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


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.

Download full-text


Available from: Peter H R Green, Jun 05, 2014
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Coeliac disease is a well-defined condition that is estimated to affect approximately 1% of the population worldwide. Noncoeliac gluten sensitivity is a condition that is less well defined, but is estimated to affect up to 10% of the population, and is often self-diagnosed. At present, the only remedy for both conditions is a lifelong gluten-free diet. A gluten-free diet is often expensive, high in fat and low in fibre, which in themselves can lead to adverse health outcomes. Thus, there is an opportunity to use novel plant breeding strategies to develop alternative gluten-free grains. In this work, we describe the breeding and characterization of a novel ultra-low gluten (ULG) barley variety in which the hordein (gluten) content was reduced to below 5 ppm. This was achieved using traditional breeding strategies to combine three recessive alleles, which act independently of each other to lower the hordein content in the parental varieties. The grain of the initial variety was shrunken compared to wild-type barleys. We implemented a breeding strategy to improve the grain size to near wild-type levels and demonstrated that the grains can be malted and brewed successfully. The ULG barley has the potential to provide novel healthy foods and beverages for those who require a gluten-free diet.
    Full-text · Article · Oct 2015 · Plant Biotechnology Journal
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the identification of critical etiological factors such as wheat gluten peptides and the predisposing human gene encodement, coeliac disease remains one of the most common chronic human inflammation diseases. Whilst daily gluten intake has increased up to 50 grams per day for some individuals in some developed countries mostly through manufactured gluten additives, average gluten avoidance by consumers has increased from 15 percent in 2013 to 22 percent in 2014, with the average serves of core grain food decreasing by 29 per cent between 2011 and 2014. This study focused on wheat bread, and examined 12 different preventive and symptom-treating pathways against risk mitigation, added risk, consumer acceptance, cost effectiveness, and time efficiency, and concluded that dough fermentation type, enzyme additives, and time considerations in the baking processes offered the best solutions to achieve a consumer-safe bread from wheat gluten. While bakers are not the sole cause of coeliac disease, there needs to be better understanding and adequate education for bakers of protein hydrolysis in the fermentative microbiological processes and enzyme activities. A cost and time effective measurement of gluten residues in the baking process remains a serious limitation to increased prevention of coeliac disease.
    Full-text · Conference Paper · Sep 2015
  • Source
    • "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). "

    Full-text · Dataset · Sep 2014
Show more