Community Question: Celiac, Food Allergies and Fatigue – Part One

food sensitivities, celiac

For any of us who experience digestive health concerns,  we are all so familiar with the daily ups and downs with energy and the constant questioning of additional foods that are making us feel unwell.

If you are celiac, removing gluten in it’s entirety is needed.  But, what happens if we still feel unwell? Unfortunately, the research is slim when it comes to individuals with celiac disease and increased risk of additional food allergies (note, this is not the same as a sensitivity). However, there  are multiple factors that can effect how we feel, which have nothing to do with additional food allergies or sensitivities and, is very commonly, overlooked.

Below are the strategies I use with my clients before we may start looking to additional food culprits.

  1. Date of celiac diagnosis:

Typically, a newly diagnosed celiac will start feeling better within the first month on the gluten free diet.  However,  the villi, fingerlike projections that line your small intestine that absorb vitamins and minerals, can take up to 3-18 months to heal on the gluten free diet.  So, if you are still feeling unwell one year into your diagnosis, it may be that your villi haven’t had the full time to heal.

     2.  Ensuring gluten is 100 percent out of the diet, consistently:

This is by far the most common reason why a celiac does not feel better.  Gluten is a sneaky, sneaky protein and can hide out in spots completely unbeknownst to you.  This is why it is extremely to important to meet with a dietitian with expertise in the gluten free diet upon diagnosis.

Common items that I see in my practice that may result in gluten cross contamination include purchasing GF grains and their products, lentils and seeds without a ‘gluten free’ claim, eating out without asking the correct questions on preparation methods, and purchasing from bulk food bins.

    3.  Vitamin, mineral and additional health condition status:

It is quite common for celiacs to be deficient in certain vitamins and minerals because of the damage done in the small intestine where absorption occurs.

Those relating to fatigue would include iron status, Vitamin B12 status, and folate status. Additional health conditions that could contribute to fatigue include thyroid function and blood sugar status.

    4.  The gluten free diet:

Another common culprit of fatigue and low energy levels is the quality of your gluten free diet. Unfortunately, many individuals with celiac disease consume a diet that is too high in gluten free processed foods, such as breads, cereals, bars, and baked goods.  This results in a diet that lacks a variety of vitamins and minerals and a diet that is low in fiber which, ultimately results, in not feeling great.

Basic guidelines for a healthy gluten free diet that will result in increased energy levels includes the following:

  • Frequent eating for energy:  energy starts to dwindle after going without food at around the ~3 hour mark.  So, ensure to eat something every 3-4 hours to keep those energy levels stable.
  • Protein at each meal and snack: Protein choices help make you feel ‘full’ and keep appetite and energy levels stable.
    • Extremely beneficial protein sources for celiacs include beans/legumes, lentils, tofu, nuts/seeds, yogurt, cheese, eggs, fish, chicken and moderate amounts of red meat.
  • Limit gluten free processed foods to no more than once/day.
  • Eat a rainbow of colors each day.  The color groups include green, orange, red, yellow, blue/purple/black, white/tan/brown.
    • Most choices should come from produce items –  vegetables and fruit – with a few choices coming from whole, intact gluten free grains such as quinoa, black rice, teff, millet, sorghum etc.
    • Aim to get a minimum of 1/2 cup per color group (from fruits and veggies)
    • More ideally, aim to get two, 1/2 cup servings per color group (most from fruits and veggies, and a few coming from whole grains too)
  • Translation to your plate?  
    • Make at least half your plate non-starchy vegetables
    • Make 1/4 plate either fruit, starchy veggies (think root veggies) or GF whole grains
    • Make the last 1/4 plate from a protein

          5.  Emotional well-being:

Very much overlooked in the treatment of celiac disease, is the psychological impact this diagnosis can take on your emotional health.  Due to the restrictive nature of the diet, it can be hard to navigate safe food choices in your social life.   Subsequently, it is common for individuals with celiac disease to suffer from depression and anxiety.  It doesn’t matter if your diet is 100 percent gluten free,  anxious behaviour and mood imbalances have powerful effects on the body and can manifest as physical symptoms.  Looking after your mental well-being is imperative in managing celiac disease.

If the above strategies do not work, we then start doing some investigative work looking at potential food sensitivities.  Stay tuned for part two!

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Real Life Advice from a Dietitian Living with Celiac Disease