Wednesday, November 17, 2010

Hypertension and Aging: Enhancing Flavor in Whole Foods with Low Sodium Techniques

Guest Blogger, Bret Rust, Doctoral Candidate, Graduate Group in Nutritional Biology, UC Davis

As we age the number of our taste and olfactory receptors declines creating a flavorless inadequacy to meals while our needs remain high for micronutrients, vitamins, minerals and flavonoids abundant in whole foods. When high micronutrient needs are compounded by declining energy requirements, the consumption of micronutrient-rich whole foods becomes a vital component to the diet of the aging population. Thus the challenge for elders and their caregivers is to create appetizing whole food dishes that deliver sufficient micronutrients when dietary intake is limited.

Typically standard flavor enhancers, like salt, are used to achieve more appealing dishes for those whose taste sensation may be diminished; however cardiovascular disease remains the number one cause of death worldwide and the proportion of deaths from cardiovascular disease increases as we age. Hypertension itself is a primary risk factor for cardiovascular disease and control of sodium intake is often used as medical nutrition therapy for controlling hypertension. Current sodium recommendations for elders is 1300 mg per day, or about half a teaspoon of salt—a huge restriction for those tasked with preparing palatable and flavorful foods for this population.

In cases where sodium restriction is necessary, cooking methodology can be an important tool in enhancing flavor without excessive use of salt. For instance, instead of boiling or steaming vegetables, stir-frying or sautéing in a heart-healthy olive or canola oils will bring out the natural flavor of foods and mitigate bitter compounds that may reduce the palatability of some vegetables. Layering seasoning, the process of seasoning dishes judiciously as ingredients are added, will maximize effectiveness of the salt used and bring out the flavors of each ingredient rather than adjusting flavor with excessive salt after the dish has been prepared.

Using garlic or other flavor-enhanced salt products during the layering process can further enhance flavor but beware of, and avoid monosodium glutamate which may cause allergic reactions in some patients. Be aware of the idiosyncrasies of herbs and spices and when their use is most effective. For instance basil is a delicate herb whose flavor degrades quickly in heat and should be used at the end or just after cooking. The flavors of peppers are locked in by the cell wall and can be released by toasting them in a skillet (without oil) before adding them to a dish.

Economical use of garlic can enhance a food without overpowering the dish with garlic flavor. Some elders may not care for the flavor of garlic but using small amounts during cooking enhances flavor without overpowering the dish. Do not fear using small amounts of oils and sugar. A little bit can markedly improve the palatability of foods—a few drops of sesame oil, honey or agave nectar in stir fry can go a long way towards improving flavor. Citrus can enliven food with a squirt before serving.

Salt substitutes are a common means of reducing sodium intake but they merely substitute potassium ion for the sodium ion in about half the volume. These products produce a bitter flavor and may reduce the palatability of foods rather than enhance their flavor. Sea salt and ancient Himalayan salt contain a broader mineral spectrum than iodized salt and can impart a stronger flavor so that less may be used to achieve the same effect. Soy sauce has often been used as a salt substitute, but when choosing a soy sauce, Wheat-free Tamari is the low sodium option. Wheat-free Tamari contains 1/8 of the sodium in 1 teaspoon of table salt. Because it is wheat-free, tamari contains a higher concentration of soybeans yielding a richer, more complex flavor.

These techniques are simply the approaches that good chefs might take to improve a meal but caregivers are confronted with a daunting and sometimes overwhelming task in providing sound overall care that can include transfers, transportation, medication management and administration, budgeting, bookkeeping and cleaning. Caregivers may not have time for or be acquainted with all the tools trained chefs bring to their profession, but by using a few of these techniques when time allows, caregivers can improve the quality and perhaps the length of our elders’ lives.

Not all carbs are created equal

Carbohydrates have gotten a bad rap from fad diets when in actuality not all carbs are bad for you and some carbs are better for you than others. You may have heard of “complex” or “unrefined” carbs. This refers to whole foods like fruits, vegetables and legumes. These foods can have positive effects on our blood sugar levels, our digestion, mood and energy levels. Whereas “simple” or “refined” carbs like white flour, candy, soda and pastries, when eaten in small or excessive amounts, can have a more detrimental effect on our health. This is because these foods contain minimal fiber, protein and essential vitamins and minerals which moderate the absorption of glucose. Fiber plays an essential role in blood sugar balance and it has a range of health benefits like improved digestion, increased immunity and reduced cholesterol. “Complex” carbs are truly complex because they contain a variety of other nutrients like fiber, protein, healthy fats, phytochemicals, vitamins and minerals. These carbs are ideal for blood sugar balance and mood and energy stability. Chronic blood sugar imbalances can eventually lead to diabetes, heart disease and cancer. Below are snack and meal suggestions that incorporate a balance of complex carbs, proteins and healthy fats to help you sustain blood sugar and optimal energy.

Hummus or black bean dip with raw chopped vegetables or whole grain corn chips
Low-fat organic cottage cheese with fresh fruit
Gluten-free toast or bread with nut butter (cashew, almond, sunflower, peanut)
Fresh fruit with nuts or cheese
Plain yogurt with fresh fruit
Tofu chive spread or roasted garlic tofu spread on GF crackers
Sardines*, smoked salmon*, or sliced deli meat* on corn tortillas with mustard or avocado
Hard-boiled egg and a piece of fruit
Edamame (soybeans)

Whole grain (GF oats, buckwheat, millet) porridges with nuts and/or seeds, milk and fresh berries
Scrambled eggs or deli meat with vegetables on a corn tortilla
Brown rice topped with lemon tahini sauce or peanut sauce, cubed tofu and sautéed vegetables
Bean soups e.g., split pea, black bean, chili, lentil, or navy bean, with vegetables
Baked sweet potato topped with chili, plain yogurt, salsa and broccoli
Brown rice and black bean tacos with avocado, salsa and cilantro
Miso soup with cubes of tofu and chopped vegetables such as: bok choy, kale, carrots, watercress, collards, seaweed, sesame oil and brown rice
Stir-fry of various chopped vegetables such as kale, chard, mushrooms, peas, bell peppers, zucchini and squash with tofu, chicken, shrimp, scallops, or beef and served over brown rice, quinoa
Rice pasta and tomato sauce with tempeh or ground meat, spinach and cannellini beans and a green salad
Baked salmon or meat of choice, quinoa or whole grain of choice and steamed vegetables