Restaurants have marketed gluten-free menu items for years, but it wasn’t until May that such claims drew controversy. That’s when Domino’s Pizza unveiled a gluten-free crust  it admitted may not be safe for those with severe gluten sensitivity.
Although the new crust was free of gluten-containing products, Domino’s said in disclaimers and a video on YouTube that cross-contamination might compromise it, making it unsafe for those with celiac disease. What officials at the 9,700-unit chain called transparency, however, critics called exploitation , charging Domino’s with endangering people with a serious medical condition in its efforts to capitalize on a hot dietary trend.
“A product is either gluten free or it is not,” said Dr. Stefano Guandalini, founder and president of the North American Society for the Study of Celiac Disease and medical director of the Celiac Disease Center at the University of Chicago. “Marketing a product to be ‘sort of’ gluten free or ‘low’ gluten is completely useless for those who require the strict diet.”
Domino’s is not the only restaurant brand to be caught in the dustup. References to gluten on restaurant menus jumped 61 percent from 2010 to 2011, according to research firm Technomic Inc.
That could be a nod to the 15 percent to 25 percent of American consumers who say they are looking for gluten-free options for a variety or reasons, including those inspired by celebrities and athletes who tout the diet as more healthful.
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Meanwhile, about 1 percent of the U.S. population, or roughly 3 million people, is estimated to have celiac disease, an autoimmune disorder that is triggered by gluten proteins in wheat, barley and rye. And another 6 percent of Americans, or about 18 million, are thought to be gluten sensitive, having an intolerance of gluten that is not tied to celiac disease.
Technomic’s research reflects those percentages. Of 250 respondents who described themselves as on a restricted diet or living with someone with restrictions, only 4 percent identified gluten intolerance as the cause. Still, about 25 percent said they believe gluten-free foods are better for you.
That thinking is helping fuel sales of gluten-free products, which surpassed $2.6 billion in 2010 and are expected to reach more than $5 billion by 2015, according to Packaged Facts.
The controversy over Domino’s use of the phrase “gluten free,” however, is forcing restaurateurs to tread carefully if they decide to tap into the trend.
A defining moment
Nutrition consultant Anita Jones-Mueller, president and founder of Healthy Dining in San Diego, sees those with medical reasons for avoiding gluten falling into two camps: those who are gluten sensitive but who may not be concerned about cross-contamination, and those with celiac disease, or severe sensitivity to gluten, for whom “even just a speck of gluten can cause havoc to their health.”
The segment with severe sensitivity “truly needs gluten-free items to be totally gluten free,” she said. “So you can imagine the difficulty that celiac sufferers contend with when trying to decipher whether a menu item promoted as gluten free is completely free of gluten.”
Part of the problem, said celiac advocates like Guandalini, is the fact that the term “gluten free” has no legal definition.
In 2004 Congress asked the Food and Drug Administration to come up with a definition for “gluten free” on nutrition labels. In 2007 the agency decreed that manufacturers could label a food “gluten free” if it does not contain wheat, rye or barley, a crossbreed of any of those grains, or if it contains less than 20 parts per million of gluten.
More recently, the FDA indicated that a regulatory definition would be published before the end of 2012. Still, it’s not clear that definition will have any impact on what restaurants can describe as “gluten free.”
Jones-Mueller said she believes the FDA at some point will set a “not-to-exceed” level that will disqualify many menu choices now promoted as gluten free based on ingredients.
Meanwhile, the agency has not addressed the hazard of cross-contamination. For those with celiac disease, even minute amounts of gluten introduced to a food can cause harm. For instance, if a gluten-free ingredient is fried in the same oil as something containing gluten, cross-contamination can occur.
Last year, California Pizza Kitchen introduced a gluten-free crust, but the option was quietly dropped a few months later after celiac sufferers questioned whether the chain had taken any steps to avoid cross-contamination.
CPK said on its website that it is working with the Gluten Intolerance Group to review preparation processes, procedures and training materials. The page also points to other non-pizza gluten-free menu options — with a warning that kitchen operations involve shared cooking and preparation areas, so the chain cannot guarantee that any menu item is completely gluten free.
Some operators try to distinguish between products safe for the celiac community and those simply described as gluten free.
The Melt, a grilled-cheese chain based in San Francisco, offers gluten-free alternatives to menu items on request. Up to 2 percent of customers ask for meals to be gluten free, said Paul Coletta, the chain’s chief marketing officer. He noted, however, that the alternative options are not celiac safe.
Domino’s worked with the National Foundation for Celiac Awareness, or NFCA, in developing its gluten-free crust.
At the time, the NFCA had recently launched a tiered credentialing program with the goal of communicating more information about a restaurant’s gluten-free protocols.
Restaurants that earned a “green” designation would have “robust” gluten-free protocols that meet the needs of both those with celiac disease and the gluten sensitive. In addition, servers, managers and kitchen staff would be comprehensively trained, incoming ingredients would be verified gluten free and strict cross-contamination controls would be in place.
An “amber” designation would reflect ingredient verification and a basic level of staff training, but those with celiac disease and gluten sensitivity should “ask questions and exercise judgment,” the NFCA said.
Domino’s had initially earned an amber designation for its gluten-free pizza. But Guandalini said he believed such a tiered system could confuse matters even more.
An amber designation, for example, could imply that the gluten intolerant could eat the pizza safely, he said.
“But we don’t know enough about the condition to say, ‘You can have a little gluten. ... It may not hurt you, after all.’”
Even those with celiac disease could be tempted to try the new crust because of its gluten-free label, he said.
“There should be no need for disclaimers,” Guandalini argued. “The threshold has to be set at the same level for everybody.”
After the Domino’s controversy, the NFCA dropped the amber and green designations, saying the program needed further thought.
“We will conduct a review to determine the most effective and clearest way to warn the community of the risk of cross-contamination and the use of the phrase ‘gluten free,’” the NFCA said.
Meanwhile, in June the makers of CeliAct, a nutritional supplement for those with celiac disease, said they tested Domino’s gluten-free pizza crusts in three cities for gluten. Two had no detectable amounts, and one had 7 parts per million — well under the proposed FDA guidelines.
No room to ‘dabble’
Alice Bast, NFCA’s president, said too often restaurants aren’t even grasping the basics.
She still goes to restaurants and orders a gluten-free plate, only to find it includes couscous — a wheat product — or some other hazard, she said.
“Restaurants don’t know what they don’t know,” said Bast. “Gluten free has become such a big trend, but there’s a loss of connection to the disease.”
Jules Shepard, author of “The First Year: Celiac Disease and Living Gluten-Free” and an industry consultant, said she counsels restaurants not to “dabble” when it comes to gluten-free offerings.
“If they’re going to do it, it has to be all-in,” she said.
Shepard points to brands like Chuck E. Cheese, which earlier this year began testing gluten-free products. Its pizza comes from a gluten-free facility and is baked in its original packaging and only opened at the table — virtually eliminating cross-contamination risk.
Such technology is ideal for a delivery pizza chain, she said.
“You could have it delivered to your door in the bag, right into your gluten-free household,” she said.
Other chains also are known for gluten-free menu offerings that are trusted by those with celiac disease, including P.F. Chang’s China Bistro, Outback Steakhouse, Carrabba’s Italian Grill and Planet Hollywood, she said.
P.F. Chang’s reveals which sauces and ingredients are gluten free, such as its chicken broth or oyster sauce. Gluten-free soy sauce is available on request, and gluten-free dishes are prepared with dedicated woks and utensils. Meals are served on plates with gluten-free logos so servers can be sure guests get the right dish.
Such protocols can make loyal — and highly viral — fans of those who avoid gluten for medical reasons, Shepard said.
“Those fad dieters are not going to stick with gluten free,” said Shepard. “It makes no sense to have that as your target audience.”
Betsy Craig, founder and chief executive of Kitchens With Confidence, based in Fort Collins, Colo., certifies restaurant chains for being safe for those with food allergies.
Craig said cross- contamination protocols for gluten-free dining are not any more difficult than those that prevent foodborne illness.
“You prevent it the same way you do when you have raw poultry and lettuce in your kitchen [so] you don’t end up with salmonella in your salad,” she said.
Fresh Brothers, a six-unit pizza chain based in Manhattan Beach, Calif., sells about 1,000 celiac-safe pizzas each week — despite the fact that pizza chains have a high risk of cross- contamination with airborne flour in kitchens, said chief executive Adam Goldberg.
The gluten-free crust comes in from a certified gluten-free facility in a sealed box and goes directly to a cooler where there is no airborne flour. All gluten-free toppings and sauces are kept in containers for gluten-free-pizza use only. The pizzas are prepared in the cooler in a dedicated space with dedicated tools and cutting boards.
After baking on pans that prevent the pizza from touching an oven surface, the pizza goes back into a gluten-free box and is sealed for delivery to the table or home.
Goldberg noted that Fresh Brothers charges about $3 more for a medium gluten-free pizza because the dough is pricier and it’s more labor intensive to make.
The move has paid off financially, he said, but even more, it has connected the brand to the community.
“We’ve brought families together that can now share a pizza meal when they couldn’t before,” said Goldberg.
“I have really seen this build over the past two years,” Goldberg added. “I don’t think gluten free is a fad or a trend. It’s here to stay.”
Like most companies, however, Fresh Brothers has a disclaimer on the menu warning about the potential for cross-contamination.
Craig recommends that disclaimers focus on communicating efforts to ensure safety, which the gluten sensitive would look for. But nothing is 100 percent, she noted.
“In the end, every guest has to choose whether they want to eat in the restaurant or not,” she said.