It's all too common for many of us with celiac disease or gluten sensitivity: we get that "uh-oh" feeling that we've been glutened, and then we get slammed with what feels like a brick wall of fatigue.
Fatigue is one of the most frequent symptoms mentioned by those with celiac or gluten sensitivity, and it's one of those that seems to stick around (or recur all too often) long after you adopt the gluten-free diet.
And gluten-related fatigue can be debilitating in some cases, even more debilitating than the diarrhea and other gastrointestinal symptoms more commonly associated with celiac disease and gluten sensitivity. Therefore, figuring out how to cope with it is a high priority, especially if you experience symptoms frequently.
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Malnutrition, Anemia May Cause Fatigue in Celiac Disease
It's not entirely clear what causes fatigue in celiac disease and gluten sensitivity, but it's one of the top symptoms mentioned, both prior to initial diagnosis and when people are accidentally exposed to gluten following that diagnosis. One study found that 82% of newly-diagnosed celiacs complained of fatigue.
Some researchers speculate that fatigue may be caused by malnutrition, at least in those with celiac disease. Fatigue also can be caused by anemia, which frequently appears in people with celiac disease who haven't yet been diagnosed or who aren't following the gluten-free diet.
Since people with gluten sensitivity don't have the same intestinal damage as those with celiac, malnutrition and anemia don't explain why non-celiac gluten-sensitives experience fatigue, too ... but they definitely do experience it.
In addition to fatigue, brain fog and sleep problems are common effects of accidental gluten ingestion. Both obviously have an impact on fatigue, as well brain fog makes it even more difficult to function, and insomnia makes you even more tired.
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So How Can You Cope with Gluten-Induced Fatigue?
It's depressing to say that there's no magic bullet to relieve fatigue once you've been glutened. Therefore, most of what I can recommend involves common-sense measures you can take to ease your tiredness while your body is recovering:
- Slow down. Clear your schedule to the extent that you can (easier said than done, I know!), and try to do as little as possible. If I can manage the time, I find just relaxing with a book (one that doesn't take much concentration) or browsing online without a research goal in mind can make me feel a bit better.
- Take a nap. I suffer from gluten-induced insomnia, but I find that it is possible for me to nap during the day when I've been glutened. It does help with both the fatigue and with the brain fog.
- Stay organized. Fatigue plus brain fog can make you careless and a bit stupid. When I'm suffering from gluten-related tiredness, I make lists of things I need to do and then follow those lists. A little structure seems to help my thinking, and getting some things accomplished helps me feel more energized.
- Get some exercise. It seems counterintuitive exercising when you're already tired? but a short walk or some yoga can increase your energy level, not decrease it. Don't overdo it (now is not the time to start marathon training), but even a few minutes of mild physical exertion can help with your fatigue, and may help you sleep better.
- Get to bed early. If you also suffer from gluten-induced insomnia, you may feel as if you want to avoid bed, since hitting your pillow may wind up being an exercise in futility. But I've found that going to bed early, closing my eyes and resting (even if I don't actually sleep) does help improve my fatigue level the next day when I've been glutened.
Possible Help in Supplement Form?
There's some evidence that supplements of L-carnitine, an amino acid, can help with fatigue in people with celiac disease. L-carnitine helps your cells produce energy by breaking down fat, and may help your brain more efficiently utilize the neurotransmitters serotonin and glutamate. Studies have shown that L-carnitine reduces fatigue in people with chronic fatigue syndrome and fibromyalgia (see more on this from About.com's Guide to Fibromyalgia & Chronic Fatigue here).
In a small study performed in Italy, 30 celiacs took 2 grams of L-carnitine daily for six months while another 30 took a placebo, and researchers then compared the fatigue levels in the two groups. They found fatigue, as measured by a validated scientific scale, was significantly reduced in the L-carnitine group when compared with the placebo group.
Keep in mind that this study hasn't been duplicated you definitely should talk about the benefits and risks with your doctor before trying L-carnitine for gluten-related fatigue. Side effects can include a rapid heart rate, high blood pressure, nausea, headache and even difficulty sleeping (not what you want when you're suffering from fatigue). People with thyroid disease or liver disease may need to steer clear of L-carnitine supplements altogether.
There's no doubt that fatigue is a major problem for those with celiac and gluten sensitivity ... and it's a problem that has no easy solution. As I said, there's no magic bullet or pill to make you instantly not tired. However, trying a few of these strategies the next time you get glutened may help you feel a little more energetic.
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Ciacci C. et al. L-Carnitine in the treatment of fatigue in adult celiac disease patients: a pilot study. Digestive and Liver Disease. 2007 Oct;39(10):922-8. Epub 2007 Aug 10.
Jordá FC et al. Fatigue as a determinant of health in patients with celiac disease. Journal of Clinical Gastroenterology. 2010 Jul;44(6):423-7.
Zipser RD et al. Presentations of adult celiac disease in a nationwide patient support group. Digestive Diseases and Sciences. 2003 Apr;48(4):761-4.