Athletic Training and Sports Health Care

Pearls of Practice 

Managing Celiac Disease in the Athletic Population

Lindsey E. Eberman, PhD, ATC, LAT; Leamor Kahanov, EdD, ATC, LAT

Abstract

The authors are from the Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Ind.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Lindsey E. Eberman, PhD, ATC, LAT, Applied Medicine and Rehabilitation, Indiana State University, 567 North 5th Street, Student Services Building 257, Terre Haute, IN 47809; e-mail: leberman@indstate.edu.

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.…

The authors are from the Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Ind.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Lindsey E. Eberman, PhD, ATC, LAT, Applied Medicine and Rehabilitation, Indiana State University, 567 North 5th Street, Student Services Building 257, Terre Haute, IN 47809; e-mail: leberman@indstate.edu.

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.

Foods with and Without Gluten

Table: Foods with and Without Gluten

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—Consultation with a skilled registered dietician, Education about the disease, Life-long adherence to a gluten-free diet, Identification and treatment of nutritional deficiencies, Access to an advocacy group, and Continuous long-term follow-up.3

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.

References

  1. Haines ML, Anderson RP, Gibson PR. Systematic review: The evidence base for long-term management of celiac disease. Aliment Pharmacol Ther. 2008;28:1042–1066. doi:10.1111/j.1365-2036.2008.03820.x [CrossRef]
  2. Inman-Felton AE. Overview of gluten-sensitive enteropathy (celiac sprue). J Am Diet Assoc. 1999;99:352–362. doi:10.1016/S0002-8223(99)00091-7 [CrossRef]
  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.
  4. Greenberg L. Case management implications of celiac disease. Prof Case Manage. 2008;13:211–217.
  5. Leffler DA, Edwards-George J, Dennis M, et al. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Dig Dis Sci. 2008;53:1573–1581. doi:10.1007/s10620-007-0055-3 [CrossRef]

Foods with and Without Gluten

GLUTEN FREEDO CONTAIN GLUTENMAY CONTAIN GLUTENOFTEN CONTAIN GLUTEN
BuckwheatRiceCornPotatoTapiocaBeanSorghumSoyArrowrootAmaranthQuinoaMilletTeff flourNut floursWheat (durum, semolina)RyeBarleySpeltTriticaleKamutFarinaBrown rice syrup (frequently made with barley)Caramel colorDextrin (usually corn, but may be derived from wheat)Flour or cereal productsHydrolyzed 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 starchMonoglycerides & diglycerides (in dry products only)Natural and artificial flavorsSoy sauce or soy sauce solids (many soy sauces contain wheat)BreadingBrothCoating mixesCommunion wafersCroutonsImitation baconImitation seafoodMarinadesPastasProcessed meatsRouxSaucesSelf-basting poultrySoup baseStuffingThickeners
Authors

The authors are from the Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Ind.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Lindsey E. Eberman, PhD, ATC, LAT, Applied Medicine and Rehabilitation, Indiana State University, 567 North 5th Street, Student Services Building 257, Terre Haute, IN 47809; e-mail: .leberman@indstate.edu

10.3928/19425864-20110428-02

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