The gluten-free diet has been en vogue for years now, replacing the more generalized anti-carb revolution and specifically targeting the pesky protein found in everything from breads and pastas to soy sauce. But for the estimated 3 million Americans who suffer from celiac disease—a truly terrible affliction where antibodies attack the lining of the small intestine—and more still who are categorized as gluten sensitive, it can be a tricky business dining out without risking terrible symptoms of gluten ingestion.

Restaurants have been trying to keep up with the dietary trend, with everyone from Domino's Pizza to Del Posto offering up gluten-free dishes. But guaranteeing a 100% gluten-free environment has proven to be very difficult, reports the WSJ.

Following complaints after the launch of its initial gluten-free crust, the California Pizza Kitchen chain has doubled down, using pre-stretched dough in sealed bags and requiring a manager be present for each gluten-free order. Further, the restaurant uses rice flour for stretching its traditional crusts, eliminating the possibility of cross-contamination, and uses designated tools to ensure there's no contact with gluten items. "It's a pretty intense process," explained senior vice president of culinary development Brian Sullivan. In the case of Domino's, the chain offers a gluten-free crust but cautions that the dough is prepared alongside regular crust pizzas and therefore may not be safe for celiac sufferers. What's the point?

Next year a new regulation from the FDA requires any food labeled gluten-free to contain fewer than 20 parts per million of the protein. The labeling will be helpful for navigating the grocery store aisles but won't necessarily protect from unscrupulous chefs who poo-poo what they feel is a bogus disease—despite medical acknowledgement. The chefs aren't totally wrong to be skeptical about gluten sensitivity claims; market research from NPD Group, Inc. showed that 25.5% more Americans are avoiding gluten than they were three years ago while only about 1% of the population suffers from some form of celiac disease.