Celiac.com 03/02/2009 - Many people suffer symptoms of fatigue prior to being diagnosed with celiac disease or gluten intolerance.  For some, fatigue is a major reason for initially seeking medical attention.  In both Celiac disease and gluten intolerance, malabsorption of nutrients can result in weakness, lack of energy, and even iron-deficiency anemia.  Iron-deficiency anemia can be compounded by gynecological conditions, especially in peri-menopause.

A thorough physician will test for and sometimes treat underlying vitamin and mineral deficiencies common in malabsorption disorders such as celiac disease and gluten intolerance, and after three-to-six months, many symptoms related to such deficiencies will resolve.  Some alternative practitioners even offer injectables such as B-Vitamins and Magnesium.  Oral supplements range from plant-based liquid concentrates, to sublingual drops, to tablets and capsules, allowing a range of options for sensitive individuals.

Recently I spoke to a gluten intolerance group where a woman raised an important question.  She described her symptoms, which included profound fatigue and asked, “What can you do if extreme fatigue persists on a strict gluten free diet and supplements, even after a year or two?”  At the time, I wasn’t sure how to answer her, other than to suggest, off the top of my head, that she ask her Naturopath to do a saliva-based adrenal function panel.  I guess my reasons for doing so were based on fifteen years of nursing experience and the fact that she was probably about my age, and possibly in peri-menopause, which I knew places an additional strain on the adrenals.

In women the sex hormones are produced in varying amounts in both the ovaries and adrenal glands.  A smooth transition through menopause would involve a gradual transition that decreased production of sex hormones by the ovaries, and increased production of sex hormones by the adrenal glands.  But, what happens if there are other factors in a woman’s life that prevent the adrenals from assuming this additional burden?  Coupled with the added strain that menopause places on the body and indirectly on the adrenals, a triggering event like a significant accidental gluten exposure, an increase in food allergies, or infection with a virus or bacterial illness, could simply tax the adrenals beyond their ability to meet this increased demand.

The Gluten Connection

Although relatively tiny, the adrenals have a very big job.  Adequate levels of the adrenal hormone cortisol are required by the body to help prevent inflammation and tissue destruction, keep blood sugars level, moderate nervous system responses, and attempt to maintain homeostasis, or the steady-state of balance in the body.    Periodically experiencing incredibly painful episodes of inflammation and tissue destruction from an accidental exposure to gluten, the protein found in wheat, barley, and rye, places a huge strain on the adrenals, including a sudden demand for high cortisol levels to help moderate the inflammatory response.  Each time, the body is able to cope, but with each experience it may take longer for the adrenals to recover.  When stress is prolonged, these high levels of cortisol must be maintained.  And if there is no significant recovery period during which the adrenals can rest and replenish themselves, adrenal fatigue results.

After doing some research for a new book I’m working on, I found another possible connection, especially for those with celiac disease.  Many of us are aware of the strong, well-documented association between celiac disease and autoimmune thyroid disorders like Hashimoto’s thyroiditis.  We also know there is a relationship between celiac disease and another endocrine gland, the pancreas.  (Diabetes has a strong correlation with celiac disease.)  Autoimmune hepatitis affects the liver – the body’s largest internal organ. Nephropathy, which affects the kidneys, is a very serious, less familiar disorder linked to celiac disease.  But, we rarely hear about the adrenals, especially in relation to celiac disease. Could there be a connection?  In fact, there are several important connections that are often over-looked.

In researching autoimmune disorders, I learned about a disorder called “Autoimmune Adrenal Hypofunction” or “Autoimmune Hypo-Adrenalism”, which sometimes occurs together with other autoimmune disorders.  As in other autoimmune disorders, the body produces antibodies targeted against its own tissues, in this case, the two walnut-sized adrenal glands that sit atop the kidneys.  While thought to be relatively uncommon, Autoimmune Hypo-Adrenalism is most closely associated with celiac disease.  In fact, I was quite surprised by the wealth of information on this association, based on many studies done in Italy and Ireland, both countries where celiac disease is common.  While the connection between other autoimmune disorders and celiac disease is generally accepted in the U.S., the case for adrenal insufficiency in relation to celiac disease has not appeared to have received as much attention.  So, it can’t hurt to mention this link here, since it has the potential to affect those with persistent fatigue and/or chronic inflammatory disorders such as interstitial cystitis, in which low cortisol levels may play an important role.


Stress, Food Allergies, and Nutrition

As anyone who has studied stress and the allergenic response knows, diet does matter.  One of the least recognized forms of stress is untreated or unidentified food allergies and sensitivities. 

In Dr. Wilson’s book, “Adrenal Fatigue – the 21st Century Stress Syndrome”, he writes, “It has long been observed that people suffering from adrenal fatigue have a definite increase in allergic responses or become allergic to things that did not previously bother them.” This is because levels of the adrenal hormone cortisol, the most powerful anti-inflammatory substance in the body drop, making it “more likely that the body will have severe allergic (inflammatory) reactions and that these reactions will be more severe.”

Another factor in adrenal function through is nutritional status.  As we know, many people with Celiac disease or gluten intolerance do have some underlying nutritional deficiencies, and these become more difficult to address as we age.  Certain vitamins and minerals are essential to replenishing and nourishing the adrenal glands.  Ideally, we’d obtain these essential nutritional components through our diet.  In cases of adrenal fatigue, it is important to discuss with your physician what you can do to help your adrenals recover, both by eating an ideal diet, and taking recommended supplements, including B-Vitamins, Vitamin C, Magnesium, and specific herbs and amino acids.
 
Symptoms of Adrenal Fatigue

Ten relatively common symptoms of adrenal fatigue are listed below:
  • Fatigue
  • Depression and memory difficulties
  • Sleep Disturbances
  • Migraine Headache
  • An increase in allergies or the development of new allergies
  • Alcohol Intolerance
  • Low Blood Pressure and Low Body Temperature
  • Blood Sugar Regulation Problems (Hypoglycemia)
  • Low Libido & Hormonal Imbalances
  • Inflammation

Adrenal Testing

Testing for adrenal insufficiency isn’t rocket-science, but an established and useful diagnostic tool that might have important implications for poor regulation of inflammation as well as for general health.

The first step is to check for a low cortisol level, in combination with other hormones, including DHEA, Progesterone, Estrogen, and Testosterone.  This is easily done with a safe, reliable, and cost-effective serial saliva test, with four samples taken at specified time periods throughout the day.  Your physician often stocks these kits in the office, and can provide one for you to use and then mail to the laboratory.  The laboratory will perform the tests, and send the results to your physician, who will discuss them with you.  The whole process takes a week or two, and can be repeated every few months to track your recovery.  It is not expensive, and may even be covered by your insurance.

In fact, you do not need a doctor to order the test, but the results will be of little value without a physician to interpret them, make a plan to address any abnormal findings, and support and monitor you in your treatment.

Blood tests, including and ACTH challenge, may be indicated, but a serial saliva test is a good first step.

Adrenal Recovery

Any program of adrenal recovery must incorporate lifestyle changes that include avoiding stress or dealing with stress in healthy ways, such as exercise, relaxation, and meditation.  Eating an anti-inflammatory diet, free of sugars and alcohol, is essential, as continuing to follow a strict gluten-free diet.


This article is partially excerpted from “The Better Bladder Book – a Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain through Diet, Lifestyle, & Self-Treatment”, available soon through my website.  The book provides documentation for all research and factual content, including the information in this article.

As always, Celiac.com welcomes your comments (see below).