The patient in the hospital bed had just had a quadruple bypass when the doctor gave him the news:
“You have to restrict your sodium.”
Christopher Lower was nearby, recovering from a heart transplant, when he heard his roommate try to order a meal.
Oatmeal was the only option that met the sodium requirements, and the roommate began to cry.
Lower offered his help. “What do you want to eat?”
The pulled pork sandwich on the menu had caught the eye of the patient.
“Do you like rice? We can put the pulled pork on rice instead of a bun,” suggested Lower.
With that simple exchange in 2014, Lower knew what he had to do: share information he had discovered on low-sodium diets.
He had overcome the daunting prospect of flavorless meals since a fluke illness had resulted in heart damage in 2002. While traveling for business, he had caught the flu, which settled into his heart and enlarged it significantly. His diagnosis was congestive heart failure, with a prognosis of five years to live.
“That wasn’t acceptable,” said Lower, who was then 34. “I had a child on the way. I had just started a business. I didn’t want to be gone in five years.”
He made all the right choices: was tested for sleep apnea, went low-sodium to protect against hypertension and lost 115 pounds, the latter with a diet based mostly on Mediterranean eating habits and plenty of exercise.
“But I always hated diets,” he said. “With a low-sodium diet, it had to be a lifestyle decision that I could live with every day for the rest of my life. I had to figure out how to make food that still tasted great.”
The medical world was not much help. Lower received a brochure that didn’t say much more than to “avoid this” or “avoid that.”
“They don’t tell you real life-skills,” he said of the mealtime advice he received from health professionals. “Most people think that they just have to throw away the salt shaker and they would be good. But hidden salt is everywhere, even in bottled water.”
The business he and his wife Mary ran, Sterling Cross Communications, a public relations and marketing firm in Maple Grove, Minnesota, served as home base for his research. His first client had been a chocolatier, which led to working with other food professionals, whom he later contacted for cooking advice.
“I was a home cook and, at best, a journeyman at that,” Lower said.
That casual conversation with the hospital roommate would lead him along a new path as he gathered dietary insight to pass along to others. His platform was a blog, hackingsalt.com, where he offers recipes, tips and product reviews for managing a diet few willingly choose.
Readers took note, and so did a publisher. Rockridge Press contacted him and said it had been testing his recipes. “You are the No. 1 blogger on low salt,” he was told.
Better yet, they wanted him to write a book.
Lower set to work testing recipes in October 2016. In January he landed in the hospital with more heart issues, and from there he completed writing the cookbook. Today he is conducting its local marketing campaign from the hospital, while awaiting a second heart transplant.
“The Easy Low-Sodium Diet Plan & Cookbook” (Rockridge Press, 220 pages, $15.99) offers the experience of 15 years of making low-sodium meals acceptable to his family and him. The book includes 100 recipes with commentary, and offers a subtitle that spells out his approach: “Quick-Fix & Slow Cooker Meals to Start (& Stick to) a Low-Salt Diet.”
His voice is strong and encouraging as he offers advice on low-sodium (and even no-sodium) menus that assure flavorful meals.
“We have a lot of cooking from scratch at home,” he said. “We’re not short-order cooks at home, so mealtime has to be approved by our 8-year-old twins, a 15-year-old and my wife. They have to pass the taste test at home, with layers of flavor.”
Lower offers this advice for those watching sodium levels in their diets:
Read the labels. In addition to the amount of sodium, pay attention to portion size. For those who are diabetic, as well as in need of low sodium, there’s a need to check carbohydrate and potassium amounts.
Sodium level. The American Heart Association recommends no more than 1,500 mg salt (3/4 teaspoon) for a healthy person without high blood pressure or heart disease. The Mayo Clinic recommends that limit for all Americans age 51 and older.
Be wary of low-sodium claims. There’s a difference among sodium-free (less than 5 percent per serving and no sodium chloride), very low sodium (35 mg or less), low sodium (140 mg or less) and reduced or less sodium (at least 25 percent less sodium per serving than usual sodium in similar product).
Restaurant dining is difficult, but not impossible.
“If I go out to eat, it has to be a from-scratch kitchen and I have a conversation with the chef. Even that is hard because so many people ask for dietary exceptions,” Lower said.
On his blog, he offers a guide he developed to low-sodium foods on the menu of restaurant chains.
“I still want to go out and eat, and enjoy that time with friends,” Lower said.
Salt replacement products aren’t necessarily safe. These replacements include potassium chloride, which patients with heart, liver and kidney problems need to avoid because it interacts with most medications that treat those issues.
Make the food taste good. Garlic and lemon juice are often added to provide flavor. He leans more toward heat, as in peppers. Lower also depends on liquid smoke with its smoky, bacony flavor. Grilling makes a difference as the resulting char adds layers of flavor to food; broiling is a good substitute. Vinegar offers a supporting role, with sour playing into the salty part of the palate.
Dr. Peter Eckman, section head of heart failure at the Minneapolis Heart Institute, treated Lower in earlier years.
“We probably all could stand to lower our sodium in our diets, and I say that as one who just spent the day at the State Fair,” he said.
“Patients often say they can reset their sodium preferences. I’ve had patients who are diligent about a low-sodium diet and they get used to it. When they are served a conventional sodium meal, they are struck by how salty it tastes.”
Reassuring words from those who know. So put down that salt shaker.
Chickpea Burgers With Tahini Sauce
Note: These meatless burgers are a lighter version of falafel, which is typically deep-fried. Tahini is a paste made of ground sesame seeds, and is widely available. From “The Easy Low-Sodium Diet Plan & Cookbook,” by Christopher Lower.
1/2 cup plain low-fat Greek yogurt
2 tablespoons tahini (see Note)
1 tablespoon lemon juice
1/2 cup chopped flat-leaf parsley
1 (19-ounce) can chickpeas (also called garbanzo beans), drained and rinsed
1 garlic clove, minced
1 1/2 teaspoons ground coriander
1 1/2 teaspoons ground cumin
Freshly ground black pepper
1 medium carrot, grated
2 tablespoon flour
2 tablespoon extra-virgin olive oil
2 (6-inch) whole wheat pitas, halved
1 cup baby spinach, optional
1 red onion, sliced
1 Persian cucumber, minced
To make the tahini sauce: In a medium bowl, combine yogurt, tahini, lemon juice and parsley. Set aside.
To make the burgers: Add the chickpeas, garlic, coriander, cumin and black pepper to a food processor. Process to a rough paste, then add the carrot, egg and flour. Process briefly until evenly mixed, but slightly rough. The mixture will be moist. Form into 4 patties.
Heat oil in large nonstick skillet over medium-high heat. Add patties and cook until golden and beginning to crisp, 4 to 5 minutes. Carefully flip and cook until golden brown, 2 to 4 minutes more.
Warm pitas, if desired. Top each pita half with tahini sauce, spinach and a chickpea patty. Garnish with onion and cucumber. Serves 4.
Nutrition information per serving: 351 calories, 14 g fat, 135 mg sodium, 45 g carbohydrates, 2 g saturated fat, 198 mg potassium, 17 g protein, 47 mg cholesterol, 9 g dietary fiber
Pork Chops With Tomato And Fennel
Note: From “The Easy Low-Sodium Diet Plan & Cookbook,” by Christopher Lower.
7 garlic cloves, divided
2 tablespoons extra-virgin olive oil, divided
4 (6-ounce) lean boneless pork chops, visible fat trimmed off
2 fennel bulbs, thinly sliced (about 2 to 3 c.)
1 large onion, thinly sliced
2 (14-ounce) cans no-salt-added diced tomatoes
1 1/2 teaspoons dried oregano
1 teaspoon dried rosemary
1/2 teaspoon dried thyme
Freshly ground black pepper
1/4 cup chopped fresh basil
Cut 1 garlic clove in half lengthwise. Rub the cut sides of the garlic on both sides of the chops, then discard garlic.
Heat 1 tablespoon oil in large Dutch oven over medium-high heat. Add pork chops and quickly brown on both sides, 3 to 4 minutes per side. Transfer chops to a platter to keep warm.
To make the sauce, reduce the heat to medium and add remaining 1 tablespoon olive oil. Add the fennel and onion, and sauté for 4 to 5 minutes.
Meanwhile, mince the remaining 6 garlic cloves. Add to the fennel and onions, and cook for 1 minute more. Add tomatoes, oregano, rosemary, thyme and black pepper, and bring to gentle boil.
Return chops to Dutch oven. Cover, reduce heat to low, and cook for 10 minutes.
Uncover and continue cooking for additional 5 minutes, or to desired doneness. Serve garnished with chopped fresh basil. Serves 4.
Nutrition information per serving: 312 calories, 15 g fat, 413 mg sodium, 18 g carbohydrates, 4 g saturated fat, 281 mg potassium, 29 g protein, 56 mg cholesterol, 7 g dietary fiber