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Let me be clear; given the opportunity to eat good food (organically grown, fresh, ripe, etc.), any kind of fast food is a crappy choice. With few exceptions, and certainly none I can think of at any of the huge chain fast-food places, the food is sourced from our industrial agriculture system, where the beef is grain fed and chock-full-o'-antibiotics, the produce is grown halfway around the globe and forced into ripeness chemically, and the omega-3 / omega-6 fatty acid ratio is off-the-scale and in the wrong direction.
However, it is conceivable that we may sometimes be stuck for options. I remember vividly (during my previous life as an event production guy, or "roadie") doing a tiny crap event in Texas for a gaming client. I had to drive hours from Houston to get there, as that was the nearest airport, and not even the Interstate highways went anywhere near it. To this day I have no idea why we set up at the event (the event in question was some kind of local festival, and it involved killing lots of snakes. Don't ask, I don't know).
The only restaurants in town were McDonald's, Pizza Hut, and Dairy Queen. That's it. There was a grocery store, but I had no facility for preparing food at my motel. Now, at this point in my life I wasn't as concerned about nutrition as I am now, but I still tried to eat what I thought of at the time as "well," and these choices were definitely not on the list. Now that I'm concerned with what I eat, I'm actually less depressed when they are, for whatever reason, the best or only options (though, thankfully, those kinds of situations almost never arise now).
If I were to be dropped into Freer, TX again I would order the side salads from McDonald's, get a Double Quarter Pounder (without cheese) and hold the bun, thanks. I would get water to drink (the little cup of free water, from the fountain machine, which you can refill as much as you want). I would get the buffet at Pizza Hut, get a few slices of "with everything," and just eat the toppings, along with a salad.
I would eat similarly at Dairy Queen as I would at McDonald's... though, I would probably still get a small ice cream cone, dipped in butterscotch. It's attached to some great childhood memories. Sue me. :-)
The point here is, you can still eat pretty well within the strictures of the Paleo diet, even at fast-food joints. The quality of the food might not be great, and certainly not as high as you'll have preparing your own meals, but avoiding grains and other starchy carbs, dairy, and legumes is pretty do-able.
At Taco Bell, you can get a couple of chicken soft tacos, and just eat the guts out of them, leaving the tortilla. At Subway, you can get all the stuff you'd get on a sandwich done as a spinach salad, dressed with salt, pepper, and olive oil. At any burger joint or sandwich shop, you can always have them hold the bun... and if they give you the confused, blank response I got at a McDonald's one day, you can toss the bun out somewhere for birds to snack on after you get your meal. And, these places almost all have a side-salad option of some kind, now.
Faced with the prospect of eating out, especially at a fast-food restaurant, we see nothing but what look like poor options, nothing healthy, and the temptation is strong to just go ahead and order a burger and fries because there're no better choices. But, that just isn't the case... it's always possible to make some adjustments to bring your meal more in line with your paleo plans. Doing so at a traditional restaurant is even easier; get the veggies as a side dish, order an entrée that isn't covered in a sugary sauce, ignore the basket of rolls they bring to the table before you order. No sweat.
So, remember this post the next time you're shouting into that crappy little intercom...
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