Can you eat at restaurants on a keto diet?
When I first started implementing a low-carb diet over 20 years ago, like most doctors, I didn’t know much about nutrition. I had two of my patients lose weight – over 50 pounds – by doing the “Atkins diet.” I was curious, so I went to visit Dr. Atkins, Dr. Bernstein, Dr. Rosedale, and a couple of doctors in the Midwest. I wanted to learn how to implement a program in Durham, North Carolina (at my clinic). In the first study we ever did, we were telling people to keep the carbs under 20 total grams per day, we were going to follow them over six months, and everyone got the low-carb diet as Dr. Atkins taught it in New York City. (That’s the list of foods that I got permission to use after I visited there.) I was learning that you could actually eat in restaurants and fast food places. It didn’t matter what grocery store you went to either. The practical implementation of it was actually a lot more flexible than the stereotype of what the Atkins diet was, which is what it was called back then. Now, the strictest version of Atkins is called Atkins Induction, which is really a similar type of diet to a keto diet today. There are lots of ways to do it; you could do a very fancy Atkins style with beautiful meals and yet, that wasn’t the patient population I was trying to teach here in Durham, North Carolina.
I learned that the major theme was keeping the carbohydrates really low so that the body starts burning its own fat. Basically, you’re getting all the nutrition you need but you’re not blocking the fat-burning by eating carbohydrates. Everybody will go into ketosis if they don’t eat for two days; fat is our stored fuel (and ketones come from burning fat). It’s almost like the safe mode on a computer. There’s nothing wrong with it. This idea that ketosis is harmful or bad or to be afraid of it or it’s dangerous just really hasn’t rung true through the years of clinical use and the studies about this kind of approach. In North Carolina, I learned pretty quickly that you had to address a couple of things. Getting access to fast food places and restaurants, especially Mexican and Chinese, and the idea that you had to get chocolate. That’s probably true on any approach but this is the first type of dietary program that I’ve ever studied. I came from internal medicine, studying smoking cessation techniques. I learned the ins and outs of how to do a low-carb diet using meat, eggs, fish, and poultry. Those are all complete proteins. I worry less now about your nutritional needs if you’re eating that set of foods first.
I really didn’t plan on learning how to help someone if they had to go to a fast food place or a restaurant, but by a practical need the idea, I had to learn, “Okay, you’re going to a Mexican restaurant – the chips are full of carbs so you can’t have chips,” and then of course at first people worry about no chips. I tell them, “Relax, actually, it’s a lot easier once you get started. After a couple of days you don’t even miss these things.” If you’re feeling a little cheeky, you can bring in your own chicharrones or pork rinds as a chip substitute, but some restaurants probably wouldn’t want you to do that.
In our area, probably the most popular Mexican restaurant item is fajitas. They’re called “naked fajitas” when you don’t use the tortilla wraps. You get the sizzling meat and vegetables, but no beans and rice. Sometimes, in our area, they’ll give you a guacamole salad or a pico de gallo salad as a side with your sizzling fajitas. With fajitas, you could get meat, chicken, or shrimp or a combination of the three. Other popular things to do at Mexican restaurants is getting bacon-wrapped shrimp with spices or hot sauce, but you can’t have the rice. Guacamole for most people is fine; at first we would just recommend not having too much guacamole because avocados have some carbs, they’re not zero, so there should be some limit on it. Most people don’t get dessert at a Mexican restaurant in our area, but you’d want to stay away from really sugary desserts.
Chinese restaurants are also frequented very often here. You wouldn’t want to have an egg roll because the egg roll wrap has carbs. You want to get a dish that is stir-fried or steamed without a lot of breading or batter on it. You want to be very careful about the breading on foods that you get, including at a Chinese place. You shouldn’t have any rice – you might get chicken satay if they have it, which is chicken on a stick. Or order a dish with beef and broccoli or some sort of shrimp and vegetable combination without a lot of sauce on it. The idea of always having to have rice with the dish will fade away, don’t worry. Be sure, too, to stay away from really sugary sauces like sweet and sour sauce. (Use soy sauce or hot mustard as condiments.) Depending on your metabolism and what you’re trying to accomplish, you may be able to have more carbs or you may have to have fewer carbs. In my clinic situation, I assume that everyone has to be really strict; most people are coming to me with a long weight loss journey or the desire to reverse serious medical problems like type 2 diabetes, high blood pressure, or metabolic syndrome. I keep these folks at 20 grams total carbs or less a day and would advise even to scrape off the extra sugary sauce if you can when you’re out and about at a restaurant.
Pizza is also very popular. You can always scrape off the toppings to avoid eating the crust if someone else has purchased the pizza. You get the meat lovers or some combination of meats on the top, cheese, and tomato sauce, which are relatively low in carbs. In our area, people are putting pizza in a bowl without breading at all, so there are these “crustless pizzas” available. There’s one company that has a keto crust – I calculated the carbs and the whole thing turned out to be about 25 total carbs. If you were splitting one of those pizza crusts with a keto crust with someone else, that would bring it down to about 12.5 grams of carbs. So, even pizza is not out of bounds. You can find some crusts and pizzas at the store but be careful – always look at the total carbs, not net. Net carbs are less certain and I want it to be certain, so it’s more accurate if you use the total carb method. In fact, it’s a little stronger – I call that the “prescription-strength” method of keto where you’re looking at the total carbs not the net carbs. (Cauliflower crusts and grain-free crusts are NOT always low-carb!)
Sub-sandwich places seem to have it down; they just put the meat on lettuce. A lot of places serve a “sub in a tub” or a salad with meat on the top. You get to really enjoy full-fat dressings, like blue cheese, ranch, or Caesar. Putting ranch dressing on a sub sandwich on some lettuce, that’s not bad! Remember, no suffering is allowed on a program like this. If it’s going to be sustainable, I’ve got to help you figure out how to not only eat at home and shop at the places you want to shop but also help you navigate when you’re traveling and going to fast food or ethnic restaurants. You really can eat anywhere.
Why not make it simple sometimes and go to a steak place? If I could, I would live on steak and that’s just fine! Remember, don’t allow them to even put bread on the table at first. After a while, you won’t even be tempted by the bread. Just give it a few days, it’s remarkably fast.
You don’t need to have desserts. Down the road, after someone’s been on this a while or they’re trying to reincorporate carbs and they’re at their goal, you might have something like a half a slice of cheesecake, just don’t eat the crust. You might have some berries with some whipped cream on it or the underside of the créme brulee without the top, which is the sugary part. There are ways to reincorporate these foods.
Other really popular restaurants in our area are the barbecue places. I have to say, I could live on brisket. I grew up in Wisconsin; we had bratwurst and kraut. Here, there’s one particular store and you have to find the one that you like best but whenever I’m in that part of town I’ll go in for the brisket. I like the sausages there or you might have the pulled pork. Of course, no bun and no bread. (And be careful with high-carb sides: no beans or mac & cheese. Opt for collard greens, if available.)
If you go to a chicken place, remember don’t get the chicken with the breading on it, just get chicken that’s grilled chicken or rotisserie chicken. You might get a chicken sandwich, just don’t eat the bun.
When it comes to restaurants and fast food, just be sure to always avoid rice, bread, beans, those kinds of things. It really has never been easier to do a low-carb diet with the resources at the stores at the restaurants. In my clinic, that’s my job – to help you figure out how to make it work within your lifestyle.
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