Today’s Dietitian
Vol. 28 No. 3 P. 16
Food insecurity remains a persistent public health issue in the United States, affecting approximately 13.5% of households in 2023.1 In Michigan, rates are slightly below the national average at 12.5%, or one in eight adults from 2021 to 2022.2 Food insecurity is defined as an ongoing inability to access enough food for every person in a household to live a healthy life.3 Adequate access to food is a critical social determinant of health. Food insecurity is associated with negative health outcomes and an increased risk of diet-sensitive chronic diseases such as hypertension, diabetes, and CVD.4 Certain medical conditions, such as celiac disease, require adherence to specialized diets as an essential component of the treatment plan. Currently, a gluten-free diet is the only treatment option for people with celiac disease. Therefore, access to safe, gluten-free food is necessary to achieve intestinal healing to aid in disease control, and to improve symptoms as well as quality of life. This further complicates things for people with celiac disease who are food insecure. One study found that 15.9% of patients with celiac disease in the United States are food insecure, which is higher than the national average for the general population.5
Gluten-free foods are significantly more expensive and less readily available, contributing to the issues with food insecurity. In fact, on average gluten-free products were 183% more expensive than wheat-based counterparts.6 There are limited resources on the accommodations from food banks and pantries for individuals with medically necessary dietary restrictions such as celiac disease or other food allergies. Additionally, research on how food insecure individuals manage gluten-free needs is lacking.
To address this gap locally, a survey throughout the state of Michigan was conducted to explore the prevalence, awareness, and accessibility of gluten-free assistance resources. Additionally, there were questions to assess the interest from individuals in opportunities to further support improving gluten-free access within community food programs across the state. With this information, the goal is to build awareness and increase resources and volunteers within the community to stock and support a gluten-free section within community food programs in Michigan.
A survey was distributed in November 2024 using Google Forms. It was shared within the community through social media platforms, professional networks, email listserv, Michigan Academy of Nutrition and Dietetics forums, and within the University of Michigan Department of Gastroenterology community website. The form included multiple choice, checkbox, and open-response questions. The survey aimed to assess the current availability of gluten-free options at food pantries, the degree of need, barriers in obtaining gluten-free foods, and willingness to collaborate on solutions to address gluten-free assistance needs.
Survey Results
A total of 674 individuals responded to the survey. Eight individuals answered that they do not have someone in their household who must eat gluten-free, and three responded that they did not live in Michigan, leaving 663 total responses. The respondents were from 60 different counties within the state of Michigan. Key findings include 39% of respondents reported being unable to purchase gluten-free foods in the past year due to cost, and that 15% of individuals or loved ones had to eat gluten because they couldn’t afford gluten-free products. Gluten-free items that appeared to be the most difficult to access include bread, pasta, soups, baked goods, cereal, and packaged goods, with bread being the most common response. Travel willingness to obtain gluten-free food from a pantry varied, with 41% willing to travel 10 to 20 miles, 29% willing to travel five to 10 miles, 21% willing to travel over 20 miles, and only 9% preferring to stay within a zero-to-five-mile range. Roughly 200 individuals responded with willingness to help organize a gluten-free section in food pantries in their area.
Discussion
This preliminary survey highlights a significant need for gluten-free food access amongst food insecure individuals in Michigan. A common theme from the survey was lack of availability of gluten-free items, and some respondents reported that food pantries in their area do not offer any gluten-free foods at all. Our survey found that roughly one-third of individuals were unable to buy gluten-free foods, which is two times higher than the national estimated average of one in six individuals.5 However, the proportion of individuals who intentionally consumed gluten because they couldn’t afford gluten-free food were more consistent with the national estimate.5 This discrepancy may be explained by individuals who, despite limited resources, relied on naturally gluten-free foods or reduced their overall food intake to avoid gluten. Thus, further research is needed to better understand these differences in access and dietary behavior.
Demographic data showed the highest number of responses came from Oakland, Wayne, and Macomb counties. This could be due to the increased sharing of the survey which was done by individuals in these counties. The county with individuals reporting that they couldn’t afford gluten-free food most frequently was Kent County. Interestingly, this did not correlate with the higher proportion of individuals in the same county who reported they intentionally ate gluten due to inability to afford gluten-free food. This disconnect suggests that although many individuals in Kent County face barriers to purchasing gluten-free products, they may be engaging in alternative strategies to receive gluten-free food or avoid gluten-containing foods. These findings highlight a critical gap in our understanding of how individuals with a medical need for the gluten-free diet navigate food access barriers and the need for further research. Respondents were generally willing to travel up to 20 miles to access gluten-free food, suggesting that centralized county level food pantries could serve multiple cities and communities.
The survey findings also highlight the compounding challenges that medically required diets introduce in the context of food insecurity. For individuals with celiac disease, consuming gluten-free food is not optional; it is the only treatment for their life-long autoimmune disease. When gluten-free options are not available at food pantries, individuals may be forced to either skip meals or consume foods that cause damage to the small intestinal lining, making nutrients difficult to absorb, leading to a cascade of negative symptoms and health implications.
In conclusion, this survey emphasized the need for education and awareness about providing safe alternatives for people with medically necessary dietary restrictions, specifically, the gluten-free diet. Educational material and training for food pantry staff and volunteers could be an effective starting point. Awareness in the community concerning the higher rate of food insecurity among people with celiac disease and its negative impact on health could hopefully drive the increase in resources and donations to support gluten-free offerings. Partnerships with national and local food companies, as well as community volunteers, could help fill this gap. Overall, continued efforts in awareness, advocacy, and research are essential to address this underserved need within food assistance programs in the state of Michigan and across the country.
This study was approved by the University of Michigan Institutional Review Board HUM#00282021.
— Amanda Lynett, MS, RDN, is the lead outpatient dietitian with the Division of Gastroenterology and Hepatology at the University of Michigan Health System in Ann Arbor, Michigan and codirector of the annual GI-focused continuing education conference, FOOD: The Main Course to Digestive Health.
References
1. Household Food Security in the United States in 2023. Usda.gov website. https://www.ers.usda.gov/publications/pub-details?pubid=109895. Published 2023.
2. Rabbitt MP, Hales LJ, Burke MP, Coleman-Jensen A. Household Food Security in the United States in 2022. US Department of Agriculture, Economic Research Service; 2023.
3. USDA ERS – Food Security in the US. USDA website. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us. Published April 22, 2022.
4. Chronic disease risk increased with U.S. household food insecurity. Economic Research Service. USDA website. https://www.ers.usda.gov/data-products/charts-of-note/chart-detail?chartId=108913. Published 2024. Accessed October 15, 2025.
5. Ma C, Singh S, Jairath V, Radulescu G, Ho SKM, Choi MY. Food insecurity negatively impacts gluten avoidance and nutritional intake in patients with celiac disease. J Clin Gastroenterol. 2022;56(10):863-868.
6. Lee AR, Wolf RL, Lebwohl B, Ciaccio EJ, Green PHR. Persistent economic burden of the gluten free diet. Nutrients. 2019;11(2):399.
7. Find a Food Bank/Pantry Near You – National Celiac Association website. https://nationalceliac.org/find-a-food-bank-pantry-near-you/. Published October 2024.
8. Food Insecurity Resources for Healthcare Provides – Celiac Disease Foundation. Celiac Disease Foundation website. https://celiac.org/foodinsecurityresources-hcp/. Published 2025. 9. Gf-foodinsecurity. Dr. Schar Institute website. https://www.drschaer.com/us/institute/n/gf-foodinsecurity. Published March 8, 2022.