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Exercise causing me to flare-like symptoms...help!

Hi! I'm new to this community. I hope I can glean some useful perspectives from other crohnies here in this community.

I've been super into bodybuilding and powerlifting for around 6 years. However, due to my diagnosis, in the past 2 to 3 years I have been having difficulty getting back into the gym.

I started with Humira around 6 years ago and I did great on it for around 2 years before I got into a serious flare. Ever since, I have jumped between Stelara --> Entyvio --> ressection --> and now finally skyrizi.

Skyrizi is the only medication that has controlled my inflammation symptomatically.
My CRP has gone from 50 --> less than 2
Fecal Calprotectin has gone from 3600 --> 1000

I am pretty severely anemic with my hemoglobin around ~7 and ferritin <1. I am currently getting treated for it.

Symptomatically, I feel good enough to get back into the gym and have been in the gym on and off for around 6 months. I've noticed anytime I do my usual routine involving Bench, Deadlifts, Squats, etc. I get flare-like symptoms pretty immediately.

I have been trying my hardest to figure out what is the cause: Is it too high-intensity? Is it because my core-involvement is too high? etc. etc.

Around 3 months ago I've decided powerlifting is pretty much no longer an option for me. So, I shifted to bodybuilding and exclusively doing movements that have very little abdominal movements.

I started very very slowly...starting with just bicep/tricep curls and lateral/rear delt raises. After a week of doing that and feeling okay, I added one chest movement. The following week, I did the same thing adding another chest movement.

I added a back movement (pull-ups and chest-supported row) and basically immediately I started having slight flare-symptoms again.

It is basically a perpetual repeat of this where anytime I do any exercise that involves my core too much causes stomach issues...

I really don't know what to do at this point. I have read a lot of people's experience with IBD and exercise and I've noticed that most people can do exercise normally but they do specifically say they avoid sit-ups and what not. However, mine isn't even to that extent. I can't do any movement that involves the core a lot...which makes me think...is it even core related?

At this point I have a few theories:
1. Everytime I start working out, I lose some sleep. I go from maybe getting 7.5 to 8 hours to sleep to 6 to 7 hours of sleep. I'm a student and once I start working out, I dig into my study time and so end up getting less sleep. I know this causes significant fatigue and I know sleep-deprivation can cause inflammation. Those who workout consistently...do you notice you have to sleep like 8 to 9 hours to appropriately recover?

2. Maybe it really is core-related. If so, does anyone have tips that can get me back into the gym?

3. There are some literature out there showing that exercise causes reduced bloodflow to watershed areas (areas in the body particularly sensitive to decreased blood flow) in the gut. Exercise can induce intermittent hypoxia, which results in inflammation. I'm curious if maybe supplementatin of L-citruline and/or L-arginine will increase blood flow through increased production of Nitric Oxide.

I'm a medical student and so I'm constantly looking for a scientific explanation as to why I am struggling the way I am. I would love to hear others experience. I really want to get back into the gym.
Kudos for your search for a scientific explanation.

by any chance did you start any supplement around the same time as the exercise? I've never experienced issues with exercise and symptoms. unless you are seriously over-training perhaps. But ibd symptoms themselves can disrupt sleep, and exercise typically enhances sleep quality, while lowering inflammation.

Supplements contain plenty of additives that are usually bad for the gut, especially the synthetic capsule material, while gelatin capsules would not affect ibd.

Protein powders often contain artificial sweeteners, and pretty much all of them have been linked to disturbing good bacteria in the gut.
Nope, I don't take any supplements at all.

No protein, no caffeine, nada.

I get my nutrients through food for the most part and a multivitamin. I don't really change anything up other than eating more when I start working out.

It's so frustrating because I do fine right until I start adding exercises that require a tad-bit more core involvement and bam...before you know it I have stomach pains and use the bathroom more frequently. I know going to the gym makes some people have to use the bathroom before and/or after, but I don't know if the symptoms I'm experiencing are just normal human things or flare-like symptoms...

It isn't like I'm monitoring CRP and fecal calprotectin before and after going to the gym to see if its actually an inflammatory response to going to the gym or if it's just usual poop activities from hitting the gym.

And I don't really push aside my symptoms as "oh it's just normal gym side effects" and keep pushing until it ends up not being a 1 to 2 day flare and more like a 1 to 2 year flare with medication failure.
mechanical/muscle movement around the abdominal area can, likely, stimulate peristaltic movement of the intestines, so can vibration impact from running. This is usually a good thing for normal healthy people to keep regularity in bowel movements. Perhaps this could be how it might be triggering any symptom related to IBD you are experiencing.

Also perhaps your biology itself might be different from me, considering I do not take the same medication you take. So my own experiences may not even apply to you very well.
Yup that is very possible.
I know physical activity is causing my bowel symptoms, I just don't know if theyre normal or inflammatory.

Don't want to risk thinking everything is normal and realize it is actually messing me up and end up in a severe flare again.
And if you are anemic, that's another skew on normal biology ,so who knows how anything would behave under those conditions. I am aware that iron is still pretty important with maintaining effective immune responses,like most vitamins would be, but I'm not sure how it would be connected to peristalsis or abdominal muscle movements, there probably is a some connection, but too minimal to ever notice, and probably pretty technical.
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So it seems you may have a good point with hypoxia and G.I. Inflammation being a possible explanation for an increase in your symptoms related to abdominal exercises. But I may add that iron is crucial for hemoglobin to supply oxygen to cells. So low Iron/anemia is exacerbating intestinal hypoxia, leading to more inflammation.

It could be a combination of all of the above, but definitely correct your low Iron, that would be a good start.

"Notably, the degree of hypoxia found in the intestinal mucosa is exacerbated significantly in inflammatory bowel disease, leading to a more extensive and severe hypoxia termed inflammatory hypoxia, which can contribute to disease development through the regulation of mucosal immune cell function"
Yup! Exactly, the association between hypoxia and inflammation makes me think my severe iron deficiency is probably contributing to hypoxic conditions even moreso than normal.

Got 3 more IV iron infusions to go and hopefully after I see significant improvement, I'll have to give it a go again. I'll be sure to update here as it may be useful for others in my scenario.
Yup! Exactly, the association between hypoxia and inflammation makes me think my severe iron deficiency is probably contributing to hypoxic conditions even moreso than normal.

Got 3 more IV iron infusions to go and hopefully after I see significant improvement, I'll have to give it a go again. I'll be sure to update here as it may be useful for others in my scenario.
I have iron infusions every other year or so. I don't tolerate oral iron very well. The infusions help a lot with my energy level and they work fast.

I don't exercise the same way you do. Prednisone packed a lot of weight on me, I work full-time, and I also have fibromyalgia. So if I push too hard when exercising I do more harm than good.

I hope the infusions help you, and you should definitely discuss with your GI so they can make note of the issue.
Exercise seems to make my symptoms worst. Immediately after exercise, I get sinus congestion and cold like symptoms. My Crohn's seems to be in the small intestine and I've had these symptoms for over a decade. When I do not exercise, my symptoms seem contained. My experience seems rare and I've been able to locate others who experience similar issues or even find solutions to resolve it.
Any update after your iron infusions? Thanks!
Hey James. O' man. So many updates.
I ended up getting a serious GI bleed and ended up in the hospital last year.

Skyrizi definitely helped to some degree, but my inflammation was too bad to be honest and it would have never been enough to completely settle things entirely. Anyways, I had an ostomy bag for around 3-months and got it reversed this past December.

All in all, things are looking pretty good. I'm currently on Rinvoq and my Fecal Calprotectin is 132 currently. Better than it has been in 3 years! Prior to my surgery, my Fecal Calprotectin was even better at 32 mg and that is why I was able to get the reversal so quickly.

Anyways, my doctor says 132 isn't anything to be worried about. Especially considering I got my calprotectin measured 5-weeks post-op and I was also suffering from a small bout of food poisoning, there is a good chance that my calprotectin would have been <50 if I didn't have those two confounding variables.

My surgeons say I am good to go with running for now. In around 4-weeks, I'll be able to start resistance training again.

So, starting tomorrow, I'm going to start running. I'll keep everyone updated on how things go. Once resistance training starts up, that is when things get really serious for me. I'm stoked. Truly am.