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

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Abstract
Purpose: Coeliac disease (CD) is a life-long condition requiring strict adherence to a gluten-free (GF) 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 CD is being limited in England. The purpose of this paper is to investigate the availability and cost of GFF in an area where patients with CD have restricted access to prescriptions and to assess the nutritional composition of GFFs available in comparison with foods containing gluten (FCG). Design/methodology/approach: Eight food categories that were representative of a range of commonly purchased GFFs were selected. Availability and cost of the 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 FCGs (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. GFFs cost, on average, 2.18 times more than FCG. When making nutritional comparisons with gluten-containing food, protein content was lower across 55 per cent of GFF categories. There was significantly less sugar in GF brown bread, crackers, and wholegrain pasta compared with those containing gluten (CG). Another main finding was GF ready-meals contained significantly less salt than ready-meals CG. Originality/value: Limited resources and perceived wide availability of GF 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 GF diet and is most likely to affect patients from deprived groups. This study recommends that the prescription of GFF to patients with CD should be continued.

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