Narrative review of celiac disease and sports: nutritional deficiency and strategies to optimise athlete health and performance

Celiac disease is an autoimmune disorder that compromises the integrity of intestinal mucosa and impaired nutrient absorption. Gluten-free diet is currently the only available therapy, but it is not always sufficient to ensure adequate nutritional intake and may be associated with micro- and macronutrient deficiencies, with potential metabolic and functional consequences, particularly in athletes with high energy demand. Indeed, athletes with celiac disease are at increased risk of developing nutritional imbalances, which may have a harmful effect on both intestinal health and performance. In recent years, the inclusion of naturally gluten-free cereals and pseudocereals, in conjunction with bioactive compounds such as polyphenols, has been demonstrated to enhance the nutritional quality of a gluten-free diet. In addition, probiotics supplementation shows promise in improving gut health, modulating inflammation, contributing to better recovery and performance. However, gaps in evidence persist, particularly concerning high-performance athletes. Therefore, this review integrated clinical and nutritional evidence, including a few available trials on athletes with celiac disease to provide an updated synthesis of how gluten-free diets, microbiota modulation, and nutritional strategies influence performance, recovery, and metabolic health, highlighting future directions for evidence-based interventions in sport to optimise athlete health and performance.