Appropriate and cost-effective prescribing of gluten free products


Best practice points to ensure cost-effective prescribing of Gluten Free Products

  • Gluten free products should be prescribed only for those with Gluten sensitive enteropathy, coeliac disease and dermatitis herpetiformis. Gluten Free Products are not ACBS listed for other conditions such as irritable bowel syndrome or self diagnosed gluten intolerance
  • All newly diagnosed coeliac patients should be referred to a dietitian for appropriate dietetic assessment and review
  • Coeliac UK provides guidance on approximate monthly quantities of Gluten Free Products required, see Table 1
    • It should be stressed that this is only a guide. Some patients such as children with faltering growth, children during growth spurts, adults who are underweight or have increased requirements through illness, breast feeding and third trimester of pregnancy, those who are very active may require more
    • Patients on twice daily insulin regimens do have a requirement for regular intakes of carbohydrate foods and as such need adequate amounts of prescribable gluten free products
    • Patients outwith these categories requesting or receiving significantly more than this should be reviewed by dietitian
  • Some companies provide free starter packs of basic products to enable patients to identify he products they prefer: Glutafin: 01249 466270, Juvela:   0151 432 5312
  • If starter packs are not available, patients should be prescribed small quantities of a variety of products from different companies initially until they are aware of their preferred products
  • Prescriptions should largely be for staples, such as bread, pasta, flour, mixes, plain crackers and biscuits. Other luxury items should be purchased by the patient where possible. In more rural areas, on-line shopping should also be encouraged if Gluten Free Products are not stocked locally
  • Genius is a company who provide fresh bread and although it is not available on prescription some patients do receive it through a pay and report. It is expensive and comes in packs of 6. Patients should have adequate facilities to store this volume of fresh bread to prevent waste.

Guidance for quantities prescribed

Gluten-free foods have been given a unit value 
1 unit tends to = 1 packet of the product however there are some exceptions- see table below.

Age and sex

 Number of units

 child 1-3 years  10
 child 4-6 years

 11

 child 7-10 years  13
 child 11-14 years  15

 child 15-18 years

 18

 male 19-59 years

 18

 male 60-74 years

 16

 male 75+ years

 14

 female 19-74 years

 14

 female 75+ years

 12

 breastfeeding

 add 4

 3rd trimester pregnancy

 add 1

 high physical activity

 add 4

 Food item

 Number of units

 400g bread/rolls/baguettes  1
 500g mix

 2

 200g biscuits/crackers  1
 250g pasta  1

 500g pasta

 2

 2 x 110-180g pizza bases

 1

Example:

Male aged 15-59 years requires 18 units per month.
This could be made up of:
10 x 400g loaves of bread (=10 units)
1 x 2 pack of pizza (= 1 unit)
1 x 500g pasta (= 2units)
1 x 200g crackers (= 1 unit)
1 x 500g flour mix (=2 units)

Queries :  Contact your local dietitian or Carole Noble, Dietetic Prescribing Advisor, NHS Grampian, 01224 556305