CAN DIETARY CHANGES TRIGGER ATHLETIC AND PROFESSIONAL SUCCESS?

In 2006 the tennis world was properly introduced to a rising star- a young Serbian by the name of Novak Djokovic. It was the year Novak won his first ATP title and stormed into the top 20. Not only was the 19-year-old player immensely talented, but he also had charm.



I vividly recall being out with Novak and his team in New York that year, and seeing first hand his remarkable people skills, confidence and charisma – virtues that would later propel him to the highest level of stardom both on and off the court.

Novak’s rise to the top steadily continued, and by the end of 2007, he was ranked 3 in the world and had beaten both the ‘giants’ of the game at their peak - Roger Federer and Raphael Nadal. It appeared that the only obstacles in his path were frequent bouts of ill health and questionable fitness.

Novak’s first grand slam win came in 2008 at the Australian Open. From 2008 to 2010 Novak maintained a powerful presence in the sport, but despite his formidable game and unrivalled commitment to improvement, his performances were known to be erratic - generally due health issues. Searching for answers Novak changed coaches, trainers, physios and sought out the worlds best doctors in an attempt to resolve this health and fitness conundrum. It made no absolutely sense. Novak trained harder, smarter and with more commitment than most of the players on the tour.

According to Novak his all-time professional low occurred at the Australian Open in 2010, during his quarterfinal match against Jo-Wilfried Tsonga. In the match, Novak was two sets to one up and playing superb tennis, poised to move through to the semifinals. Then, without warning, Novak’s health took a turn. His chest closed (as it did frequently) and he became ill. Struggling to breath and far from focused, he lost the match without much resistance.

However, this was a turning point for Novak, in that a fellow Serbian and family friend happened to be watching the match. Dr Igor Cetojevic, a nutritionist specialising in food sensitivities, believed he knew what was to blame for Novak’s health issues and promptly set up a meeting.

Using simple diagnostic methods, Dr Cetojevic was able to identify a range of food intolerances that triggered Novak’s health afflictions, however the principal protagonist was unquestionably sensitivity to GLUTEN.

Incredibility, through the process of elimination, two weeks later Novak’s health began to show signs of improvement. 18 months after his professional low, Novak reached his career dream and a professional high - he captured the world number 1 position as well as became the Wimbledon champion.

Sport writers cite Novak’s 2011 season as the greatest single year ever by a tennis player. He won 3 grand slams, 10 titles and 43 consecutive matches. Who would have imagined that small (but consistent) dietary changes could be the catalyst to one of the greatest sporting stories in modern history?

In his book ‘serving to win’ Novak comments: “… I felt fresher, more alert and more energetic than I had in my life. I was faster, more flexible, and able to get to balls other players couldn’t; yet I was still as strong as I’d ever been, and my mental focus was unshakable. I never felt tired or out of breath. My allergies abated; my asthma disappeared, my fears and doubts replaced by confidence”.

The truth is that Novak’s food sensitivity story is not unique. So many of us suffer from food intolerances and don’t even know it. Sensitivities of this nature impact us physically, emotionally and cognitively and strike without warning or any sense of predictability. Gluten happens one of the most common sensitivities, yet foods containing this protein are a staple within our modern diet.

What makes wheat and gluten so bad?

Gluten is a protein composite found in wheat, rye, barley, spelt and oats. It consists of two proteins namely gliadin and glutenin.

Gluten along with secalin and hordein (found in barely and rye) are the only proteins we are unable to digest. Typically enzymes found within the digestive system are able to dismantle food molecules in less than 60 minutes, however the proteins found in gluten can resist digestion for up to 20 hours.

According Dr Allesio Fasano (a leading authority on gluten related health issues), the issue with these undigested gluten-derived protein particles is that our immune system mistakenly interprets them as dangerous life-threatening bacteria. Consequently, the defensive immune reaction parallels that of a serious bacterial threat, which involves immense inflammatory responses as well as the production of harmful antibodies.

Dr Fasano believes that this response is evoked in everyone, which is why many health authorities insist that gluten is toxic and should be avoided completely. Although there is merit to this argument, like the bacteria we face on a daily basis, MOST people can overcome the negative effects of gluten, despite the insurmountable strain it places on the body. However, for some (like Novak), gluten can have devastating health and performance consequences.

Just as each person is unique, so too is our reaction to gluten. For many, gluten-containing foods merely cause abdominal discomfort and poor concentration. However, for a small group of individuals, gluten may be associated with several chronic illnesses that can reduce life expectancy by more than 4-fold [i].

Common gluten related health disorders include a wheat/gluten allergy, gluten sensitivity and celiac disease. Without question, the most devastating and impactful of the three disorders is celiac disease, which affects just over 1% of the population.

Celiac disease

Celiac disease is an autoimmune disorder triggered by gluten in which the immune system attacks lining of the small intestine. The extensive damage to the small intestine is often associated malabsorption of many nutrients (iron, vitamin D, calcium) and the progressive destruction of the barrier that protects the body from the contents of the digestive system, known as the gut-immune barrier.

As one would expect, typical celiac symptoms include bloating, abdominal pain and diarrhoea. However, a major issue with this disease is that the symptoms are seldom limited to the intestine. In fact, many of the aggressive immune cells (triggered by gluten) leave the intestine and target other body tissues and organs.

Celiac disease is often associated with infertility, diabetes, severe skin pathologies, thyroid damage, joint compromise, muscular pain as well as neurological and behavioural abnormalities (anxiety and depression).

What is alarming is that many of those who suffer with the disease go through life undiagnosed. According to a study published in the American Journal of Gastroenterology, 80% of people who have celiac disease don’t even know they have it[ii]. This is partly because gastrointestinal symptoms are not always present in celiac disease, and the fact that autoimmune symptoms only appear weeks, if not years, following gluten exposure.

At present only a small percentage of the world’s population suffer from celiac disease, however it appears that this is rapidly changing. According to a study published in the journal Annals of Medicine, the prevalence of celiac disease has increased by 200% within the last 15 years. More concerning is the sharp rise in celiac diagnosis since the mid 1970’s. According to researchers from the University of Maryland School of Medicine in Baltimore, there has been a 5-fold rise in celiac disease in the last four decades.

Scientists are still unclear as to why the prevalence of celiac disease has increased so dramatically. Although there is a strong genetic component to celiac disease (HLA-DQ2/DQ-8), some scientists strongly suggest that this rise may be due to modern agriculture. A 2013 study published in the journal of Interdisciplinary Toxicology showed that a common herbicide used extensively in wheat farming called ‘Glyphosate’ might be a major trigger.

This is highly plausible in the sense that for thousands of years our immune system fought a single enemy – microorganisms (bacteria, viruses, fungi, yeast)! Only recently have we have been exposed to a wide variety of man-made chemicals and artificial compounds. Most (if not all) of these chemicals aren’t recognised by the immune system. Additionally, they are far more complex than the immune system is equipped to handle. Not surprisingly, the immune system can become overwhelmed and poorly regulated leaving a trial of significant devastation in an attempt to protect the body. Diagnosing celiac is a lengthy and complex process that involves the presence of the genetic markers (HLA-DQ2/DQ-8), confirmation of intestinal damage detected by an endoscopic biopsy, further confirmation through a specific blood test (tTG-IgA), the presence of coexisting autoimmune disorders, as well as signs and symptoms compatible with the disease.

Gluten/wheat allergy

Another common condition related to foods containing gluten, is known as a wheat/gluten allergy. Classic symptoms include irritation of the digestive tract (bloating, gas and pain), respiratory system compromise (difficulty breathing, asthma and tight chest), acne and rashes as well significant cognitive and behavioural issues (poor concentration, an inability to focus, depression and anxiety). One of the fundamental differences between celiac disease and a wheat allergy is the time it takes for symptoms to appear. Unlike celiac disease, where symptoms take weeks if not years to develop, a gluten/wheat allergy is associated with an immediate reaction (within minutes or hours).

According to research published in the British Medical Journal in February of 2012, wheat/gluten allergies affect around 3-9% of the population. Fortunately, a simple pinprick test can provide a successful diagnosis.

Gluten sensitivity

Gluten sensitivity is a gluten-related disorder that is neither celiac disease nor a gluten/wheat allergy. Although current estimates suggest that 6-8% of the population suffer from this condition, recent evidence presented by a team of European researchers shows the prevalence to be as high as 13%[iii].

People with gluten sensitivity typically experience symptoms hours or days after gluten exposure. Although 68% of gluten sensitive people will experience abdominal discomfort[iv], many of the symptoms are outside of the digestive system. Reactions to gluten containing foods include muscle cramps, muscle and joint pain, fatigue (chronic), an inability to focus and concentrate and even headaches. This is certainly not an optimal state for us to thrive let alone succeed in a professional environment. Fortunately Novak was able to identify this early in his career, make the necessary changes, and take the tennis world by storm.

The problem with gluten sensitivity is that there are no laboratory biomarkers that are specific for this condition. For the time being the only measure is an elimination diet and careful monitoring of symptoms.

Deciding whether or not to go on a gluten-free diet

If any of the symptoms or health scenarios discussed in the article resonates with you or your family, it may be worthwhile consulting your doctor and going on a gluten-free diet. Since 2008 gluten-free diets have surpassed low fat and low carbohydrate diets (Banting, Atkins) in popularity with a compound annual growth of over 28%. The reason for this is partly health motivated, and partly for the purpose of weight loss.

This diet may seem like a difficult and limiting task, but once you get going it is much easier than it appears. Give yourself two weeks as a ‘test run’ before you make a decision as to whether or not to adopt a gluten-free diet as a more permanent model.

What you need to avoid

  • Any foods containing wheat, barely, rye, spelt and some types of oats (those that don’t state ‘gluten free’).
  • This means no bread; pasta, pastries, some sauces, marinades, cakes, beer, grain-containing soups etc. - unless they are gluten-free versions of course.

What you can have

  • All natural foods. This includes fruits, vegetables, meat and poultry, fish, diary, nuts and legumes.
  • Grains and starches such as rice, corn, quinoa, millet, sorghum, gluten-free oats (limited to ½ cup daily), tapioca, potatoes and sweet potatoes.

Gluten free substitutes

  • There are some excellent gluten-free pasta’s, breads, crackers and flours readily available. This said, care must be taken with gluten free products as they may be heavily processed, contain added sugars, gums and emulsifiers. As with many health practices, try stick to natural foods.

 Sauces, soups and stocks

  • This is a major concern in that these products often contain hidden gluten. Wheat flour is typically used as a thickening agent, and as such strict avoidance is advised. There are products that may not contain gluten, so as a general rule read the labels carefully.

Beverages

  • Wine, ciders and distilled alcohols are gluten-free.
  • Avoid beer, malts, ales and lagers as they do contain gluten.

Vitamins, medication and supplements

  • Many of these products can contain gluten, so it is important to read the labels carefully.

 

Note: It is strongly recommended that you consult with your doctor before starting any new diet plan, especially if you have existing health issues.

 

[i] Rubio–Tapia, Alberto, et al. "Increased prevalence and mortality in undiagnosed celiac disease." Gastroenterology 137.1 (2009): 88-93.

[ii] Rubio-Tapia, Alberto, et al. "The prevalence of celiac disease in the United States." The American journal of gastroenterology 107.10 (2012): 1538-1544.

[iii] Molina-Infante, J., Santolaria, S., Sanders, D. S. and Fernández-Bañares, F. (2015), Systematic review: noncoeliac gluten sensitivity. Aliment Pharmacol Ther, 41: 807–820. doi:10.1111/apt.13155

[iv] Sapone, Anna, et al. "Spectrum of gluten-related disorders: consensus on new nomenclature and classification." BMC medicine 10.1 (2012): 1.

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