Nutritional quality, cost and availability of gluten free food in England

Purpose: Coeliac disease is a life-long condition requiring strict adherence to a gluten free diet. Due to wide claims of availability and lower costs of gluten free food (GFF) and Clinical Commissioning Groups (CCGs) in England needing to save costs, access to prescriptions for patients with coeliac disease (CD)is being limited in England. The purpose of this study is to investigate the availability and cost of GFF in an area where patients with coeliac disease have restricted access to prescriptions and to assess the nutritional composition of GFFs available in comparison with foods containing gluten. Methodology: Eight food categories that were representative of a range of commonly purchased GFFs were selected. Availability and cost of cheapest and most expensive branded and non-branded GFFs and gluten containing equivalents were surveyed at physical stores (n=19) and online stores (n=8). The nutritional composition of some of the widely available GFFs identified (n=190) and comparable foods containing gluten (n=218) were calculated using MyFitnessPal. Findings: None of the budget stores or corner shops surveyed stocked any of the surveyed cereal-based GFFs. Online stores had more availability than physical stores, however there was no significant difference in cost. Gluten free foods cost on average 2.18 times more than food containing gluten. When making nutritional comparisons with gluten-containing food, protein content was lower across 55% of GFF categories. There was significantly less sugar in gluten free (GF) brown bread, crackers, and wholegrain pasta compared with those containing gluten. Another main finding was GF ready-meals contained significantly less salt than ready-meals containing gluten. Originality: Limited resources and perceived wide availability of gluten-free products resulted in reduced GF prescriptions to patients in England. The findings in this study revealed that there is no availability of cereal-based GFFs in budget stores, high cost and limited access to prescriptions can influence adherence to a gluten free diet and is most likely to affect patients from deprived groups. This study recommends that the prescription of gluten free food to patients with CD should be continued