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 this is the only treatment for coeliac disease and that failure to stick to the diet can lead to serious complications such as osteoporosis. This is crucial because, as we discuss below, 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In recent years, prescribing support has been withdrawn in a number of areas in England.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 better support the coeliac community.

With this in mind, we’ve listed below some of the key arguments for why gluten free prescriptions matter.

The case for gluten free prescribing

The gluten free diet can be challenging and failing to stick to it can have serious impacts on people’s health.

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.

Even the smallest crumb can lead to people feeling unwell and long term, the failure to stick to the diet can lead to developing other serious complications such as osteoporosis, vitamin D deficiency and iron deficiency and 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 and a flour is a huge part of the diet - you can’t easily replace bread with rice or potatoes!

Bread and flour is a big part of the UK diet and it’s not easily replaced by naturally gluten free alternatives alone.

It's really important that people are able to access gluten free bread and flour, which form the basis of most diets in the UK. Simply replacing bread with rice or potatoes, as is sometimes suggested, is complex and would have a significant impact on nutrient intake. 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%.

Gluten free food costs more, is harder to access and isn’t reliably available – despite what you might think!

Gluten free staple products are significantly more expensive than gluten containing equivalents. For example, gluten free bread is more than 4 times as expensive as gluten containing bread and contrary to popular belief, the cost difference has actually grown in recent years. For the cheapest loaf, it can be more than 7 times more expensive!

Despite significant 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. Research shows that of all the gluten free products, it is gluten free bread that people are most likely to struggle to reliably find in the shops. For example, 66% of participants in a recent study indicated they had to visit multiple stores in order to obtain the gluten free produce they needed. And whilst the availability may be much better in the larger stores, small convenience stores and budget supermarkets can be far less reliable.

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!

In 2021, Gluten free prescriptions represented just 0.07% of total prescribing in England and the cost to the NHS of providing bread and flour mix on prescription are dwarfed when compared 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. 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 – 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.