Posted Sept 16, 2011
Eating at a restaurant can be a challenge for anyone on a restricted diet.
But when eating the wrong food can make you sick, eating out can be become downright scary.
Getting sick from food is a real possibility for the growing number of Americans who have celiac disease.
People with celiac disease have an intolerance to gluten, a protein found in wheat, barley and rye. It is considered the most under-diagnosed disease in the country, and it may affect one out of every 133 Americans, according to the Gluten Intolerance Group of North America, a national support group.
In addition, many more people have found that they have a sensitivity to wheat and/or gluten. Others have chosen not to eat wheat or gluten for various reasons. Some say they feel better without it; others think it helps with weight loss.
In the past, eating out has been difficult for anyone on a gluten-free diet. In carb-crazy, wheat-loving America, sometimes a salad might be the only thing on the menu that doesn’t use flour, bread, pasta or something else with gluten. And many times that salad comes with croutons.
Thomas Manning, a Forsyth County native who lives in North Raleigh, remembers eating out six years ago after he first found out he had celiac disease. Often, after he explained his situation, restaurant employees would become scared to serve him, worried that any mistake might make him sick. And many times when they did serve him, they’d offer nothing beyond a plain grilled chicken breast and a salad. “I got so tired of chicken breast and salad,” he said.
But now restaurants are starting to listen to — and welcome — the increasing numbers of diners who avoid wheat and gluten.
“There are a lot more restaurants that offer gluten-free options,” said Debbie Fisher of Clemmons, who also has celiac disease. “And the gluten-free menus have a lot more items on them.”
When Martha Russell learned she had celiac disease in 2003, “some people didn’t even know what gluten is,” she said. “Chefs are so much more aware of this now. And they love the challenge of creating something different for you.”
The Gluten Intolerance Group (www.gluten.net) has enrolled 1,620 restaurants in the country in its Gluten-Free Restaurant Awareness Program. In Winston-Salem, several restaurants now offer gluten-free options.
Extensive gluten-free menus are offered at such chains as Bonefish Grill, Carrabba’s Italian Grill, Firebirds Wood Fired Grill, Outback Steak House and Village Tavern, and at such independent restaurants as New Town Bistro and River Birch Lodge.
Jason’s Deli, a chain based in Texas with a location on Hanes Mall Boulevard, offers sandwiches on gluten-free bread. Mellow Mushroom and Brixx Wood Fired Pizza both offer gluten-free pizza.
Serving gluten-free meals is not as simple as removing or replacing the bread or pasta.
The gluten from wheat, barley and rye show up — or rather hide — in many ingredients.
“I’m very skeptical about any sauce or salad dressing,” said Fran Fox, because those often use flour for thickening. Fox, who has been gluten-free for 25 years, said it does require asking a lot of questions at restaurants.
Another hidden ingredient is soy sauce, which usually contains wheat. Other ingredients, such as malted barley, lurk in many processed foods.
Russell and others tend to stay away from Chinese and other Asian restaurants that use soy sauce. They often feel more comfortable in Mexican and Indian restaurants that do not rely heavily on wheat.
But it’s not just the ingredients. Cross-contamination poses a danger, too. Vegetables chopped on the same cutting board as a loaf of bread can contaminate someone’s salad and make them sick.
Similarly, the cook who makes a salad with croutons and then makes a gluten-free salad can contaminate the gluten-free salad.
At New Town Bistro, chef Donny Smith pulls out a clean cutting board and clean utensils when someone orders a gluten-free item.
“It’s not the best thing at 7 p.m. on a Saturday night, but there’s no other way around it,” Smith said. “It just becomes part of our job. We want to make sure people didn’t use tongs to grab bread out of the oven, then use it to grab a gluten-free entree.”
At Mellow Mushroom, general manager Margaret Waters said the staff changes aprons, washes hands and moves to a separate work area after receiving an order for a gluten-free pizza.
“We even have a different cart of ingredients — toppings, the sauce, the cheese — that we keep separate from everything else,” she said. And the pizza is put on a special rack so it does not touch the same oven surfaces that the regular pizzas touch.
When someone orders a gluten-free sandwich at Jason’s Deli, “only the managers are allowed to make it,” said supervisor Nancy Hernandez. “We make it in the back of the restaurant. We get all of the ingredients fresh from the back. We don’t use anything from the line” that might have come in contact with regular bread.
A plain piece of meat might seem like a safe choice, but not if it’s grilled on the same spot as grilled bread. Chef Travis Myers of River Birch Lodge sautes meats on his gluten-free menu in clean pans instead of grilling them.
Myers cooks all of his breaded and other gluten foods in one deep fryer, dedicating a second fryer to gluten-free items. “We can do french fries and (homemade potato) chips and not worry about cross-contamination,” he said.
Myers has a gluten-free menu of five appetizers, five salads, four sandwiches, eight entrees and three desserts.
In some cases, he has made an item gluten-free simply by removing the gluten ingredient. For instance, the seared tuna appetizer comes with pickled ginger but without the usual ginger sauce, which is made with soy sauce.
“Once we dove into the nuts and bolts of it, it was easy to make things gluten-free, because we make most things in-house,” Myers said. >
River Birch has offered a gluten-free menu longer than most — about six years. “Our lawyer’s family is gluten-intolerant, so that’s how we learned about it,” he said.
“Word of mouth has really helped us. Now I’d say one out of every five tables we’re getting a gluten-free order. A lot of times we’ll have a whole party of gluten-free.”
That was the case last Thursday when about a dozen members of the local Gluten Intolerance Group ate lunch at River Birch. Myers sent out a continuous supply of gluten-free items to sample.
Some are naturally gluten-free, such as the homemade potato chips with dipping sauces, and the cedar-plank salmon. Some require simple substitutions from the regular menu, like serving the goat cheese fresh instead of breaded and pan-fried in the chevre salad.
Other items include pulled pork, Thai chicken salad and gluten-free pasta in a white-wine sauce.
“Getting the staff up-to-date has been the key to this,” Myers said. “We train and retrain, telling them how serious it can be if a gluten-intolerant person got a big, old crouton on their salad.”
But the more gluten-free orders he gets, the better he and his staff can do. “I think once you get over the initial crunch, and you really grasp things, it’s easier.” mhastings@wsjournal.com
About celiac disease
Celiac disease is most often referred to as gluten intolerance. For someone who has the disease, consumption of gluten — a protein found in wheat, barley and rye — causes damage to the small intestine.
The disease has many symptoms, and different people exhibit different symptoms and different sensitivities to gluten. Possible symptoms include diarrhea, bloating, weight loss, weakness, anemia, chronic fatigue, muscle cramps, migraine headaches, nerve problems and bone pain.
Because of the variety of symptoms, celiac disease is often confused with other diseases, and it often goes undiagnosed. But a panel of blood tests has been developed to screen for the disease.
Celiac disease is a chronic, inherited disease. A cure does not exist. Treatment consists of eating a diet free of all gluten. Because the disease causes nutrients to pass through the small intestine instead of being absorbed, the disease can lead to malnutrition if left untreated.
Gluten-free menus
Here are some area restaurants that offer gluten-free menus. The menus also are posted on their websites:
* Bonefish Grill, www.bonefishgrill.com
* Brixx Wood Fired Pizza, www.brixxpizza.com
* Carrabba’s Italian Grill, www.carrabbas.com
* Firebirds Wood Fired Grill, www.firebirdsrestaurants.com
* Jason’s Deli, www.jasonsdeli.com
* Mellow Mushroom, www.mellowmushroom.com
* New Town Bistro, www.newtownbistro.com
* Olive Garden, www.olivegarden.com
* Outback Steak House, www.outback.com
* River Birch Lodge, www.riverbirchlodge.com
* Village Tavern, www.villagetavern.com
Note that these menus typically contain warnings or qualifiers that say the restaurants do not assume responsibility for the accuracy of the menus, which typically have been prepared by an outside dietitian or other person.
Many gluten-free diners say that a gluten-free menu is no guarantee of a gluten-free meal. Several local diners mentioned instances when their “gluten-free meal” arrived with wheat croutons in the salad or wheat bread on the plate.
Adequate training and knowledge can be especially difficult in large restaurants or those in which employee turnover is high.
In short, a gluten-free meal is dependent on the understanding and communication of all parties involved, including the wait staff, kitchen staff and diners.
Grace Johnston, team leader of the local Gluten Intolerance Group, makes these suggestions for eating out on a gluten-free diet:
* Go when the restaurant isn’t busy and has time to accommodate special requests.
* Talk directly with the head chef or a manager about the need for a gluten-free meal.
* Ask lots of questions about ingredients and preparation.
Michael Hastings
©2011 Winston-Salem Journal (Winston Salem, N.C.)