Article

Economic Burden of a Gluten-Free Diet

Department of Biological Sciences, Columbia University, New York, New York, United States
Journal of Human Nutrition and Dietetics (Impact Factor: 1.99). 11/2007; 20(5):423-30. DOI: 10.1111/j.1365-277X.2007.00763.x
Source: PubMed

ABSTRACT

Coeliac disease is a common, autoimmune disorder, for which the only treatment is lifelong adherence to a gluten-free diet. This study evaluates the economic burden of adhering to a gluten-free diet.
A market basket of products identified by name brand, weight or package size for both regular wheat-based products and gluten-free counterparts was developed. The differences in price between purchase venues, both type of store (general grocery store, an upscale grocery store and a health food store and four internet-based grocery sites) and region was also analysed.
Availability of gluten-free products varied between the different venues, regular grocery stores carried 36%, while upscale markets carried 41%, and health food stores 94%, compared with 100% availability on the internet. Overall, every gluten-free product was more expensive than their wheat-based counterpart (P <or= 0.05). Bread and pasta was twice as expensive as their wheat-based counterparts. Cost was affected more by shopping venue than geographic location.
This study demonstrated that gluten-free foods have poor availability and are more expensive than their gluten-containing counterparts. The impact of these findings on dietary compliance and the quality of life needs to be addressed.

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    • "Both conditions require lifelong dietary exclusion of gluten-like proteins in wheat (gliadin and glutenins), barley (hordeins), rye (secalins) and in some 8% of coeliacs, oats (avenins) (Hardy et al., 2014). Gluten-free diets are traditionally low in fibre, high in fat and economically more costly (Lee et al., 2007; Ohlund et al., 2010; Wild et al., 2010). In addition up to 90% of coeliacs remain currently undiagnosed, a phenomena termed the 'coeliac iceberg' (Catassi et al., 1996; Ravikumara et al., 2007). "
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    • "Diets that are 'gluten-free' are generally less available and more expensive (Lee et al, 2007), with family, travel, and external dining difficulties (Lee and Newman, 2003), lower palatability (Lerner, 2010), generally inferior nutrition (Thompson et al, 2005; Shepherd and Gibson, 2013), higher sugar intake (Wild et al, 2010), lower shelf-life properties (Hamer, 2005), requiring dietician monitoring (Sollid and Khosdla, 2005), and with high non-compliance (Dewar et al, 2012). Compliance to gluten-free foods is difficult due to insufficient motivation (Ciclitira et al, 2005), inadequate product labelling, insufficient knowledge of minimal gluten levels to avoid coeliac disease (De Angelis et al, 2006), with many starchbased gluten-free wheat flours often containing gluten through contamination (Collin et al, 2004). "
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    • "One reason noted for the exclusion of this portion of the diet was due to the increased cost of the gluten-free products in the USA. The increased cost of gluten-free foods was confirmed in our recent study that looked at cost and availability across different regions of the USA (Lee et al., 2007). The alternative grains selected provide the specific nutrients that are lower in the standard gluten-free diet menu pattern (Thompson, 2000). "

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