In today’s relentlessly busy world, where many of us are juggling multiple demands and responsibilities, it’s natural to feel tired from time to time. But at some point, that tired feeling can progress from the occasional yawn into something more persistent: fatigue.
Fatigue is different than drowsiness. A deep-in-your-bones type of exhaustion, fatigue has been described as a feeling of being severely overtired to the point where your day-to-day life becomes more difficult. Fatigue is a common symptom of many ailments. Certain lifestyle habits can contribute to fatigue, as can certain medications and treatments. But there’s also an often-overlooked cause for this nagging overtired feeling: celiac disease.
The Celiac Disease Foundation estimates that 3 million Americans have celiac disease. Yet 70% to 80% of cases are undiagnosed, and just 50% of Americans report knowing anything about the disease. Read on for a quick primer on this disease, including its symptoms, its link to fatigue, and how to manage the condition.
What is celiac disease?
Celiac disease is an autoimmune disorder. For those with celiac disease, eating gluten-containing foods — items with wheat, barley, or rye — can trigger an immune response. The immune system perceives gluten as a threat, and it ends up waging war with the villi, the hairlike protrusions in the small intestine that absorb vitamins, minerals, and other nutrients from food. This ultimately damages or erodes the villi, which can lead to difficulty digesting or absorbing nutrients from food and can cause a host of other symptoms.
In some cases, people with the disease may not experience symptoms at all. However, those who do have symptoms can experience a wide range of debilitating effects. There are more than 250 symptoms related to celiac disease, according to the nonprofit Beyond Celiac. These can include gastrointestinal symptoms — diarrhea, constipation, bloating, and gas — and extraintestinal symptoms that have nothing to do with digestion. Common extraintestinal symptoms include brain fog, fatigue, and headache.
Celiac disease and fatigue
“The cause of fatigue in many medical situations is inflammation,” says Dr. Gerald Bertiger, a gastroenterologist and board member at Beyond Celiac, a research and advocacy group. This is often the case with celiac disease.
Like many autoimmune disorders, celiac disease can cause widespread inflammation. This inflammation can lead to “sickness behaviors.” Sickness behaviors are adaptive responses that help our bodies conserve energy while battling illness or infection. Fatigue, depression, and a loss of appetite are all common sickness behaviors.
“Unfortunately, [in most people] the immune system doesn’t have the ability to differentiate an autoimmune disorder with the infectious process it might get exposed to,” says Dr. Michael Burkholz, a gastroenterologist at Associates in Gastroenterology of Colorado Springs who has celiac disease. “With autoimmune disorders like celiac disease, that same kind of immune response happens and people [may] experience fatigue, decreased energy, and even some degree of depression.”
Fatigue isn’t just “feeling tired” for a short time, like during an afternoon energy dip — fatigue is often relentless and persistent. This feeling of perpetual exhaustion is common in autoimmune disorders, including celiac disease.
“The evidence shows that about 50% of patients with celiac will complain about fatigue,” Burkholz says. “The fatigue can be quite severe.”
If you’re experiencing a range of symptoms, such as gastrointestinal issues, headaches, and fatigue, consider getting a celiac panel as part of your annual physical. To ensure accurate results, continue eating gluten-containing foods around six to eight weeks before your panel and until all testing is done.
How to manage celiac disease
Although there’s no cure for celiac disease, there is a treatment: opting for a gluten-free diet. While that may seem simple enough in theory, gluten is found in many foods, including unexpected ones like blue cheese, soy sauce, and beer. Its appearance in so many foods makes gluten difficult to eliminate entirely, and the challenge is further compounded by cross-contamination, which can occur when gluten-free food is prepared on a surface gluten has touched, such as a counter, shared pan, or even fryer oil. This is why it’s important to investigate where and how all your food is prepared and packaged.
While some celiac patients may feel major improvements in their symptoms after going gluten-free, according to Bertiger this dietary change doesn’t eliminate all symptoms for everyone. In some cases, Bertiger says, “There is something else that we don’t understand that is going on, which causes the patient not to respond completely to a gluten-free diet.”
What if you’re fatigued but don’t have celiac disease?
Celiac disease is not the only disorder that causes fatigue. Fatigue can also stem from other autoimmune issues or conditions. Diabetes, sleep apnea, depression, and COVID-19 are just a few of the many other conditions linked to fatigue.
Even if you’re not diagnosed with celiac disease, eating gluten could be causing prolonged over-tiredness. Some people have non-celiac gluten sensitivity (NCGS), which can cause many of the same symptoms as celiac disease. It used to be thought that people with NCGS had no intestinal damage. However, a 2016 Columbia University study has raised evidence to the contrary.
What if you don’t have celiac or NCGS but are feeling fatigued? Don’t give up the pasta and pizza just yet, Bertiger says.
Bertiger notes that in the eyes of many Americans, gluten has become a sort of poison. However, it’s not an equal enemy for everyone. “If you don’t have celiac disease, then gluten has no ill effects,” he says.
If you feel tired after eating carbs, it may mean that you’ve eaten too much or your body is working overtime to digest it. There also may be a spike in your blood sugar. It’s important to note that this situation is more temporary, whereas fatigue is longer lasting.
If your tired feeling just won’t go away and you think your diet might be why, try keeping a food journal where you record how different foods impact your energy levels. If you suspect that celiac disease could be causing your fatigue, ask your doctor to test you for this often-overlooked or undiagnosed disorder.