Does IBS cause fatigue?
Or, does fatigue cause IBS?
It may seem counterintuitive, but the health of your gut will have a profound impact on nearly every other system inside your body. Including your body’s energy production systems. If you want to optimize your energy levels, you need to ensure you’ve got a healthy gut!
The gut-fatigue connection
Do you remember how exhausted you felt the last time you had the stomach flu?
If your symptoms were anything like mine, you probably weren’t even able to get out of bed. I couldn’t even lay in bed and enjoy Netflix. Watching Netflix takes almost no energy. I was so sick and tired that I couldn’t even summon the will to stare at a screen.
Sleeping was all that I could do. This is an example of the profound impact your gut has on your energy levels.
GI issues like IBS are going to slow you down. But perhaps what’s less intuitive is that fatigue can also cause GI issues. In fact, it is estimated that up to 90% of those with chronic fatigue syndrome also have IBS. (1)
If your energy levels are not where you want them to be, you need to look to your gut! The health of your gut could hold the secrets to higher energy! I’ve written in detail about how the health of your gut affects your energy in previous articles! All that talk about a leaky gut, it’s got a surprising connection to your energy levels too.
I’ll show you what I mean below!
Is IBS even a real condition?
Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder that involves problems with motility (how fast/slow the bowel moves contents through your intestines) and sensitivity (how your brain interprets sensations in the bowel). (2)
IBS affects 11% of the population on Planet Earth. (3) Said another way, that’s 836 million people affected by IBS. Yet only 30% of people will seek medical help. (4) IBS is more common in females than in males. Affecting females almost three times as often as their male counterparts. However, this gender difference may only be due to the fact that females are more likely to report their symptoms to their doctor.
IBS can occur in any age group; though the prevalence is most common among those aged between 20 and 50 years old. IBS does seem to lessen as you age. IBS is thought to be a first-world disease. Meaning that it is associated with the modern, industrialized diet, as well as the higher stress levels found in modern-day careers. (5)
In all likelihood, your hunter-gatherer ancestors did not suffer from IBS. The diet of your ancestors did not include Kit-Kats, Pogos, or Kraft Dinner. While we can’t say that modern convenience foods cause IBS, I do feel it’s safe to say that they don’t help. And they may very well be contributing.
Similar to chronic fatigue, irritable bowel is a syndrome, not a disease. That means it is a collection of symptoms. There is not one thing causing your IBS. In the conventional healthcare setting, syndromes are poorly managed. Often because there is no known cause.
When you don’t know the cause, finding a solution becomes challenging. Fortunately, there are some steps you can take to better manage both your IBS and your fatigue. I’ll show you what those are below!
Why treating IBS is such a pain in the gut
If you didn’t think IBS was already murky, the diagnostic classification won’t help clarify matters. At the time of this writing, IBS is diagnosed using something called the Rome IV criteria. The Rome IV states that in order for IBS to be diagnosed, the following symptoms need to exist:
- Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
- Related to defecation
- Associated with a change in the frequency of stool (meaning that you’re tending towards either an increase or a decrease in the number of bowel movements you experience each day).
- Associated with a change in the form (appearance) of stool (check out the Bristol Stool Chart. If you notice a dramatic change in your stool, then this section gets marked as positive).
These rather vague descriptions are then sub-classified based on the predominant manifestation. The IBS sub-types include:
- IBS-C is characterized by constipation.
- IBS-D is characterized by loose stools or diarrhea.
- IBS-M will have alternating or mixed loose stools and constipation.
How do you know what type of IBS you have?
The Bristol Stool Chart is a great way to determine whether your bowel movements are too loose, too firm, or, just right. (6)
- Type 1: Separate hard lumps, like nuts (hard to pass)
- Type 2: Sausage-shaped, but lumpy
- Type 3: Like a sausage but with cracks on its surface
- Type 4: Like a sausage or snake, smooth and soft
- Type 5: Soft blobs with clear-cut edges (passed easily)
- Type 6: Fluffy pieces with ragged edges, a mushy stool
- Type 7: Watery, no solid pieces, entirely liquid
Healthy bowel movements are thought to be type 3 and 4. As you move up the scale (towards 1 and 2) your bowel movements move towards constipation (IBS-C). As you move down the scale (towards 5, 6, and 7) you move towards diarrhea (IBS-D). But remember, in order to classify as IBS, abdominal pain must also be present!
For most, their IBS seems to fluctuate dramatically. This can make it incredibly confusing to uncover what might actually be causing your symptoms.
Is it the food you eat?
Is it your stress levels?
Did last years food poisoning trigger it?
When you combine this rather confusing array of symptoms with intense levels of fatigue, it’s no wonder you’re at a loss of what to do. Before I get into how to improve both your fatigue and IBS symptoms, I need to cover some of the weird and wonderful. Specifically, the weird and wonderful symptoms that can occur alongside IBS.
The weird and wonderful symptoms associated with IBS
Those with IBS often claim to have additional symptoms that are not even associated with their digestive tract. Doctors call these extra-intestinal symptoms. These seemingly unrelated symptoms are sometimes linked to the digestive tract. But at other times they can affect other parts of the body that seem to have nothing in common with the gut.
Those strange, seemingly unexplainable symptoms of yours, they could actually be related to your IBS!
The GI-related symptoms of IBS include:
- Abdominal pain and/or cramping
- Constipation (passing three or fewer stools in a week or passing hard, dry stools and/or straining during a bowel movement)
- Diarrhea (passing three or more stools per day, and/or urgent need to have a bowel movement)
- A feeling of incomplete emptying of the bowels
Non-GI related symptoms of IBS:
- Back pain
- Frequent urination
- Sleep irregularities (difficulty fall and/or staying asleep)
- Heart palpitations
If you’ve already experienced trying to get conventional treatment for IBS, you know how frustrating this can be. This only becomes more challenging when your IBS causes weird symptoms like fatigue, headaches, or anxiety. These extra-intestinal symptoms are often dismissed by conventional medical professionals.
And let’s not forget about fatigue. One of the most common extra-intestinal symptoms of IBS is fatigue. (7) I’ll show you why your guts make you tired in the next section!
Your IBS could be making you tired. Very tired
60% of those with IBS report fatigue as a co-current symptom. (7) Fatigue is cited as the third most common symptom among those with IBS. The only two more prevalent symptoms? Abdominal pain and altered bowel movements. (8)
- Loss of vitality
- Cognitive, physical, and/or psychological fatigue
There was a direct correlation between fatigue levels and GI symptoms. The worse the abdominal pain and/or GI symptoms, the worse the fatigue. Some studies found fatigue worse in IBS-C. Other studies found fatigue worse in IBS-D.
I think that fatigue is going to be a dominant symptom whenever the GI tract is affected – whether that is due to a speeding up (diarrhea) or slowing down (constipation) does not matter.
Your guts are connected through a super-highway of nerves to your brain. Some call this the gut-brain axis. Below, I’ll show you how the gut-brain axis can wreak havoc on your energy levels!
How exactly does IBS cause fatigue?
To be clear, researchers are not sure. Studies have started to find some correlations. But correlations are very different than causations. At the time of this writing, these are our best guesses.
Below, I describe some of the more common connections between fatigue and IBS. Please note that these are correlations, not causes.
Anxiety & depression:
Anxiety and depression are commonly associated with IBS. (11) While the exact mechanism behind why that is has yet to be determined. What we do know is that fatigue is almost always a symptom of anxiety and depression. So, if your IBS is strongly tied to your anxiety or depression levels, in all likelihood, your energy levels will be negatively affected.
Sleep disturbances are common among those with IBS. (12) As you know, if your sleep quality (or quantity) are affected, you’re going to feel tired. One study found that those with high levels of IBS and fatigue also had the highest number of sleeping issues. (13)
Does that mean if you improve your sleep, you’ll improve your IBS?
It’s a great question. I do know that improving your sleep will have a profound, positive impact on many different aspects of your life. So, it’s certainly worth your time to do everything you can to improve your sleep. One place I often recommend is through lighting – LED bulbs could be preventing you from sleeping!
Those with IBS that have had an increased level of mast cells (a marker used to determine inflammation) also reported higher levels of fatigue. (14, 15) I’ve discussed the importance of adopting a low-inflammatory diet for those with IBS in the past. If you have fatigue, the same information applies to you. Food sensitivities are commonly associated with elevated levels of inflammation (and therefore fatigue).
In general, those with IBS tend towards a type of fatigue called central fatigue. Central fatigue describes a condition that arises from the brain or central nervous system. It’s that general feeling of malaise or exhaustion. You may also experience it as brain fog or sluggish thinking.
Peripheral fatigue is a muscular condition. Think about the last time you were lifting weights and your muscles started to tire. That’s peripheral fatigue.
IBS causes central fatigue. At the time of this writing, researchers do not have a conclusive theory as to why it occurs. The most promising theory is the gut-brain axis. The gut-brain axis is a series of nervous that connect your gut to your brain. Through this nervous system, your body senses and experiences its GI tract and relays that information to your brain. (15)
Imagine if you saw a bear or cougar while you were hiking. You’d feel anxious/nervous, right?
If you have an infection in your gut – a hidden cause of IBS – your nervous system would respond to this stress in a very similar way to seeing a predator. Only this time, you’re not aware of any reason why you’re feeling anxious. The anxiety is caused by the hidden infection in your gut. This is the gut-brain axis in action. And it could be a promising field of research in the coming years!
So, how should fatigue & IBS be treated?
Proper identification of the root cause of your symptoms needs to be identified.
Is your fatigue causing IBS?
Or, is your IBS causing fatigue?
Answering this question is of paramount importance. Do not expect to obtain a root cause resolution from your conventional medical practitioner.
Conventional treatment for IBS will depend on the type of irritable bowel syndrome you have. For IBS-C, stool softeners and laxatives are often prescribed. For IBS-D, antidiarrheals from the opioid family are prescribed. Medications used to ease muscle spasms (antispasmodics) will often be recommended for abdominal discomfort. While there is not a lot of evidence, low doses of antidepressants are also sometimes prescribed.
The key piece to keep in mind is that the conventional treatment of irritable bowel syndrome is not addressing the root cause of the disease. When the root cause is alleviated, you should no longer be dependent on continuous medical intervention.
At Flourish Clinic, we always begin the treatment of both fatigue and IBS with changes in nutrition. This includes either lab testing or a reset diet to determine what foods you best tolerate. Sometimes, simple dietary changes are enough to completely eliminate your symptoms.
When diet therapy does not change your symptoms, I recommend finding a knowledgeable functional medicine practitioner to work with. He/she can look to see if you have a hidden gut infection like SIBO or Blastocystis Hominis. Often, it’s these hidden infections that maintain your IBS and fatigue symptoms.
Ok, now you know the link between IBS and fatigue. That fatigue you’re experiencing, it’s not just in your head. There is a medically documented connection between IBS and fatigue.
Now, I want to hear from you!
How has the health of your gut impacted your energy levels?
What strategies have you found to improve both your IBS and fatigue?
Share your answers in the comments section below.
Also published on Medium.