Can Prescriptions for Bread Support Well-Being?

It might sound quirky—prescribing bread. But for people with coeliac disease, being able to get gluten-free staples on the National Health Service (NHS) was once much more than a nice benefit. It was a lifeline. A source of safety. And, increasingly, it’s disappearing.

Across England, access to gluten-free prescriptions now depends less on clinical need and more on where you live. What was once a nationwide policy has become a postcode lottery—and the impact is more than just financial. When access to safe food becomes harder, physical health suffers. But so does mental well-being.

It’s Not a Trend—It’s a Treatment

Gluten-free diets might be popular in wellness culture, but for people with coeliac disease, avoiding gluten isn’t a lifestyle choice—it’s the only treatment.

Coeliac disease is a serious autoimmune condition where even tiny traces of gluten (a protein in wheat, barley, and rye) trigger the body to attack its own small intestine. The long-term consequences of unmanaged coeliac disease are severe: malnutrition, osteoporosis, infertility, and even certain cancers (Laurikka et al., 2022). There’s no cure. The only way to stay well is through a strict, lifelong gluten-free diet—every single day.

Some people with coeliac disease may choose to buy naturally gluten-free foods or manage their diet well without prescriptions. But for many, especially those facing financial pressure or living in rural areas, having access to gluten-free staples like bread and flour through prescription provides vital support.

More Than Just Bread: What Prescriptions Really Offer

For decades, people diagnosed with coeliac disease in England could access staple gluten-free foods—bread, pasta, flour—on prescription. This wasn’t about convenience. It was about health protection.

Prescriptions helped ensure consistent access to safe, gluten-free alternatives in a food system where gluten dominates and where gluten cross-contamination is an invisible but serious threat. Beyond the physical necessity, prescriptions also address some of the emotional burden of navigating a restrictive diet. They offered reassurance. Stability.

But, since NHS England’s 2017 guidance limiting prescriptions to just bread and flour mixes, local health bodies (Integrated Care Boards) have made their own decisions. The result? An unequal system. According to the Coeliac UK (2024) cost of living report:

• 37 percent of people in England now have no access to gluten-free prescriptions at all.
• 54 percent can access bread and flour mixes through the NHS.
• The rest are subject to age or condition-based restrictions.
• In contrast, Wales, Scotland, and Northern Ireland still provide gluten-free staples as standard.

And while supermarket shelves might seem like an alternative, reality tells a different story.

The Price of Safe Food

Gluten is a staple of the UK diet—especially in bread. For people with coeliac disease, the Coeliac UK Cost of Living Report (2024) indicates that finding safe substitutes is harder and more expensive than it should be:

• Gluten-free bread can cost up to 6.1 times more than regular bread (gram for gram).
• A weekly gluten-free shop is, on average, 35 percent more expensive.
• 87 percent of Coeliac UK survey respondents report issues with product availability.

These challenges hit hardest in rural areas and lower-income households—the very people who benefit most from prescription support. When access is removed, many are left facing an impossible trade-off between health and affordability.

And when the gluten-free diet becomes harder to follow, the consequences aren’t just personal—they’re systemic. Suboptimal management of a gluten-free diet leads to long-term complications, driving up NHS costs down the line.

The Hidden Cost: Mental Health

Eating is never just about nutrition. It’s social. Cultural. Emotional. For people with coeliac disease, food can become a source of stress, fear, and exclusion (Satherley et al., 2022). When prescriptions are withdrawn, that emotional weight grows heavier. People with coeliac disease must spend more time examining food labels, worrying about contamination, or missing out on shared meals. Many report increased anxiety, loss of confidence, and a sense of being forgotten by the very system meant to protect them (Crocker et al., 2023).

While not everyone chooses to take prescriptions, people manage the gluten-free diet in different ways. For those who do rely on this support, the loss of gluten-free prescriptions can be significant.

Policy conversations are starting to catch up. In March 2024, the issue of gluten-free prescriptions was brought to the House of Lords, where healthcare professionals, people with coeliac disease, Coeliac UK, and researchers—including our team from the University of Surrey—highlighted growing concerns around regional inequality and its impact on well-being. The discussion reinforced the urgent need for consistent national guidance and greater involvement of people with coeliac disease in decisions about their care.

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So... Can Bread Improve Mental Well-Being?

In this case, yes. Or at least, having guaranteed access to safe, necessary food can. It brings peace of mind. It supports self-management. It says, “Your condition is recognised, and your needs matter.”

In the end, this is about more than just bread. It’s about whether people with coeliac disease have consistent, equitable access to what they need to stay well—physically and mentally.

Author

Rosie Satherley is a senior lecturer in clinical psychology in the School of Psychology, University of Surrey. Her work focuses on how to support people to live well with coeliac disease.