Tuesday, July 20, 2010

Reflection on a Tuesday: Throwing Salt in the Wound and in the Game

True story--This week at Grady:

Me: "We could probably get your blood pressure down quite a bit by making some changes to your diet. That can be as helpful as adding a medication.

Patient: "Oh, I already eat a no salt diet, so that definitely ain't my issue.

Me: "Wow. . . I've heard of a low salt diet, but seems like it would be tough to have a no salt diet."

Patient: "Yep, well it ain't that hard. You just gots to put your mind to it, you know what I'm sayin'?"

Me: "I hear you. You know sometimes salt can be hiding in stuff."

Patient: "Not my food. I prepares all the food in my house. So it ain't no salt in none of it. Matter of fact, we don't even have no shakers in our house." She smacked her lips between each sentence for emphasis.

Me: "Wow, that's impressive. . . uh. . I mean, great. What do you season your food with?"

Patient: "Mostly Accent or Zatarain's."

Me: "Umm, Accent or Zatarain's?"

Zatarains = creole-seasoned salt, Accent = MSG

Patient: "Yeah ma'am. Or just bouillon. You don't never cook with no bouillon? I drops me a block off in jest about everything. Make it taste so good without salt." Alrighty then.

Me: "Umm, bouillon? In everything?"

Patient: "Oh yeeeeeeaaah. Vegetables, rice, all that stuff."

bouillon = meat stock flavored SALT

Me: "Uhhh. . . . okay. . . so. . .tell me this--what'd you have for breakfast this morning."

Patient: "A sandwich and some coffee. Biscuit with a little piece of meat. . .some leftover fatback, tha's all. But I didn't sprankle no salt, though, and this time, no bouillon." She smiled and still smacked her lips with each point.

a little piece of fatback on a biscuit

Me: "What about dinner last night?" I could feel myself breaking out in a cold sweat.

Patient: "Chicken and some butterbeans, oh and some white rice."

Me: "The chicken. . .baked, fried? And how'd you season the butterbeans?" Please don't say it. Please don't say it.

Patient: "I ain't gon' lie, it was fried. But I seasoned it only with the Zatarain's. The butterbeans just had a ham hock in it, tha's all." Tha's all. Sigh. I looked at her stout middle, and thought about her initial complaint, How can I lose some of this weight? I keep trying but nothin' is happening. . . .

Me: "A ham hock. . . .did you. . .eat it?"

Patient: "Ummm hmmm. I ate only part of it, but not all of it. But no salt, though. Definitely no salt."

smoked ham hocks, unsalted. . . .?

She was so proud of herself. Chest all poked out and proud about her no salt diet. It hurt my heart to have to burst her bubble about the foods she'd grown up on like ham hocks and fat back. This particular patient was low literate, and wasn't very good at reading labels. It felt so enormous, trying to think about how to start explaining sodium intake to her. Like Zatarain's is seasoned salt. And a bouillon cube is pretty much dehydrated chicken or beef stock and, well, salt. And Accent? It wakes up the flavor because of the sodium. Sodium wakes everything up. Sigh. The fat back is salt cured, and so is the smoked ham hock. So, in other words, don't eat any of the things that you call comfort foods. Your specialty? Don't cook it. And all those foods that don't perish in 3 days that your fixed income can afford you? Out of the question.

Some of these interactions start out funny, but then quickly evolve to not funny at all. Fresh food costs money. Education and exposure to different things in life is a privilege that often comes with, well, money. I truly believe that this woman was really giving her personal best. She deeply believed that her diet was indeed a "no salt diet."

And so, first, I congratulated her on her effort. I told her that effort is where it all starts, and that she was ahead of most for that reason. I silently berated myself for allowing the six ridiculously expensive organic peaches I bought from Whole Foods last week go bad. Then I took a deep breath and then slowly began explaining sodium to her. Showing her labels so that she could know the word by sight. And after looking crestfallen, she finally said, "Damn, I can't eat nothing."

And you know what? Considering that I was sitting across from her in a public hospital where she'd just told me that she could barely afford her medicines, the co-pays for her visits, or even the cost of public transportation to come and see us, it was hard to argue with her.

"The percentage of food shoppers who are obese is almost 10 times higher at low-cost grocery stores compared with upscale markets, a small new study shows. In the Seattle area, a region with an average obesity rate of about 20 percent, only about 4 percent of shoppers who filled their carts at Whole Foods Market stores were obese, compared with nearly 40 percent of shoppers at lower-priced Albertsons stores."

-University of Washington Study

celeb Rachel Bilson doing some swanky grocery shopping. . .but definitely not on a fixed income!


  1. (That fatback looks amazing. Just had to put that out there.)

    That's really tough. The cheapest 'meal' I can think of? Ramen. 19 cents a serving. Fresh produce is not cheap. Eating healthy is work, and can be expensive. In SF there's a huge movement toward local, organic, artisanal foods--which I support--but it's hard to ask people to pay two dollars for an heirloom tomato; so many literally can't afford it. It's so, so, so unfortunate that eating nutritious food seems financially unattainable for so many.

  2. bacon is the food of life...a la teryaki! grea post Dr M!!

  3. I agree with Kelly, the fatback (we called it "white meat" when I was a child) looked great. As I read your words of concern about bursting her bubble I remember going to a fifth grade teachers class to explain to her that she was teaching a math concept incorrectly. She thought that I came in to understand the concept and she enthusiastically started to explain it to me. As I listened to her, I was trying to figure out how to stop her and tell her that she was totally wrong... when I finally did tell her, the pain on her face almost brought me to tears.. she said "oh my God, I been using the ditto sheet for five years...

    Poop Deck

  4. Well... I do not sprinkle salt, and I generally don't cook with any of the things mentioned... EXCEPT for the Knorr chicken bouillon. I do sprinkle a little in my water when I steam veggies. That is all. :-)

  5. I thought I was being conscious of my salt intake, but after reading this, I may have to rethink some things. I don't use salt that often, but I love using Lawry's seasoning salt and onion salt...that's all. lol

  6. This is a great post. My mom is a dietician and worked at a county hospital before retiring. She often complained that doctors didn't understand the environment many of their patients lived in. How do you convince a 50 year old woman to give up her "seasonings" or try another method. Fresh food is best, but tell that to the 65 year old house bound, limited income woman that eats canned soup everyday. If you're teaching doctors to look at the whole patient, that is great!

    Great post!


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