November 2013 Issue

Spice Up the Flavor!
By Juliann Schaeffer
Today’s Dietitian
Vol. 15 No. 11 P. 22

Experts offer tips for preparing tastier home-cooked meals with little sodium to help clients prevent chronic disease.

While salt may make for a crave-worthy potato chip, too much doesn’t do a body good—and you know most Americans currently are consuming way too much.

“According to the American Heart Association, over 50 randomized trials have been conducted showing that as the intake of dietary sodium levels increases, so does blood pressure,” says Janet Bond Brill, PhD, RD, LDN, CSSD, a cardiovascular nutritionist, the author of Blood Pressure Down and Prevent a Second Heart Attack, and a Go Red spokesperson (see recipe here).

To be clear, however, the consequences stemming from high salt intake don’t end but begin with hypertension. “The harm from excess sodium intake goes far beyond blood pressure,” Brill says, noting that in addition to being a major risk factor for cardiovascular disease, which still is the leading cause of death among both men and women, high salt intake boosts the risk of conditions such as proteinuric kidney disease, hypercalcemia, urinary stones, arterial stiffness, and osteoporosis.

With one in three Americans currently diagnosed with hypertension, according to the Centers for Disease Control and Prevention (CDC), you can conclude that excessive salt consumption is a widespread problem.

In actuality, almost everyone is consuming too much sodium, Brill says. “The American Heart Association recommends that most Americans strive to cap their sodium intake at 1,500 mg/day, or a little over 1/2 tsp of salt,” she says. “But that’s just a fraction of what the average American eats. Salt [sodium chloride] saturates the American food supply, with the average man in the United States consuming 10.4 g of salt/day [the equivalent of roughly 6,200 mg of sodium] and the average woman consuming 7.3 g/day [roughly 4,400 mg of sodium], which is nearly triple the maximum daily amount.”

Even if your clients and patients aren’t part of the one-third of Americans with high blood pressure (or another third with prehypertension), Brill points out that nine in 10 Americans will one day develop hypertension, meaning everyone is “salt sensitive.” As such, “All Americans—even infants—should be monitoring their salt intake, as convincing scientific evidence has accumulated showing that increased sodium intake is a serious public health hazard that must be addressed,” she says. “If you’re eating food from a box, a bag, a can, a bottle, or off a menu, odds are you’re consuming excessive amounts of harmful sodium. The less processed your food, the less salt you’ll eat.”

What does that mean for the average American? It means cook more and consume less salt. “Fresh and prepared at home is best, when possible,” says Sonya Angelone, MS, RDN, CLT, a spokesperson for the Academy of Nutrition and Dietetics.
The trouble is most clients don’t cook at home most days of the week. And if they do, they still may throw a frozen pizza in the oven and count it as one night’s dinner. But while most people aren’t used to cooking most weekdays, it’s a skill they can learn.

Today’s Dietitian interviewed expert cooks and dietitians specializing in cardiovascular health who offer tips on what foods clients should avoid, how they can begin cooking more at home, and ways to pump up the flavor of their favorite foods without adding salt.

Where to Start
First up in getting clients to consume less sodium is a little education on the source of their salt habit. “Step one should be to educate patients on the top 10 food sources of sodium in the American diet,” Brill says. “People understand food, not milligrams.

“Almost half of the sodium we eat comes from only 10 types of foods,” she explains, referencing a recent CDC study that found 44% of Americans’ sodium consumption comes from the categories of bread and rolls, cold cuts/cured meats, pizza, poultry, soups, sandwiches, cheese, pasta mixed dishes, meat mixed dishes, and savory snacks.

Angelone uses the American Heart Association’s infographic, called the Salty Six, to discuss the top high-sodium foods with clients. “This is a good visual,” she says. “It includes the six [most] popular foods that can add high levels of sodium to the diet.”

In addition to educating clients on these high-salt culprits, “Suggest substitutions or livable options, such as cutting down on the number of pieces of bread consumed or purchasing lower-sodium brands,” says Brill, who also stresses to clients that while 65% of sodium comes from processed foods, another 25% typically comes from restaurants. “So consume more fresh and whole foods and eat out only once per week,” she says.

Cooking Ed
Next comes the real education that will make a low-sodium diet more feasible for clients: cooking tips. In addition to suggesting low-sodium recipes, encourage them to focus on what they’re adding to a dish to give it more flavor instead of what they’re losing—namely the salt. According to Robin Plotkin, RD, LD, a culinary nutritionist based in Dallas, one (or all) of three things can almost always be added to a dish to add flavor in lieu of salt: citrus, vinegar, and/or spice (see recipe here).

Amanda Gilley, RD, LDN, a chef at LifeBridge Health & Fitness, agrees: “Use a lot of spices and some sort of acid. The combination of salt and acid is what really awakens your palate to taste the flavors of food. By using more spices and herbs in combination with acid and less salt, you’re still going to get your taste buds’ attention.”

According to Michelle Dudash, RDN, a Cordon Bleu-certified chef and the author of Clean Eating for Busy Families, meals generally turn out better when clients know what flavor profile they’re going for before they start (see recipe here). “In general, when seasoning foods, think about the end goal, not necessarily about whether it’s an entrée or vegetable,” she says. “For example, if you’re making an Italian-inspired meal, most dishes can benefit from parsley, garlic, basil, oregano, and red wine vinegar.

How can clients determine which flavor profile to shoot for? Elaine Good, a personal chef specializing in organic gluten-, dairy-, and sugar-free cooking and who developed her own line of powdered seasonings called Herblends, suggests clients flip through a cookbook similar to the type of food served at their favorite restaurant “and look at the ingredients used for seasonings, and you’ll see the flavor profile you like,” she says.

“Overall, add a variety of textures in dishes when possible to add interest, like crunchy and chewy,” Dudash says. “And incorporate different flavors, such as tart, sweet, savory, and earthy.”

Having certain staple seasonings on hand for any given cooking session will help clients go far in adding flavor to many different recipes, according to Dudash. “The must-have seasonings to add to a variety of dishes are fresh garlic, garlic powder, Italian seasoning, and chili powder,” she says. “I finish almost every dish with freshly ground black pepper. Fresh chopped Italian flat-leaf parsley can enhance most dishes.”

Fresh lemon or lime juice and chopped fresh dill and garlic are fabulous with all types of fish dishes, Brill says, adding that balsamic vinegar, “especially the well-aged sweet variety,” is an absolute must for salads.

Plotkin recommends rosemary for chicken, steak, and potato dishes, and suggests having cinnamon on hand for oatmeal, baked goods, and baby food.

For clients who may be intimidated by the mass of herbs and spices lining the shelves at the grocery store, Dudash recommends they start out small—and slow. “Start out with a few salt-free seasoning blends, such as Mrs. Dash and McCormick, which take the thinking out of which spice to use on what,” she says. “Then your clients won’t have to invest in a whole arsenal of herbs and spices.”

Gilley suggests a little spice experimentation to introduce clients’ palates to new tastes. “Start experimenting with different combinations by creating spice mixes and sprinkling them on a cracker or piece of bread to see how they taste,” she says. “Typically, spices with similar colors mix well together—reds with reds, yellows with yellows.”

Starting an herb garden also can make clients more inclined to try new spices. It will help them “become familiar with various varieties and then, when your herbs hit their growing season, you have a lot extra,” Gilley says. “It will encourage you to use more or give some to friends, so they can experiment and give you suggestions. Introducing new ingredients into your routine will help you incorporate them easier into your lifestyle.”

Kicking Up the Flavor
In addition to experimenting with various herbs, there are other ways to spruce up flavor.

Lean proteins: When it comes to low-sodium cooking, Rene Ficek, RD, LDN, CDE, lead nutrition expert for Seattle Sutton’s Healthy Eating, a family-owned Illinois-based company that serves healthful meals for weight loss and chronic disease management, says citrus and herbs should be clients’ new best friends. “Substitute bottled marinades for citrus juice and olive oil,” she suggests. “Instead of reaching for the premade marinade that’s packed with salt, let meat soak in a mix of olive oil and citrus juice such as lemon or lime to get the rich flavor without the added sodium.”

She also recommends clients experiment with various vinegars to add a low-sodium flavor kick. “Use flavored vinegars for meat marinades,” she says. “Experiment with new flavor combinations to season and soften the meat without adding salt.”

An apple fruit-infused vinegar, such as one made by Mangé, pairs great with pork and a strawberry variety goes well with chicken, according to Ficek.

For clients craving some crunchiness, Dudash recommends stirring chopped nuts into a chicken or fish breading as well as garlic and onion powder for flavor without the salt.

Pan searing offers another way of getting the crispness of fried chicken or fish without all the unnecessary sodium that typically accompanies what’s served at a restaurant. “For a chicken breast or heartier fish, like a salmon or mahi mahi filet, pan searing adds a crisp, caramelized layer onto your meat,” Plotkin says. “This caramelized crust adds flavor, so less salt is needed. Before searing, marinate poultry and fish in a marinade made from olive oil, lemon juice, and rosemary.”

Vegetables: Margaret Pfeiffer, MS, RD, CLS, a practicing cardiac nutritionist and the coauthor of the recently released Indian Inspired Gluten-Free Cooking, says vegetables are a great place to start experimenting with a little spice. “Bring them alive with a bit of oil and spices,” she says, recommending chopped fresh sage with zucchini and fresh tarragon on steamed green beans.

“A great savory spice mix for vegetables includes cumin, chili powder, paprika, pepper, garlic powder, onion powder, and red pepper flakes,” Gilley says.

Brill says curry can add a ton of flavor to any vegetable dish. And she likes to roast her favorite veggies with extra-virgin olive oil and balsamic vinegar. “You’ll never miss the salt,” she says.

Plotkin agrees: “Roasting vegetables in the oven—like Brussels sprouts, onions, cauliflower, or bok choy—has a way of intensifying the sweet veggie flavor through the process of caramelization. Steaming or boiling dilutes flavors. Toss veggies with olive oil and garlic powder and then roast in the oven until tender.”

After cooking, Dudash suggests a spritz of fresh lemon juice or a splash of vinegar for a flavorful finish. “Enjoying seasonal produce tastes better than produce that’s been sitting around for a long time, so you don’t have to manipulate it with as much salt,” she adds.

Rice and beans: Washing canned beans before using can significantly decrease the salt content. “Be sure to rinse your canned beans until they no longer foam up,” Plotkin says.

Brill likes adding a nutty flavor to rice. “Nuts and dried berries such as sliced almonds and cranberries help spruce up rice and pilaf dishes,” she says. “And beans can be flavored with red wine, onions, and garlic.”

Nutritional yeast seasoning is Dudash’s low-sodium secret to adding umami flavor without the salt. She also suggests onion flakes, Italian herb seasoning, and apple cider vinegar to spruce up a rice pilaf. “Cook rice pilaf in low-sodium broth instead of water,” she says. “While the broth contains some sodium, it brings a wealth of aromatic flavorings, too, allowing you to skip the salt shaker altogether.”

Pasta: How can clients keep pasta tasting great without adding salt? There are multiple ways to do it, but Gilley says adding any fresh herb mixed with fresh garlic, fresh lemon juice and zest, olive oil, pepper, and a little mustard works nicely on almost any pasta.

“Think ‘heat and sweet’ for tomato-based pasta dishes,” says Brill, who recommends making homemade tomato sauce to avoid the high salt content of commercial varieties. “Then flavor with red pepper flakes, a touch of sugar, and lots of fresh basil, garlic, oregano, and onions.”

Ficek says using tomato purée instead of tomato sauce also can save a bundle of sodium. “Tomato purée is a bit thicker and is even a little bit cheaper,” she says. “Almost every recipe you use tomato sauce in, you can substitute tomato purée. It has only about 20 mg of sodium per serving.”

When a dish without cheese just isn’t in the cards, Plotkin says using high-quality ingredients can go far to reduce sodium. It’s all in how much you use, she says: “Using a high-quality Parmesan cheese adds a ton of flavor, and yes, some salt. But using these strong, high-quality cheeses means you don’t need to add as much cheese [and salt] to the dish,” Plotkin says, noting that although it’s recommended, adding salt to water in which the pasta is cooking isn’t necessary.

“For a low-sodium version of macaroni and cheese, replace half of the cheese with roasted and mashed acorn squash,” Plotkin adds.

Soups and stews: Soups are a fall and winter staple in many households, but too much salt doesn’t have to be. To make low-sodium soups that taste great, Dudash recommends starting with the right flavors. “Build a good foundation with aromatic vegetables such as onions, celery, carrots, and leeks,” she says. “Bay leaves and parsley stems can be added to homemade soups when the broth is added, but make sure you remove before eating.”

Low-sodium broths currently are available at most grocery stores, such as Pacific Foods’ line of broths and stocks, and these can help lower overall sodium counts. For an alternative to broth, clients can take Ficek’s advice: “Instead of using beef, chicken, or vegetable broth, simply boil shiitakes [dried or fresh] in water for 30 to 40 minutes,” she says. “Not only do the mushrooms lend an earthy flavor to any soup, stuffing, or gravy, they also happen to be packed with natural umami.”

To top it off, Plotkin suggests making an herb topping for a flavorful finish. “Top soups and stews with fresh cilantro or basil, depending on what flavor profile you’re going for,” she says.

Sauces: Dijon mustard, onion powder, and garlic powder are Dudash’s favorite flavorings for low-sodium creamy sauces and dips, adding that a touch of nutmeg is the perfect finish to a creamy pasta sauce. “For Asian-inspired dishes, use Chinese five-spice powder, ginger, and rice vinegar,” she says. “Rice wine, dry sherry, or vermouth adds depth to sauces.”

Ficek suggests using a balsamic vinegar reduction as a substitution for salty sauces. “Bring balsamic vinegar to a boil using a nonreactive pot and simmer until it’s reduced by half,” she says. “This goes great as a mildly sweet topping on meat and fish.”

Desserts: Because premade bakery items can harbor large amounts of hidden sodium, clients are better off baking their own. “When baking, use vegetable oils, substitute avocado for butter, use fresh/dried fruits, honey, jam, jelly, and yogurt,” Plotkin says. When that’s not possible, she says sorbets, sherbets, frozen dairy desserts and, of course, fruit, are clients’ best low-sodium sweet treats.

“My family loves ripe banana slices with cinnamon,” Angelone says. “Microwave for 1 to 1 1/2 minutes. No added salt or sugar. Delicious!”

“If chocolate is in order, you could have a couple squares of Ghirardelli dark chocolate—0 mg of sodium per serving,” Brill says.

Variety Is Key
Overall, tell clients variety isn’t just the spice of life but the best way to keep them on track with a low-sodium diet. “Aim for variety in your cooking,” Plotkin tells clients. “Experiment in the kitchen with different cuisines. Changing up the spices you use keeps your palate from getting bored and reaching for salt.”

It seems a regular home-cooking routine may be the best prescription yet for high blood pressure and all its dire consequences.

— Juliann Schaeffer is a freelance writer and editor based in Allentown, Pennsylvania, and a frequent contributor to Today’s Dietitian.


Janet’s Roasted Tofu and Cauliflower Curry With Brown Rice

Serves 6

One 14-oz container extra-firm tofu
One 2-lb head cauliflower, cut into 1-inch pieces (about 8 cups)
3 T olive oil
1 large sweet onion, halved and sliced
4 T curry powder
1 tsp ground ginger
1 tsp ground cumin
1 tsp salt-free seasoning blend
3 cups cooked brown rice

1. Preheat oven to 450˚F. Remove tofu from the container and drain.

2. Place several paper towels on a plate. Set the tofu on the paper towels and put several more paper towels on top of the tofu. Place a heavy plate on top of the tofu to press the excess moisture out of the tofu. Cut the tofu into 1-inch pieces and combine with the cauliflower. Set aside.

3. In a large skillet, heat the oil over medium heat. Add the onion and cook, stirring until golden brown, about 5 minutes. Stir in the curry, ginger, cumin, and salt-free seasoning blend to coat the onions. Mix the curry and onion mixture with the cauliflower and tofu. Stir gently to combine.

4. Spray a baking sheet with nonstick cooking spray. Spread the tofu and cauliflower in a single layer on the sheet and bake, stirring occasionally, for about 30 minutes or until the cauliflower is tender. Serve over cooked brown rice.

Nutrient Analysis per serving (1 cup cauliflower and 1/2 cup brown rice)
Calories: 279; Total fat: 11 g; Sat fat: 2 g; Trans fat: 0 g; Cholesterol: 0 mg; Sodium: 62 mg; Total carbohydrate: 37 g; Dietary fiber: 8 g; Sugars: 6 g; Protein: 12 g

— Recipe reprinted with permission from Blood Pressure Down by Janet Bond Brill ©2013


Mediterranean Quinoa Salad

Serves 6

2 cups Welch’s 100% Grape Juice
1 cup quinoa
2 T feta cheese
1 T toasted walnuts, coarsely chopped
1 T Greek olives, finely chopped
2 T chickpeas, skins removed
Juice from 1 lemon
1/4 cup fresh parsley, chopped (reserve 1 T for garnish)

1. Cook quinoa according to package directions, replacing the water with Welch’s 100% Grape Juice made with Concord grapes.

2. Transfer cooked quinoa into a large bowl. Add cheese, nuts, olives, and chickpeas. Stir gently. Add juice from 1 lemon and parsley. Stir gently. When serving, add remaining parsley for garnish. Serve warm.

Nutrient Analysis per 1/2-cup serving
Calories: 240; Total fat: 5 g; Sat fat: 1 g; Trans fat: 0 g; Cholesterol: Less than 5 mg; Sodium: 120 mg; Total carbohydrate: 40 g; Dietary fiber: 4 g; Sugars: 9 g; Protein: 8 g

— Recipe courtesy of Robin Plotkin, RD, LD


Rosemary Sweet Potato Oven Fries With Spicy Aioli

“I finally discovered the perfect dipping sauce for sweet potatoes in France, where the French dip traditional fries in mayonnaise instead of ketchup,” says Michelle Dudash, RDN.

Serves 4 (12 fries each with 1 rounded T aioli)


Expeller-pressed canola oil spray
2 sweet potatoes, peeled, cut lengthwise into long batons (like French fries)
1 T and 1 tsp expeller-pressed grapeseed or canola oil
2 tsp chopped rosemary (or 1/4 tsp dried thyme)
1/4 tsp freshly ground black pepper
1/8 tsp salt

1/4 cup light olive oil mayonnaise (or plain light mayonnaise)
1 T low-fat plain Greek yogurt
1 tsp lime juice
1/8 tsp curry powder
1/8 tsp garlic powder

1. Preheat oven to 450˚F and line a large sheet pan with a silicone baking mat or parchment paper coated with canola oil spray.

2. To make the fries: Toss sweet potatoes with oil, rosemary, pepper, and salt and spread them out in a single layer on the sheet pan. Bake on the bottom rack of the oven until golden, about 30 minutes, turning them and rotating the pan after 15 minutes.

3. To make the aioli: Stir together mayonnaise, yogurt, lime juice, curry powder, and garlic powder in a small bowl.

4. Serve the fries with the aioli.

Nutrient Analysis per serving
Calories: 148; Total fat: 9 g; Sat fat: 0 g; Trans fat: 0 g; Cholesterol: 5 mg; Sodium: 174 mg; Total carbohydrate: 16 g; Dietary fiber: 2 g; Protein: 1 g

— Recipe reprinted with permission from Clean Eating for Busy Families by Michelle Dudash, RDN (Fair Winds Press, December 2012)