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The Effects Celiac Disease Has On Female College Athletes

By Allie Wondrasek

Abstract
The research collected will find solutions to common side effects and diet issues for female college athletes with celiac disease. Celiac disease is an autoimmune disorder that causes the body to react negatively to gluten and causes symptoms like nausea, vomiting, diarrhea, brain fog, and abdominal cramping. Females specifically struggle with this disease because they experience things like infertility issues, mental and eating disorders, and significant weight fluctuations on top of these other symptoms. Now, there is a select group of females with celiac who also play a collegiate sport and need to navigate through a successful academic and athletic life with this disease. Unfortunately, there are few answers to navigating this specific lifestyle. In addition, going on a gluten-free diet is hard because food and treatment options are
limited, so these female college athletes need to find solutions to help satisfy their diagnosis and symptoms while away at school and playing a sport. This research will find answers using the Lewis Library peer-reviewed sources and my experience as a female college athlete with celiac to develop reasonable options and plans to make this group of women’s lives easier. These include diet tips, symptom relief, and lifestyle changes needed to thrive in celiac life. Keywords: athlete, autoimmune, celiac disease, collegiate, females, gluten Introduction Celiac disease is a chronic autoimmune disease that affects a significant number of people.

Celiac disease means the person affected cannot eat gluten because it destroys their digestive tract. Since this requires such a strict diet, you can only imagine how difficult it is to find or make meals, all while assuring the right amount of nutrients are in every meal or are maintained through supplements. This is specifically challenging for athletes and, even more specifically, female college athletes. There is an excellent struggle for this specific group of people because of the more severe effects it has on women in general, as well as the stress and anxiety around eating enough to maintain a successful life and athletic career—athletes in college struggle with finding the right places and things to eat daily. Switching to a gluten-free diet comes with the stress of planning meals ahead of time and ensuring nutritional needs are
met, all while dealing with the demanding collegiate athlete lifestyle. This is so difficult for athletes in college because many dining halls do not offer gluten-free options, it is tough to prepare meals in college dorms, being on the road makes it hard to choose places to eat, and gluten-free foods are more expensive than “normal” foods in the grocery store. These are all a lot of day-to-day issues collegiate athletes with celiac disease face.

On the female side of collegiate athletes with celiac, there are plenty of added stressors in their lives specifically. Females struggle with digestion and nutrient absorption due to the natural makeup of their bodies, so celiac amplifies these issues. Iron deficiencies are typical in females because of blood loss during menstruation but can become dangerously low in females with celiac. Additionally, females have impaired fertility due to nutrient deficiencies and immune issues, making starting or maintaining a pregnancy harder. This is also why miscarriages are so common. Females are known for having “stomach problems” and problems with weight fluctuations. Hence, increased consciousness of eating and weight also increases the females’ risk for mental health issues like anxiety and depression.

I wanted to research this topic because I was diagnosed with celiac disease at 18 years old as a freshman in college. I am also a collegiate softball player, so this research has helped me find answers to my questions and hopefully help others. I have experienced all the symptoms I mentioned in this paper and know how discouraging and scary this whole lifestyle can be. Therefore, I will answer the question: How are females affected differently from males by celiac? How do people with celiac disease make sure they consume adequate nutrients to make up for malabsorption? How does celiac disease develop/what are the causes, and what are the side effects of a diet change to entirely gluten-free? These are all significant questions people with celiac would love to find the answer to help improve their quality of life and lessen their
worries.

Literature Review: Celiac Disease
As stated in a research study done by Armone & Conti (2019), “One of every 133 people in the United States has celiac disease” (p. 6), and “In the United States [...], CD affects approximately 1% of the total population,” (p. 5). Celiac disease is an autoimmune disease that desperately destroys the villi of the small intestine and digestive tract to protect them against gluten. Gluten is anything made of or contains wheat, barley, or rye. Like any food allergy, the body mistakenly identifies food as something harmful. Though this is the case for celiac disease, the only difference is that it is identified as an autoimmune disorder. This means the body creates antibodies and lymphocytes to attack these substances as they enter the body, which causes the body to attack itself. This is more severe than an allergy in that it destroys perfectly healthy parts of the body and the allergen it should only be worried about. As I mentioned, celiac damages the small intestine's villi, specifically. Villi are small, fingerlike projections that line many parts of the digestive tract and aid in absorbing vitamins, minerals, and nutrients. The small intestine is the most important digestive organ for absorption because it contains the most surface area and most villi absorb these nutrients. Since celiac targets the small intestine, people with it often have way more medical issues they deal with before or after a diagnosis. Before a diagnosis, people typically experience severe bloating, fatigue, constipation or diarrhea, headaches, and nausea or vomiting. These are some signs that it may be time to get tested for celiac through a blood test. According to a study done by Mancini (2011), “The prevalence of celiac disease is 4% to 12% in individuals with first-degree relatives who have celiac disease” (p. 9). Since celiac disease is hereditary or runs in the family, it is essential to know if another family member has
this disease to possibly push for a blood test if a doctor does not recommend one. If positive, an upper endoscopy is required to rule out more severe risks like cancers or ulcers throughout the
digestive tract and more bloodwork to look for iron or nutrient deficiencies or other autoimmune diseases. This means a long, thin camera is placed down the throat, and small biopsies are taken.
Once confirmed through all of these tests, the only treatment is a lifelong gluten-free diet. Unfortunately, this is where many female athletes begin to have trouble. There are different severities when it comes to celiac disease. If I were to eat gluten as someone with celiac, I would get severe stomach pains and experience heart palpitations. Heart palpitations are when your heart begins to beat so fast it feels like skipping a beat. This is how I know if I accidentally ate gluten or not. On the other hand, my roommate's best friend has celiac so bad that she would need to be hospitalized if she were to eat gluten. Some people even have silent celiac, which means they have no symptoms, but it is so dangerous because it still damages the digestive tract without the patient even knowing. Celiac does not treat everyone equally and
varies significantly among ages and genders.

Effects Celiac Disease Has on a Female Mind and Body
Compared to males, females have a weaker immune system and are more susceptible to the disease. It is estimated that 60-70% of all celiac diagnoses are females. Prolonged, undiagnosed celiac disease has been linked to female problems like infertility, miscarriages, chronic fatigue, early menopause, menstrual irregularities, and severe iron deficiencies. When a woman is diagnosed at a young age, they are aware of the fertility and menstrual issues that celiac could soon cause. This is something they can prepare themselves for. Females who go their whole lives not knowing they have celiac can have infertility problems or miscarriages. Celiac could be the one to point the finger at later after a diagnosis. Celiac disease is known to decrease the quality of life for a female due to these issues. Females tend to pay more attention to their weight and appearance than males. It is estimated that 75% of women have had some sort of eating disorder, diagnosed or not. Counting calories and paying attention to weight causes women a great deal of anxiety and stress due to the social pressures put on them to look a certain way. The weight fluctuations associated with celiac are widespread and cause much confusion for people affected. Although this is a symptom that celiacs have no control over, it will still cause people to try and lose or gain weight to meet their appearance expectations. Since it is so hard to control, women can develop eating disorders causing them to overeat or undereat. This is also associated with things like anxiety and depression since they constantly count calories and pay attention to everything that goes into their body. This is specifically prevalent for celiacs because of the strict diet they are on because of the disease. Being worried about cross-contamination or if a stomach ache is due to consuming gluten is an added burden in a celiac’s everyday life.

Females with celiac are more likely to develop iron deficiencies and iron deficiency anemia. Anemia is a lack of red blood cells, which are made from iron. Due to the female’s menstrual cycle, females are already more susceptible to this lack of iron. Celiac disease impairs the small intestine’s ability to absorb iron which causes celiacs to lose a great amount of iron constantly. Females not yet diagnosed with celiac may notice that they are highly fatigued, easily lightheaded, get frequent headaches, and have a faster heartbeat, especially around their menstrual cycle. Women lose, on average, 60 milliliters of blood, which is not a lot. This could also be more for women with heavy bleeding and extended periods. A sudden amplification in these symptoms may indicate an iron deficiency. Getting a blood test for iron deficiency could
also lead to a celiac diagnosis if other symptoms are present, but this does not necessarily mean the patient has celiac. In a study done by Abdlla (2017), “[...] celiac disease is one of the causes
leading to iron deficiency. Correspondingly, iron deficiency, and anemia are prevalent abnormalities in celiac disease” (p. 18). Although there is no direct correlation between the two, iron deficiency and anemia are common in people with celiac disease.

Difficulties in a College Athlete’s Everyday Life
There was a study done by Leone, Massie, and Rossi (2005) that monitored a 20-year-old female collegiate tennis player who was diagnosed with celiac disease midseason. They found, "After the tentative diagnosis, the athlete was allowed to continue competing fully as tolerated” (p. 13). A celiac disease diagnosis is not like a season-ending injury. No research shows athletes with celiac should not play a sport and should give it up right then and there. The issue is the symptoms and lifestyle changes that come with it. Being a collegiate athlete, for any sport, is insanely physically, emotionally, and mentally demanding, no matter who the person is. Athletes pay attention to their caloric and nutritional needs and goals daily. In order to be successful and to give your body the correct fuel, the right foods are a massive contributor to this success. Eating the right amount of protein, vegetables, fruits, and carbohydrates and even drinking enough water is constantly on an athlete's mind.

It is easy for a typical athlete to run into the dining hall any time during the day and grab a meal or a snack, but this is more complex for an athlete with celiac. Eating on a gluten-free diet takes a lot of strategic planning. Meals must be planned a week before to ensure athletes get the nutrition they need. This means going to the grocery at the beginning or every two weeks and buying weekly meals. Then, the athlete needs to prepare these meals by cooking them so that they are ready for the week. In a study done by Zysk and Guzek (2018), they explained that “CD patients are concerned about the possibility of finding gluten-free (GF) food products or dishes in restaurants, as well as about the possibility of cross-contamination of available GF products,” (p. 4). Even on the road, the coaching staff must talk with the athlete to find out if they are comfortable eating at certain restaurants and will be satisfied with their meal. It is all a process that takes time.

Athletes live their whole lives paying attention to their weight, muscle mass, and body fat percentages. This alone tends to cause body dysphoria and can develop eating disorders from trying to maintain weight. Sports like wrestling are more strict when it comes to this because these athletes need to maintain a certain weight to compete in a certain weight class. On the other hand, sports like basketball and softball do not require a certain weight to be maintained to play a certain position, so it is not as hard on weight. Although it is not that specific when it comes to weight, athletes are constantly weight training and doing cardio to look and feel their best to succeed in their respective sport. It is hard to not pay attention to weight losses or weight gains when it comes to being an athlete. The pressure to succeed and train your hardest is always present and is something that is unavoidable.

A few things could be improved with this lifestyle regarding being an athlete. Student-athletes dedicate so much time and energy to their sport and school that balancing a social life and having free time to do other things is hard. Being a full-time student and a collegiate athlete leaves little to no time for things like meal preparation and time for grocery shopping. This also includes finding the money to live on this gluten-free diet because, as sad as It is, it was found that gluten-free foods are 242% more expensive than non-gluten-free options. Athletes need more time to get a job to pay for this food, so it is in their best interest to research to find the cheapest meal options available. Also, these athletes can work with their trainers and coaches to help maintain a healthy relationship with food and to know when and what to eat. This helps the athlete know that they will maintain, lose, or gain weight in a healthy way and not just doing it based on habit and looks.

How to Make Life Easier
Some possible solutions for female college athletes dealing with celiac are simple, while others may be challenging. Some simple thoughts to help find gluten-free options are to research what stores carry more gluten-free options than others. Stores like Whole Foods, Aldi, and Trader Joe’s tend to be more organic based, which often indicates many gluten-free options. To know if a product is gluten-free, it is vital to look by the ingredients or on the front of the package to find the official gluten-free symbol, which is just a giant “GF.” This guarantees that there is no risk of cross-contamination or any sort of gluten in the product. In addition, some apps have barcode scanners that warn you of possible cross-contamination risks or if the product is entirely gluten-free. It is also essential to call a restaurant ahead of time to ensure that their cooks can guarantee their meals will have no contact with gluten and are safe for celiacs to eat. Most restaurants are beginning to be way more accommodating to this since there is a general rise in people who eat gluten-free.

Some things in the celiac lifestyle will be much more time-consuming, but they also lower anxiety or worries around eating. The first solution is to prepare meals ahead of time. This includes making a list of needed ingredients for the week, going to the grocery store, and preparing these meals in the athlete’s downtime or on the weekend. These meals must also meet all specific dietary needs, not just random ones. This is specifically important for athletes because it is hard to find time during the day to take the time to cook a fresh meal thoroughly. It is relieving to know that food is already prepared in the refrigerator that can be popped in the microwave anytime, especially on the go. This allows less time to worry about when and where the athlete will eat and not have to schedule this around practice and game times. It allows them
to eat when hungry, not just when a specific dining hall is open. Also, it is crucial to find snacks that are nutritional and that are enjoyable. These snacks can be brought onto long bus rides, to games, and just around campus during school hours. It is nice knowing extra snacks and food can be enjoyed at a hotel or a respected sport. These athletes can also talk with a dietician or nutritionist to help make a meal plan. These people specialize in helping others meet their nutritional needs. They are not just for weight loss or gain; they benefit people with allergies and other athletic goals.

Females must keep up with their doctor’s appointments and track any physical or emotional changes due to celiac. It is also essential to keep up with vitamin and mineral supplements to help compensate for impaired absorption and iron deficiencies. This will help maintain a healthy internal balance and keep the mind happy, knowing it is being cared for. Also, it is important to understand the disease itself to relieve any of this added stress that is around weight and eating to help maintain a healthy relationship with food as well. It is important to listen to your body and fuel it as needed. See a doctor if you notice any negative thoughts towards your body or find it hard to eat correctly. There are dietitians, trainers, and nutritionists that are available to make this easier.

Later in life, it is important to talk with a doctor when trying to have a baby or if there are any problems maintaining a pregnancy because celiac could be the reason. During a pregnancy, it is important to keep up with food intake and to maintain the supplement routine to help the baby get the nutrients it needs as well due to the lack of absorption. Since the baby eats whatever the mom eats, it is important to keep up with this disease. Celiac makes eating hard as it is; there is no reason to struggle anymore.

Universities can help these student-athletes by incorporating more gluten-free options in their dining halls. A study done by Sandvik (2020) found that “Students discussed accommodations provided by dining and other, non-athletic, university services. Some participants reported their dining services offered a gluten-free section. These participants were grateful for this accommodation and expressed less food insecurity” (p. 17). Having gluten-free options makes students less worried that they will or will not have something to eat at different times throughout the day. Universities can be more accommodating by paying attention to the
students with celiac at their school and helping them feel more comfortable and confident in their eating habits on campus.

Conclusion
My research has found more negatives than positives for a female college athlete with celiac disease. Although celiac causes a person to eat more cleanly, it is hard to find gluten-free options on the road or at most universities. Females with celiac endure so much stress and confusion when trying to navigate the gluten-free lifestyle, and athletes deal with the stress of their sport and school on top of it all. Females experience minor things, from weight loss and weight gain to hurtful things like infertility problems. Celiac causes excellent frustration for female college athletes and the people around them. From ensuring all meals are covered to guarantee success on the field or court to ensuring all required medicine is taken, it is a lot for an athlete to go through daily.

A celiac and gluten-free lifestyle is expensive, draining, and hard to navigate initially, but it gets easier the longer you do it. Celiac disease is manageable and can be mastered through enough research and experience. Celiacs may need some help from universities and people around them, but there are options available. Female college athletes dealing with celiac disease can improve their quality of life and live academically and athletically successful lives as they did before celiac. It just takes time and experience. Celiac does not define female college athletes.

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