For people with celiac disease, gluten-free food is the only treatment. Unlike in parts of Europe, patients in Estonia must cover the extra cost of gluten-free foods alone.
Celiac disease is a chronic autoimmune condition triggered by gluten and with a strong genetic component. When someone with celiac disease eats gluten, a protein found in grains including wheat, barley and rye, the immune system attacks and damages the lining of the small intestine.
Symptoms can range from fatigue, nausea and abdominal pain to more serious complications such as liver dysfunction, neurological problems or recurrent miscarriage, also known as recurrent pregnancy loss (RPL).
Celiac disease differs from non-celiac gluten sensitivity (NCGS), which can cause similar symptoms but does not damage the small intestine.
For those with celiac disease, the only treatment currently available is strict adherence to a gluten-free diet, said Estonian Celiac Society (ETS) chair Aive Antson.
“At present, science has no other pill, injection or other medication available for us,” she said.
Gluten-free products are typically more expensive than standard foods, however, and like other groceries, prices have only gone up with inflation.
Antson noted that Estonia lacks comprehensive research comparing gluten-free and regular food prices across categories, but the ETS conducted its own study in late 2024. Bread showed the biggest gap.
“Gluten-free bread was 6.3 times more expensive than rye bread,” she said, adding that gluten-free baking flour mixes were also 5.1 times pricier than wheat flour.
No extra support in Estonia
A Ministry of Social Affairs study conducted several years ago estimated that monthly grocery bills for someone with celiac disease average around €90, Antson noted.
That figure also included services such as visits to a dietitian, however, and has likely risen since regardless.
Although the primary treatment for celiac disease is a special diet, Estonia does not provide financial support or reimbursements for gluten-free food.
Several other European countries, meanwhile, have introduced measures to help ease the burden. In Finland, low-income patients can apply for assistance with food costs. Ireland offers tax relief on gluten-free food purchases and additional support for those facing financial hardship, while Italy provides food vouchers.
In the U.K., gluten-free products may even be available by prescription depending on the region.
Minister of Social Affairs Karmen Joller (Reform) said the issue has not been discussed recently, but acknowledged the need to consider possible solutions.
“Since this is essentially therapeutic food, it should either be covered by the Estonian Health Insurance Fund (EHIF) or perhaps [compensated] via rehabilitation services,” Joller said.
EHIF, however, said covering everyday food purchases out of health insurance funding isn’t possible.
“EHIF pays for healthcare services included in the official list of healthcare services,” the agency said in a written comment, noting that medicines are likewise reimbursed based on a central list of subsidized pharmaceuticals.
Officials added that decisions on reimbursing treatments or medicines in Estonia are based on medical evidence, effectiveness and cost.
Celiac Society: We’ve run out of steam
Antson said the Estonian Celiac Society has not held substantial discussions with policymakers for several years.
“The ETS celebrates its 30th anniversary this year,” she said. “We were more active in the society’s early years and even 10–15 years ago, but in recent years, we’ve run out of steam because our proposals haven’t led anywhere.”
Still, the organization now hopes to reopen the conversation. It plans to gather updated data on the cost of gluten-free diets and the additional expenses faced by people with celiac disease and their families.
Once that information is compiled, Antson said, the ETS intends to bring it back to Estonian policymakers.
She also emphasized the need for closer cooperation with doctors and healthcare professionals, noting that celiac disease remains underdiagnosed across Europe.
“People will often go to the doctor’s with various symptoms for years — or even decades,” Antson said.
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