How to Cook without Salt

I had some autoimmune health issues growing up, and I took an aggressive hit with a flare-up of lupus when I was twenty-one. I was told that I was in complete kidney failure, and I was waiting for my dad to give me his kidney. Every body is different; sodium, potassium, phosphorus, and protein are generally all important to watch with kidney failure. For me, the thing I really have to watch is sodium, even though I should be sensitive to having too much potassium. I’ve changed a lot about my lifestyle and diet, and I’ve been at stage 3B kidney disease since 2004. I have not had a transplant yet. I’ve been off dialysis for fourteen years, and with the help of my diet, I regained 20 to 30 percent kidney function. I’ve been told this is really rare. My doctors don’t even know exactly how to talk about it.

Part of the reason I started writing about a low-sodium lifestyle is because some of the information that’s out there is information for people who don’t have to live it. I’m not writing from a clinical perspective—people should always talk to their doctors and dietitians—but I wanted to share some of the simple things I was doing that were helping me. So often, we’re focused on the no. In my own life, I wanted to find a way that was all about what I could eat, what I could feel. I wanted to make a low-sodium diet about making a prettier plate and even making a plate that could be on the front covers of food magazines. The same way that a vegan, Whole30, or gluten-free meal would be.

I worked with the same doctors for fifteen years at Stanford and a variety of nutritionists. A lot of it was learning together about what medicine and approaches work for my life. A lot more was about how to make the diet not another challenge. It was a way to take control back and feel empowered in a situation where you feel like you’ve lost all control.

The first thing people always say when you’re low-sodium is “that’s going to be so bland” or “that’s not easy.” Right away, I say go look at the spice aisle in the market: Salt is one out of so many different seasonings out there. Most people who don’t work in food have tried maybe two to five of the other spices on the rack. When you take away salt, there is a whole world of flavor out there.

Surprising your taste buds is the best way to flavor a dish, whether it’s trying a brand-new herb every night for a week or cooking with smoked paprika. Most people eat three to four times the amount of sodium that’s recommended, so when you cut back, you’re really missing something. We’ve become addicted to the taste of salt, so it takes a month, if not two to three months, for taste buds to adjust. The flavor of natural food is really powerful. Salt is meant to be an enhancer of it, not a cloak. When you take away the salt or use it more appropriately, you can taste the nuances.

One of the things I realized early on is that sodium exists naturally in ingredients. An egg has seventy milligrams of sodium in it, so in an omelet, you’re getting close to a third of your daily intake. That’s not a bad thing. If you’re using eggs, celery, artichokes, chard, beets, arugula, lemon—all of that has a salty taste to it, and you can use that to your cooking advantage. You can get the salty taste from foods without touching the salt shaker.

That’s where I tell people to start. Play with things you’ve never cooked with before; make use of strong-flavored ingredients. Keep it colorful and fun, whether it’s a pop of color with herbs or even a colorful plate that you’re using.

Heat is a great place to start. I became friends with a woman who is a food developer, and one of my questions was “What exactly is salt doing in food?”—if I can figure out what it’s doing, maybe I can mimic it. I learned that it wakes up the flavor; it releases the essences, the smells, the taste; it balances out other tastes; and last but not least, it makes things salty. I tried to think about those five elements when I cook. One way you can release flavor, for example with tomatoes, if you’re not infusing them with salt, is by roasting them in an oven.

If you’re getting started, some of my favorite “gateway spices” included:

• Dill, or dried dill weed.

• Dried celery seed. Again, celery is naturally salty, so dried celery seed in an egg salad gives it a salty taste.

• Cumin, because it has a nice smoky flavor.

• Paprika, especially with dishes like roasted vegetables or potatoes.

• Cayenne, red chili pepper flakes, and lemon juice can also wake up food.

I think people can see their food transform just with those spices. Start with something simple when you cook, if it’s potatoes or roasted broccoli or roasted chicken, and play with spices. Those are great canvases to start exploring flavor and adding spices.

I have to keep a very low-sodium diet, so I don’t eat any shellfish because it’s all very high in sodium. Everything else I eat, I use to my cooking advantage.

For somebody who can eat more sodium but wants to cut back a bit, once you understand it’s naturally in your food, you can just eat smarter. You want a salty kick? Use some Parmesan or capers to give pasta your salty kick. Once you know that sodium is in canned tomato sauce, you can use fresh roasted tomatoes instead. Then when you add Parmesan, you’re not eating an entire day’s worth of sodium in one plate of pasta. It starts with knowing where the sodium is coming from, and then you can be smart about what you’re using.

Bread is one of the biggest sodium culprits. Use white bread and you can end up with a third to half of your daily recommended 1,500 milligrams before even counting condiments or deli meat or anything else on it.

Instead of avocado toast, I love my lightly salted avocado rice crackers every morning. Another desk and travel favorite are sheets of nori seaweed. It can have zero milligrams of sodium if you find the right one—I like Emerald Cove or Eden brands (just be sure to look at the labels on the back). I make burrito rolls with them: I use rice or some homemade hummus, fill them with a lot of fresh vegetables and protein, and wrap it up into the perfect travel snack.

The Salty Six is a list of what the American Heart Association has called the most high-sodium foods that we eat all the time. Pizza is on that list, so I think the thing that people miss the most is probably cheese. My favorite substitute I’ve found is a cauliflower ricotta replacement: You steam cauliflower and blend it with toasted almonds, pine nuts, or cashews, and it has that perfect, spreadable texture. You can flavor it with whatever you want. I also use it as a white sauce for macaroni and cheese, so I’ll make that for my kids and they love it. They don’t know what real macaroni and cheese is like. I’ll leave it thicker as a spread for when people come over for appetizers; I’ll use it as a base for nori wraps or sandwiches. I also use it on top of my pizza as a sauce.

People ask this question a lot because I think they’re overly concerned that my kids are not getting enough sodium. My son is one, so he eats baby food, but if you look at baby food, there is very little to no sodium in it. Baby food is as good as real food in a package, so a lot of times when I travel or go backpacking, I carry baby food with me for emergencies. Kids, and everyone, in general, are eating way too much processed food, which tends to be packed with sodium. It’s not the salt on the table; it’s all the processed food that’s the bigger issue. It’s not that I’m limiting their salt intake at all, we just eat a lot of whole foods and fresh foods, and I cook from scratch most nights. And yes, my daughter enjoys the luxury of things out of a can and microwaveable meals because I’m not a monster. We use cheese and salt appropriately, and so she naturally eats the recommended amounts of those because we’re eating vegetables, too.

Pretty early on, my husband and I were determined to eat at all the best restaurants in San Francisco. We realized that if he had to tell somebody all the things I can’t have by mouth A: they are going to forget, or B: It’s probably going to be totally wrong because the waiter is passing it back to somebody in the kitchen, and then somebody else is making it. Someone else is checking it before it leaves the kitchen, and the waiter brings it back out. That’s a lot of people for that information to go through.

We needed a way to communicate directly with the chef in a positive way, and so my mom made this little laminated card that fits in my purse that says, “[Jessica] has kidney failure; she cannot have any added salt or sodium.” It starts with a list of things I cannot have, but then it says everything that I can have that they can choose from. It’s laminated so they can take it in the kitchen, it can get dirty back there, and then come back to me. I also get it translated every time I travel out of the country, and that has allowed me to travel abroad with dietary needs. I almost always get positive feedback from chefs.

Here is some advice on how I approach eating out in general:

Try to alert the kitchen ahead of time. A tip that I learned from watching food television is that even if you order steamed broccoli, with nothing on it, it’s going to get salted. Most vegetables and grains are hard-boiled during prep, in salted water. The more notice you give the kitchen to your needs, so they can cook in fresh water or steam broccoli without using salt water, the more options you’ll have when you eat out. The kitchen will also appreciate having extra time to prepare. The other thing that’s huge has been OpenTable. I added my food notes to our account so anytime I make a reservation, it automatically goes into the system.

Get to know the chef. Once we find places we like to eat, we frequent them a lot. We become really good friends with the chef, and that makes eating out even more enjoyable for me. It’s not just about the food; it’s the whole experience. Knowing all these chefs in San Francisco, where we live, has been an added plus. I call myself the “salt-free VIP.” At our local restaurants, the chefs will put something on the menu every month that they know they can make for me in case I pop in. That also makes eating on the fly a lot easier when you know a restaurant knows you well. The Progress and Firefly are two of my favorite restaurants like that in San Francisco. I never feel like I’m missing out on anything, and chefs often tell me that the experience is fun for them.

Use technology. If you’re traveling, try Facebook and give yourself an extra day to get local recommendations. I’ll say, “Hey, all you people on gluten-free diets or vegan diets, where have you found that chefs really respect your needs?” because I can probably eat there, too.

When you’re cooking low-sodium, you can’t just take away the salt. It’s just not going to work, it’s not going to taste good, and you’re going to know something is missing. You have to replace it with something. That could be a spice; it could be a new protein you’ve never had before. It could also be beautiful plates you’ve never eaten on. Ambience elevates your food. You have to replace it with something—to make the food taste good and make everything a better experience.

This is my low-so advice to remember:

1. Most people equate umami with high-sodium products like soy sauce and Parmesan, but the fifth taste actually occurs naturally in mushrooms and tomatoes. Give a flavor boost to your favorite recipes with these ingredients instead.

2. Again, don’t just remove the salt; replace it and experiment with “salt-ernatives” by ditching the shaker and filling a small bowl with celery seed, dried dill, za’atar, or lemon peel instead. Try sprinkling something new every week.

3. Cook as vibrantly as you wish to live. Make sure your food—and your plates, table décor, and kitchen—have lots of color. By playing with your other senses, you will enhance the flavor of your food.