title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  The athlete was treated with a gluten-free diet, which excludes wheat, barley, and rye. Dietary substitutions were incorporated to maintain adequate caloric intake.
  
  
  RESULTS
  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.
authors.affiliation: College of Education, Department of Health, Physical Education, and Recreation, Florida International University, Miami, FL 33199, USA. ebermanl@yahoo.com
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Eberman
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Cleary