Tune into any sports event today, and you’ll likely see athletes who are following the gluten-free diet. Some have celiac disease or gluten sensitivity and have to follow the diet as a medical treatment. These athletes face challenges including pre- and post-game or race fueling, gastrointestinal upset, management of day-to-day nutrition and the complications of traveling.
Other athletes adopt the diet because they believe it helps improve performance, decreases gastrointestinal distress, aids in weight loss, and reduces inflammation in the body. But how many of these benefits are supported by research? And are there drawbacks when an athlete adopts the gluten-free diet when there is no medical need?
Gluten-free in sports…help or hype?
Tennis player Novak Djokovic was one of the first athletes to publicize that he used the gluten-free diet to improve his athletic performance. Since then many athletes, both those who have celiac disease and those who don’t, have also shared stories about how the gluten-free diet has helped them.
The Sport Performance Optimisation Research Team at the University of Tasmania, Tasmania, Australia, in 2015 studied about 900 athletes who don’t have celiac disease, including world and Olympic medalists and found that 41 percent were following the gluten-free diet at least half of the time. Of these athletes, 57 percent had self-diagnosed their issues with gluten, and 81percent felt the diet reduced gastrointestinal symptoms such as bloating, gas, pain, diarrhea and fatigue. A 2012 study of 279 cyclists found similar results. It was the most popular “special” diet among the cyclists, with self-reported gastrointestinal improvements in most who used it.
But does that mean that all athletes should consider trying the gluten-free diet? Jessica Pearl, R.D., a board-certified sports dietitian in New York City, advises otherwise.
“I personally don’t believe that anyone without celiac disease or non-celiac gluten sensitivity should be on the gluten-free diet. I don’t see a benefit,” she says, noting that some of her patients try the diet anyway. “Sometimes they’ll tell me they feel better off of gluten, but we come to find out it was another component of their diet that was causing digestive issues,” she says.
Indeed, a small study in 2015 also done by researchers at University of Tasmania, and the Canadian Sports Institute in Victoria, British Columbia, indicated that the gluten-free diet may have no benefit for athletes without celiac disease. Thirteen cyclists who did not have celiac disease or gluten sensitivity were studied after following a gluten-free diet for seven days and then switching to a gluten-containing diet for seven days.
It was a double blind study in which neither the researchers nor the participants knew which diet they were following. Researchers found that there was no significant difference in gastrointestinal symptoms, performance, inflammation and wellbeing. This study also suggests that what the authors called the “belief effect” may be in play; athletes adopt the gluten-free diet because they perceive it will improve health and performance benefits. This “belief effect” has been shown to actually improve performance.
Meanwhile athletes who choose the gluten-free diet to improve performance can face risks, including nutritional deficiencies. “Athletes on the gluten-free diet are at risk of eating too little fiber, as well as vitamin/mineral deficiencies,” according to Pearl. In addition the gluten-free diet may limit food choices.
A game changer
But for athletes diagnosed with celiac disease or gluten sensitivity, the gluten-free diet can have a profoundly positive effect on performance.
Brandon Button of Marysville, Ohio, was in the middle of training for his first marathon in 2011 when he noticed a problem. “Occasionally one leg would randomly give beneath me on a stride. My lack of strength became disconcerting. I began having numbness in my arms and legs more frequently, and my heart raced,” he recalls. “One day I drove myself to the emergency room thinking I was having a heart attack.” Button was found to be healthy, except that his iron level was extremely low. Subsequent tests showed he had celiac disease, and he started the gluten-free diet.
Button says his running has improved greatly since diagnosis. “Over the next year, my comfortable pace dropped almost a minute per mile, and I was able to qualify for my first Boston Marathon. It’s amazing what having red blood cells and improved oxygen exchange will do,” he explains.
Kim Bouldin, a National Academy of Sports Medicine certified personal trainer from Columbus, Ohio, began running after her celiac disease diagnosis, which came on her 33rd birthday in 2006. “I had IBS [irritable bowel syndrome] on and off for many years, but after the birth of my daughter things became much worse,” she says. Bouldin took up running two years later and has learned to manage both the diet and training. “In preparing for my first full marathon in 2010, I learned a lot about my long-term goal, to continue running for life. I have learned to pay attention to my body, training and plan,” she says.
Potential pitfalls
For athletes with celiac disease, cheating on the diet and not being 100 percent gluten free can have consequences. Nutritional deficiencies in iron, calcium, Vitamin D, B12, zinc and folate can impact their performance.
Teen athletes, in particular, may be struggling with feeling different from their teammates and may be tempted to cheat. This may leave them feeling tired and sick during practices or games. Button offers encouragement to young athletes who may be considering this. “Restaurants and grocery stores are embracing the gluten-free diet. Take advantage of it and stick to your diet,” he says. “There is no need to cheat when there are so many good and safe alternatives.”
In her practice, sports dietitian Pearl often recommends a gluten-free multivitamin or additional supplementation while the villi of the small intestine heals. She also finds that athletes on the gluten-free diet may not eat enough carbohydrates to support activity and may fall short of recommended fiber goals. Athletes should get at least 25 to 35 grams of fiber per day, which Pearl says can be a challenge with low-fiber gluten-free breads and crackers.
“I suggest plenty of fruits and vegetables, gluten-free whole grains, legumes and nuts to meet those goals,” she says, cautioning that fiber should be introduced slowly to avoid gastrointestinal distress. Drinking adequate water is also important.
Fueling up right
Athletes need to eat plenty of carbohydrates, which can be a challenge without the typical staples of wheat-based breads or pastas.
“Pre-diagnosis I ate pretty much everything. However, given the choice between pasta and rice, I would always choose rice,” Button recalls. “I am fortunate as rice has become a staple of my gluten-free diet.”
Traditional pre-race meals, made with gluten-free foods, are important because those final carbohydrates are stored in the muscles. When Button is home he carb-loads for marathons by eating baked beans over rice or steak or chicken over rice. Bouldin is a big fan of mixed bowls. “The night before a race, I’ll often have a larger baked potato than usual to make my meal heavier on the carbs,” she says. Bouldin recommends sticking to whole, unprocessed foods whenever possible.
On the road again
Travel is a challenge for almost everyone with celiac disease, and athletes who go to away games or out-of-state races are no exception. Pearl suggests that athletes be very open and upfront about their dietary needs. “I suggest that athletes talk to their coach, athletic trainer and team dietitian, if there is one, about the need for the gluten-free diet.”
Bouldin brings her own food to out-of-town races. “I just don’t trust eating in a restaurant the night before a race,” she says. “I’ll bring my own gluten-free foods and nutrition bars just to be safe.” Button goes to restaurants with a specific gluten-free menu. “I’ll get a couple of sweet potatoes and broccoli at a steakhouse, and as much lemonade as they will bring me,” he says.
Race day rules
Perhaps the most important thing athletes should remember is to avoid trying any new food or drinks on race or game day. Depending on the intensity of the event, temperature and hydration, any athlete can experience gastrointestinal distress. To help avoid this, anything an athlete intends to consume should be tried out during training.
“It’s taken me a long time to figure out what works for me,” says Bouldin. During races, she eats jelly beans for fuel and drinks plenty of water. “Carb energy gels just don’t agree with me, even though they are gluten free,” she notes.
Button uses sports drinks and carb gels and may even drink a regular soda toward the end of a marathon. But he notes that for longer races, such as 24-hour race relays, he has to rely on more solid foods such as bananas, deli meats and gluten-free crispy rice treats (See recipe page x).
After an event, it’s important to replenish carbohydrates and protein within 15 to 30 minutes. Many athletes, especially those with gastrointestinal issues, may not want to eat immediately after an event. However this is a critical time to start recovery of the muscles. Chocolate milk (or soy milk if lactose is an issue), gluten-free pretzels, sports drinks, a gluten-free energy bar or fresh fruit are all good choices for that initial post-event snack. A larger meal with gluten-free carbohydrates and protein should be eaten two hours after.
Hydration help
With all the focus on the gluten-free diet, athletes should not forget the importance of good hydration. Gastrointestinal complaints during or after an event are often the result of not drinking enough fluids.
Even if the event takes place in cool weather, it’s still important to hydrate properly. Athletes should consume fluids all day long, not just before or after practice or an event to stay properly hydrated. The best choices for hydration are water and sports drinks. A general rule of thumb is to divide your weight by two to arrive at the number of ounces needed each day. For example, a 200-pound athlete would need to drink about 100 ounces per day, or about eight 12-ounce glasses.
Juice and soda do a poor job of hydrating due to their high sugar content. Particularly in hot weather, athletes should weigh themselves before and after exercise and replace each pound lost with 16 ounces of fluid. For athletes who cramp frequently or who see salt on their skin or clothing after exercise—so-called “salty sweaters”—hydration and sodium intake are both important. Choose gluten-free pretzels or crackers with salt, pickles, vegetable juice, and gluten-free soup and broth along with plenty of fluids.
The finish line
No matter why an athlete is following the gluten-free diet, the same general rules apply. Plan ahead for meals and travel, don’t try anything new on race day, eat nutritiously before events and be sure to incorporate nutrition into recovery.
For athletes with celiac disease, healing significant damage to the intestine may take time, which can be frustrating. Button recommends being patient. “Understand it may take a while for your body to respond to you going gluten free,” he says. “You won’t necessarily have tons of energy at first, but if you stick to the diet and allow your body to catch up, you’ll be pleasantly surprised at the things you’ll be able to do.”
This article was originally published in the March/April 2016 issue of Gluten-Free Living.
