Limited Availability and Higher Cost of Gluten-Free Foods Continue in the United Kingdom: A Comparative Follow-Up Over More Than a Decade.

backgroundCoeliac disease requires strict lifelong adherence to a gluten-free diet, although adherence is challenged by the limited availability and higher cost of gluten-free foods. The demand for gluten-free foods has increased over recent years, yet its impact on availability and cost is unknown. This study aims to assess the availability and cost of gluten-free food across diverse retail outlets and compare changes over 11 years.

methodsReplicating the same methodology as our previous study in 2010, the availability and cost of 20 foods (10 wheat-based, 10 everyday foods) were assessed in 30 stores across a diverse range of London boroughs and compared over an 11-year period. For each of the 20 foods, the cost of four products were selected (branded gluten-free, cheapest gluten-free, branded standard, cheapest standard) and compared.

resultsAvailability of the 20 foods in 2021 was generally limited, with an average of 7.6 (SD 5.7) gluten-free foods per store (38.2% of foods surveyed). Regular supermarkets in particular saw a reduction in availability over time from 18.0 (SD 2.0) of the 20 foods (90% of foods) available in gluten-free versions in 2010 decreasing to 14.0 (SD 1.4, 70%) in 2021 (p = 0.008). Gluten-free foods were more expensive than gluten-containing counterparts. In terms of secular trends, the 2021 cost generally exceeded inflation-adjusted estimates; however, the ratio between the cost of gluten-free and gluten-containing foods declined over the 11 years.

conclusionsOver 11 years in the UK, gluten-free food availability remained limited and more costly. Any impact of sustained limited availability and higher cost on adherence to a gluten-free diet should be addressed and interventions to overcome these issues should be tested.