Fatigue - Athlete

[Jmun5]

My 15 year old daughter has been gluten free for about 3 months. She has seen a dramatic improvement in the symptoms, and we're happy with her progress, except for one area. When she plays sports, she immediately gets fatigued. She is a high school athlete, and in her first summer league soccer game last night (she's the goalie), she felt exhausted during warm ups. She was so fatigued after the game, that she barely spoke, and today she is still feeling very tired and hasn't wanted to do anything. I'm honestly starting to wonder if she needs to take a year off of sports. I know this takes time, but I'm wondering how long it might take for her to be able to compete like she used to without the fatigue. Also, any general advice for an athlete fighting an autoimmune disease? 

[apprehensiveengineer]

You might consider Relative Energy Deficiency Syndrome (RED-S), which is caused by underfueling. Basically, it is an updated and expanded view on what used to be known as the "female triad syndrome." Symptoms/consequences include anemia, poor bone health, amenorrhea/hormonal disturbance, fatigue, depression, reduced response to training stimulus.

In otherwise healthy athletes, RED-S is primarily caused by under-eating relative to the amount and intensity of physical activity done. In someone with celiac disease, this could result from impaired nutrient absorption, or just a hangover from problems the pre-diagnosis state. Celiac disease takes a lot out of you and one cannot expect to be performing at an optimal/elite level immediately.

Not to scare you, but if your daughter is having problems like this it is essential to back off training. You can do long-lasting damage by pushing through that could jeopardize her ability to pursue to sports long-term. Unfortunately, many coaches and GPs are not very educated on the topic of women in sport and RED-S, so you might be better off trying to see a Sports Med specialist, or an RD who specializes in sport nutrition. They should be able to advise you better on her specific nutritional needs, and an appropriate training load.

[cyclinglady]

I would advise taking the year off.  Hard to do when you are an athlete, but to keep up competitively is hard.   I really dislike that kids are doing their sport year round.  I am from the old school of cross training.  I think there is less chance of repetitive injuries.  

Has she has follow-up testing for deficiencies, anemia, bones?  Osteopenia or osteoporosis is common.   You want to avoid fractures.  Luckily, she still has the chance to build bones at her age.  Not so, for older celiac patients who were diagnosed late in life.  

Open Original Shared Link

Edited June 6, 2018 by cyclinglady

[apprehensiveengineer]

(In case you're having trouble finding info here are some links... not to dox myself, but I'm a few data points in some of these studies listed )

• International Olympic Committee statement: Open Original Shared Link
• Diagnosis/Return to Play advice: Open Original Shared Link

I competed at the intercollegiate level and found out I had celiac just after graduation. It took me a good 2 years of GFD to really be able to train and compete consistently again. Part of it was the learning curve, but a big part was also that my body was very, very tired from 10 years of hard training in a compromised state.

Patience is key, and thanks for being a dad looking out for his daughter. I coach pre-teens/teens, so I know how easy it is for parents to get caught up in the immediate success of their kid. Hope your daughter begins to feel more like herself soon.

[cyclinglady]

10 minutes ago, apprehensiveengineer said:

You might consider Relative Energy Deficiency Syndrome (RED-S), which is caused by underfueling. Basically, it is an updated and expanded view on what used to be known as the "female triad syndrome." Symptoms/consequences include anemia, poor bone health, amenorrhea/hormonal disturbance, fatigue, depression, reduced response to training stimulus.

In otherwise healthy athletes, RED-S is primarily caused by under-eating relative to the amount and intensity of physical activity done. In someone with celiac disease, this could result from impaired nutrient absorption, or just a hangover from problems the pre-diagnosis state. Celiac disease takes a lot out of you and one cannot expect to be performing at an optimal/elite level immediately.

Not to scare you, but if your daughter is having problems like this it is essential to back off training. You can do long-lasting damage by pushing through that could jeopardize her ability to pursue to sports long-term. Unfortunately, many coaches and GPs are not very educated on the topic of women in sport and RED-S, so you might be better off trying to see a Sports Med specialist, or an RD who specializes in sport nutrition. They should be able to advise you better on her specific nutritional needs, and an appropriate training load.

I learned something today!  You are right that most coaches are not trained to train young women.  Even jumping and landing is different for a woman’s body than a man’s.  

This book discusses this very subject and is worth reading!  

Here is an article about the book found in The NY Times:

Open Original Shared Link

[Jmun5]

Thank you so much for all the responses. I am going to spend the rest of the evening clicking all these links and doing some research. My daughter just finished her freshman year of HS and lettered in soccer, basketball and track. Soccer wasn't bad, but basketball season is when everything hit the fan. She had extreme fatigue and we knew something wasn't right. She started the gluten free diet right after basketball ended, but still wanted to do track. She is a high jumper and long jumper, so it helped to not do a lot of running. Her coaches were very understanding and let her do modified workouts since she just couldn't keep up. She took two weeks off to rest, and just yesterday had the summer soccer game. I just called her pediatrician today to request blood work to make sure she doesn't have other deficiencies. She is taking probiotics and vitamin D (because they suspected a deficiency) but her vitamin D levels were never tested. She will have blood work done this week. One more question... she was going to work with a personal trainer and do mostly weight lifting. She has some back issues, and lifting will help with her back, and just to get stronger overall. The trainer is great, and understands her issues. I thought that it would be good for her. Think she shouldn't even do that?  

[Jmun5]

40 minutes ago, apprehensiveengineer said:

You might consider Relative Energy Deficiency Syndrome (RED-S), which is caused by underfueling. Basically, it is an updated and expanded view on what used to be known as the "female triad syndrome." Symptoms/consequences include anemia, poor bone health, amenorrhea/hormonal disturbance, fatigue, depression, reduced response to training stimulus.

In otherwise healthy athletes, RED-S is primarily caused by under-eating relative to the amount and intensity of physical activity done. In someone with celiac disease, this could result from impaired nutrient absorption, or just a hangover from problems the pre-diagnosis state. Celiac disease takes a lot out of you and one cannot expect to be performing at an optimal/elite level immediately.

Not to scare you, but if your daughter is having problems like this it is essential to back off training. You can do long-lasting damage by pushing through that could jeopardize her ability to pursue to sports long-term. Unfortunately, many coaches and GPs are not very educated on the topic of women in sport and RED-S, so you might be better off trying to see a Sports Med specialist, or an RD who specializes in sport nutrition. They should be able to advise you better on her specific nutritional needs, and an appropriate training load.

I'd never even heard of this before. She does have normal periods, and just reading the basic symptoms, I'm not seeing any red flags. 

[Jmun5]

40 minutes ago, cyclinglady said:

I would advise taking the year off.  Hard to do when you are an athlete, but to keep up competitively is hard.   I really dislike that kids are doing their sport year round.  I am from the old school of cross training.  I think there is less chance of repetitive injuries.  

Has she has follow-up testing for deficiencies, anemia, bones?  Osteopenia or osteoporosis is common.   You want to avoid fractures.  Luckily, she still has the chance to build bones at her age.  Not so, for older celiac patients who were diagnosed late in life.  

Open Original Shared Link

I just called her pediatrician today to request blood work to make sure no other deficiencies are present that they didn't check for. She is taking probiotics to try to get her gut health back in shape and vitamin D. I'm wondering if she could be anemic. 

[Jmun5]

34 minutes ago, apprehensiveengineer said:

(In case you're having trouble finding info here are some links... not to dox myself, but I'm a few data points in some of these studies listed )

• International Olympic Committee statement: Open Original Shared Link
• Diagnosis/Return to Play advice: Open Original Shared Link

I competed at the intercollegiate level and found out I had celiac just after graduation. It took me a good 2 years of GFD to really be able to train and compete consistently again. Part of it was the learning curve, but a big part was also that my body was very, very tired from 10 years of hard training in a compromised state.

Patience is key, and thanks for being a dad looking out for his daughter. I coach pre-teens/teens, so I know how easy it is for parents to get caught up in the immediate success of their kid. Hope your daughter begins to feel more like herself soon.

Actually, I'm a mom, but her dad does look out for her too.  Even though it's been fun watching her compete in 3 high school sports, I'm much more interested in her feeling well again. 

 

[cyclinglady]

Well, not to frighten you, but I just presented with anemia (no GI issues).  My anemia was so bad, my doctors kept asking me to have some transfusions, but I refused.  Two months after my diagnosis, I fractured  two vertebrae doing NOTHING!   I have osteoporosis as a result of celiac disease.  Due to my age, building bone is pretty impossible.  I did take a year off from riding my bike and running to avoid falls.  I exercised in the water once my hemoglobin levels improved and to avoid damaging my heart (took a few months of being gluten free).  

I have a 17 year old daughter who played  two sports as a freshman, but gave it up for other activities and academics.  I was a little sad, but she just could not do it all!  

[GFinDC]

Hi,

Here's an article about anemia that might help.  She may have either or both iron and B-12 deficiency anemia.  Another nutrient deficiency that can cause fatigue is selenium.  It can take months to recover from iron deficiency because the new blood cells are made slowly.

Another possible and maybe more common cause of fatigue is poor absorption of fats and carbs.  If her gut can't absorb fats and carbs well she won't have much energy.  That doesn't mean she should eat more fats and carbs, but meats and oils are good for her.  Sugary foods should be avoided though, as they can cause bloating.

There was a study a while back that found a large % of children had not fully healed their guts after 18 months on the gluten-free diet.  It is not a quick thing sometimes.

You probably heard the advice to stick with whole foods like nuts, meats, veggies, eggs.  That is the best diet to speed up healing for most of us.

Open Original Shared Link

[Ennis-TX]

I had to take a few years of going easy with working out after diagnosis and after a few years of the gluten free diet and healing I am doing weight training, resistance training, and trying to body build. I still can not go out running or anything too extreme as  I tire and have issue catching my breath. I started having issues with this way back in Jr High years before diagnosis.

I agree with many of the points of GFinDC about the B-vitamins I might suggest a supplement like Liquid Health Stress & energy just adding the liquid to a drink  3 times a day, and many of the iron issues, To help with iron take vitamin C supplements (vitamin C is necessary to for your body to absorb and utilize iron) with high iron foods like meats easy crock pot roast, and sheet pan meals, like beef roast slow cooked and shredded, this can be served over week or 2 with other dishes like eggs, stews, soups, with roasted potatoes, stir fry, if you prefer a plant based source, Look up stuff like Growing naturals Pea protein which is high in iron and use it in a shake or a non dairy yogurt.

Magnesium is another thing that many of us have issues with, athlete will really deplete it stressing our bodies faster and with celiac you will have issues absorbing it. Do look up the symptoms of magnesium deficiency and see if that raises any flags. Supplementation depends on bowl habits, if constipation or not going daily then Natural Vitality calm using a dosing to tolerance method is needed starting off at 1/4tsp (1-2g) a day and upping it that much til you get the full dose or loose stools then back back down. IF bowl habits are already normal then Doctors Best is suggested taking a scoop with dinner or before bed.

[apprehensiveengineer]

12 hours ago, Jmun5 said:

I'd never even heard of this before. She does have normal periods, and just reading the basic symptoms, I'm not seeing any red flags. 

It's a bit of a newer thing (last 6-7 years). Previously there was a condition called "female triad syndrome" which was anemia, amenhorrea, and poor bone density caused by under-eating/disordered eating in female athletes. Researchers have found more recently that the symptoms are a bit more systemic than this, and that male athletes too can be affected (instead of amenhorrea, they get low testosterone, which is a less obvious sign). Though nutritional deficiencies (eg. anemia) present, fixing the nutritional deficiency through supplementation is not enough because the real problem is the lack of available energy from caloric intake. 

A lot of the literature focuses on the cause being disordered eating, but the effect would be the same (inadequate caloric intake, inadequate intake of vitamins/minerals) for someone with celiac disease who is either undiagnosed or still healing. Getting enough calories to fuel intense sport is a challenge as well when your diet is restricted for any reason. I eat 3500-4000 calories per day, which is definitely a challenge since I have trouble with a lot of processed food.

Getting bloodwork done (with a hormone profile) will identify if this is currently a concern, or if it is a simple nutritional deficiency. If your daughter is still getting her period regularly, then she might be ok, but this condition is still something to keep in the back of your head - athletes who keep pushing through fatigue will end up there!

Also sorry for thinking you were her dad... must have mixed up something from a different post ?

[pschwab]

Solid plan to have her vitamin d, calcium and iron levels checked! It’s not uncommon for teenage girls to be low in iron (mild anemia) even without celiac.

[Jmun5]

Had some blood work done on my daughter Friday, and already got the iron results electronically. Her iron is low, which is what I suspected since she's still so tired. Didn't get the rest of the results yet, but hope to have them early next week.