Niki Bezzant: Gluten or not, that's the puzzle

As more people cut out gluten, better gluten-free food is becoming available. Photo / Mark McKeown

Gluten is a nutrition topic that has been hot for years now.

It's partly because more awareness means more people are being diagnosed with coeliac disease, the permanent autoimmune disorder that means sufferers need to avoid all traces of gluten for life.

There are also more people who don't have coeliac disease, or a confirmed diagnosis of it, but believe they have issues with gluten, known as Non-Coeliac Gluten Sensitivity.

This condition seems to be widely debated, with some experts challenging its existence.

Research on it is limited.

Gluten has also unfortunately been somewhat demonised in the alternative health and wellness space, and blamed for everything from weight gain to brain fog.

That means there may be people who are avoiding gluten without really needing to because they think its absence is making them healthier.

These groups combined mean the growth in gluten-free eating has led to more gluten-free products being developed, which has led to more awareness of gluten, and so on and so on.

There's no doubt advances in gluten-free foods are a boon for gluten-free eaters.

Gone are the days, mostly, of gluten-free bread resembling a brick and tasting like cardboard. Some extremely good gluten-free versions of staple foods are readily available now, although it's still, for the most part, more expensive.

And sometimes it's less healthy, in terms of nutrients and vitamins, than regular food.

So there are good reasons for not going gluten-free without an accurate diagnosis. And this is the focus for this year's Coeliac Awareness Week.

Self-diagnosis is problematic. That's because putting yourself on a gluten-free diet can interfere with getting an accurate diagnosis of coeliac disease.

Gluten has to be present in the diet - in other words you need to be eating it regularly - for a blood test or small bowel biopsy to prove you have coeliac disease.

It can't be diagnosed simply by cutting out gluten and feeling better because that could happen for other reasons, including malabsorption of fermentable sugars (Fodmaps), which also happen to be in some gluten-containing foods.

Or it could be coincidental.

Coeliac New Zealand has launched an online assessment tool to help people at the start of the diagnosis journey.

The new tool takes people through some simple questions to assess a risk level for coeliac disease. A referral letter for those at risk is provided for people to take to their GP to order further testing.

It's estimated that 65,000 New Zealanders have coeliac disease, but 80 per cent don't realise it.

Coeliac New Zealand general manager Dana Alexander says early diagnosis is essential to avoid potential lifelong chronic illness such as osteoporosis, neurological issues, liver disease and infertility.

The online assessment tool, she says, "helps people join the dots and consider that coeliac disease may be the cause of their overall unwellness".

It could also help others eliminate coeliac disease as a possibility.