You know the importance of following your doctor’s guidelines about medication, exercise, and rest; reducing stress; and eating a healthy diet. But if you’re like many people with lupus, at one time or another you’ve come across a dietary or herbal supplement that really sounds as though it could help you. So, what do you do?
By Melanie Padgett Powers
She may not be faster than a speeding bullet or able to leap tall buildings in a single bound, but Jessica Goldman, 28, is quite the superhero. As her alter ego, “Sodium Girl,” she could easily don a red satin cape and a pair of leather boots before heading out to knock down her arch-enemy—salt—with a lethal kick.
Her sodium-fighting ways began in 2004. After experiencing headaches, intestinal problems, and fatigue, she headed to the ER only after severe water retention added 10 pounds in just a few hours one night. She was diagnosed with lupus, and suddenly, her brain and kidneys were under attack. She suffered grand mal seizures, her bone marrow was struggling to function, and she was placed on dialysis and given chemotherapy. “The first 10 days were very touch and go. They actually didn’t think I was going to make it,” says Goldman, who lives in San Francisco.
But she began to improve, and after three months in the hospital, she headed home to a new life. The Stanford University student, who had just spent a glorious, pasta-filled semester abroad in Florence, Italy, was now living with her parents and hoping to return to school.
The only part of her new life that knocked down her positive attitude was kidney dialysis. “It was the only time that I felt very upset by the situation, because I was tethered to a machine,” she says. “I was going three times a week, and I was attached to the machine for four hours.”
She confided to her doctor that the process was bringing down her spirit and asked if she had any other options. He allowed her to switch to peritoneal dialysis (using a catheter), which she could administer herself.
Support from her friends and her parents—who lived just down the street from her university—allowed her to go back to college. “I would go to school just for my classes, and in between classes my friends would meet me. They made a room in our dorm house as sterile as it could be, so I could change my dialysis bag,” she says. “As a team, we made it work. And then my parents would pick me up at the end of the day.”
Knocking Out Salt
As Goldman adjusted to dialysis, she wondered what more she could do to improve her health. Her doctor had encouraged her to cut back on salt, because doing so can lower blood pressure and reduce fluid retention in dialysis patients. Goldman’s medical team had given her a copy of the DASH Eating Plan. “It’s a great start, but it’s very general,” she says. “It warns you to stay away from canned soup and soy sauce, but the intricacies of the diet aren’t laid out.” DASH—Dietary Approaches to Stop Hypertension—is based on studies supported by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health.
Even for people who never pick up a salt shaker, it’s difficult to avoid sodium. Much of the packaged and processed food we eat every day—even those labeled as healthy—have high amounts of sodium: frozen entrees, canned soups, processed cheese, baked goods, instant packs of rice and noodles, and condiments, as well as many restaurant and fast-food menu items. It’s no surprise, then, that U.S. residents age 2 and older consume on average 3,436 milligrams (mg) of sodium per day, well above the recommended amount, according to the Centers for Disease Control and Prevention. High levels of sodium increase the risk of hypertension, heart disease, and stroke.
The 2010 federal dietary guidelines recommend reducing daily sodium intake to less than 2,300 mg. For those 51 and older, all African Americans, and anyone with hypertension, diabetes, or chronic kidney disease, the recommended amount is 1,500 mg. The goal Goldman set for herself? To consume only 500 to 1,000 mg a day.
That summer Goldman gradually began to feel better and noticed she was urinating more often, meaning her kidneys were improving. She remembers one pit stop where she really had to go. “I could hear my mom screaming outside of the door ’cause she was so excited that I was peeing so long,” Goldman says, laughing. She was able to stop dialysis, and her kidneys now function at about 40 percent.
Cutting back on salt is often a healthy move for most Americans, but there’s no evidence that it will directly improve your kidney function, says Brad H. Rovin, MD, director of the Division of Nephrology at The Ohio State University Medical Center in Columbus, OH. With appropriate treatment of their lupus, many people can recover enough kidney function to eventually come off dialysis, he says. Any dietary changes should first be discussed with your rheumatologist or nephrologist.
While Goldman’s kidneys improved, she still battles lupus, taking about 20 pills a day. “My constant is as if I have a bad flu. And every week it seems like there’s a new random symptom in my body and I’m off to the doctor to check it out.”
The Road to Salt Fighter
Seven years later, Goldman has stayed committed to her low-salt diet and has developed a loyal blog following at sodiumgirl.com. Now a full-time writer, she is penning a low-sodium cookbook—slated to be published in fall 2012 by Wiley Publishing—that will include thoughtful, healthy, and delicious meals. She wants her recipes to be simple enough for the everyday cook and to be accompanied by beautiful, mouth-watering photos. Her aim is to create a cookbook that will be at home alongside top-selling cookbooks, not relegated to the “medical” section of the bookstore.
How did a fried-chicken and mac ’n cheese-loving college student turn into a full-time sodium crime fighter? When she started her low-salt crusade, Goldman cooked a lot of stir fry, chili, and risotto—one-pot meals. Then, she began to riff on those basic canvases, experimenting with different spices. “I found quickly with cooking, you need to be fearless and you need to be patient with yourself. But you can’t go too wrong. If something doesn’t taste right, you can generally fix it.”
She realized that herbs and spices added bold flavor to her dishes. She began using cayenne pepper and a lot of citrus. She also learned just how much all that salt was masking the true flavors of food. “It took about a month for my taste buds to adjust, but soon I was really tasting food and ingredients for their real flavors.”
She bought armloads of cookbooks and began tweaking yummy-sounding recipes, looking for ingredients she could use as a substitute for salt. After she met her now-husband, Alejandro Foung, he asked to cook for her for their second date. Her first reaction? “Oh my God, I’m gonna die,” she remembers, laughing. “How do I tell him that I can’t eat his food? And I know I’m going to eat it because I’m going to be nervous.”
But she explained her salt restriction, and when she showed up for the date, she was pleasantly surprised to see the meal awaiting her: chicken thighs sautéed in sesame oil with steamed bok choy, which she had never tried before. “There were only three ingredients, and those three ingredients happened to be so full of flavor on their own. It was a huge light bulb: Keep it simple, experiment with things you’ve never eaten before, try new cuisines.”
Her enthusiasm for seeking out salt substitutions intensified. “I love the challenge of taking the saltiest dish in the world and trying to figure out what to substitute to make it salt-free,” she says. “What I found is that people will say, ‘It doesn’t taste exactly like pad thai, but I actually like it better than pad thai, because I can taste all the ingredients.’ It’s very clean food at that point.”
A few substitution examples: “Let’s say you want to make something with mayonnaise in it. Well, instead of mayonnaise, I like using Greek yogurt, which is two-thirds less sodium per serving generally.” Another example: miso-marinated cod. “That is the dish that inspired me to write a cookbook,” she says. Miso is a traditional Japanese seasoning that contains up to 700 grams of sodium per serving, Goldman explains.
“I was smelling miso, and it occurred to me that it had a similar aroma to molasses, so my husband made one version with miso and I made another version with molasses.” Both dishes were delicious and were extremely close in flavor. “Those are the substitutions that open up the world again and make people realize, ‘I don’t have to give anything up; I just have to be super-creative.’
Committed to the Crusade
In February, as part of Heart Health Month and to celebrate the new federal dietary guidelines, Goldman asked other food bloggers to create a low-sodium recipe. Fifteen responded to her Love Your Heart Recipe Rally (searchable on her blog), helping her prove it’s possible to make any meal tasty.
At first, the cooks told her, “Oh, yeah, this is going to be easy.” Then, emails started trickling in, saying things like, “Oh my God, I didn’t realize how much sodium was in milk,” or “I just read the back of the low-sodium soup can, and it says it’s 400 mg per serving, but that’s only for one-fourth of the can.”
According to Goldman, “low-sodium” packaging simply means the food is lower in salt than the regular product. “The trickery of these labels is horrible,” she says. “I think it makes people realize, ‘Wow, I don’t really need that. The food I make at home can be good and actually taste better.’”
Whether Goldman is browsing the spice aisle at her local supermarket or picking vegetables at her community garden plot, she’s constantly thinking of new innovative and tasty low-salt dishes. Her red satin cape may actually be a yellow apron emblazoned with “Sodium Girl” (a gift from a friend), and her leather superhero boots may really be faded blue garden clogs borrowed from her husband, but Sodium Girl remains committed to the fight between good and evil—convincing Americans that food can be delicious without all that salt.
Find Flavor Naturally
Flavor doesn’t just come in a can or a bottle. You can find many flavors naturally in whole foods. Sodium Girl encourages us to spice up our low-sodium meals with these five flavor-packed ingredients:
Radishes—When eaten raw, radishes have a strong, peppery taste and add subtle spice to raw salads. But sautéed or roasted, they become surprisingly sweet. Play with different cooking techniques and discover the spectrum of tastes this little root holds.
Beets—One red beet can contain up to 64 mg of sodium, which is quite high for a vegetable. But don’t necessarily rule them out; use their natural saltiness to your advantage. Skip the shaker and add diced beets to salads, or use them to make homemade pickles.
Mushrooms—Forget about the soy, fish sauce, or even the store-bought stocks. A broth made from dried or fresh shiitake packs a lot of punch and can add complexity to marinades, soups, and stir fry.
Meat fat—The next time you roast a pork chop or panfry a slab of steak, don’t throw those juicy leftovers in the sink. Use a bit of that naturally salty meat fat in place of oil, butter, and salt to sauté your side of greens.
Peppers—It may be obvious, but don’t forget about the range of sweet, hot, and even smoky flavors packed in these spice bombs.
Sodium Girl’s 6 Favorite Ways to Create Flavor
- Vinegars and oils—These two simple ingredients come in a whole host of flavors: champagne, red wine, chili, avocado, and coconut, to name a few. Treat yourself to a few and diversify. A little drizzle of these special varieties will make even a plain bowl of pasta sing.
- Citrus—A quick squeeze of lemon, lime, or orange juice or a teaspoon of zest will add zing and brightness to your low-sodium food. Get creative by using the juice in place of stocks or broths (like in risotto or slow-roasted meats) to create a unique, salt-free take on classic dishes.
- Alliums—This plant category refers to onions, garlic, and their aromatic cousins, scallions (green onions), shallots, leeks, and even chives. Raw or cooked, sliced or diced, they are an easy way to add depth and flavor to your cooking. Try to always keep some in the kitchen.
- Pepper—Collecting flavored salts has become quite a trend. So why not do the same with pepper? Depending on its color and place of origin, every kind of peppercorn (green, red, white, black) has a distinct flavor and spice. Experiment with each variation and see how much it changes the taste of a dish.
- Sugar—It’s not just for dessert. A touch of sweetness will add complexity to many low-sodium savory dishes. A sprinkle of white sugar smoothes out the bitterness in radicchio, and a drizzle of honey can enhance the secret candy qualities in Brussels sprouts and carrots. Even a molasses- and brown sugar-based glaze works wonders on roasted pork or ribs, balancing out the natural saltiness and making every messy bite finger lickin’ good.
- Spices and herbs—Remember, salt is just one of the many ways to season food. By removing it from your cooking tool belt, you will be forced to explore a more diverse palette of flavors. Explore the flavors of different cultures and cuisines, and discover new combinations of spices and herbs that can add a kick, a punch, and a sprinkle of exotic flavor to every meal. The five I use most often are cumin, curry, smoked paprika, fennel seed, and lemongrass. —Jessica Goldman
Sodium Girl’s 5 Favorite Low-Sodium Substitutes
- Soy or Greek yogurt (with 60 mg or less of sodium per serving)—Use in place of sour cream or buttermilk for tangy dips and marinades, like a zesty, salt-free ranch or a creamy soak for truly moist fried chicken.
- Molasses—When mixed with sake, vinegar, or sesame, this dark, musky syrup is an excellent impostor for soy sauce and miso paste.
- Fennel—The next time a recipe calls for chopped celery (which, surprise, has around 80 mg of sodium per cup), replace with the more interesting licorice taste of chopped fennel bulb (only 45 mg of sodium per cup).
- Coconut or nut milk—One cup of milk can contain more than 120 mg of sodium. So swap it for a carton of coconut or nut milk, weighing in at a mere 15 mg of sodium per serving.
- Eggs—When you’re dining out and salad is your only low-sodium choice, dress it up with a poached or fried egg. It will not only look beautiful and add some protein to your meal, but the runny yolk works as a flavorful, bright dressing.
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