Sep 21, 2016Going Gluten-Free
Whether it’s for medical reasons or a personal choice, the number of people dropping gluten from their diets is increasing–and athletes are part of the trend. Some of the increase can be attributed to better recognition and diagnosis of celiac disease, but there are more than a few elite athletes who do not have a medical condition and have decided to go gluten-free.
These athletes often cite alleviation of gastrointestinal symptoms, improved mental acuity and focus, having more energy, and improved performance as advantages of forgoing gluten-containing products. While there is no research to support or refute a performance-enhancing effect, the many anecdotal reports of improved overall wellbeing and athletic gains cannot be discounted.
The term “gluten intolerance” is often used when referring to the entire category of gluten- and wheat-related issues. But it is important to have a thorough understanding of each of these conditions when discussing nutrition’s role in combating them.
Celiac disease (CD) is an inherited autoimmune disorder that is thought to affect about one percent of the population. The ingestion of gluten–a protein found in wheat, rye, barley, spelt, and oats (except those certified gluten-free)–triggers an antibody that attacks the lining of the small intestine. The result is villous atrophy, the hallmark sign that distinguishes CD from other types of gluten intolerance. Since damaged villi cannot effectively absorb nutrients, a wide array of nutritional deficiencies can ensue. A completely gluten-free diet is the only known treatment for CD.
A wheat allergy causes the immune system to negatively respond to wheat and can affect tissues throughout the body. This immune response is often short-lived and does not cause lasting harm. Symptoms occur within a few minutes to a few hours after eating wheat and may include swelling and itching of the mouth or throat; hives, an itchy rash, or swelling of the skin; nasal congestion; itchy, watery eyes; abdominal cramps, diarrhea, nausea, or vomiting; and anaphylaxis. When a wheat allergy is present, one must avoid wheat, but can eat other sources of gluten.
A non-celiac gluten sensitivity is a non-allergic, non-autoimmune condition in which the symptoms may be similar to those of CD or a wheat allergy. However, in contrast to CD, a non-celiac gluten sensitivity is characterized by negative antibodies and a lack of intestinal damage. It is estimated that up to six percent of the population has a non-celiac gluten sensitivity.
While it has been debated, experts currently believe there are no biomarkers that can consistently and accurately diagnose non-celiac gluten sensitivity. Thus, if CD and wheat allergy have been ruled out, trying a gluten-free diet can provide clues. If symptoms improve, a non-celiac gluten sensitivity can be assumed.
There are several factors to consider when discussing why a gluten-free diet can result in improved performance among athletes. If an athlete has CD or a wheat allergy, it’s a no-brainer–a gluten-free or wheat-free diet, respectively, means no distressing symptoms that can hinder performance. The same goes for an athlete who falls within the estimated six percent of the population with non-celiac gluten sensitivity.
An athlete may also be experiencing improved performance with a gluten-free diet because it spurs an overall healthier eating plan. Many processed, packaged foods, as well as fast food items, contain wheat, barley, and/or their derivatives. These additives are often used as thickeners, sweeteners, or fillers. When gluten is eliminated, the athlete must stop eating many of these foods and find alternatives. If fresh, less-processed natural foods are chosen more often, the quality of the athlete’s diet improves automatically.
Additionally, grains that do not contain gluten, such as quinoa, amaranth, teff, and millet (collectively, these are called the “ancient grains”) tend to be rich in vitamins, minerals, fiber, and protein. Thus, when an athlete consumes cereal, bread, pasta, or crackers made from these grains instead of refined grains, nutritional intake is improved. When these foods are combined with others that are naturally gluten-free, such as fruits, vegetables, lean proteins, nuts, and seeds, the diet is extremely rich in nutrients.
Finally, when an athlete is interested in improving performance through dietary changes, their entire diet receives greater attention. I have often found that when an athlete I’m working with attempts to follow a gluten-free diet, they have a greater overall interest in nutrition and are more aware of how their body responds to different foods and eating patterns. In the process of learning about a gluten-free diet, they spend more time planning and preparing healthy meals, reading nutrition labels for sources of added sugar and salt, and eating more fruits and vegetables. In general, this often leads to the development of fueling strategies that support better training, performance, and recovery.
A gluten-free diet should not negatively impact an athlete’s performance. In other words, gluten-containing grains are not required for optimal health. However, potential problems could arise if gluten-free dietary changes are not carried out carefully and thoughtfully.
For example, carbohydrate intake must continue to be adequate. Most athletes require six to 10 grams of carbohydrates per kilogram of body weight on a daily basis. Endurance athletes may need more during certain phases of training and competition. In addition to fruits, vegetables, and dairy, athletes depend heavily on grain products for carbohydrate. If they do not regularly consume enough gluten-free grains, then their total carbohydrate intake may decline, resulting in glycogen depletion, fatigue, and poor performance.
A gluten-free diet must also include good food choices. While unprocessed gluten-free products are available, there are also many highly processed, refined gluten-free foods. For example, soda and sweetened tea are “naturally” gluten-free, but contain excess sugar and few nutrients. The same is true for many types of candy and snack foods. Some types of gluten-free bread consist mainly of white rice flour and cornstarch, which are both poor nutrient sources. A variety of gluten-free cakes and cookies have also entered the marketplace. While they are wonderful for a special occasion, they are no healthier than their gluten-containing counterparts.
Perhaps the most profound problem with attempting a gluten-free diet is that it could potentially delay the proper diagnosis of CD or another medical condition. While fatigue, headaches, bloating, constipation, diarrhea, abdominal pain, skin rashes, muscle pain, and joint pain have all been associated with CD and sometimes non-celiac gluten sensitivity, these symptoms have also been connected to many other medical conditions. If specific, unexplained symptoms are present, an athlete should have a complete physical exam to determine the cause–including appropriate testing for CD before starting a gluten-free diet.