Amy Burkhart, MD, RD

Amy Burkhart, MD, RD

Amy Burkhart, MD, RD, is a board-certified emergency medicine physician and registered dietitian. She also trained in integrative medicine with Dr. Andrew Weil at the University of Arizona Center for Integrative Medicine. Her practice is located in Napa, CA.
1100 Lincoln Ave. Suite 200
Napa, CA 94558
(707) 927-5622 Office


As I was driving down Highway 5 in California with my family this past week, I couldn’t help but think about “food plans” for the trip. As anyone with dietary restrictions knows, traveling requires planning, planning and more planning. No longer can you hop in the car and easily “pick up something on the road.”  The stops are planned around the restaurant options and pockets are packed with protein bars just in case. Food becomes central to the planning process because the last thing anyone wants to do is spend their vacation sick or hungry.

I admit that traveling has gotten easier, with more options available and smart phones 5776980_soverflowing with information. But, despite this increased availability, in some ways dining out feels like it has gotten riskier. In the past, when inquiring about gluten-free options at a restaurant you were typically faced with a puzzled look or a questions such as “Is that the same as MSG?” These days, the reply is often “gluten-free – no problem!” But, for those on a medically restricted diet, the casual approach to gluten-free is definitely a problem.


Does growth in the gluten-free market mean increased risk to diners?


Restaurants are drawn into the gluten-free market by economic incentive and customer requests. According to a recent survey by consumer research firm NPD Group , 30% of the American population is on, or has tried, a gluten-free diet. Despite predictions of its demise, the trend seems hotter than ever. Here in the San Francisco Bay Area a new magazine called GFF, dedicated solely to gluten-free “foodies,” is hoping to launch with its first issue in the fall of 2014.

Restaurants that offer gluten-free selections increase their appeal, customer base and potential for profit. Despite the ever-increasing popularity of gluten-free items offered by restaurants, diners on a gluten-free diet for medical reasons must proceed with caution to protect their health. Although gluten-free dining options have increased, education on how to institute it safely have not necessarily kept pace.  Diners need to determine if the restaurant staff understands cross contamination and if the advertised options are really gluten-free.

Will the new GF labeling rule help you eat out more safely or limit your choices?

In August 2013, the FDA published the gluten-free labeling rule for packaged foods and beverages. The FDA took many in the gluten-free community by surprise in November 2013 when it also clarified that restaurants will be expected to comply with the new definition of less than 20 ppm gluten when voluntarily labeling their menu items “gluten-free.” In February 2014, the FDA provided a bit more guidance on its regulation of gluten-free claims, stating that it plans to work with the restaurant industry to support education and outreach, and with state and local governments in oversight of restaurants with respect to gluten-free labeling.


How will the new labeling rule and its inclusion of restaurants affect you? For the most part, it remains to be seen, once the rule is enforced beginning in August 2014. At this point, there are more questions than answers: Will this limit dining options just as they are becoming more available or will more safe options arise? Will restaurants shy away from serving gluten-free options for fear of legal ramifications? Will restaurants avoid addressing cross contamination by using legally accepted terms such as “no gluten ingredients”?

The important fact to remember is that restaurants are being included in the gluten-free labeling rule in order to make dining out safer for people with celiac disease or gluten sensitivity. It may take time and a good bit of industry education, but in the long run the hope is that it will help our community eat out more safely. For now, the responsibility still falls primarily on the diner to clearly convey their needs and to make their experience the safest it can be. Despite the risks, dining out is an important part of our culture and social well-being. CeliacNow, a website offered by the Celiac Center at Beth Israel Deaconess Medical Center, provides useful information on dining out safely on a gluten free diet.  (On that page, see levels 2 and 3 in the menu column on the left or on the bottom of the page for more detailed safe dining information.)

Do certification and awareness programs mean less risk?

No one has scientifically evaluated whether or not restaurants that participate in a certification or awareness program offer a lower risk for diners. It would be very difficult to study. But I would argue that any restaurant vested in training its staff in proper technique is a safer option than one that doesn’t.

Restaurants have a variety of training options. The Gluten Intolerance Group of North America (GIG) offers restaurant awareness and food service certification resources. The National Foundation for Celiac Awareness (NFCA) offers Gluten-Free Resource Education and Awareness Training (GREAT). Food Allergy Research & Education (FARE) offers resources for restaurants, and has a partnership with the National Restaurant Association to offer the SafeServ Allergens Online Course, and one with MenuTrinfo to offer the AllerTrain program.

What about 100% gluten free restaurants?

There is much comfort in finding a restaurant that is dedicated to providing a 100% gluten-free environment. The ability to order from a menu without asking the barrage of questions typically required is an immense relief for those on a gluten-free diet. While it is still important on the initial visit to determine whether they understand the gluten-free diet and the importance of sourcing gluten-free ingredients, 100% gluten-free restaurants can provide a much welcomed sense of normalcy. The Celiac Restaurant Guide offers an online list of 100% gluten-free restaurants. As always, please inquire on your visit about their practices.

Using apps and online resources to find gluten-free dining options


There are many apps and websites available for finding restaurants that cater to gluten-free diners. In addition, Yelp and Urban Spoon reviews can be helpful. What is vital to remember is that these are only starting places to locate gluten-free dining options, as the information may not be not monitored, updated or validated. It is always best to still question as you would otherwise, even if choosing a restaurant that is “highly recommended.” You will never be sorry for asking the questions. You will only be sorry if you don’t.

In the end, your health is what matters, but social situations play a close second

After improving health, dining out is one of the most relevant topics to people on a gluten-free diet. The use of technology provides streamlined access to information on restaurants and dining out, but it is important to use the information as a base from which to start. Ultimately, the responsibility is yours to ask the questions and assess the risk. The new labeling rule may change the face of dining out for people with celiac disease and gluten sensitivity in the long run, but the questions around the new regulation are many and the answers few.  Traveling and dining out on a restricted diet have their challenges, but it is my hope that with time it will continue along the path it is currently following: more awareness, more options and more fun.