It is estimated that 1 in 133 people in the United States have celiac disease, and 6% of the population is gluten intolerant. Whether due to a diagnosis of celiac disease or non-celiac gluten sensitivity (NCGS), the gluten-restricted athlete faces possible threats to their performance.
Gluten consumption in the case of a celiac diagnosis will damage the small intestinal villi and interfere with the absorption of nutrients. Failure to comply with a gluten-free diet will result in a lack of energy and diminished performance capacity. Nutrients of primary concern are iron, calcium, vitamin D, folate, zinc, and vitamin B12. Those newly diagnosed with celiac disease may need temporary supplementation as their intestinal lining heals.
Gluten may further impede performance as it can cause abdominal pain, diarrhea, indigestion, and chronic fatigue if not eliminated from the diet when necessary. Long-term complications include anemia, vitamin and mineral deficiencies, and bone mineral loss (which can lead to osteoporosis and further bone damage).
The gluten-free athlete must ensure adequate carbohydrate intake to fuel activity. Non-gluten grains include: amaranth, arrowroot, buckwheat, chickpea, lentil, corn, millet, potato, quinoa, rice, and sorghum.
A drawback of gluten-free carbohydrate sources is their lower fiber content. Athletes need ~25-35 g fiber/day, which can be met by incorporating gluten-free fiber sources from other food groups, such as fruits, vegetables, legumes and nuts. Fiber should be introduced into the diet slowly, with adequate water consumption and physical activity to support motility.
It is important to maintain an overall balanced diet, including protein, fruits, vegetables, and healthy fats. Fresh fruits and vegetables are naturally gluten-free. Canned products are acceptable if packed in water, rather than syrup or other substances, as these products may contain gluten.
Meals and snacks should be planned ahead of training and competition, especially if on the road. It is advised to always have a snack handy. Some convenient options include dried fruit/nut trail mix, rice cakes with peanut butter, a piece of fruit, or gluten-free sports nutrition bars.
Athletes should notify team health care members (dietitian, athletic trainer, physician, etc.) of their dietary restriction. Gluten may be present in sports foods, supplements, and catering at group meals. Alerting the staff can help avoid possible contamination.
It is advisable to check food labels on all sports foods and gels, and to seek out items marked gluten-free. Safe brands and products include: Gatorade, PowerBar Protein Plus Powder, PowerBar Gels, Gu Energy Gels, Ensure, Lara Bar, KIND Bar, PURE Bar, Clif Builder’s Bar, and Odwalla.
With the appropriate planning, support, and education, the gluten-free athlete can meet all of their nutritional needs and avoid any detriment to their performance.