The Fifth Event

0 CommentsSaturday • March 15, 2014 • by Imei

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Nutrition for Athletes, Gluten Intolerance, Celiac Disease, Food Allergies

Do you ever find yourself wishing that someone was eavesdropping on your story,  so that they  could magically step in and say, “I have the solution to your problem”?  If someone knew what  you were dealing with, maybe you would not have to suffer a minute longer than necessary.

The last few months, I’ve been there. I’ve taken some time out from blogging on  this site in  order to reflect on what has happened to me since last year. A nagging  and worsening set of  “tummy problems”, fatigue, and syndrome of joint pain and  inflammation stopped me in my  tracks. I’ve been sharing bits and pieces of my thoughts on Facebook. I’m finally ready to write about the whole experience.

We refer to triathlons as a three-event endurance race, yet the reality is that triathletes  actually participate in  five events: swim, bike, run, sleep, eat. Get one of them wrong, and  you’re done. This post is dedicated to the  Fifth Event, and the one that had almost wiped me  out before I started racing.

 

      The Backstory: Maui 2013

We had just finished a lovely 90 minute run in the sun along the Kaanapali beach of Lahaina  in Maui, HI. It  was March 2013, and the weather was a mix of sunshine, gentle rains, and  humid air. Because of the humidity and heat, I was grateful for a full Camelback hydration  system strapped to my back (now replaced by a Nathan women’s hydration vest for endurance  runners) on top of my triathlete-inspired two-piece swim suit, my little belly beautifully suspended over the top of the suit shorts in that sort of oh-so-grabable kind of way that bellies do. The team members who accompanied me were from Washington and Canada, with many fine amateur athletes in good form and a couple of professional level triathletes as well. It felt good to run with those who had long since answered the compelling call to become endurance athletes on their own terms.

By evening, the picturesque events of the day dissolved into a night of diarrhea, cramping, bloating, nausea, and unexplained skin rashes. By Day 4, I had medicated myself with an anti-diarrheal to stop the symptoms, but as the medication wore off, the symptoms would come back with a vengeance. We had an amazing chef who prepared our meals according to our sensitivities. I told her about the food allergies I knew of, and yet day after day, I slowly became sicker and sicker. I kept all that information to myself. It’s not in our mindset to share personal health issues like this with others.

Looking back, that was nothing compared to what I was about to experience in the coming months.

By September 2013, I had lost almost 15 pounds, and my ribs began to show. Fatigue crept in, and I found myself constantly complaining, in my head, and later, out loud to any friends who would listen, that I had never felt so tired in my life. I had completed my first Sprint-distance triathlons, setting personal records in my run times and getting stronger. I was dancing on weekends. My work at Seattle Direct Counseling as a therapist was going better than ever.

And I was so very tired.

After returning from Maui, I did a 14- day challenge to remove gluten from my diet. I had suspected that I had developed a gluten sensitivity millions of Americans have developed later in life for eating a wheat-based diet after I left home. In those 30 days,the  troublesome symptoms I experienced in Maui disappeared, including headaches that I had been struggling with for so long, I had ceased to try to remove them. At the end of the 14-day challenge, I ate a piece of bread. The bread triggered the same symptoms as before.

I had become gluten intolerant.

Holy sh!t.

If the story ended there, all I would have needed to do is eat a gluten-free diet, and the problem would be solved. But unfortunately, gluten intolerance was only one clue in the puzzle, “What’s eating Imei?”

 

What’s Eating Imei: Gluten and More Food Allergies

In hindsight, insidious weight loss despite constant vigilant eating should be a clue to any person, athlete or not, that something is wrong. However, with women, this weight loss is often dismissed, ignored, or admired. I am sorry to say how many compliments I received for how I looked: slim, strong, accomplished, yet I am not confused why people gave the compliments. In this culture, women are judged much more negatively and positively based on their appearance, when appearance says very little about our spirit, soul, emotions, or personal worth. We reward people who look good to us. And being trim tends to look good to people these days.

As I trained for a half marathon in December (see my previous post), I remember pulling on a long-sleeved shirt I had bought earlier in the year. I looked in the mirror, and stood still for a moment. The shirt now hung at my sides, and the top of my right scapula was easily detectable as it poked out the back. I had become anemic and was taking iron supplements twice a day with orange juice between meals. Yes, all of this while being on a strictly gluten-free diet, and feeling like a cow with its head in a food trough every couple of hours.

In December, I was at my usual dance gig, and the evening’s activities flowed as they normally do. Customers tipped me and thanked me for dancing, admired my costume, and said I looked fantastic. One of the staff members quietly asked me if I was unwell. “You look like you lost a lot of weight. Have you been ill?” I assured him everything was fine, even though I knew everything was not fine. And then I went to my car and sulked. I had done everything I knew to do, and taken every piece of advice related to gluten sensitivity. No one would accuse me of being dismissive or glib about eating.

In January 2014, I took a DNA test for the markers for gluten intolerance, which came back positive. It’s one thing to take a blood test and see if you’re allergic to wheat (i.e. reactive); it’s another to realize that it runs in my family, and that I’m highly likely to have developed Celiac Disease, the auto-immune inflammatory response of the small intestine that leaks gluten beyond the gut wall into the body where it can wreak havoc. I had been reading about Celiac Disease because I was preparing for the worst-case scenario: what if I have had the DNA markers, but the disease had not been activated until later in life through long-term exposure to gluten? I just wasn’t quite mentally prepared to find out that my worst-case scenario had already unfolded.

 

Living With Celiac Disease As A Triathlete: A Three-step Waltz

If living with Celiac Disease was as easy as eating a gluten-free diet, the  story would end here. As you read above, the story only started to get interesting! I was still having problematic symptoms on occasion even while eating a strictly gluten-free diet, and I was finding out from others  in the GF community that they were having symptoms too. What was I  doing wrong?

After reading the literature on Celiac Disease, I’ve discovered what I am describing as my three-step waltz through the dance of living with Celiac  Disease. I say living, because the statistics for CD are not good.  Untreated, many CD people do not live past their 50′s, and if they do,  they have complications with malnutrition. You read that right:  malnutrition, from poor absorption of nutrients over years of GI  distress. It gives them a poor quality of life, and it interferes with one’s  ability to be active, let alone be an athlete. My response was to grieve,  and then to fight back. Or rather, keep dancing!

Through this dance, I’ve discovered that so many other people with Celiac Disease have increased  food sensitivities to the other most common food allergy sources, which include dairy, soy, corn,  oats, nuts, and seeds. What I was doing wrong was assuming that because quinoa wasn’t a grain, I  should be able to eat it, right? In my case, the answer was WRONG! Quinoa makes me feel as sick as a goat who has just ingested a Tonka toy truck. Very sick. And when given Tamari as a substitute for soy sauce (gluten), I became ill as well. Turns out, I developed a sensitivity to soy right along with the gluten intolerance.

It was time to put my dance shoes on and dance my way through yet another challenge.

 1. Waltz Step 1: Go Gluten-Free

To stop further damage caused by inflammation in the gut, the only  known action at this time is to stop eating gluten and its derivatives. A  reduction of gluten in the diet is not enough. One must completely and  permanently cease ingesting gluten.

The long and short of Celiac Disease is that gluten exposures cause an  inflammatory response in the body, and the proper first response is to stop that exposure from happening. The stress and inflammation response to gluten will quiet down when there are no more “triggers” introduced to the gut. And you absolutely cannot cheat. From experience, you won’t want to either. Have a craving for a beer? Drink one, even half of one, and you will be sick for days, with blisters in your mouth, joint pain, fatigue, diarrhea, nausea, dizziness or “brain fog”, and a serious feeling that you cannot function. During my last accidental exposure to gluten,  it was like I switched brains with my cat for five days! I wanted to sleep for 16 hours, and I couldn’t put more than a few words together.

2. Waltz Step 2: Repair the Damage

While sitting in a lecture on nutrition for triathletes, a naturopath in the room approached me after I had mentioned to the group that I had discovered I had a number of food sensitivities and had become gluten intolerant. She asked me the million-dollar question:

“What are you doing to heal your gut?”

Much of the literature to the public about Celiac Disease is based on the medical diagnosis and prevention of further inflammation to the gut. Very few of the blogs and articles available talk about what to do AFTER your diagnosis, besides the obvious avoidance of gluten.

While I refuse to diagnose anyone via Internet and give out nutritional advice willy nilly (it would be against my scope of practice and licenses), I can talk about three areas I’m working on to help heal my gut:

a. Stress reduction — I meditate daily, exercise for at least one hour daily, try to get 8 hours of sleep a night (sometimes more!), and I’ve actually changed my schedule around a bit by delaying deadlines and taking on a little less work in order to keep my stress under control. Lowered stress = lowered inflammations.

b. Eliminate the need for aspirin, NSAIDs and antibiotics — prior to 2013, I could count on getting an upper respiratory infection at least one to two times per year. After I became a triathlete, I stopped getting colds and flus, and I have not had Bronchitis since early 2012. Antibiotics mess with the natural flora of your gut, making food even harder to digest, so if I can avoid the need for them, it’s better for my condition. Non-steroidal anti-inflammatory drugs, aka NSAIDs, such as Ibuprofen also mess with the lining of the gut and cause inflammation. I used to take them for muscle aches from racing. Now, I use ice and heat to relieve sore muscles, and I splurge for A.R.T (active release therapy) and Shiatsu. The same goes for aspirin.

c. Take L-glutamine, an essential amino acid that decreases the anti-inflammatory response. And yes, this powder can be very pure, free of gluten, soy, sugar, corn, and other unnecessary fillers.

There are foods that are supposed to help heal the gut as well, but people are so different, it didn’t seem useful to post them here. If you have food allergies, you have to figure out which, if any, will be of help to you. I know I’m allergic to most of them.

 

3. Waltz Step 3: Educate Everyone Around You, Including Restaurants

As I mentioned earlier, gluten-free eating is popular enough that you may have seen GF options in your grocery store and in your favorite restaurants. The challenge for people with CD is that they aren’t seeking these options for weight loss or as a food preference, but because they have a medical condition that is exacerbated with even tiny amounts of gluten.

I once went into a chain restaurant and ordered a gluten-free meal. The waitress said, “You don’t look like you need to lose weight,” as if my choice of the meal was for the purpose of reducing my carbohydrate intake. I very calmly stated, “You are correct. I’m not trying to lose weight. I am trying to prevent myself from ending up in the hospital from being poisoned by wheat gluten.” You should have seen her eyes pop out of her head!

OK, so there is probably a better way of informing your server and your chef that you require a safe, gluten-free meal. I realize that I’m in a position to educate the restaurants that are wishing to capture the GF market AND meet the requirements of the Celiac and Sprue Association by providing food options with less than 20 ppm of gluten and in non-crosscontaminated kitchens.

My tasks this year are to produce two items for my community:

1. Easy-to-customize cards with the words, “I have a medical condition called Celiac Disease, an auto-immune disease triggered by wheat gluten and the following related foods”, followed by the most common derivatives of wheat gluten, including related foods like oats, buckwheat, barley, and rye. On the back of the card will be room to include your other food allergies, such as soy, dairy,  and corn (including high fructose corn syrup). The card can be laminated and given to the chef so that s/he does not have to produce your food from memory.

When the chef produces a safe meal for you, you return the favor and give them a good review on Social Media or an app that collects this information and shares it with other CD people.

2.  A picture oriented “menu” app for restaurants and foods that are gluten-free friendly and safe. While there are a few Facebook pages that have started these, I think we need local ones build on mobile app platforms to share information quickly with others.

My “dream app” would be built on Google Glass, so I could take a picture of my food, Make A Vignette with the restaurant or store’s name and contact information, and add a caption to explain what it is I wish to call attention, i.e. “this restaurant used XYZ Gluten Free pasta, which contains sorghum”. The information could then be sent to a website that serves this community, divided into local chapters. When you travel, you could look up the what others have said about the dining in that city while searching for gluten-free meals.

This kind of application may take a long time to develop, but it could be instrumental to people like me. And there are a lot of us.

 

Celiac Disease and Athletic Activity

I’ve read a few too many true stories of athletes who got really sick before they were diagnosed with Celiac Disease or non-Celiac gluten intolerance. Some people die slowly of malnutrition, and it’s their children in adulthood who discover the genetic pattern for CD in themselves and their own children. What I am learning is if the disease is handled well and the gut is healed, one can continue being an athlete. That is my intention!

I’m preparing for my first full marathon on May 4 2014 in beautiful Vancouver B.C., and my training is in full-swing with short runs, strength training, long runs, and other activities to work through the soreness and gain strength and comfort for the 26.2 mile run through downtown Vancouver to the waterfront. This race has been rated by Forbes as one of the top ten destination marathons in the world.

In June 2014, I’ll return to the world of triathlon by opening the season with an Olympic Distance triathlon. I’m eye-balling the Saunders Subaru Triathlon (long, Olympic, and Sprint courses) for its warm water and beautiful Elk Lake course.

In September 2014 I’ll finish the season with the Lake Stevens Olympic Distance triathlon. In between June and September, there will be plenty of duathlons, relay races, and swim competitions for me to enjoy, as I’ve been working on improving my swim since November 2013. My swim has come along enough to seriously consider the option of entering an Ironman distance race that allows relays; perhaps 2015 will see me completing the 2.4 mile swim and the marathon, while another teammate battles it out on the road for the bike event.

And as always, there is dance, dance, dance. I’ve never been stronger, or more grateful that I can move. I’ve noticed that long choreographies and sets are easy because my stamina has increased, and after the majority of my symptoms have decreased, my health is returning.

The one thing I can’t change: I can’t seem to get my pretty little belly back. It’s true  that because my food intolerances and CD prevent me from eating calorically dense  foods, I have a difficult time holding onto weight. I had to adjust all my costumes,  one by one, to keep them from sliding off of me. Some will simply need to find a  new owner because they can’t be further adjusted. In the long run, this is not a  horrible problem to have.  I will likely never be a part of the $75 billion dollar cost of healthcare because of obesity. Instead, I can help others move towards more healthy food choices and activities.

Once again, here I am at the beginning. It’s the realization that nothing about me as a person has changed, and yet everything feels different. I live in a world where the average person is much larger than me and watches their food intake to lose weight, while I can essentially eat as much of the gluten-free and allergen free foods I like, whenever I like, and it is nearly impossible for me to become fat. I mean, how much kale would I like to eat? Broccoli? Rice milk?

During races, I have to carry all my real food, because most gels and race food have  ingredients my tummy can’t tolerate. So I get to eat a seaweed roll with white rice  and scrambled eggs, bacon bits, and a little avocado. Yes, during a long race. Yes,  it’s messy. In between, a little honey gel and a couple of ounces of water. No  Gaterade for this girl. It’s complicated, but the rewards are good — personal records, comfort, and a smiling race as I run across the finish line.

Would you be surprised if I told you that there are elite performance athletes who willingly select a gluten-free diet (granted, they can eat gluten items on occasion) in order to excel in their sport? In the book, The Gluten-free Edge (Peter Bronski, Melissa McLean Jory, and Amy Yoder Begley) share the details of what gluten intolerance is, and why so many elite athletes have chosen a GF diet even if they don’t have Celiac Disease).

I do want to make one thing very clear: if you think that a GF diet using processed GF foods are going to make you lose weight, don’t bother using gluten-free foods as your new diet craze. Why? Because many processed GF foods are made of flours with low nutritional value, and dumb manufacturers add fats and extra sugar to make them taste better. What you get is often a high glycemic index food with a bunch of sugar and fat. No athletically-minded person has any business eating that kind of diet and expecting to trim up.

But Imei, if I’m exercising a ton, doesn’t that mean I eat anything I want as long as the calories balance out? 

Well, I’m not the Food Police, but in a nutshell, the answer is, No. If I ate that way, I would still end up feeling sick. So would you. During intense workouts, your body needs good fuels before, during, and after to run efficiently. Just like you wouldn’t think of putting cheap gas in a Jaguar, why on earth would you — oh fine tuned Human Being! — think of putting cheap food like fried bagel chips in your bio machine?

If eating really is the Fifth Event of triathlon, or dancing, or skiing, or hiking, or mountain climbing, or whatever it is you love to do, it’s time for you to re-think your relationship to food and activity. You don’t live to eat; that is, you no longer workout just to give yourself the excuse to eat whatever and how much you want. You eat in order to live; that is, you eat to fuel yourself for the amazing activities you do, and that you give your very best.

Before your next gig, race, or endurance activity, think about it. How will you make the shift to thinking about eating as the pure fuel towards better performance? Who will make the decision about what is healthy eating: the food producers who stamp, “Better Food Choice” on the outside of a junk-food package because they added iron to it, or took out wheat gluten while substituting excess fat and sugar? Or the real science of nutrition, which explains how your body needs real foods in the form of carbohydrates, fats, and protein, plus electrolytes and water, to bring you better health and performance?

To all of you: I’m doing so much better these days! I wish you could see the difference the way I do, and not just in the excess fat I dropped from my belly. Every step on my run is lighter, every recovery day is easier because the joint pain is almost negligible for the amount of pounding they are taking in my race prep. I’m looking forward to my post-marathon recovery after May 4, and I have every reason to look forward to an amazing summer of triathlon races and dancing.

 

 

 

 

 

 

Posted in: dance, food, food sensitivities, inspiration, Triathlon, weight loss, weight loss tips

Tagged with: athletes, Celiac Disease