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The cost of living
crisis has a unique impact on people with coeliac disease

Our viewpoint

This week is coeliac disease awareness week. Here at LCP, we’ve looked at the cost of gluten free diets and analysed national prescribing data for gluten free food in England. In the context of the cost of living crisis, where many people are struggling to afford to eat healthily, the struggle is even harder for those with coeliac disease. 

What is coeliac disease?

Coeliac disease is an autoimmune disease in which a person’s body attacks itself in response to the intake of gluten, which is found in wheat, barley and rye. If someone with coeliac disease eats or has a drink containing gluten, the initial autoimmune reaction can vary from no symptoms to severe fatigue with brain fog, requiring up to a week off work in some cases. The most common symptoms are fatigue, weight loss and diarrhoea, but there are also long-term consequences for peoples’ health, including a higher risk of other autoimmune diseases such as multiple sclerosis and bone disorders such as osteoporosis, and a corresponding impact on the wider health care system.

Coeliac disease affects about 1 in 100 people and, for the vast majority, stopping eating gluten clears up all symptoms of the disease. However, to prevent symptoms reappearing, a lifelong gluten free diet is required. Many coeliacs also don’t eat oats due to the risk of contamination during processing, which restricts what they can eat even further.

Eating gluten free is expensive

You’ve probably seen the “free from” aisle at your local supermarket and this is where gluten free versions of food normally containing gluten, such as bread, pasta and cereals, can be found. But these gluten free foods are considerably more expensive than their standard counterparts. We pulled data from a leading supermarket chain to compare the price of regular versus gluten free foods, finding that gluten free foods often cost at least double the non-gluten free equivalent.

Section

Available on prescription in England since 2017

Item – Gluten free

Cost – Gluten free

 

Equivalent item – with gluten

Cost – with gluten

Bread

Yes

Genius gluten free toastie – 500g

£2.70

Warburtons Toastie Sliced Bread – 800g

£1.10

Tesco free from sliced bread – 500g

£1.80

Tesco white bread – 800g £0.60

Pasta

No

Tesco free from fusilli – 500g

£1.00  

Tesco Fusilli pasta – 500g

£0.75

Cereal

No

Nutribrex gluten free (24 pack)

£3.70

Weetabix Cereal – 24 pack

£3.00 (but only £1.92 for 24 if bought as a pack of 72)

Tesco free from cornflakes – 500g

£1.50

Tesco cornflakes – 500g £0.60

Prescriptions for gluten free foods are falling

Historically, gluten free foods were prescribed by GPs, but there were only a few specialist brands available and lengthy waiting times because pharmacies generally did not keep them in stock. Gluten free bread originally came in a can, but now better tasting versions are available made from different flours, including rice, corn, potato and tapioca flour. In addition, gluten free foods are increasingly available from supermarkets as gluten free diets have become popular.

In 2017, NHS England published new guidance about which gluten free foods can be prescribed by GPs, restricting this to bread and flour replacements. In order to understand the impact that this has had on prescriptions for gluten free foods, LCP analysed national data on all the prescriptions made by GPs in England. This data shows that there has been a rapid drop in the prescription of gluten free foods in recent years, and thus since 2017, people with coeliac disease have been expected to pay for other gluten free food themselves.

The availability of gluten free food on prescription depends on where people live

Our analysis of prescribing data in England shows huge variation in the number of NHS prescriptions for gluten free foods. After adjusting for differences in population, the number of prescriptions for gluten free foods were 200 times higher in some areas of England compared to others (essentially because some NHS areas have restricted prescriptions of these foods almost completely).

We also looked to see if there was an association between rates of prescribing and levels of deprivation, and found little evidence that these foods were being prescribed at higher or lower rates according to how deprived the local population was. This means that there is a risk of people with coeliac disease in the most deprived areas of the country not having access to gluten free foods due to a combination of lack of access through prescriptions and lack of money to purchase foods.

How can you help?

On a personal level, everyone can help people with coeliac disease access gluten free food by donating non-perishable gluten free food to local food bank collection boxes. If you have coeliac disease and are struggling to afford supermarket prices, ask your general practitioner what gluten free food options are available - some of the brands offer packs of six or eight loaves of bread for the price of a single prescription, which can then be frozen for later use.  Given the challenges that many people are now facing to afford the essentials of life in a time of high inflation, it may also be the time for policy makers to consider how less well-off people with coeliac disease can be supported to access gluten free food, no matter where they live.