WATERLOO - Nicole Simmerman, 11, has her own side of the kitchen stocked with her own food and furnished with her own toaster. She doesn't have issues sharing with her family, she has celiac disease - an allergy to wheat gluten.

"I'm very careful," she said.

Her caution has paid off so far - she hasn't had an attack in three to four years. For it to pay off, her parents have paid. Going gluten-free isn't cheap.

Nicole's macaroni and cheese is around $5, compared to less than $1 for a box that contains gluten.

Celiac disease affects one out of every 100 people. It damages the lining of the small intestine, makes it difficult for the body to digest and absorb nutrients. The only treatment for the disease is to eliminate gluten from the diet. Subtracting gluten adds to the grocery bill.

"At the beginning it's 'what do I feed my child,'" said Kristi Simmerman, Nicole's mother. "Later it's 'how do I afford $6 for a loaf of bread?'"

Some foods that use replacement ingredients, such as xanthan gum, are higher-priced.

Xanthan gum-blend flour goes for up to $12 per pound compared to conventional flour that goes for less than $2 per pound.

It's a useful but expensive staple, Kristi Simmerman said.

"You can actually, cup-to-cup, change a recipe," she said.

Many gluten-free foods are also produced by smaller health food companies that shun cost-cutting food production ingredients and techniques.

For people on a fixed income, avoiding foods that make them sick takes a higher percentage of what little they have coming in.

"I can't get all my food at once," Sally Ripplinger of Cedar Falls said.

Ripplinger is blind and on disability. While she is able to find most of what she needs in the health market of grocery stores, affording her monthly groceries is a struggle.

"My dollar doesn't go as far," she said.

Some large companies are helping bring the cost of gluten-free foods down. Betty Crocker has introduced gluten-free cake and brownie mixes. General Mills has come out with gluten-free versions of its various Chex mix flavors. Rice Chex cereals also are gluten-free.

"There are more choices out there than just a year-and-a-half ago," said Mark Schnackenberg, KWWL meteorologist. Schnackenberg was diagnosed with celiac disease in March 2008.

For Kristi Simmerman, that availability does have a downside.

"I wonder how those smaller businesses that have been with us from the beginning are going to be able to compete," she said.

Simmerman is president of the Waterloo/Cedar Falls Celiac Support Group. Her husband, Kenneth, is working on a Web site that will list what gluten-free foods are available and where and which restaurants offer gluten-free menus.

Oddly, eating out doesn't carry as much of a mark-up as grocery shopping, Schnackenberg said.

"It's a matter of eliminating ingredients," he said, adding he hasn't been able to order breaded chicken since his diagnosis.

"You get to know the chefs and the cooks after a while."

For people who keep records and itemize their tax returns, if their total medical expenses for the year exceed 7.5 percent of their adjusted gross income, they can deduct the difference in cost of gluten-free products over comparable conventional foods.

For Kristi Simmerman the costs aren't as much of a hassle as just finding gluten-free foods used to be when Nicole was first diagnosed 8 years ago. Instead of shopping online, she can head to the health market section of most grocery stores.

"They see the need there," she said. "We're seeing more all the time."