In July 2017, the first study to report a significantly higher proportion of patients adhering to a gluten-free (GF) diet when receiving GF foods on prescription, compared with those not receiving GF foods on prescription, was published.

The study by Muhammad, Reeves, Ishaq, et al. explores the practical challenges of a GF diet and dietary adherence in Caucasian and South Asian adults with coeliac disease.

Coeliac disease (CD), an autoimmune condition affecting 1% of the population, requires lifelong exclusion of gluten from the diet. A GF diet for a coeliac patient usually consists of foods naturally free from gluten (e.g. rice, potatoes and meat) and manufactured GF products (e.g. GF bread, GF pasta and GF cereals).

Adhering to a GF diet is known to be challenging, and this is shown by levels of adherence ranging between 36-96%. In England, National Prescribing Guidelines recommend prescribing 18 units per month for adults clinically diagnosed with CD. However, a number of local clinical commissioning groups (CCGs) are currently restricting or removing GF prescriptions, resulting in disparity.

In recent years, England has seen an increase in the number of manufactured GF versions of wheat-based foods in regular and quality supermarkets, as well as online, but issues still remain with the significantly higher cost of these products and budget supermarkets and local ‘corner’ shops often having low, if any, stock of these products.

The current trend of CCGs restricting GF prescriptions, coupled with the high costs and limited availability of GF foods (compared with gluten containing foods) leads to real concerns over long-term health risks for people with CD.

This study found that a large proportion of participants with CD were not adhering to a GF diet despite adherence being fundamental to the treatment of CD to prevent long term complications. Findings did show, however, that the role of the dietitian was important in the long-term management of CD and, of the patients receiving GF foods on prescription, 58% adhered to a GF diet compared to 38% of those not receiving GF foods on prescription.

Of the 74% of patients who received GF products on prescription, 75% reported receiving sufficient GF products on prescription, whilst 25% were unsatisfied. At the time of data collection, the national guidance of 18 units per month was in place although it should be noted that data on the amount of GF food on prescription received by respondents was not collected.

Other findings included the understanding of food labels was important to help adhere to the GF diet, along with membership of Coeliac UK. Members, however, are most likely to be a self-selected group of patients who may exhibit greater motivation to adhere to the GF diet. Additionally, coeliac societies do offer practical advice and support which may also contribute to GF dietary adherence.

The authors concluded, ‘We, therefore, recommend retaining adequate GF foods on prescription and improving access to suitably priced GF foods, membership of a coeliac society and regular consultations with a dietitian to provide patients with coeliac disease the knowledge, skills, and support required to adhere to a GF diet.’

The abstract and full study can be found below:


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