Sunday, January 22, 2012

Celiac Disease and how to cope as a athlete

Below are a few articles about Celiac Disease and how you can live with it as a runner or athlete.

Celiac disease, also known as gluten intolerance, is a genetic disorder that affects at least 1 in 133  Americans.
Symptoms of celiac disease can range from the classic features, such as diarrhea, weight loss, and malnutrition, to latent symptoms such as isolated nutrient deficiencies but no gastrointestinal symptoms. The disease mostly affects people of European (especially Northern European) descent, but recent studies show that it also affects Hispanic, Black and Asian populations as well. Those affected suffer damage to the villi (shortening and villous flattening) in the lamina propria and crypt regions of their intestines when they eat specific food-grain antigens (toxic amino acid sequences) that are found in wheat, rye, and barley. Oats have traditionally been considered to be toxic to celiacs, but recent scientific studies have shown otherwise. This research is ongoing, however, and it may be too early to draw solid conclusions.

Because of the broad range of symptoms celiac disease presents, it can be difficult to diagnose. The symptoms can range from mild weakness, bone pain, and aphthous stomatitis to chronic diarrhea, abdominal bloating, and progressive weight loss. If a person with the disorder continues to eat gluten, studies have shown that he or she will increase their chances of gastrointestinal cancer by a factor of 40 to 100 times that of the normal population. Further, gastrointestinal carcinoma or lymphoma  develops in up to 15 percent of patients with untreated or refractory celiac disease. It is therefore imperative that the disease is quickly and properly diagnosed so it can be treated as soon as possible.

Facing the challenge of running gluten free
By Amy Fisher

Imagine a world where there are no puffy post-run bagels. Or what if you were suddenly banned from your favorite cereal (the one that always gets you through that hilly run)? Runners with celiac disease can relate to such scenarios.

Celiac disease is a lifelong autoimmune intestinal disorder estimated that affects nearly one in 132 individuals in the United States. Celiacs are unable to ingest gluten, a protein found in grains like wheat, rye and barley. Eating gluten acts as a poison, damaging the hair-like projections called villi that line the small intestine. Eventually, the intestines stop absorbing basic nutrients.

If it goes untreated, it can damage the small bowel and lead to an increased risk of certain long-term conditions and autoimmune disorders like anemia, osteoporosis and thyroid disease.

Since eliminating gluten from the diet is the only way to combat celiac disease, it can pose a huge challenge for trail runners whose diets consists largely of cereals, bagels, energy bars, pastas and other grain-based foods. What's a runner to do?

How will I know?
The cause of celiac disease is unknown, although, according to the Celiac Disease Foundation, it may be linked to a group of genes on Chromosome 6. Some experts believe that stressful events such as surgery, severe emotional stress or childbirth may trigger symptoms for the first time.

Common symptoms include abdominal cramping, intestinal gas, distention and bloating, chronic diarrhea or constipation (or both), fatty stools, anemia and weight loss. Other not-so-obvious signs can include dermatitis herpetiformis (blister-like skin rash), depression, infertility (male and female), bone or joint pain, fatigue and osteoporosis.

"CD is a multi-system, multi-symptom disorder. Symptoms are extremely varied and can often mimic other bowel disorders," says the Celiac Disease Foundation. Common misdiagnoses range from IBS (irritable bowel syndrome) and chronic fatigue syndrome, to fibromyalgia and lymphoma. That's why it's crucial to get a professional diagnosis.

Diagnosing the disease often begins with a line of antibody blood tests. If these come back positive, the next step is likely an intestinal biopsy, the gold standard for diagnosis.
It's important to note the difference between having celiac disease and being gluten intolerant. While both conditions may illicit similar symptoms when gluten is eaten, they typically subside in those with a gluten intolerance and don't cause permanent intestinal damage.

People who are unfamiliar with celiac disease may think we active celiacs aren’t quite up to the challenge that other athletes are. Football, golf, tennis, running—all of these take major skill and athleticism in their own way. But once someone with undiagnosed celiac gets the correct diagnosis – it’s life changing – even for an athlete.
If you doubt me—take a look at some of these examples:

This week the Dallas Morning News profiled the second-string quarterback at the University of North Texas. Nathan Tune got on the team as a walk-on three years ago and has been a on the bench ever since. His college coach is proud of him for his patience and sticking it out with UNT, saying he could have given up.
“Tune had an excuse to give up football in celiac disease,” the article says. “The disease forced him to give up sandwiches, pasta and fast food last year.
He stuck with it, though, and after adapting to the condition, he moved up the depth chart to become UNT’s backup quarterback.” – Dallas Morning News
Sarah-Jane Kenyon of Queensland Australia improved significantly having her best season in 2008 since being a rookie on the LPGA tour. The reason? A diagnosis of celiac disease and complete change to the gluten-free diet. Kenyon says she was diagnosed after doctors discovered her mother had it.
“Fortunately, the dietary change has contributed to her success on the course, which has included two runner-up finishes on the 2008 Duramed FUTURES Tour.”

In an interview with the website, she explained her diet and what she eats when golfing.
“I cut out bread and pasta and it’s really helped. I feel better on the course and the new diet has given me more energy. It requires a lot of planning, though. You can’t just grab a sandwich when you go out on the course. Now, I eat a lot of gluten-free energy bars, fruits and nuts, and rice cakes with wheat-free peanut butter.” –Sarah-Jane Kenyon interview with

Research about athletes and celiac disease

A case report published in the Journal of Athletic Training in 2005 looked at the case of a college tennis player who was diagnosed with celiac disease. She suddenly began having symptoms and blood and food allergy tests were conducted and doctors gave her a celiac diagnosis.
The case report conclusion,
“A properly educated sports medicine staff can help to identify symptoms consistent with celiac disease early, so damage to the intestine is minimized. Prompt recognition and appropriate management allow the athlete to adjust the diet accordingly, compete at a high-caliber level, and enjoy a healthier quality of life.” — Journal of Athletic Training

Cold Turkey
For celiacs, the only effective, proven treatment for healing the gut and promoting regrowth of intestinal villi is to completely remove gluten from the diet. The time it takes to fully recover varies, depending on how long the intestinal damage has been occurring. Those with a gluten intolerance should also follow the same course of action. It's crucial to rid the diet entirely of foods or food ingredients made from grains, including wheat (all types), bran, rye, barley, bulgur, kamut, spelt, wheat germ and semolina.

Oats have been a hot topic amongst gluten-free forums and health reports as to whether or not they're safe for celiacs. There's a concern that oats may be contaminated by other gluten-containing grains during the growing and packaging processes. "Some consider oats safe for all but the most sensitive celiacs," states Jax Peters Lowell, author of the Gluten-Free Bible. "Others feel that because of the difficulty of measuring the varying degrees in sensitivity between celiacs, it's hard to know how many oats a celiac can consume without damaging the villi." (Bob's Red Mill brand has recently introduced the first GF-version of oats that meets strict gluten-free guidelines.)

Further complicating matters is the fact that gluten can be "hidden" in many unlikely foods such as jelly beans, deli meats, soups, salad dressings and soy sauce. It can even be buried in the ingredients of some toiletries and pharmaceuticals. Celiacs must learn how to read labels and identify the hidden culprits.

Food for Thought
So for gluten-free runners, the big question becomes, "What can I eat?" Gluten-free flours made from rice, soy, corn or potatoes are all gut-friendly choices. Fresh meats, fish and poultry (not breaded or marinated), fruits, vegetables, rice, potatoes and most dairy products are also safe.

If a gluten-free diet seems spartan without favorite desserts or treats, think again. Health food stores like Vitamin Cottage and Whole Foods have long stocked their shelves with gluten-free cookies, crackers and other foods. Now, chains like King Soopers have also jumped on the bandwagon, and some restaurants such as P.F. Chang's China Bistro have added gluten-free menu options.

In January 2007, the FDA published a proposed rule to establish a definition for the term "gluten free," so consumers could easily identify safe foods in grocery stores.

Getting Personal
An entire diet and lifestyle overhaul can be overwhelming, so consider enlisting a certified nutritionist, who can develop an eating plan tailored to your needs. A nutritionist can take the guesswork out of what to eat, and significantly cut down on the trial-and-error recovery phase.

Trail to Recovery
In addition to watching the diet, those weaning themselves from gluten must allow their bodies a period of full rest in order to completely restore their health. As tough as it may be for an avid runner to scale back on weekly mileage or intensity of runs, it's often a crucial part of the healing process.

Consider these tips to aid the recovery process:
Take it easy. For many runners, the natural response to a lag in energy or a sub-par performance is to kick it up a notch, but extra exertion can lead to maxing out the adrenals when your body is already taxed.

Cut out the bad stuff. Consider avoiding or at least cutting back on alcohol, caffeine and sugar, since these substances only stimulate your body to work harder.

Get the gunk out. The lymph system is the body's mechanism for clearing toxins from its cells, and lymphatic massage is a great way to aid the detox process

Walk. In addition to helping the transition back to running, walking encourages movement of the lymphatic system.
Take it to heart. With a heart-rate monitor, you can objectively gauge your exertion level, which is often different than your perceived exertion.

Consider supplements. To counteract possible nutrient deficiencies due to malabsorption, it may be beneficial to add zinc, EFAs (essential fatty acids), iron, vitamin D, vitamin K, calcium, magnesium and folic acid in supplement form.
Pay attention. Take this recovery period to be very mindful of physical, mental, and emotional changes. Keeping a log or journal can be extremely helpful in conveying critical information to a doctor or nutritional counselor.

Gluten-Free Grub
Tasty, field-tested trail foods to get you started

- GU Energy Gels
- Hammer Gel (all Hammer products are gluten free)

Sports Drinks
(most are free of gluten)
- Accelerade
- Gatorade
- Powerade


- Clif Nectar
- Lara Bars
- Perfect 10 Natural Energy Bars
- PranaBar Gluten-Free Bars
- Think Thin Protein Bars

(add peanut butter for a great trail snack)
- Enjoy Life Gluten-Free Bagels
- Food For Life Gluten-Free Breads
- Gillian's Foods Gluten-Free Cinnamon Raisin Rolls

Easy-to-Stash Sweets and Treats
- EnviroKidz Cereals (most are gluten free)
- EnviroKidz Organic Vanilla Cookies
- Glutino Pretzels
- Pamela's Cookies (all the wheat- and gluten-free flavors are divine)

GF for Everyone
Not a celiac or gluten-intolerant runner? You can still reap the benefits of a gluten-free diet on the trail-especially during longer-distance runs.

- Choose foods that have a high-protein and low-glycemic load (and are naturally gluten-free).
- Focus this type of nutrition on your pre-run meals to maximize your gains while running.

- Keeps blood-sugar levels steadier during runs, which means a more constant energy level.
- Helps prevent a hypoglycemic "bonk" at the start of a run (typically within the first 30 minutes).
- Teaches your body to draw energy from its fat stores rather than rely on the food in your stomach.
- Reduces the amount of muscle glycogen you use on a run, which can help improve endurance.

What to Eat Pre-Run
- Beans, lentils and chickpeas
- Breads and pastas made with chickpea- or legume-based flour
- Buckwheat (soba) noodles
- Leafy green veggies
- Lean protein
- Low-fat milk and yogurt

As one runner writes:
“This is not a fun disease to have -- runner or not. Much depends on how long the person with Celiac has been on a gluten free diet and how their body responds to it. Personally speaking, I have been on one since around April. Unless I have been inadvertently consuming gluten (cross-contamination), I still have screwed up intestines. So often I go to the bathroom many times--up to around 10 or so--times a day. When in this stage, your small intestine is distressed; the microvilli aren't therefore able to facilitate essential vitamins and nutrients across. They are also damaged and inflamed, which in turn makes you 100 times more likely for intestinal cancer--and a greater risk of other cancers because it is a whole-body situation. So before and during a run you may be deficient in many ways, fatigued (I have been majorly fatigued), and you may need to hit the port potty if there is one, if not, the woods...more than once. Foods and gels, drinks etc must of course not only be free of gluten in the ingredients, but not contaminated. Long distance running is not so friendly on the gut and not a great idea if you are having issues. HOWEVER, if you have healed your intestines you are in good shape again for all that.”

Other information:


  1. nice article..very helpful

    Thanks alot !

  2. Would love an update on celiac college athletes - when to discuss this in the recruiting process, how they manage at college and on the road, the typical calorie consumption and types of gf food/snacks pre and post games, etc.

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