Dining Out With IBS: Italian 

Do you have Irritable Bowel Syndrome (IBS)? Have you struggled with bloating, stomach cramps, gas, or worse after eating Italian food out for dinner? Have you wished you had a clear guide on what you can or cannot eat to avoid your IBS symptoms? What if you are following the low FODMAP diet for IBS? What Italian dishes can you eat, and which ones should you stay clear of? Well, read on! 

Whether you are craving classic Italian food, like aglio e olio, or Italian-American favorites, like baked ziti, garlic often plays a big role, as do onions and wheat. Garlic, onions, and wheat often cause gastrointestinal issues for people with IBS. 

And what about everyone’s favorite: pizza? All these dishes contain FODMAPs, which are limited on the low FODMAP diet, especially during the Elimination Phase, but we still crave them. This article is about dining out and indulging in your Italian favorites.

Learn which Italian menu items are likely low FODMAP and less likely to trigger digestive symptoms, or that can be prepared to your specifications. 

Expand Your Choices With FODZYME

Learn how to use the digestive enzyme blend FODZYME to help you enjoy dishes that are high FODMAP, and to ensure you avoid potential digestive upset due to unforeseen ingredients present in a meal. 

To begin, please read our articles on general Strategies For Dining Out With IBS, and FODZYME®: Digestive Enzymes To Help With Digestive Distress, then come back to this article.

What Can You Eat At An Italian Restaurant? 

We have created a Quick View list of foods for you immediately below, but you must read this post in its entirety for vital FODMAP information you need when ordering at an Italian restaurant.

Quick View: Italian Food Menu Options You Can Order During the Elimination & Challenge Phases of the Low FODMAP Diet

Note: These lists assume classic approaches to these Italian dishes. Preparation can vary. For important details, please read the full article.

Low FODMAP Options:

• Antipasti: Pick and choose the low FODMAP options.
• Caprese Salad.
• Green Salad: Ask for no onions.
• Low FODMAP Gluten-Free Pasta: Toss with olive oil and steamed or grilled shrimp, or low FODMAP tomato sauce.
• Polenta: If just cornmeal and water. 
• Simply Prepared Proteins: Olive oil, salt and pepper.
• Cacio e Pepe: With low FODMAP pasta.
• Carbonara: With low FODMAP pasta.
• Amatriciana: With low FODMAP pasta.
• Gnocchi: If low FODMAP.
• Chicken or Veal Piccata: Contains low FODMAP amount of wheat.
• Sorbetto: Choose a low FODMAP flavor.

Order & Use FODZYME:

These are options you can order if you are using FODZME Digestive Enzymes as directed. 

• Bruschetta, Focaccia, Garlic Bread or Breadsticks.
• Fried Calamari.
• Mozzarella Sticks.
• Minestrone or Pasta e Fagioli.
• Risotto.
• Pizza.
• Meatballs.
• Any Tomato Sauce.
• Shrimp Scampi.
• Linguine with Clams.
• Lasagna, Ravioli, Manicotti, Baked Ziti, Stuffed Shells.
• Bolognese Sauce, Pesto, Vodka Sauce, Fra Diavolo.
• Chicken, Veal or Eggplant Parmesan.
• Gelato, Panna Cotta, Cannoli.
• Tiramisu, Italian Cheesecake.
• Affogato.

Detailed Guidelines For Ordering Italian Menu Options

The rest of this article provides you with the details you need about dining out Italian with IBS.

A Note On Garlic, Onions, Wheat and Dairy

The low FODMAP diet is not entirely free of FODMAPs; the suggested low FODMAP serving sizes are based (partially) on FODMAP thresholds that are known to trigger irritable bowel syndrome (IBS) symptoms in most people. This is how it is possible to have lab tested certified foods that contain garlic and or onion, like Sriracha and Worcestershire Sauce, and to have low FODMAP servings of wheat pasta. In addition, while the diet is low in lactose, it is not dairy-free. The diet is very much dependent on serving size.

All this information can be found in the Monash University app and FODMAP Friendly Low FODMAP app, which are essential tools for following the low FODMAP diet. If you are not familiar with these two primary low FODMAP diet apps, please be sure to read these articles:

• How To Use The Monash University Low FODMAP Diet App
• How to Use The FODMAP Friendly Low FODMAP Diet App

When dining out Italian, we are bombarded with garlic, onion, wheat, and lactose-containing dairy in large amounts. That is what puts so many of your favorite Italian dishes into high FODMAP territory. 

A Note On Fat

FODMAPs are carbohydrates. Fats are fat, and therefore not a FODMAP issue, but fat can be an IBS trigger. Many Italian dishes are high fat with liberal use of cheese, butter, olive oil, and other dairy. Know your tolerances and order accordingly.

Strategies When Dining Italian

If you are following the low FODMAP diet, when you scan an Italian menu, you will probably see garlic, onion, wheat, and dairy in over 75% of the offerings. And your heart sinks. What can you eat?

Pro Tip: Be well acquainted with the Monash University and FODMAP Friendly apps. Keep your smartphone handy for quick checking.

Know What Low FODMAP Gluten-Free Means

At some Italian restaurants, the gluten-free menu items can be a low FODMAP option. This section addressed how gluten-free and low FODMAP are not the same thing, offers guidance for those who want to eat gluten -free, and how gluten-free menu options can be a good place to start to find low FODMAP menu choices.

Pro Tip: Wheat contains both gluten and fructans. Many people who are not celiac, but negatively react to wheat, mistakenly blame gluten for causing digestive upset. Very often it is the fructans. You can read more in our article, The Low FODMAP Diet is Not a Gluten-Free Diet.

However, when it comes to determining whether a pasta, pizza, or other gluten-free selection (like a breaded eggplant Parmesan) is also low FODMAP, please keep a few things in mind.

Gluten-Free vs. Low FODMAP Flours

The low FODMAP diet is not gluten-free, and not all gluten-free flours are low FODMAP. We always suggest asking what a gluten-free dish is made from. Keep your eye out for chickpea and bean flour, soy flour, and amaranth flour, which are all gluten-free but not low FODMAP, as examples.

Low FODMAP Gluten-Free Pasta

Many gluten-free pastas are 100% rice-based and, therefore, low FODMAP. Some are rice, corn, and quinoa, or a combo of just two of those, and they also have low FODMAP servings.

Low FODMAP Gluten-Free Pizza

Gluten-free pizza crust is a little more problematic and can be made in any manner of ways, including cauliflower crust, which is quite high FODMAP. Ask about the ingredients. We have had great luck with finding low FODMAP pizza crusts at restaurants, but we always ask.

What About Pasta Menu Dishes?

One look at an Italian menu, from the appetizers to the primo (first courses), or secondo (the main courses), and you will see lots of pasta. Traditional Italian pasta is wheat-based, and wheat contains fructans, which statistically are the FODMAP that negatively affect IBS sufferers the most. Pasta might be made from semolina, a type of coarse flour made from durum wheat; it also contains fructans.

It is hard to get away from pasta on an Italian menu. Above, we gave you tips for alternative pasta, and below, we will show you how to enjoy classic Italian pasta with the help of enzymes like FODZYME.

Pro Tip: Monash University lab testing states that a small ½ cup (74 g) serving of cooked wheat-based pasta is low FODMAP. The problem is that many people cannot tolerate this amount or want to eat more! It also becomes Moderate and High in FODMAPs very quickly, at 2/3 cup (101 g) and 1 cup (148 g), respectively.

Tomato Sauce Is Everywhere

Red sauce. Tomato sauce. Sunday gravy. Pasta sauce. Marinara. Whatever you might call it, classic tomato-based sauces often contain garlic and/or onion. Some restaurants might have one sauce in multiple dishes, while other establishments might have a few different ones. Ask questions; maybe you will luck out!

Pizza sauce can be a (good) exception. Traditionally, many pizza sauces contain tomatoes, salt, maybe some pepper, and perhaps a bit of basil or oregano. They can often be found without garlic or onion. Again, ask; you might find a low FODMAP offering.

Design Your Own Pizza!

If a low FODMAP pizza crust is available, you are in great shape! Here are best practices for ordering a low FODMAP pizza.

• Ask what is in their gluten-free crust. Many menus offer one; be prepared to know the difference between a high FODMAP gluten-free crust, and a low FODMAP option.
• Sourdough Pizza: If you are lucky enough to find sourdough pizza and you are not celiac, we encourage you to try it. The fructans in wheat are consumed during the fermentation that creates sourdough. Without lab testing, there is no way to know how low or high FODMAP the crust is, but it will be lower in fructans than non-sourdough. Please read our article, How To Choose Low FODMAP Bread, for more information.
• Inquire about their tomato sauce. Pizza sauce is traditionally very simple, and you might find that their stand-by is low FODMAP.
• If their tomato-based sauce is high FODMAP, ask if they have tomato passata (puréed, strained, uncooked tomatoes) or crushed tomatoes. This could serve as a tomato base for your pizza. Or you could start with sliced fresh tomatoes.
• Cheeses: Please read our article, Is Cheese Low FODMAP, in which we teach you how to tell if anycheese is low FODMAP. Mozzarella, Parmigiano Reggiano, and Pecorino Romano are all low FODMAP. 
• White pizza begins with a drizzle of olive oil and garlic; simply ask for the garlic to be held back. Add some low FODMAP cheese, oregano, and hot pepper flakes, or low FODMAP vegetables, and you have a fantastic pizza.
• Pizza Toppings: We have an entire article for you on low FODMAP pizza toppings. There are many! It comes down to serving sizes, but some of your favorites are low FODMAP: olives, peppers, canned mushrooms, extra cheese, spinach, broccoli, pineapple, anchovies, and so many more. Use our article and your smartphone apps to determine a selection.
• Red & White Wine: There are low FODMAP servings of both; please refer to your apps.

Low FODMAP Italian Menu Choices

Here are some good low FODMAP choices, but always ask how dishes are prepared, and use your Monash University and FODMAP Friendly smartphone apps to determine serving sizes:

• Antipasti: Olives, artichoke hearts, anchovies, hard cheeses, mozzarella balls, roasted red peppers, prosciutto, pickled vegetables like carrots – even canned button mushrooms (which can have low FODMAP seasoning) all have low FODMAP serving sizes.
• Caprese Salad: This classic is low FODMAP as is. It should simply be fresh mozzarella, tomatoes, basil, a little salt and pepper, and olive oil. That’s it, but ask. Some restaurants might not take this purist approach.
• Salad: Almost every restaurant has a simple green salad. Ask for any onions to be left out. If they forget, simply remove them yourself; you don’t have to be concerned with cross-contamination from a FODMAP perspective.
• Gluten-Free Pasta: I list this as “gluten-free” because that is how it will be listed on a menu. If the pasta is also low FODMAP, ask for simple olive oil and Parmesan. Depending on how cooperative the chef is, perhaps they would toss your pasta with olive oil and steamed or grilled shrimp. If you have cleared that they have a low FODMAP tomato sauce, you can ask for that, too.
• Polenta: Often made with just cornmeal and water, both low FODMAP. Ask, and then you could have it served with low FODMAP tomato sauce and cheese.
• Simply Prepared Proteins: I have often had great luck with a simple roast fish, like Branzino, with olive oil, salt and pepper. Ask if steak, chicken, fish, shrimp or scallops can be simply prepared. 
• Cacio e Pepe: Classic versions call for pasta, salted water, freshly ground pepper, and Pecorino Romano. Know your fat tolerance. Order with low FODMAP pasta.
• Carbonara: Crispy bits of pork (guanciale or pancetta), eggs, and cheese. Know your fat tolerance. Order with low FODMAP pasta.
• Amatriciana: Guanciale, wine, red pepper flakes, crushed tomatoes, and cheese. Order with low FODMAP pasta.
• Gnocchi: Ask if they have potato gnocchi and about all the ingredients. It is possible that they are wheat-free or that they have a small enough amount to be low FODMAP. Ask for them tossed in low FODMAP tomato sauce or browned butter.
• Chicken or Veal Piccata: These proteins are dredged in wheat flour and sautéed. The amount of wheat flour is most likely low FODMAP. Only choose these dishes if you know that the fructans in wheat do not bother you in small amounts. Or, if they do, you can move these dishes into the High FODMAP category and treat them as described below, using FODZYME to help.
• Sorbetto: Many Italian restaurants offer sorbetto, which is a dairy and egg-free frozen dessert. Choose a low FODMAP flavor, like lemon or strawberry. If it is made in-house it is unlikely to contain high fructose corn syrup; ask about ingredients.
• Flourless Chocolate Cake: Many Italian restaurants also offer decadent chocolate cake, often a flourless one. Ask for ingredients. Some can be as simple as dark chocolate, eggs, and sugar, in which case there is a low FODMAP serving. A dollop of whipped cream is low FODMAP, too.

Ask About Fettuccine Alfredo 

Classic fettuccine Alfredo is made with pasta, butter, Parmigiano Reggiano, and pasta cooking water, which makes it creamy. There is no cream. This is one of our pet peeves. We wish all the pseudo Alfredo sauces, both recipes and jarred products, would at least call themselves Alfredo-inspired rather than trying to pass off as the real thing.

So, the good news is that if the restaurant makes it in a traditional manner, and you do well with wheat-based pasta, or they have low FODMAP pasta, this would be a great option for you.

And no, there is no chicken, shrimp or broccoli in the classic version, but that doesn’t mean you can’t ask for some. Remember, pure proteins contain no FODMAPs at all.

Pro Tip: Fettuccine Alfredo is a high fat dish, so know your tolerances.

High FODMAP Italian Dishes You Can Enjoy, Using FODZYME

Now we come to the fun part! You are craving shrimp scampi, you’ve been dreaming about a cheesy sausage lasagna, or maybe you just want to dive into traditional spaghetti and meatballs. Guess what? It is all possible! With the help of targeted enzyme supplementation, you can enjoy all these Italian and Italian-American dishes. 

FODZYME is a digestive enzyme blend that is specifically formulated to aid in the digestion of fructans (found in garlic, onions, wheat, grains, and vegetables), galacto-oligosaccharides, referred to as GOS (found in beans, legumes, and nuts), and lactose (in dairy products). 

Oftentimes, people who are sensitive to multiple FODMAPs find they tolerate moderate amounts of fructose and polyols when using FODZYME. We generally recommend limiting foods very high in polyols and fructose, however, eating foods with these FODMAPs in the context of a larger, balanced meal with FODZYME, can often mitigate polyol and fructose sensitivities. FODZYME is used with the first bite or first few bites of FODMAP-containing food, which maximizes the enzymes’ ability to support digestion of your meal.

As mentioned before, many Italian dishes are heavy with garlic, onions, wheat, and lactose, and FODZYME can specifically address these ingredients.

Have your FODZYME at hand and go ahead and order:

• Bruschetta: Pronounced, “broo·skeh·tuh”. Made with wheat flour bread, toppings vary.
• Arancini: Fried rice balls; usually include wheat flour and/or wheat breadcrumbs and other high FODMAP ingredients.
• Caponata: Onions, possibly garlic, and other high FODMAP ingredients.
• Fried Calamari: It is typically coated with wheat flour, and dipping sauces can contain garlic and/or onion.
• Fritto Misto: This classic fried dish is comprised of mixed vegetables and proteins, dipped in a wheat-flour batter.
• Mozzarella Sticks: Breadcrumbs or other coating is typically wheat-based. Dipping sauces can contain garlic and/or onion.
• Mozzarella in Carrozza: This is basically a fried cheese sandwich made with wheat bread and breadcrumbs.
• Garlic Bread or Breadsticks: Fructans in the garlic and the wheat.
• Minestrone: This classic soup typically contains garlic, onion and beans.
• Pasta e Fagioli: Often called pasta fasul(e) or pasta fazool, containing garlic, onion, beans and wheat pasta.
• Focaccia: Fructans in the wheat.
• Panzanella: A salad made with wheat bread.
• Pizza: Any kind!
• Mussels: Many mussel dishes have a good dose of garlic and are often served with wheat-flour bread to sop up the juices.
• Risotto: This classic rice dish uses stock as the liquid, which almost always contains onions and sometimes garlic.
• Meatballs: They are usually made with wheat-based breadcrumbs and possibly garlic and onions. If served with red sauce, onions and garlic can also be included in that component. They are often served with wheat-based pasta.
• Baked Clams: We love the garlicky wheat-based breadcrumbs packed onto these fresh clams, and now we can enjoy them with FODZYME!
• Stuffed Artichokes: Wheat (breadcrumbs), garlic.
• Shrimp Scampi: Garlic and more garlic. Often served with wheat pasta, too.
• Vodka Sauce: Onions, garlic, and cream, typically served with wheat pasta.
• Lasagna: It contains layers upon layers of FODMAPs: high-lactose ricotta (along with other cheeses), wheat-flour pasta, a red sauce typically made with garlic and onion, and maybe garlic-laden sausage, too.
• Ravioli: Wheat-based pasta; sauces can be high in FODMAP, as can fillings.
• Bolognese Sauce: Made with onions, and sometimes garlic and/or stock, served with wheat-based pasta.
• Pesto: Made with garlic.
• Puttanesca: Contains garlic.
• Linguine with Clams: Wheat-based pasta and garlic.
• Fra Diavolo: Typically made with onion and garlic; served with wheat-based pasta and garlic.
• Spaghetti Aglio e olio: This is wheat-based spaghetti, garlic and olive oil.
• Chicken, Veal or Eggplant Parmesan: Wheat flour coating; red sauce made with garlic and/or onion.
• Manicotti: Wheat-based pasta, high lactose ricotta, and red sauce that will most likely contain garlic and/or onion.
• Baked Ziti: This wheat-based pasta sometimes includes high-lactose ricotta, and it is served with a red sauce that will most likely contain garlic and/or onion.
• Stuffed Shells: Wheat-based pasta, high-lactose ricotta, and red sauce that will most likely contain garlic and/or onion.
• Gelato: Gelato is a frozen dessert similar to ice cream. It is rich in lactose and some flavors, such as pistachio, peach, and apricot, are also high in FODMAP.
• Affogato: Espresso with lactose-rich vanilla gelato or ice cream.
• Panna Cotta: Usually made with whole milk and/or cream.
• Cannoli: Wheat flour in the shells; lactose in the ricotta filling. Possible pistachios, too (fructans and GOS).
• Tiramisu: Wheat flour based ladyfingers; also rich with lactose.
• Semifreddo: This is a frozen dessert, rich with lactose. And depending on flavors, could be even higher FODMAP, such as pistachio flavor.
• Biscotti: Made with wheat flour. Flavors will vary widely.
• Cheesecake: Many Italian-American restaurants offer cheesecake. Crust will contain wheat, and filling will be rich in lactose. An Italian version will contain high lactose ricotta.
• Pizzelle: Wheat based cookies.
• Zeppole: Wheat based deep-fried puffs.
• Tartufo: Lactose-rich ice cream.
• Italian Cookies: Too many kinds to mention, from rainbow to cuccidati, anise sugar cookies to fig-filled – these are all based on wheat-flour.

FODMAP Stacking at Italian Restaurants

We have presented the ideal approaches here, but we know it can be difficult to figure everything out in the moment, even if you plan ahead. Then, there is FODMAP stacking to calculate, which occurs when we eat too many low FODMAP ingredients at once, creating a high FODMAP situation. For instance, you might choose a dish with a low FODMAP amount of wheat pasta, but by the time you take into account the red sauce made with garlic and onion, and the sausages that also contain garlic, the dish has become high FODMAP. Calculating stacking, especially on the fly in a restaurant, can be extremely challenging.

You are sitting there at the restaurant, friends are ordering, and it’s your turn—what do you do? We keep FODZYME in our bag or pocket just for this kind of situation. Being able to choose almost any dish and know that we will have the digestive help we need not only brings peace of mind—it allows us to have the food we want.

Let’s Make A Reservation!

We hope you are uplifted by this information! Now you know how you can enjoy your favorites at your little local hole-in-the-wall, or Italian-American chain restaurant. With FODZYME, we look forward to eating out again. FODZYME comes in jars as well as individual packets. We keep the packets in our bag or pocket and dine out without worry. There are pizza, lasagna, and spaghetti and meatballs in your future!

Read All of Our Dining Out Guides

Whether it is Italian tonight, or Mexican tomorrow, we have the low FODMAP dining out guides you need:

• Dining Out With IBS: Italian 
• Dining Out With IBS: Mexican & Tex-Mex 
• Dining Out With IBS: Chinese 
• Dining Out With IBS: Indian 
• Dining Out With IBS: Greek  
• Dining Out With IBS: Thai  
• All About Sushi & The Low FODMAP Diet