If you have a big enough–and motivated–study population, even modest reductions in daily sodium intake can make a big difference in preventing strokes and heart attacks. Last month, cardiovascular researchers from Beijing and Sydney announced a new 5-year diet trial in Science to do just that (see the general overview article, “China tries to kick its salt habit”).
China’s northern rural poor eat an estimated 12 grams of salt a day on average, considerably more than Americans’ 9 grams a day (which is still over the top) and more than twice the WHO’s recommended 5 grams or less. An estimated 54%, more than half, of Chinese adults over 45 have high blood pressure these days, and the Chinese government is taking practical steps to provide antihypertensive medications and shift the tide back–but that’s an awful lot of prescriptions.
Given the cost of antihypertensive drugs for such a huge population, and the cost of dealing with side effects and consequences of untreated or undertreated high blood pressure, prevention seems the better way to go. The researchers project that reducing the national average by even 1 gram of salt a day would save 125,000 lives a year in China. So they’ve recruited 21,000 villagers so far in China and Tibet, and plan to provide test groups with nutrition counseling plus a lower-sodium salt substitute for cooking, then compare their sodium intakes and rates of heart attack and stroke with those for a control group.
Most Chinese still do their own cooking at home, especially outside the big cities. If lowering the sodium content of the salt they use works, it has the potential to get an awful lot of people off daily hypertension medication and reverse a major health threat. But will people do it if they’re not in the trial, or once it ends? Will it catch on? And is it the right answer in the long run?
Salt substitutes, with potassium chloride replacing some of the usual sodium chloride, have been tried by heart patients in the US since the 1970s or so. They’re a little more expensive than table salt or kosher flake salt, at least in the US, but they’re not all that expensive. But they’ve never really caught on here with most consumers.
Similarly, a few decades ago, a big public health campaign in Japan to reduce the high rate of stroke led to the introduction of low-sodium soy sauces, with about half the sodium content per tablespoon of traditional ones.
Not much market research is available on how many people have been buying low-sodium vs. regular soy sauce in Japan since its introduction. From the few current market reports I could find–one of them an executive report from Kikkoman–it looks like low-sodium is still a smaller if steady fraction of their business in Japan, and that it’s more popular in Europe and the US than at home.
It’s important to have a low-sodium line for reasons of corporate responsibility and even prestige, but there was no mention of its percentage of total domestic or worldwide sales. Traditional soy sauces, which can range from 14-18% sodium concentration w/v, are still apparently preferred for taste, and the Kikkoman executives attribute much of their expected taste appeal to salt rather than the other flavors in each one’s profile.
That’s kind of discouraging to me. The Japanese are known for more refined and sensitive palates on average than Americans, and their range of soy sauces and tamaris for specific food combinations is much broader and more sophisticated. The higher-quality low-sodium soy sauces are produced by ion filtration to get sodium out rather than simply diluting them with water, so most of the flavor that’s actually flavor remains. I would have hoped the key flavor signature of each match was the actual flavor of the brewed soy sauces, not the saltiness.
It’s likely, though, that the Japanese are just as susceptible as the rest of the world to the sodium tolerance phenomenon–the more sodium you eat habitually each day, the more you expect and consider normal in your food, and you almost stop even noticing it as a separate flavor.
The overall Chinese market for soy sauce is currently estimated at $20 billion and grew about 23.4 percent over the past 5 years, mostly due to population growth. The stakes are pretty high for China, but the government has tighter control of its salt and soy sauce producers than other countries do, and the will to make a broad change seems to be present, at least at a government level, and if the new study is anything to go by, among ordinary villagers as well. So maybe this time it will catch on once the study’s over.
But obviously, if you’re starting out at a 12-gram-a-day salt habit, the best way to reduce sodium in home-cooked food would be to cut back hard on salt and salted items altogether. That takes time, practice, awareness and deciding that it’s worth going through that first couple of weeks until your palate readjusts to a lower-sodium diet (which it will, but it takes a couple of weeks and a little patience).
Can cutting the salt be done with Chinese food? Not American souped-up chain restaurant caricatures of Chinese dishes, which are hideously over-the-top and greasy as well, but actual home cooking? I’ve done low-sodium adaptations at home for tofu, fish and vegetable dishes that I like well enough, but I’m not Chinese, and all I can do for an educated guess is to look at the cookbooks I have and consider the food I’ve eaten in people’s homes here in California.
Even so, I think the sensible answer has to be yes, and that given some decent ingredients (that may be more of a stretch vegetable-wise in northern China’s poorer villages than in the eastern cities like Shanghai and Guangdong) it might not be so hard to choose more of the traditionally lightly-salted dishes, and to cut out a lot of the salt in the others by emphasizing the balance of flavors–sweet, sour, umami, bitter, aromatic, hot spice, and cold spice–with saltiness a distant last on the list.
A couple of suggestions for doing that, and I hope these aren’t total sacrilege:
- First, obviously, use low-sodium soy sauce–Kikkoman, Yamasa, even Trader Joe’s are decent and have about half the sodium of standard. “Low-sodium” should be about 400-500 mg per tablespoon or serving, not 1000 mg–check the label. And be sure to measure whatever you use so you know you’re not doubling up to compensate.
- If you use canned or vacuum-boxed chicken broth, always choose the lowest-sodium version (140 mg per serving, not 500, 600, 700 or more). Vegetarian broths are also likely to be high-sodium (sometimes worse than the meat broths!), so always check the nutrition label and go for the 140 mg version.
- Or make your own fresh unsalted broth on the spot–it only takes a few minutes in a microwave while you’re prepping other ingredients. Microwave onion, carrot and celery covered for a few minutes to wilt, then pour water over it, add garlic and optional pinches of curry powder, peppercorns and/or dill, and microwave a few more minutes, just to the boiling point. Bok choy and/or shiitake mushrooms microwaved in water to cover for a few minutes also make a quick and good-tasting (and inexpensive) unsalted vegetarian broth that’s easy to doctor into a hot-and-sour soup or use in stir-fries. Spinach and garlic with water to cover works too.
- For dipping sauces, cut the low-sodium soy sauce back to maybe a tablespoon in half a cup of sauce, not the usual half-and-half or more proportions of soy sauce to other ingredients. To make up the volume and taste, balance competing tastes: vinegar, dark molasses, and a little wine or water or unsalted broth (mushroom, shiitake, chicken, bok choy–as desired). Don’t forget to add ginger, garlic, scallions and hot pepper/garlic paste (with cilantro, my preference) plus a drizzle of toasted sesame oil–add or delete as you prefer.
- Same idea for marinades. The “classic” marinade we used for “teriyaki grilled” chicken breasts at the restaurant where I worked during college was a huge bucket of raw chicken pieces soaking in gallons of soy sauce and orange juice overnight in the cooler. The chicken came out kind of cooked in the acid and salt, and not all that juicy once it was grilled. It would be better–easier, quicker, less messy and wasteful, and fresher-tasting–just to make a paste or rub of the dipping sauce ingredients above, but with less liquid overall and a lot less soy sauce, and coat the chicken up to half an hour before cooking. The flavor of the sauce would be concentrated on the outside and make a better contrast to the flavors of the meat inside. You’d get the impact of it without all the sodium, and you’d do it faster and cheaper. And you could vary it with different spice combinations and additions–wine? orange peel? 5-spice or star anise? curry spices? coconut?
- For traditionally salt-added dishes like spinach with garlic or Szechuan green beans, skip the salt altogether. Most of these dishes have enough other strong signature flavors that salt is just excess. And contrary to popular opinion, you do not need to salt vegetables to get them to wilt–the heat alone will do it just fine in about the same time. Either cover the frying pan a few minutes to let them steam first, maybe with a drizzle of water, and then stir-fry with oil, garlic, ginger, chiles etc. Or you can give things a head start in the microwave for a minute or so to wilt, then sizzle them in the hot frying pan with the flavorings.
- To add a savory note in stir-fries without resorting to oyster sauce, use unsalted bok choy broth or the broth from rehydrating shiitake mushrooms, and include the vegetables themselves–the savory hit from biting into them will carry over. To avoid swamping a stir-fry dish, fry the proteins and vegetables first, then add a little of the broth at a time and let it sizzle down before adding more. You get umami flavor without big salt, and you can still make a thickened sauce at the end with the last of the broth and a bit of cornstarch dissolved in water. Cilantro leaves, cumin, and toasted sesame oil also provide savory undertones and are traditional to specific regional dishes. These three also go well with some of the dishes that traditionally call for oyster sauce, but obviously they won’t actually taste like oyster sauce because they have their own signatures.
- Fermented black beans and black bean sauce or paste are two other very popular but high-sodium flavorings. For dishes such as tofu in black bean sauce, where the black beans traditionally are first soaked in water and both they and the soaking liquid are added back into the dish, you might just use the molasses-based dipping sauce above (minus much of the vinegar) for frying, plus shiitakes and their broth after browning the tofu, and add just a little low-sodium soy sauce. It won’t look the same but it will hit most of the same fermented-flavor notes (other than the screaming salt).
- Prune paste (chopped prunes microwaved in water and mashed or blended), mixed with garlic, ginger, vinegar, sesame oil and scallions, and maybe a drizzle of low-sodium soy sauce, also substitutes surprisingly well for either black bean paste or hoisin sauce as a rub or coating for fish and chicken, or as a dipping sauce for mu shu wraps and grilled skewers.
- Add a contrasting and flavorful accent or garnish ingredient at the end–browned mushrooms, raw shredded scallions, red bell pepper, chopped cilantro, water chestnuts. Or browned almonds, walnuts or peanuts. Or something bright and unexpected–Szechuan peppercorn, lemon or orange zest.
Filed under: DASH Diet, frugality, nutrition, Revised recipes, sauces and condiments, shopping, soup, Vegetabalia | Tagged: cardiovascular disease, high blood pressure, low-sodium Chinese recipes, low-sodium cooking, salt substitutes, sodium research, soy sauce |