Editorial: Fatigue in Disorders of Gut-Brain Interaction–An Important Symptom to Recognise 2026 Alger and van Gils

[Andy]

Fatigue is a common symptom in gastroenterology clinics. Patients may describe it as exhaustion, lack of energy, brain fog or an inability to recover after ordinary activity [1]. During outpatient clinics, however, clinicians may focus more on gastrointestinal symptoms compared to less specific symptoms such as fatigue, which might be caused by complex underlying mechanisms and which lack specific treatment strategies. However, for many patients, fatigue is not a secondary symptom, it is a central determinant of their functioning, work participation, and quality of life [2].

Open access

 

[Midnattsol]

Fatigue is also ignored in celiac patients, although for some it might be more pronounced than any gut symptom (some even say they don’t have gut symptoms, but I find it difficult to know as others again only realize they’ve had symptoms after going on a gluten free diet and discovered that what they’ve felt like previously was not symptom-free).

 

[Evergreen]

When trying to put on weight a few years ago, I was encouraged to have lots of snacks. A bit tricky as I am intolerant of lots of FODMAPs and some other foods, so the usual dairy snacks and supplements are out.

I discovered that with certain snacks, I would get incredible waves of fatigue. There was a smoothie I tried between breakfast and lunch with cocoa powder, almond milk, oats and dates that felt like anaesthesia. We halved it and I was no longer as sedated, but still really fatigued. Had to abandon it even though it was yummy. The same thing happened to a lesser extent with other snacks e.g. dates with almond butter.

I think maybe FODMAPs were stacking with those in the previous meal and reaching a threshold that you just wouldn't reach when eating normal amounts of food. Or something else about eating large amounts of the foods I could eat had this effect. I think I did read something about oats or was it cocoa having this effect, sorry, not going to check it now.

It was a real surprise to me as I hadn't connected FODMAPs with fatigue before. But when I had to eat unusual amounts of them, the problem was fatigue, not GI symptoms. The dietician who was helping me put on weight didn't seem to believe me about the fatigue.

The answer was peanut butter with breakfast.

 

[Evergreen]

The answer was peanut butter with breakfast.

Sorry, that was a bit facetious, probably not helpful for anyone who reads it and is trying to put on weight too. So just in case someone else findds themselves in the same position, what I used instead of dairy supplements was a lot of:

• peanut butter
• walnut butter
• tahini
• olive oil slathered over everything
• salmon
• avocado
• big portions of tofu or other protein with every meal
• basically maximising protein and fat instake
• loads of desserts

And actually I was better with big calorie-dense meals than snacks, perhaps because snacks require more sitting up and more interruption/cognitive exertion. Tried so hard with smoothies and could not make them work wth the inregdients I could tolerate. Protein powder did not agree with me.

 

[rvallee]

Nevermind the "gut-brain interaction" nonsense, millions of people have been saying this for decades, and it's always been part of what patients report, but psychosomatic ideology doesn't care about any of that. It's entirely medicine's fault that they invented concepts based not on what the patients are experiencing, but based on what they do in their day job, or maxing out at three symptoms and talking over us.

Patients may describe it as exhaustion, lack of energy, brain fog

Brain fog is not fatigue, it's a different thing. They can, but don't always happen at the same time. It takes very poor listening skills to miss this.

And, no, the answer is not the ridiculous "multidisciplinary" teams featuring not a single physician, or anything of this sort. The problems are entirely with how health care works, how it's completely unfit for purpose on issues like this, and that it doesn't have to be this way.

And of course it's exactly what they propose:

Management will often require integrated care, including education, sleep optimisation, graded activity planning, psychological therapies and disease-specific treatment where appropriate

It's never work, it has no chance of ever working, and it's damn lazy and incompetent, but there's zero accountability and no one in those systems seem to care enough so whatever.