Celiac Disease in an Elite Collegiate Volleyball Athlete September 13, 2007

I am particularly interested in the athletic performance of people who have been diagnosed with celiac disease, because I am trying to maintain an athletic lifestyle while on a gluten free diet.  I found a case study (from the Journal of Athletic Training) of a collegiate athlete who was ultimately diagnosed with celiac disease.  She was first thought to have an eating disorder such as anorexia.  After being referred to a gastroenterologist she was found to have celiac disease.  With treatment it is reported: 

The patient was prescribed a gluten-free diet (GFD), which excludes all wheat-based products, and nutritional counseling. Symptoms subsided with these immediate alterations to her diet. The athlete was unable to return to volleyball practice immediately, but as she gained command of her diet to meet the demands of her daily activities and her athletic participation, she returned to play. As the GFD was implemented, the athlete completed her sophomore season and continues to participate without limitation. Her coaches and teammates reported that her athletic performance improved and even exceeded that of her pre-illness status.

It is interesting to me that her performance improved and even exceeded that of her pre-illness status.  It tells me that you can improve your athletic performance while on a gluten free diet.

This article states that celiac disease is present on one of every 200-400 individuals.  I thought it was more like one in 100.  Whichever is true, it would be present in athletes in the same proportions.  The article reports on the challenges of athletes with celiac disease to meet their nutritional needs through their gluten free diet:

Challenges of Athletes With Celiac Disease
Many demands are placed on today’s collegiate athlete. Stresses imposed by full or partial scholarships, academics, social life, physical demands of the sport, and the challenges of living away from home affect every aspect of the collegiate athlete’s daily life. Daily stresses place an even greater emphasis on nutrition and dietary concerns; however, only 32% of young athletic adults (22 to 29 years old) have reported they are nutritionally conscious and make healthy selections in their diet choices.14 According to the American Academy of Sports Medicine, the American Dietetics Association, and the Dieticians of Canada,15 at times of high-intensity exercise, energy intake must meet or exceed energy output. A low-energy diet can cause fatigue, loss of muscle mass, menstrual irregularities, loss of bone density, and increased risk of injury or illness.
Compared with nonathletes, female athletes tend to take energy primarily from carbohydrates and less so from lipid sources.16 Carbohydrates are an important source of energy, especially during exercise. The recommended intake of carbohydrates is 6 to 10 g/kg of body weight, but energy output, sport, sex, and climate can affect these recommendations.15 Breads, pasta, cereal, rice, and fruit are the common diet choices linked to carbohydrates, but those diagnosed as having celiac disease are unable to eat these wheat-based items. Several simple alternatives include vegetables, milk, and yogurt.17 Table 2 reflects appropriate gluten-free dieting, providing common carbohydrate sources and their gluten-free alternatives. A GFD becomes slightly more complicated and eliminates the ingestion of wheat, barley, and rye, all of which are carbohydrate-rich and gluten-rich sources. Typical carbohydrate substitutions within a GFD are rice, corn, flax, quinoa, tapioca, potato, amaranth, nuts, and beans.5 The challenge of a GFD for the average person is significant, and most dietitians recommend at least 4 consultations with a nutritionist.2 The most important consultation involves identifying commonly consumed gluten-containing foods within the patient’s diet and finding suitable alternatives. Patients must maintain the GFD for their entire life to avoid recurrence or exacerbation of the disease. 

Table 2
Suggested Alternatives to Gluten-Rich Foods*

Effective treatment of celiac disease in an elite athlete depends on a successful transition to a GFD while sustaining a high-energy output. Optimal athletic performance reflects dedication and self-control while maintaining a GFD and continuing to provide the body with sufficient carbohydrate alternatives for energy.

Uniqueness of Our Case
Certified athletic trainers and other health care professionals should be aware that the occurrence of celiac disease is higher than once thought. Clearly, the potential exists for athletes to have celiac disease and for its signs and symptoms to be confused with other conditions. In our case, we were initially unable to identify the signs of celiac disease because we suspected a possible eating disorder. This case of celiac disease was unique because of the presentation and the role the certified athletic trainers played in tailoring the treatment to meet the athlete’s needs. Daily adaptations were necessary, and the recommendations made by the physician, the nutritionist, and the certified athletic trainer aided in the athlete’s return to elite athletic activity. Referral is indicated when the athlete’s care extends beyond the playing field and when the athlete’s activities of daily living are affected by the signs and symptoms. Guidance in a life-changing treatment is required and should come directly from those health care professionals closely associated with the athlete’s daily care. Certified athletic trainers are the health care professionals closest to the athlete and, because of this relationship, we are ideal and educated counselors to our athletes.

It is possible to excel at athletics while on a gluten free diet.  You will need to become knowledgeable about nutrition but you will be rewarded with a strong body and sharp mind.  Good Luck!