Salt Headlines That Make The Vein In My Forehead Throb

Salt has been all over the news this week because of a study just published in The New England Journal of Medicine claiming that if everyone in the U.S. reduced their sodium consumption by 3 grams/day, there would be 32,000 fewer strokes, 54,000 fewer heart attacks, and 44,000 fewer deaths every year. The story that got my attention was:

Remaining Arctic Ice Seen Melting Away Completely! (...on a computer screen)

That’s surprising, I thought. Everything I’ve read suggests that the relationship between salt consumption and cardiovascular disease is weak, inconsistent, and probably only valid for 20-30% of the population. So I expected the article to refer to some new research where, you know, “big benefits” were “seen.” As in observed. Like, in the world. And, given the claim about the magnitude, probably also measured.

To their credit, the authors of the study claim no such thing. The numbers are projections based on the application of several assumed effects of salt reduction, adjusted for different demographics and then applied to a model of the entire U.S. population. Thus, the title of the study: “Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease.”

The article seems to grasp the essentially speculative nature of the findings. The very first sentence uses the conditional tense:

…scientists writing in The New England Journal of Medicine conclude that lowering the amount of salt people eat by even a small amount could reduce cases of heart disease, stroke and heart attacks as much as reductions in smoking, obesity, and cholesterol levels.

The headline, on the other hand, seems to have confused the “scientists” with clairvoyants. Never mind doing any checking into the validity of their assumptions.

And the claim about how the benefits compare to smoking and obesity reduction led to a few headlines like this:

webmd salt

This crazypants idea initially sounds a lot like what the study’s lead author claims:

"The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels."

But the logic behind the claim is that a small improvement in the health of every single American would be as significant as a large health improvement in the health of every single smoker:

Dr. Bibbins-Domingo said that for many people the decrease in blood pressure would be modest, which is why, she said, “many physicians have thrown up their hands and said, ‘I’m not going to advise my patients to reduce salt because it’s too hard for patients and the benefits for any individual are small.’

“But small incremental changes in salt, such as lowering salt in tomato sauce or breads and cereals by a small amount, would achieve small changes in blood pressure that would have a measurable effect across the whole population,” she said. “That’s the reason why this intervention works better than just targeting smokers.”

For any given individual, there is no question about whether cutting salt is even close to “as good” as quitting smoking. The evidence for the link between smoking and lung cancer and death is strong, reliable, consistent, and has a clear causal mechanism (carcinogens). The link between salt and cardiovascular disease and death is weak, inconsistent, and still poorly understood.

That latter point starts to get at the problems with the study itself, and not just the headlines it inspired. A number of the assumptions the projection was based on are either demonstrably false or simply unsubstantiated. More on this some other time; for now, a few quotes and links to the essays they come from in Esquire and the medical journal Hypertension:

In a more recent statement, the founder of the American Society of Hypertension, Dr. John Laragh, goes further: "Is there any proven reason for us to grossly modify our salt intake or systematically avoid table salt? Generally speaking the answer is either a resounding no, or at that, at best, there is not any positive direct evidence to support such recommendations."

Studies show that 30 percent of the Americans who have high blood pressure would greatly benefit from a low-sodium diet. But that’s about 10 percent of the overall population — the rest of us are fine with sodium. And drastically cutting out sodium may actually hurt some people. ( "Go Ahead, Salt Your Food")

And:

The available data suggest that the association of sodium intake to health outcomes reflected in morbidity and mortality rates is modest and inconsistent. Therefore, on the basis of the existing evidence, it seems highly unlikely that any single dietary sodium intake will be appropriate or desirable for each member of an entire population…. The decision to adopt a low sodium diet should be made with awareness that there is no evidence that this approach to blood pressure reduction is either safe, in terms of ultimate health impact, or that it is as effective in producing cardioprotection as has been proven for some drug therapies. (Salt, Blood Pressure, and Human Health)

NYE 2010 Part I: Party Nibbles You Can Make Weeks in Advance

Life, as usual, gets in the way of finishing all the half-completed entries on cholesterol, trans-fats, cherry-almond oatmeal muffins, butternut squash soup, pie crust with and without lard, how to make your own sourdough starter, etc. It’s folly to start yet another series of entries I’ll never get around to finishing, but I tried cramming all the things I made for New Year’s Eve into one post, and I just couldn’t do it. 

This is why.

Roughly clockwise from the upper left corner, that’s matzoh toffee, peppermint bark, spicy cheese straws, spiced nuts, goat cheese and fig jam crostini, smoked salmon rolls, more nuts and cheese straws, bacon-wrapped dates stuffed with chorizo, warm crab florentine dip with flatbread and sourdough, flourless chocolate-orange cake, shortbread bars with strawberry-raspberry, peach-apricot, and blueberry preserve fillings, more cheese straws and nuts.

There’s no way I could have made and served that many different things by myself if many of them couldn’t be made in advance. So that’s the theme of the first entry in the NYE 2010 series. These are all things that I made before Christmas. In most cases, I doubled or tripled the recipes and packed most of them into tins and boxes to give as gifts. But I set aside enough to put out on New Year’s Eve. In short, these are handy recipes to have, especially around the holidays.

More pictures and recipes below for Spiced Nuts, Matzoh Toffee, Peppermint Bark, and Spicy Cheese Straws.

Spiced Nuts (adapted from Smitten Kitchen)

One of the things I miss most about living in New York City is the smell that wafts from the street vendors who sell their version of these: nuts encrusted in cinnamon and sugar. I would occasionally cross the street just to pass a walk by one of the carts or linger a little downwind. But I rarely bought them—partially because they’re kind of expensive, but also because the taste doesn’t quite live up to the smell. They’re not very crunchy, which I assume is an inevitable cost of keeping them warm. And maybe that’s an acceptable trade-off, not just because of how the heat augments the smell, but because the heat makes the wax paper pouches they come in kind of soft and flexible, and especially in winter, walking down the street holding a warm little bundle of nuts that smell like grandmothers’ kitchens probably smell in heaven is basically sublime in the full sense of the word—like, it really does inspire the kind of immediate awareness of your own happiness and well-being that gives meaning to the cliche, “so happy I could die.”

Making these at home will never be able to compete with that experience. But on just the level of taste, these win hands down. It’s the bite from the cayenne and extra hit of salt in these and the fact that they stay crunchy—I’m actually not allowed to make them again until next Christmas because they’re so irresistible.

I used a mixture of pecan halves, hazelnuts, almonds, and cashews, and I can’t think of a nut that wouldn’t be even better this way. This recipe uses a beaten egg white to adhere the spice mixture. Some recipes use butter, some add an herb like rosemary, some forego the sugar. I don’t think there’s a bad way to make spiced nuts. This is just one way that is very, very good.

Ingredients

  • 1 lb nuts (like almonds, cashews, hazelnuts, pecan halves, or walnut halves)
  • 1/3 cup dark brown sugar
  • 2/3 cup white sugar
  • 1 1/2 t. kosher salt
  • 1/4 t. cayenne
  • 1 t. cinnamon
  • 1 egg white
  • 1 T. water

Method:

1. Preheat oven to 300F. Line a cookie sheet with parchment paper or foil.

2. Beat the egg white and water until the the mixture is frothy, but not stiff. Add to the nuts and stir to make sure they’re all moistened all over.

3. Combine the brown sugar, white sugar, salt, and spices. Pour the mixture over the nuts and toss until they’re evenly coated.

4. Bake for 30 minutes, stirring occasionally.

5. Let cool and break apart.

If they’re still sticky after they cool, which happened with one of three pans I made (it got the dregs of a triple batch, so I think it had more of the egg white than the other two), you can just put it back in the oven for another 10-15 min.

Matzoh Toffee (from David Lebovitz)

The function of the Matzoh here seems to be to add structure and snap to the toffee, which is baked instead of finished on the stovetop. That means no candy thermometer necessary, no washing down the sides of a pan with water to prevent crystallization, etc. As with most things involving caramelized sugar, a healthy pinch of salt does a lot to enhance the flavor. I made three batches, which used almost exactly one box of Matzoh and made enough to fill three large tins with more than enough left over to serve on New Year’s Eve.

still learning to use my new camera...

 Ingredients:

  • ~4 sheets unsalted matzoh
  • 1 cup butter
  • 1 cup light brown sugar, packed
  • 1/2 tsp. vanilla extract
  • pinch of salt
  • 1 cup semisweet chocolate chips
  • 1 cup chopped, toasted sliced almonds

Method:

1. Preheat the oven to 375F and line an 11”x17” pan with foil. Cover the bottom of the pan with parchment paper.

2. Line the baking sheet with the matzoh, breaking them as necessary to fit.

3. Melt the butter and brown sugar over medium heat until it boils. Boil for 3 min, stirring constantly. Remove from heat and add vanilla and salt.

4. Pour the mixture over the crackers, using a spatula to spread evenly.

5. Put in the oven and lower heat to 375. Bake for 15 min, checking occasionally to make sure it’s not burning. I turn the pans about halfway through because my oven’s uneven.

6. Sprinkle the chocolate chips evenly over the hot surface and let stand 5 min. When melted, spread into a thin, even layer. Then sprinkle the toasted almonds over the top.

7. When completely cool, break into pieces.

Peppermint Bark (from Orangette)

This is basically like a sheet of truffle: two layers of tempered white chocolate with a layer of dark chocolate ganache flavored with peppermint extract in the middle. Topped with crushed peppermints. You have to cool each layer before spreading the next and last year I had some problems with the ganache melting. So this year, I froze one batch before pouring the top layer of white chocolate. And for some reason, that batch eventually…sort of wept. A lot of the crushed peppermint became a sort of sticky pink goop. The other batch was lovely, I swear, but that all got given away as Christmas gifts. Thus the little picture: I’m ashamed of my goopy bark.

I actually tossed the goopy pieces in more crushed peppermint in an attempt to mitigate the goopiness, but of course that just made them even goopier. and the lesson is: when a recipe for candy tells you to chill something in the refrigerator, it may not be a good idea to chill it in the freezer

Ingredients:

  • 17 oz. white chocolate, chopped (I use Callebaut)
  • about 30 striped peppermints, finely crushed
  • 7 oz. bittersweet chocolate, chopped
  • 6 T. heavy cream
  • 3/4 t. peppermint extract

Method:

1. Cover the bottom of a baking sheet with foil and mark a 9”x12” rectangle.

2. Put the white chocolate in a metal bowl and set it over a bowl of simmering water. Stir until the chocolate is melted, but don’t let it get too hot. Should be ~110F. Pour 2/3 cup onto the prepared pan and spread evenly to the edges of the rectangle. This is much, much easier using an off-set spatula. Sprinkle about 1/4 cup of the crushed peppermints on top and chill for at least 15 min in the refrigerator.

3. Meanwhile, melt the bittersweet chocolate with the cream and peppermint extract in a saucepan over low heat just until the mixture is smooth. Let cook until barely warm to the touch.

4. Spread the chocolate layer over the chilled white chocolate. Chill at least 25 minutes in the refrigerator.

5. Re-warm the remaining white chocolate to 110F. Pour over the chilled ganache and spread to cover. Sprinkle with remaining crushed peppermints and chill until firm.

6. Lift foil from baking sheet to a cutting board and peel the foil away. Cut into 2” strips, cut each strip into 2-3” pieces, and cut those diagonally into 2 triangles.

Spicy Cheese Straws

 (adapted from a recipe on GOD-DESS I think I found elsewhere)

These are basically thin strips of cheese-flavored pie crust spiked with cayenne, the homemade version of store-bought cheese crackers. These : Cheez-Its as Homemade Chocolate Chip Cookies : Chips Ahoy. The more you like the cheese you use, the more you will probably like the straws it produces, but as with most baked goods there is a ceiling. In other words, don’t use commodity cheese, but don’t use $16/lb cheese either. I shoot for something as sharp as I can get for around $8/lb. You can also make interesting variations using cheeses like parmeggiano, romano, and asiago and an herb like rosemary or thyme instead of the paprika/cayenne, but cheddar-blue-cayenne is my favorite.someday I will learn to focus and frame things in a way that is not vaguely disorienting

Ingredients:

  • 8 oz. butter, cut into 1/2” cubes and frozen
  • 8 oz. sharp cheddar, grated
  • 2 oz. blue cheese, grated or crumbled
  • 2 t. salt
  • 2 t. paprika
  • 1/2 t. cayenne pepper
  • 1 1/2 c. all-purpose flour
  • 2 T. ice water

Method:

1. Cut and freeze the butter while you grate the cheese. I use a food processor.

2. If using a food processor, switch to the normal blade and add the flour, salt, spices, and butter. Pulse a dozen times or so, until the pieces of butter are the size of small peas. If mixing in a bowl, use a pastry cutter, fork, or two knives to combine the ingredients into a lumpy meal.

3. If using a food processor, let it run while adding the ice water in a slow stream. Stop as soon as the mixture begins to stick to itself and form a ball of dough. If mixing in a bowl, add the water 1 tsp. at a time until it begins to form a dough.

4. Spread a piece of plastic wrap out and dump the mixture onto it. Using the plastic wrap, press the mixture into a slab or a tube about 1” thick, wrap well and chill in the refrigerator for 30 min.

5. Preheat the oven to 350. Break the dough into 4 equal parts, re-wrap 3 and return them to the refrigerator. On a lightly floured surface, form the dough into a tube about 12” long and 1” thick. Flatten it so it’s a rectangle about 12” long, 2” wide, and 1/2” thick. Then, use a rolling pin or empty wine bottle or glass to roll it out to about 18” long, 3-4” wide, and 1/8” thick.

6.  Slice the dough into strips about 3/8” thick and place on ungreased cookie sheets. You don’t want them to touch, but they can be pretty close together.

7. Bake for 12-15 minutes, or until the edges are just beginning to brown. Watch them closely towards the end of the baking time, and rotate the sheets so they bake evenly if your oven, like mine, is uneven. If you under-bake them, they won’t be crisp, but too much and they’ll taste burnt.

8. Cool on paper towels, which will wick away a little of the excess grease. When cool, store in airtight containers.