AIS Sports Nutrition

Gluten-free diets

What is a gluten-free diet?

Gluten is a protein found in wheat, rye, barley, triticale and possibly oats. It is also present in foods made from these, for example, malt. A gluten-free diet avoids all foods that contain gluten.

Who needs a gluten-free diet?

Anyone who has coeliac disease needs to follow a gluten-free diet. Coeliac disease is a permanent intolerance to gluten. The walls of the small intestine are lined with tiny finger-like projections called villi. The villi are necessary for digesting and absorbing nutrients such as carbohydrate, fat and protein. When people with coeliac disease eat gluten, the villi become flattened and inflamed. This interferes with the absorption of nutrients and can cause poor nutritional status along with symptoms such as weight loss, diarrhoea, abdominal pain, and anaemia.

Is there any advantage in following a gluten-free diet if I don't have coeliac disease or a related condition?

No. There is no advantage in avoiding gluten if you do not have coeliac disease or a related medical condition. The majority of people are capable of digesting gluten without any impact on the villi in the intestine. Many symptoms such as gastrointestinal discomfort and fatigue are attributed to gluten or wheat 'allergies'. Consequently, it has become popular to restrict the intake of foods containing wheat and gluten. However, there is no scientific reason to justify the exclusion of gluten unless coeliac disease or a related condition is diagnosed. Following a gluten-free diet is very complex and time-consuming. Athletes who do not have coeliac disease will waste valuable effort learning all about this complex diet, which would be better spent on other aspects of good eating and hard training. Any diet that unnecessarily restricts the range of foods that an athlete can eat is at risk of causing nutrient deficiencies and reducing the enjoyment and ease of eating.

How will I know if I have coeliac disease?

Coeliac disease may cause a number of symptoms including diarrhoea, anaemia (due to poor absorption of iron, folate and B12), mouth ulcers, indigestion, abdominal pain, bloating, weight loss, fatigue, and infertility. These symptoms can also be caused by a number of other conditions so it is essential that coeliac disease is diagnosed by a doctor before you decide to follow a gluten-free diet. These symptoms may not be significant in some individuals.

The only method to conclusively diagnose coeliac disease is via a small bowel biopsy. This involves a gastroscopy (passing a tube from the mouth into the gut) to sample the wall of the small intestine. Total or partial flattening of the villi whilst consuming a gluten-containing diet indicates coeliac disease. It is important not to trial a gluten-free diet before having the small bowel biopsy, as the villi may return to normal and prevent a proper diagnosis. A blood test alone is insufficient to diagnose coeliac disease, although it can be used as a screening aid to measure the level of antibodies to gluten. A blood test can help to identify if a small bowel biopsy is required.

How is coeliac disease treated?

Treatment of coeliac disease requires a gluten-free diet for life. When gluten is removed from the diet, the damage to the small intestine heals. Symptoms usually begin to improve within days of eliminating gluten, and in most people the symptoms will eventually disappear. It is essential to remain on the gluten-free diet even though symptoms improve. The consumption of even small amounts of gluten will cause damage to recur and can increase the risk of problems such as nutritional deficiencies, osteoporosis, infertility, miscarriage, gastrointestinal cancer and chronic ill health. When coeliac disease is conclusively diagnosed, it is essential to remain on the gluten-free diet for life.

What foods must be avoided on a gluten-free diet?

Gluten is found in wheat, rye, barley, and triticale. These grains and foods containing them need to be avoided on a gluten-free diet. Oats are also currently excluded in a gluten-free diet to avoid cross-contamination of gluten from wheat products. Many foods made from these grains are obvious, for example, breads, breakfast cereals, cakes, biscuits and pasta. However, there are a number of foods which contain hidden gluten in the form of additives such as thickeners, stabilisers and flavours. People with coeliac disease need to become skilled at reading ingredient lists and recognising potential sources of gluten. The Coeliac Society of Australia is able to help in the identification of problem foods. It is also recommended that people starting a gluten-free diet seek advice from an accredited practicing dietitian (APD) for individualised advice.

What foods are suitable on a gluten-free diet?

Plain meat, fish, chicken, fruit, vegetables, legumes, dairy products, fats and oils are gluten-free and can be enjoyed on a gluten-free diet. Grains and "starchy" foods that are gluten-free included rice, corn/maize, potato, tapioca/arrowroot, sago, soya, lentil/pea, amaranth, lupin, buckwheat, sorghum, quinoa and millet. These foods are used to make a wide range of gluten-free products including breads, bread mixes, pasta, biscuits, crackers, cakes, pastries and mixes for biscuits, pancakes and pizzas.

The following table provides a guide to foods that are gluten-free. The composition of products can change regularly therefore this table is subject to change. It is necessary to continually check the ingredients on all products. The Coeliac Society of Australia is able to provide the most up-to-date advice on the status of foods. If there is any doubt about a food, it is best to avoid it.

Food Gluten-Free (Safe to Eat) Contains Gluten (Must be Avoided)

Breads

Gluten-free breads, rolls etc. and breadcrumbs made from these

Regular breads, rolls, muffins, crumpets, breadcrumbs

Cereals and Grains

Specialty gluten-free cereals, rice and corn breakfast cereals without malt extract, polenta, sago

Wheat-based breakfast cereals, porridge, cous cous, barley

Pasta and Noodles

Gluten-free pasta, rice noodles

Wheat-based pasta and noodles

Rice

All types - white, brown, glutinous, rice bran, rice flakes

 

Flours

Corn flour made from maize (NB. some corn flours are wheat based and must be avoided), rice flour, gluten-free flour (plain and self-raising)

Wheat flour (white, wholemeal, self-raising, organic), cornflour made from wheat, rye flour, gluten flour

Biscuits, Cakes, Pastries

Gluten-free biscuits, cakes, pastries and mixes, plain rice cakes or crackers

Regular crackers, cakes, crispbreads, biscuits and pastries, flavoured rice crackers*

Fruit

Fresh, canned, dried, stewed, preserved (no thickeners added)

Fruit mince*, pie fillings and commercial thickened products*

Vegetables

Fresh, frozen and canned (no thickeners added), fresh herbs, dried pulses, legumes and lentils, tofu

Commercial vegetables in sauce*, commercial hot chips, processed or canned legumes*

Soups

 

Clear soups (with gluten-free stockcubes), soups thickened with gluten-free flours, rice, gluten-free pasta, lentils and pulses

Soups containing thickeners, cereals or grains e.g. barley, noodles, pasta

Dairy Products

Fresh or powdered milk, cream, plain cheese, yoghurt*, dairy snacks*, icecream*

Malted milks, artificial cream, cheese dips*, yoghurt dips*, icecream with cone, wafer or biscuit crumbs

Lollies and Sugars

Sugar (white, brown, caster), pure icing sugar, plain dark and milk chocolate, chocolate bits

Soft icing sugar, icecream toppings, sweets*, lollies*, filled chocolates*, chocolate bars* and chocolate snack foods*

Snack Foods

Plain popcorn, plain potato chips*, plain corn chips*

 

Pretzels, flavoured crisps*, flavoured corn chips*

Sauces

Tomato sauce, gluten-free gravy mixes, gluten-free stock cubes, white vinegar, balsamic vinegar

Commercial sauces*, soy sauce*, most stock cubes and gravy mixes*, malt vinegar

Drinks

Water, mineral water (plain and flavoured), soft drinks, tea, coffee, red wine, white wine

Coffee substitutes, milk flavourings, beer, drinking chocolate*

* Check the label carefully on these products. 

How do I read food labels to ensure that foods are gluten-free?

Only foods that are gluten-free can be included in this diet - even foods labeled as "low gluten" must be avoided. According to Australian Food Standards, gluten-free foods must not contain any detectable gluten, with a specific limit of 0.003%. Any food that carries a claim of being gluten-free must have a nutrition information panel that specifically lists the amount of gluten it contains.

In the case of foods that don't have a nutrition information panel containing details about gluten content, it is necessary to read the ingredient list to check that all ingredients are gluten-free. You can obtain a copy of an ingredients list book when you join your local Coeliac Society of Australia. This book is an essential guide to the ingredients in foods and anyone with coeliac disease should ensure they have an up-to-date copy.

What nutritional issues exist for athletes with coeliac disease?

Carbohydrate

Many common carbohydrate-rich meals and snacks are based on foods containing gluten, which means athletes with coeliac disease need to be careful when choosing suitable carbohydrate foods to ensure they consume adequate amounts. The following table lists some examples of sports foods used at the AIS which are gluten-free and also those that need to be avoided (contain gluten). Keep in mind that the composition of products can change so always check the ingredient list before using any product.

Sports Food/Drink Gluten-Free (Safe to Eat) Contains Gluten (Must Be Avoided)

Sports Drinks

Gatorade

 

Meal Replacement Drinks

PowerBar Protein Plus Powder
Sustagen Sport
Ensure Hospital Formula

 

Sports Gels

Carboshotz
PowerBar Gels
Gu Energy Gels

 

Sports Bars

 

PowerBars
Uncle Toby’s muesli bars

Electrolyte Powders

Gatorlytes

 

Fibre 

Many foods that contain gluten also provide fibre. Athletes with coeliac disease need to include plenty of gluten-free, fibre-rich foods in their eating plans to ensure an adequate fibre intake. It is recommended that at least 30 g of fibre be consumed each day. Common gluten-free sources of fibre include fruit, vegetables, legumes, lentils, rice bran, psyllium husks, soy flour, soy grits, brown rice, nuts and seeds.

The table below provides examples of the fibre content of some gluten-free foods:

Gluten-Free Food Fibre (g)

1 slice gluten-free bread

1-2

1 rice cake

0.25

50 g gluten-free muesli

4

1 cup cooked white rice

3

1 cup cooked gluten-free corn pasta

2

1 cup baked beans

10

1 cup cooked lentils

6.5

1 medium apple

3

1 medium orange

4

1 medium potato

1

2/3 cup cooked carrots

3

1/3 cup cooked peas

3

Travelling

Overseas 

Athletes travelling to other parts of the world need to be aware of the differences in food labeling laws between various countries. Gluten-free standards in the United Kingdom are less strict than Australian standards. In the UK, foods may be labeled gluten-free if they contain less than 0.3% gluten. In Australia, gluten-free foods must contain less than 0.003% gluten. Standards for gluten-free foods are even more restrictive in the United States with all foods made from gluten-containing grains excluded.

Before going overseas, it is valuable to consult an Australian sports dietitian to investigate any differences in gluten-free labeling laws and receive advice about the best foods to include in your country of destination. Your local branch of the Coeliac Society of Australia can also provide a letter translated into many foreign languages which explains your condition and the dietary restrictions required.

Airline Travel 

Most airlines are able to provide gluten-free meals provided you book in advance. Let the airline know of your special dietary requirements when you book your flight, and double-check this with the airline at least a few days prior to departure to confirm that they still have your requirements on their records. The gluten-free meal will be recorded with your seat number, so let the cabin crew know if you change seats during the flight. It's also a good idea to take some gluten-free foods with you for use in case of emergency, both on the plane (for example, if your gluten-free meal is not available) and during the trip (if it's hard to find foods in your new location).

Interstate Travel 

When travelling interstate, contact the local state-based coeliac society for information on the local availability of gluten-free foods. For example, gluten-free fresh bread, food outlets and recommended cafes and restaurants.

What resources are available for athletes with coeliac disease?

The Coeliac Society of Australia is an invaluable resource for anyone with coeliac disease. Membership entitles you to access to information sessions, handouts covering ingredients and food labeling (including the ingredient list book), cooking issues, recipe books, shopping tours, eating out, availability of gluten-free products, advice on travel etc. The society provides a regular magazine and support groups, and will make it easier to cope with coeliac disease and gluten-free eating

Written by AIS Sports Nutrition, AIS © Australian Sports Commission Updated in 2009.

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