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So a doctor has diagnosed you with Celiac disease and told you to stop eating gluten.
Suddenly, it feels like your life as an adventurous Front Range diner has come to an end. But before you cancel Saturday’s dinner reservation and discard your list of new restaurants to try, Dr. John Riopelle, a gastroenterologist based in Lone Tree, has some good news for you.
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“I often tell patients that it used to be really hard to find a restaurant to go to and know safely that you could eat the food,” Riopelle says. “But nowadays, nearly every place is aware of it, and they will mention what is gluten-free and what is not.”
Riopelle has been a physician in his specialty for roughly 20 years, so he’s seen the way society’s understanding of gluten has evolved. Two decades ago, most people didn’t know about it or how to keep it out of their diets, if necessary. Now, he points to the many people who don’t have a diagnosed sensitivity who still cut out gluten as a sign that it’s entered the mainstream.
Dr. Ankush Kalra, who has practiced out of South Denver Gastroenterology for two years, seconds that notion. He estimates that, between those with Celiac disease, those with a gluten sensitivity, and those following the diet by choice, roughly 20 percent of diners might ask an eatery for gluten-free options.
“If [a restaurant] wants to be able to accommodate diners and eaters who are frequenting the restaurant scene, and it’s able to offer gluten-free choices, that’s a good thing for everyone,” Kalra says.
Still, dining out is a little more complicated for those with a diagnosed medical condition. Should gluten accidentally land on a Celiac disease patient’s plate, that person can get sick: Riopelle lists stomach discomfort or pain, gas, nausea, vomiting, and diarrhea as common reactions to eating gluten.
None of those symptoms make for a fun night out. To help you or a loved one navigate, we consulted the experts and used their advice to put together these guidelines.
What exactly is Celiac disease?
While many call it a “gluten allergy,” Celiac disease is actually an autoimmune disorder. That means that, when a person with Celiac disease eats gluten (a protein found in wheat, barley, and rye), their immune system interprets it as an intruder and attacks.
Villi, millimeter-long strands that line the small intestine to help absorb nutrients, get caught in the crossfire. The overly reactive immune system blunts the projections, preventing them from transferring vitamins and minerals into your body.
That’s why those with untreated Celiac disease tend to have iron, vitamin B12, vitamin D, and calcium deficiencies, among others. If a patient continues eating gluten long-term, their bone density may suffer. Children often struggle to put on weight.
Riopelle says several of his patients have reported brain fog before changing their diet. Mental health problems can arise as well, such as depression or anxiety. In extreme cases, folks may experience gallbladder disease, heart failure and liver failure, intestinal cancer, and other symptoms.
Thankfully, the treatment is simple: Stop eating gluten. If patients cut it out of their diet, the villi in their small intestine are able to recover and function properly again (barring other medical conditions). For the most part, early diagnosis and avoiding gluten is enough to dodge any long term health impacts.
Less simple, though, is figuring out how to navigate nutrition. While “don’t eat gluten” seems straightforward, different patients have different sensitivity levels, says Riopelle. Some people could ruin their night if they eat French fries made in a fryer not reserved for gluten-free ingredients. Others don’t need to be as careful.
“A lot of patients who have minor symptoms will say, ‘You know what? It’s Friday night. I’m going out with my friends. I’m gonna have pasta, and if I’m a little sick to my stomach the next day, that’s the price I pay,’” Riopelle says.
Ultimately, individuals should work with their doctors, and perhaps a dietician, to identify their limits. Some trial and error is normal, Kalra says, and the occasional mistake usually isn’t cause for concern—long-term health problems like nutritional deficiencies aren’t likely unless you eat gluten regularly.
How to navigate restaurants when you’re on a gluten-free diet
Ideally, if you’re making plans to dine out with a friend, Kalra recommends you research restaurants ahead of time. Identifying which brunch spots have “GF” next to some of their menu items—and which don’t—will help you narrow down your options and better your chances of enjoying breakfast sans stomach pain.
There are still more questions you can ask, Kalra says, to determine the chances of cross-contamination, which occurs when gluten accidentally winds up in a dish that is supposed to be free of the ingredient. He recommends calling or emailing ahead of time, if possible.
Both he and the Celiac Disease Foundation recommend inquiring about the following details, preferably outside busy lunch and dinner rushes so that restaurant staff can properly attend to your questions:
- Does your kitchen use any ingredients with gluten?
- Are gluten-free items prepared in a separate part of the kitchen? If not, how does your staff ensure cross-contamination does not occur?
- Do you use separate utensils, pots, pans, cutting boards, etc. for gluten-free dishes? (Kalra notes that cutting boards are usually porous, so cleaning them may not be enough to remove every particle of gluten.)
- Do you have a separate grill, flattop, or other cooking surface dedicated to gluten-free items? If not, do you have a sanitization process in place to ensure no gluten remains on the cooking surface?
- Is there a dedicated gluten-free fryer? If not, is the oil in the fryer changed before frying food for a diner with a gluten sensitivity?
- How do your waitstaff and kitchen staff communicate about food allergies and sensitivities?
You, with the advice of your doctor, will need to decide how the answers to the above questions impact your decision to eat at a certain restaurant. One that does not use any ingredients with gluten is likely going to be the safest place to grab a meal. Such spots are rare (though there are a few in Denver), but that doesn’t need to put the kibosh on your dinner plans—many diners can enjoy an establishment without such strict rules and not become ill.
Whether or not you’ve been able to conduct research ahead of time, once you arrive, you should always inform the waitstaff about your sensitivity. That way, both they and the chef know to warn you about potential opportunities for cross-contamination and to take extra caution while preparing your meal.
Politely asking questions is perfectly normal, and even recommended, Karla says. You might inquire about whether a salad has croutons, for example, or verify that the chef doesn’t sprinkle flour on chicken or a baked potato to make it crispy. The Celiac Disease Foundation provides an extended list of possible hiding spots for gluten here.
It’s your body and your health, so it’s OK to advocate for yourself. “Don’t be afraid to walk away from an eating establishment if you feel like your questions are not being answered, or if the answers are not within your realm of comfort,” Kalra says.
Don’t feel like doing all that leg work? Never fear: We got in touch with nearly a dozen restaurants around the Denver metro and asked the tough questions for you. You can find our breakdown here.