Tired Woman

Tired? Exhausted? It Could Be Gluten.

If you’re tired of feeling tired, consider gluten as a potential culprit.There are many studies that cite fatigue as a common and prevailing symptom associated with both celiac disease and gluten sensitivity. A recent study published in Nature Reviews Gastroenterology and Hepatology (May 2012, “Opinion: New understanding of gluten sensitivity”) specifically noted that in gluten sensitivity, symptoms outside the GI tract are extremely common and a clinician should expect to find “two or more extraintestinal (occurring outside the intestines) symptoms, the most common being fatigue (36%).”

Fatigue is one of the most common complaints that doctors hear from patients. After conducting a physical and basic blood test looking for obvious causes such as anemia, thyroid malfunction, insomnia, or other diseases, too often patients are told they’re “fine” and not to worry since their test results are normal. If the patient persists and asks what they can do for their fatigue, they’re advised to get more rest, relax, and try to reduce their stress load. Such generic advice may be helpful for some, but most people don’t find complete relief and therefore continue to suffer with their fatigue or exhaustion.

Having treated patients for 25 years, I’ve seen my share of tired patients. Let me walk you through my thought process for getting to the bottom of it.

As mentioned, a complete physical exam and comprehensive blood test to rule out any obvious causes of fatigue is a mandatory first step. But too often, a basic blood test shows nothing, despite the patient’s symptoms of fatigue or downright exhaustion.

This is the reason I practice root cause medicine. With the understanding that the body always gives symptoms for a reason, my team and I work relentlessly to discover the underlying reason behind why a symptom is being created. Persevering along that path opens the road to a handling. If you know there’s always a reason why, you don’t give up when one tool (in this case a basic blood test) doesn’t provide the answer.

Before we illustrate what those tools are, it’s important to understand some fundamentals of body physiology. Energy is produced from the foods we eat. Healthy food going in the mouth is just one facet of turning food into energy for your 10 trillion cells. The food must be ingested, yes, but it also must be digested (broken down) and successfully absorbed by your cells so they can be nourished and energetic.

Therefore, you won’t find it surprising that the very first place we look when trying to identify the source of a fatigue problem is the diet.

Food needs to be:

Nourishing. Look at the Standard American Diet (SAD) laden with preservatives, chemicals, and hormones and you’ll quickly see the problems that can arise here. Food sensitivities also lurk in this arena. If you’re sensitive to a food such as gluten or dairy, when you eat that food it will act like a toxin to the body rather than nourishment.

Digesting. Foods that the body reacts to due to a sensitivity are often unable to be broken down properly. Gluten is a large protein that no human can properly digest, making for frequent discussion of whether it should truly be considered a food for humans. Similarly, dairy products are poorly digested by most humans after childhood.

Absorbing. Because gluten is unable to be fully broken down by the human digestive tract, partial absorption is the best that can be accomplished for anyone, regardless of whether they are gluten sensitive or suffer from celiac disease. When either condition does exist, gluten’s partial digestion is not a benign event. Rather, it wreaks havoc on the digestive system, immune system, and any other system with which it becomes negatively involved. Gluten is known to cause over 300 symptoms and conditions. It has been seen to attack almost every system and organ in the human body.

After analyzing the diet, the next place we look to is hormonal imbalance. Proper adrenaline and sex hormone levels create good energy when normal and healthy. When compromised, fatigue and exhaustion along with moodiness or depression can result.

It’s interesting that the production of adrenaline by the adrenal glands (stress glands) has as much to do with good diet as it does stress load. So, too, are sex hormone levels associated with good nutrition and diet. You just can’t get away from the cold, hard fact that you are what you eat, digest, and absorb. And while this fact affects many aspects of your health, it squarely and profoundly affects your energy level.

What about stress? Doesn’t that cause fatigue? It certainly can, but it’s interesting to note that even when a patient comes into the clinic with fatigue related to stress, we find that through optimizing nutrition, they can heal and regain energy despite a high stress load.

Normalizing nutrition and diet strengthens the adrenal glands such that energy is restored despite the stress load. This is exciting because it means that a healthy body can sustain life’s stresses and still function with sufficient energy to do well in life. If every stressor resulted in exhaustion, the amazing machine called the human body wouldn’t be that strong. Fortunately, that’s not the case. The body is strong and it’s designed to feel great and be energetic despite stress.

But, much like any machine, it needs fuel. It may sound silly, but if you forgot to put gas in your car would you be surprised if it didn’t move? No. We understand that our cars need fuel to be “energetic.” Yet time and time again, patients exclaim that they can’t believe how much better they feel when “all we’ve done” is change their diet! They are so surprised that a change of diet caused a change of energy and a reduction of other symptoms that have been bothering them.

Once the correct diet – free of foods such as gluten and dairy – has been addressed, the next step is to identify any aspect of the digestive tract that is unable to turn that good food into fuel. While removing common foods that cause fatigue (like gluten) is a most important first step, one cannot neglect the digestion and absorption of nutrients.

Does that also relate to gluten? It certainly can.
Gluten is not only associated with diminished absorption of such energy producing nutrients as vitamin B12, folic acid, and iron, but it also creates irritation to the lining of the gut that can compromise absorption of most other good food that’s consumed. In an interesting catch-22, the enzymes that are needed to break down food are generated from the food we eat. So if we aren’t either eating good food or digesting it, we actually see a decreased ability to digest and absorb due to compromised levels of digestive enzymes. It’s a circular pattern that can be hard to break when it’s not identified.

Toxins, infections, and other stressors also create fatigue. We look for these in functional lab tests that can reveal the presence of parasites, amoeba, bacteria, heavy metals, or Lyme disease. In such instances, the immune system has become compromised to the degree that it isn’t able to successfully defend itself against the invading organism or toxin. As you can imagine, having a hostile organism or substance in the body is something that can cause fatigue or exhaustion.

To come full circle, it is important to realize where the immune system is primarily in the human body. Seventy to eighty percent is found in the GI tract of humans. It would only make sense then that a healthy immune system would require a healthy gut, wouldn’t it?

And how do we maintain a healthy gut? You guessed it: good, healthy, nourishing food.

Now you see why we always begin with the digestive tract when assessing the root cause for fatigue. In truth, if poor diet or food sensitivities are overlooked, it’s likely that a major factor causing fatigue has also been missed.

To your good health,

Dr Vikki Petersen, DC, CCN

1. Alimentary Pharmacology & Therapeutics, Volume 22, Issue 5, pages 489–494, September 2005 Fatigue in adult celiac Disease M. Siniscalchi, et al
2. The American Journal of Gastroenterology (2001) 96, 1464–1469; Gluten challenge in borderline gluten-sensitive enteropathy Peter J Wahab1, J Bart A Crusius3, Jos W R Meijer2 and Chris J J Mulder1
3. American Family Physician [2002, 66(12):2259-2266] Gluten-sensitive enteropathy (celiac disease): more common than you think. Nelsen DA Jr
4.Science 27 September 2002: Vol. 297 no. 5590 pp. 2275-2279 Structural Basis for Gluten Intolerance in Celiac Sprue Lu Shan, et al
5.Scandinavian Journal of Gastroenterology, 2002, Vol. 37, No. 236 , Pages 60-65 Coeliac Disease: Changing Views on Gluten-Sensitive Enteropathy P. J. Wahab, et al
6.Nature Reviews Gastroenterology and Hepatology 9, 295-299 (May 2012) | doi:10.1038/nrgastro.2012.15 Opinion: New understanding of gluten sensitivity Umberto Volta & Roberto De Giorgio
7. Gastrointestinal Endoscopy Clinics of North America, Volume 22, Issue 4, October 2012, Pages 723–734 Non-celiac Gluten Sensitivity Knut E.A. Lundin, MD, PhD
8.Annals of the Rheumatic Diseases 2004;63:1501-1503 Gluten sensitivity masquerading as systemic lupus erythematosus M Hadjivassiliou, et al

Gluten Free & More magazine, by Edgewater Park Media Inc. (EPM) is publishing this article for purposes of medical topic, however no warranty is made that the article is accurate and there is no assurance that any statement contained or cited in the article touching on medical matters is correct, or up to date. EPM also states that nobody in EPM takes responsibility for the results of any attempt to use any information in the article. Always seek the advice of a medical professional before starting any new protocol.

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