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Gluten Intolerance & Bodybuilding

Coeliac disease (CD) is an autoimmune disorder with a genetic predisposition in which affected individuals develop adverse reactions to gluten, a protein contained in wheat, barley and rye. Alcohol-soluble fractions called prolamins exist in gluten have been identified as gliadin (wheat), secalin (barley) and hordein (rye). These compounds trigger an inflammatory immune response along the digestive tract which can damage intestinal cells responsible for nutrient absorption. Early symptoms such as abdominal cramps, bloating and diarrhoea can progressively worsen with prolonged gluten exposure leading to fat mal-absorption, iron-deficiency anaemia, weight loss, skin problems and osteoporosis. The symptoms of CD are highly variable and can be severe or even absent in some individuals. What may seem as favourable weight loss to some people should be considered along with other symptoms and their consumption of wheat-based products. This is because late diagnoses have been associated with a higher likelihood of severe morbidities later in life such as fractures and fat-soluble vitamin (A, D, E & K) deficiencies such as night blindness and easy bruising.

Coeliac Disease (CD) Detection

Recognising early signs and symptoms requires experience and a formal assessment of a person’s past history and physical examination by a medical practitioner. Hence, it is important to consult professional advice when experiencing abdominal discomfort, loose bowel motions, increasing fatigue and weight loss. Do note that these symptoms are not entirely suggestive of CD as infection from contaminated foods and lactose intolerance for example may also be responsible. A blood test would be done to detect autoimmune markers suggestive of CD, and hence often used to confirm a provisional diagnosis. It was recently highlighted in the Journal of Athletic Training that certified trainers have crucial roles in helping detect CD in athletes. Likewise, it is equally important as responsible individuals concerned in the area of fitness and health to gain knowledge regarding CD to help improve the quality of life of our affected clients, friends or associates.

Diet Therapy For Coeliac Disease

CD is unique because the main trigger of its clinical manifestations is known. Although risk factors such as age, gender and genetics cannot be modified, controlling the environmental determinant through a gluten-free diet is currently the most effective method to eliminate the symptoms and long-term health risks associated with gluten intolerance. Gluten is predominantly found in baked goods, grains, cereals and packaged foods which are processed on the same equipment containing wheat products. Nowadays, it is compulsory for food manufacturers to label their product as containing gluten (including trace amounts) or gluten-free. The total amount of gluten intake should not exceed 50mg per day during treatment and exceeding 100mg. Hence adherence to a strict gluten-free diet is crucial to keep the risk at a minimum. As a well-balanced diet with adequate energy intake is important for good workout performance. Thus, planning ahead for each meal will ensure efficient absorption of nutrients. Some individuals with CD may temporarily develop lactose intolerance. Hence, consumption of dairy products should be kept to a minimal during the treatment phase. Including a multivitamin supplement can also facilitate optimal nutrient intake whilst sustaining energy levels. Most protein supplements these days are fortified with essential vitamins and minerals. Quality products with high purity and gluten-free is preferable.

The following table presents common foods that are likely to contain gluten and possible substitutes. It is important to carefully identify gluten-free labels to be safe. Foods are such as oats, hydrolysed vegetable/soy protein, starches (corn/tapioca/rice) seasonings and spices are questionable and should be carefully selected to ensure they are not processed on machines containing wheat.

Gluten-free

Gluten containing

Cereals (Amaranth, buckwheat, corn, millet,  quinoa, all types of rice)

Fish

Meat

Nuts

All Vegetables including root vegetables

Legumes (soy and other beans)

Cereals (Wheat, rye, barley, spelt, triticale, semolina, malt)

Baked goods containing wheat flours

Pasta (made from semolina)

Coeliac Disease & Bodybuilding

The constitutional effects of CD can be detrimental to bodybuilding efforts without a proper management plan primarily through dietary changes and a good workout regime. It would seem that individuals with CD have the tougher route. However, a prudent mind fuelled by knowledge and motivation will transcend any barriers to achieving the ultimate goal.

Green, PHR and C. Cellier, 'Medical progress: celiac disease' (2007) 357(17) New England Journal of Medicine 1731Howe, W.B., 'Celiac Disease' (2005) 40(4) Journal of Athletic Training 370
Mancini, L.A., T. Trojian and A.C. Mancini, 'Celiac Disease and the Athlete' (2011) 10(2) Current Sports Medicine Reports 105
Niewinski, M.M., 'Advances in celiac disease and gluten-free diet' (2008) 108(4) Journal of the American Dietetic Association 661
Pietzak, M.M. et al, 'Celiac disease: going against the grains' (2001) 16(6) Nutrition in Clinical Practice 335

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