Celiac Disease in Athletics: An Under-recognized Condition? James E. Leone, Ph.D., LAT, ATC, CSCS,*D, CHES The George Wash...
<ul><li>What is Celiac Disease? </li></ul>
Background <ul><li>Body sensitivity to gluten </li></ul><ul><li>Autoimmune response </li></ul><ul><li>Cellular damage res...
Also known as… <ul><li>Celiac sprue </li></ul><ul><li>Gluten sensitive enteropathy </li></ul><ul><li>Coeliac Disease </li>...
Common Differential Dx with CD Addison Disease Pernicious Anemia Celiac Disease Crohn’s Disease Diverticular Disease Fibro...
Histology
Normal vs. Pathological Villi
Comparison
Crypt Hyperplasia
Prevalence of CD <ul><li>Typical stats range between 1 in every 250-300 people* </li></ul><ul><li>More recent data suggest...
Geographic & Regional Factors <ul><li>CD is common in European countries: Ireland, Italy, Sweden, & Austria. </li></ul><u...
Geographic & Regional Factors <ul><li>Most population studies underestimate the prevalence of CD because many patients who...
The Impact of CD in Athletics <ul><li>NCAA reports approx. 380,000 athletes* </li></ul><ul><ul><li>If 1:3000 = 127 athle...
The Impact of CD in Athletics <ul><li>Approximately 7.2 million H.S. athletes in U.S.* </li></ul><ul><ul><li>If 1:3000 = ...
How to identify CD <ul><li>Symptoms of celiac disease include: </li></ul><ul><li>gas </li></ul><ul><li>recurring abdomina...
CD: Signs & Sx’s
The Culprit <ul><li>GLUTEN </li></ul>
Consequences <ul><li>Stunted growth </li></ul><ul><li>Failure to thrive </li></ul><ul><li>Loss of key minerals & nutrients...
Identification & Treatment Options <ul><li>Identification </li></ul><ul><li>ELISA panel test </li></ul><ul><li>Immunoglobu...
Essentials of the GFD Thompson T. Celiac Disease Nutrition Guide , 2nd ed. Chicago: American Dietetic Association; 2006. ...
GFD (Cont.) Thompson T. Celiac Disease Nutrition Guide , 2nd ed. Chicago: American Dietetic Association; 2006. © American...
GFD (Cont.) Thompson T. Celiac Disease Nutrition Guide , 2nd ed. Chicago: American Dietetic Association; 2006. © American...
<ul><li>Case Studies in Athletics </li></ul>
Case Study #1 <ul><li>Celiac Disease Symptoms in a Female Collegiate Tennis Player: A Case Report </li></ul><ul><li>Treatm...
Cow’s Milk Gliadin Gluten Rye Wheat Leone et al. J Athl Train . 2005;40(4):365-369.
Leone et al. J Athl Train . 2005;40(4):365-369.
Case Study #2 <ul><li>Celiac Disease in an Elite Female Collegiate Volleyball Athlete: A Case Report </li></ul><ul><li>Bac...
Athlete’s Blood Panel Eberman & Cleary. J Athl Train . 2005;40(4):360-364.
Discussion of Case Studies <ul><li>One presents w/ clinically significant sx’s </li></ul><ul><li>Other presents w/ underly...
Personal Communications <ul><li>“ I have been searching & searching for any research on CD & athletes, & I came across you...
<ul><li>“ I found your web abstract on CD. I have a 20 yr old daughter who is a basketball player at the national level. S...
Take-Home Points: <ul><li>People w/ CD can’t eat foods or use items w/ gluten </li></ul><ul><li>CD harms the small intesti...
Resources <ul><li>Celiac Disease Awareness Campaign National Digestive Diseases Information Clearinghouse 2 Information Wa...
<ul><li>American Celiac Society P.O. Box 23455 New Orleans, LA 70183–0455 Phone: 504–737–3293 Email: [email_address] Inte...
<ul><li>American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL 60606–6995 Phone: 1–800–877–1600 E...
<ul><li>Celiac Disease Foundation 13251 Ventura Boulevard, #1 Studio City, CA 91604 Phone: 818–990–2354 Fax: 818–990–2379 ...
<ul><li>Celiac Sprue Association/USA Inc. P.O. Box 31700 Omaha, NE 68131–0700 Phone: 1–877–CSA–4CSA (272–4272) Fax: 402–55...
<ul><li>Gluten Intolerance Group of North America 31214 124th Avenue SE Auburn, WA 98092 Phone: 253–833–6655 Fax: 253–833–...
<ul><li>National Foundation for Celiac Awareness P.O. Box 544 Ambler, PA 19002 Phone: 215–325–1306 Email: [email_address]...
Select References <ul><li>Ciacci et al. Scand J Gastroenterol. 1995;30(11):1077-81) </li></ul><ul><li>Maaki M et al. Gut...
THANKS FOR ATTENDING!
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Nata.2008.Celiac.Athletics.Leone

Celiac Disease in Athletics
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Nata.2008.Celiac.Athletics.Leone

  • 1. Celiac Disease in Athletics: An Under-recognized Condition? James E. Leone, Ph.D., LAT, ATC, CSCS,*D, CHES The George Washington University Department of Exercise Science School of Public Health and Health Services Email: jleoneatc@yahoo.com
  • 2. <ul><li>What is Celiac Disease? </li></ul>
  • 3.
  • 4. Background <ul><li>Body sensitivity to gluten </li></ul><ul><li>Autoimmune response </li></ul><ul><li>Cellular damage results </li></ul><ul><ul><li>Small intestine </li></ul></ul><ul><li>Nutrient Absorption </li></ul>
  • 5. Also known as… <ul><li>Celiac sprue </li></ul><ul><li>Gluten sensitive enteropathy </li></ul><ul><li>Coeliac Disease </li></ul><ul><li>Gluten intolerance </li></ul><ul><li>Gee-Herter-Heubner disease </li></ul><ul><li>Non-tropical sprue </li></ul>
  • 6. Common Differential Dx with CD Addison Disease Pernicious Anemia Celiac Disease Crohn’s Disease Diverticular Disease Fibromyalgia (CRPS) Lactose Intolerance Leone et al. (2005) J Athl Train ; 40(4):365-369
  • 7. Histology
  • 8. Normal vs. Pathological Villi
  • 9. Comparison
  • 10. Crypt Hyperplasia
  • 11.
  • 12. Prevalence of CD <ul><li>Typical stats range between 1 in every 250-300 people* </li></ul><ul><li>More recent data suggest 1in every 100-150 people** </li></ul>* Worldwide: geographic regions vary **Ciacci et al ( Scand J Gastroenterol , 1995 Nov, 30:11, 1077-81); Marcu Maaki et al., 2006.
  • 13. Geographic & Regional Factors <ul><li>CD is common in European countries: Ireland, Italy, Sweden, & Austria. </li></ul><ul><ul><li>Northern Ireland, for example, one in every 300 people has CD. </li></ul></ul><ul><li>In Finland, prevalence may be as high as one in every 100 persons. </li></ul><ul><li>CD also occurs in N. America where the prevalence has been estimated at one in every 3000 people. </li></ul>Source: http://www.medicinenet.com/celiac_disease/article.htm
  • 14. Geographic & Regional Factors <ul><li>Most population studies underestimate the prevalence of CD because many patients who develop CD have few or no sx’s until later in life. </li></ul><ul><ul><li>Iceberg model </li></ul></ul><ul><li>A recent study in the U.S. suggests that the prevalence of CD in the U.S. is similar to Europe. </li></ul>Source: http://www.medicinenet.com/celiac_disease/article.htm
  • 15.
  • 16. The Impact of CD in Athletics <ul><li>NCAA reports approx. 380,000 athletes* </li></ul><ul><ul><li>If 1:3000 = 127 athletes </li></ul></ul><ul><ul><li>If 1:250-300 = 1267-1520 athletes </li></ul></ul><ul><ul><li>If 1:100-150 = 2533-3800 athletes </li></ul></ul>Source: NCAA CHOICES Program: 2008
  • 17. The Impact of CD in Athletics <ul><li>Approximately 7.2 million H.S. athletes in U.S.* </li></ul><ul><ul><li>If 1:3000 = 2400 athletes </li></ul></ul><ul><ul><li>If 1:250-300 = 24,000-28,800 athletes </li></ul></ul><ul><ul><li>If 1:100-150 = 48,000-72,000 athletes </li></ul></ul>Source: National Federation of State High School Associations (NFHS). 2005--2006 High School Athletics Participation Survey. Indianapolis, IN: NHFS; 2006.
  • 18. How to identify CD <ul><li>Symptoms of celiac disease include: </li></ul><ul><li>gas </li></ul><ul><li>recurring abdominal bloating and pain </li></ul><ul><li>chronic diarrhea </li></ul><ul><li>pale, foul-smelling, or fatty stool </li></ul><ul><li>weight loss / weight gain </li></ul><ul><li>fatigue </li></ul><ul><li>unexplained anemia (a low count of red blood cells causing fatigue) </li></ul><ul><li>bone or joint pain </li></ul><ul><li>osteoporosis, osteopenia </li></ul><ul><li>behavioral changes </li></ul><ul><li>tingling numbness in the legs (from nerve damage) </li></ul><ul><li>muscle cramps </li></ul><ul><li>seizures </li></ul><ul><li>missed menstrual periods (often because of excessive weight loss) </li></ul><ul><li>infertility, recurrent miscarriage </li></ul><ul><li>delayed growth, failure to thrive in infants </li></ul><ul><li>pale sores inside the mouth, called aphthous ulcers </li></ul><ul><li>tooth discoloration or loss of enamel </li></ul><ul><li>itchy skin rash called dermatitis herpetiformis </li></ul>
  • 19.
  • 20. CD: Signs & Sx’s
  • 21. The Culprit <ul><li>GLUTEN </li></ul>
  • 22. Consequences <ul><li>Stunted growth </li></ul><ul><li>Failure to thrive </li></ul><ul><li>Loss of key minerals & nutrients </li></ul><ul><ul><li>Vit. K, Na+, Ca </li></ul></ul><ul><li>Weight Loss </li></ul><ul><li>Seizures </li></ul><ul><li>GI ulcers/CA (adenocarcinoma) </li></ul><ul><li>Death… </li></ul>
  • 23. Identification & Treatment Options <ul><li>Identification </li></ul><ul><li>ELISA panel test </li></ul><ul><li>Immunoglobulin A (IgA) </li></ul><ul><li>anti-tissue transglutaminase (tTGA) </li></ul><ul><li>IgA anti-endomysium antibodies (AEA) </li></ul><ul><li>Treatment </li></ul><ul><li>Strict GFD </li></ul><ul><li>Tx for skin issues </li></ul><ul><ul><li>Dapsome </li></ul></ul><ul><li>Vitamin & mineral supplementation </li></ul>
  • 24. Essentials of the GFD Thompson T. Celiac Disease Nutrition Guide , 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. Adapted with permission. For a complete copy of the Celiac Disease Nutrition Guide , please visit www.eatright.org . Allowed Foods Amaranth Arrowroot Buckwheat Cassava Corn Flax Indian rice grass Job’s tears Legumes Millet Nuts Potatoes Quinoa Rice Sago Seeds Soy Sorghum Tapioca Wild Rice Yucca
  • 25. GFD (Cont.) Thompson T. Celiac Disease Nutrition Guide , 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. Adapted with permission. For a complete copy of the Celiac Disease Nutrition Guide , please visit www.eatright.org . Foods To Avoid <ul><li>Wheat Including einkorn, emmer, spelt, kamut </li></ul><ul><li>Wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein </li></ul>Barley Rye Triticale (a cross between wheat and rye)
  • 26. GFD (Cont.) Thompson T. Celiac Disease Nutrition Guide , 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. Adapted with permission. For a complete copy of the Celiac Disease Nutrition Guide , please visit www.eatright.org . Other Wheat Products Bromated flour Durum flour Enriched flour Farina Graham flour Phosphated flour Plain flour Self-rising flour Semolina White flour Processed Foods that May Contain Wheat, Barley, or Rye Bouillon cubes Brown rice syrup Chips/potato chips Candy Cold cuts, hot dogs, salami, sausage Communion wafer French fries Gravy * Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer.
  • 27. <ul><li>Case Studies in Athletics </li></ul>
  • 28. Case Study #1 <ul><li>Celiac Disease Symptoms in a Female Collegiate Tennis Player: A Case Report </li></ul><ul><li>Treatment: The athlete underwent a series of blood & allergen tests to confirm/refute a dx of CD. When CD was suspected, dietary modifications were made to eliminate all wheat-based & gluten-based products from the athlete's diet. </li></ul><ul><li>Uniqueness: The athlete was able to fully compete in a competitive NCAA D-I tennis program while experiencing the debilitating effects associated w/ CD. The immediacy of sx onset was notable because the athlete had no history of similar complaints. </li></ul>Leone et al. J Athl Train . 2005;40(4):365-369.
  • 29. Cow’s Milk Gliadin Gluten Rye Wheat Leone et al. J Athl Train . 2005;40(4):365-369.
  • 30. Leone et al. J Athl Train . 2005;40(4):365-369.
  • 31. Case Study #2 <ul><li>Celiac Disease in an Elite Female Collegiate Volleyball Athlete: A Case Report </li></ul><ul><li>Background: Athlete lost 8.1 kg during the first 20 days of training, & we initially suspected an eating disorder . </li></ul><ul><ul><li>found she did not have psychological sx’s indicative of an eating disorder. </li></ul></ul><ul><ul><li>Results of routine blood tests revealed critically high platelet counts; in conjunction w/ physical findings, the athlete was referred to a gastroenterologist. </li></ul></ul><ul><li>Treatment: Tx w/ a GFD, which excludes wheat, barley, and rye. </li></ul><ul><li>Uniqueness: The presence of active CD may not be uncommon. However, elite athletes who face CD present a new challenge for the athletic trainer. The athletic trainer can help guide the athlete in coping w/ lifestyle changes associated w/ a GFD. </li></ul>Eberman & Cleary. J Athl Train . 2005;40(4):360-364.
  • 32. Athlete’s Blood Panel Eberman & Cleary. J Athl Train . 2005;40(4):360-364.
  • 33. Discussion of Case Studies <ul><li>One presents w/ clinically significant sx’s </li></ul><ul><li>Other presents w/ underlying sx’s (anorexia n.) </li></ul><ul><li>BOTH are likely CD, but high functioning </li></ul><ul><li>Different ways in which they were managed </li></ul><ul><ul><li>Many doctor’s have not experienced or heard of CD, particularly in athletes </li></ul></ul>
  • 34. Personal Communications <ul><li>“ I have been searching & searching for any research on CD & athletes, & I came across your article in the JAT. I am the captain of the men’s soccer team at X University & I was just dx w/ CD. I have had 2 injury filled & frustrating yrs as I pushed myself through my muscle fatigue, weight loss, & weakness. I have high hopes to return to my former health. I am wondering how hard to train & whether there are supplements that celiac athletes should take? I am desperate for some kind of help. Any information would be appreciated!” </li></ul>Personal communication, 3/18/2006
  • 35. <ul><li>“ I found your web abstract on CD. I have a 20 yr old daughter who is a basketball player at the national level. She had a 3 week episode of serious leg cramps & is now hospitalized for vertigo & cramps that go on for 2 hrs at a time. She has had so many tests, but nothing has been found. She has lost weight, but denies an ED. Please help!” </li></ul><ul><ul><li>Communication from Finland </li></ul></ul>Personal communication, 3/18/2006
  • 36. Take-Home Points: <ul><li>People w/ CD can’t eat foods or use items w/ gluten </li></ul><ul><li>CD harms the small intestine. </li></ul><ul><li>People w/ untreated CD can’t get needed nutrients. </li></ul><ul><li>Without tx, people w/ CD can develop other health problems. </li></ul><ul><li>CD is dx by blood tests & biopsy of the small intestine. </li></ul><ul><li>A GFD must be followed for life. </li></ul><ul><li>A dietitian can help people choose the right foods. </li></ul>
  • 37.
  • 38. Resources <ul><li>Celiac Disease Awareness Campaign National Digestive Diseases Information Clearinghouse 2 Information Way Bethesda, MD 20892–3570 Phone: 1–800–891–5389 Fax: 703–738–4929 Email: [email_address] Internet: www.celiac.nih.gov </li></ul>
  • 39. <ul><li>American Celiac Society P.O. Box 23455 New Orleans, LA 70183–0455 Phone: 504–737–3293 Email: [email_address] Internet: www.americanceliacsociety.org </li></ul>
  • 40. <ul><li>American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL 60606–6995 Phone: 1–800–877–1600 Email: [email_address] Internet: www.eatright.org </li></ul>
  • 41. <ul><li>Celiac Disease Foundation 13251 Ventura Boulevard, #1 Studio City, CA 91604 Phone: 818–990–2354 Fax: 818–990–2379 Email: [email_address] Internet: www.celiac.org </li></ul>
  • 42. <ul><li>Celiac Sprue Association/USA Inc. P.O. Box 31700 Omaha, NE 68131–0700 Phone: 1–877–CSA–4CSA (272–4272) Fax: 402–558–1347 Email: [email_address] Internet: www.csaceliacs.org </li></ul>
  • 43. <ul><li>Gluten Intolerance Group of North America 31214 124th Avenue SE Auburn, WA 98092 Phone: 253–833–6655 Fax: 253–833–6675 Email: [email_address] Internet: www.gluten.net </li></ul>
  • 44. <ul><li>National Foundation for Celiac Awareness P.O. Box 544 Ambler, PA 19002 Phone: 215–325–1306 Email: [email_address] Internet: www.celiaccentral.org </li></ul>
  • 45. Select References <ul><li>Ciacci et al. Scand J Gastroenterol. 1995;30(11):1077-81) </li></ul><ul><li>Maaki M et al. Gut. 2001;49(4): 502–505 . </li></ul><ul><li>http://www.medicinenet.com/celiac_disease/article.htm </li></ul><ul><li>NCAA CHOICES Program: 2008 </li></ul><ul><li>National Federation of State High School Associations (NFHS). 2005--2006 High School Athletics Participation Survey. Indianapolis, IN: NHFS; 2006. </li></ul><ul><li>Thompson T. Celiac Disease Nutrition Guide , 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. </li></ul><ul><li>Leone et al. J Athl Train . 2005;40(4):365-369. </li></ul><ul><li>Eberman & Cleary. J Athl Train . 2005;40(4):360-364. </li></ul>
  • 46. THANKS FOR ATTENDING!

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