Gluten-Free Restaurant Study: Flawed, Click Bait, Misleading

“One-third of restaurant foods labeled GF contained at least 20 ppm of gluten.”

Maybe you’ve seen the headline on news sites or caught an alarming snippet on television, including on Dr. Oz. The reporting of this study is intended to frighten and makes it sound as though we are very likely to be exposed to levels of gluten that would make those who have to avoid gluten sick when dining out.  I want to explain why we shouldn’t be alarmed AND why we should be questioning the “study” (it is more a research abstract than a study) just as much as we question those who prepare our food when we dine out.

First, a little technical information: this research abstract was presented at the American College of Gastroenterology annual meeting. It is titled “Gluten Contamination of Restaurant Food: Analysis of Crowd-Sourced Data.” According to the abstract, study authors, including physicians from the Celiac Disease Center at Columbia University “analyzed data from a portable gluten detection device (Nima), collected across the USA during an 18-month period by users who opted to share results of their point-of-care tests.” You can read the entire study here.

The lowdown: 804 people used a Nima sensor in restaurants to test 5624 items. 

Why this is problematic: 

• The Nima sensor is flawed.
  A. You can read more here about the false positives as well as false negatives . As pointed out here,  if a sample contains a gluten level of 10 ppm there is about a 50:50 chance of getting either a smiley face result OR a gluten found result.
  B. Tests were conducted by 804 people like you and me, not scientists. The Nima sensor test sample is based on weight, however people like you and me dining out are advised to insert a pea-sized sample. The size I believe a pea to be and the size you believe a pea to be are two different things. Neither of those may be the ideal weight of sample for the Nima sensor. You can read more about testing variances with weight differences of sample size based on Nima’s own research here.
  C. The Nima sensor tests only a pea-sized sample, which means only a small area of an item can be tested. The entire food item is not tested with a device like this. The results in this research abstract came from a consumer device, not from a laboratory with a controlled test environment where the entire food item is tested.
• What questions did the testers ask of the restaurant staff?
  This question bothers me greatly, as I know many restaurateurs who DO want to safely feed those of us who have to be gluten-free. Did those testing the foods in this research abstract alert the restaurant to their needs? Did they ask for separate preparation? Before they ate the fries, which the abstract represents as problematic, did they ask if they were made in a dedicated fryer with no gluten foods? Did they ask for separate sauce and toppings to be used in preparing their pizza, a clean cutter used to cut it? We don’t have that information and it’s likely the methods used (or not used) to alert the restaurant staff members vary greatly from person to person. This flaws the final study results.
• The type of restaurants used in the analysis are limited to casual, fast casual, and quick service.
  The likelihood of the restaurants being chain restaurants is very high, based on the type of restaurants visited. We all know this means restaurants with minimal training and minimal ability to make any changes necessary to address any specific dietary need. This greatly increases the risks of being served food with gluten. Why go to a restaurant you know to likely be risky and then test their food? Why not choose from safer options from the start?And speaking of choosing safer options from the start, a few dining out tips:
  I fully understand dining out can be a challenge. I dine out safely in my hometown of Kansas City and have dined out safely on three continents. I know that fad dieters have made it challenging for those of us who have to be very diligent in remaining gluten-free, perhaps even more challenging for those of us who react quickly and severely. (Or maybe it’s worse for those with silent symptoms who don’t know quickly they are being exposed to gluten. Neither is good.) What I do know is that we CAN safely dine out but we have to do a bit of work.
• When possible, choose a dedicated gluten-free restaurant.
• Just because an item is labeled gluten-free on a restaurant menu does NOT mean you don’t have to ask questions, inform your server and confirm with your server when your order is delivered that it is indeed the gluten-free option you ordered.
• Call ahead, ask questions, talk to the chef or owner or manager, ask more questions, be polite. Ask questions again when you arrive. Ask questions every single time you dine someplace, even if you go there once a week and the server knows you by name. Ingredients change, kitchen staff changes, busy staff can forget. It’s really ok to nicely ask and remind about your needs. Really, it is.
• Choose foods that are naturally gluten-free and prepared in a manner that is least likely to come in contact with gluten-containing foods. Less chance of an issue if you aren’t eating pasta or bread or fried foods.
• Pick a restaurant that is NOT a chain restaurant. Dine at places where the kitchen staff are educated and willing to make adjustments to safely prepare a meal for you. You are likely to have a unique experience, try new foods, meet a chef who gives a damn. Make the search for a place to eat fun, be open to a new experience.
• Don’t eat fried foods that are fried in the same fryer with gluten foods! I don’t care if it’s only a potato, if it’s fried with onion rings, it is no longer only a potato.
• Be choosy who you accept recommendations from. I am not a fan of crowd-sourced recommendations and highly recommend you seek out a trusted gluten-free food writer in a city you are visiting. Or get a recommendation from a friend whose level of adherence to the gluten-free diet matches yours. Be wary of social media groups; make certain the person you accept a recommendation from really understands what gluten-free means.
• Pizza. Just because a gluten-free crust is offered does not make the pizza gluten-free. Many of the casual and fast-casual pizza places are offering a gluten-free crust. The same places use the sauce ladle to spread sauce on the crust. Follow along here: ladle of sauce touches gluten crust, spreads sauce on gluten crust, returns to sauce container. Next crust is a gluten-free crust, sauce is ladled onto gluten-free crust and then spread with the ladle. AND now your gluten-free pizza crust is topped with sauce with gluten in it. Same goes for toppings. If they won’t use fresh sauce, cheese and toppings, skip it. If they won’t cook the pizza on a clean pan in the oven (i.e. not on the oven surface as many places do), cooked way far away from gluten pizzas, skip it. If they don’t use a clean cutter on a safe surface, skip it. Part of what I find so flawed about the study above is that we have no idea how the pizzas pointed out to likely be contaminated with gluten were prepared.
• AND SO MUCH MORE. You are welcome to leave your tips in the comments. We have to be so diligent in dining out and this “study” makes no mention of that.

Gluten Free Watchdog and MI Gluten Free Gal have both written about this research abstract on a more scientific level than I have. You can read Gluten Free Watchdog’s post here and MI Gluten Free Gal’s post here. I encourage you to read both of their posts for a better understanding of why this research abstract is problematic.

Thanks for reading along. I’d love to hear your thoughts on both the research abstract and how you safely dine out while being gluten free.