DOWNEY - It is once again time to attack (I mean…discuss) fast food. Even as I counsel my patients as to how they can find healthful food even at a fast food restaurant, I am astounded at how just plain awful some of the menu choices can be.Let's begin with some nutritional target goals. For simplicity, we'll assume that we need 2,200 calories per day, a reasonable target for an "average" adult. • We all need some fat in our diet. Ideally, approximately 20% of our calories should come from fat, so 20% of our goal of 2,200 daily calories means that 440 calories should come from fat. Since each gram of fat has 9 calories, we should eat no more than 49 grams of fat each day. Less then half of that should be saturated (as is the fat in a hamburger, cheese, mayonnaise, and other common components of fast food). • The target for protein is around 20%. Typically, this is not difficult to reach. • It's also necessary to have sodium in our diet. For our "average" adult, let's target about 2,500 mg each day maximum. (A brief reminder: too much salt can raise the blood pressure, put some people into congestive heart failure, and give many others swelling throughout their body and especially in the legs.) • Sugar, a refined simple carbohydrate, has no nutritional value, and ideally none of our calories should come from it. A perfect goal would be to eat only complex carbohydrates. Nevertheless, sugar surrounds us, is very difficult to avoid (read those labels!) and very few of us choose to steer clear of it completely. The World Health Organization suggests that a maximum of 10% of our total calories be sweeteners. 10% of our 2,200 daily calorie goal is 220 calories, and at 4 calories per gram, that results in a limit of 55 grams of simple carbs each day. With fats representing 20% of the calories in our diet, protein representing another 20%, and simple carbs (sugar) representing a maximum of 10%, the remaining 50-60% should be complex carbohydrates, such as fruits, vegetables, and whole grains. Now, let's examine some common fast foods! • I have recommended that patients go to Quizno's for the low fat items on the menu, but I would hate to discover that they ended up ordering the "Tuna Melt" (regular). It has 1,420 calories, 118 grams of fat, and 1,535 grams of sodium. Note those targets, above. This single sandwich has more than double the fat and ¬æ of one day's calories. • Everyone loves In and Out Burger. If you order a hamburger with onions, tomatoes, and lettuce you will consume 650 mg of sodium, 19 grams of fat and 390 calories. It may not be considered health food, but it's not too far out of the target range for a meal. Now, add some french fries, along with their 245 mg of sodium, 27 grams of fat and 400 calories. If you are brave enough to order a hamburger, fries and a shake, you will consume 1,245 grams of sodium, 101 grams of fat, and 1,480 calories, and your pretty decent fast food choice has turned into a nightmare. • I have also referred people to Subway for reasonable fast food items. They offer eight six-inch sandwiches that have 6 grams of fat or less, 370 calories or less, and 1,260 mg of sodium or less. However, if we chose the "Sweet Onion Chicken Tempura" sandwich, we would end up consuming 2,400 grams of sodium (our target is 2,500 for the day) and 750 calories. • I like El Pollo Loco for fast food. They promote their "Pollo Bowls" as a healthy alternative. These offer 543 calories and 10 grams of fat, but 2,159 mg of sodium (nearly an entire day's target amount). Compare these to their "Chicken Tostada Salad" at 990 calories, 52 grams of fat (your full day's amount) and 1,755 mg of sodium. • Many of McDonald's salads will run around 300 calories, under 10 grams of fat and under 900 mg sodium. As another nutritious alternative, try their "Fruit 'n Yogurt Parfait" at 160 calories, 2 grams of fat and 85 mg of sodium. On the other hand, how about their "Deluxe Breakfast" (without syrup and margarine)? It has 1,140 calories, 59 grams of fat, and 2,250 grams of sodium, nicely covering your dietary needs for fat and sodium for the entire day. At least it's not the "Chocolate Triple Thick Shake" (32 ounces), with 1,160 calories, 27 grams of fat and 510 mg sodium. That's half your daily fat and caloric requirements in just your drink for one meal! • Outback Steakhouse prepares a "Steakhouse Aussie Cheese Fries with Ranch Dressing". This is a french fries appetizer…with 2,900 calories and 182 grams of fat, more than a day's calories and three day's fat - before the meal? • Domino's "Deep Dish Extravaganza" (two large slices) contains 860 calories, 46 grams of fat, and 2,260 grams of sodium. You've got the hang of these calculations by now: that's enough fat and sodium for the day. • We all know people who visit Starbucks (or their favorite coffee house) daily. If you try their "Peppermint White Chocolate Mocha with whip" (medium size) at 560 calories, 22 grams of fat and only 240 mg sodium, then your daily Starbuck's run ends up costing you a quarter of your desired calories and half of your desired fat (and saturated, at that!). We won't discuss here the dollar cost for this treat. (Does anybody out there still drink black coffee or tea?) • Fast food restaurants make a huge portion of their profits on the sale of soda. A 12-ounce serving (equal to a can) contains between 22 to 32 grams of sugar. Drinking two cans of soda will meet that 55 gram daily maximum target for sugar, all in liquid form. (Note that teenagers drink "on average" 1.4 cans per day!) • Let's wrap up with an indulgence that will neatly take care of roughly 100% of your goal for calories and sodium, and 200% of your goal for fat (saturated, naturally), all in one. Now, that's convenience. We would all expect a Baskin Robbins shake to be loaded with fat and calories, but could you have guessed just how much? Their "Heath Shake" (large) has 2,310 calories, 108 grams of fat, and 1,560 grams of sodium! So what does this all mean? The typical American eats fast food every four days on average, which makes it quite difficult to achieve our goals to limit sodium, sugar, and fat. Making one poor selection from a fast food menu will put us near or over at least one of our targets before we even eat a whole meal, much less satisfy our hunger for the rest of the day. Every fast food restaurant offers an enormous variety of food with just as enormous a range of nutritional content. Nutrition information is readily available on restaurant websites, and increasingly available at the fast food restaurant itself. I strongly advise you to research what you are eating, read labels, and be knowledgeable about the calories and fat, sodium and sugar grams in common foods. It is just too easy to go way over reasonable goals and never even know it. I wish you healthful and SMART eating! Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240. ********** Published: February 13, 2009 - Volume 7 - Issue 43