Following a gluten-free diet but feeling tired

Melinda Dennis MS, RDN, LDN
Q: I have celiac disease and fastidiously avoid gluten. However, I am very tired. Are there any new treatments I should be looking out for? Or do you have any suggestions about how I could feel less tired?


Gluten exposure is one of the most common reasons for continued fatigue in celiac disease. Even if a person thinks he/she is following a strict gluten-free diet, it’s always helpful to review practices for dining out safely, and consider new sources of possible cross contact in the kitchen. Take a few minutes to recheck labels of food and supplements, recheck medications, and make sure all flour, grain and grain-based products (such as amaranth, quinoa pasta, etc.) are labeled gluten-free. Consider following to keep informed of gluten-free products that have been tested for gluten contamination via the best testing protocols. These are just a few examples of ways to make sure gluten is not sneaking into your diet.

There are many other reasons for fatigue, including thyroid conditions or other medical conditions, an unbalanced diet, nutritional deficiencies such as magnesium and vitamin D or iron, folate and B12 which can lead to anemia, poor sleep quality, depression, reactions to medications, food intolerances or food allergies, inadequate or excessive exercise, and stress, among many others. Fatigue can also be caused by other comorbid conditions, such as small intestinal bacterial overgrowth (SIBO), an overgrowth of bacteria in the small intestine that disrupts the digestive tract. SIBO can lead to nutritional deficiencies and many gastrointestinal symptoms, as well as fatigue.

Share your symptoms with your doctor who may check celiac antibodies, such as IgA-tTG, and run additional lab tests to check for anemia or other vitamin and mineral deficiencies. A dietitian can help review the gluten-free diet to see where positive changes can be made.

I have no financial interest in Gluten Free Watchdog.

Reviewed September 16, 2022

Note: This information is provided by NCA and Melinda Dennis, NCA's Senior Consulting Dietitian. This information is meant for educational purposes and is not intended to substitute for personalized medical advice or replace any medical advice provided directly to you by your health care provider. This information can be printed and used in consultation with your physician or dietitian. No liability is assumed by NCA, Ms. Dennis or her nutrition consulting service Delete the Wheat, LLC. by providing this information..

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About Melinda Dennis MS, RDN, LDN

Melinda Dennis, Senior Nutrition Consultant for NCA, is an expert celiac dietitian and and Nutrition Coordinator for the Celiac Center at Beth Israel Deaconess Medical Center in Boston, MA. Diagnosed with celiac disease in 1990, she specializes in the nutritional treatment of patients with celiac disease and gluten-related disorders.

Melinda lectures internationally and has written extensively on the nutritional management of celiac disease including the award-winning book Real Life with Celiac Disease. Melinda was the original founder of NCA in 1993 and so it is only fitting that she comes back to us in this capacity. We are truly honored to have her on our team.