Celiac disease is known to cause fatigue. But what about if you’re not celiac but still feel tired every time you eat bread?
Celiac disease is recognized as a legitimate medical condition affecting more than 3% of the population. One of the main symptoms of which is fatigue. But what’s going on for those of you who are not celiac but still seem to react to bread or gluten? Is there a hidden allergy that your doctor doesn’t know about?
In the conventional medical setting, after a celiac screen, your doctor will stop exploring gluten’s effect on your health. Many of you may have been told that you’re not celiac so eating bread is not a problem. Why then do you continue to feel terrible after eating it
I’d like to introduce you to a condition called non-celiac gluten sensitivity (NCGS). Non-celiac gluten sensitivity (NCGS) remains controversial in the medical field. But it could very well be a hidden cause of your fatigue.
What is non-celiac gluten sensitivity, really?
Let’s start by creating a clear distinction between celiac disease and non-celiac gluten sensitivity:
Celiac disease is a serious autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. It is estimated to affect 1 in 100 people worldwide. Two and one-half million Americans are undiagnosed and are at risk for long-term health complications. (1)
Non-celiac gluten sensitivity
Gluten sensitivity is a condition with symptoms similar to those of celiac disease that improve when gluten is eliminated from the diet. (2) As the name implies, those with non-celiac gluten sensitivity do not have celiac disease. But their immune system reacts to gluten and wheat products in a similar manner.
People with gluten sensitivity can experience symptoms such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, but other symptoms are also possible. While these are common symptoms of celiac disease, these individuals do not test positive for celiac disease or for a wheat allergy. (3)
Is non-celiac gluten sensitivity a legitiment diagnosis?
Medical doctors may give you a skeptical look when you mention that you suspect a gluten sensitivity after your celiac test comes back negative. However, the below research will show you that non-celiac gluten sensitivity is indeed a real condition.
In fact, a 2015 study published in the Journal of Gastroenterology and Hepatology performed a randomized, double-blind, placebo-controlled, cross-over trial. (4) In the scientific community, this is the gold standard for testing.
In this study, 61 adults without celiac disease (CD) or a wheat allergy were enrolled. These participants believed that the ingestion of gluten-containing food(s) to be the cause of their intestinal and extra-intestinal symptoms. The study’s participants were given a pill with either gluten or rice starch (the placebo) for one week. (5)
The primary outcome was the change in overall (intestinal and extra-intestinal) symptoms, determined by established scoring systems, between gluten and placebo intake. A secondary outcome was the change in individual symptom scores between gluten vs placebo. (6)
The 15 intestinal symptoms that patients were asked to grade daily from 0 to 3 (0 = absent; 1 = mild; 2 = relevant; and 3 = severe and interfering with daily activities) were:
- Abdominal pain
- Abdominal bloating
- Borborygmus (a rumbling or gurgling noise made by the movement of fluid and gas in the intestines)
- Reduced consistency of stools (tending towards diarrhea)
- Increased consistency of stools (tending towards constipation)
- Incomplete evacuation
- Acid regurgitation (heartburn)
- Epigastric pain (stomach-ache)
The 13 extra-intestinal symptoms that patients were asked to grade daily from 0 = absent to 1 = present were:
- Foggy mind (brain fog)
- Aphthous stomatitis (mouth ulcers)
- Paresthesia (an abnormal sensation, typically tingling or prickling – pins and needles)
- Arthralgia (pain in a joint)
- Myalgia (pain in a muscle)
- Rhinitis (irritation and inflammation of the mucous membrane inside the nose)
- Skin rash
At the end of the trial, there was data from 59 patients who completed all aspects. In these patients, intake of gluten significantly increased overall symptoms compared with the placebo. (7)
The most consistent symptoms of gluten intake included:
- Abdominal bloating
- Intestinal symptoms
- Foggy mind
- Aphthous stomatitis (mouth ulcers)
To conclude, this trial showed that those who do not have celiac disease can have symptoms very similar to those with diagnosed celiac disease. Non-celiac gluten sensitivity (NCGS) is indeed a recognizable medical condition.
In addition, this study brought to light many symptoms that are intuitively not thought to be related to gluten sensitivity. Therefore, should you be suffering from any of the above listed symptoms, embracing a gluten-free diet for a period of thirty days (minimum) is likely an effective means of treatment.
The gluten-fatigue connection
In the study I referenced above, researchers found that those with non-celiac gluten sensitivity had a leaky gut. If you’re at all familiar with gluten’s effects on the gut, this should come as no surprise. Whether you’re celiac, non-celiac gluten sensitive, or have no reaction to gluten, every time you eat it you will be causing intestinal permeability or leaky gut. (8)
Perhaps more importantly, the group with non-celiac gluten sensitivity showed a generalized activation of their immune system. Blood measurements of lipopolysaccharide-binding protein (LBP) were elevated in those with NCGS. (9) LBP are indicators that microbes from your gut have made their way into your bloodstream. This causes a chronic low-grade inflammation and an altered gut microbiome.
Those with chronic fatigue syndrome or myalgic encephalomyelitis have been shown to have an altered microbiome. (10) In fact, new research suggests chronic fatigue syndrome may even be able to be diagnosed based on a stool sample. (11)
Those with chronic fatigue show elevated levels of lipopolysaccharide-binding protein (LBP). Yes, the very same substance that was elevated in those with non-celiac gluten sensitivity. In addition to elevated inflammatory markers, those with chronic fatigue also had fewer beneficial bacteria species taking up residence in their guts as well as an increase in bacteria species known to increase inflammation (Firmicutes).
Research on the gut-fatigue connection is just beginning. Initial results look promising. If you are struggling with chronic fatigue syndrome, optimizing your gut health should be a major priority of yours.
The first step I recommend for all patients to improve their gut health is to identify whether (or not) gluten is contributing to their symptoms. This is the gluten-fatigue connection.
Do you have non-celiac gluten sensitivity?
Remember, if you test negative for celiac disease, you could still have NCGS. At the time of this writing, there are two methods I recommend those with chronic fatigue follow to identify how their body reacts to the gluten protein:
- The Fatigue Reset Diet
- I designed a 30-day nutrition plan to increase energy levels and to identify hidden food intolerances.
- Removing gluten for a period of 30-days and then slowly reintroducing it can be a stellar indicator of your reaction to wheat products. If after bringing gluten back into your diet you notice negative changes to your energy levels, brain fog, or ability to concentrate, it’s likely that you have non-celiac gluten sensitivity
- Laboratory testing
- I recommend using cyrex laboratories for gluten testing.
- No other lab offers comprehensive testing for gluten and wheat-related allergies. If you’ve read my previous article, you’ll know wheat consists of many more proteins than just gluten. Accurate testing will evaluate your response to as many of these proteins as possible.
If you have access to a functional medicine practitioner, consider working with him/her. She can help clarify how gluten contributes to your fatigue.
Now, I want to hear from you!
How does gluten affect your energy levels?
Also published on Medium.