Why are gluten free staples food offered on prescription

Having difficulty accessing gluten free prescriptions

Why are gluten free staples food offered on prescription

Gluten free prescriptions support people with coeliac disease to maintain a strict gluten free diet. This recognises that a gluten free diet is the only treatment for coeliac disease and that failure to stick to the diet can lead to serious complications such as osteoporosis, neurological dysfunction, unexplained infertility and in rare cases, small bowel cancer. This is crucial because the diet can be hard to stick to, gluten free foods are more expensive than their gluten containing equivalents, and they can be difficult to find in local shops.

In recent years, prescribing support has been withdrawn in a number of areas in England. We continue to work with policy makers and our commercial partners to raise awareness of the challenges facing the coeliac community, particularly in light of current cost of living pressures and urge them to use the resources at their disposal to provide better support. We’ve listed below some of the key arguments for why gluten free prescriptions matter.

The gluten free diet is the only treatment for coeliac disease and failure to stick to it can have serious consequences

Following a strict gluten free diet for life is the only treatment for people with coeliac disease. This means completely avoiding food containing more than 20ppm of gluten (a protein found in wheat, barley and rye), much of which is a central part of our diet in the UK.

Failure to stick to the diet can lead not only to debilitating symptoms but in the long term to developing other serious complications such as:

Osteoporosis
Neurological dysfunction
Unexplained infertility
Iron deficiency
In very rare cases, small bowel cancer
For children, long term untreated coeliac disease can have additional consequences including faltering growth and delayed puberty

Bread is a staple of the UK diet and cannot be easily replaced by alternatives such as rice or potatoes

Gluten free staple products play a crucial role in supporting people with the condition for both practical and nutritional reasons. It is not as simple as switching gluten free bread for rice and potatoes.

For example, replacing an average portion of gluten free bread with a portion of rice containing the same amount of calories would reduce the iron intake by 96% and the calcium content by 90%.
Similarly, replacing gluten free bread with a portion of peeled, boiled potatoes containing the same amount of calories would reduce the iron content by 71% and the calcium content by 93% [1, 2].

Gluten free staples cost significantly more

Gluten free staple substitute products cost significantly more than gluten containing equivalents. Coeliac UK’s recent report, The Gluten Free Diet: What does it cost and why does it matter? (2024 Update) shows that:

A weekly gluten free food shop can be as much as 35% extra.
A loaf of gluten free bread is on average more than 4 times as expensive as a gluten containing one. And this is even worse when looking at the cheapest loaf.
This is on average 6 times as expensive, disproportionately hitting those least able to afford it.
A recent Coeliac UK survey showed 8 in 10 of those with coeliac disease struggled to afford the gluten free products that keep them well.

Read about our cost of living campaign

Gluten free staples are not readily and reliably available

Despite progress in recent decades, it remains difficult to reliably access gluten free bread and flour in the shops, particularly if you live in rural or poorer areas [3]. In our cost and availability supermarket survey,

35% of survey respondents shopped at budget supermarkets, yet they reported no availability of gluten free bread.
Gluten free pasta was only available in 1 in 10 shopping trips.
Gluten free flour was not available for any of the shopping trips to budget supermarkets.

When shopping online:

1 out of 3 orders for gluten free bread loaves were out of stock and 1 out of 4 orders for gluten free flour were out of stock. Where substitutes were allowed or provided, in 1 in 3 cases they were not suitable for a gluten free diet.
Out of the 15 supermarkets visited, no supermarket had availability of every item included in a weekly food shop for a gluten free diet.

The result is that our most vulnerable – those on a limited income, the elderly, or those living in remote rural areas with reduced mobility – are severely disadvantaged in maintaining their gluten free diet and this potentially risks their health.

Gluten free prescriptions are good value for money for the NHS

The cost to the NHS of providing gluten free bread and flour mix on prescription are overshadowed in comparison to the financial impact of treating associated conditions caused by someone not being able to stick to the diet.
We understand that there is a need to control costs within the NHS but cutting gluten free prescriptions is a false economy; small savings in prescription costs could lead to higher treatment costs associated with poor health outcomes and increased health complications.
Gluten free prescriptions represent just 0.07% [4] of total prescribing in England.
It costs approximately £195 a year per patient to support gluten free food on prescription. The average cost to the NHS of an osteoporotic hip fracture is £27,000 [5] – the equivalent of 138 years of gluten free prescribing. This is significant given that osteopenia and osteoporosis are found in 40% of adult patients at diagnosis of coeliac disease [6].
Coeliac UK survey showed 8 in 10 of those with coeliac disease struggled to afford the gluten free products that keep them well.

References:

[1] McCance and Widdowson (2021) Composition of foods integrated dataset (CoFID): https://www.gov.uk/government/publications/composition-of-foods-integrated-dataset-cofid
[2] Coeliac UK, Coeliac Diet and Nutrition Survey conducted 2018-2019 (unpublished)
[3] Hanci, O. and Jeanes, Y.M. (2018) “Are gluten-free food staples accessible to all patients with coeliac disease?,” Frontline Gastroenterology, 10(3), pp. 222–228. Available at: https://doi.org/10.1136/flgastro-2018-101088.
[4] NHS England Prescriptions cost analysis 2022 (published 2023)
[5] NICE, Clinical Guideline CG124: The management of hip fractures in adults. 2011
[6] Lucendo, A.J. and A. Garcia-Manzanares, Bone mineral density in adult coeliac disease: an updated review. Rev Esp Enferm Dig, 2013. 105(3): p. 154-62.