Sunday, August 16, 2009

Gluten-Free = Wallet Woes

After a few months living in California I was struck by the number of food allergies and intolerances of my friends, colleagues, and their families. Gluten-free, lactose-free, peanut-free, pit-free...the list goes on and on. I don't believe that these diseases are just more 'common' in people living in the Bay Area, rather I think it is more likely that doctors (and patients) are probably more aware of food allergy signs and symptoms and thus more apt to screen for and diagnose these problems. In a highly educated, wealthy area like the Penninsula (i.e. Silicon Valley) this makes sense.

The peanut allergy epidemic (I'm not sure that it would officially be characterized as such....) that led to pretzels in airplanes and banning of peanut products in some schools surely raised America's awareness about some food allergy issues. Lactose intolerance has been around for a long time and is fairly well-known. Although many Americans suffer through stomachache after stomachache unwilling to believe that glass of milk or bowl of ice cream could be the culprit. Celiac disease, an extreme form of gluten intolerance is another story.

This week the New York Times ran an article on Celiac disease entitled 'The Expense of Eating with Celiac Disease'. Celiac disease (CD) is an immune disorder triggered by eating products containing gluten (a protein found in most of America's staple grains: wheat, rye, and barley). Even products that you might not have these grains as a primary ingredient may contain traces of it that can trigger extreme pain and health problems for someone with CD.

While the number of Americans with CD is fairly small, a recent epidemiological study in Gastroenterology shows that the disease is more common now than in the 1950s. Lack of diagnosis and treatment of CD also seems to increase the risk of premature death (nearly 4 times!). Though few people are diagnosed with full out CD, many more likely suffer from gluten sensitivities (or intolerance) that might not reach clinical or immunological proportions. Avoiding gluten for the gluten-sensitive can result in greater energy and stamina, fewer digestive problems, and an overall feeling of wellness.

Nonetheless, dealing with health conditions related to food allergies and intolerances, including CD is not covered by health insurance in the US. This is because, as the NY Times article points out, there is no pill or prescription to treat it. The regimen: a strict, allergy-free diet. For those that can't have gluten this means avoiding many cheap, inexpensive, American staples. It means eating more 'whole foods' (fruits, vegetables, meats, legumes, etc). If you think I'm kidding, go to the grocery store and compare the price of a bag of brown rice flour to a bag of wheat flour.

Apparently in Britain, those with CD are afforded insurance coverage (albeit through their government plan) to help offset the added cost of a gluten-free diet.

I think these lifestyle changes are often overlooked by health insurance companies because they don't fit the pharmaceutical quick fix framework. However, I hope that there is good debate over how these types of real-world issues related to a diagnosable, medical condition can be subsidized and included in an insurance plan (even if its through that pre-taxed flexible spending account that you can use to buy over-the-counter drugs and copays).

  • For more information on how to eat gluten-free on a budget read the NY Times article.
  • For more on the article in Gastroenterology read the following review in Science Daily.
  • For recipes and cooking tips/ideas check out one of my favorite food blogs: Karina's Kitchen (aka the gluten free goddess).

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