Celiac review examines exercise, diet and gut microbes in children and athletes

A clinical review concludes that physical activity, dietary management and the gut microbiota jointly influence gastrointestinal health in children and athletes with celiac disease. Synthesizing available evidence rather than reporting a new trial, the review examines gastrointestinal physiology, exercise-related disorders, bone health, dietary strategies and microbial modulation. It finds that appropriately prescribed activity can support intestinal function, immune regulation, body composition, skeletal health and quality of life, partly through favorable changes in gut microbes, while excessive exercise, nutritional imbalance and underlying gastrointestinal disorders can adversely affect intestinal integrity and athletic performance.

Exercise appears to have context-dependent effects. Regular physical activity is generally associated with better intestinal function and systemic health, whereas prolonged or poorly individualized high-intensity exercise may impair gastrointestinal integrity. The mechanisms identified in the review include splanchnic hypoperfusion, increased intestinal permeability and oxidative stress; prolonged intense activity may also cause transient changes in the gut microbial community. These effects can compromise gastrointestinal performance in athletes. The review therefore emphasizes the intensity and individualization of activity, but the supplied evidence does not establish a specific timing protocol or a single exercise regimen for people with celiac disease.

Diet acts through nutrient intake, symptom control and the microbial environment, making its relationship with exercise and immunity especially relevant in celiac disease. A Mediterranean-style gluten-free diet appears to improve nutritional adequacy and musculoskeletal health in the evidence summarized by the review. For selected individuals who adhere to a strict gluten-free diet but continue to experience irritable bowel syndrome-like symptoms, a short-term low-FODMAP diet may provide symptom relief. That finding concerns persistent gastrointestinal symptoms rather than demonstrated improvement of celiac disease itself, and the review does not establish a universal diet for children or athletes. Nutritional adequacy, gastrointestinal tolerance and gluten-free requirements must instead be considered together when assessing dietary strategies.

Children with celiac disease offer a clinically relevant setting for examining these interactions because physical activity, dietary management, growth and skeletal development converge during development. The review reports that integrating individualized activity with optimized dietary management supports growth, skeletal development and long-term health, including among physically active children and young athletes. It also positions celiac disease as a model for studying how lifestyle factors affect intestinal physiology, immune regulation and microbial communities. As a review, however, its conclusions depend on heterogeneous evidence involving different populations, activity patterns, diets and microbiome profiles; it does not demonstrate that one combined intervention produces a uniform benefit. The central conclusion is that individualized exercise and nutritional optimization may improve gastrointestinal function, musculoskeletal health and quality of life, while excessive training or nutritional imbalance can undermine those outcomes.

Subject of Research: Clinical review of exercise, diet and gut microbiota in children and athletes with celiac disease

Article Title: Interactions between physical activity, diet, and gut microbiota in gastrointestinal health: celiac disease as a model in children and athletes

Article References: Montano, A., Paolini, A., Felli, C., Bruno, S. P., Baldassarre, A., Sandal, S., & Masotti, A. (2026). Interactions between physical activity, diet, and gut microbiota in gastrointestinal health: celiac disease as a model in children and athletes. Frontiers in Sports and Active Living, 8, Article 1940762. https://doi.org/10.3389/fspor.2026.1940762

Image Credits: AI Generated

DOI: 10.3389/fspor.2026.1940762

Keywords: celiac disease, physical activity, gut microbiota, gastrointestinal health, children, athletes, gluten-free diet, low-FODMAP diet, bone health, immune regulation, Interactions, between