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    Copyright 2008-2018Slow Food Fast. All writing and images on this blog unless otherwise attributed or set in quotes are the sole property of Slow Food Fast. Please contact DebbieN via the comments form for permissions before reprinting or reproducing any of the material on this blog.

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    SlowFoodFast sometimes addresses general public health topics related to nutrition, heart disease, blood pressure, and diabetes. Because this is a blog with a personal point of view, my health and food politics entries often include my opinions on the trends I see, and I try to be as blatant as possible about that. None of these articles should be construed as specific medical advice for an individual case. I do try to keep to findings from well-vetted research sources and large, well-controlled studies, and I try not to sensationalize the science (though if they actually come up with a real cure for Type I diabetes in the next couple of years, I'm gonna be dancing in the streets with a hat that would put Carmen Miranda to shame. Consider yourself warned).

Instant Pickles, Hold the Salt

Fast-marinated cucumbers, half-sour kosher dill style

One of the things that kept me motivated for blogging SlowFoodFast after the first fine careless rapture was my indignation at how popular over-the-top salting was becoming in popular food magazines, cookbooks, blogs and TV shows as chefs became celebrities, and how dangerous I knew it was for most people to eat that way regularly. A large part of my career a couple of decades ago was exploring the history of dietary sodium in cardiovascular research and writing about the DASH Diet.

What I’ve missed the past few years is just how many people, particularly younger ones, are starting to take up the challenge of cooking low-sodium and blog about their trials and successes. There’s a whole community out there, and they’re cooking pretty well. It is definitely possible, and generally easy once you get past the “how do I read a label and cook from scratch” aspect.

I just ran into Sodium Girl (aka Jessica Goldman Foung)’s blog-based cookbook, “Sodium Girl’s Limitless Low-Sodium Cookbook”. Diagnosed with lupus and kidney failure in her early 20s, she turned around her diet by dropping her sodium intake drastically to give her kidneys a rest in the hope they’d regenerate, and it worked. She’s been innovating with low- and near-to-no-sodium versions of favorite foods ever since, working with the National Kidney Foundation and other organizations. Her book, like her blog, is attractively photographed, full of cheerful writing and surprise takes on favorite foods.

One of the substitutions she makes that I have to approve of is a molasses-and-vinegar-based “faux soy sauce”. So I wasn’t the only one!

Another of her successful experiments is pickles. She goes for sugar-and-vinegar-style pickles, which makes sense, since they have no added salt in them, but I can’t help it–I have always cringed at sweet pickled anything. If it’s supposed to be a pickle, for my money, it’s gotta be a half-sour kosher dill and nothing but (or else an Indian lime or mango achaar pickle, or Moroccan preserved lemons, but that’s another story and still pretty high-salt at this writing. I’m working on it, but not yet holding out a lot of hope…)

Anyway, looking through Foung’s book reminded me of a simple, hearty and low-to-very low sodium version of my favorite pickles in the world. Continue reading

DASH is US News & World Report’s “Best Overall Diet”

US News & World Report asked a panel of nationally recognized nutrition, diet, cardiovascular health and diabetes prevention experts to rank 32 popular diets. DASH (Dietary Approaches to Stop Hypertension) topped out as the overall best, including for long-term weight loss and maintenance.

The article and rankings online: Best Diets 2014 | US News & World Report

Where the experts complained–sort of–was that following it requires eating more real food and fewer boxed processed meals. So it’s technically “harder” to do than Lean Cuisine, Jenny Craig, and so on. They also said that buying produce is more expensive than eating out at fast food restaurants all the time. I’m not sure where they’re shopping or how they’re counting. But from my experience and checking out current fast food prices for a family of three, shopping relatively smart and unchic and sticking with the cheap nutritious bulk vegetables rather than the fashionable or precut, prebagged ones in the foodie magazines that cost three times as much–I’d have to say no, it really isn’t more expensive for what you get. Especially if you count the extra gasoline per trip to the fast food joints on a daily basis.

And I’m not happy that a nationally acclaimed panel of nutritionists–or the editorial staff, I’m not sure–seem more than a little veg-phobic. Buried somewhere in the blather–I mean, expanded description of the DASH Diet and how they ranked it–is the distinct suggestion that it’s too much work and too unrealistic to expect people to prepare and eat–you know–fresh unprocessed vegetables and fruits themselves. They actually put in the phrase that it’s too much “gruntwork” unless you can hire a private chef to do your cooking for you. Makes you wonder how they were raised–probably on a steady diet of Pop-Tarts.

Hunan Tofu, spare the salt (spoil the child)

tofu with broccoli

Last year my daughter kept hocking me that I never made enough meat. This year she’s going on twelve and decided, about a month before Passover, that she needed to be vegetarian because she has ambitions of becoming a veterinarian. Hard enough for anyone to deal with, but for a diabetic, it’s an added challenge, especially at Passover, which we got through with a lot of vegetables and a dispensation for tofu (though without soy sauce, which contains wheat) so she wouldn’t be stuck with only eggs and cheese and yogurt and nuts for protein. Next year, rice and beans are going back on the menu–I’m not stuck in Ashkenazi-think, and a lot of synagogues in the US are starting to reconsider the role of legumes, pulses and non-wheatlike grains at Passover. I’m all for it.

Still, we’re well past Passover now, and the issue today is tofu; see under: how to feed a vegetarian preteen some protein without overdosing her on sodium. One of our favorite Chinese restaurant dishes is tofu in black bean sauce, but no doubt about it, it’s loaded.

[Update Note, cue theme “Do the Math Yourself”: Check out the recent LA Times’ version of Hunan Tofu with Black Bean Sauce–looks wonderful, right? but the sodium stats at the bottom of the recipe are WAY off, even if Andrea Nguyen, the food writer, had been using low-sodium soy sauce. Perhaps the editors forgot to count the salt in the fermented black beans–which on its own is something like 850 mg per tablespoon, as far as I could find (it’s not listed in the USDA nutrient database). You really can’t rinse that kind of salt out, especially not if you’re using the rinse as a broth and adding it back into the dish. That plus 1/4 t. salt “or more” at 560 or so mg. and a couple of tablespoons of soy sauce–you’re looking at 750-1000 mg for each of 4 servings, or 1500-2000 each as “dinner for two”, or about an entire day’s worth of salt in a single dish–definitely not the 350 or so as stated in the article!]

Cooking at home is a lot cheaper in a number of ways (a 14-oz pack of firm tofu runs about $1.50 where we live), and we can figure out what to do about the sauce if we really want it. Invariably, the restaurant container is always swimming in sauce with a layer of oil on top, so I think just not doing that would be enough to improve the nutrition stats considerably.

Frying tofu at home won’t usually get you that crispy outside texture that you get in the Hunan tofu dishes from the restaurant–mostly, they’re shallow- or deep-frying the cubes or triangles in a lot more fat than you’d want to use at home for an ordinary dinner. A little less than that level of crispy is still okay by me. Getting any kind of brown on the outside would be a step up from the pale, flabby results I was used to achieving in the trusty nonstick pan.

So I started actually paying attention to the cookbooks I have on the shelf and to the techniques I invented for pan-browning things like salmon without salting the dickens out of them. I needed a (small amount of) sauce that tasted okay but wasn’t swamped with sodium. That means a little low-sodium soy sauce and a lot of ginger, garlic, maybe a bit of vinegar and sesame oil–and a surprise ingredient for browning and flavor depth: molasses.

Most syrups (agave included) run about 16 g. carb per tablespoon, a whisker more than a tablespoon of ordinary granulated sugar. Blackstrap molasses runs a bit less, at 11 g. per tablespoon. And it’s really thick, really strong-flavored, and really brownish-black. Also relatively inexpensive. Half a teaspoon will darken and thicken an ounce of sauce for frying tofu. It helps “stretch” the soy sauce–for looks as much as flavor and volume–without adding much sodium or carb to the dish. Even stranger (and better), molasses is a powerhouse source of potassium at 600 mg and iron at 20% of the RDA per tablespoon (not that we’re adding that much here, more like 1/6th tablespoon). The vinegar and sesame oil lend rich pungent flavor that doesn’t depend solely on the saltiness of the soy sauce, and ginger and garlic round out the combination.

So that’s the sauce. To get the tofu to brown in the frying pan, you have to get some of the extra water out of it first. There’s always the press-it-with-a-weighted-plate-on-top-for-30-minutes scheme, which always seems more of a pain than it’s worth. But I’m impatient.

There are two decent ways to press tofu other than the weighted plate setup. One requires thinking ahead (not my forte): slice the tofu and freeze the slices, then thaw them. The other–are you surprised yet?–is to slice and microwave the tofu on an open plate for a couple of minutes, say 4 minutes for a whole 14-oz. pad of firm tofu, or 2 minutes for half a pad. Then drain off the watery stuff that’s come out of the tofu (let it sit another few minutes and redrain), and pat the tofu dry.

To fry, heat a bit of olive or other vegetable oil in a nonstick pan. Brown some onion or scallion a few minutes. Make a frying sauce: 1-3 teaspoons of low-sodium soy sauce, depending on how much tofu you’re making, a minced clove of garlic, a teaspoon of fresh grated ginger, a few drops of sesame oil, a dash of vinegar and a pinch of brown sugar or better, a half-teaspoon of molasses. Hot pepper flakes or z’khug optional.

Pour the sauce into the hot pan and let bubble up a second or two. Then add the tofu cubes or triangles and toss a couple of times in the sauce. The sauce will be just enough to color the surfaces a little and get them started.  It’ll take another 5-10 minutes of stir-frying to get the tofu surfaces to brown nicely, but it does work. Serve atop microwaved broccoli and/or bok choy. Garnish at will with some chopped scallion, toasted almonds, fried mushrooms or slices of red bell pepper (or hot peppers and roasted peanuts for kung pao, if that’s your thing).

Sodium counts for this version:

If you figure the dish serves 3 people a decent meal-sized portion of protein, and the sodium is coming exclusively from the low-sodium soy sauce, a full tablespoon of soy sauce would be about 450-600 mg, so each serving is about 200 mg at the higher end. I don’t think I usually use quite that much for us, but even so it’s pretty reasonable. If you don’t mind doubling the sodium to about 400 mg per serving, you could make another dose of the frying sauce to drizzle the dish with at the last minute.

Questionable sodium study, even more questionable comments

A new European study that purportedly shows low-sodium diets to be ineffective in preventing high blood pressure, and even more unlikely, that they increase the risk of death from heart attack or stroke, is being published in the May 4 issue of JAMA, and predictably it’s already excited a variety of comments in Gina Kolata’s current New York Times article from the CDC and from…Dr. Michael Alderman.

Predictably, because the CDC researchers think too few people were studied for too short a time with unreliable methods (24-hour urine collection to measure sodium intake indirectly, after the fact as it were.)

Alderman’s reaction was also predictable: he’s still insisting that only a nation-wide feeding study sort of clinical trial that follows its subjects until they die is sufficient to prove a true link between sodium intake and cardiovascular disease. Something so expensive and unwieldy it couldn’t be completed even if it were started, and we’d still be waiting around 30 years later wondering if salt had anything to do with heart attacks or strokes. Very convenient for the processed food industry, but pretty useless for public health. And also conveniently, Gina Kolata found more than one expert to say so.

What she didn’t find, but could have, is that a number of large-scale feeding studies have already been done and shown that eating a balanced lower-sodium diet helps reduce blood pressure and prevent blood pressure increases. DASH-Sodium is one of them. And no one had to wait until the study subjects died to figure it out.

AHA: Diet sodas and excess salt both linked to strokes

The latest from the American Heart Association and American Stroke Association’s joint International Conference on Stroke 2011, which is going on in Los Angeles this week from Wednesday through Friday.

Diet soda may raise odds of vascular events; salt linked to stroke risk.

Two large studies on a mixed-race/age/gender/other health status population have just shown that:

1. Drinking diet soda every day increases your risk of a heart attack or stroke in the next 9-10 years. In the study, diet soda regulars had a 48% higher rate than nondrinkers even after accounting for metabolic syndrome and existing or past heart disease.

2. For every 500 milligrams of sodium you eat per day over the AHA’s recommended 1500 max, you have a 16% higher risk of getting a stroke–no matter whether you have high blood pressure or normal blood pressure.

There was one other piece of really bad news announced:

The Centers for Disease Control’s analysts looked at hospitalizations for ischemic stroke (blocked arteries to the brain) between 1994 and 2007 and found that while strokes are decreasing in people over 65 (which is good), they’re INCREASING in children, teens and younger adults. Although older adults still have much higher overall risk of stroke than younger people, the trend toward higher stroke hospitalization rates for younger people is significant and needs to be explored further. Stroke hospitalizations increased by:

  • 31% among boys 5-14; 36% among girls 5-14
  • 51% in men 15-34, 17% in women 15-34
  • 47% in men 35-44, 36% in women 35-44

The CDC researchers didn’t have clear evidence of a cause for the rise in strokes among younger people, but said the rise in average body weight, blood pressure and diabetes, which are known risk factors for stroke, bore a closer look.

The fact that stroke hospitalization rates started rising in children over 5 (the researchers looked at younger children as well but didn’t find an increase under age 5) suggests to me that part of the trend may be due to a more processed diet with higher salt consumption as children head for school. All in all, it gives you the impression that we are the junk food generation, and it’s catching up with us as we speak.

Age, salt and the new USDA dietary guidelines

Last Monday the USDA released its latest version of the Dietary Guidelines for Americans (nominally dated “2010”). I was driving home and NPR carried USDA Secretary Tom Vilsack’s speech, in which he listed a few of the new highlights: eat less, eat less food with solid fats, eat less processed food, eat more vegetables and fruits, eat less sodium.

How much less sodium? About 2300 mg or 6 grams (1 teaspoon) of table salt per day, he said, is the recommended maximum for healthy adults, in line with the long-standing National High Blood Pressure Education Program’s guidelines, which are shared by the American Heart Association and many other professional medical groups.

There’s a second lower-sodium recommendation for anyone overweight, African-American, with heart or kidney disease or high blood pressure or diabetes, and anyone middle-aged or older. This year, as the more specifically heart-health-oriented professional organizations already recommend, the USDA guidelines set the lower maximum at 1500 mg per day, or about 3 grams of table salt.

And you’d think that was great, and I do, that the USDA guidelines have finally caught up with what the medical associations have been demanding based on the overwhelming weight of studies on dietary sodium intake as it affects blood pressure, cardiovascular disease including stroke, and kidney disease.

But there are two catches hidden in the midst of all this, and I’m not even sure Vilsack was aware of it. Smaller one first: Middle-aged? How old is middle-aged?

“Fifty-one and older,” Vilsack said. Whew, I thought. Four more years before I have to start thinking of myself as middle-aged. By the time I get there, I’m hoping the standard will have gotten fudged upward by at least another decade or so.

Because, you know, if you’re not 50 yet, 51 sounds reasonable–and comfortably remote for a lot of younger adults. Which I am, thank you very much. Don’t look at me like that.

So here’s Catch-51: When I was working at the National Heart, Lung and Blood Institute back in the mid-’90s, the general working recommendation for lowering sodium to 1500 mg/day was all the other high-risk groups Vilsack mentioned…and healthy adults 40 and up. Not 51 and up.

The choice of a cutpoint at age 40 for otherwise healthy people was based on the risk data from the first three National Health and Nutrition Education Surveys, which began collecting data across the nation starting in the 1970s. The latest version collected data around 2006 and its findings were just released last spring by the Centers for Disease Control. All the NHANES studies correlate  in-depth interviews about diet, exercise and lifestyle patterns, and cardiovascular history along with clinical health measurements (height and weight, blood pressure, cholesterol, urinary sodium excretion, blood iron, etc.) from thousands of ordinary Americans. Even early on, there appeared to be an independent higher risk and a greater need to lower sodium at 40 and older, all other health risk factors being equal.

But of course 40 seems too young to be middle-aged. And the USDA, which issues the Dietary Guidelines for Americans, tends to downplay certain elements of the risk statements so that no one, or at least not the agency’s chief constituents, gets upset. The no one in this case might easily be the Continue reading

A Year of Artichoke Hearts

“Top 10 Recipes” lists are a big thing at the new year, a way to look back and figure out which dishes made a hit and which ones were just so-so. But sometimes, after an entire year, the top-10 judging criteria can get a little distorted. How do dining section editors compare five quasi-Asian stir-fried noodle-and-greens dishes, most of them mysteriously pumped up with bacon crumbles (2009’s star ingredient), and decide all five really belong in the top 10 for the year?

In one of my early posts, I was thinking about toasted cheese sandwiches (grilled cheese, hard to believe, was a Top 100 Dishes entry for Bon Appétit at that point). At the end, I threw in a quick little recipe for marinated artichoke hearts done in a microwave as an antidote to all the middle-American boredom. Yesterday I ran across an artichoke and potato salad from the LA Times‘s 2009 top-10 list and realized my artichoke hearts would probably make it better. Because they make everything better, or almost.

Marinating your own artichoke hearts takes five minutes, is less expensive than buying a jar of prepared ones, tastes fresher, and has a short list of real ingredients. A ~12-oz batch lasts more than a week in the fridge, where it’s  ready to serve as a pick-me-up for sandwiches, pasta, fish, omelets, salads, and hot vegetable dishes. I use these artichoke hearts so often that whenever I get to my Trader Joe’s and they’ve run completely out of bags of plain frozen artichoke hearts in the freezer and won’t get any in for weeks, I feel horrible and deprived, like someone who’s just been told not to talk with her hands.

That puts it in MY top 10.

You don’t need more than a dash of salt in this recipe to make the artichoke hearts taste intense and bright. The fresh lemon juice and garlic do it for you, and something about the artichokes themselves makes the combination work. Continue reading

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