Thai and Vietnamese restaurants with IBS, celiac disease or food allergies

Often, yes. Both cuisines lean on rice, rice noodles and rice paper, which helps if you avoid wheat. The things to ask about are sauces (soy, oyster and fish sauce), peanuts, shrimp paste, and garlic, shallots and onion in curry pastes and dressings. Monash University suggests ordering Thai stir-fries with no onion or garlic and steamed jasmine rice, and the BIDMC Celiac Center advises avoiding soy sauce unless gluten-free, oyster sauce, and fish sauce if it contains wheat.

Recipes vary a lot between restaurants and regions, so use this guide as a list of good questions rather than a list of answers. For the basics, see eating out with IBS and eating out with celiac disease.

Rice noodles and jasmine rice are naturally gluten-free, but the sauces poured over them may not be. The BIDMC Celiac Center’s Thai dining handout points to these:

BIDMC also notes in its Chinese dining handout that while some noodles are made from 100% rice flour, some may also have wheat flour added. It’s worth asking what the noodles are made from, and whether they are cooked in water used for wheat noodles.

Our guide to whether soy sauce is gluten-free explains labels and alternatives, and gluten-free vs celiac-safe covers why a gluten-free dish still needs careful preparation.

Garlic and onion are high in fructans and appear in many Thai and Vietnamese dishes. BIDMC describes a typical green curry paste as blended from ingredients including shallots, green chilies, garlic, galangal, turmeric and shrimp paste. Because the paste is part of the sauce, it can’t be removed once a curry is made.

Monash’s guide to dining out at Asian restaurants offers these ideas:

• Thai: curries may need to be avoided, but stir-fries are often adaptable if you ask for no onion or garlic. They usually come with steamed jasmine rice.
• Vietnamese rice vermicelli bowls: beef, chicken, prawn or tofu over rice noodles with salad vegetables and peanuts. Ask for no onion. They usually come with fish sauce, which Monash lists as low FODMAP, on the side.
• Rice paper rolls: made with rice vermicelli. Ask which vegetables are inside.
• Chili: Monash notes that chili is low in FODMAPs but may still bother some people, so asking for a milder version is fine.

Spring onion (green part only) is one of the flavor options Monash suggests, so a green-onion garnish may sit better than a sauce made with white onion. See hidden garlic and onion and spicy food, IBS and reflux for more.

Several of the nine major US allergens are common in these cuisines: peanuts, tree nuts, fish, crustacean shellfish, soy, egg and wheat. FARE notes that peanuts and other nuts are used frequently in Asian cuisines, and lists restaurants known to use your allergen in many dishes among the riskier choices.

• Peanuts appear in pad Thai, satay sauce, peanut dressings and as a topping on vermicelli bowls (all described in the BIDMC and Monash guides). A peanut sauce can also be stirred into dishes where you wouldn’t expect it, so name the allergy rather than asking about one dish.
• Fish is in fish sauce, which is used widely as a seasoning and a dipping sauce.
• Shellfish is in shrimp paste, which BIDMC lists as a typical curry paste ingredient, and in dishes with prawns or shrimp. The ACAAI notes that people allergic to shrimp may react to crab and lobster.
• Egg is part of pad Thai, as BIDMC’s description of the dish shows.
• Soy is in soy sauce and tofu.

Shared woks, utensils and fryer oil can carry allergens from one dish to the next. FARE explains that cooking does not remove an allergen and that removing an allergen from a finished meal does not make it safe. FARE also advises avoiding fried foods unless you know for sure they are prepared safely, and being careful with desserts.

If staff can’t answer clearly, FARE’s advice is to ask for a manager, and to remember that sometimes the safest choice is not to eat there. See food allergies and the major allergens and nuts, FODMAPs and allergies.

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

For celiac disease, BIDMC suggests asking that the pan used for fried rice isn’t used to fry anything with wheat, and having tofu cooked on a washed grill without regular soy sauce. If any surface or utensil has been used for foods you avoid, you can ask for it to be washed first or for foil to be used.

1. Check the menu online and pick a few dishes that look adaptable.
2. Call ahead outside busy hours if your needs are complex. FARE suggests asking to speak to a manager.
3. Name your needs at the start, and ask the server to pass them to the chef. A chef card listing your allergens helps in a busy kitchen.
4. Ask about each sauce, including dipping sauces and dressings.
5. Check the dish when it arrives. If a garnish you asked to leave off is there, send it back rather than picking it off.

• "Is there soy sauce, oyster sauce or fish sauce in this? Do any of them contain wheat?"
• "Do you have gluten-free soy sauce?"
• "Are the noodles 100% rice?"
• "Could this stir-fry be made without onion or garlic?"
• "Does the curry paste contain shrimp paste, garlic or shallots?"
• "I’m allergic to peanuts. Is there peanut in the sauce, dressing or topping, and is the wok washed between dishes?"
• "Is the fryer oil shared with battered or wheat-containing foods?"

For more scripts, see talking to restaurant staff about allergies.

A reaction or a flare after a meal out doesn’t mean you did anything wrong. Kitchens are busy and recipes vary.

• Jot down what you ate in a food and symptom diary. Patterns over several meals are more useful than one evening.
• If heat bothers you, note the chili level too, since it’s separate from FODMAPs.
• Talk to your doctor or dietitian about symptoms that keep coming back or change.
• For signs of a severe allergic reaction, use your epinephrine if prescribed and call emergency services.