Female Collegiate Volleyball Player with Celiac Disease: A Case Report

Estimates of one in every 200 to 400 individuals, including the athletic population, suffer from celiac disease. Elite athletes present a unique complication when implementing a gluten-free diet because of the need for a high energy fuel. Dietetic adjustments such as increasing the caloric content and frequency are necessary to meet energy needs of highly physically active individuals. A National Collegiate Athletics Association (NCAA) Division I female volleyball player (height = 183 cm, weight = 81.0 kg) presented a unique case which initially mimicked the early stages of an eating disorder exacerbated by a significant increase in physical activity (preseason conditioning consisted of 11 days of three exercise sessions per day with one day of rest). The athlete was observed before, during, and after volleyball practice and competition and before, during and after meals. Under this superficial surveillance, her behavior supported the presumption of an eating disorder. The athlete was removed from volleyball activity once her condition began to affect her performance and her activities of daily living. The athlete had lost a considerable amount of body mass during the first 20 days of the season (-8.1 kg). This finding prompted the sports medicine staff to refer the athlete to the University Health Center for diagnostic testing. All initial blood tests were within normal limits; however, her weight at this time was 72.9 kg and she was 14.5% body fat, prompting referral to a gastroenterologist. After extensive gastroenterological testing, this female athlete was diagnosed with celiac disease, a condition primarily characterized by diarrhea and malabsorption (Pugh, 2000). This case report describes a differential diagnosis for athletes presenting with loss of body mass or decrease in body fat percentage. Increasing diagnoses of celiac disease appears to be occurring in the general population including the athletic population. Background and Significance Celiac disease, also known as gluten-sensitive enteropathy and celiac sprue, is a gastrointestinal condition affecting the small intestine. The disease causes chronic inflammation of the villi on the mucosal lining of the jejunum in the small intestine (Pugh, 2000). Characteristics specific to celiac disease include a mosaic pattern and scalloped folds in the lining of the small intestine, best identified with an endoscope. These mucosal characteristics as well as pallor and erythema with obviously visible blood vessels within the lumen of the small intestine are the best indicators to diagnosing celiac disease. The cause of histological changes in the small intestine is attributed to a hyper-sensitivity to gluten, an insoluble protein found in wheat, barley, and rye grains (Branski, 1998; Wardlaw, 1999). The disease is labeled “silent” or sub-clinical as cases often differ greatly between individuals and may go undiagnosed for years because the patient does not exhibit any outward signs or symptoms of the disease (Branski, 1998). Celiac disease may be exhibited by signs and symptoms of diarrhea, bloating, abdominal pain, weight loss, menstrual irregularities, fatigue, and weakness (Inman-Felton, 1999). Celiac disease is fairly common and various etiological factors appear to contribute to its development. In North American and European populations, celiac disease is prevalent in one in 200 to 400 individuals (Branski, 1998; Inman-Felton, 1999); however, many individuals with subclinical celiac disease may not have been diagnosed. Celiac disease is often triggered by a