# WHY am I always tired?



## hamster139 (Sep 17, 2012)

I understand Crohns = fatigue, but I really don't know why.

Even my Doc didn't really address this question.  I just wish I knew the reason why we have to suffer this fate.


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## Jennifer (Sep 17, 2012)

There are many reasons such as dehydration, malabsorption, medications and even your body fighting inflammation or infection can cause fatigue. 

Gotta have all of your vitamin levels tested such as vit A, B12, C, D, E, Folic Acid, Iron, Magnesium, Potassium and Zinc. Even if you aren't deficient in any of these being low can give you symptoms of a deficiency. When you have scar tissue or inflammation it becomes harder to impossible to absorb nutrients properly. 

Dehydration is common when you have chronic diarrhea so do your best to increase your fluid intake. 

Are you taking any medications at the moment? Fatigue is a common side effect for many.


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## David (Sep 17, 2012)

When it comes to fatigue and Crohn's the top things to check in my opinion are:

1.  Vitamin B12 deficiency
2.  Iron deficiency anemia
3.  Dehydration
4.  Medication side effect

Or more likely, a combination thereof.  For a much more in dept look at fatigue and IBD, check out this wiki entry.


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## hamster139 (Sep 17, 2012)

Thanks for the information. I have moderate Crohn's in my ileum.  

I was tested for Iron deficiency, and was ok.  I havent been tested for the others, but Ive been taking B12 supplements along with a multivitamin for a couple months now with no change

I am on Asacol, and occasionally Prednisone (which stops the fatigue).    

I havent had a surgery, other than removing my appendix and a teeny bit of my illeum... but I had the fatigue before this as well.

I have diarrhea a lot, but not all the time.  And I have the fatigue with or without the dairrhea...   I also have the fatigue when im not having a flareup,  but its less severe.

The fatigue is debilitating, I feel almost like I am sick all the time.  It reduces my motivation, my focus, and I become like a zombie much of the day.


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## thisisme (Sep 17, 2012)

I am not much help myself... as I am new to this world! 
But I have pretty much the same problem. I feel like a zombie everyday, and find it hard to get anything done, and just want to go to sleep.  I have active Crohn's in my terminal ileum, which is currently attached with a fistula developing between my TI and bladder, as well as in my colon. 

I am not on any medications yet, as I was just diagnosed last week - so for me it can't be related to side effects from medications, but I am seeing my doc for a treatment plan on Wednesday... and plan on bringing it up with her then. 

Sorry I don't have much in the way of info or advise for you! But at least you aren't the only one feeling like an extra on the "walking dead" every day!!


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## CrohnsChicago (Sep 17, 2012)

It's a very physically exhausting disease. Our body and immune system are working overtime internally to attack something in our intestines that doesn't exist. Not much different in theory I would think from how your body responds to having a flu or cold, but the fatigue is x100 for crohn's. At least that's how I've come to explain my fatigue. 

I also take daily multivitamins and occasionally take b-complex pills when I am in need of an extra boost to get through the day ahead of me. What i like to do usually is take the b-complex before bed so it has time to work its way through my system and it helps me get up a bit more easily because I am NOT a morning person...ESPECIALLY when I am in a flare.


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## David (Sep 17, 2012)

If you are deficient in vitamin B12 due to Crohn's (a VERY good chance) then taking oral vitamin B12 will very likely be nowhere near enough to get you back to proper levels and relieve the fatigue.  Point being, *get your vitamin B12 levels tested*.


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## Jennifer (Sep 17, 2012)

All of the above are still a possibility unfortunately and as mentioned its likely a combination of them. What stands out is that the fatigue is less severe while not in a flare. Are you absolutely positive you were in remission between flares? How long were you in remission for? My guess is that your body was still healing and still absorbing less water and nutrients making you tired. Fatigue is also a side effect from Prednisone. Also with all the possible side effects from Asacol I wouldn't be surprised if you became tired from those as well.

Also, I said even being low in the normal range can still bring on symptoms of a deficiency. Do you know what your number was for the Iron? As mentioned you HAVE to request the others to be tested especially B12 as its extremely common to be low to deficient in it (remember that being low can bring symptoms of a deficiency). Multivitamins are not enough. I'm sorry. Even if you take a supplement with a high amount you still need to have blood work done again to see if that supplement is doing anything at all. Chances are its not. Even I have to get a B12 shot cause I don't absorb the stuff at all really. There are many that come in shot or infusion form. Get more blood work done for sure and keep checking it. You can have your GI or GP check this stuff for you.


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## CrohnsChicago (Sep 17, 2012)

I was diagnosed with anemia in 5th grade and had it all the way until my early 20s when I was diagnosed as a "borderline anemic". I was always a tired, sluggish kid if I didn't take my pre-natal pills or iron pills. Been that way ever since. 

I had a blood test done two weeks and nothing out of the ordinary showed up related to iron or b-12 deficiencies. But I still get sluggish/fatigued from time to time.

Have you ever considered a part of it being mental as well? Dealing with this disease can zap both my physical and mental energy. I just get drained physically and even sometimes mentally from all the stress of being sick or worrying or having so much to do in so little time as well as personal issues. I also try to do guided meditation recordings a few times a week as an added treatment to help keep me balanced. It does help and it gives me back some of my focus.


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## Jennifer (Sep 17, 2012)

Definitely stress, anxiety and depression could be playing a role as well.


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## David (Sep 17, 2012)

CrohnsChicago, what was your B12 level out of curiosity?

I forgot to mention vitamin D as well.  That's a common deficiency in Crohnies that can affect energy levels.


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## CrohnsChicago (Sep 17, 2012)

I don't recall. Honestly, the two times I had a blood test since crohn's I was told it was nothing to worry about/it was fine and that was okay with me. 
I even asked about taking b-12 and probiotics and was told while it wasn't necessary for me, it wouldn't hurt to use them if I felt I needed to.

The only thing that was odd about my blood each time was it was determined my C-reactive proteins were not my best indicator of detecting inflammation because despite major inflammation and mucous found during my colonoscopy, the proteins weren't anywhere near a level to detect the major inflammation going on in my body.

I should probably be more pro-active about knowing these things but its all new and I get overwhelmed sometimes.

I don't think I have had a vitamin D test done.


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## David (Sep 17, 2012)

It can indeed be very overwhelming 

It's not that uncommon for CRP to be normal or not too highly elevated in Crohn's patients.  I'm a bigger fan of fecal calprotectin and fecal lactoferrin for tracking inflammation in Crohnies.

Next time you have a doctors appointment, I'd ask them to test your B12 and D levels and get the actual results from them.  Start keeping track of ALL your results.  You'll be glad you did.


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## CLynn (Sep 17, 2012)

Crabby said:


> All of the above are still a possibility unfortunately and as mentioned its likely a combination of them. What stands out is that the fatigue is less severe while not in a flare. Are you absolutely positive you were in remission between flares? How long were you in remission for? My guess is that your body was still healing and still absorbing less water and nutrients making you tired. Fatigue is also a side effect from Prednisone. Also with all the possible side effects from Asacol I wouldn't be surprised if you became tired from those as well.
> 
> Also, I said even being low in the normal range can still bring on symptoms of a deficiency. Do you know what your number was for the Iron? As mentioned you HAVE to request the others to be tested especially B12 as its extremely common to be low to deficient in it (remember that being low can bring symptoms of a deficiency). Multivitamins are not enough. I'm sorry. Even if you take a supplement with a high amount you still need to have blood work done again to see if that supplement is doing anything at all. Chances are its not. Even I have to get a B12 shot cause I don't absorb the stuff at all really. There are many that come in shot or infusion form. Get more blood work done for sure and keep checking it. You can have your GI or GP check this stuff for you.


  True. If we have Crohn's in our ileum, we will probably never absorb most of what we eat/take, etc. And that spot is the one part of the body that absorbs B12, thus, shots are a better alternative for us.


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## CrohnsChicago (Sep 17, 2012)

My crohn's is in my colon. I'm not sure how much deficiency goes on down there compared to the small intestine. Besides maybe Vitamin D deficiency?


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## hamster139 (Sep 17, 2012)

I was under the impression that not absorbing B12 from oral supplements would be because of a resection of the ileum, which I haven't had.  I just had a teeny bit removed from a benign tumor that was removed in that area.

Are there specific types of bloodwork I would need done?

Yes, it all can be stressful, and I too have the issues of not being able to get anything done, which is very stressful in itself.  but I havent really noticed a relationship between the stress and fatigue.


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## Laura Dawn (Sep 17, 2012)

I get vitamin B shots to help with fatigue , otherwise I'm dysfuntional. I was DX in July and have yet to go into remission. Changing Doctors. Mine is not proactive at all. Hope you feel better.


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## Jennifer (Sep 18, 2012)

hamster139 said:


> I was under the impression that not absorbing B12 from oral supplements would be because of a resection of the ileum, which I haven't had.  I just had a teeny bit removed from a benign tumor that was removed in that area.
> 
> Are there specific types of bloodwork I would need done?


You'd request your B12 to be tested (while you're at it have all vitamin levels tested along with your blood sugar as it can also affect how you feel). Either a GP or your GI can order the blood test.

Yes a resection can cause problems but when the intestine is inflamed or if there's a lot of scar tissue then that also reduces absorption.


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## Laura Dawn (Sep 18, 2012)

I get vB injections weekly. Huge ! Take care.


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## David (Sep 18, 2012)

hamster139 said:


> I was under the impression that not absorbing B12 from oral supplements would be because of a resection of the ileum, which I haven't had.  I just had a teeny bit removed from a benign tumor that was removed in that area.


This is a common misunderstanding and quite understandable.  The problem with B12 and Crohn's is Crohn's can interfere with every step of the very intricate process that is required for B12 to go from food bound to successful absorption.  In order for vitamin B12 to be successfully absorbed, haptocorrin (R-protein or R-factor) must first be secreted in the mouth and by the stomach's parietal cells and bind to the vitamin B12 in the stomach when hydrochloric acid and pepsin separate the B12 from protein. The stomach's parietal cells must excrete intrinsic factor and the pancreas must secrete pancreatic protease which separates the haptocorrin and B12 in the duodenum, then the intrinsic factor must bind there to the B12. Recirculated B12 is also released at this point via the bile duct. Then the cubam receptors must absorb the B12 in the terminal ileum. Once absorbed, vitamin B12 binds to transcobalamin II and becomes holotranscobalamin (active vitamin B12) and is transported throughout the body. Those with Crohn's Disease have potential issues at each point, especially the terminal ileum which is the most commonly inflamed area for people with CD.  Resection increases the chance of deficiency, but anyone with Crohn's is at high risk and should be tested regularly.  Based upon my research, everyone should strive to get their level well in excess of 500pg/ml and oral formulations are very unlikely to do that for many.  If you take oral and your tests come back above 500pg/ml then great.  But if not, then injections are necessary.


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## rkoll327 (Sep 18, 2012)

I just saw a new GI on Friday who was wonderful, and was the first doctor to ever test my B12 levels. Turns out I was around 215 and they said that they like for people to be well over 400 (I am not sure what these numbers represent though). I will be starting injections this week, hoping they will help with fatigue and itchiness in the legs! You should  definitely ask your GI to test you!


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## David (Sep 18, 2012)

Here in the usa those numbers are likely 215pg/ml and 400pg/ml.  Each lab is a little different, but the reference range is typically around 200-900pg/ml.  And it is a TERRIBLE reference range as most people in the "low normal" range are in fact deficient.  That your GI wants you above 400pg/ml is a very good sign.  I personally recommend getting above 500pg/ml as I like cushion but wouldn't debate a GI who said 400.  Ok, I probably would, but still, it makes me happy to hear your GI wants you above 400 as most go by the normal reference range.


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## rkoll327 (Sep 18, 2012)

David said:


> Here in the usa those numbers are likely 215pg/ml and 400pg/ml.  Each lab is a little different, but the reference range is typically around 200-900pg/ml.  And it is a TERRIBLE reference range as most people in the "low normal" range are in fact deficient.  That your GI wants you above 400pg/ml is a very good sign.  I personally recommend getting above 500pg/ml as I like cushion but wouldn't debate a GI who said 400.  Ok, I probably would, but still, it makes me happy to hear your GI wants you above 400 as most go by the normal reference range.


Oh thank you! That is super helpful. When the doctor called to tell me I was trying to write everything down I forgot to ask what the numbers were for :ywow: He definitely said I was deficient and was surpised my last doctor didn't catch it. Not necessarily looking forward to using a syringe, as I got used to the Humira pen, but if it helps me feel better I am all for it! Thanks for the input


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## Jennifer (Sep 19, 2012)

You'll be fine rkoll327.  The B12 doesn't hurt like the Humira medication does and the needle is smaller than the one the pen uses. As always if you aren't comfortable doing it yourself you could have a nurse do it for you in the office. I have a nurse do it for me every other month (the option to do it myself was never given to me).


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## hamster139 (Sep 19, 2012)

I failed to mention one thing.  When I am tired I am often feeling sick as well....nauseous really, like I have a touch of the flu.  And when I try to do anything physical... .sometimes even standing for a while, it causes my to feel sick.  I don't know if this means anything.   

At any rate, I will make sure to get everything tested.


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## Jennifer (Sep 20, 2012)

When I was in flare I had flu like symptoms (tired and nauseous mainly) if that helps.


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## CrohnsChicago (Sep 20, 2012)

I also get flu symptoms when in a flare. It's the spontaneous fevers and sometimes vomiting along with the typical crohn's symptoms that knock me out.


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## David (Sep 20, 2012)

I suspect that some of you who experience symptoms such as nausea and vomiting when flaring are related to magnesium deficiency.  Just an idea to keep in mind and maybe discuss with your doctor


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## thisisme (Sep 24, 2012)

well.. sounds like you all have it right! I got a call from my doc with my blood results, and turns out B12 was very low. Starting on weekly injections tomorrow! Here's hoping for less "walking dead" feelings!


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## David (Sep 25, 2012)

I'm glad they found that for you thisisme.  Keep us updated as to whether you feel any different with the injections   I'd also suggest you keep track of your B12 lab readings.  Such data can be VERY useful and important over time.


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## Jennifer (Sep 25, 2012)

Indeed keep track of your results! Glad you found out now and will hopefully start feeling better! 

And yes David, I have been told that I'm low in magnesium.


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## CrohnsChicago (Sep 25, 2012)

So I took the suggestions of everyone here and while at the doc today to get a TB test (to prep for possible Humira treatment), I asked her details about my lab results from 3 weeks ago. 

I DID take a Vitamin D test and the results were slightly low (27 - with 30-100 being normal range) but she said that it could be more of a regional effect/where I live rather than a crohn's effect.

She also wrote me an order to get a B12 level test done after I asked her. And said if it came back significantly low, she could give me b12 shots monthly.

We will see what the results are in a few days. 

Thanks again for giving some of us here a bit more insight and push to get these things tested!


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## Jennifer (Sep 25, 2012)

My vit D is also low CrohnsChicago so I started taking liquid vit D to help bring it up some. I take 5,000 IU a day but still don't know my lab results yet to know if its helped any (I missed my doc appointment due to being too tired from the wedding planning but I rescheduled). You could try supplements to see if it helps bring it up.


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## David (Sep 25, 2012)

CrohnsChicago, I would either get out in the sun if you're able to or supplement with a vitamin D level that low.


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## CrohnsChicago (Sep 27, 2012)

Got my B12 results back. I AM borderline low. My count was 326 (the normal range this lab used was 200 - 1100)

I opted to try B12 injections monthly to see if it helps me out in any way.

I will also be looking into Vitamin D supplements. 

Thanks again to everyone for encouragi us to get these things tested:heart:

It's funny how much of a sense of relief you can feel when you finally have answers....and a solution.


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## Jennifer (Sep 27, 2012)

Keep us posted on your progress!


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## hamster139 (Oct 6, 2012)

I got all my blood-work results back... everything is normal... no deficiencies... nothing even borderline... I am starting to think that the only treatment for this fatigue is Prednisone... but I certainly don't want to be on that drug all the time.


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## Gianni (Oct 6, 2012)

Hey hamster, 
Sorry to hear you aren't happy with the results. Please do realize that these vitamins aren't going to hurt you so feel free to go out in the sun and soak up those Vitamin D rays. You always want to be on the high side of the vitamin and mineral levels and even in some cases exceed the levels. I try to make sure i exceed the limits in just about every vitamin and am towards the high range in minerals (excluding a few minerals). Have you had your thyroid levels tested?

all the best

Gianni

PS (edited in): also do you sleep okay during the night or do you have to regularly use the restroom? Disrupting your Rem cycle can have a profound effect on your energy levels.


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## Jennifer (Oct 6, 2012)

David I remember you saying that having too much of certain vitamins can actually cause damage. Can you share what that/those was/were again please?


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## Gianni (Oct 6, 2012)

Crabby said:


> David I remember you saying that having too much of certain vitamins can actually cause damage. Can you share what that/those was/were again please?


They are the fat soluble vitamins, Vitamins A, D, E, and K. The only symptoms from overdosing are nausea and irritability. Mega over dose can cause more severe reactions such as skin rashes, vomiting, bone pain. However these rare more severe reactions happen almost exclusively in children.

I exceed all my vitamins even the fat soluble ones by a good amount and i don't experience any of these symptoms. 

The other, water soluble vitamins can take just about any dose. There are cases in which patients will take 100,000 milligrams of vitamin C a day 

Gianni


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## Jennifer (Oct 6, 2012)

No that's not the complications that David had posted. I believe it was more along the lines of causing further complications with the body and possibly Crohn's and age was not a factor. I'm sure he'll pop in at some point and elaborate.


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## Wooddy (Oct 6, 2012)

hamster139 said:


> I failed to mention one thing.  When I am tired I am often feeling sick as well....nauseous really, like I have a touch of the flu.  And when I try to do anything physical... .sometimes even standing for a while, it causes my to feel sick.  I don't know if this means anything.
> 
> At any rate, I will make sure to get everything tested.



Hamster,

     If your B-12 levels are low, you can try taking oral B-12 tablet under the tongue, just let the tablet dissolve and it will get absorbed much better than if you swallow it.  Injecting B-12 is the most direct method and is probably the most reliable and only needs to be done once weekly.  However, if you crinkge at the thought of injecting yourself, there is another formulation of B-12 that gets absorbed well and you don't need a needle, it's called Nascobal.  It's an intranasal formulation that delivers 500mcg of B-12, you just spray it in your nose once weekly but it's expensive.

If your levels B-12 levels are fine and you are still tired, have your doctor check you urine for elevated delta-aminolevulenic acid (ALA) levels.  This particular 5-carbon metabolite has a structure that suspiciously resembles the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and elevated ALA levels have been associated in some cases of inflammatory bowel disease.   Testing is usually done with a 24 hour urine sample, if your doctor decides to order it, it's imperative that the sample stay in the refrigerator and protected from while you collect it.  Make sure you bring it to the lab in a cooler bag and that they put it in the refrigerator straight away.  The sample is good for 1 week refrigerated or 1 month if it's frozen.

I have UC and am frequently tired through out the day and sometimes have terrible bouts of nausea and intense abdominal pain, it's no fun.  


Good luck.


Good luck!


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## Wooddy (Oct 6, 2012)

*Vitamins*



gtzucc said:


> They are the fat soluble vitamins, Vitamins A, D, E, and K. The only symptoms from overdosing are nausea and irritability. Mega over dose can cause more severe reactions such as skin rashes, vomiting, bone pain. However these rare more severe reactions happen almost exclusively in children.
> 
> I exceed all my vitamins even the fat soluble ones by a good amount and i don't experience any of these symptoms.
> 
> ...


Gianni,

     Taking too many vitamins is not good at all.  Even though vitamin C does not get stored and needs to be replenished every day - taking more than 250-500mg/day can cause serious problems in the long run.  The body can't use more than that and must work hard to get rid of the excess.  

Vitamin C is an acid and consequently will acidify the urine as the body  eliminates the excess.  If the pH of the urine drops too low then minerals can precipitate out and form kidney stones.  Another problem with having urine that's too acidic is that it can affect the elimination of certain drugs which can obviously lead to serious problems as well.

The fat soluble vitamins stick around longer and you have to be careful of them too.  Vitamin D for example, is fat soluble and the current recommendations on dosing are between 1000iu to 4000iu daily, depending on your age.  If you take 50,000iu/day for several months, your levels will get too high and you can develop a rare condition called Hypervitamosis D (Vitamin D toxicity).  This will definitely cause fatigue, nausea, dehydration, anorexia, dehydration, irritability and among other things it causes elevated calcium levels in your blood which lead to kidney stones and/or irreversible kidney damage.  Imagine what would happen if you took too much vitamin D together with too much vitamin C,,, Can you imagine peeing out that monster size stone?  YIKES!  

This is what could happen if you exceed the recommended limit of just two vitamins.  Imagine the havoc wreaked in your body if you take excessive levels of all of them.  :yfaint: 

The long and the short of it is maintaining the proper balance of vitamins in your body will do you the most good.  If you take more vitamins than your body can use, then more energy and resources are tied up to get rid of them.  That is not a good thing.  So be careful because overdosing on vitamins can even be fatal in extreme cases. Tell your doctor and pharmacist what supplements you are taking and make sure you also talk to them about the dose.


I hope this helps


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## Gianni (Oct 6, 2012)

Wooddy said:


> Gianni,
> 
> Taking too many vitamins is not good at all.  Even though vitamin C does not get stored and needs to be replenished every day - taking more than 250-500mg/day can cause serious problems in the long run.  The body can't use more than that and must work hard to get rid of the excess.
> 
> ...


Hiya woody

In no way was i promoting a 100,000 milligram daily allowance of Vitamin C. Personally I take about 2,000 milligrams on vitamin C a day and I have never had a kidney stone. As for Vitamin C causing kidney stones, many studies have been attempted but none could produce a vitamin c causing kidney stone. http://orthomolecular.org/resources/omns/v01n07.shtml .. I actually took a nutrition class one summer and my teacher was so funny because he was so mad when someone commented that Vitamin C caused kidney stones. http://lpi.oregonstate.edu/f-w99/kidneystones.html
It is based on theory.

I am someone that doesn't believe the daily allowance standards set forth by the government reflect optimal health, but just enough to "get by".



> Vitamin D for example, is fat soluble and the current recommendations on dosing are between 1000iu to 4000iu daily, depending on your age.  If you take 50,000iu/day for several months, your levels will get too high


The fact that the recommended dose-age for vitamin d is 1,000-4,000 iu daily and for me to get sick i would have to take 50,000 iu/day for several months i think says all that needs to be said. Also i suggested soaking up vitamin d rays, i don't think there is enough sun in the day for me or anyone to achieve 50,000 iu. Seeing as i don't supplement any vitamins in pill or bilingual form (except b12) but rather through sunlight or vegetation I think Im good. 


With that being said, I'm glad you have brought up these points. I should have been more specific in the post about how high my levels are and where to draw the line. 

Gianni


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## Wooddy (Oct 6, 2012)

Gianni,

    I assumed that you weren't taking 100,000mg of vitamin C because that would mean ingesting 100 tablets if they were 1000mg each... YUCK! :ylol:

As for causing kidney stones, I can assure you that acidifying the urine increases your chances of having kidney stones.  They don't happen over night and the risk not the same for everyone -- however it can happen over time if your urine remains acidic.  It not that Vitamin C causes kidney stones alone, it's just one factor that sets up a favorable environment for them to form and some people are more prone that others  

There is plenty of documentation that acidic urine increases the risk of kidney stone formation.  For example the sulfa drugs have been implicated in this, they can not remain in solution if the pH is too low and kidney stones are a problem particularly in acidic urine.  That's what happens when calcium is elevated in your blood, only so much of it can stay dissolved before it precipitates out and collects in the kidneys.  I know that you are not denying that kidney stones exist, I am just trying to make you aware of the conditions that promote their formation.

If you insist on taking 2000 mg vitamin C just make sure that you drink plenty of water, and remember that if your body cant absorb the vitamin C it winds up in your urine.  So don't piss away too much money  

I appreciate the links that you included.  Don't get me wrong, I certainly agree that the RDA requirements are too low, and I feel very comfortable recommending 250-500mg/day of vitamin C supplementation.  Remember that you do get additional vitamin C in your diet and extra from fortified food.  However, I don't want to suggest taking too much because some people don't handle the extra load very well, especially older people. 

Just like vitamins are good for you, Red wine is good for you as well, but what happens if you drink too much of it?  Just ask the French.  Red wine is very good for your heart.  The people in France drink lots of it and have a lower incidence of heart disease despite the crazy amount of fat in their diet.  However, the rate of liver disease is also higher and is directly proportional to the amount of wine ingested. 

Just keep in mind, your body is constantly trying to maintain a delicate balance.  Over loading it (even slightly) with one or two of the bazillion nutrients it needs will cause the body to react and deal with the excess to maintain homeostasis.  Each person will react differently, it is by no means an exact science but this much is certain, as you get older you will find that your body is not as forgiving as it is now, enjoy being young. :cheerss:

Certainly it's important for us to have enough nutrients available for our body to function and is of particular importance with us since we are prone to certain deficiencies that can exacerbate our condition, just try not to over do it.  

I am going to take my dog out for a walk before it rains.   Have a nice day were ever you are.


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## Tina80 (Oct 6, 2012)

I also find fatigue a real issue. I have Crohns  in the terminal ileum and I have had low b12 even before my resection. I get injections every 3 months but I find that after about 2 months I start to feel really tired and get cuts in the corners of my mouth. I asked my consultant if I could them more regularly but he said it should not be needed.

Do you think I should be pushing for more regular b12? I've also just been told my calcium and vitamin D are low so I've started taking supplements of them.


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## Niklovely (Oct 6, 2012)

I'm always tired! I find it difficult to wake up in the morning, feel tired all day, take 2-3 hour naps during the day and then I'm still tired enough to go to bed at 8 or 9pm at night and sleep the whole night. 

I'm anemic and have low Vitamin D. I take a liquid iron supplement because I was told by my naturopathic doctor that it's easier to absorb and just a generic brand Vitamin D supplement.


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## David (Oct 6, 2012)

Crabby said:


> David I remember you saying that having too much of certain vitamins can actually cause damage. Can you share what that/those was/were again please?


All of them?    Obviously some vitamins and minerals are worse than others and are easier to get too much of.  And problems such as kidney or liver issues makes that even easier still.  Common ones people take that I worry a lot about are zinc, vitamin B6, and vitamin A.  The problem with the vast majority of Vitamin A is it bypasses the body's mechanism for making sure you don't get too much.  You can't really OD on carrots but you sure can on OTC vitamin A.

Each causes different kinds of symptoms though.  For example, too much vitamin B6 can lead to peripheral neuropathy.  Too much zinc can lead to abdominal pain, diarrhea, nausea, and vomiting.

But I'm not sure specifically what I might have been speaking of that you're referring to, sorry 

But for these reasons (and more) I think it's VERY important not to supplement blindly.  Get tested and supplement based upon the test results so that dosage and delivery mechanism can be properly optimized over time.


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## Jennifer (Oct 6, 2012)

I'll have to wander through your post history then. It really wasn't that long ago. I'll find it if its the last thing I do!


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## Gianni (Oct 6, 2012)

Wooddy said:


> Gianni,
> 
> I assumed that you weren't taking 100,000mg of vitamin C because that would mean ingesting 100 tablets if they were 1000mg each... YUCK! :ylol:
> 
> ...


Hey woody, 

It isn't so much the acidifying of urine that causes the kidney stones, as is the calcium oxalates and phosphates. Kidney stones are not caused by Vitamin C, do some research on the matter. Many studies have shown that Vitamin C can actually prevent stone formation by keeping Calcium bound in its true form. Also Vitamin C is a diuretic which keeps urine flow constant and quick which ruins an environment where a stone could form. Furthermore stones tend to form around bacterial infections. Seeing as Vitamin C is anti-bacterial, it removes the environment from which they form. 

Now let's say for the sake of the argument I agree with you and believe that Vitamin C does cause kidney stones. I would have to take around 340,000 mgs of vitamin C to equal one can of soda. I think it is worth mentioning that someone can drink a soda in a matter of minutes. Also sodas are even more acidic and actually promote bacterial growth. Further more the phosphoric acid, caffeine, sugar, sodium and even lower ph all deplete our bodies from calcium. And then calcium comes out through the urine and stones have a huge increase of forming. Vitamin C doesn't contain any of that except a low ph but not even as low as soda. 

My 2,000 mg of Vitamin C a day is the equivalent liquid amount of me drinking 7/100's of one ounce of soda. Not to even mention the difference in ph as well as all the other crap within soda. 

A gorilla will consume 4,000-6,000 mgs of Vitamin C a day, and the RDA sets its guidelines for a full grown male to consume 95mg of Vitamin C a day. Yet amazingly enough the RDA yields that our body should contain 300mg of Vitamin C at all times to avoid scurvy... hmmm... One of us is right, I think it's the gorilla. I realize you don't agree with the RDA, but just wanted to show the massive difference between them and nature. 

Let's say i was taking 100,000 mgs of Vitamin C, I would still only be drinking less than 1/3 of a can of soda. 


Red wine good for you? That's something my grandmother says as she is sipping her 3rd glass. It's no secret that the alcohol is bad for the liver. If you are trying to compare red wine(alcohol) to the same caliber as vitamins, i feel like you aren't giving vitamins a fair trial. 
Red wine... "may improve heart health" I believe this as much as honey nut cheerios "may help lower your cholesterol". 

Also let's say it is good for your heart, okay but it is bad for your liver. The liver is in my mind one of the most important organs. The big 3 to me are heart, brain, and liver. So why destroy your liver for something that "may help improve heart health". Yet you can pick up an acai berry and get the same amount of antioxidants. It's like saying cheerios "may help lower cholesterol" ..... (in small text) "but may also cause brain damage". So yeah i don't think using red wine as a "too much of a good thing" example makes any sense. 

Fun Have a nice day as-well. Cute dog by the way. 

Gianni


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## Jennifer (Oct 6, 2012)

Ok David, there's no way I can find it. You have like a billion posts each day.  I still believe it was along the lines of if you take too much of one it makes it so you don't absorb or process another very well which can result in damage to your body or a particular organ. I don't really remember though. Oh well. 

The point is basically do not blindly supplement. Have blood work done to see what you actually need and go from there. If you don't need it then there's no reason to take more of it.


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## hamster139 (Oct 6, 2012)

ok, will check out my ALA and Gaba levels.....  I guess thats the one thing I havent checked...  I am tempted to go on another Prednisone regimen, but the last one made me feel great when I was on it... but then I flared back up after I got off it.


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## Jennifer (Oct 6, 2012)

How much inflammation do you have (your CRP)?


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## hamster139 (Oct 7, 2012)

Crabby said:


> How much inflammation do you have (your CRP)?


Not sure, I just had my general doctor do the blood levels to find deficiencies.  My GI doctor said I have moderate Cronh's of the terminal Ileum.   The stomach pain is really not too bad at the moment... I think that is probably because of the Asacol and careful eating... but the fatigue is ever-present.... its the one part of the disease that I feel I have no control over.


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## Jennifer (Oct 7, 2012)

If the inflammation isn't out of hand then maybe Entocort (may not have the crazy energy boost that some people get with Pred though) would be good to help bring down the inflammation. It has less side effects and for all we know the fatigue could also be your body fighting the inflammation. The body gets tired when its working hard to stay healthy.


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## Wooddy (Oct 7, 2012)

Gianni,

    Thanks for the comment about my dog he is my buddy.  

You are pretty smart and I agree with many points that you make - I believe that some of the points made may have been taken out of context.  One thing that shouldn't be ignored is that taking too many vitamins (including vitamin C) can certainly lead to toxicity.  

Click on link below from the MAYO clinic and read through it.  That link provides a more comprehensive explanation than I can provide on this forum, especially since I tend to ramble off subject all the time.  

http://www.mayoclinic.com/health/vitamin-c/NS_patient-vitaminc/DSECTION=safety

I hope this was helpful in some way.


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## hamster139 (Oct 7, 2012)

Crabby said:


> If the inflammation isn't out of hand then maybe Entocort (may not have the crazy energy boost that some people get with Pred though) would be good to help bring down the inflammation. It has less side effects and for all we know the fatigue could also be your body fighting the inflammation. The body gets tired when its working hard to stay healthy.


Yes, my GI suggested Entocort last time I saw him.... does it typically boost the energy at all?

Yes, I think you are right... I am pretty sure its the flareup causing it.


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## Jennifer (Oct 7, 2012)

hamster139 said:


> Yes, my GI suggested Entocort last time I saw him.... does it typically boost the energy at all?
> 
> Yes, I think you are right... I am pretty sure its the flareup causing it.


I never noticed a vast amount of energy from it although I never noticed any from Prednisone either. Some people have mentioned more energy from Entocort though. If its the flare that's causing the fatigue and if the Entocort can bring the inflammation down then you should notice more energy for sure. I always opt for Entocort because Prednisone just has far too many side effects that my body just can't handle anymore. It messes with my blood pressure too much (I have a heart condition) so for me it does more harm than good.


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## Wooddy (Oct 8, 2012)

I hate prednisone.  It kills you while it's saving your life.


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## thisisme (Oct 9, 2012)

Just about to have my 4th B12 shot (having them weekly right now)... I have to say, the difference is amazing! I'm not falling asleep at my desk by 1pm in the afternoon, and although I still get pretty exhausted by the end of the day, I feel like I can actually get stuff done.
The Prednisone is definitely helping the energy I think, as it makes me need to keep going non-stop until I crash. I have been tapering and am going down to 25mg this week... and I have noticed I have been able to sleep a bit more through the night as I taper down. Still waking up several times though. 
Can't wait to be done with the Pred!


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## David (Oct 9, 2012)

That's fantastic Amy!  I'm glad the B12 is helping


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## Spooky1 (Oct 9, 2012)

I suffer extreme fatigue and if i exert myself i get incredibly nausic and throw up.  They won't inject B12 in Cornwall, but i do buy the supplements, not sure they are absorbed as i've had most my ilium removed and half my bowel.  My white blood cell count is usually 'abnormally high' according to doc and i'm wondering if this is anything to do with it.  folic acid is often low though.


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## David (Oct 9, 2012)

Spooky, have you had your actual B12 level tested?  If so, what was it?

And I don't know of B12 affecting white blood count.


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## Spooky1 (Oct 10, 2012)

Can't digest fruit to save my life unfortunately because i absolutely loved fruit.

my doctor just tells me that my b12 is low, he doesn't give an actual number though.  he also mentions at most blood test results that my white cells are abnormally high.  this apparently is a marker for the amount of inflammation in the body.  I was wondering if both were linked, and whether i actually absorbe the tablets that i take (b12).  I suppose with a load of intestine gone its possibly hard for my body to absorb.


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## Wooddy (Oct 10, 2012)

Spooky

     Place the b-12 tablet under your tongue, you will absorb it that way. :ytongue:


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## rkoll327 (Oct 10, 2012)

I am on my 4th week of B12 injections and I am SO happy they found out my levels were low. The injections work wonders, I have so much more energy and overall just feel better. It has also helped with the itching I was experiencing, I am not sure if it will be the cure, but it is helping for the moment. After getting over the initial shock of sticking a syringe into my stomach, it's all been good


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## David (Oct 10, 2012)

rkoll, what specifically was itchy that the B12 helped with?


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## rkoll327 (Oct 28, 2012)

David said:


> rkoll, what specifically was itchy that the B12 helped with?


I created a post about it in another section somewhere on here. I was having AWFUL itching in my legs, and sometimes my arms. But usually just my extremities. None of my doctors could figure it out, and I tried just about every antihistamine and steroid cream out there (nothing helped). So fingers crossed but I think the B12 may have been the answer. After dealing with the itching for periods on and off for 4 years I have to say it is such a relief!:thumleft:


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## thisisme (Oct 31, 2012)

Just finished 4 weekly injections of B12, and now will be going monthly. Have definitely seen some improvement with the B12, however still quite exhausted. 
I got a call yesterday from my GI saying my iron levels are quite low, and as a result will be going for an iron infusion on November 12th.  A little nervous, but hoping it will help with the exhaustion!


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## CrohnsChicago (Oct 31, 2012)

Glad to hear you are seeing some positive results 

I had my first b12 injection three weeks ago. I definitely felt some improvement in my mental sharpness and ability to move about but I didn't get that surge of energy I commonly hear about (which i found interesting because the b12 pills tend to do that for me). I actually slept for about 6 hours after I got the injection lol.

I had two side effects: dizziness and increased diarrhea, but that went away after the first day and a half.

Due for my 2nd b12 injection in two weeks. We will see if it offers further improvement.


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## UncleChuckSucks (Oct 31, 2012)

I hear you! The same question is what drove me to finally join a message board after 8 years suffering without support from others who know what I'm dealing with. 

Here is the thread, which was really helpful to me: http://www.crohnsforum.com/showthread.php?t=41816

I think it's because our bodies are more or less always fighting the flu, except it thinks our intestines are the flu. Fun fun! 

But don't be discouraged or beat yourself up. Take care of yourself and do the best you can.


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## thisisme (Nov 5, 2012)

Just when I thought the B12 was doing good, I got a call today that my levels havent improved  ... so back to more frequesnt B12 shots I go! I've been extra tired lately... just been kinda trying to ignore it I suppose!


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## Laura Dawn (Nov 5, 2012)

I went to my PCP whom I've been going to forever and she is teaching me to give myself injections. My B12 is still 80. She is amazing ! Have you been given this option?


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## thisisme (Nov 6, 2012)

I haven't, but it would be nice! I'm not sure if I could do it myself (fear of needles)... but I'm sure my boyfriend would LOVE to jab me with a needle every once and awhile :sign0085:

Going to the doctors office every other week for a shot, on top of all my other current apointments is getting quite hectic.. I might look into seeing if this is an option for me ... thanks for the tip!


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## Laura Dawn (Nov 6, 2012)

Hey, just say these other progressive PCP's in WA State are doing at home B12s. Dr. Ego will spur he or she on. I think I'm joking about the ego part. My Dr. soley did it to spare me more trips. If you say you are concerned about doing it they won't suggest this. I will let you know if it helps.


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## thisisme (Nov 28, 2012)

Well it feels like I never get a chance to ask to do it myself, because they are constantly calling me to change the dosage! I was suppoed to be doing it monthly... then after blood results they changed it to biweekly... and just yesterday they have decided to go weekly.
I guess this is a benefit of getting the weekly bloodwork due to being on Imuran! They are definitely keeping ontop of my B12 and iron!

I dont think I could handle doing them myself... I am not a fan of needles!
At least his office isnt far from work... so just means I miss out on a lunch hour to go get a B12 shot once a week!


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## Laura Dawn (Nov 28, 2012)

I'm glad that they are on top of the B12. I uses to get them weekly at lunch too! Now I'm 45 min away, so my husband gives them to me weekly. I'm sure they are helping me . I also juiced for 3 days which helped me a ton. Then I ate. Anyway, hopefully they can get you levels to a norm so you feel better!


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