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Short Summary
Main recommendation: On a keto diet, you can eat at restaurants and fast food places by keeping total carbohydrates very low, typically 20 grams or less per day, and ordering meat, fish, poultry, or eggs without breading, rice, beans, bread, chips, or sugary sauces. Dr. Eric Westman says the approach is flexible enough for travel, ethnic restaurants, pizza, sandwiches, barbecue, and buffets.
Key Points
- Dr. Westman says his early low-carb study in Durham, North Carolina (starting around 1999-2000) led him to realize that eating at restaurants and fast food places was practical and more flexible than the strict Atkins stereotype.
- The core mechanism he describes is keeping carbohydrates low so the body shifts to burning fat, with protein from meat, eggs, fish, chicken, and poultry as the foundation.
- Restaurant "swaps" are preferred over strict avoidance: skip chips, bread, rice, and tortillas, and keep the protein and vegetables.
- He says he prefers total carbs rather than net carbs, calling total carbs the "prescription-strength" method because it is more certain, though he notes net carbs may work for some people.
- Patients with diabetes, high blood pressure, or metabolic syndrome are kept at 20 grams or less, and he advises scraping off extra sugary sauce when eating out.
Details Worth Noting
- Concrete instructions:
- Mexican restaurants: order naked fajitas (chicken or beef) without the tortilla, skip beans and rice, and use guacamole or pico de gallo sparingly because avocado contains some carbs. Spices or hot sauce are acceptable. Avoid sugary desserts.
- Chinese restaurants: avoid egg rolls, rice, and heavily breaded dishes. Choose stir-fried or steamed dishes such as chicken satay or beef and broccoli with little sauce. Avoid sweet and sour sauce and General Tso's sauce.
- Pizza: scrape off the toppings and eat them without the crust, or choose a keto-crust pizza. He calculated one keto-crust pizza at about 25 total carbs, or about 12.5 per person if split.
- Subs: order the meat on lettuce ("sub in a tub" or a meat salad). Full-fat dressings such as blue cheese, ranch, and Caesar are acceptable.
- Steakhouses: ask that bread not be placed on the table at first; choose steak with vegetables. Skip dessert, or have berries with cream, or the custard part of crème brûlée without the sugary top.
- Barbecue: choose brisket without the bun or bread.
- Chicken: choose grilled or rotisserie chicken, not breaded chicken. Eat a chicken sandwich without the bun.
- Buffets: choose fresh protein and vegetables; avoid rice, bread, and beans.
- Label reading: check total carbs on packaged foods, not net carbs.
- Dr. Westman says that after a few days on the diet, cravings for chips and bread usually fade.
- He notes that avocados, while low, are not zero-carb, so guacamole should be limited at first.
- He says that in his clinic, he assumes most patients need to be strict at first, and that some patients may reintroduce more carbs later after reaching their goal.
- He emphasizes that the diet should be sustainable and enjoyable, not a source of suffering.
Bottom Line
Eating keto at restaurants is practical when you choose protein-first meals, remove breading, rice, bread, and sugary sauces, and check total carbohydrates, with a stricter limit of about 20 grams per day for people with serious metabolic conditions.
