Celiac Disease in an Elite Female Collegiate Volleyball Athlete: A Case Report
Abstract
Objective: To present the case of an elite female volleyball player who complained of diarrhea and fatigue after preseason training.
Background: The athlete lost 8.1 kg during the first 20 days of training, and we initially suspected an eating disorder. The sports medicine team interviewed the athlete and found she did not have psychological symptoms indicative of an eating disorder. The results of routine blood tests revealed critically high platelet counts; in conjunction with the physical findings, the athlete was referred to a gastroenterologist.
Differential Diagnosis: Our initial suggestion was an eating disorder. Therefore, the differential diagnosis included anorexia athletica, anorexia nervosa, and bulimia nervosa. On referral, the differential diagnosis was anemia, gastrointestinal dysfunction, lymphoma, or bowel adenocarcinoma. Diarrhea, weight loss, and blood test results were suggestive of active celiac disease, and a duodenal biopsy specimen confirmed this diagnosis.
Treatment: The athlete was treated with a gluten-free diet, which excludes wheat, barley, and rye. Dietary substitutions were incorporated to maintain adequate caloric intake.
Uniqueness: The presence of active celiac disease may not be uncommon. However, elite athletes who face celiac disease present a new challenge for the athletic trainer. The athletic trainer can help guide the athlete in coping with the lifestyle changes associated with a gluten-free diet.
Conclusions: One in every 200 to 400 individuals has celiac disease; many of these individuals are asymptomatic and, therefore, their conditions are undiagnosed. Undiagnosed, untreated celiac disease and patients who fail to follow the gluten-free diet increase the risk of further problems.
Celiac disease affects as many as 1 in every 200 to 400 individuals in North America and Europe.1,2 We suggest that the frequency of celiac disease in the general population is mirrored in the athlete population. As a result, athletic trainers should become aware of the signs and symptoms, referral practices, and treatment of celiac disease to best care for patients. The following is a case report of a female collegiate volleyball player with the uncomfortable and performance-inhibiting symptoms of celiac disease and the successful diagnosis and treatment of her condition.
Footnotes
Lindsey E. Eberman, MS, LAT, ATC, contributed to conception and design; analysis and interpretation of the data; and drafting and final approval of the article. Michelle A. Cleary, PhD, LAT, ATC, contributed to conception and design and critical revision and final approval of the article.
Address correspondence to Lindsey E. Eberman, MS, LAT, ATC, College of Education, Department of Health, Physical Education, and Recreation, Florida International University, Miami, FL 33199. Address e-mail to moc.oohay@lnamrebe.