Mediterranean Diet at Italian Chains? Fuhgeddaboudit!

Customers at two of the country's largest Italian food chains could be getting much more than just a taste of Italy in their entrees.

They may be getting oodles of calories and saturated fat, suggests a report published Wednesday by the Center for Science in the Public Interest.

The report, published in the November issue of the Center's Nutrition Action Healthletter, panned popular Italian food chains Romano's Macaroni Grill and the Olive Garden for their less healthful offerings.

Among the highlighted entrees was the Olive Garden's fettucine alfredo, which served 1,200 calories and 33 grams of saturated fat, according to an independent lab analysis commissioned by CSPI. Another entree at Macaroni Grill, spaghetti and meatballs with meat sauce, treats diners to 2,430 calories and 57 grams of saturated fat.

Aside from finding that restaurant menus may not be entirely forthcoming about the actual amounts of fat and calories in their fare, CSPI's director of nutrition Bonnie Liebman said the higher-calorie, higher-fat offerings could be especially dangerous to those consumers who believe that they are sitting down to a healthful Mediterranean-style meal when they visit these establishments.

"Italy is a Mediterranean country, so many people assume that Italian food represents a Mediterranean diet," Liebman said.

"Many Americans have only a vague notion of what's in a Mediterranean diet," she added. "Most probably assume it's got olive oil, pasta and tomatoes, but few realize that it's missing the meat, cheese and butter in popular Italian dishes like lasagna, spaghetti and meatballs, baked ziti and fettuccine alfredo."

Dietary experts remain split, however, as to whether consumers could mistake the restaurants' high-calorie offerings for traditional Mediterranean fare -- although some agree that consumers may fall into this trap.

"Consumers are certainly at risk of believing that these meals are 'Mediterranean' due to the ambience that the restaurants create and promote in their advertisements," said Dr. George Blackburn, director of the Division of Nutrition at Harvard Medical School in Boston.

"I would suspect that the average consumer would believe that these restaurants were serving a healthy Mediterranean fare," agreed Dr. Charles Clark, professor of medicine at Indiana University School of Medicine in Indianapolis.

But others say there is little chance that consumers actually believe that just because an entree includes olive oil and tomatoes, it is healthy.

"I think the CSPI is really stretching the connection between a Mediterranean diet and Italian restaurants in America," said Madelyn Fernstrom, associate professor and director of the University of Pittsburgh Medical Center's Weight Management Center.

"I do not think consumers are viewing these restaurants as consuming a Mediterranean diet."

"I have not seen these restaurants advertising that they serve foods consistent with the Mediterranean diet," noted Mary Beth Kavanagh, instructor at Case Western Reserve University's department of nutrition. "I suppose some people might think that these Italian restaurants might be more 'healthy' than a burger joint or steak house. But I really do not think most people are familiar with the Mediterranean diet and therefore would not make the connection."

"I don't believe consumers actually go to restaurants like Olive Garden or Romano's Macaroni Grill to become devotees of this healthful eating style," said Jackie Newgent, culinary nutritionist and author of "The All-Natural Diabetes Cookbook." "I believe consumers go to these Italian chain restaurants because they love the food and they get filled up without spending a fortune."

Restaurants Respond

Both the Olive Garden and Macaroni Grill were quick to respond to the CSPI report. Both chains noted that customers at their restaurants were free to request healthful alternatives to many options on the menu.

"Our menu has something for everyone, from traditional favorites to lower-fat garden fare items," the Olive Garden said in a statement. "There are also choices available to guests to tailor their meal to accommodate their preferences from whole wheat pasta to steamed vegetables."

"Macaroni Grill is able and happy to modify most menu items to fit the individual dining and dietary needs of its guests," read another statement from Macaroni Grill. "For example, substituting side items or whole wheat pasta, getting sauces or dressings on the side, and asking for adjustments in preparation or a container for leftovers are very common guest requests."

And even CSPI applauded Macaroni Grill for posting its nutritional information online. But diet experts were quick to point out that the heavy portion sizes at these establishments, more often than not, tipped the scales against the chances for a healthy dining experience.

"The quantities are outrageous, often two to three times the calories and fat that a meal should contain," said Keith Ayoob, associate professor in the department of pediatrics at Albert Einstein College of Medicine New York. "That's the antithesis of the Mediterranean diet."

What the Mediterranean Diet Is -- and Isn't

Part of the problem is that, with all that Americans hear about a Mediterranean diet, few truly understand what might constitute such offerings.

"Basically, a Mediterranean-style eating approach refers to a plant-based diet with plenty of produce, grains, beans, nuts, seeds and olive oil, some cheese and yogurt, fresh fish and poultry, very little red meat, moderate alcohol (mainly wine) consumption and plenty of exercise," Newgent said.

"It's a diet that is based heavily on fruits, vegetables, fish and for fat, olive oil," Ayoob said. "But olive oil is simply the main fat source; it doesn't drown everything, as some would like to believe."

The Mediterranean diet is so foreign a concept in mainstream American restaurant cuisine that some say it's almost a sure bet that if you're eating out, the food you're enjoying is probably nothing like what actually graces the tables of families living on the shores of the Mediterranean sea.

"The idea that a chain restaurant could produce healthy Mediterranean food is unlikely," said Dr. Darwin Deen of the department of family and social medicine at Albert Einstein College of Medicine. "I have eaten at both Romano's Macaroni Grill and Olive Garden and can tell you that while it is possible to eat healthy from their menus, most of what is offered is no better than a steak house in terms of complying with the Mediterranean diet."

How to Keep Your Italian Healthy

There are ways for Italian chain restaurant faithful to make their outings as healthy as possible.

"Go occasionally, not regularly," Kavanagh said. "Split entrees, and tell the waiter or waitress not to bring the breadsticks at Olive Garden."

"They've got to get a salad with a monounsaturated oil [dressing], a limited amount of pasta -- not all you can eat -- and consider an entree that is not pasta-based," said Dr. Ken Fujioka, medical director for the Scripps Clinic Center for Weight Management in La Jolla, Calif. "Concentrate on veggies, fruit, and protein, and limit starch. Also, red sauces only -- no white cream sauces."

And past president of the American Dietetic Association Connie Diekman noted there is even a good solution to the portion problem.

"If the portion is large, I get the take-home container right away," Diekman said. "I divide the portion into what I'm going to eat now and put the rest into the container. While dining out almost always means more calories than when dining at home, as consumers we can control what we choose to eat at the restaurant and what we take home for the next day or the next several days."

But most important, Ayoob notes, is that consumers should also open their eyes -- not just their mouths -- to what they are eating.

"Some consumers may operate on a 'Don't ask, don't tell' basis," he said. "They may consider information like this as 'spoiling their fun'; they still deserve to make an informed choice, however."

"Knowledge is power, and you can't know how to change if you don't know what you're doing."

And if you're really yearning for a taste of the Mediterranean, you might be best off bringing it into your own kitchen.

"If you are truly interested in following a Mediterranean eating plan, make time to get acquainted with your own kitchen at home," Blackburn said. "Fill your fridge with plenty of fruits, vegetables, whole grains and enjoy healthy fats (olive oil, nuts, seeds, legumes) in moderation."