No more pizza.

No more toast with your eggs.

No bun with your hamburger.

That could be your life if you are one of the two million Americans with celiac disease.

Celiac disease is a fairly common digestive disease that damages the small intestine and interferes with absorption of certain nutrients from food. Those suffering from celiac disease cannot tolerate a protein present in gluten from wheat, rye, barley, and, for some, oats. While it affects some people differently, general symptoms include:

• Diarrhea
• Weight loss
• Abdominal pain
• Chronic fatigue
• Malnutrition,
• Gastrointestinal problems

Treatment of celiac disease is simple, but not necessarily easy—avoid any foods that contain gluten. Dietary training, meetings with nutritionists, and following new food rules can help cope with the disease.

"It is important for people with celiac disease to remain on a gluten-free diet," says David Elliott, MD, PhD, director of the Celiac Clinic. "When a person stays on a gluten free diet, we can't tell he has celiac disease. However, if he returns to eating food containing wheat, rye, barley, or oats, he redevelops the intestinal inflammation."

For more information, contact the Celiac Clinic at the James A. Clifton Center for Digestive Diseases, 319-356-3792.

Unsuspected culprits

Gluten is often added to processed foods including:

• Bouillon cubes
• Chips, potato chips
• Candy
• Cold cuts, hot dogs
• French fries
• Imitation fish
• Rice mixes
• Sauces
• Self-basting turkey
• Soups
• Soy sauce
• Vegetables in sauce
• Gluten is even found in the glue on envelopes and in some medicines and vitamins

Celiac disease is often undiagnosed or misdiagnosed. Some symptoms mirror other diseases, and celiac disease is often confused with irritable bowel syndrome, Crohn's disease, or chronic fatigue syndrome.