Eating out can be a headache these days for people who are trying to stick to a healthy diet. Meals are intentionally loaded with sugar, fat, and salt to make them more palatable, and while most chains are making efforts at cutting down on fat, a new study published in the Archives of Internal Medicine finds that they're doing a pretty poor job of reducing the salt, exposing a large percentage of Americans to more than an entire day's recommended sodium allotment of 2,300 milligrams (mg) in a single entrée. Concerns about America's over-salted diet have prompted the federal government to consider regulating the use of salt in packaged and restaurant food.
"In all fairness to these places, if you conducted a similar study at sit-down restaurants, you'd get similar results," says Joan Salge Blake, MS, RD, spokesperson for the American Dietetic Association and professor of nutrition at Boston University. "This is why the industry really needs to step in to help us. Between, calories, fat, sugar and sodium, we have the consumer looking for so many things when they go eating out, it's easy to get confused about what the best food choices are." Fortunately, there are ways to navigate the drive-through and still have a relatively healthy meal.
THE DETAILS: Representatives from the New York City Department of Health asked customers of major fast-food chain restaurants to give them their meal receipts, and the researchers analyzed the sodium content of each entrée on that receipt (they didn't look at side dishes like french fries and small salads). In total, they collected 6,580 receipts from a variety of fast-food restaurants, including burger joints, pizzerias, sandwich shops, fried-chicken chains, and Mexican-food chains. On the whole, the findings with regard to salt content were pretty grim. The average entrée contained 1,751 mg of sodium, and 20 percent of the meals contained greater than 2,300 mg. The highest levels were found in Popeye's fried-chicken restaurant entrées, at an average of 2,497 mg of sodium, with Domino's Pizza coming in a close second, at 2,465 mg per entrée. The lowest levels were found at McDonald's, with an average of 1,477 mg per entrée.
WHAT IT MEANS: Even at the low end of the sodium spectrum, eating a single fast-food meal can put some people in the danger zone for daily sodium intake. Imagine what that means for people who eat fast-food fare multiple times per weekéor per day. While 2,300 mg of sodium per day is the maximum safe level recommended for the average healthy adult, the authors write, the U.S. Centers for Disease Control and Prevention advises that several demographic groups, including African Americans, middle-aged and older adults, and people with hypertension, should limit their consumption to 1,500 mg per day. Together, those groups make up 69 percent of the adult population in this country.
Avoiding fast-food restaurants is the best way to avoid their heavily salted food, but that's not always possible. Here are some things to keep in mind when ordering:
1. At burger chains, pay attention to hidden sources of salt, which are usually in toppings and condiments like bacon, pickles, processed cheeses, and ketchup. Flavor your burgers with extra vegetables, says Blake, such as lettuce and tomatoes. If you're ordering a salad, she says, light dressings are lower in fat and calories but not necessarily lower in sodium, so use half of the dressing packet. And decline the offer of croutons or other toppings that add even more sodium.
2. In sandwich shops and delis, the most prominent source of sodium is the deli meats, which helps explain why Subway, despite its focus on healthier fare, still averaged 1,883 mg of sodium per entrée. Ask if low-sodium meats are available, Blake advises. If not, cut the meat in half. "If they're piling on turkey, tell them to give you half the amount they're piling on," she says. "In some cases, that's three to four ounces—a substantial amount." Grab extra vegetables from the salad bar and pile those onto your sandwhich. Extra cucumbers, carrots, and sprouts can make your sandwich more filling, less salty, and healthier in general. And ask for whole grain bread while you're ordering. "Any meal that has whole grains and a lot of fresh vegetables, right out of the gate, will be naturally low in sodium," Blake says.
3. Fried-chicken restaurants can be a salt minefield. Fatty and artery-clogging, fried-chicken meals are among the saltiest out there, and opting for grilled chicken isn't necessarily better for your sodium intake. "In the calorie department, grilled chicken gets an A++ over battered and fried. But you just don't know about the sodium, because you don't know how it's been seasoned," Blake says. For instance, according to KFC's nutrition information, grilled drumsticks have about two-thirds the sodium of their Original Recipe fried drumsticks, but at McDonald's, the grilled chicken sandwiches are essentially equal to their fried counterparts when it comes to sodium. Wherever you are, go for grilled chicken, Blake says, but cut the portion size in half when you get it, and finish out your meal with a salad or a baked potato.
4. When ordering pizza be as veggie-focused as possible, as the toppings are often the only thing you can control. "When you go to a pizzeria, the crust is the crust, the sauce is the sauce, and the cheese is the cheese," she says. But you can keep from adding more sodium to your pizzas by topping it with vegetables, say, green peppers, mushrooms, and tomatoes, rather than salty processed meats like pepperoni and sausage. "If you just put vegetables on top, you've lowered the sodium content significantly."