Clinical nutritionist Ishi Khosla, who is also founder of Whole Foods, adds that while there is a genuine increase in cost, a rise in demand would help.
Walking down the alleys of a bustling supermarket, one is spoilt for choice when it comes to food. Various condiments, snacks, sauces, beverages, confectionary and ready-to-eat foods beckon consumers with the sheer variety they offer. Sadly, for some people, it’s all untouchable. They are the ones who suffer from various food allergies, and have to keep away from most processed and packaged foods, because in India brands do not furnish allergen information on labels. This includes even foreign brands that otherwise provide this information for the same products in other countries.
So what do these people do? They have an alternative, but it’s not for everyone again. And this time the conundrum is not labelling or availability, but price. Special stores abound in metros and large cities offering food products for those with intolerance for milk, nuts, wheat, soy, etc. But they are few, and concentrated only in tier-I cities. And prices of these products are prohibitively expensive. For instance, a small pack of gluten free biscuits costs over Rs 100, which would be around Rs 20 for its regular variant.
This very situation forces people like Poonam Lohiya, a 35-year-old homemaker and resident of Delhi who suffers from celiac disease and is on a life-long gluten-free diet, to opt for only homemade food. “The prices of gluten-free products are more than double the rate of regular products available in the market, which is why I have not bought any packaged food items all these years, even though I was diagnosed with celiac disease in 2010,” she says. With Lohiya’s husband being the sole bread winner of the joint family that the couple and their two children are part of, there is little room for her to be able to afford gluten-free products available in the market. “I grind my own flour at home, and stick to eating home-made food. I have tried gluten-free bakery items like bread, biscuits, etc, bought from outside but only on special occasions. The sellers do not offer any discounts, even during festive season,” she rues.
This situation persists even after the Food Safety and Standards Authority of India (FSSAI) in June this year laid down specific guidelines and instructions for proper testing and labelling of products. “When presence of any allergens is identified in food ingredients and products, controls shall be put in place to prevent their presence in foods where they are not labelled. Where cross-contact cannot be guaranteed, consumers shall be informed,” wrote FSSAI in its Guidance Document released in June. Under the heading titled “Health Supplement/ Nutraceuticals Processing”, a subhead titled “Allergen Management” is dedicated entirely to giving information regarding the major allergens present in foods, enlisting the steps manufacturers can take to minimise chances of cross-contamination, while ensuring that they provide all allergen-related information fair and square on the products’ labels. However, very few brands have made the effort to provide full disclosure regarding the presence of allergens in their products and whether they have been prepared in separate facilities.
Interestingly, the FSSAI has started looking into the matter seriously this year only — a stark contrast to the scenario in the West where the USFDA enforced the Food Allergen Labelling and Consumer Protection Act in 2004 to ensure that manufacturers label their products right.Why the delay? Lack of abundant research and testing, say the authorities. “Consumers are now becoming more aware about food allergens. In fact, many brands are now innovating on allergen-free products. It (recognition of allergens in foods) requires testing. We have initiated a little bit of work in that space, and more work needs to be done,” says Pawan Aggarwal, chief executive officer of the FSSAI. “ However, there are many challenges involved in preparing such specialty foods. For instance, millets are gluten-free but it is difficult to develop the right binding and puffing with all these grains —ragi, corn, bajra, etc. Hence, the need of the hour is more home-grown brands, generating awareness and easy availability of products,” he adds.
The awareness lag
Manufacturers feel the government has still not looked into the matter seriously. “Of the total population, the number of people with celiac disease is very small. Even among those few people, majority are not aware of their condition, which is why we have not seen proper laws for allergen labelling and specialised foods production,” says Kirti Bhatia, owner of Jalandhar-based Savour Life Products, a company that manufactures a variety of gluten-free products on a small scale. “A couple of years back, there were not even appropriate guidelines defining gluten-free. At least now the FSSAI has taken cues from the USFDA and adopted some guidelines. I think there’s still a lot of work to be done there,” she adds. Even though the company does not operate on a large scale, Bhatia says their gluten-free breads, pizza base, kulcha, muffins and biscuits are the most popular items.
“We are seeing an increase in food-related allergic disorders in India. It is a condition where symptoms appear within minutes to hours of a particular food allergen intake. The five most important and common foods that lead to allergy include seafood, eggs, wheat, milk, peanuts,” explains Govind Makharia, professor of gastroenterology and an acclaimed expert in celiac disease at AIIMS, New Delhi. “Food allergy is poorly recognised in our country and many doctors do not even suspect it. We are seeing an increase in awareness about the condition of food allergy, but only in minority. There is a dire need to study the burden of food allergy in India, and the type of food allergens in our context,” he adds.
Proper awareness or not, the number of people with food intolerance has only been increasing. A 2013 journal titled Problems and Challenges to Adaptation of Gluten Free Diet by Indian Patients with Celiac Disease published by doctors at AIIMS, New Delhi, revealed that nearly 80 lakh Indians are estimated to have celiac disease, which is an autoimmune disorder that occurs because of ingestion of a protein called gluten present in wheat, barley, oats and rye, and affects mainly the small intestine. It added that nearly 1 in 100 people have celiac disease in India. Besides, almost 60-70% Indians are lactose intolerant as per a 2013 study conducted by department of gastroenterology at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow. Since the data available is quite dated, it is only natural to assume that the numbers have increased over the years.
As a result of increasing instances of people with food intolerance, the demand for specialised foods is increasing, albeit at a softer pace owing to poor awareness and pricing. Harinder PS Lamba, chief executive officer of Patiala-based Cheers Food and Beverages that manufactures gluten-free products under the brand name Wheafree, says their gluten-free flour, cookies, cake rusk and fresh bakery items are being widely demanded. Shuja Shaikh, chief operating officer and co-founder of Raw Pressery, says there has been a steady demand for their lactose-free almond milk.
As per the FSSAI’s Guidance Note No. 09/2018, only foods that contain 20 mg gluten per kg or less can be labelled ‘gluten-free’. Yet, a lot of manufacturers irresponsibly certify their products as gluten-free. Information regarding the kind of facility the gluten-free product was created in is almost never present. “I think more than the government it is the manufacturers’ moral obligation to clearly spell out allergens, and we are seeing an increasing number of brands adopting this practice. I am positive that these actions will further streamline the packaged food industry and become more label-compliant,” feels Raw Pressery’s Shaikh. Another issue is that testing requires a lot of money and manufacturers are often hesitant to walk that extra mile in the absence of stricter government controls. “Manufacturers do not spend money in lab infrastructure to install Elisa Plate reader and recruit professionals to test the allergens in their products and even general manufacturers who might have a gluten-free product like besan refrain from labelling their products right due to high chances of cross-contamination,” says Wheafree’s Lamba.
“The ministry of health and agriculture has to sit together to understand the sensitivity of allergens and see how crops can be segregated at agriculture markets and do not get cross-contaminated. In Italy, the farms are separate, the produce is kept separately and also processed in dedicated gluten-free plants. The government has to be more sensitive which is missing at the moment,” he adds.This kind of carelessness cannot be adopted in case of food intolerance that can result in dire and lifelong consequences. Studies conducted in this domain have highlighted that consumption of gluten by a celiac disease patient can result in chronic inflammation, which can take the form of cancer at a later stage. The patient also becomes increasingly prone to metabolic diseases such as diabetes, heart disease and arthritis. Prolonged consumption of gluten despite the body’s intolerance has also been known to cause infertility among women.
Besides, mental health disorders such as schizophrenia and bipolar disorders are are being linked to a “leaky gut” that can be the result of consumption of an allergen like milk or nuts. Without proper awareness and labelling, many people with food allergies have cited falling sick accidentally. “Restaurant and food service managers should also be trained to be aware of the serious nature of food allergies and to avoid cross-contact during food preparation and service. The FSSAI is already in the process of finalising the norms for labelling of allergens in its new regulation on labelling and display of pre-packaged foods. Once the regulation gets implemented, the above problem would be addressed,” says Aggarwal of FSSAI.
Nearly all specialised foods — lactose-free, nut-free, gluten-free — are priced at more than double the rate of mainstream packaged products that are available in larger volumes. A loaf of gluten-free bread, for instance, costs anywhere between Rs 100 and Rs 150, a pack of biscuits weighing 400-500 gm costs anywhere between Rs 200 and Rs 300, and a 200-ml bottle of lactose-free milk is priced at Rs 100 and above.
One of the major causes of this inappropriate pricing mechanism is lack of adequate demand. Since awareness of food allergies-related disorders is relatively poor, there are not enough buyers and hence the market is tilted towards the supply side. Secondly, raw materials being used to substitute wheat or dairy are costly, due to which the final product is much more expensive than its regular counterparts.
“The price of almond milk and regular milk is the same abroad. But in India, almond milk is almost six times dearer than regular milk. Also, since it’s considered stylish and a superfood, some people are willing to shell out whatever amount even if they don’t need lactose-free food medically. Also, people are coming up with their own theories as to why they have a particular allergy or intolerance. A proper standard defining the conditions is missing. I think we need more regulation,” says Parmeet Kaur, chief dietician, department of dietetics at AIIMS, New Delhi.
Manufacturers say increased demand should help bridge that gap. “The idea is to not only to serve a product that customers demand but also a product of great quality. While we cannot control the prices of nuts like almonds that we use to make lactose-free milk, with more adoption and increase in volume, we see that the production cost will come down to some extent and so would the selling price,” says Shaikh. “However, there would still be a big gap between regular dairy milk and non-dairy almond milk, but one can expect more non-dairy milk options such as oat milk which will be priced more economically,” he adds.
Clinical nutritionist Ishi Khosla, who is also founder of Whole Foods, adds that while there is a genuine increase in cost, a rise in demand would help. “When you try and substitute wheat in a food, you are at a loss of certain binding properties. If you are substituting with potato starch or some gum, they are definitely pricier. That is a genuine increase in cost,” she says, adding, “The testing cost of these foods is also really high, and there is no bulk production for now. As a manufacturer, I can tell you that distributors say it upfront that there is no such great market for specialised foods. I think things will get better once the volume picks up an d food industry also starts making more of these products.”
Lamba, on the other hand, says the retail margins on specialised products such as those devoid of allergens are as high as 40% due to market trends. “There is a trend in the retail market that such products come at high margins and where distributors are ready to work at 10-15% margins on general products, for products free from allergens, they demand margins of 25-40%,” he says. “Besides, there is no support from the government. They know that a celiac patient is on a lifelong diet of gluten-free products, yet they give no concession to the patients. Cookies being taxed at 18%, savouries at 12% and flour at 5% are other factors that make these products expensive,” he adds.
Some say the government can take cues from other countries that have successfully devised ways to tackle the food-allergy crisis. “Why cannot the prescription of celiac patients be linked to Aadhaar card through which direct GST subsidy can be given to the patient, thereby avoiding giving them to manufacturers or retailers to avoid misuse?” asks Lamba. “The UK, Italy, USA have different models to offset the high cost of gluten-free food products,” he points out.