What is coeliac disease?

Coeliac disease is a genetic medical condition that results from exposure to gluten – a protein fraction found in wheat, rye, barley and oats; an environmental trigger and an autoimmune response. It affects many organs of the body including the small intestine (gastrointestinal tract). The degree of sensitivity varies among people with coeliac disease. An adverse immune response to dietary gluten damages the lining (villi) and surrounding cells of the small intestine and leads to an inflammatory response. This interferes with the absorption of nutrients and causes damage to other organs and systems, including the bones.

The only treatment for coeliac disease is a strict, lifelong gluten free diet that prevents further villi damage and encourages villi to return to normal so that nutrients in foods can be properly absorbed.

What are the symptoms of coeliac disease?

Individuals may or may not have symptoms and symptoms vary from person to person. There is no correlation between symptoms observed and the severity of damage to the bowel. The consequences of untreated coeliac disease are typically lethargy and gastrointestinal symptoms (diarrhoea and/or constipation, abdominal pain and bloating, nausea and vomiting). Specific nutritional deficiencies predominantly affecting iron, vitamin D, folate, zinc and vitamin B12 are also common. Fertility can also be compromised in untreated coeliac disease. 

Where is gluten found?

Gluten is a protein fraction found in the following grains:

• Wheat (including spelt) • Barley • Rye • Oats (in Australia)
• Any foods made from these grains including:
• wheat flour
• wheat starch
• wheat thickener
• wheat maltodextrin
• wheat dextrin
• wheaten cornflour
• malt, malt extract, malt vinegar
• yeast extract made from barley
• wheat based vegetable protein additives or hydrolysed wheat protein, etc

All of the above ingredients can be made from gluten free grains. You need to understand how to read food labels to check the gluten status. Many Coeliac state organisations provide food label reading workshops and supermarket tours for members.

How do I avoid eating gluten?

There a several options available for athletes requiring a gluten free diet. These include:

1. Foods that are naturally gluten free

Unprocessed fruit, vegetables, meat, poultry, fish, seafood, legumes, lentils, milk, eggs, rice, nuts, seeds, sugar, butter and oils.

2. Foods that have a Gluten Free claim

Any product that makes a claim that it is Gluten Free must abide by the Food Standards Australia Code and be tested to contain no detectable gluten. The claim overrides the ingredients list.

3. Foods not labelled gluten free but are suitable based on ingredients

Products can be gluten free if they do not contain any gluten containing ingredient. In Australia, any ingredient coming from a gluten containing grain must have the source declared. Ingredients that do not identify the source grain must come from a gluten free grain.

4. Products that use the crossed grain logo

 Products displaying the crossed grain logo are endorsed by Coeliac Australia and are tested to be suitable for people with coeliac disease.

Furthermore, some ingredients become so highly processed and refined that even if they come from a gluten containing grain they no longer contain any detectable gluten and are gluten free including:

• glucose syrup (wheat)
• caramel colour (150) (wheat)
• dextrose (wheat)

Allergen and Cross-contamination statements

• If there is a warning statement such as ‘Contains gluten’ then avoid.
• ‘May contain gluten’ statements usually refers to cross-contamination issues. The Coeliac Society of Australia recommends these products be avoided.

As a general rule:

• If in doubt leave it out. If you are not sure whether a food contains gluten then leave it behind and check with the Coeliac Society of Australia for next time.
• Check the ingredients of a product each time you purchase it as ingredients can change.

Nutritional concerns for gluten-free athletes

Meeting carbohydrate targets

Many carbohydrate-rich foods contain gluten, but there are many gluten free alternatives (see options above or our handy guide). Plan ahead for training and competing, go prepared with suitable snacks and discuss menu options with appropriate staff when eating out to ensure that your meal is gluten free.

Are you getting enough fibre?

Gluten free diets contain less fibre than standard diets because wheat-based foods (e.g. wholemeal bread, wholegrain cereals and pasta) are a major source of fibre in the Australian diet. Fortunately, high fibre gluten free choices are becoming more readily available. Fibre assists with appetite, bowel regularity and preventing bowel cancer. For athletes with large volumes of training, lower fibre options may be necessary to meet energy requirements. However, it is still important to ensure that gluten free grainy foods are included for other nutrition benefits, such as B vitamins, iron and zinc.

Nutrient deficiencies

Athletes, particularly female athletes and distance runners, have a higher risk of nutrient deficiencies, typically iron, zinc, calcium and vitamin B12. Athletes with recently diagnosed or untreated coeliac disease are at a greater risk of these deficiencies and these need to be resolved as quickly as possible to avoid fatigue, injury and poor immunity. Some nutrients may require a brief period of supplementation, followed by well-planned meals and snacks to provide sources of these nutrients through foods.

The glycaemic index (GI) of gluten free foods

A gluten free diet typically has a higher glycaemic load (often due to being lower in fibre). For this reason, some athletes find that they are hungrier and eat more on a gluten free diet, which can lead to unwanted weight gain. Smart food choices (i.e. choosing foods that contain protein and/or fibre) will help meet nutrient requirements avoid excessive hunger and/or weight gain.

Any athlete following a gluten free diet should seek the expertise of an Accredited Sports Dietitian to ensure that their performance goals are achieved and health needs are addressed.

Acknowledgements:

We thank Dr Sue Shepherd, Accredited Practising Dietitian for her invaluable knowledge and expertise in writing this fact sheet.