In defence of the NHS's gluten-free prescriptions

There has been uproar this week over prescriptions for gluten-free products, but the truth is, they are a lifeline for many

The NHS can prescribe coeliacs gluten-free foods
The NHS can prescribe coeliacs gluten-free foods Credit: Photo: GETTY

Earlier this week, there was uproar at reports that gluten-free food on prescription costs the NHS £116 million per year. The implication was that coeliacs are gorging themselves on fast food, at the cost of the taxpayer, and contributing to the obesity epidemic.

But we shouldn't be too quick to judge.

"These items can cost 3-4 times more than the gluten-filled counterparts, which over a year can add up to hundreds of extra pounds"
Rosie Norman

As Barbara Holt, gastroenterology specialist dietitian at King’s College Hospital, puts it: “Gluten free products on prescription such as bread, pasta, flour and cereal are staple foods within a healthy balanced diet.

"Not once have I requested a GP to prescribe doughnuts, burger mixes or pasties. I think it is very unfair and misleading to state that this is a regular occurrence.”

The truth is, for coeliacs, gluten-free food is actually a form of ‘medicine’. In fact, the only proven treatment for coeliacs is a strict gluten-free diet for life.

I was diagnosed with coeliac disease in my teenage years. This is a life-long, autoimmune disease caused by a reaction of the immune system to gluten, a protein found in wheat, barley and rye.

When someone with coeliac disease eats gluten, their immune system reacts by damaging the lining of the small intestine. At diagnosis, having the disease meant I had brittle bones, anaemia and was grossly underweight.

The great gluten-free scam
Pasta is a staple in many peoples diets (ANDREW CROWLEY)

Following a gluten-free diet has so far enabled me to live a full and healthy life. And now working as a dietitian, I’ve seen how this disease can affect others. Many find it very difficult to follow a gluten-free diet and need to have staple substitute items such as bread, flour and pasta in order to make that diet practical. The problem is in supermarkets, these items can cost 3-4 times more than the gluten-filled counterparts, which over a year can add up to hundreds of extra pounds. And that’s if you can find the substitutes, which are more scarce in budget supermarkets or convenience stores.

Of course, some people are saying that coeliacs should just buy naturally gluten-free foods.

Certainly, eating more rice, lentils and potatoes is something I’ve embraced. But try telling that to a newly diagnosed, isolated and elderly coeliac with limited cooking abilities, or a five-year-old coeliac who just wants a slice of cake at their birthday party. If you are elderly, young, on a low income or have mobility problems, prescribable products can become a lifeline.

Rice is naturally gluten-free (MATTHEW MEAD)

And what is the real cost of prescribing gluten-free products on the NHS? In 2014 it was apparently £26.8 million (not £116 million), making the annual cost per diagnosed patient £180. This cost is both a treatment and preventative measure, being arguably cheaper than treating the associated health conditions coeliacs risk developing if they don’t comply strictly with their diet. “Undiagnosed or untreated coeliac disease can lead to osteoporosis, infertility and in rare cases, small bowel cancer and without support, people with coeliac disease are at greater risk of these complications” said Sleet in her letter this week. A few loaves of gluten-free bread on prescription certainly seems the preferable option.

If we can address issues surrounding availability and cost in shops, there would not be a need for prescriptions, but at present GPs, pharmacists and dietitians working together to ensure correct prescribing is our best option.