Coeliac disease is a disease caused by our own antibodies attacking the lining of our small intestine causing a range of symptoms: bloating, wind, diarrhoea, nausea, lethargy, fatigue, constipation, anaemia, mouth ulcers, headaches, weight loss, hair loss, skin problems, depression, and in more extreme cases infertility, recurrent miscarriages and joint/bone pain. Physical symptoms can be mild in some patients, so much so they don't realise they have coeliac disease for years until it shows up in a blood test following anaemia.

The wall of the small intestine is comprised of microscopic protrusions called villi which help us absorb our food by holding digested food against the intestinal wall and increasing the wall's surface area. In coeliac disease antibodies disrupt the villi and they become flattened. The innocent culprit is gluten which triggers the antibodies. Gluten is a protein found in wheat, rye and barley, and some coeliacs also react to oats which contains a very similar structure protein called avenin. Therefore coeliacs have to exclude all foods containing wheat, rye, barley and oats and products associated with them from their diet; even minute amounts can cause symptoms.

Dermatitis herpetiformis is a skin condition also caused by gluten intolerance; it has remarkably similar pathology: instead the antibodies attack areas of the skin causing red patches, severe itching and a rash commonly affecting the elbows, knees and buttocks but can affect any area of the skin. Dermatitis herpetiformis affects fewer people than coeliac disease, but the two conditions can be related. Nutritional advice for coeliac disease also applies to people with dermatitis herpetiformis.

Specially produced gluten free bread, flour, biscuits and pasta and other products are available for people who follow a gluten free diet. Some of these are available on prescription, but only for patients formally diagnosed with coeliac disease or dermatitis herpetiformis.

Coeliac disease is completely treatable and the treatment is a gluten free diet. So fortunately, in most people, soon after diagnosis when a gluten free diet is followed strictly, symptoms subside and you can return to full health. Due to the previously untreated illness, it's not uncommon for a newly diagnosed coeliac to have lost a lot of weight, so weight training is encouraged to help build your physique back up now you can eat without any discomfort and absorb your nutrition properly.

Although coeliac disease is 100% treatable, when a gluten free diet has been adhered to for some time, patients become even more sensitive to gluten and even a minute amount causes villi disruption and symptoms. For this reason gluten must be excluded completely, and even foods containing trace amounts must be avoided. Foods which obviously contain wheat, rye, barley and oats are easy to avoid, but less obvious manufactured products should always be checked. Look out for foods labelled 'gluten free' or which contain the crossed grain symbol. If you're still not sure, check with the manufacturer; and always remember: if in doubt, leave it out.

The primary goal for bodybuilders is to gain muscle and strength without additional bodyfat. In order to do this you must eat good amounts of food throughout the day; ideally six or seven smaller meals or snacks, rather than three big meals. Include plenty of high protein food choices like lean meat, chicken, fish and eggs; low glycaemic carbs; fruit and vegetables (nuts and pulses are also good sources of protein); as well as sources of essential fats. For more information on nutrition in bodybuilding.

Bodybuilding often calls for a good intake of slow releasing carbohydrate foods, so a coeliac bodybuilder needs to be particularly careful with these as all wheat, rye, barley and oat products will need to be eliminated entirely. Obviously bread, pasta, porridge, flapjacks, oatcakes, rye crispbread and couscous, all usually great bodybuilding diet choices, will have to be avoided. But basmati rice, quinoa, new potatoes and sweet potatoes are suitable, otherwise use the specially formulated gluten free products.

Timing of meals is important for optimum performance and results, so spread meals regularly through the day and try to stick to a schedule. It's especially important to eat good amounts of protein and carbs after training.

In respect of sports supplements look at the label to make sure the products are gluten free; if in doubt then contact the manufacturer. Bodybuilding supplements which you need to be particularly cautious with include maltodextrin and other carb powders, weight gainers and meal replacement formulas as they may contain carbohydrate sources based on wheat, rye, barley or oats. Whey protein is a useful supplement, but quality of blends do vary. With protein powders check the source of protein: is it gluten free? Also remember that supplements are there to supplement an already good diet and are not meant to replace good wholesome food.

The following meal plan is an example plan of a healthy diet which is suitable for a coeliac bodybuilder or anyone following a gluten free diet who wants to gain muscle size and strength. Use the plan as a learning tool to give you an idea of suitable gluten free, muscle building foods, and remember to vary your food choices and to drink plenty of water through the day. Select a range of protein foods, fruit and vegetables, and adapt the plan to suit your own needs and adjust portions and food choices according to progress and performance. The plan does include the use of specially produced gluten free items.

Follow a suitable weight training regimen, and also include some cardiovascular exercise for good health and fitness.

Remember to check with your doctor or gastro-enterologist before following this plan.

Wake 7.30 am
Breakfast
Large bowl of gluten free breakfast cereal, e.g. Rice Krispies, cornflakes or buckwheat flakes + 250ml skimmed milk + 1 tsp sugar
2-3 slices gluten free bread with natural peanut butter*
1 scoop whey protein in water
200ml fruit juice
Mug tea/coffee
Mid-morning
Sandwich: 2 slices gluten free bread + chicken/ham/tuna/ salmon/mackerel
Item fruit
Mug tea/coffee
Lunch
75g (dry weight) basmati rice / gluten free pasta
175g tuna / chopped chicken
Peas / sweetcorn
Low fat / low sugar yoghurt*
Drink water
Mid afternoon
4-5 rice cakes
250g cottage cheese or quark
Item fruit
Mug tea/coffee
45 mins pre-workout
80g chicken breast
Large handful mixed nuts

TRAIN – 45-60minutes
Immediately post workout
40g whey protein + 20g dextrose in water
Evening Meal
200g chicken breast / white fish / lean meat
Large serving basmati rice / gluten free pasta / 6-7 boiled small new potatoes / large sweet potato
Loads of veg / large salad
Drink water
Evening
3-4 gluten-free biscuits
200g low fat natural yoghurt* + fruit
Drink water
Bedtime
1 scoop protein powder in 200ml skimmed milk

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