DONATE
FOR PHYSICIANS
HEALTH AND NUTRITION
  Action Alerts
  Breaking Medical News
  Continuing Education
  Health Topics
  Cancer Resources
  Diabetes Resources
  Food for Life Classes
  Healthy School Lunches
  Vegetarian and Vegan Diets
  Reports and Surveys
  Clinical Research Studies
  Health Care Professionals
ETHICAL RESEARCH & EDUCATION
MEDIA CENTER
LEGISLATIVE FOCUS
CLINICAL RESEARCH
EDUCATIONAL LITERATURE
MEMBERSHIP
SHOP

CONNECT WITH PCRM

 

 

    


21-Day Vegan Kickstart

Nutrition CME: Free CME courses for health care professionals

The Cancer Project

Healthy School Lunches: Improving the food served to children in schools

Nutrition MD: Helping health care providers and individuals adopt healthier diets

Nutrition for Kids


Download this fact sheetThe Worst Low-Carb Restaurant Entrées

 

A Report by the Physicians Committee for Responsible Medicine
March 2004

As the food industry tries to cash in on the low-carbohydrate craze, many restaurant chains are adding menu items labeled “low-carb,” “Atkins-friendly,” or “protein-style.” These items are often advertised as being healthy—but are they? To answer that question, nutrition professionals with the Physicians Committee for Responsible Medicine (PCRM) evaluated low-carb entrées at 10 large restaurant chains.

Background

The market for low-carb goods passed the $15 billion mark in 2003. In recent months, a wide range of restaurants have introduced new products (or repackaged traditional menu items) to take advantage of this trend.

Findings

PCRM found that most low-carb entrées are actually far from healthful. This report lists the 10 most unhealthful offerings, based on three criteria—fat content, fiber content, and calories.

The Worst New Low-Carb Entrées

Rank

Worst Low-Carb Entrées

Restaurant

1

Spring Chicken Salad

Ruby Tuesday

2

Double Whopper with Cheese (no bun, ketchup, or mayo)

Burger King

3

Beef Fajita Caesar Salad

Chili’s

4

Black Angus Sirloin Low-Carb Fajita

Don Pablo’s

5

Double-Double Burger Protein-Style

In-N-Out Burger

6

1/3 Pound Low-Carb Thickburger

Hardee’s

7

Grilled Chicken Bacon Ranch Salad w/ Extra Chicken and Ranch Dressing

McDonald’s

8

Steak Picado

Baja Fresh

9

Buffalo Chicken Salad

Blimpie

10

Chicken Bacon Ranch Wrap

Subway

 

The Restaurants

Dietitians at PCRM searched the Web and followed up on news reports and advertisements to find restaurant chains offering menu items targeting consumers who are restricting carbohydrates or trying to increase protein intake. Twelve large chains were identified: Baja Fresh, Blimpie, Burger King, Carl’s Jr., Chili’s, Don Pablo’s, Hardee’s, In-N-Out Burger, McDonald’s, Ruby Tuesday, Subway, and TGI Friday’s.

PCRM then used company Web sites or customer service numbers to locate nutritional information on foods identified as high-protein and/or low-carb. Because Carl’s Jr. and Hardee’s are essentially West Coast and East Coast versions of the same restaurant, PCRM chose to include Hardee’s but not Carl’s Jr. in this report. TGI Friday’s was surveyed, but the chain does not offer a full nutritional analysis of its new “Atkins-Approved” menu items, so PCRM was unable to rate these menu items at this time.

Rating System

For this report, PCRM employed three criteria: total calories, percentage of calories from fat, and fiber content. These factors are highly relevant to both weight management and overall health, and information on all three was available for all restaurants that provided nutrition data.

Calorie intake is clearly one of the most important factors in achieving and maintaining a healthy weight.1 A recent review of 107 research studies on low-carbohydrate weight-loss diets concluded that weight loss was associated with longer diet duration and reduction of calories, but not with reduced carbohydrate intake.2 Diets high in fat, especially saturated fat (which is most concentrated in foods from animal sources), have been linked by scientific research to increased risk of heart disease,3 diabetes,4 obesity,5 and some cancers.6-8 Fiber-rich diets, on the other hand, help reduce the incidence of chronic disease and have been found to be quite useful for weight management.9-11

Using these criteria, PCRM ranked all low-carb, high-protein offerings at each restaurant. Then, PCRM chose the worst item from each restaurant. These 10 items (one from each restaurant) were then compared to one another using the same three criteria (calories, fat, and fiber) to create a list of the 10 worst low-carb restaurant entrées.

Saturated Fat and Other Factors

A food’s healthfulness also depends on several other factors, including saturated fat content, cholesterol level, and sodium content. This information was not available from some of the restaurants evaluated for this report. The following restaurants do provide information on saturated fat, cholesterol, and sodium: Baja Fresh, Blimpie, Burger King, Don Pablo’s, Hardee’s, In-N-Out Burger, McDonald’s, and Subway. These do not make such information available: Chili’s, Ruby Tuesday, and TGI Friday’s.

Many low-carb menu items are dangerously high in saturated fat, which has been identified as a key factor in raising the risk of heart disease.3,12 For instance, the “protein-style” version of In-N-Out Burger’s Double-Double burger derives 29 percent of its calories from saturated fat, for a total of 17 grams of saturated fat.

Methodology

Scores were determined by ranking items by the following:
1. calories (highest to lowest)
2. percent of calories from fat (highest to lowest)
3. fiber (lowest to highest)

These scores were then added together. The entrée with the lowest total number became the worst item, the entrée with the second lowest score became the second worst, and so on. Ties were broken by calorie content.

Scoring System

Restaurants

Worst Low-Carb Entrée

Rank for Calories
(highest to lowest)

Rank for % of Calories from Fat
(highest to lowest)

Rank for Fiber
(lowest to highest)

Overall Score
(sum of rankings)

Ruby Tuesday

Spring Chicken Salad

1

1

4

6

Burger King

Double Whopper with Cheese (no bun, ketchup, or mayo)

6

4

1

11

Chili’s

Beef Fajita Caesar Salad

3

5*

4

12

Don Pablo’s

Black Angus Sirloin Low-Carb Fajita

4

6

3*

13**

In-N-Out Burger

Double-Double Burger Protein-Style

7

3

3*

13**

Hardee’s

1/3 Pound Low-Carb Thickburger

9

2

2

13**

McDonald’s

Grilled Chicken Bacon Ranch Salad with Extra Chicken Breast and Ranch Dressing

5

7

3*

15

Baja Fresh

Steak Picado

2

9

5

16

Blimpie

Buffalo Chicken Salad

10

5*

2

17

Subway

Chicken Bacon Ranch Wrap

8

8

5

21

* Tie
**Three-way tie broken by calorie content

 

Detailed Results

1. Ruby Tuesday, Spring Chicken Salad: 1,161 kcal, 98 gm fat (76%), 4 gm fiber

Ruby Tuesday’s Low-Carb/“Smart Eating” Menu offers 22 entrées, including the single worst low-carb item offered by any restaurant evaluated in this report. The Spring Chicken Salad has the most calories and the highest percent of calories from fat. While salads are often a healthful option, this one is piled high with chicken, bacon, cheese, and an oily dressing. Despite facing such tough competition as a burger wrap served with pork rinds and a steak fajita covered with cheese and sour cream, the Spring Chicken Salad tops PCRM’s list of nutritional nightmares with a whopping 1,161 calories, 76 percent of calories from fat, and only four grams of fiber.

For a true health disaster, Ruby Tuesday patrons might pair the Spring Chicken Salad with Buffalo Wings (a chicken wings appetizer that serves either one or two diners and totals 1,090 calories and 85 grams of fat) and conclude with a piece of Carb-Smart cheesecake (360 calories and 32 grams of fat), which are both also on the “Smart Eating” menu. With that one meal, a consumer would exceed the daily value for calories for both men and women and consume a whopping 215 grams of fat (more than three times the upper limit recommended for the average adult by most health experts).

2. Burger King, Double Whopper with Cheese, no bun, ketchup or mayo: 630 kcal, 47 gm fat (67%), 23 gm sat fat (33%), <1 gm fiber

Burger King has not yet unveiled its full line of low-carb options, but the burger chain already offers the second-worst low-carb entrée on PCRM’s list. To qualify as low-carb, all of Burger King’s Whopper sandwiches can now be ordered without the bun, ketchup, or mayo. The worst option is the low-carb version of the Double Whopper with Cheese, which has 630 calories, 67 percent of calories from fat, and less than one gram of fiber. Nearly fiber-free, this entrée will do nothing to help a diner achieve the recommended fiber intake of 25 to 35 grams a day—a level of consumption that reduces cancer risk, helps achieve weight goals, and maintains the health of the gastrointestinal tract.14

3. Chili’s, Beef Fajita Caesar Salad: 806 kcal, 58 gm fat (65%), 4 gm fiber

Chili’s new “Make It Mine” menu offers 11 items that have been modified to help consumers looking for a high-protein, carbohydrate-reduced meal. However, no one is helped by an item like the Beef Fajita Caesar Salad, which provides over 800 calories, 65 percent of which are from fat. Other Chili’s items also pose nutritional problems. For example, the Beef Chili’s fairly modest calorie count (402 calories) belies its high fat content (26 grams of fat and 58 percent of calories from fat).

4. Don Pablo’s, Black Angus Sirloin Low-Carb Fajita: 680 kcal, 45 gm fat (60%), 24 gm sat fat (32%), 3 gm fiber

Don Pablo’s Low-Carb Fajitas are served with lettuce wraps, the restaurant’s “New South Beach Sauce,” and a bed of low-carb veggies (yellow squash, zucchini, button mushrooms, and asparagus). Three types are offered: Mahi-Mahi, Smoked Chicken, and Black Angus Sirloin. The last option is the most nutritionally disastrous, since it contains 680 calories, 45 grams of fat, and a whopping 32 percent of calories from artery-clogging saturated fat. But the other two options are not far behind: the Mahi-Mahi Fajita is highest in cholesterol (230 milligrams), and the Smoked Chicken Fajita has 1,870 milligrams of sodium, which means this one entrée puts a diner near the recommended daily limit for sodium. A better bet would be a double order of the bed of veggies, without the meat and sauce.

5. In-N-Out Burger, Double-Double Burger Protein-Style: 520 kcal, 39 gm fat (68%), 17 gm sat fat (29%), 3 gm fiber

At In-N-Out Burger, customers can choose from three “Protein-Style” options from the “Secret Menu,” which consists of three different burgers wrapped in lettuce rather than served on a bun. The worst option is the Double-Double, which contains two beef patties served with lettuce, tomato, spread, two slices of American cheese, and optional onions. This item contains 520 calories and derives 68 percent of those calories from fat. Worse yet, much of this fat (29 percent of calories) is artery-clogging saturated fat. That puts a diner well on the way to exceeding limits set by the American Heart Association, which recommends that no more than 7 percent of an individual’s calories come from saturated fat.

6. Hardee’s, 1/3 Pound Low-Carb Thickburger: 420 kcal, 32 gm fat (69%), 12 gm sat fat (26%), 2 gm fiber

Hardee’s offers only one low-carb entrée, but it is a nutritional nightmare. The Low-Carb Thickburger ranks second worst both in percentage of calories from fat (69 percent) and in lack of fiber (only two grams). Made with a one-third-pound Angus beef patty wrapped in iceberg lettuce leaves, this burger is topped with a reduced amount of ketchup (to avoid carbs) but the usual amount of mustard, tomato, dill pickles, red onion, mayo, and cheese. For an even more unhealthy meal, customers can make the Thickburger a double, for a total of 1,005 calories and 87 grams of fat—37 grams of which are saturated fat.

7. McDonald’s, Grilled Chicken Bacon Ranch Salad with extra chicken breast filet and Newman’s Own Ranch Dressing: 660 kcal, 42 gm fat (57%), 9.5 gm sat fat (13%), 3 gm fiber

McDonald’s has stopped short of offering new items that are specifically labeled low-carb. However, it does list in detail how customers can modify existing menu items to meet low-carb goals. The worst of these suggestions involves adding an extra chicken breast to the already saturated-fat-laden Grilled Chicken Bacon Ranch Salad. This salad starts off well, with premium mixed greens, sumptuous grape tomatoes, and shaved carrots. But it also features piles of jack and cheddar cheese, bacon, and two grilled chicken breasts coated with ranch dressing. That adds up to 660 calories, 42 grams of fat, and just three grams of fiber. McDonald’s other low-carb suggestions, such as ordering burgers without buns or condiments, are not only unappealing but also produce meals high in fat and calories and low in fiber.

8. Baja Fresh, Steak Picado: 840 kcal, 45 gm fat (48%), 21 gm sat fat (23%), 11 gm fiber

On its “Lifestyle Choices” menu, Baja Fresh offers four high-protein options: Steak Picado, Chicken Picado, the “Side-By-Side” (chicken and a side salad, served with guacamole, cheese, avocado slices, and a fat-free dressing), and Baja Ensalada (salad topped with chicken). The worst option is Steak Picado, a charbroiled steak with grilled green peppers, onions, and melted cheese, topped with enchilada sauce, guacamole, sour cream, and fresh salsa and served with a side salad. While the vegetables contribute to the relatively high fiber content (11 grams), the beef, cheese, and sour cream play a key role in this meal’s total of 840 calories and 45 grams of fat. At Baja Fresh, a weight- or health-conscious diner should choose one of the low-fat options offered in the same “Lifestyle Choices” section of the menu.

9. Blimpie, Buffalo Chicken Salad: 390 kcal, 28 gm fat (65%), 7 gm sat fat (16%), 2 gm fiber

Blimpie offers six “Carb Counter” menu choices: four sandwiches and two salads. The Durango Roast Beef and Cheddar Sandwich may sound like the nutritionally worst item, but it is beaten by the healthier-sounding Buffalo Chicken Salad, which is described as “fresh green lettuce with four ounces of tangy buffalo chicken, topped with rich blue cheese dressing.” While the Buffalo Chicken Salad does have fewer calories (390 calories) than many low-carb items, it also features 28 grams of fat and 85 milligrams of cholesterol.

10. Subway, Chicken Bacon Ranch Wrap: 480 kcal, 27 gm fat (51%), 9 gm sat fat (17%), 11 gm fiber

Subway has partnered with Atkins Nutritionals to, as Subway puts it, “offer customers more choices to help them maintain a healthy, controlled-carb lifestyle.” Subway offers two of these Atkins-friendly, carb-controlled wraps: the Chicken Bacon Ranch Wrap and the Turkey Bacon Melt Wrap. While both have relatively high levels of fiber (11 and 12 grams, respectively), these two wraps also derive more than 50 percent of their calories from fat. Subway’s worst option is the Chicken Bacon Ranch Wrap, which contains strips of white meat chicken, crispy bacon, red onion, green peppers, olives, and melted and shredded Swiss cheese, topped with ranch dressing. The chicken, bacon, cheese, and ranch dressing all contribute to this sandwich’s high fat content, which increases the risk of cancer and heart disease.

References
1. Freedman MR, King J, Kennedy E. Popular diets: a scientific review. Obes Res. 2001;9:1S-40S.
2. Bravata DM, Sanders L, Huang J, et al. Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA. 2003;289:1837-50.
3. Report of a Joint WHO/FAO Expert Consultation. Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916, 2003.
4. Gin H, Rigalleau V, Aparicio M. Lipids, protein intake, and diabetic nephropathy. Diabetes Metab 2000;26:45-53.
5. Dreon DM, Frey-Hewitt B, Ellsworth N, Williams PT, Terry RB, Wood PD. Dietary fat: carbohydrate ratio and obesity in middle-aged men. Am J Clin Nutr 1988;47:995-1000.
6. World Cancer Research Fund/American Institute for Cancer Re-search. Food, Nutrition, and the Prevention of Cancer: A Global Perspective. American Institute for Cancer Research, Washington, D.C., 1997.
7. Cho E, Speigelman D, Hunter DJ, Chen WY, Stampfer MJ, Colditz GA, Willett WC. Premenopausal fat intake and risk of breast cancer. J Natl Cancer Inst 2003;95:1079-85.
8. Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC. Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res 994 ;54:2390-7. Anderson JW, O’Neal DS, Riddell-Mason S, Floore TL, Dillon DW, Oeltgen PR.
9. Postprandial serum glucose, insulin, and lipoprotein responses to high- and low-fiber diets. Metabolism 1995;44:848-54.
10. Salmeron J, Ascherio A, Rimm EB, et. al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997;20:545-50.
11. Liu S, Buring JE, Sesso HD, Rimm EB, Willett WC, Manson JE. A prospective study of dietary fiber intake and risk of cardiovascular disease among women. J Am Coll Cardiol 2002;39:49-56.
12. Nestel PJ, Shige H, Pomeroy S, Cehun M, Chin-Dusting J. Post-prandial remnant lipids impair arterial compliance. J Am Coll Cardiol 2001;37:1929-35.
13. Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients): A Report of the Panel on Macronutrients, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, 2002.

This site does not provide medical or legal advice. This Web site is for informational purposes only.
Full Disclaimer | Privacy Policy

Physicians Committee for Responsible Medicine
5100 Wisconsin Ave., N.W., Ste.400, Washington DC, 20016
Phone: 202-686-2210     Email: pcrm@pcrm.org