Breakfast and brunch out with IBS, celiac disease or food allergies

Yes, with a few questions. At breakfast, the main things to ask about are shared griddles and grills, wheat in unexpected places (including pancake batter in omelets), egg and milk in batters, and the FODMAP content of fruit, sweeteners and toast. The Celiac Disease Foundation warns that omelets may contain pancake batter to make them fluffier and suggests asking whether the grill is washed before gluten-free food is cooked.

Breakfast can feel simple, but it’s often cooked fast on shared surfaces during a busy rush. A few clear requests make a big difference. For general tips, see eating out with IBS and eating out with celiac disease.

Many breakfast kitchens cook pancakes, French toast, eggs, bacon and hash browns side by side on the same flat-top. FARE gives a simple example of cross-contact: using the same spatula that flipped a cheeseburger to flip a hamburger. The same idea applies to a spatula moving between pancakes and eggs. FARE also stresses that cooking does not remove an allergen.

The Celiac Disease Foundation suggests asking:

• "Is the grill washed before gluten-free food is cooked?"
• "Is there a separate prep space for gluten-free food?"
• "Do you use separate or freshly washed cookware and utensils?"
• "Is there a dedicated fryer, or is the oil for fries or hash browns also used for breaded foods?"

Restaurant breakfasts labeled gluten-free aren’t always free of gluten. A 2019 study using crowd-sourced results from a portable gluten sensor found gluten in 27% of gluten-free labeled breakfast foods tested, compared with 34% at dinner. The authors note the data is self-selected and the sensor detects gluten below the 20 parts per million labeling threshold, so it doesn’t show how often a meal was unsafe, but it is a reason to ask.

Toast is a common question. A small preliminary study reported by the Celiac Disease Foundation found that gluten-free bread toasted in a shared toaster stayed below 20 ppm, while gluten-free pasta cooked in shared water did not. The authors called for more research, and the foundation advises continuing to follow your celiac care team’s guidance. A restaurant toaster also handles far more bread than a home one, so it’s reasonable to ask how gluten-free toast is made.

Oats are a topic of their own. Our guide to whether oats are gluten-free explains why, and hidden gluten sources covers more places wheat can turn up.

Egg and milk are both among the nine major allergens under US law, and breakfast menus use them everywhere. The ACAAI notes that eggs are a hidden ingredient in many foods, including salad dressings and ice cream, and that even some commercial egg substitutes contain egg protein.

• Egg allergy: ask whether pancake, waffle and French toast batters and any sauces contain egg, and whether your food can be cooked away from eggs on the griddle.
• Milk allergy: butter on the griddle or toast, milk in batters and scrambled eggs, cream in sauces and coffee. Ask whether the kitchen cooks with butter or oil.
• Tree nuts and peanuts: ask about granola, pastries, spreads, toppings and nut-based milks before ordering.

FARE lists buffets and bakeries among the riskier choices for food allergies, because foods sit close together, shared serving utensils move between dishes, and many baked items are made with common allergens and aren’t packaged. A cooked-to-order brunch is usually easier to ask about than a buffet. For more, see eggs, allergy and IBS and food allergies and the major allergens.

For people following a low-FODMAP approach, breakfast has a few common sticking points. Monash’s sample lists of high- and low-FODMAP foods include:

These are samples, and portion size matters: a small amount of a higher-FODMAP fruit may be fine for you, while a large fruit plate or a smoothie with several fruits can add up. See FODMAP portion sizes and honey, maple syrup and agave.

For coffee and milk drinks, Monash notes that plant milks contain no lactose but not all types are low FODMAP, so ask which one the café uses. Our guide to coffee, IBS and reflux covers the coffee itself.

Savory brunch dishes can include garlic and onion too, so ask what goes into salsas, hollandaise-style sauces, hash and sausage.

These are starting points to ask about, not dishes that suit everyone.

• Eggs cooked to order (fried, poached or scrambled) in a separate pan, with nothing added to the eggs.
• Plain bacon or ham, after checking for wheat in seasonings, with eggs and a lower-FODMAP fruit like orange, kiwifruit or pineapple.
• Potatoes or roasted potatoes cooked in a pan rather than a shared fryer, if the fryer isn’t dedicated.
• Oatmeal made with gluten-free labeled oats and lactose-free or plant milk, topped with blueberries and maple syrup, if oats suit you.
• Bring your own bread. The Celiac Disease Foundation suggests bringing gluten-free foods with you, such as bread.

1. Choose a quieter time if you can. FARE suggests the first hour of a service period, when staff are more attentive.
2. Tell your server about your needs, and ask that the cook knows too. A chef card helps.
3. Ask about the griddle, fryer and batters for the dishes you are considering.
4. Check the plate when it arrives. The Celiac Disease Foundation says not to be afraid to send things back.

• "Can my eggs be cooked in a separate, freshly washed pan, with nothing added?"
• "Do you add pancake batter or flour to your omelets?"
• "Are gluten-free pancakes made on a separate griddle or pan?"
• "Is the hash brown fryer shared with breaded foods?"
• "What’s in the hollandaise, salsa or hash? Any garlic or onion?"
• "Which plant milk do you use?"
• "I have an egg (or milk, or nut) allergy. Can the cook use separate utensils?"

If staff aren’t sure, ask for a manager. FARE notes that sometimes the safest choice is to enjoy the company and eat elsewhere. For more scripts, see talking to restaurant staff about allergies, and for café visits, coffee shops and cafés.