Gluten

My wife is gluten-intolerant, and hasn't eaten wheat in three years. And so, at first thought, my plan for an Italian vacation bordered on insanity. While I'm a huge fan of Italian food, for Jen a week and a half of pasta, pizza and bread - the holy trinity of the Italian table - sounded like a nightmare. As far as she was concerned, 10 days in Italy meant 10 days condemned to salads dressed with oil and vinegar. Even dessert wouldn't be safe: gelato and tiramisù typically contain wheat.

To the approximately 1 percent of the world's population with celiac disease, gluten, a protein found in wheat and other grains that gives bread and pizza crust and other Italian staples their satisfying spring, is a toxin. Doctors have also recently recognized that many more may be sensitive to gluten, and simply feel better when they cut wheat and other glutinous grains out of their diets. (Jen is in the latter camp.) You'd think Italy would be hell for the gluten-intolerant.

To our surprise, we found it to be closer to heaven. Wheat's prevalence in Italian cuisine has made Italians especially conscious of celiac disease and Italy one of Europe's best destinations for food-conscious travelers avoiding gluten. Celiac disease was recognized as a serious condition there sooner than in the United States or elsewhere in Europe. The Associazione Italiana Celiachia, or AiC, Italy's celiac association, was founded in 1979; today many of the world's leading experts on celiac disease are Italian.

Awareness of the problem has penetrated everywhere from the menus of top restaurants and hotels to the most basic country guesthouses and neighborhood gelato stands. More than 150,000 people have been diagnosed with celiac disease in Italy, though the AiC estimates that the true numbers may top a half-million.

Still, when we left Berlin, where we live, for an all-day train ride to the northern Italian port of Genoa, I was nervous. Would there be anything for Jen to eat? Or would we be getting second-rate substitutions and missing out on the highlights? Not long after dropping our bags at the hotel, we headed to Exultate, a punk-themed pizzeria on a lively square deep in the labyrinthine city center that I first came across on a visit to Genoa a few years ago.

For an extra 1.50 euros, Exultate will happily make any of the pizzas on its two-page menu with a gluten-free crust. (The only thing off-limits was the long and varied beer list, a rarity for Italy.) Piled high with Italian sausage and mozzarella, it was Jen's first pizza in years, and it was good.

The next night, after a day exploring Genoa's steep, winding streets, we headed to tiny Trattoria Gianna with friends. Its specialty is seafood, but I was desperate to share a genuine pesto genovese, which I had been raving about for years, with Jen and two friends. The owner, Immacolata di Nocci, was happy to accommodate us, offering gluten-free fusilli rather than the more traditional hand-rolled trofie (a short, twisty Genoese specialty). 'If you can't eat pasta, we need to find something else for you,' Ms. di Nocci said.

The only catch, Ms. di Nocci added in rapid Italian, was that the restaurant was too busy and her kitchen too small to make just one serving gluten-free. And so, soon all four of us were digging into a family style platter of the fusilli in a creamy, emerald-green sauce made from young basil plucked from the hills outside the city. There were no complaints.

Underlying that sort of flexibility is an emotional resonance you may not find elsewhere. We found that Italians responded to the magic words 'senza glutine' not with exasperation or annoyance but with genuine concern, verging on pity. In Italy, not being able to stomach wheat is more than an inconvenience or fad diet.

'It's a tragedy for Italians,' said Susanna Neuhold, the AiC's manager of food programs. 'Food in Italy is the center of social life and relationships with people. For someone who can't go out with their friends or to a work meeting at a restaurant, it's a very big problem, psychologically and socially.'

That resonance has translated to an institutional empathy that might shock Americans. For example, the first stop for Italians avoiding gluten (or travelers hoping to cook for themselves) isn't necessarily the supermarket, but the local pharmacy. In central Turin, I asked a bespectacled pharmacist what packages of corn pasta, rice-flour cookies and specially formulated focaccia were doing hanging next to his dark wood counter. It turns out people with celiac disease are given a monthly allowance of about 100 euros (about $135) from Italy's national health system to buy specially formulated gluten-free products. 'In Italy, this food is medicine,' the pharmacist said.

There have been similar strides in the world of dining out. Since 2000, the AiC has offered training and certification for restaurants, bars and hotels. Its network now numbers more than 3,500 establishments all over Italy, inspected each year by volunteers. 'Ten years ago, the problem was where to eat. Now there are more choices,' Ms. Neuhold said. 'This helps improve the quality of gluten-free meals. Italian customers are very demanding - also celiacs.'

In Turin, center of Italy's Slow Food movement, the tourist information office on the Piazza Castello offered a seven-page list of restaurants with gluten-free options. We started just a few steps away at the local outpost of Grom, a chain of artisanal gelaterias based in Piedmont.

When Jen got to the front of the long line, she hesitantly mentioned she'd like a cup, not a cone, and asked if the apricot gelato was senza glutine. The busy server's eyebrows shot up. In what was clearly a well-rehearsed ritual, she went to the back and washed her hands, then lifted the steel canister of apricot gelato aside to reveal another - uncontaminated by cone crumbs - underneath. A spoon, carefully folded in a clean napkin, was procured from a sealed tub in the back of the shop.

Grom (which has two branches in New York, plus a stand in Central Park open in the summer) was a best-case scenario, but we found that even at small gelaterias and restaurants not on the AiC's list, the servers knew their stuff. Ingredient lists were always close at hand, and sometimes prominently displayed.

Indeed, Italy's obsession with quality ingredients works to the gluten-free traveler's advantage. At L'Archivolto, a restaurant in Ovada specializing in Piedmontese cuisine that was the surprise standout of our trip, a server, Paola Padoan, was almost offended when I asked in badly broken Italian how she knew so much of the menu was gluten-free.

'What do you mean, how do I know?' she said. 'There are lots of people with food allergies. It's important that we know what's in the food. We make everything - from the meringues to the pasta - in our kitchen, so of course I know what every single ingredient is.'

As Jen was sadly eyeing L'Archivolto's tajarin, traditional Piedmontese egg noodles with salsiccia in a buttery raguù, Ms. Padoan asked if gluten-free penne would be an acceptable substitute. It was.

Thanks to intense competition (and the aforementioned state subsidies), most gluten-free alternatives are good enough for restaurants to put out next to their wheat mainstays. M-Bun, a 'slow fast food' burger chain based in Turin, even serves its grass-fed beef patties up on gluten-free buns (and from separate trays, to avoid contamination) on request.

Some of the most rewarding meals we had, however, took advantage of the many regional specialties that lend themselves naturally to a wheat-free diet, particularly in northern Italy. 'What most Americans don't know is that pizza and pasta are a big part of the culture in Italy, but they're not the whole thing,' said Shauna Ahern, a Washington State-based gluten-free cookbook author and blogger who teaches cooking classes in Italy several times each year.

Polenta, for example, is as big as pasta in Friuli-Venezia Giulia, northeast of Venice. In Turin, the capital of Piedmont, we feasted on farinata, a thick baked crepe made of chickpea flour. (Tuscans make something similar and call it cecina; just across the border in France it's known as socca.) Nearby is Vercelli, a sun-baked, slightly run-down town set amid seemingly endless acres of bright-green rice paddies and Italy's risotto capital. Menus there include many takes on the satisfying, gluten-free dish - like local specialty panissa, a hearty mix of risotto rice, sausage and beans; and borbone, a delicious mixture of risotto, eggplant and smoked mozzarella.

As the sun set, we drove through steep, vine-covered valleys to Agriturismo Latimida, a working farm a few miles from the spa town of Acqui Terme that I found on the AiC website. The owner has offered gluten-free menus for 13 years, ever since her son was diagnosed with celiac at the age of 4.

As children chased geese in the courtyard outside, we sat down under an arched-brick ceiling to a five-course meal. When the waiter (the owner's son, in sneakers and a T-shirt) brought out fresh rolls, still warm from the oven, Jen looked at them dubiously. I tried one and honestly wasn't sure if they had wheat or not. 'Senza glutine?' I asked.

'Si, certo,' he said with a shrug, retreating to the kitchen. For the next two hours, we worked our way through five courses, including gluten-free noodles with zucchini from the garden outside, sweet pickled onions that melted in our mouths, and a vivid purple risotto mirtilli, made with wild blueberries.

After each course, we looked at each other with a mixture of amazement and relief. 'It's the nonvigilance,' Jen said. 'Knowing you can eat this, 100 percent, it's a really good feeling.'

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