, but you should still build a healthy diet with a variety of fruits, veggies, whole grains, and lean meats from the list of foods you can eat.
  • Exercise. Aim for at least 30 minutes of moderate exercise most days of the week. But check with your doctor before starting a fitness plan, Choudhary advises. If you have anemia, working out may make you feel even more fatigued. “If you are over 50, low hemoglobin and exercise can put a strain on the heart,” she says.
  • Manage your time. “It’s a matter of being good at prioritizing and delegating,” Domilici says. “Look at your week and have a sense of what you can manage and not manage.” If your day planner is overbooked, cut some of your commitments.

If you have Crohn’s, you’re used to problem solving to manage symptoms and flare-ups. Think of fatigue as another piece of the puzzle you and your doctor can figure out together.

Additional reporting by Christine Gordon

Ever wonder why you are feeling so tired, weak, sore and/or depressed?

Ever wonder why you are feeling so tired, weak, sore and/or depressed?

If you have Crohn’s disease or ulcerative colitis there is a strong likelihood that missing out on vital nutrients that can lead to these and other symptoms, and can impact on your long-term health.

One in three Crohn’s patients and four out of five people with ulcerative colitis have an iron deficiency, one of the most common causes of fatigue.

Seventy-five percent of Crohnies and 35 per cent of UC patients have a Vitamin D deficiency, leaving them at risk of bone and muscle pain and weak and brittle bones.

Folate, Vitamin B12 and calcium are among the other nutrients commonly deficient in people living with inflammatory bowel disease.

To find out more about the causes of these deficiencies, the possible complications, your risk and what you can do about it, read this article by CCA’s Peer Support Coordinator and Accredited Dietitian Jessica Chapman.

Tags: diet

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Persistent fatigue plagues many IBD patients

SAN DIEGO – Nearly two-thirds of patients with inflammatory bowel disease who initiate biologic therapy continue to experience persistent fatigue up to 1 year later, results from a prospective cohort study showed.

Doug Brunk/MDedge News

Dr. Nynke Z. Borren

“Fatigue is one of the most heard complaints in the clinic,” lead study author Nynke Z. Borren, MD, said in an interview at the annual Digestive Disease Week.® “In the past few years there has been more interest because we know there is a communication system between the gut and the brain. Some studies suggest that biologic therapy improves fatigue symptoms, but it’s really correlated with disease activity.”

In an effort to define the longitudinal trajectory of fatigue in IBD patients initiating treatment with infliximab, adalimumab, vedolizumab, or ustekinumab, Dr. Borren, a research fellow at the Massachusetts General Hospital Crohn’s and Colitis Center, Boston, and colleagues prospectively enrolled 206 patients with Crohn’s disease and 120 patients with ulcerative colitis. They used the seven-point fatigue question in the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) to define fatigue. A score of four or less for this question was used to define fatigue. To validate this question, the researchers used two widely used questionnaires: the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F), and the Multidimensional Fatigue inventory (MFI). Next, they used multivariable regression models to examine the independent association between attainment of clinical remission and the resolution of fatigue.

Of the 326 patients, 134 initiated biologic therapy with infliximab or adalimumab, 129 with vedolizumab, and 63 with ustekinumab. Nearly two-thirds of all patients (198, or 61%) reported significant fatigue at baseline, which was associated with female sex, depressive symptoms, and disturbed sleep (P less than .001). Those reporting significant fatigue at baseline also had higher disease activity scores, compared with those without fatigue (P less than .001).

Among the 198 patients who reported fatigue at baseline, 70% remained fatigued at week 14, while 63% remained fatigued at week 30, and 61% remained fatigued at week 54. Dr. Borren and associates observed that at each of these time points, achieving clinical remission was associated with threefold lower likelihood of remaining fatigued. However, 35% of patients who achieved clinical remission experienced persistent fatigue at week 14, compared with 37% of patients at week 30 and 35% of patients at week 54.

The researchers observed no significant differences between the different therapies in the proportion of patients who remained fatigued. In addition to disease activity, disturbed sleep at baseline was associated with persistent fatigue at week 14 (OR 9.7) and at week 30 (OR 3.7).

“We think that gut dysbiosis might be involved in inducing fatigue,” Dr. Borren said. “In the beginning, we thought that it might be due to ongoing inflammation, but our research has shown that we find a less diverse gut microbiome in those patients with fatigue compared to patients without fatigue while they were in remission. There is something in the gut that influences the central nervous system. We are still exploring this.”

The researchers reported having no financial disclosures. The abstract received a “poster of distinction” honor at the meeting.

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Fatigue an underestimated aspect of inflammatory bowel disease

True fatigue is something that can be hard for those who don’t have it to understand.

Clinically speaking, fatigue is an overwhelming sense of tiredness, exhaustion and lack of energy. It’s exhaustion that doesn’t disappear after rest or sleep.

“Many people describe it as feeling like their battery is completely discharged. They can’t manage to do anything at all,” says Katrine Brække Norheim at Stavanger University Hospital.

“They may also have brain fog, which means they have difficulty concentrating, forget what they are doing and find it difficult to absorb information.”

In recent years it has become clear that fatigue is a major aspect of different inflammatory diseases, such as lupus, arthritis, psoriasis and inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis.

Now Norheim and her colleague Tore Grimstad have conducted a review of the research on fatigue in patients with IBD.

Their conclusion is that fatigue is a significant and often underestimated aspect of these illnesses. They also say we need to know more about the mechanisms behind the phenomenon, to find new treatment options.

Underdiagnosed and undertreated

The two researchers looked at 28 different studies of fatigue and IBD, and concluded that people with the diseases experience extreme exhaustion much more frequently than normal.

While 2 to 12 per cent of the general population reports being fatigued, fatigue affected between 22 and 77 per cent of IBD patients.

Additionally, these patients were often more exhausted when their disease was more active.

The results do not surprise Norheim.

“If you ask these patients if they experience fatigue, they say often yes,” Norheim said.

“But fatigue has long been underdiagnosed and undertreated. Many patients find that their physicians are not that concerned if they talk about the problems with fatigue.”

Norheim believes the significance of fatigue in IBD has been underestimated.

“Sometimes it’s fatigue—not the other symptoms—that is the main reason why people do not have jobs,” she said.

Sickness Behaviour

Currently, no one is really sure what causes exhaustion in these patients. But one leading hypothesis is called sickness behaviour.

This describes your immune system’s reaction to an infection or inflammation where you feel lifeless and lose your appetite, and just want to hide under a blanket on the couch. It’s exactly how you feel when you have a bad cold or the flu.

Indeed, it can be a helpful behaviour when you are sick. It ensures that you get rest and conserve the energy your body needs to heal. It also has the added benefit of making you less likely to infect others, since all you want to do is hide under that blanket on the couch.

But people with chronic inflammatory diseases, such as IBD, may end up almost constantly fatigued, as if the body is permanently reacting to the inflammation.

Norheim says some patients have benefitted from treatment using anti-inflammatory drugs. This supports the hypothesis that the immune system itself causes the symptoms of fatigue.

But the researchers caution that we still don’t know enough about why people with inflammatory diseases are so often deeply fatigued.

Exercise, cognitive therapy

There is currently no specific treatment for extreme fatigue, Norheim says. Patients are advised to get regular exercise and may be offered cognitive therapy to help them find ways of coping with the disease in daily life.

The few studies that exist show that this can have a positive effect, but that the effect disappears once the therapy ends.

It appears, however, that research on the topic is accelerating, according to Norheim and Grimstad’s article, which was recently published in the Journal of the Norwegian Medical Association.

“There is a huge benefit for patients that there is more focus on fatigue,” Norheim says.


Tore Grimstad og Katrine Brække Norheim, Utmattelse ved inflammatorisk tarmsykdom , Tidsskriftet for Den norske legeforening, 2016.

Read the Norwegian version of this article at

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