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    Half-sour cucumbers, hold the salt

    Half-sour cucumbers, hold the salt

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    Copyright 2008-2015Slow 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

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

Salt reduction vs. hypertension meds–which would you choose?

One of the big complaints processed food companies, physicians in clinical practice, and the great gourmet media all have in common is that cutting back on salt would make food taste flat, and you as an individual wouldn’t necessarily get a big drop in your personal blood pressure from doing it. They argue that only “salt-sensitive” people have to worry about their intake, and anyway, a few points lower, they all say, isn’t really impressive enough to give up your 300-mg serving of sodium in a bowl of Kellogg’s raisin bran or 390 in a slice of La Brea sourdough. And don’t, for g-d’s sake, ask your favorite name brand celebrity chefs to stop salting early and often in each dish!

A big statistical modeling study in the New England Journal of Medicine this week knocks all this wishful thinking on the head, and does it very nicely. The study looked not at individual blood pressure drops but the health and cost benefit of dropping average salt intake by 3 grams a day over the entire U.S. population.

The researchers found that if everyone drops their salt intake back down, the benefits start to look like the ones from quitting smoking, cutting cholesterol and saturated fat, and losing weight to get to a normal BMI.

That’s because even when individual blood pressures drop by only a few points, they’re not going up (as they are today), and when a small average drop happens in a very large group, the big bell curve of disease shifts toward lower risk of consequences and later starts for developing heart disease and high blood pressure. After the first national cholesterol lowering guidelines were issued in the late 1960s, the nation’s heart disease and stroke risk dropped by about a third, and at least until obesity and blood pressure started to cause a back-reaction, the average age for a first heart attack went from 50 to 60 in men. That’s a huge kind of benefit.

The combined drop in heart disease and stroke deaths from cutting salt would be something like 200-400,000 people per year, a lot more than can be saved by simply putting everyone on blood pressure medications–the study made that comparison directly.

Altogether, a solid recommendation for dropping sodium levels in processed and restaurant foods, which make up about 80% of today’s sodium intake. And for not imitating processed food and chain restaurant thinking in your professional or home cooking, as Francis Lam seems to in his Salon.com commentary on the new NYC Department of Health initiative. And if there was any doubt that the Culinary Institute of America has been training Continue reading

Getting the Salt Out: NSRI and Voluntary Compliance, Again

In the wake of its city-wide diabetes reduction and restaurant nutrition labeling initiatives, the New York City Department of Health is leading yet another dietary health campaign, this time one that involves a national coalition of cities, states, and medical organizations. My hat’s off to them, even though I think the demands they intend to make of the food industry are much too light and much too toothless.

The National Salt Reduction Initiative, announced on Monday, will  encourage “voluntary compliance” from the processed food and restaurant industries to lower their sodium content by about 20% over the next 5 years. That’s pretty modest considering that both industries have doubled the standard sodium content of many common foods in the past 20-30 years, and that the national obesity epidemic seems to have coincided pretty nearly with that trend.

The UK’s national salt reduction campaign, which started in 2003 and serves as a model for NSRI, has government backing and its goal is 40% reduction of sodium in processed foods within 5 years, not 20%. They seem to be getting there, too.

NSRI’s coalition includes the Los Angeles Department of Health and a variety of medical organizations like the American Heart Association and the American College of Cardiology. What it doesn’t include this year, to my surprise–and, frankly, dismay–is involvement, funding or guidance from the National Heart, Lung and Blood Institute at NIH.

Ten years ago the NHLBI would have participated one way or another in encouraging this sort of initiative, but that was before the Bush years. NHLBI has been reorganized several times in the last decade. Two of its key diet-related outreach and education programs–the National Cholesterol Education Program and the National High Blood Pressure Education Program, which would have been the leading outreach proponent for NSRI–have receded from view, with perfunctory descriptions on the agency web site, no functioning links to current activities if there are any or to updated program pages, and no clear leadership or place in the agency’s organizational chart. But the need for them certainly hasn’t ended.

Voluntary compliance programs don’t have a great track record in the processed food industry. Look at the recent Smart Choices nutrition labeling program fiasco (see under, Froot Loops) from October.

Starting a national  program like this with voluntary compliance as a key component means the designers don’t think there’s much way to enforce the changes other than persuasion. It also means the government doesn’t have the tools, the money, or–and here is the crux of it–the will to enforce even modest limits on sodium content. Both the AHA and the AMA have been working on the FDA for years to get salt off the “generally harmless Continue reading

Stuffed: A Food Industry Insider Attempts Moderation

It’s taken me over a week to read and figure out what I wanted to say about Stuffed: An Insider’s Look at Who’s [Really] Making America Fat. As usual, I’m about 6 or 7 months late to be the very first reviewer—I waited until my library acquired it. But having read it, I’m astonished that none of the bloggers, pro- or con-, have picked up on the fascination of reading a food politics book for its entertainment value as it unfolds and reveals its eccentricities. Because this is one strange concoction.

Hank Cardello, who spent most of his career as a marketing exec for General Mills, Coca Cola and other giants of the branded food world, is not the kind of player you’d expect to enter the current obesity debate, certainly not as a champion for health. His current organization is “a consulting firm that helps businesses take the lead on solving social issues.” Does that mean he’s pro-processed? Anti-processed? Well, not exactly.

Stuffed is neither a counterattack from the food industry nor the next go-green manifesto. It’s Cardello’s attempt to mediate between restaurant chains, supermarkets, Big Food manufacturers, Big Agro, the government, public schools, and pretty much every other player in food politics. It does pack some original insights about the interlock between food industry, government, and consumer behavior and a few genuine surprises among his recommendations—some reasonable, some so strange it’s worth reading just to find out how Big Food envisions its future.

Cardello spends the first part of his book dissecting the ways processed food companies, supermarkets and restaurants make decisions about the food they sell, and how they market it to consumers. Although some of it’s been done before–-usually with more indignation–-Cardello takes full advantage of his inside experience to shed light on the large web of influences surrounding profit, the bottom line, and manipulation of consumer perception and demand.

Why is a muffin or bagel twice as big as it was 30 years ago? How did Swanson’s TV dinners steer American expectations toward convenience over quality? Who decides what goes on the supermarket shelves? How did Pizza Hut get the cafeteria concession at your child’s school? How come the price of fruits and vegetables rose by 40% in a decade while the price of sodas and snacks fell?

His answers reveal the fundamental gridlock of businesses that have grown so successful that they can’t change easily without shutting down. Without exactly letting anyone off the hook for clinging to damaging business practices, Cardello contends that not only basic business constraints but government and consumer expectations are making it difficult to shift the system enough to improve the overall health of processed food. Continue reading

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