WSJ Interview: Making Sense of the Salt Shaker

I have been asked to do several interviews on salt (aka. sodium) in food recently, and wanted to share the one that was published most recently in the Wall Street Journal on September 27, "Making Sense of the Salt Shaker."

This story gives some interesting tips and tricks to reduce sodium intake without sacrificing flavor--including highlighting the method I use to properly season the food that I cook with salt. Clearly, the beef chili example used in the recipe was not my choosing, but the technique works well for anything that you can stir and season: think soups, stews, sauces, or a pot of beans. 

Please try this out and share your thoughts in the comments!

Radio Interview on WSRQ, Part 1 - Sugar, salt, fat and weight control

Recently, I was interviewed about risk factors for heart disease and diabetes on Health Check with Heidi Godman.

Here is a link is to Part 1 of the interview - Click to here to Listen or Read Transcript below.

Oil, Salt, Sugar*

10/8/2014 -- Transcript:

Heidi: Welcome to Health Check, I’m Heidi Godman. You know doctors are always telling us to eat a healthy diet and that sounds fine until you’re trying to figure out how to make your dinner taste great, too. But, we have some help for you today. Dr. Michelle Hauser is an internist who also went to culinary school and she joins us now from Stanford University.

Michelle: Hi, Heidi. How are you?

Heidi: I'm great! I'm glad you're here. I interviewed you when you were at Harvard University and we did a number of nutrition stories together when you were at the medical school. Oh wait, it was your residency, right, when you were at Harvard Medical School?

Michelle: Yes, that's right we first met when I was in residency.

Heidi: Okay, so you just going to Stanford. Tell us what you're doing.

Michelle: Okay, so now that I'm done with my internal medicine residency, and I'm feeling like a real doctor with a license and whatnot…

Heidi: Yes, congratulations.

Michelle: Thank you. I'm doing a postdoctoral research fellowship where I am basically studying the effects of healthy lifestyle change on disease prevention like diabetes and heart disease.

Heidi: Well, that's very interesting. So, what is it that you are hoping to do with the rest of your career?

Michelle: For the rest of my career, I'm hoping to have a mix of doing the sort of research that I just mentioned, seeing patients in an academic medical center where I'm able to teach med students and residents, and hopefully take what I've learned from research and help change public-policy to help make it easier to make healthy lifestyle changes.

Heidi: Fantastic, and I know you also have that policy background. Tell us about that.

Michelle: Oh, so while I was in the middle of med school, quite a few years ago now, I went to the Harvard Kennedy School of Government and got a degree which focused on public policy and public administration.

Heidi: Fantastic. You are so well-rounded and you have this wonderful approach -also made even more wonderful because you went to culinary school. In fact, you went there long before you went to medical school, right?

Michelle: Yes, definitely.

Heidi: Tell us about that. Why did you go to culinary school?

Michelle: That was about 15 years ago, now. Oh my gosh. And, I went there because I - it's a longer story than we have time for today, but the gist of it is that I grew up in a pretty poor family and no one had a lot of faith that I would really end up being a doctor. I was trying to find my second passion to focus on so I ended up going to culinary school because I thought that would be what I would do with my life. Now, I guess I'm still doing something with it. But, I decided I would try out the medicine and that’s working out okay.

Heidi: Yeah, I think you've done very, very well. Congratulations on all of your success so far. So this nutrition approach, I know gives you a really great perspective on treating all kinds of diseases - especially heart disease which is what you're focusing on now. Tell us about that perspective.

Michelle: So, that perspective really stems initially from some personal changes that I made. That is, when I was growing up I had some extra weight and was doing all the unhealthy things that we talk about. I was drinking a lot of soda, eating a lot of fried and fast foods. When I made the changes in my life, when I learned what they were and figured out ways to do them, I just feel like a totally new person. So, while I was in my premed classes, I was also teaching at a culinary school. At that time, I started researching nutrition on my own. My students at the culinary school would ask a lot of questions about what they could do to make something healthier.  After awhile, their family members started telling me stories about how they didn't have to be on a blood pressure medicine or that they were off insulin - or they cut down their insulin - for their diabetes, or were off anti-depressants. I think I was really hooked for the long term at that point on. When I really realized I could make a big difference if I focus on healthy lifestyle changes.

Heidi: Incredible. Well, what about the mistakes that people have been making that you've noticed. Have you been able to help them change their diet, change what they’re eating? But what is it that they were doing that wasn't right?

Michelle: There are quite a few things, and I mean we really pay people a disservice by focusing on people not having enough "willpower.” But, it's really over the years as we've grown more obese and overweight as a nation that the food environment has really changed. The things that are easiest to eat and easiest to make are the things that tend to be the least healthy for us. They also tend to be less expensive because of the way we subsidize our food in this country. So, you know, things like sugar sweetened beverages – which are sodas and juices - fast food, fried food and basically anything that's really far away from how it started out when it grew from the ground. Things like cookies and things that come in boxes and packages in the store.

Heidi: Things that are very processed.

Michelle: Very processed, yes.

Heidi: Well, I do want to talk about some of the consequences of eating this food because we know, generally speaking, it's bad for us. But, let's get down to the nitty-gritty. So, you mentioned sugar sweetened beverages. The statistics on how much added sugar people are eating everyday are very disturbing. So, let's talk about sugar and what it can do to our bodies. Why is too much sugar not a good thing?

Michelle: So, the biggest risk of too much sugar - and I think you made a good point that the sugar were talking about is added sugar. So, I'm not telling anyone they should be cutting out fruit or sugars that are naturally occurring. That's a separate issue. Added sugars, we don't actually need any to survive and they do present an increased risk of diabetes and weight gain. And the weight gain plays into the risk of diabetes and also into heart disease and other risk factors that go along with that like high blood pressure.

Heidi: What is it about sugar when it gets into the bloodstream? I know it's making high blood sugar, and what else is it doing physiologically to us?

Michelle: So, when we eat added sugars what happens is that an organ, kind of right where you would point to your “stomach” if you said, “oh, you know, I'm really hungry,” is an organ called the pancreas which makes our natural insulin. When we have a bunch of sugar, it will spit out a bunch of insulin - usually more than you would really need to digest and use that sugar. What happens then is that after your blood sugar goes up really high, that extra insulin makes it go down really low, really fast. What that does is it makes you hungry right away, as soon as your blood sugar gets low, even though you didn't do enough work for burn off enough calories to take care of whatever it was you just ate. It's a vicious cycle.

Heidi: Sure.

Michelle: You don't have enough willpower to fight that. It’s a thing that’s been there as long as we've been humans. We can't really fight it.

Heidi: And sugar is also linked to inflammation and diabetes and heart disease and there was a big study that just talked about the link between added sugar and heart disease. So yeah, added sugar - you definitely want to avoid that. What about the consequences of fat? Fat, I think, it's a very confusing topic. Some fat, the unsaturated fats, are good for us in a limited amount. Of the saturated fat, the trans fat, what are the problems with those?

Michelle: Right. As you said, fats are a complicated thing. There are a lot of experts who are very well respected who will say low-fat diets, or higher fat - as long as they are good fats - are fine. So where everyone agrees, I think, is that we should be cutting out trans fat as much as possible. The government says that we should get less than 1 g per day. But, really, if you get none, that would be best. That's because trans fats cause our bad cholesterol to go up and our good cholesterol to go down. It has the worst effect of any type of fat on our cholesterol. That means, I think that one of the statistics was, 200,000 heart attacks and deaths could be avoided, at the peak of our trans fat consumption, if we cut trans fat out of our diets. It really  leads to a lot of cholesterol problems. Where you get trans fat in your diet is mainly hydrogenated vegetable oils. There's a little bit naturally-occurring in beef and red meat and dairy fats. But I think the jury is out for little bit on whether or not those are quite as bad as the ones that are artificially made with the vegetable oils.

Heidi: Right, right, and what about the saturated fat? Because, because you're mentioning beef and things like that which, of course, are full of saturated fat.

Michelle: So, saturated fat. So, we know saturated fat, it's found in things like meat and dairy products, like butter and cheese, and fast foods and desserts, that puts us at increased risk of things like heart disease, bad cholesterol going up, and what not. But, it's not as bad for you as trans fat, and, I think, the studies really give a complicated picture. The way that I read through them is that it's good to cut out saturated fat - if you replace it with how the fat with fruits and vegetables. But, if you just replace the saturated fat with things like added sugars and a lot of processed food, it actually makes you less healthy. So, you really have to be careful when you cut out saturated fat, what you're putting your diet to replace it.

Heidi: Excellent point. And I think a lot of people don't think about that. They just think, “oh, I'm getting rid of this one thing and now I can fill it with all this other stuff.” So, very good to bring that up. Then we should also mention salt, sodium. So many foods have it - restaurant food and so many different things – but salt is also a risk for high blood pressure and our heart. Tell us about that.

Michelle: The thing is with salt is that we eat about 1 1/2 to 2 times twice as much as we should per day. And, that is, when we say how much we should eat, it's actually a maximum of what we should eat. So, we actually need a very, very tiny portion of what we take in to actually survive, because we need a little. I don't think there's anyone out there that has to be concerned about getting enough salt - unless you're a marathon runner or some sort of really elite athlete. The main problem with salt is that it raises blood pressure, and for some people it raises blood pressure a lot and for some people it doesn't have quite as much of an affect. The tricky part is just that testing it out on yourself you don't really know whether or not you're one of those people that it affects a lot or little. So, anyone that has high blood pressure would really benefit from trying to cut out - even if it's for a short time, as much as they can and really get the level down low to see if their blood pressure improves. If it doesn't improve that much, they should still stick to the recommended amount, but, you know, maybe they need to look elsewhere, like weight loss and exercise and what not to get at lifestyle factors that affect their blood pressure.

Heidi: Yes and weight-loss and weight control, at least, we should say has a huge impact on good health. Tell us about that.

Michelle: Yes, weight control is one the most important things we can do, because a lot of the risk factors that we talked about before really are tied to, and you can't separate them from, weight control. Because a lot of bad habits and things that we do to ourselves travel together. Many of them lead to increased weight, so if you're gaining weight, or you're quite overweight or obese, then you're a much higher risk of not only heart disease and stroke, but diabetes, cancer, worsening arthritis for sure, infertility - which a lot of people don't think about - and a lot of problems with sleep, like sleep apnea. Then, when you don't get enough sleep, or enough good sleep, it actually makes you hungrier and you eat more and that's also a vicious cycle. So, it's very important.

Heidi: Alright, well these are all excellent points, and now we want to find out what to do about it, but we need to take a quick break. So, everybody don't go away. More with Dr. Michelle Hauser from Stanford in just a minute. You're listening to Health Check with Heidi Godman on WSRQ.

*Photo credit:  http://www.fstjournal.org/features/27-1/natural-ingredients

Salt, Blood Pressure and the Diet

In this video, I discuss what salt is, how it is related to blood pressure, why we’re supposed to eat less of it and how that translates to the food we eat and real-life things we can do to cut down on the salt in our diets while still eating delicious food!

The text of the video is below.  Some items, such as “tips to reduce salt when eating out” and the equation for figure out how much sodium is in your salt at home, as well as figures and pictures are not included on the video.  

Salt

What do you think of when you think of salt?  In chemistry, salts are ionic compounds that result from the neutralization reaction of an acid and a base. Salts are responsible for countless essential things that you may not think about including growing food, sanitizing pools and drinking water, making computers work, creating nanotechnology, keeping things cold, melting ice, laboratory tests to diagnose diseases and drugs to treat them. 

Salts can give food any of the 5 flavors – salty, sour, bitter, sweet and savory.  They can be every color of the rainbow. 

But that’s probably not why you decided to watch this video. 

Like most people around the world, you’re most concerned with the health effects of sodium (aka. NaCl or sodium chloride) in your diet.  The average American gets almost 3,500mg sodium per day – way more than 2x the recommended amount and 1,100mg more than the tolerable upper intake. 

Definition: tolerable upper intake is a term used to caution against excessive intake of nutrients that can be harmful in large amounts. This is the highest level of daily consumption that current data have shown to cause no side effects in humans when used indefinitely without medical supervision.

Don’t get me wrong – we need sodium to survive.  How much do you think we need each day for survival? 180-500mg.  Assuming we need 500mg, the average American gets 7x that. 

Source: Centers for Disease Control (CDC) 

Why is this important? 

Because nearly 400,000 deaths each year are attributed to high blood pressure. 

As people eat more salt (on average) blood pressure increases.  The opposite is also true – when populations of people eat less salt, blood pressure decreases on average.  While it is true that many people will get high blood pressure as they age, it has been shown many times that populations of people that eat low salt diets do not develop high blood pressure at the early ages that people in the US (and countries with similar diets) do. 

The people most at risk of high blood pressure or worsening high blood pressure are:

- 51 year-old or older

- African Americans

- Those with diabetes

- Those with chronic kidney disease

- Those who already have high BP

For these groups of people, it is recommended you consume no more than 1,500 mg of sodium per day.

For anyone else, the recommendation is no more than 2,300mg of sodium per day.

But want does this really mean for real people? How much salt can you have each day? That’s why I’m here.  First, a few more numbers.

You’re supposed to have no more than 1,500mg per day if you’re in one of the groups listed above or 2,300mg if you’re anyone else.  How much salt is this?

Amount of sodium per measure of generic U.S. table salt

1/4 teaspoon salt = 600 mg sodium

1/2 teaspoon salt = 1,200 mg sodium

2/3 teaspoon salt = 1,500 mg sodium ** Maximum recommended sodium for groups listed above

3/4 teaspoon salt = 1,800 mg sodium

1 teaspoon salt = 2,300 mg sodium ** Maximum recommended sodium for all others

From top to bottom: 1 teaspoon measuring spoon, 1 teaspoon Diamond Crystal Kosher salt, 

2/3 teaspoon Diamond Crystal Kosher Salt 

Are all salts created equal? No.

Generic U.S. table salt weights 273 g per cup,

Morton’s Kosher Salt weights 218 g per cup and

Diamond Crystal Kosher Salt weighs 142 g per cup. 

Wow – that’s a big difference!  You can eat twice as much Diamond Kosher Salt by volume as you can regular table salt. 

No, I have no affiliation whatsoever with any salt company!  Why is this?  I use Diamond Crystal Kosher salt when I cook because, well, I’m used to it and know how much saltiness a pinch adds to a dish, but also like it because there’s less tendency to over salt, it is pretty inexpensive, has no off flavors and has a nice crunch. 

How much sodium is in your salt at home?

If you want to find out how much sodium is in the salt that you use, you’ll need a scale that weighs in grams.  Weigh 1 level cup of your salt (making sure not to include the weight of the container) and then multiply that number by 40% (or 0.4) to give you the grams of sodium per cup since salt is 40% sodium.  Now multiply that number by 1000 to get the number of mg of sodium per cup.  Take this number and divide by 48, which is the number of teaspoons per cup to get the mg of sodium per teaspoon of your salt.  

[(Weight of salt in grams) x 0.4 x 1000]

_________________________________     =    mg sodium per teaspoon salt

                               48

Unfortunately, it’s not as easy as saying “hey, I’ll measure out my allotted amount of daily salt and use only that.”  At least 75% of the salt an average American eats comes from processed food.  Unless you make all of your processed food at home by opening cans and boxes and measuring portions and recording sodium per serving, it is almost impossible to keep track of your daily sodium – unless you minimize high salt processed foods and eating out. 

The absolute best thing you can do to reduce your salt intake is to prepare more meals at home using fresh, unprocessed or minimally processed foods.   

I give a number of other tips in other blog posts, particularly the recent on Flavoring Foods with the Farmer’s Market Bounty…Not a lot of Salt and will continue to address this issue in future posts because it is so important, but again, the best thing you can do to reduce your salt intake is to cook at home. 

This doesn’t mean you have to slave over the stove three times per day to make wholesome, elaborate meals.  The point of my blog is to show people how to make healthy cooking, delicious, time effective and reasonably priced.  If I could eat healthy as a poor kid in college and now as a time-strapped internal medicine resident, then you can, too!

Tips to reduce salt at home:

1) Cook at home.

2) Taste before you add salt.

3) Try adding something with a bit of acid – like hot sauce, lemon juice or a few drops of vinegar – either before adding salt or along with adding salt since the combination of acid and salt helps to bring out flavor in foods.

4) Use fresh and dried herbs and spices to add flavor.

5) Add interest to your plate by eating a variety of colors, flavors and textures – we eat with all of our senses and the less dull your plate is, the less likely you are to feel the need to add salt.

6) If you do use processed foods, opt for low sodium or salt-free versions.  You can always add salt or other seasonings or flavorings to taste later and will definitely add less than the processor would have in the full-salt versions.

Tips to reduce salt when eating out:

1) Opt for sauces and dressings on the side so that you can add only the amount needed as these items are generally salt heavy. 

2) Stay away from soup unless it is made completely from scratch. 

3) Stay away from tomato-based sauces unless they’re made completely from scratch with fresh tomatoes since the canned tomatoes used in most restaurant preparations of pasta and pizza sauces are very high in salt.

4) Avoid cheese and deli meats.

5) Look for foods that are grilled, baked, steamed, sautéed or roasted.

6) Ask if your dish can be prepared with little or no salt.

7) Avoid chain fast-food or fast-casual (i.e. Applebee’s, Chili’s) because food is usually just assembled and there is little control over preparing something with less salt.  However, you can look at these restaurant’s websites for sodium information and pick a dish ahead of time that’s lower sodium.

8) Any item with a lot of fruit and/or vegetables in it that is not a casserole or cream and cheese-based dish is likely to be a low-salt option.

9) Stay away from salty condiments like soy sauce, pickles, olives, ketchup.

10) The sauces on Chinese, Japanese, Thai and Indian food generally tend to be very high in salt, again try to get sauces on the side and add only as much as you need to steamed or lightly stir-fried vegetables and rice.

11) Choose sorbets and fresh fruit for dessert or a small piece of dark chocolate or share a dessert with the table.

Potassium

Finally, it is really important to get plenty of potassium in your diet to maintain a healthy blood pressure as well.  The recommendation is 4,700 mg/day of potassium.  All the details of potassium will have to be another video, but eating a good variety of fruits and vegetables is the best way to get enough potassium. 

Good sources of potassium:

Green leafy vegetables (spinach, swiss chard, kale, etc.)

Beans (lima, soy, pinto, lentils, kidney, etc.)

Potatoes and sweet potatoes

Bananas

Papaya

Avocado

Herbs

Dried Apricots, prunes, currants, raisins and dates

Nuts and seeds

Dark Chocolate

Chili peppers and powder

Fish (salmon, pompano, halibut, tuna, lingcod, mackerel, anchovies, cod, snapper, grouper, trout, etc.)

Thanks for joining me, A Chef in Residency – I hope you’ve learned something to improve your health and I wish you all Happy Cooking!