What Does Fatigue Have to do With It?

I just had a blood test to check my iron levels and it got me thinking about an often overlooked issue in autoimmune disease…FATIGUE!

Have you ever felt the fatigue of autoimmunity, but haven’t received answers or options to manage and improve your symptoms?

Fatigue in autoimmunity means symptoms of tiredness and exhaustion that do not improve with rest. Symptoms of fatigue can interfere with everyday life. You might experience brain fog, exercise intolerance, and headaches.

I was first diagnosed with inflammatory arthritis over 12 years ago. I was happy to finally have a reason to explain all of the random joint pain I was experiencing. I was not, however, prepared for the fatigue and brain fog that would follow me as a constant reminder of my disease.

When I asked my medical team about it, I received the frustrating response that it was just part of life with an autoimmune disease. Fatigue can be a confusing and often overlooked aspect of your disease, but it shouldn’t have to be!


When we dig deep, there are several root causes we can uncover for fatigue that actually have solutions!


When I talk about fatigue, I’m not talking about Chronic Fatigue Syndrome. This is an autoimmune disease that can lead to debilitating exhaustion and a host of other symptoms. This deserves mention, because it’s something to have ruled out as a root cause of your fatigue with your medical practitioner.


Reasons for Fatigue

When living with an autoimmune disease, fatigue can arise due to:

  • Medication use
  • Chronic inflammation
  • Anemia
    • Of Chronic Disease
    • Iron-deficiency
    • B12/folate deficiency
  • Depression/anxiety
  • Increased stress (adrenal fatigue)
  • Malnutrition

Let’s take a look at each one of these:

1) Medications:

  • Several medications used for autoimmunity work by interacting with the functioning of the body’s immune system.
  • Fatigue is a common side effect.
  • Discuss the potential for fatigue with your primary care provider.

2) Chronic Inflammation:

  • Inflammation is a common part of autoimmune disease.
  • A side-effect of inflammation is fatigue. This occurs because your body is devoting resources to mount an immune response, which can be an exhausting process.
  • Periods of inflammation can be assessed with blood testing, especially for CRP (C-reactive protein) and ESR (Erythrocyte sedimentation rate). Talk to your health care provider about these tests and if inflammation could be contributing to your fatigue.
  • There are several nutritional options available to decrease inflammation. Eating whole, unprocessed foods and reducing sugar intake is a great place to start!

3) Anemia:

  • Anemia is a common cause of fatigue, but not all anemia is due to low iron.
  • Anemia is defined as a reduced quantity/quality of red blood cells. This can lead to fatigue, exercise intolerance, shortness of breath, palpitations, decreased cognitive function, and changes in skin/hair/nails.
  • There are 3 main types of anemia:
    • Anemia of chronic disease
      • This develops after the onset of chronic inflammatory, infectious, or autoimmune diseases. It’s a result of decreased red blood cell synthesis or quantity that can happen as a result of increased immune response.
      • Supporting the immune system through nutrition and lifestyle changes can help to reduce symptoms of fatigue.
    • Iron-deficiency anemia
      • This develops when iron stores become low.
      • To diagnose, you need evidence of iron deficiency that can be determined through a blood test.
      • Ferritin is the storage form of iron and the recommended test for diagnosis of iron deficiency.
      • Foods and supplements high in iron can help to reverse symptoms (see below).
    • Pernicious anemia 
      • This can develop when B12 and/or folate (folic acid) stores become low.
      • Inflammation of certain stomach cells can lead to this condition.
      • A blood test to measure B12 and folate levels is required to identify this type of anemia.
      • B12 and folate are needed for iron to be used by our cells, so a deficiency in these nutrients can also contribute to iron deficiency.
      • Foods and supplement high in B12 and folate can help to manage symptoms.

4) Depression/anxiety:

5) Stress and adrenal fatigue

  • Stress can play an important role in autoimmune disease!
  • The adrenals are small glands located above the kidneys that are responsible for secreting stress and sex hormones.
  • Increased stress due to daily life with an autoimmune disease, let alone the stress of life in general, can over-work these glands, leading to exhaustion.
  • Decreasing stress and supporting your body’s ability to respond to stress through dietary and lifestyle habits can help to reduce the strain on these important glands.

6) Malnutrition

  • Autoimmune disease can wreak havoc on our ability to absorb and digest our food.
  • When we lack important nutrients from our diet or because our digestion is compromised (due to medication, disease state, etc.), we can feel fatigued.
  • Making sure to include quality whole foods into your autoimmune nutrition plan is vital for increased energy and optimal digestion.
  • You can work with me to develop a personalized nutrition plan to make sure you are getting all of the nutrients that you need to feel your best!


Lacking Iron?

Since iron deficiency is quite common for women and autoimmune disease appears to have a sex bias, I wanted to touch on ways to increase iron through nutrition. If you determine that your fatigue is due (at least in part) to iron deficiency, you can increase your levels by including more iron-rich foods in your nutrition plan.

Foods high in iron:

  • Molasses
  • Lentils
  • Dried peaches
  • Egg yolk
  • Oysters
  • Nuts
  • Quinoa
  • Organic soy
  • Swiss chard
  • Peas
  • Good quality animal liver

The iron found in animal sources, is referred to as ‘heme’ iron and is more absorbable than the plant-based ‘non-heme’ form. You can increase the absorption of non-heme sources through the addition of vitamin C.


Should you supplement with iron?

  • Always talk to your practitioner and have lab tests done before deciding to supplement.
  • If you get the go ahead, keep in mind that iron supplementation can often lead to constipation, a symptom that can be harmful for autoimmunity. Look for iron in the form of iron citrate/glycinate/bisglycinate to decrease this symptom and increase absorption.
  • Take iron away from food and caffeine to increase the absorption.
  • Vitamin C is required for iron absorption. Many supplements come with built-in vitamin C.
  • It takes about 3-4 months to see iron levels improve. Monitor ferritin levels every 3-4 months to see if supplementation is having an effect.

If you have persistent symptoms of fatigue, it’s important to talk to your health care team so that you can get to the underlying root cause(s) of your symptoms. Working with a nutritionist can improve your absorption and tolerance of nutrient-rich foods and supplements to relieve symptoms. If you want personalized support, apply to work with me!


Although common, fatigue doesn’t have to be part of your everyday life with autoimmunity.


The above reasons are not exhaustive of the underlying root causes of fatigue. Having a thorough assessment with your medical team can be an important first step in identifying the reasons for your fatigue.

The more we talk about our symptoms and increase awareness, the greater the chance that research and patient-guided solutions will become more common. Your voice is important!