When Your Student Has Crohn’s Disease or Ulcerative Colitis
4 Reasons UC Causes Fatigue and 5 Ways to Fix It
If ulcerative colitis is making you so tired that you can barely function, it’s time to take action.
By Sandra Gordon
Medically Reviewed by Kareem Sassi, MD
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Soon after being diagnosed with ulcerative colitis (UC) in 2009, Jackie Zimmerman began experiencing “unbearable” fatigue. “I could have put my head down on my desk at any time and easily taken a nap,” says the 32-year-old executive director and founder of Girls with Guts, a national support network for women with inflammatory bowel disease. “When I got home from work at 6 p.m., I would just go to bed, then get up and do it all over again. I felt like I was never rested.”
Zimmerman’s symptoms have improved since having a total colectomy in 2010, followed by a J-pouch in 2011, and switching to working from her home office rather than commuting. “But I still don’t have what I feel like is a normal day, where you wake up feeling somewhat rested and don’t feel the need to nap,” Zimmerman says. “I end up falling asleep on the couch every night at 8 p.m.”
Zimmerman is hardly alone. Fatigue — being so tired that you can’t do what you want, whether it’s staying alert at work or taking care of your family — is common among people with UC. According to the Institute of Medicine at the University of Gothenburg in Sweden, up to 41 percent of people with inactive disease and up to 75 percent of people with active disease report feeling fatigued. Fatigue also tends to be more common in women with UC than men.
“Just having chronic or active inflammation itself could lead to fatigue,” says David Hudesman, MD, medical director of the Inflammatory Bowel Disease Center at NYU Langone in New York City. He notes four other possible reasons for fatigue:
- Nutritional Deficiencies Not having enough protein in your diet or being low in vitamin D or vitamin B12 can cause fatigue.
- AnemiaLosing blood in your stool, even if it’s invisible, can lead to iron-deficiency anemia, which can leave you sluggish.
- Depression and AnxietyPeople with UC tend to have higher rates of depression and anxiety and report a lower quality of life. “Not socializing with your friends or getting out of the house because of your disease could lead to depression and anxiety, which could lead to fatigue as well,” Dr. Hudesman says.
- Thyroid ProblemsHaving an underactive thyroid (hypothyroidism), which is not uncommon for people with UC, can make you feel depleted.
Fortunately, you don’t have to take fatigue lying down. Here are five steps toward feeling more energetic.
- Get UC into remission. If you’re constantly feeling run down, see your doctor. “The first step is to make sure there’s no active inflammation,” Hudesman says. If there is, you want to get the disease into remission. Minimizing inflammation with the appropriate medication can reduce fatigue, Hudesman says. According to a 2019 study in the Scandinavian Journal of Gastroenterology, fatigue improved among patients after three months of conventional UC treatment.
- Check for deficiencies.If your doctor determines that you don’t have any obvious inflammation, ask to have your vitamin B12, vitamin D, and iron levels tested, and get your thyroid checked. Your doctor can recommend specific supplements and other treatments, if necessary, to increase low levels.
- Fit in fitness. Once the disease is in remission and any nutritional shortfalls are corrected, it’s good to start a regular exercise routine. “Being physically active three or four times per week can help reduce fatigue in people with UC and without,” Hudesman says. “It’s not about building a certain amount of muscle or getting your heart rate up.” It’s about moving more and getting out of the house, which can boost feelings of well-being and put a spring in your step. Zimmerman can vouch for that. She plays with a local Roller Derby team that practices for two hours twice a week. “When you’re tired all day every day, you think, There’s no way I can do that,” Zimmerman says. “But when I’m playing Roller Derby, I have so much adrenaline that I don’t feel tired.” After a day of recovery, she’s ready to do it again.
- Eat a balanced diet.A diet with a healthy balance of protein, fat, and carbohydrates is especially important if you have UC. “Sometimes patients with UC will minimize carbohydrates, thinking that by restricting them, they’ll minimize inflammation,” Hudesman says. But carbs are a major energy source. Limiting carbs can cause your energy level to bottom out. If you are fatigued even though you eat enough carbs, Hudesman recommends working with a nutritionist who specializes in managing UC.
- Limit energy drinks, caffeinated soda, coffee, and medication for fatigue.Confession: “I do a lot of things you’re probably not supposed to,” Zimmerman says. “I drink coffee. I’ll have a soda if I feel like it, and 5-hour Energy drinks, which I feel work for me.” Twice a day, she also takes Provigil, a prescription medication that promotes wakefulness. “I can’t say it works, but I think it does,” she says. Hudesman (who is not Zimmerman’s physician) doesn’t recommend these quick-fix tactics, especially taking medication for fatigue or 5-hour Energy drinks. “If you’re still tired after getting your disease in remission, correcting nutritional deficiencies, and exercising more, talk to your doctor about other options,” he says.
Video: What is the cause of ulcerative colitis ? | Better Health Channel
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