In 2008, shortly after Shallan Knowles was diagnosed with celiac disease, the co-owner of Out There Monthly magazine created the Gluten Free Spokane website to review restaurants that offered gluten-free dishes.

Back then, Knowles says, few establishments offered gluten-free alternatives, and fewer knew how to do so consistently.

Fast forward five years, and that dynamic has changed, says Knowles, 36. She had tried to keep a list of restaurants that include gluten-free options on their menus, but recently stopped.

"I can't keep track of it," she says. "The industry is growing so fast I can't keep up, which is a good thing."

Knowles estimates that fewer than half of Spokane-area restaurants offer gluten-free options, but they are becoming more common—and arguably more savory. National restaurants with a presence in Spokane—Red Robin Gourmet Burgers and P.F. Chang's China Bistro, among others—were among the first to add such options here, but a number of locally owned establishments are following suit, she says.

Gluten is a protein found in many grains, and Knowles says people seek gluten-free foods typically due to celiac disease, gluten intolerance, or wheat allergy. People with those conditions typically become nauseous, experience stomach pain, or develop diarrhea after eating food that contains gluten.

"It's hard for restaurants because there are so many variables," Knowles says

Rusty Moose Bar & Grill, located at 9105 U.S. 2 on the West Plains, revamped its menu late last year and added a gluten-free section at the request of a number of customers, says Aaron DeLis, who owns the eatery with his father, Frank.

DeLis says they came up with 26 nongluten menu items, and about a third of Rusty Moose's menu now is gluten free.

"Restaurants go through fads that come and go," DeLis says. "Gluten free is definitely something that will stick around. It's not a fad diet. This is more of a lifestyle."

About 10 months into offering gluten-free entrees, Rusty Moose currently is selling about 250 gluten-free meals a month, which DeLis says is roughly 10 percent of its total.

He says he expects that percentage of the total meals served to grow slowly and steadily, adding, "It's not going to take over the menu."

White Box Pies LLC, located at 28 E. Sharp near Gonzaga University, was an early adopter of the gluten-free movement, offering its first such options seven years ago, says Shirley Glodt, who owns the company with her husband, John.

Now, 80 percent of the company's items—it serves lunch in addition to selling its baked goods—either are gluten free or can be made gluten free.

Most of the baked goods and the buns used for sandwiches are made with recipes developed in-house and honed through the years through trial and error, Goldt says. It takes a long time to find the right balance when developing a new product that doesn't include flour or other grain-based ingredients. The substitute products often are more coarse and can have a more distinct taste than conventional baking flour.

"You have to be careful with what you do with them," Glodt says. "You don't want a chocolate cake that tastes like garbanzo beans."

In general, she says, gluten-free items are drier than traditional baked goods and don't keep quite as long. Also, White Box Pies doesn't charge extra for the gluten-free alternatives, but the profit margins are a little more narrow.

Many customers, however, come to the restaurant and bakery because of its gluten-free options.

"People come in, and they have tears in their eyes because they can't find this kind of stuff," Glodt says.

Pizza Rita Inc., a Spokane-based takeout- and delivery-pizza operation with four locations here, began offering a medium, thin-crust, gluten-free pizza about a year and a half ago at three of its locations, owner Brian Dickmann says.

He says he looked into gluten-free options a couple of years earlier but felt the quality of crusts was subpar.

"When I tried it three years ago, I thought, 'I don't care what people want. I can't serve this,'" Dickmann says.

Now, the gluten-free crusts that Pizza Rita uses, which are made by Spokane-based pizza crust maker Rizzuto Foods Inc., are "on par" in quality with a traditional thin-crust pizza, he says.

Only 2 percent of Pizza Rita's total orders involve gluten-free crusts, Dickmann says, and he doesn't expect that share to change dramatically.

Regardless, he says, it's important to make the option available so those who can't eat flour and other grains "get to eat pizza with everybody else."

Knowles says that, while restaurants want the food to taste like the goods that contain flour and other grains, having a product that's safe is most important to those who have celiac disease, are gluten intolerant, or have a wheat allergy.

"We're more sensitive about it being safe than having the best bun, for example," Knowles says. "Having a bun puts you miles ahead of most."

Restaurateurs who offer gluten-free dishes say the biggest challenge is protecting against cross-contamination. Such measures involve thorough hand washing and using separate food-preparation surfaces, utensils, and ingredient containers in making gluten-free dishes.

"It's a pretty simple procedure," Dickmann says. "You just have to follow it every time."

DeLis says the decision to offer gluten-free options requires extensive training of staff to understand the procedures and the consequences—that someone could get sick—if those procedures aren't followed.

Knowles says that for full-service restaurants with wait staff, it's just as important for servers to understand the rules as it is for cooks.

"The server is the translator, and that translator needs to be well versed in the language," she says.

DeLis says he expects more restaurants to develop gluten-free items, but he says in his experience, they should complement established offerings and not stray far from core strengths.

"In the restaurant business, net profits aren't easy to come by," he says. "Every restaurant should take a step back and take a look at it and see if you can get it done."