The survivor's guide to restaurant food
How to eat out without wrecking yourself or your planet.

By Masha Gutkin

ONE RECENT RAINY evening, I asked the server at El Nuevo Frutilandia, a Cuban-Puerto Rican joint, to point out the healthiest dish on the menu. My friendly server looked at me askance and dubiously indicated the short list of vegetarian options. Chile relleno – the centerpiece of which is deep-fried cheese – was prominently featured. The chile relleno was quite good, although I wasn't sure it qualified as healthy by any standards. Even the Atkins gurus would likely reject it for its side of glycemic white rice.

Not too long after dining at Frutilandia, I found myself at Il Fornaio, an Italian restaurant, in Beverly Hills. Again I asked what the healthiest item on the menu was. Not surprisingly, as West L.A. may represent the most physique-obsessed plot of land in the world, my server didn't bat an eye. He recommended the grilled chicken breast – cooked with no extra fat.

Is either one of these contradictory recommendations actually healthy? What did I mean by healthy, and what did they mean by healthy? How does one make healthy choices when eating out?

Americans eat out a lot. Nationwide, 24 percent of meals are eaten in restaurants – that's nearly one in four meals. California has a hefty share of restaurant sales in the United States (better than $44 billion in 2003 and growing, more than any other state, and more than New York, New Jersey, and Pennsylvania combined). Americans spend an increasing amount of their "food dollars" on eating out – 41 percent of such dollars in 2000 compared to 19 percent in 1955. The National Restaurant Association predicts that in 2004, with 12 million employees, the restaurant industry will be the second largest national employer after the government.

It's apt that the restaurant business should come up in the same sentence as the government. Any industry as large as this is bound to be quite influential. And this being the business of food – necessary for our very existence (while also an element of pleasure and even indulgence, and culturally entwined) – no one is unaffected. Most of us eat out, and most of us either have been or know someone who is or was a cook, a waiter, a café worker, et cetera. The domino effect of the industry – where and how food (animal, vegetable, and mineral) is grown and processed, how it reaches us, the power of the component industries to determine environmental, animal health, and labor regulations, the impacts on the environment and, inextricably, on our physical health – are less visible.

It's only taken a generation or so for the way we eat to drastically change and for us to get thoroughly distanced from the production of our own food. Occasionally, and it seems ever more frequently, a frightening crisis will lift the veil and snap our attention to the (relatively) new reality. Right now it's the mad-cow debacle, but just a couple of months ago it was the hepatitis A outbreak stemming from a Chi-Chi's restaurant in Beaver County, Penn., and then there are the not infrequent E. coli eruptions at eating establishments around the country. These are serious health issues. On the Safe Tables Our Priority Web site, I read an account by a mother whose six-year-old son died of E. coli poisoning from eating a contaminated hamburger: "We wanted to donate Alex's organs.... We were told we couldn't. The toxins produced by E. coli had destroyed all his internal organs. They had liquefied entire portions of his brain."

Yet there seems to be a disconnect between the mainstream conception of healthy eating and a recognition of the industry practices that cause E. coli and similar public health crises. Information about how to eat out in a way that's healthy for you is inevitably focused on caloric intake. And certainly, that's not a topic to be dismissed lightly, as obesity reaches an all-time high and the perils of unhealthy diets are illustrated in epidemics of, to mention just a few, type 2 diabetes, heart disease, high blood pressure, and even gout (once an affliction of the wealthy).

Eating out is, in general, significantly less healthy (calorically and even qualitatively speaking) than preparing food at home. According to Restaurant Confidential, a book put together by the Center for Science in the Public Interest , "USDA surveys find that food eaten outside the home is nutritionally worse than home-cooked food in practically every way.... Restaurant meals are, on average, 20 percent fattier than home cooking, and they're about 15 percent higher in saturated fat.... They're also higher in sodium and cholesterol and much lower in calcium, dietary fiber, and iron." I'm not sure how much of a surprise the gist of this is. I hazard that most people realize they're eating a healthier meal when they cook for themselves than when they eat out. The extent of the calorie-richness of restaurant food may be a little more jarring. The CSPI created a sensation with its study on restaurant food 10 years ago, which revealed the astronomical calorie content of the average restaurant meal. For example, in a typical Chinese restaurant "a single entrée, kung pao chicken with rice, contained 1,600 calories, 76 grams of fat, and 2,600 milligrams of sodium," i.e., more fat and salt than you need in a day and more than three-fourths of the average person's recommended daily allotment of 2,000 calories.

Part of the problem is portion size. At restaurants not of the California-cuisine persuasion, servings are usually gargantuan and often "bundled" with a drink and an appetizer to make you, the diner, feel like you're getting more bang for your buck. Although most of us eat out often, our mentality hasn't caught up with the reality that it's no longer an occasional indulgence. CSPI's report, and the subsequent increasing scrutiny of the restaurant industry, resulted in many chains restaurants offering items that are designated as "healthy" or "fat free," for which they are required to provide nutritional information on request. Many chains now provide the nutritional facts of their menu items.

Nevertheless, eating out involves relinquishing much of the already limited control you have over the nature of what you're eating. You can mitigate this by informing yourself. If you like to eat Indian food but don't really know what's in it because you never cook it, you can read a cookbook or refer to a number of other print resources; the aforementioned Restaurant Confidential as well as Dining Lean, by Joanne V. Lichten, have chapters on types of restaurants and the likely content of popular dishes. For example, from the chapter on Indian restaurants in Dining Lean, you may discover that poori and paratha, types of Indian bread, are fried, while chapati, naan, and tandoori roti are not. In Restaurant Confidential's chapter on steak houses, you may be surprised to read that porterhouse steak has four times the saturated fat of sirloin steak and well over twice the calories. Learn what's really in béarnaise sauce before you order it, and if you don't know what a term on the menu means, ask!

Then there's alcohol, which doesn't yet have a nutritional facts label (no doubt coming soon). We all know we shouldn't drink too much, but did you know that eight ounces (that's one measuring cup) of red wine has about 200 calories or that the same amount of a martini has 480 calories? Speaking of ounces: even if you have the nutritional facts in front of you, can you visualize three ounces of fish? I couldn't until I had to weigh portion sizes on a scale at a restaurant. Dining Lean uses a deck of cards and life-size illustrations to help you picture portion size. The Mayo Clinic Web site also has helpful everyday-object comparisons to illustrate a serving size – one and a half ounces of cheese is the size of a pair of dice or dominoes. Odd how gambling emerges as a theme here.

Although I consider calorie counting a fate worse than death, it's enlightening to at least have a concept of calorie content, especially as impressions can often be deceptive, even to the well-trained palate. A survey conducted by New York University and the CSPI in 1996 found that dietitians asked to gauge the calorie and fat content of restaurant dishes such as lasagna and a tuna salad sandwich seriously underestimated the actual numbers – by 37 percent on calories, and 49 percent on fat. There are also books and Web sites listing the calorie counts for a huge range of foods. They'll be especially helpful if you can picture the serving sizes. The Doctor's Pocket Calorie, Fat and Carbohydrate Counter seems to be a pretty exhaustive catalog, though occasionally redundant, since it lists packaged items that already have nutritional labels. On the other hand, it can be useful for quick reference comparison shopping.

The three books I mentioned, as well as resources on "eating out healthy" from Web sites such as the CSPI, Mayo Clinic, and the American Heart Association, suggest eating a balanced diet with lots of veggies and fruits and offer commonsense advice that's repeated almost word for word wherever you look: avoid foods whose preparation is high-fat (e.g., fried, breaded, au gratin, scalloped, alfredo); ask for your salad dressing on the side (restaurant salad dressing is a major calorie culprit); watch your portions (ask your server to pack up half your entrée before it's served to you); consume alcohol in moderation (i.e., one drink a day for women, two for men); limit your dessert intake, or better yet, avoid dessert entirely (sigh); ask what's in a dish, ask for substitutions, special preparations – ask, ask, and ask.

The last is a point especially well taken for those of us interested to know what we're eating on another level. Fat is not the only peril of modern eating. As the mad-cow situation illustrates, most of our food isn't raised and processed in a healthy way. When you go out to eat, take a moment to ask where the ingredients are from. It may be a while yet before El Farolito starts serving organic food, but anyplace with table service should be able to answer at least some questions. I was pretty disappointed when I went to Chez Papa a couple of months ago and found that, despite the "delicious revolution" style manifesto in the window, the waiter had no idea where any of the seafood on the menu came from and was basically too busy to find out.

As of 2000, Americans spent 10.6 percent of their disposable income on food, less than most of the rest of the world. As recently as 1965, 15.1 percent of the American income went to food – less than any other country in the world. Food is cheap in the United States. Yes, our income is higher than most of the world's. Also, the business of food has become increasingly "efficient" – increasingly industrialized – though the price of industrial efficiency looks to be more than we bargained for. The "delicious revolution" that promotes a return to organic, free-range, local, sustainably harvested, "slow" foods is primarily a revolution of the moneyed and educated. It takes a level of commitment and investment in these issues to eat this way. But healthy food choices are readily available when we eat out – especially in the Bay Area.

Get informed. There are a growing number of Web sites where you can search for restaurants that serve sustainable food and find the information you need to order in good conscience. On Eat Well Guide you can enter your zip code and find restaurants within a specified number of miles that serve sustainably farmed meat. Also check out the Meatrix, which has lots of information and resources about fighting factory farming and supporting local farms. The Niman Ranch site tells you what restaurants serve the company's carefully raised meat. Sea Web and the Monterey Bay Aquarium's Seafood Watch site offer information about the conditions of fish stocks and what's safe to eat – for you and for the environment. Because eating out healthy doesn't just mean watching your waistline.

Masha Gutkin writes the Food Snoop column for the Bay Guardian.