Managing Celiac Disease in the Athletic Population
Introduction
A gluten-free diet is the most common and effective treatment prescribed to individuals with celiac disease.1 The diet substitutes potatoes, rice, and corn-based carbohydrates for wheat, barley, and rye (Table).2 The unique concern for athletes is the increased caloric level needed to meet the energy expenditure.
| GLUTEN FREE | DO CONTAIN GLUTEN | MAY CONTAIN GLUTEN | OFTEN CONTAIN GLUTEN |
|---|---|---|---|
| Buckwheat Rice Corn Potato Tapioca Bean Sorghum Soy Arrowroot Amaranth Quinoa Millet Teff flour Nut flours | Wheat (durum, semolina) Rye Barley Spelt Triticale Kamut Farina | Brown rice syrup (frequently made with barley) Caramel color Dextrin (usually corn, but may be derived from wheat) Flour or cereal products Hydrolyzed vegetable protein (HVP), vegetable protein, hydrolyzed plant protein (HPP), or textured vegetable protein (TVP) Malt or malt flavoring (usually made from barley. Okay if made from corn) Modified food starch or modified starch Monoglycerides & diglycerides (in dry products only) Natural and artificial flavors Soy sauce or soy sauce solids (many soy sauces contain wheat) | Breading Broth Coating mixes Communion wafers Croutons Imitation bacon Imitation seafood Marinades Pastas Processed meats Roux Sauces Self-basting poultry Soup base Stuffing Thickeners |
Athletes with celiac disease must maintain a gluten-free diet, no matter the level of competition at which they perform. Therefore, practitioners should encourage athletes to use strategies to counteract deterrents to maintaining a gluten-free diet. The most comprehensive strategies are outlined by the American Dieticians Association in the acronym CELIAC—
Dietician Consultation
After diagnosis, individuals with celiac disease should immediately schedule an appointment with a registered dietician. Consultation with a dietician should provide an overview of gluten-free and gluten-rich foods to appropriately shape a new diet plan. A clear understanding of the sources of gluten is essential to maintaining a gluten-free diet. In addition, the dietician can provide information about maintaining the gluten-free diet during dining out experiences.
Education and Adherence to a Gluten-Free Diet
Active patients who engage in learning about their disease are often more likely to continue a gluten-free diet.4,5 Common methods of acquiring information include searching Internet sources and participating in blogs and forums focused on celiac disease ( http://www.celiac.org/, http://www.celiac.nih.gov/, http://www.mayoclinic.org/celiacdisease). Adherence to a gluten-free diet is drastically improved when patients are members of an advocacy group.5 Support groups can be in-person or online and can be beneficial to incorporating the patient in a larger community of individuals experiencing the same challenges.5
Consumption of gluten can cause relapse to symptomatic status.5 Eliminating gluten from the diet can be beneficial within 3 to 6 days, but full histological restoration of the small intestine will not occur for approximately 6 months.2 Labeling practices on foods to indicate gluten free or gluten sensitivity can aid individuals with celiac disease in selecting more appropriate foods.3 Maintenance of celiac disease is like any other life-long chronic disease (eg, diabetes mellitus) and athletes need to adapt to maintain good health.3
Identification and Treatment of Nutritional Deficiencies
Because nutritional deficiencies can be associated with celiac disease, practitioners should continually evaluate their patients to identify concomitant conditions. Recent literature has linked celiac disease with osteoporosis and osteomalacia.1,4 Diagnosis of celiac disease in adult life, active celiac disease, lapses from the gluten-free diet, lactose intolerance, and malnutrition associated with low body mass index are additional risk factors for the development of bone density disorders among these patients.1,4 Vitamin supplementation (Vitamin D in particular)1,4 may be the only way to access the necessary nutrients that cannot be naturally absorbed through the diet.
Support Network
A multidisciplinary team should be involved in the long-term follow-up of athletes with celiac disease.5 Managing celiac disease requires a lifestyle change. Support from practitioners, including physicians, dieticians, athletic trainers, and other mid-level providers, is essential.4,5 Social support should also be stressed to the athlete, as well as seeking professionals who can help with psychological issues that may accompany diagnosis and the necessary lifestyle changes. The health care team should communicate regularly to help the athlete monitor the disease.
In addition to dietary requirements, consistent reinforcement, education, and intervention from health care providers ensure that the athletes remain healthy and competitive. The most important message for athletes is that celiac disease does not have to affect athletic participation. The proliferation of gluten-free products in local markets has made maintenance easier. By using the right resources, celiac disease can become part of the athlete’s daily training regime.
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10.1111/j.1365-2036.2008.03820.x > CrossrefGoogle Scholar - 2.Inman-Felton AE. Overview of gluten-sensitive enteropathy (celiac sprue). J Am Diet Assoc. 1999; 99:352–362.
10.1016/S0002-8223(99)00091-7 > CrossrefGoogle Scholar - 3.National Institutes of Health. National Guideline Clearinghouse: Celiac disease (CD). Evidence-based nutrition practice guideline. Available at: http://www.guideline.gov/content.aspx?id=14854&search=Behavioral+therapy. Accessed on September 6, 2010. > Google Scholar
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