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A Nutritionist’s View: Treating Clients With Celiac Disease

Volpe, Stella Lucia Ph.D., R.D., L.D.N., FACSM

doi: 10.1249/FIT.0b013e31823d043e

Treating Clients With Celiac Disease.

Stella Lucia Volpe, Ph.D., R.D., L.D.N., FACSM, is professor and chair of the Department of Nutrition Science at Drexel University, Philadelphia, PA. Her degrees are in both nutrition and exercise physiology; she also is ACSM Exercise Specialist® certified and a registered dietitian. Dr. Volpe’s research focuses on obesity and diabetes prevention using traditional interventions, mineral supplementation, and more recently, by altering the environment to result in greater physical activity and healthy eating. Dr. Volpe is an associate editor of ACSM’s Health & Fitness Journal®.

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Celiac disease, also known as celiac sprue, nontropical sprue, gluten intolerance, or gluten-sensitive enteropathy, is a condition that results in damage to the lining of the small intestine, decreasing its ability to absorb some foods. This damage is a result of a reaction to gluten, which is a protein complex found in foods processed from wheat, barley, and rye. Gluten’s role is to act as a “glue,” giving elasticity to dough, allowing it to rise. The cause of celiac disease is not known, although individuals who are more likely to contract celiac disease are those with autoimmune disorders such as type 1 diabetes mellitus, Addison disease, thyroid disease, or lupus. Because the symptoms of celiac disease are so varied among individuals, diagnosis can be difficult. Some symptoms include diarrhea, steatorrhea (fatty stools), abdominal pain, and indigestion. For some, these can be very painful, for others, the symptoms may be less painful but then become worse over time (2).

Celiac disease occurs in about 1% of the population in the United States. The prevalence of celiac disease in an otherwise healthy person is 1 in 133 people. In individuals who have related symptoms, the risk increases to 1 in 56 people (3,6).

If there is a suspicion of celiac disease, it is important not to begin a gluten-free diet before testing because it may affect the testing. Once diagnosed, a change to a gluten-free diet will be sufficient for a person’s symptoms to dissipate; however, corticosteroids, like prednisone, might also be prescribed, even for short periods, to help with the pain. Going to see a registered dietitian who specializes in celiac disease would be a good start in helping to move forward and becoming symptom-free (5,7).

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Mancini et al. (5) emphasize the importance of sports medicine physicians to recognize celiac disease in athletes. Athletes with celiac disease usually have difficulty with iron absorption and vitamin D and calcium absorption, leading to anemia and poor bone health, respectively. They state the importance of care for athletes who have had celiac disease for a long period to ensure reduction in symptoms and maintenance of their normal training and competition schedule.

In a case study, Eberman and Cleary (1) presented an elite female volleyball player complaining of diarrhea and fatigue after preseason training. She had lost 8.1 kg of body weight during her first 20 days of training. At first, an eating disorder was suspected, but after careful evaluation, she was referred to a gastroenterologist. The athlete was diagnosed, based on her diarrhea, weight loss, and blood test results, as having celiac disease. A duodenal biopsy confirmed the diagnosis.

The athlete was treated with a gluten-free diet that incorporated enough kilocalories to maintain a healthy body weight and for optimal performance. The authors concluded, “One in every 200 to 400 individuals has celiac disease; many of these individuals are asymptomatic and, therefore, their conditions are undiagnosed. Undiagnosed, untreated celiac disease and patients who fail to follow the gluten-free diet increase the risk of further problems” (1). Leone et al. (4) presented a similar case study in a female collegiate tennis player. Once the athlete had been properly diagnosed and treated, she was able to return to practice and competition at a National Collegiate Athletic Association Division I tennis program.

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Although treatment of celiac disease is straightforward, it requires a major change in a person’s life. Suddenly, a person needs to avoid wheat, barley, and rye. At first, this is difficult because reading food labels is required to help a person adhere to the dietary restriction needed to ensure that there is no gluten within the food and become symptom-free. Typically, taking a multivitamin/mineral supplement each day also will help. When eating out at restaurants, many have gluten-free menus, but for those that do not, it may take a little more time for a person to order because they must ensure that there will be no gluten present in the meal. Having dined with several friends of mine who have celiac disease, I’ve found that some restaurants are very accommodating, although others are not simply because they are not set up to do so.

The Table lists some foods that are gluten-free. Fortunately, there are many more gluten-free foods today than there were in the past. Note that individuals with celiac disease also must be aware of gluten in over-the-counter medications, vitamins, cosmetics, lipstick, lip balms, and lip gloss.

The author declares no conflict of interest and does not have any financial disclosures.

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Recommended Readings

American Dietetic Association:
National Foundation for Celiac Awareness:
The University of Chicago Celiac Disease Center:
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1. Eberman LE, Cleary MA. Celiac disease in an elite female collegiate volleyball athlete: a case report. J Athl Train. 2005;40(4):360–4.
2. Green PH, Cellier C. Celiac disease. N Engl J Med. 2007;357:1731–43.
3. Green PH. Where are all those patients with celiac disease? Am J Gastroenterol. 2007;102(7):1461–3.
4. Leone JE, Gray KA, Massie JE, Rossi JM. Celiac disease symptoms in a female collegiate tennis player: a case report. J Athl Train. 2005;40(4):365–9.
5. Mancini LA, Trojian T, Mancini AC. Celiac disease and the athlete. Curr Sports Med Rep. 2011;10(2):105–8.
6. Semrad CE, Powell DW. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Ausiello D, editors. Cecil Medicine. 23rd ed. Philadelphia (PA): Saunders Elsevier; 2007. chap 143.
7. The University of Chicago Celiac Disease Center [cited 2011 Sept 9]. Available fromml:
© 2012 American College of Sports Medicine.