Summary
This article explores the daily challenges individuals with gluten-intolerances and celiac disease face, highlighting the lack of adequate dining options, cross-contamination risks, and limited awareness of food sensitivities within the food industry. It emphasizes the importance of exceeding the FDA’s and ADA’s minimum requirements to promote more inclusive environments for these individuals and minimize the risks and stressors caused by dining out or attending social events.
Emily Nelson, JHBL Staffer
Introduction:
Imagine walking into a restaurant or food service area excited to share a meal with friends or family, only to realize that the menu lists dishes that you cannot enjoy safely.[1] To many of us, this situation is not a daily reality; however, millions of individuals with gluten sensitivity or celiac disease are all too familiar with the limitations caused by their condition.[2] Dietary restrictions are often written off as a preference or diet, but for many individuals, dietary restrictions can cause severe or life-altering consequences.[3] Despite the effects of dietary restrictions and the media’s continued focus on food sensitivities, misconceptions persist, and inclusivity remains a challenge for individuals who experience gluten intolerance and celiac disease.[4]
Background
Gluten is a general name for proteins found in wheat, rye, barley, and triticale that help food maintain its shape.[5] Gluten is common in many drinks and food items, including pasta, cereal, bread, and beer.[6] While many attribute gluten solely to food, gluten can also be found in products such as medication, shampoo, cosmetics, and paper straws.[7] The widespread presence of individuals with gluten-intolerance and celiac disease raises questions as to the rising prevalence of gluten sensitivity and other food intolerances.[8] Despite the long standing existence of celiac disease and gluten-intolerance, the growing prevalence of these conditions has increased due to environmental changes, medical testing advances, and food production.[9]
In the United States, 6% of the population suffers from gluten intolerance.[10] This condition, also known as non-celiac gluten sensitivity, is an immune reaction to consuming gluten, which can cause an individual to feel sick and experience adverse symptoms including gas, bloating, fatigue, and rashes.[11] Gluten intolerance, however, differs from its counterpart, celiac disease.[12] Celiac disease is a chronic digestive and immune disorder that is triggered by eating foods that contain gluten, resulting in damage to the small intestine.[13] Approximately three million individuals in the United States suffer from celiac disease; but, many individuals who experience symptoms of the disease remain undiagnosed, suggesting that the true number of those affected are much higher.[14]
Following a strict gluten free diet is currently the only safe and efficient way for patients with celiac disease and gluten sensitivity to manage their conditions.[15] It is a difficult diet to follow due to the unintended contamination of gluten-free products, improper labeling, and social constraints.[16] Currently, only one in five restaurants offer “gluten-free” items on their menus; however, these options tend to be fairly limited not only in quantity, but in taste, and are more costly.[17] Additionally, many establishments remain uneducated and untrained on preventing cross-contamination with gluten-free products, via where the food service employee prepare food, who else touched the food, and where the employee cleaned the plates.[18]
Lack of education and proper accommodations for gluten intolerance and celiac disease was highlighted in the U.S. Department of Justice’s (hereinafter DOJ) agreement with Lesley University in 2012.[19] The DOJ addressed Lesley University’s failure to provide reasonable accommodations to students with celiac disease so that they could fully enjoy the on-campus food services.[20] The failure to provide reasonable accommodations to those with celiac disease raised compliance issues under the Americans with Disabilities Act (hereinafter ADA), as the ADA considers food allergies a disability.[21] Ultimately, the DOJ and Lesley University entered into an agreement ensuring that the university complied with the ADA and that students with celiac disease were able to fully and equally enjoy the university’s food services.[22] Despite the ADA recognizing food allergies as a disability, it does not require restaurants to provide allergy-free options.[23] The ADA does, however, require restaurants to make reasonable accommodations for individuals with disabilities where it does not result in a “fundamental alteration” of the restaurant’s operations.[24]
A key challenge in ensuring safe dining for individuals with celiac disease and gluten intolerance was the lack of standardizing gluten-free products and labeling regulations prior to 2013.[25] Before these regulations, there was no U.S standards or definitions for the food industry to use in labeling products as “gluten-free.”[26] This left many individuals with gluten-intolerances and celiac disease unsure of whether the food they were ingesting was in fact gluten-free.[27] Since 2014, however, the Food and Drug Administration’s (hereinafter FDA) has required that claims on gluten-free food labels must meet a clear standard that assures consumers that the claims will be truthful and consistent.[28]
Analysis
Despite the FDA’s recent updates to the gluten-free standard and the ADA’s recognition of gluten intolerance as a disability, establishments must reach beyond the minimum legal requirements to promote better education, awareness, inclusivity within the food industry, and most importantly, protect the health of customers.[29] Although many dining establishments find implementation of gluten-free options and measures to prohibit cross-contamination burdensome, celiac and gluten intolerant diners deserve plentiful, safe, and healthy dining options.[30] Programs such as ServSafe, which trains establishments, operators, and employees on proper handling and safety protocols, could aid in preventing cross-contamination and improperly labeled menu items by educating staff.[31] Education and simple changes, such as having dedicated areas for gluten-free preparation, separate utensils, and cookware, can create safer and less stressful environments for individuals with celiac or gluten-intolerances.[32] Additionally, restaurants and other dining establishments should be incentivized to offer more gluten-free options because guests will leave satisfied and will more likely to recommend the business to others with similar dietary needs.[33]
For individuals with celiac disease or gluten-intolerance, dining out or attending social events may often feel like navigating a minefield due to the risk of cross-contamination or lack of education can lead to serious health consequences.[34] Expanding gluten-free options and creating more awareness within the food industry about safe food handling practices are not simply issues of convenience, but of equity and accessibility.[35] By prioritizing inclusivity, establishments will create an environment where celiac and gluten-intolerant diners feel safe and welcomed.[36]
The growing presence and challenges faced by gluten-free individuals and those with celiac disease emphasizes the need for inclusivity and education in the food industry.[37] For many, gluten-free dietary restrictions are not a choice, but a necessity.[38] These individuals should not need to choose from overpriced, limited, and under inspired options.[39] By exceeding the minimum requirements, dining establishments can create a more equitable and inclusive environment to ensure that everyone, regardless of their dietary needs, can safely enjoy meals and social gatherings without anxiety and stress.[40]
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHBL or Suffolk University Law School.
Emily Nelson is a second-year law student at Suffolk University Law School interested in personal injury and family law. Emily graduated from University of Massachusetts Dartmouth in 2023 with a Bachelor of Arts in Political Science and Associate of Science in Criminal Justice in 2021.
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[1] See Jean Duane, Gluten-Centric Culture: Chapter 10-Taking Action—It’s the Law!, Celiac.com (May 20, 2023), https://www.celiac.com/celiac-disease/gluten-centric-culture-chapter-10-taking-action–its-the-law-r6222/ [https://perma.cc/VP27-4AUQ] (discussing gluten centricity affects individuals). Living with gluten sensitivity limits and affects nearly every social engagement. Id.; see also Life With Celiac Disease: Anna’s Story, Child. Hosp. Phila., https://www.chop.edu/stories/life-celiac-disease-anna-s-story [https://perma.cc/P7G2-FPXH] [hereinafter Life With Celiac Disease] (noting food prominent in socialization); Jefferson Adams, Tainted Gluten-Free Meal Nearly Kills Australian Woman, Celiac.com (July 9, 2018), https://www.celiac.com/celiac-disease/tainted-gluten-free-meal-nearly-kills-australian-woman-r4495/ [https://perma.cc/JL84-382K] (discussing gluten-contamination incident). A woman with celiac disease visited a local restaurant where she previously had dined before; however, she mistakenly ate a non-gluten-free waffle. Adams, supra. She was told the gluten-free items may contain traces of gluten and were not recommended for gluten-intolerant or celiac individuals. Id.; Jon Bari, Emotional Toll From the Loss of Food Freedom & Exclusion From Spontaneous Activities Involving Food, Celiac Journey (May 6, 2023), https://www.celiacjourney.com/post/emotional-toll-from-the-loss-of-food-freedom-exclusion-from-spontaneous-activities-involving-food [https://perma.cc/K4DL-MJRJ] (emphasizing daily struggles with gluten-intolerance). Jax, a ten-year-old boy, was diagnosed with celiac disease, and his parent’s faced difficulties trying to make sure Jax was safely included in daily activities that involve food. Bari, supra.
[2] See Bari, supra, note 1; see also L.E. White et al., Coeliac Disease and the Gluten-Free Diet: A Review of the Burdens; Factors Associated with Adherence and Impact on Health-Related Quality of Life, with Specific Focus on Adolescence, 29 J. Hum. Nutrition & Diabetes 593, 593 (discussing burdens of individuals with gluten-sensitivity).
[3] See The Gluten-Free Diet: Facts and Myths, Gluten Intolerance Grp. (Aug. 2021), https://gluten.org/2019/12/16/the-gluten-free-diet-facts-and-myths/ [https://perma.cc/JEN2-9G7W] (noting common ideas surrounding gluten-free); see also Celiac Disease, Mayo Clinic (Sept. 12, 2023), https://www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220 [https://perma.cc/67BT-5K6C] (noting effects of celiac disease).
[4] See Gluten Intolerance Grp., supra note 3 (noting misconceptions about gluten-free); see also Sophie Balzora, One-Third of Americans Are Trying to Avoid Gluten—But is it the Villain we Think It Is?, NYU Langone Health, https://nyulangone.org/news/one-third-americans-are-trying-avoid-gluten-it-villain-we-think-it-is [https://perma.cc/UTT2-4F9T] (emphasizing common misconceptions); Katrina Mollo, Managing Anxiety Around Eating New Foods, Nat’l Celiac Ass’n (Oct. 20, 2022), https://nationalceliac.org/celiac-disease-questions/anxiety-around-eating-new-foods/? [https://perma.cc/KWW5-P8HU] (discussing challenges individuals face related to dining out); A Day In the Life of A Celiac Patient Who Fears Gluten Exposure, Dr. Phil CBS (Mar. 21, 2022), https://www.yahoo.com/entertainment/day-life-celiac-patient-fears-080155181.html [https://perma.cc/ME2H-J73S] (noting individuals may experience anxiety and stress); Celiac Disease and Anxiety, Beyond Celiac, https://www.beyondceliac.org/celiac-disease/related-conditions/anxiety/ [https://perma.cc/54A5-RXHP] (discussing individuals with celiac disease experience increased anxiety).
[5] See What is Gluten?, Celiac Disease Found., https://celiac.org/gluten-free-living/what-is-gluten/ [https://perma.cc/2H97-62UK] (discussing gluten composition); see also Selvi Rajagopal, What is Gluten and What Does it Do?, Johns Hopkins Med., https://www.hopkinsmedicine.org/health/wellness-and-prevention/what-is-gluten-and-what-does-it-do [https://perma.cc/RX53-QL8J] (noting gluten binding agent); Adams, supra note 1 (discussing individual served non-gluten-free meal).
[6] See Gluten Intolerance, Clev. Clinic (June 30, 2021), https://my.clevelandclinic.org/health/diseases/21622-gluten-intolerance [https://perma.cc/9RYE-GYK6] (listing examples of food with gluten); see also Celiac Disease Found., supra note 5 (noting food coloring, soups, and malt contain gluten); Elizabeth Blasi, 10 Surprising Foods That Contain Gluten, Aaptiv, https://aaptiv.com/magazine/foods-contain-gluten[https://perma.cc/42KG-5FTH] (noting salad dressing, lunch meats, and eggs contain gluten).
[7] See Clev. Clinic, supra note 6; see also Kara Fitzgerald, Hidden Sources of Gluten, Dr. Kara Fitzgerald,https://www.drkarafitzgerald.com/2017/02/02/hidden-sources-gluten [https://perma.cc/F9BM-3ZVR] (listing non-food items containing gluten). Items such as hairspray, mouthwash, soap, toothpaste, laundry detergent, lip balm, and glue on stamps can contain gluten, along with many more. Fitzgerald, supra; see also Scott Adams, Are Paper Straws Gluten-Free?, Celiac.com (Mar. 9, 2021), https://www.celiac.com/celiac-disease/are-paper-straws-gluten-free-r5471 [https://perma.cc/WU4D-BNJC] (noting possible traces of gluten in paper straws). While paper straws are generally safe, some paper straws are made with wheat starch, which makes them unsafe for gluten-intolerant or celiac individuals. Adams, supra.
[8] See Sam Mehmet, Study Reveals Why Wheat and Gluten Intolerance is Becoming More Common, New Food (Aug. 12, 2020), https://www.newfoodmagazine.com/news/115778/study-reveals-why-wheat-and-gluten-intolerance-is-becoming-more-common [https://perma.cc/3M8B-EFU3]; see also Bailey Arman, “Why is Everyone Allergic to Gluten These Days?”: A Brief History of Celiac Disease and the Gluten-Free Diet, Beyond Celiac (Mar. 29, 2024), https://www.beyondceliac.org/celiac-news/why-is-everyone-allergic-to-gluten-these-days [https://perma.cc/5VBM-WKFR] (noting gluten-free diet prevalence); Caroline Price, What are the Most Common Dietary Restrictions?, Toast (2025), https://pos.toasttab.com/blog/on-the-line/common-dietary-restrictions [https://perma.cc/ML9W-93G7] (noting gluten-intolerance one of most common dietary restriction).
[9] See Why Are so Many People Going Gluten-Free?, Piedmont, https://www.piedmont.org/living-real-change/why-are-so-many-people-going-gluten-free [https://perma.cc/2SMT-7642] (emphasizing prevalence due to changes in testing and food); see also Arman, supra note 8 (noting improved medical care in diagnosing celiac and gluten-intolerance); Mehmet, supra note 8 (discussing environmental changes).
[10] See Clev. Clinic, supra note 6 (noting current population with gluten-intolerance).
[11] See Gluten Sensitivity: Summary, Medline Plus (May 28, 2024), https://medlineplus.gov/glutensensitivity.html [https://perma.cc/7SL2-EWZE] (defining gluten intolerance); see also Go with Your Gut: 4 Facts About Gluten Intolerance, Nw. Med.,https://www.nm.org/healthbeat/healthy-tips/nutrition/go-with-your-gut-4-facts-about-gluten-intolerance# [https://perma.cc/X6TR-6T8W] (listing gluten intolerance symptoms); Clev. Clinic, supra note 6 (emphasizing symptoms experienced).
[12] See Clev. Clinic, supra note 6 (noting gluten intolerance and celiac disease differences); see also Definition & Facts for Celiac Disease, Nat’l Inst. Diabetes & Digestive & Kidney Diseases (Oct. 2020), https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease/definition-facts [https://perma.cc/UZQ2-PTQW] (discussing implications of celiac disease compared with gluten sensitivity).
[13] See Nat’l Inst. Diabetes & Digestive & Kidney Diseases, supra note 12 (defining celiac disease); see also Celiac Disease, Child. Hosp. Phila., https://www.chop.edu/conditions-diseases/celiac-disease [https://perma.cc/2KAG-UYLH] (noting digestive implications with celiac disease). Individuals with celiac disease cannot properly digest foods with gluten, such as bread and pasta. Child. Hosp. Phila., supra. When a person with celiac disease consumes gluten, the villi (tiny finger-like projections in the small intestine that absorb nutrients from food) are damaged. Id. Damaged villi do not effectively absorb and digest nutrients. Id.
[14] See Gluten-Free for Restaurants, Operator’s Edge (Apr. 1, 2022), https://www.operators-edge.com/posts/gluten-free-for-restaurants-03282022 [https://perma.cc/96JN-XLRN]; Child. Hosp. Phila., supra note 13 (emphasizing number of individuals with celiac disease); Nat’l Inst. Diabetes & Digestive & Kidney Diseases, supra note 12 (discussing many individuals undiagnosed). Celiac disease can be very challenging to diagnose. Nat’l Inst. Diabetes & Digestive & Kidney Diseases, supra note 12.
[15] See Herbert Wieser et al., Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review, 13 Nutrients 89, 89 (June 29, 2021), https://mdpi-res.com/bookfiles/book/6084/Gluten_Related_Disorders.pdf?v=1737338654 [https://perma.cc/TQ5H-Q9BP] (noting only cure gluten-free diet). The only available treatment for celiac disease is a lifelong, strict gluten-free diet. Id.
[16] See id. at 89 (discussing difficulties individuals face). Individuals with celiac disease are limited to a gluten intake of as little as fifty milligrams of gluten per day (equivalent to a few breadcrumbs) to avoid significant mucosal deterioration. Id.; see also Spyridaki Aspasia et al., The Gluten-Free Diet Challenge in Adults with Coeliac Disease: The Hellenic Survey, PEC Innovation, Mar. 29, 2022, at 1, https://pmc.ncbi.nlm.nih.gov/articles/PMC10194373/pdf/main.pdf [https://perma.cc/4SBL-CL5D] (noting diet challenges). This diet can be challenging because gluten is a common ingredient in most foods. Aspasia et al., supra; see also Gluten and Food Labeling, FDA (July 16, 2018), https://www.fda.gov/food/nutrition-education-resources-materials/gluten-and-food-labeling [https://perma.cc/4CAC-NHRE] [hereinafter Gluten and Food Labeling] (discussing issues of gluten-free labels). The FDA does not require manufacturers to place a foods “gluten-free” claim in any specific location on the food label. Gluten and Food Labeling, supra. A “gluten-free” claim is not required to be on a food package, even if the food is gluten-free. Id.
[17] See Operator’s Edge, supra note 14 (noting statistics for gluten-free restaurants); see also Janice Schroeder, Mistakes Restaurants Make in Gluten-Free Dining, Celiac.com (Mar. 8, 2019), https://www.celiac.com/celiac-disease/mistakes-restaurants-make-in-gluten-free-dining-r4744/ [https://perma.cc/BQN8-4V4A] (discussing inadequate taste of gluten-free alternatives). An individual with a gluten-intolerance noted, “sometimes the chef goes overboard in the interest of caution and removes everything that could “possibly” contain anything remotely containing gluten. What I get is a tasteless shadow of the original dish, and resounding disappointment.” Schroeder, supra; Ilima Loomis, How Someone with Celiac Disease Manages the Cost of Gluten-Free Foods—My Bill of Health, GoodRx (Nov. 23, 2022), https://www.goodrx.com/conditions/celiac-disease/cost-gluten-free-food-heather-king [https://perma.cc/85CZ-2QPN] (noting gluten-free alternatives cost more). In a 2019 study, it was found that gluten-free products cost 183% more than its regular counterparts. Loomis, supra. This number does not just include restaurants, but also grocery stores. Id.; see also Erica Julson, Celiac Disease Diet: Food Lists, Sample Menu, and Tips, Healthline (Jan. 8, 2019), https://www.healthline.com/nutrition/celiac-disease-diet [https://perma.cc/W5NQ-QFPB] (listing safe foods and foods to avoid); Why Include Gluten-Free Dishes in your Culinary Offering?, TheFork (Dec. 3, 2024), https://www.theforkmanager.com/blog/gluten-free-dishes-restaurant [https://perma.cc/GDF2-VSJN] (discussing expansion of gluten-free options).
[18] See Abdullah A. Khafagy et al., A Cross-Sectional Study of Celiac Disease Awareness in the Food Industry in the Western Region of Saudi Arabia, Cureus, June 2022, at 14, https://assets.cureus.com/uploads/original_article/pdf/99642/20220701-30101-umjs0h.pdf [https://perma.cc/R3UR-XWH7] (demonstrating lack of global research and training); see also Tracy Grabowski, Why Many Restaurants Should Not Offer Gluten-Free Menu Options…yet, Celiac.com (Nov. 28, 2016), https://www.celiac.com/celiac-disease/why-many-restaurants-should-not-offer-gluten-free-menu-optionsyet-r3934/ [https://perma.cc/P8CX-CH57] (noting lack of cross-contamination education). Many sources of gluten cross-contamination are simply unexplored or unknown by dining establishments. Grabowski, supra; see also Senior Care: Gluten-Free Living for Our Elders, Gluten Intolerance Grp. (2021), https://gluten.org/2020/01/22/assisted-living-gluten-free [https://perma.cc/7LYP-78E8] (noting cross-contaminating risks). The risk of cross-contact is higher when using shared cooking surfaces that cannot be easily cleaned. Gluten Intolerance Grp., supra.; see also Sanitization and Gluten-Free Dining: Fact Versus Fiction, FoodSafety Mag., https://www.food-safety.com/articles/6007-sanitization-and-gluten-free-dining-fact-versus-fiction [https://perma.cc/3T94-HYQJ] (discussing issues of sanitization).
[19] See U.S. Department of Justice Agreement with Lesley University, Food Allergy Rsch. & Educ., https://www.foodallergy.org/resources/us-department-justice-agreement-lesley-university [https://perma.cc/D7KU-BCYB] (describing first food allergy-related settlement); see also Dep’t of Just., DJ 202-36-231, Settlement Agreement between the United States of America and Lesley University (Dec. 20, 2012), https://archive.ada.gov/lesley_university_sa.htm [https://perma.cc/U3RW-MCQ5] (discussing institutions lack proper accommodations for celiac disease).
[20] See Dep’t of Just., supra note 19 (discussing details of settlement agreement). Lesley University agreed to improve its practices so that students with celiac disease and food allergies can obtain safe and nutritional foods. Id.
[21] See Americans with Disabilities Act, 42 U.S.C. § 12102 (noting some food allergies considered disability). Some individuals with food allergies are disabled as defined by the Americans with Disabilities Act particularly those with more significant or severe responses to certain foods. Id.; see also Questions and Answers About Lesley University Agreement and Potential Implications for Individuals with Food Allergies, U.S. Dep’t Just. Civ. Rts. Div. (Jan. 2013), https://archive.ada.gov/q&a_lesley_university.htm [https://perma.cc/7BWS-6BBD] (noting celiac disease constitutes disability). Celiac disease may qualify as a disability under the ADA due to its impact on a person’s ability to participate in major life activities. U.S. Dep’t Just. Civ. Rts. Div., supra; Celiac Disease, What is it?, Disability Help Ctr. San Diego,https://www.disabilityhelpcenter.org/article/social-security-disability-celiac-disease [https://perma.cc/WK49-LYBH] (emphasizing celiac disease possible qualification under ADA); Jane Anderson, Does the ADA Cover People With Celiac Disease?, Verywell Health (May 6, 2020), https://www.verywellhealth.com/ada-and-celiac-disease-563100 [https://perma.cc/Q5CH-ZUWY] (emphasizing ADA coverage for celiac disease).
[22] See Food Allergy Rsch. & Educ, supra note 19; see also Dep’t of Just., supra note 19 (discussing agreement providing reasonable accommodations to food services).
[23] See ADA May Require Food Allergy Accommodation by Employers, Schools & Businesses, Sol. L. Press (2013), https://slphrbenefitsupdate.com/2013/01/25/justice-department-settlement-signals-food-allergies-may-require-accommodation/ [https://perma.cc/A5DJ-DRKJ].
[24] See Sol. L. Press, supra note 23; see also Restaurants Not Required to Serve Allergen-Free Food, Asthma & Allergy Found. Am. (Feb. 13, 2013), https://community.kidswithfoodallergies.org/blog/restaurants-not-required-to-serve-allergy-free-gluten-free-but-might-need-to-accommodate-disability [https://perma.cc/W8NS-YXWC] (emphasizing need for reasonable accommodations); Dep’t of Just., supra note 19(noting possible implementation of reasonable accommodation moving forward). Settlement is likely to prompt establishments to look at their own procedures to ensure they are implementing proper protocols to enable a safer environment. Dep’t of Just., supra note 19.
[25] See Three Years Later, What is the Impact of the Gluten-Free Labeling Standard?, FDA (Oct. 4, 2017), https://www.fda.gov/food/conversations-experts-food-topics/three-years-later-what-impact-gluten-free-labeling-standard [https://perma.cc/8NDY-DYUF] [hereinafter Impact of Gluten-Free Standard] (noting prior to regulation consumers gambled with health); see also Gluten and Food Labeling, supra note 16 (emphasizing consumer health concerns).
[26] See Gluten and Food Labeling, supra note 16 (discussing issues before food labeling regulations).
[27] See id.; see also Impact of Gluten-Free Standard, supra note 25 (discussing individuals concerns regarding non-regulations). Consumers were forced to gamble with their heath because they were never sure if the food was gluten-free. Impact of Gluten-Free Standard, supra note 25. Those with celiac disease and gluten intolerances began advocating for standardized regulations. Id.
[28] See Gluten and Food Labeling, supra note 16; see also Impact of Gluten-Free Standard, supra note 25 (describing FDA gluten-free labeling requirements). The FDA required that a food labeled “gluten-free” must either be inherently gluten-free or does not contain an ingredient that is: 1) a gluten-containing grain, 2) derived from a gluten-containing grain that has not been processed to remove gluten, derived from a gluten-containing grain that has not been processed to remove gluten, or derived from a gluten-containing grain that has been processed to remove gluten, if the use of that ingredient results in the presence of 20 parts per million (ppm) or more gluten in the food. Impact of Gluten-Free Standard,supra note 25. It also notes that any unavoidable presence of gluten must be less than 20 ppm. Id.; see also Gluten-Free’ Means What it Says, FDA (May 4, 2023), https://www.fda.gov/consumers/consumer-updates/gluten-free-means-what-it-says [https://perma.cc/7VBP-ZS9M] [hereinafter Gluten-Free Means What it Says] (emphasizing gluten must constitute less than 20 ppm); Allergen Awareness Training Regulations, ServSafe (Nov. 25, 2024), https://www.servsafe.com/ServSafe-Allergens/Allergens-Training-Regulations [https://perma.cc/W3ME-LLK4] (discussing training programs implemented to prevent mishandling of food); Kylie Register, Mastering Food Safety: A Guide to ServSafe Certification, Pro. Workforce Dev. (Apr. 24, 2024), https://pwd.aa.ufl.edu/blog/mastering-food-safety-a-guide-to-servsafe-certification/ [https://perma.cc/4T8Z-X8Y2] (explaining Servsafe education program). Along with the FDA regulations on safe labeling of gluten-free products, the National Restaurant Association, a food safety certification, designed Servsafe to educate food service employees on proper procedures. Register, supra.
[29] See Grabowski, supra note 18 (discussing establishments need for increase training and education); see also Gluten-Free Means What it Says, supra note 28 (discussing gluten-free standards). In addition to limiting the unavoidable presence of gluten to less than twenty parts per million, the FDA allows manufacturers to label a food “gluten-free” if the food does not contain: any ingredient that is any type of wheat, and anything derived from grains that has not been processed to remove gluten. Gluten-Free Means What it Says, supra note 28.
[30] See Grabowski, supra note 18 (suggesting diners need for trust in meal preparation); see also Schroeder, supra note 17(emphasizing some restaurants not adequate for gluten-free individuals). “If you think your restaurant has a dedicated area to handle your gluten-free meal, you might be sadly mistaken. Using the same fryer, using the same pasta water, using the same utensils; these are just some of the things that are going on in the kitchen.” Schroeder, supra note 17. It is easier for staff to cut shortcuts during a rush than to properly prepare the gluten-free meal. Id.
[31] See ServSafe, supra note 28 (discussing allergen training program for food safety); see also Register, supra note 28 (emphasizing education program could benefit consumers). Each state or county has a food allergen awareness training requirement. ServSafe, supra note 28.
[32] See Gluten Intolerance Grp., supra note 18 (discussing methods preventing cross-contamination). Facilities that serve food can provide special utensils and cookware. Id. While not all facilities have the budget or space to separate food containing gluten, being educated in proper sanitization could help. Id.; see also FoodSafety Mag., supra note 18 (discussing restaurant sanitization for food safety).
[33] See TheFork, supra note 17; see also Grabowski, supra note 18 (noting benefits of expanding gluten-free options). Offering more gluten-free options would allow the business to serve various types of customers and is a great way to stand out among competitors. TheFork, supra note 17.
[34] See Schroeder, supra note 17 (discussing cross-contamination with gluten-containing foods); Mollo, supra note 4. Balancing living a normal life and staying vigilant to gluten exposure can be difficult. Mollo, supra note 4. An individual with celiac disease or gluten intolerance may feel anxious when eating out, due to the risk of exposure to gluten. Id. To keep themselves safe, they must research the places they will be eating at, alert the staff, and ask about preparation. Id.; see also Dr. Phil CBS, supra note 4 (noting anxiety with gluten exposure). A woman diagnosed with celiac disease stated, “I am constantly worried about ingesting gluten, and it has been controlling my life.” Dr. Phil CBS, supra note 4. The possible gluten exposure through cross-contamination creates anxiety in these individuals and more stress when it comes to dining out. Id. Some even avoid dining out at restaurants all together. Id.
[35] See Grabowski, supra note 18 (noting individuals with celiac disease’s inability to trust others to prepare their meals); see also Schroeder, supra note 17 (highlighting need for better gluten-free food options). Rather than removing everything from meal to make it gluten-free, there needs to be more options available. Schroeder, supra note 17.
[36] See Grabowski, supra note 18 (emphasizing need for inclusivity in establishments).
[37] See Price, supra note 8 (discussing gluten intolerance among common dietary restriction); see also Piedmont, supra note 9(emphasizing gluten-free prevalence).
[38] See Mayo Clinic, supra note 3 (discussing effects of gluten to individuals with gluten intolerance and celiac disease).
[39] See Schroeder, supra note 17 (emphasizing high costs and limited food options).
[40] See Grabowski, supra note 18; see also Dr. Phil CBS, supra note 4 (discussing individuals concerns with possible gluten exposure); Beyond Celiac, supra note 4 (noting individuals with celiac disease experience increased anxiety); Life With Celiac Disease, supra note 1 (discussing food plays important role in socialization); Duane, supra note 1 (noting gluten intolerance and celiac disease affects social engagements).