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Death By Restaurant

Fair warning: This is one of those Don’t Shoot the Messenger health tips. Believe me, I’ve eaten in a lot of restaurants over the years, but now, having read a series of articles recently published in medical journals, I’ll be doing more grocery shopping and home cooking.

We all get a tremendous proportion of our calories from restaurants. From the Starbucks chai latte and scone in the morning, a Jimmy John’s sandwich for lunch, and an SDR (industry speak for “sit-down restaurant”) meal in the evening, little wonder the shelves in our kitchen cupboards look dusty and neglected. And grocery stores, except for the ever-expanding prepared food sections (basically offering the same poor-quality food as low-priced restaurants), just don’t seem as crowded as they once were.

Unhealthful eating is killing us
Two thirds of us will die from cardiovascular-related diseases–heart disease, stroke, diabetes, high blood pressure–and we increase our susceptibility by eating too much food and too much salt. Being inactive and smoking ramps up the risk further, but you knew that.

Overall, I think it’s a good thing that (kicking and screaming in protest) restaurant chains are being required to post calorie counts and nutritional breakdowns of menu items. I do agree with the industry on one point, though. It’s unfair that grocery chains and their prepared foods are exempt. If you’re inclined to eat in chain restaurants like Olive Garden and Hooter’s (in industry-speak, Hooter’s is called a breastaurant), you’ll be able to whip out your calculator and total up the calories in your restaurant mega-meal. Doing so may induce mild nausea because, according to several recent studies published in JAMA Internal Medicine, a mega-meal is exactly what you get.

First, some basics of human physiology:

Calories count  Give or take a couple hundred calories in either direction, an average person doing an average amount of physical activity needs about 2,000 calories a day. Unfortunately, many of us after age 35 or so gain weight because metabolisms change with age, the mantra of approaching middle age being “I haven’t changed my eating at all and now I’m gaining weight!”

If you’re a couch potato you require even fewer than 2,000 calories, and if you’re inclined to exercise regularly and vigorously you’re allowed a few more. Readers unhappy with their weight need to trim about 300 calories daily to lose a pound a week. The formula we learned in medical school was singularly ungenerous. If your activity level is average, simply add a zero to where you’d like your ideal body weight to be. Want to settle at 140 pounds? Then limit yourself to 1,400 calories a day. (Here’s a handy app called Lose It! that lets you track those calories.) As you’ll soon see, restaurant eating will wreck your well-laid plans.

And then there’s salt  Sodium, which we eat primarily as salt, is very much related to high blood pressure. You do need some. It’s one of your electrolytes, along with potassium, magnesium, and others, and it’s required to sustain the electrical activity in your body. After studying this issue for years, doctors have pretty much concluded that about 1,500 mg of sodium a day, just two-thirds of a teaspoon, is a healthy amount. Beyond that, sodium can be dangerous and it’s a fact that we’re all currently eating more than twice our allotment, averaging 3,800 mg a day. (Here’s a helpful primer on salt if you’d like to read more.)

Interestingly, just 11% of this 3,800 mg comes from your salt shaker and 12% occurs naturally in foods. The remaining 77% is provided by the food industry, which obsessively adds salt (and to a lesser extent sodium-containing additives like sodium bicarbonate and monosodium glutamate) to everything during the processing and preparation of packaged and restaurant foods. Many foods offer the double whammy of salt and high fructose corn syrup.

The risks of eating out
Keeping in mind that excess calories and salt are the villains most likely responsible for a premature demise, here are the conclusions of three articles on the pleasures of eating out.

Soaring calorie counts at national chain restaurants  Despite the calories posted in the national SDR (remember, the sit-downs) chains, the calorie content of a entire single meal can be astonishing. The main course might be listed at, say, 1,200 calories (Olive Garden’s Fettuccine Alfredo), but the add-ons–salad dressing, appetizer, bread basket with butter, side dishes, beverage, and dessert–push most meals into sky’s-the-limit-land, likely far in excess of your entire day’s allowance of 2,000 calories.  By the way, I’ve noticed many diners at these restaurants order a diet drink as their beverage, as if that magically makes their feast less caloric.

No better at the non-chains  Non-chain restaurants (which number in the thousands in  urban areas like Chicago and New York) fare no better when it comes to either calories or salt. Since these restaurants, not being national chains, aren’t required to post calorie counts, researchers had to find a method to determine the calorie content of, for example, your plate of tandoori chicken, the large-as-your-head burrito, or that heaping oily mound of pad Thai. To do this, their team ordered take-out meals and returned to their lab to quick-freeze and ship them Fed Ex to an analytical lab, where the meal would be blended into a unappetizing slurry, freeze dried again, and ground into a dry powder. This powder was then combusted and the heat produced quantified. This method, called bomb calorimetry, showed, for example that a half rack of barbecue ribs is 2,445 calories (without your wedge of iceberg lettuce drenched in Thousand Island dressing or your “loaded” baked potato) and General Gau’s chicken is 1,962 calories. (You do remember that 2,000 calories is your limit for a single day.)

And the salt! For this article, researchers wanted to see if any manufacturer of processed foods, or any restaurant chain, was actually responding to the government’s urging to voluntarily reduce the salt content of their foods. Looking over previous records, they reviewed the sodium content of foods from 2005 to 2011. Nada. “Urging” didn’t work. In the prepared-food group, a tiny handful of products had an actually reduced sodium content by as much as 30% (certain soups, canned tuna), but a far greater number of manufacturers responded to the urging by increasing sodium content by 30%. Restaurant chains, despite the same urgings, increased their sodium content across the board by 2.6%.

Keeping in mind that the current recommendation is for a total of 1,500 mg of sodium daily, you might be dismayed to learn that a serving of Caesar salad dressing contains 1,079 mg of sodium, an order of chicken tenders 736 mg, and that the bacon you ordered with your cheese omelet this morning contained 1,803 mg.

What to do?
Well, this is definitely tough. Everyone is eating so many meals in restaurants–both fast-food joints and SDRs–and both types of restaurants are unhealthy. Moreover, when we grocery shop, we’re buying 30% more prepared food than food-food. Remember food-food? You have to cook it rather than microwave it.

How bad are these prepared foods, sodium-wise? Keeping in mind your 1,500-mg daily limit, there’s the frozen salt lick (Hungry Man Meatloaf) with 1,600 mg and the more modest Lean Cuisine Macaroni and Cheese with 600 mg. Neither is real food. And remember Whole Foods and Mariano’s aren’t required to report anything about the salt, fat, or calorie content of their tasty looking prepared foods.

For what it’s worth, here are the steps I’ve taken to deal with this troubling news:

1.  I avoid fast-food restaurants. I can’t refuse all of them, because as a Chicagoan every eight weeks my Al’s Italian Beef sandwich deficiency starts acting up. But that is my single fast-food vice (hold the fries and soft drink).

2.  My wife and I limit ourselves to two SDRs a week. When my entree arrives, I divide it immediately in half, always taking the second half home for next day’s lunch. You’ve probably noted that restaurant portions are bizarrely gargantuan. I recently ate in an excellent French restaurant and was served two portions of the entrée I’d ordered. The waiter said it was late in the evening, the item was likely to be unsold, and the chef didn’t want to waste it. I thought, “Does the chef think my foot has turned into a garbage can pedal?”

3.  We each prepare our own meals at home since my wife is practically a vegan and I am not. Neither of us ever eats much in the way prepared or prepackaged food. Most is from scratch, but I’m definitely oriented toward speed rather than haute cuisine. I’ve mastered baked fish, veg, brown rice, and salad in 15 minutes flat.

I recognize that last bit of advice isn’t practical for everyone, especially families. A good first step to making your own meals is right in your in-box. With each health tip there’s a recipe listed in the right-hand column, the vast majority chosen because they’re easy and healthful.

The World’s Healthiest Foods website has 100 quick and easy recipes that make it a cinch to prep and eat real food. And here’s a Mark Bittman roast chicken parts recipe that a child could make, with supervision. (Speaking of children, if you have any around the house get them involved too.) Click through to the Crisp Pan-Fried Potatoes recipe on that same page. And keep on clicking. There are hundreds of thousands of recipes online and, trust me, most of the best ones aren’t related to the Food Network.

This food issue…I know you must be sick of hearing me hocking about this (hocking: a Yiddish word for nagging so intense it’s like drilling a hole in your head using words alone).

For clarity, just read the opening few sentences from this Medscape article and let them sink in.

And be well,
David Edelberg, MD


Leave a Comment

  1. hatold lebovic says:

    does this salt article include Himalayan salt

  2. Dr E says:

    Hi Harold
    Salt is salt. Same risks exactly

  3. Patrice says:

    Thank you for the article Dr. E. I am very concerned about the average American diet. I just visited the World’s Healthiest Food website for quick and healthy recipes. They looked good but were all cooked. I had just watched the documentary Food Matters where it is stressed to try to eat a minimum 51% of our daily intake as raw uncooked plant based foods. Your opinion on a plant based “uncooked” diet?

  4. Marc Temkin says:

    I think the SDR problem could be solved if customers got used to the fact that the SDR still needs to make the same profit margin regardless of the volume of the food served. Unfortunately we are hooked on large amounts of food to validate the perception of a good deal. We don’t make the connection that labor, insurance, advertising is a large component of the cost that won’t go away regardless of the portion size. If we can accept a downsizing of the portions without an equal lowering of the cost then I would think the SDRs, etc. would have an easy route towards only serving reasonable portions. Note: I don’t work for restaurants or have any ownership in them.

  5. This website was… how do I say it? Relevant!!

    Finally I’ve found something that helped me. Cheers!

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