Gluten-free Diet for Runners: The Missing Link Or The Latest Fad?
The gluten-free diet has taken off in recent years and instead of being viewed as nutrition therapy for a handful of medical conditions, it may inadvertently be the new “fad diet.”
I don’t want to use that term in a negative way because the gluten-free diet is a well-researched, generally healthful, and medically necessary diet for individuals with celiac disease or related disorders.
However, it has often been viewed in the media as a weight-loss or performance-enhancing diet backed by testimonials from a wide range of celebrities and athletes worldwide who don’t actually have a known gluten sensitivity, but follow the diet anyway in the belief that it is healthier. In fact, some have estimated that 15-25% of North Americans either adhere to a gluten-free diet or consume gluten-free products.
Although it is possible to make a gluten-free training diet work for you, it is important to know all the facts before jumping on board the gluten-free ship.
What is gluten?
Gluten is a collective term used to describe specific types of proteins that are found in wheat, rye, and barley products.
It gives bread dough its elasticity and allows it to rise. It also contributes to the “chewiness” and “sponginess” in baked goods. Furthermore, it is often used as a thickener for soups, sauces, and salad dressings. Some odd places you might not expect to find gluten include soy sauce, ice cream, beer, and even some prescription medications.
Although it has been vilified by the media, gluten only poses a threat to individuals who cannot fully digest the proteins due to celiac.
Gluten is not nutritionally necessary, but it is not “bad” for us either. It only causes adverse reactions in people who are sensitive to it just, as other common foods like milk, eggs, nuts, soy, and seafood do. Even fresh fruits and vegetables have been known to cause allergic reactions.
However, no single food or food product has come under fire quite the same way as gluten has. Has all the recent attention to gluten made us all think we are allergic to it?
Celiac disease, wheat allergy, or gluten sensitivity – which do you have and why does it matter?
These three terms are often used interchangeably, albeit incorrectly, to describe a negative reaction one might have to consuming wheat products.
It is important to realize that each of these conditions is distinctly different and the treatment options, diagnosis and impact on running will vary dramatically.
Celiac disease is an autoimmune disorder with a genetic predisposition. It can manifest at any age in susceptible individuals and is often triggered by an environmental stress such as an illness or infection.
When gluten is consumed by an individual with celiac disease, it is not completely digested and the undigested fragments are absorbed and trigger an immune response which damages the intestines.
Little finger-like projections called villi become flattened and lose their ability to absorb important nutrients like iron, calcium, and folate. The more damage that is done, the less the body will be able to absorb and it is common to also see deficiencies in the fat-soluble vitamins (A, D, E, and K), as well as carbohydrates and protein.
Early symptoms of celiac disease include:
- Abdominal pain, bloating, and gas
- Diarrhea, constipation, or sporadic periods of both
- Indigestion, nausea, and vomiting
As the disease progresses without treatment, one might also notice more “extraintestinal” symptoms secondary to nutrient deficiencies and inflammatory responses:
- Chronic fatigue, weakness, and possible depression (likely due to deficiencies in iron, folate, and/or vitamin B12)
- Headaches, bone and joint pain, swelling of the hands and feet
- Mouth sores and/or easy bruising (likely due to multiple micronutrient deficiencies)
Diagnosis of celiac disease
Fortunately, celiac disease is fairly easily diagnosed by a doctor. Blood tests for antibody levels are increasingly common but, the gold standard for diagnosis is still a biopsy of the small intestine—this will plainly reveal the damaged tissue caused by the body’s autoimmune response.
The blood tests are used to identify higher-than-normal levels of specific antibodies that indicate an immune response to what the body thinks is a foreign substance (gluten). These tests are helpful but not 100% accurate and may produce a “false negative,” further delaying diagnosis.
The only definitive test for celiac disease is an intestinal biopsy that shows evidence of damage to the intestinal villi.
The prevalence of celiac disease has been increasing over the years, perhaps due to better diagnosis of the disease.
In the United States, it is estimated to affect roughly 2 million people, or about 1 in every 133 (~1%) individuals. Those who have a close relative with celiac disease are about six times more likely to develop the disease.
The impact of celiac disease on training
Celiac disease or gluten intolerance can have a profound impact on your ability to train and compete as an athlete, as demonstrated by two case studies published in 2005.
In these papers, the authors described the process of identifying and treating celiac disease in two women, both Division I athletes, who struggled with muscle and joint pain, extreme fatigue, weight loss, diarrhea, nausea, and other symptoms after beginning to train with their college teams.
In both cases, the authors took an inventory of the athletes’ symptoms, then eliminated more common diagnoses like mononucleosis and anemia. After celiac disease was identified as the source of their problems, a permanent gluten-free diet was prescribed for the athletes, and both were able to return to competition.
Notably, however, the authors of one of the case studies pointed out that the symptoms of celiac disease recede slowly, not instantly, after the adoption of a gluten-free diet.
Treatments for celiac disease
The only way to treat celiac disease and prevent the occurrence of symptoms is to follow a gluten-free diet for life.
There is currently no medical or surgical intervention to prevent or to treat it.
The good news is that a gluten-free diet is easier than ever to follow and it is possible to get all the nutrients you body needs without gluten. Ironically, the popularity of gluten-free diets as weight-loss schemes might be partially responsible for this.
Professional runners like Amy Yoder Begley and Stephanie Rothstein-Bruce prove that a diagnosis of celiac disease doesn’t have to slow you down.
For tips on a gluten-free diet, refer back to some of our delicious gluten-free recipe.
A true wheat allergy is different from celiac disease in that the immune response is triggered by a different antibody-protein mechanism.
With a wheat allergy, your body develops an allergy-causing antibody to a particular protein (not gluten) found in wheat so when this protein is detected, the body has an allergic response. The allergic response is acute in nature and can be treated with antihistamines or corticosteroids.
Unlike celiac disease, a wheat allergy does not cause permanent damage to the gastrointestinal system.
Symptoms of a wheat allergy:
- Swelling, itching or irritation of the mouth, throat, eyes, or skin
- Hives or rash
- Difficulty breathing
- Cramps, diarrhea, nausea or vomiting
Diagnosis of a wheat allergy
A wheat allergy is often diagnosed using a skin prick test. If you are allergic to wheat, you will develop a red, itchy bump where your skin was exposed to the wheat protein.
Other ways to diagnose a wheat allergy include a blood test, a food challenge test, and the use of an elimination diet.
Treatment and prevention of what allergies
The only way to prevent a reaction is to follow a wheat-free diet. Wheat allergies are pretty rare (only ~0.1% of the population), but the purpose of discussing the wheat allergy was to show that it is not the same as celiac disease or gluten sensitivity.
Gluten sensitivity is the latest topic of debate in the medical community. While celiac disease has distinct clinical manifestations (i.e. an increase in specific antibodies, visible damage to the intestine), doctors have been noticing a greater number of patients who present gluten-dependent symptoms but do not meet the diagnostic criteria for celiac disease. This leave practitioners with the questions:
- Is it possible for an individual to have a gluten sensitivity without having celiac disease and
- How do you diagnose and treat individuals that fall under this category?
Recent reviews of the literature have provided evidence that, even in the absence of celiac disease, similar gastrointestinal symptoms can result from the consumption of gluten-based products.
Results published in 2011 from a double-blind randomized placebo-controlled trial showed that consumption of gluten caused GI symptoms in subjects without celiac disease. Other studies have described non-celiac patients who experience objective improvements in symptoms after following a gluten-free diet.
In 2012, a panel of 15 international experts concluded this new condition needed to be recognized and, more importantly, described. The term used to describe this condition is “non-celiac gluten sensitivity” and it refers to when gluten-dependent GI symptoms are present, but celiac disease and wheat allergy have been ruled out.
Although there are no official statistics on the prevalence of non-celiac gluten sensitivity, data collected from the Maryland clinic experience between 2004 and 2010 reported the prevalence to be 6% of the patients included.
Unfortunately, there are not yet any diagnostic criteria or specific biomarkers that exist to determine the existence or prevalence of the condition other than self-reported improvements in symptoms when following a gluten-free diet.
Does a gluten-free diet enhance running performance?
There is no significant research or evidence to suggest that a gluten-free diet will improve athletic performance.
However, it is hard to ignore the testimonials of top-tier athletes who have claimed an increase in energy, decrease in injury, and overall better performance after going gluten-free. Perhaps the best way to explain their experiences is by thinking about what other improvements could have been made to their diets to account for these remarkable improvements.
Going gluten-free often makes people take a hard look at their own diet as they begin to restructure it. This is a chance to weed out the junk and start over again with a diet based around lean meats and proteins, fresh fruits and vegetables, and nutritionally rich whole grains like quinoa, millet, buckwheat, and amaranth.
It is worth noting that some people who find improvements on the diet may also be experiencing what is known as the “placebo effect.” In other words, you feel better on the gluten-free diet because you expected that the diet would make you feel better. This isn’t a bad thing, especially if going gluten-free made you improve the overall healthfulness of your diet.
It may just be an overall healthier diet that is at the root of athletic improvement.
Whether or not you decide to go gluten-free is up to you. There is no evidence to support that this diet is performance-enhancing (unless you have an underlying issue with gluten), but it is safe. Just keep these few tips in mind:
- Many gluten-free foods are not fortified with B vitamins and iron like other processed grain products so you should take extra care to get enough of these from other sources. Products not made with whole grains may also be lower in fiber.
- Gluten-free diets are not automatically healthier. Especially now that gluten-free products have become so popular, it is not uncommon to find gluten-free pizza, cupcakes, cookies, donuts, etc. Not exactly the cornerstones of a healthy diet.
- Gluten-free foods may be more expensive so be sure to budget your money wisely and don’t skimp on other foods like fresh fruits and vegetables.
- If you think you may have a gluten issue, get tested for celiac disease before eliminating gluten from your diet. A clinical diagnosis of celiac disease depends on the biomarkers of an immune response to gluten (the antibodies and the intestinal damage). If you have withdrawn from gluten for awhile, these markers may not be present and subsequently you may go undiagnosed.
- Celiac disease puts you at risk for other autoimmune conditions as well as certain cancers so it is important to get a definitive diagnosis and adhere to a strict gluten-free diet as soon as possible.
- If you do have celiac disease or a wheat allergy and need some helpful meal ideas, check out our long list of gluten-free snacks for runners and 5 tips for avoiding getting stuck in a gluten-free rut.
If you’ve had long-standing gastrointestinal problems accompanied by fatigue, muscle and joint pain, or some of the other symptoms listed earlier, you should consider asking your doctor about celiac disease and gluten intolerance.
Keep in mind that the medical tests used to diagnose these disorders work best if you aren’t currently on a gluten-free diet, so if you want a definite result, you shouldn’t adopt a gluten-free diet right away just because you suspect you might have gluten intolerance or celiac disease.
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Di Sabatino A, Corazza GR. Nonceliac gluten sensitivity: sense or sensibility? Annals of Internal Medicine, 2012;156:309-311.
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