Italian restaurants with IBS, celiac disease or food allergies

Yes, many people do, with some planning. The dishes that tend to be easiest to adapt are gluten-free pasta or pizza with simple toppings, risotto made with a stock you've checked, and plainly cooked meat or fish with vegetables or salad. The things to ask about are garlic and onion in the tomato sauce and stock, wheat and shared pasta water for celiac disease, nuts in pesto, and cheese if lactose bothers you. Monash University, the team behind the low-FODMAP approach, has specific tips for Italian dining that this guide draws on.

Italian menus are built around wheat (pasta, pizza, bread), long-cooked sauces and cheese. That sounds like a hard combination, but because so much Italian food is made to order, kitchens can often adjust a dish if you ask clearly.

These are starting points, not guarantees. Every kitchen cooks differently, so you still need to ask about your own triggers or allergens.

For toppings, Monash lists capsicum (bell pepper), zucchini, tomatoes and olives as lower-FODMAP choices for a build-your-own pizza. If you're still learning which foods affect you, our guide to high-FODMAP foods and swaps can help.

Garlic and onion are high in fructans, and in Italian cooking they often form the base of a dish rather than appearing in its name. Monash suggests asking whether the tomato passata on pizzas and in pasta sauces is free from garlic and onion, noting that in many traditional restaurants the sauce is simply tomatoes and salt.

• Tomato sauces. Ask whether the passata or sugo is made with garlic or onion.
• Risotto. It's rice-based, but the stock often contains onion. Monash's general advice is to be wary of stock-based dishes such as soups and risottos.
• Bianco bases and garlic bread. Ask for olive oil only.
• Dressings and dips. Ask for them on the side so you can decide how much to use.

Our guide to hidden garlic and onion covers more places they turn up.

For celiac disease, choosing a gluten-free pasta or pizza base is only half the question. The other half is cross-contact: tiny amounts of gluten reaching your food from shared water, pans, surfaces or ovens. Monash itself reminds people with celiac disease to double-check there is no gluten contamination when ordering gluten-free pizza or pasta.

• Pasta water. Ask whether gluten-free pasta is cooked in fresh water in its own pot. The Celiac Disease Foundation suggests you can even bring your own gluten-free pasta and ask the chef to cook it in a separate, freshly washed pot.
• Vegetables. A University of Arizona dietitian handout notes that some restaurants steam vegetables in the same water used for pasta, so ask how they're cooked.
• Pizza. Coeliac UK notes that conventional wheat-flour bases are unsuitable, and that kitchen contamination can be an issue even with a gluten-free base. Ask how the base is handled and baked.
• Breaded and dusted foods. The Celiac Disease Foundation suggests asking whether food has been dusted with flour before being sautéed or fried, and whether sauces are thickened with flour.
• Soups and broths. Ask whether soups contain flour or barley.
• Bread on the table. Ask for no bread basket, or for it to be kept away from your plate.

Gluten-free on the menu isn't always the same as celiac-safe. Our guides on eating out with celiac disease and gluten-free vs celiac-safe go into this in more depth. If you think you might have celiac disease but haven't been tested, talk to your doctor about testing before going gluten-free.

Cheese is everywhere in Italian food, but not all cheese is the same for lactose. Monash notes that the harder the cheese, the lower the lactose, so parmesan is a lower-lactose choice, while soft cheeses like ricotta have a smaller low-FODMAP serving.

• Ask whether a sauce is finished with cream or butter if lactose is one of your triggers.
• A sprinkle of parmesan is usually different from a dish built on ricotta or a creamy sauce.
• If you have a milk allergy, this is different from lactose intolerance: tell staff you have an allergy, since even a small amount can cause a reaction. Allergists note that many breads and bakery items contain milk and egg.

See which cheeses are low in lactose and lactose-free vs dairy-free for more detail.

The American Academy of Allergy, Asthma & Immunology (AAAAI) notes that peanut, tree nuts and sesame are common in sauces such as Italian pesto, and that many breads and bakery items contain milk and egg. FARE lists pesto as often including pine nuts or walnuts.

• Tree nuts and peanut: pesto, desserts and anything described as "crusted" with nuts.
• Milk: cheese, cream sauces, butter, desserts.
• Egg: breads and bakery items; ask about pasta and desserts too.
• Wheat: pasta, pizza, bread, breadcrumbs, flour-dusted or breaded dishes.
• Fish and shellfish: seafood pasta and risotto; ask about shared pans if you have a fish or shellfish allergy.

AAAAI suggests that simple dishes with clearly identified ingredients are safer choices than dishes with mixed ingredients and complex sauces. FARE recommends bringing a chef card that lists your allergies and asks for your food to be cooked in a separate, freshly washed area. Ingredients change, so ask every time. If you have a severe reaction, use your prescribed epinephrine and call emergency services.

1. Look at the menu online first and note two or three dishes that look adaptable.
2. Call outside busy hours. FARE suggests calling between meal periods, often mid-afternoon, and asking to speak with a manager or chef.
3. Lead with what matters most. For an allergy or celiac disease, say so first, plainly. For IBS, name the specific ingredients you avoid, such as garlic, onion or wheat.
4. Ask about the base of the dish, not just the toppings: the passata, the stock, the dressing.
5. Ask for sauces and dressings on the side where you can.
6. Check the dish when it arrives. If something looks different from what you asked for, it's fine to ask.

FODMAPs can add up across a meal. Bread, pasta, a creamy sauce and dessert together may be more than you tolerate, even if each alone would be fine. Our guide to FODMAP portion sizes explains why.

• "Is the tomato sauce made with garlic or onion, or just tomatoes and salt?"
• "Does the risotto stock contain onion or garlic?"
• "Could I have the pizza bianco with olive oil only, no garlic?"
• "I have celiac disease. Is the gluten-free pasta cooked in fresh water in its own pot?"
• "Is the gluten-free pizza prepared and baked separately from the regular pizzas?"
• "Are the vegetables cooked in the pasta water?"
• "I have a tree nut allergy. Does the pesto or any dessert contain nuts, and can my dish be made away from them?"
• "Is this sauce finished with cream or butter?"

For more on wording, see talking to restaurant staff about allergies and eating out with IBS. If you love pizza in particular, our pizza guide goes further.