An integrated nutritional and performance monitoring framework for athletes with celiac disease: A structured...

Celiac disease (CD) is an important yet under-researched condition among athletes, with the potential to disrupt nutritional strategy, recovery, and performance. The purpose of this structured narrative review is to synthesize the current evidence on nutrient deficiencies, dietary management, and performance-monitoring strategies specific to athletes with CD, and to propose an integrated framework for their nutritional and functional assessment. This review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA) and compiled from literature published in PubMed/MEDLINE, Cochrane, BioMed Central, and the BMJ collection up to 2025, and included the following: global prevalence estimates, genetic susceptibility pathways, dietary management of the Gluten-Free Diet (GFD), and monitoring of micronutrients and functional performance. While maintaining a GFD is key to avoiding intestinal damage and to health, it is also challenging given the limitations of the diet and potential for nutritional deficiency. CD has a complex, multi-faceted impact on athletes, including both physiological (iron, vitamin D, calcium, magnesium, zinc, B-vitamin deficiencies) and neurological (systemic, low-grade inflammation, altered gut-brain axis signalling) and psychological (high odds of anxiety (OR: 6.03) and depression (OR: 2.17) compared to healthy controls and social isolation due to dietary restrictions). Comprehensive dietary planning and continual nutritional monitoring are essential to good management. The review highlights specific gaps in awareness among coaches, athletic trainers, and sports dietitians regarding gluten cross-contamination risk, timing-sensitive micronutrient monitoring, and recognition of disordered eating patterns in athletes with CD, and calls for structured CD education within sports-medicine and sports-nutrition curricula. It concludes by identifying three priority research directions: adequately powered, biopsy-confirmed trials stratified by sport type, sex, and mucosal healing status; mechanistic studies of exercise-induced intestinal permeability using biomarkers such as zonulin and I-FABP; and development of a validated athlete-specific CD screening tool alongside an international performance-monitoring registry.