Work

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

Year: 2026

Type: review

Abstract: Physical activity, diet, and gut microbiota are key determinants of gastrointestinal physiology, immune regulation, and metabolic homeostasis, collectively influencing gastrointestinal health, physical performance, and long-term wellbeing. Although regular physical activity generally promotes intestinal function and systemic health, excessive exercise, nutritional imbalance, and underlying gastrointestinal (GI) disorders may adversely affect gastrointestinal integrity and athletic performance. Within this context, celiac disease (CeD) represents a unique clinical model for understanding the complex interactions among physical activity, dietary interventions, gut microbiota, and gastrointestinal health in both children and athletes. This clinical review provides a comprehensive overview of current evidence regarding these interactions, focusing on gastrointestinal physiology, exercise-related GI disorders, bone health, dietary strategies, and gut microbiota modulation. Current evidence indicates that appropriately prescribed physical activity improves gastrointestinal function, immune regulation, body composition, skeletal health, and quality of life, partly through favorable modulation of the gut microbiota, whereas prolonged or poorly individualized high-intensity exercise may impair gastrointestinal integrity through splanchnic hypoperfusion, increased intestinal permeability, oxidative stress, and transient dysbiosis. A Mediterranean-style gluten-free diet appears to improve nutritional adequacy and musculoskeletal health, while a short-term low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP) diet may relieve persistent irritable bowel syndrome-like symptoms in selected individuals despite strict gluten-free diet adherence. In children with celiac disease, integrating individualized physical activity with optimized dietary management supports growth, skeletal development, and long-term health while addressing the specific physiological demands of physically active children and young athletes. Overall, celiac disease provides a clinically relevant model for understanding how physical activity, diet, and gut microbiota interact to influence gastrointestinal health, highlighting the importance of individualized lifestyle strategies that integrate appropriate exercise with nutritional optimization to improve gastrointestinal function, musculoskeletal health, and quality of life.

Source: Frontiers in Sports and Active Living

DOI: 10.3389/fspor.2026.1940762