Eating out with any sort of dietary restriction can be tough. We eat out for the experience of eating different foods and for the camaraderie of being with others. Not being able to relax when out in a social setting and needing to worry about diet restrictions is stressful and can be upsetting.
Many restaurants now have gluten free menus. As gluten free diets have become trendy as people use them for weight loss and some other health conditions, there is a demand for more gluten free dining options. Things like gluten free bread and gluten free pasta are becoming more common. Many restaurants offer items that are already naturally gluten free like meat, potatoes, and rice.
There can be some pitfalls to these menus; while the items on the menus often are gluten free ,a common concern is cross contamination. Many of my patients have this correct concern when eating out. Cross contamination is when food containing gluten gets mixed into the gluten free food. Cross contamination often occurs when eating out when bread products are placed on the grill in the kitchen, when fryers are used for products that contain breading, or when wheat flour is used to thicken sauces. For example, french fries fried in oil are gluten free, until the breaded chicken strips are fried in the same fryer. In order to avoid cross contamination, it is important to be able to ask a few questions when ordering food:
- Is anything breaded put in the fryer?
- Is any flour added to this soup or sauce?
- Can this meat/fish be prepared in a separate pan if bread products are placed on the grill?
I often get asked about cross contamination. “How much gluten is safe?” This is a great question. We typically advise celiac patients to be 100% gluten free, as cheating on the diet has been associated with health and nutrition problems. Small medical research studies have suggested that less than 50 mg of gluten per day does not causes changes in the small intestine on biopsies. The FDA regulation of 20 parts per million (PPM) for a food to be considered gluten free means 20 mg of gluten per 1000 mg of the food. This suggests that very small accidental exposures may be tolerated by the intestine, but intentional exposure should still be avoided. This is an evolving question for medical research to answer.
- Prior to going out, review the restaurant’s menu online. Try to identify 2-3 options that may work for you on the menu.
- Consider calling ahead to make sure the establishment can accommodate people with dietary restrictions
- When ordering, tell the waiter you have Celiac disease. You need a gluten free meal and say “Allergy, not preference”. Yes, celiac is an autoimmune condition and not technically a food allergy like a peanut allergy, but using the term “allergy” can help to alert the kitchen that you are not going gluten free because it is trendy.
- Keep things simple when ordering and asking questions. Polite, but not pushy goes a long way.
- If ordering anything fried that is gluten free, be careful and ask if it is a dedicated fryer (it usually is not).