By Ryan Warren, M.S., R.D.N., C.D.N.
Fatigue in patients with inflammatory bowel disease (IBD) is not only a hot topic, but one that is inherently challenging to overcome for both patients and their clinicians. As a clinical nutritionist, I am looking for clues and answers to this complex issue day in and day out. Recently, however, the possibility of thiamine (vitamin B1) supplementation, has come onto my radar screen. Let me walk you through what I’ve learned so far...
When I’m consulting with my patients, I typically like to start our conversations by getting a sense of their current IBD symptoms. We discuss bowel habits, abdominal pain, gas, bloating, and nausea - just to name a few. Across the board, however, one of the most common complaints in my IBD patient population is fatigue, also sometimes described by patients as “very low energy” or “lethargy.” This observation is not all that surprising; in fact, research shows that nearly 80% of patients with active IBD, and 50% of patients in remission, report fatigue as a symptom!
How do we tackle fatigue? It requires quite a few considerations. From a nutritional perspective, there are a few things we'll discuss in order to address low energy levels. First and foremost, I try to ensure that the patient’s diet is as nutritionally adequate as possible and as tolerable for the patient - i.e., the diet is replete with an appropriate balance of carbohydrates, fats, proteins, vitamins and minerals.
In some cases, however, patients struggle to absorb certain nutrients regardless of the adequacy of the overall diet. This will often depend on their disease status, extent of inflammation, disease location, surgical history, etc. Bloodwork and relevant nutrition-related labs can give us a good serological picture of what a patient may be lacking, such as iron, vitamin B12, and electrolytes just to name some popular ones. Oftentimes, patients are advised to supplement with readily absorbable vitamins and minerals that can help to replete important nutrients, many of which are associated with energy generation.
Additionally, hydration status, sleep hygiene, and physical activity can be important clues to discern in trying to piece together why patients may be dealing with low energy levels. Drinking plenty of water, often with electrolyte replenishment, can help to stave off the lethargy that can sometimes be associated with dehydration. Ensuring a good night’s sleep and appropriate levels of physical activity are also important to consider when working to optimize a patient’s overall energy level.
But what if the aforementioned are not enough? Wouldn’t it be great if there was just a “magic pill” that IBD patients could take for boosting energy? And I’m not talking about caffeine! Interestingly enough, we may be getting closer to another key aspect of the low energy “solution,” if you will. Studies indicate a potentially promising finding that thiamine (aka, vitamin B1) may be one answer we’ve been seeking all along.
In one particular study, the researchers’ objective was to determine if intracellular thiamine deficiencies were potentially contributing to chronic fatigue symptoms in a group of twelve IBD patients, and secondarily, if treatment with high dose oral thiamine would sufficiently replenish thiamine levels in all cells of the body in order to enhance the efficacy of glucose metabolism. The study population was comprised of eight UC patients and four Crohn’s patients, all of whom had normal blood levels of both thiamine and thiamine pyrophosphate. The study intervention of daily supplementation with thiamine ranged from 600 mg to 1500 milligrams, depending on the patients’ weight status.
After 20 days of supplementation, the researchers assessed the patients’ chronic fatigue syndrome scale scores and blood thiamine levels. Ten out of twelve patients showed complete fatigue regression; the remaining two patients showed “nearly” complete fatigue regression. The study results therefore suggest that high dose thiamine supplementation may support passive transport of thiamine into the body cells in IBD patients whose active transport mechanisms may be compromised. In other words, many IBD patients may struggle with thiamine deficiencies at the cellular level, making supplemental thiamine a viable option for supporting the movement of thiamine from the blood into the cells. I’ll give you a moment to digest that idea...
Now, let’s address the bottom line here: despite serological values for vitamin B1 (thiamine), which may appear normal in most IBD patients, supplementation with vitamin B1 may help to improve energy levels in IBD patients by boosting intracellular transport of this important vitamin involved in metabolism and energy production.
So what does this mean clinically for healthcare professionals and patients? Should every IBD patient be supplementing with thiamine? Not necessarily. Fatigue is certainly multi-factorial as previously discussed, and other potential triggering factors should absolutely be addressed. There may, however, be certain patients who could benefit from experimental vitamin B1 supplementation to boost energy levels. As always, this is determined on a case-by-case basis. Remember to consult with your doctor and/or registered dietitian before initiating a new supplement. And, hopefully in the near future, there will be more exciting news to share about fighting fatigue!"
Bager, P., et al. (2021). Randomised clinical trial: high-dose oral thiamine versus placebo for chronic fatigue in patients with quiescent inflammatory bowel disease. Aliment Pharmacol Ther, 53(1), 79-86. https://doi.org/10.1111/apt.16166
Costantini, A., & Pala, M. I. (2013). Thiamine and Fatigue in Inflammatory Bowel Diseases: An Open-label Pilot Study. The Journal of Alternative and Complementary Medicine, 19(8), 704–708. https://doi.org/10.1089/acm.2011.0840