Eating out is always a risky proposition for those with celiac disease. No matter how careful you are, the presence of gluten in a restaurant makes cross-contamination a possibility. Understanding this, I recommend being as careful as possible to avoid gluten as much as possible, but to understand that you cannot possibly check every ingredient used by the restaurant. It would be very difficult to check items such as mayonnaise or butter at a restaurant, although you should do so at home. Focus instead on the things that are most likely to contain gluten.
Many who must eat a strict gluten-free diet avoid eating out, but I feel this is an unnecessary restriction. Although eating out is a challenge for gluten-free dieters, with education and caution, all can enjoy restaurant food safely. Note that being as careful as possible with your diet at home will reduce your overall “gluten load” and help you keep your gluten exposure as low as possible. The more often you eat out, the higher your overall gluten exposure. The more often you eat out, the more careful you need to be.
As soon after arriving at the restaurant as you can (before you sit down, if possible), state that you have a “medically-required gluten-free diet” (this gets the point across more clearly than saying you have an allergy and establishes the degree of seriousness with which your diet requirements must be treated) and would like to talk to the manager, cook, or someone who would be familiar with the ingredients used in preparing the food. In most cases, it is better to talk directly to the cook or manager rather than the server. Ask if the establishment marks which items on their menu are gluten free or if they have a list of gluten-free offerings. Ask them what procedures they use, if any, to prevent cross-contamination.
Try to eat at off-peak hours; this will make it easier for the staff to help you, as they will not be so busy. Even better, if you know ahead of time where you will be eating, call ahead earlier in the day and talk to the manager or chef. It also helps not to be starving when you arrive at a restaurant, as you won’t be able to eat the bread or chips (because of cross contamination) and will probably have to wait longer for a specially prepared meal. It helps to carry a food bar or other light snack to help avoid low-blood-sugar crankiness.
Even if you have already explained your needs to the manager, also tell the server as well. When talking to the server, emphasize that they should leave off any bread, crackers, croutons, or other gluten-containing ingredients. State that you don’t want anything containing gluten on the plate, as that would cause contamination and render the entire dish inedible to you.
Explain the diet carefully. Don’t just say wheat intolerance (this is often misunderstood as meat intolerance). Mention that you cannot eat anything that contains wheat, oats, rye, or barley. This includes anything made with flour, breadcrumbs, anything breaded or floured, and anything cooked in the same oil as other foods containing gluten. Mention some less-well-known gluten-containing ingredients such as malt vinegar, soy sauce, bouillon, broth, and sauces or soups thickened with flour. Another common misunderstanding can occur if you say, “I can’t eat wheat.” You might get the response from a waitress that I once did, “That’s OK honey, we have white bread here.” (these sorts of situations happen less frequently than in the past, as more people become familiar with what gluten-free means, however, never assume that someone understand the full diet, even if they say they do). If you are eating in a Mexican Restaurant, ask if the chips are fried in separate oil from other gluten-containing foods, ditto with French-fries or any other food that is deep-fried. Also ask that the griddle be cleaned before cooking your food.
If the plate comes along with a roll sitting next to your steak, keep your plate and ask them prepare you a completely new meal, this time leaving off the roll. After you get the new meal, give up your contaminated plate (this way they don’t just take your plate to the kitchen and pull off the roll, leaving the crumbs behind. Be alert to suspicious items such as rice with pasta-looking bits in it (“oh, that’s not wheat, it’s semolina”), large, chewy, flour-looking tortillas, or anything that looks like the sauce may have been put on then scraped off. If something doesn’t look right, ask about it.
Don’t be shy about asking for what you need. It is your health that is at stake. Restaurants are a service industry and are generally willing to help you as much as possible. A server may be grumpy about having to answer lots of questions, but grumpy servers are much easier to endure than being sick all night. If a server is especially difficult (or especially helpful), reflect this in your tip. If a restaurant is unwilling to accommodate you or treats you as an unwelcome problem, don’t return. There is always another restaurant down the road that will be happy to help.
If you frequently return to the same restaurant, always mention your dietary restrictions each time you order, even if you have ordered it before and it was OK. Even if you have ordered from the same server on several other occasions; it is easy for them to forget and slip back into the routine of putting a roll on the plate.
If you plan to go to an amusement park, be sure to call several days in advance and talk to someone in the food service department about what foods are gluten-free. Don’t wait until you are starving to look for food options, as it always takes extra time to talk to the manager and check for ingredients. Preparation of special foods often takes longer.
Helpful tools for a glutenous world
You may want to get a gluten-free restaurant card that explains the diet in detail; these cards are especially helpful when there are language barriers. Pre-printed cards in many languages are available from Celiactravel.com. There is also at least one app for GF restaurant cards.
Some gluten-free dieters use enzyme products such as GliadinX or GlutenEase to help prevent a reaction to cross-contamination that can occur when eating out. These enzymes are meant to help break down the long chains of proteins that are the cause of celiac woes, and thus render them harmless. Scientific evidence on whether or not this works is thin; it is very difficult to prove they are effective, since symptoms of minor gluten exposure can take months or years to manifest. Because of this, no such supplement is ever likely to receive FDA approval. If you choose to use one of these supplements, use it as a backup in case of accidental exposure, not a substitute for good gluten-free eating practices. Also check to make sure the supplement is gluten-free.
Testing food for gluten with a gluten sensor (such as the Nima sensor) can also give a bit of reassurance when you are concerned about a particular food (that creamy white sauce that just doesn’t look like it could be gluten-free; that too-good-to-be-true roll that’s just to light and chewy to be made without gluten). While some feel the sensor is not accurate enough to rely on, others appreciate having a option for a second opinion for those moments of doubt. Again, this is just one of the tools in the quest for gluten freedom: keep on asking questions and being careful.
The Restaurateurs’ Gluten-free Dilemma
Restaurants are supposed to adhere to the Food and Drug Administration’s rules for gluten-free labeling (foods labeled gluten-free contain less than 20 parts per million gluten). Because most restaurants don’t want to test their food or take precautions to avoid cross-contamination, they use alternative wording contortions to describe offerings that have no intentionally added gluten, but may contain gluten via cross contamination that renders them unsafe for those with celiac disease: “gluten friendly” or “gluten aware” or “gluten sensitive”. Often restaurants will put disclaimers on their menus warning of possible cross contamination of items marked as gluten-free (a practice that is technically not allowed).
This poses a quandary for those whose health depends on maintaining a strict gluten-free diet. We want to know what is gluten-free, and we want as much information as possible about how it is prepared so we can make an informed decision as to whether it is safe for us (what may be safe for one gluten-free dieter may not be so for another). We want to eat out, and we want to do so safely, but where there is gluten, there is the possibility of cross contamination. Short of not eating out at all or restricting ourselves to the handful of dedicated gluten-free establishments out there, there is no way to eat out without some degree of risk.
The best way to deal with this dilemma is to patronize those establishments willing to take extra steps to provide us with meals that are as safe as possible. Unfortunately, those are few and far between, and not always within reach, so we must often compromise. The next best thing is to have accurate information. We want to know what items contain no intentionally added gluten, and we want to know which of those items pose the highest risks of significant cross contamination. The long-term solution seems to be to have sensible rules about gluten disclosure in restaurants so that communication can be clear and without fear or having to have gluten contortions.