Salt

We overlook salt for its ordinariness—until it’s taken away.

Withholding salt feels like you are depriving love. Photo by author.

How much do you love me?" the king asked his daughters.

"As the apple of my eye!" answered the eldest.

"Ah!" exclaimed the king, kissing her tenderly as he spoke, "you are indeed a good daughter."

"I look upon you, my father," answered the youngest, "as I look upon salt in my food."

But the king did not like her words, and ordered her to quit the court, and never again to appear before him.

That fairy tale stuck with me. As a child I understood the ordinariness of salt, but not its complexity. Sodium can enhance flavor, preserve food—and in the wrong circumstance, make you ill. I also learned early that food wasn’t always safe. A neighbor boy died after trace amounts of peanut oil had dripped onto a lettuce leaf on a salad bar.

His death haunted me. How could something seemingly innocuous be so deadly? Food was supposed to be tradition, comfort, even reward. But that was the beginning of understanding food is a force that can nourish or harm.

Allergies affect somewhere between 4-8% of the population, and it appears to be on the rise. It causes inflammation due to an extreme overreaction by the immune system. But there are other adverse effects that are not immune system responses, and usually aren’t life threatening (at least in the immediate way that a food allergy can be) – but still painful and life altering.

Food sensitivities can cause joint pain, headaches, and rashes; food intolerances typically impact the digestive system; and then there are chemical sensitivities, usually from additives – which can create havoc somewhere in the body.

I was ushered into the world of special diets when I began cooking for my nonagenarian Dad.

Dad always ate with gusto - and the spicier the better. For the first half of his life, he was a meat and potatoes type of guy – slathered with hot sauce. He rarely ate fish unless it was fried, loved sausages, burgers, and steak. He disliked typical Italian-style vegetables like spinach, artichokes, or eggplant. And the smell of cooked broccoli drove him to open all the windows - to the chagrin of his mom and my mom. But at some point, sometime after Mom died in 1986, his food repertoire expanded. I don’t know what the catalyst was - but he turned a complete 180. Broiled fish, spinach salads, even the hated eggplant. And he loved his olive oil. “I take two teaspoons of it every day.”

He was in the best of health. “Nothing hurts at all,” he bragged, and flexed his fingers to show there was no arthritis. “I might not be able to run around the block anymore, but I do okay.” He didn’t take as much as an aspirin. But when he was 86, he slipped on ice and sustained a bad head injury. The resulting brain bleed triggered a small stroke and he needed an emergency craniotomy. Miraculously he came back from that - but the small stroke left him with dysphagia - the inability to swallow safely.

Swallowing is an intricate process – something like 50 pairs of muscles and nerves are involved. In Dad’s case, speech was not impacted, but his epiglottis was not keeping food and liquid from pouring into his lungs. When you are healthy and food “goes down the wrong way” your cough reflex expels the intruder. But Dad was barely moving in his hospital bed – and the food in his lungs was the perfect medium for not one but two bouts of pneumonia and two superbugs, MRSA and Clostridioides difficile or C-Diff.

The Will to Survive

Dad was now off all foods, getting nutrition through a tube inserted through the nose and into the stomach. His mouth was dry and he craved water. He was delirious from pneumonia, suffering from ICU dementia, and couldn’t understand why there was a tube in his nose. He was fighting to stay alive – and his primitive brain was in charge. Things shoved up his nose? Take it out. People blocking you from doing so? Sock it to them. People denying him water? They were trying to kill him. It was awful – yet awe-inspiring. Everything he did was evidence of his will to live. Eventually – and incredibly – we were able to get the infections under control.

Finally stable, he had a gastrostomy tube surgically placed. All his nutrition was now poured into a funnel that drained into a tube directly into his stomach.

Dad hated it. He kept asking if there wasn’t a way to get his swallow back.

I asked the doctors at the hospital and they just looked at me as if I were the one suffering dementia. “He’s 86 and had a brain injury,” they said. Someone forgot to tell Dad he was supposed to capitulate to a tube; if anyone was going to get his swallow back it would be him.

After a lengthy eight-week horror show at the hospital, we sprung him for a rehab facility that offered speech and occupational therapy. Not much success with the first set of therapists, but then we found a woman who saw my dad as a person who had the will to work hard – versus an old man who had given up.

One of the exercises is the Mendelsohn maneuver: as you start to swallow you try to hold your throat muscles in place for three counts. Another exercise was the Shaker method. While lying down flat, raise just your head, keeping your shoulders on the bed. If he was supposed to do those exercises 10 times/three times a day, he did them 10 times that. (Sometimes being a little OCD can be a blessing.)

Seven months later he was eating foods – and it was a truly thankful Thanksgiving.

But we began to notice a slight cognitive decline and bouts with chest pains and low oxygen counts. After the many sedations and infections, he was diagnosed with congestive heart failure (CHF), an aortic aneurysm, and chronic kidney disease (CKD).

CKD afflicts nearly 37 million Americans – roughly 15% of American adults. One of the manifestations of CHF is fluid build-up around the heart. Not only is breathing labored, but reduced oxygen and a build-up of toxins causes cognitive abilities to decline. The good news: a short stint in the hospital and high dosages of the diuretic Lasix resulted in him feeling better and be sent home. For several months, he was okay, but then we would hear that gurgle in his voice again and knew we were but days from another hospital visit.

To be more proactive, we bought him a pulse oximeter, which measured the oxygen in his blood. Whenever his oxygen fell to 90, he would just double up on the Lasix at home. For, a couple years this worked well - but unfortunately, the medicine wreaked havoc with his kidneys. His body was catching up to others his age. But he still wanted to fight it - so we found another diet modification.

“No salt,” they said.

The Flavorless Flight

But Dad lived by himself, didn’t really use the stove or oven, and migrated to prepared and processed food, which is typically loaded with salt. He bought processed ham and had “just one piece.” By now, I am living in New Jersey, and the diet patrol fell to my sister, Chris, and brother, John. I felt helpless and tremendously guilty.

It is amazing how much sodium is in items like bread, cheese, and even milk. Chris packed up and supplied meal portions of brown rice, sweet potatoes, and pasta, while John made meatloaf and sliced individual portions for him. All those foods were good for him - but they were flavorless.

Turns out no salt is a rough diet to swallow. His appetite waned. Clothes were literally falling off him.

My sister moved from Buffalo to Florida for a job, and our house in New Jersey was under renovation, so for several months all the caregiving was shouldered by John. My guilt grew. Finally, it was hazard-free enough to have Dad come stay with us for a couple weeks at a time. I was determined to make him meals that would be visually appealing, nutritious –and loaded with calories.

But, damn, that was hard. I made a tomato sauce loaded with onions, garlic, fennel, crushed red peppers. I would put it on pasta - and cover it with fresh basil. But despite all the ingredients, without the salt, it was tasteless.

Salt was a magic ingredient.

The salt-free diet reminded me of a fairytale I read as a child: About a king who asked his daughters how much they loved him. Outraged by his youngest daughter’s answer – banished her, and didn’t see her again until her wedding banquet. Cleverly, she told the chefs not to use salt on his food - and when the king complained - she said, something to the effect of, “Yo, what did I try and tell you?” To which he proclaimed her the most wonderful daughter - and presumably she passed the shaker of salt.

Cruelly, in order to show Dad how much we loved him, we had to deprive him of salt.

Seasoned With Curiosity

Fortunately, I think just eating with Tim and me spurred his appetite. That and experimenting with different flavors. Dad sat at my kitchen counter taking it in as I sliced, diced, and ground up spices.

His time in the kitchen with me took me back to the years I spent cooking with the boys. Like with the boys, food preparation was a way to engage, be in the moment, and just enjoy each other’s company. While my primary goal was to feed him, and have him put some weight on, it was also to have fun too. I let him mash potatoes, or cut up his broccoli. We were making Krustez lemon squares and I had him pat down the crust and whip the filling. It gave him purpose, and seemed to bring him joy. When he left to go home, I packed up soup, meatballs, an apple pie, and his favorite lemon squares.

I adored his curiosity.

“What’s that,” he asked.

“Fennel.”

“I’ve never heard of that. Let me try it.” He’d give it a nibble, concentrating on the flavor. “Ohhh, that’s good!”

“Yep! I put it in my sauce, soups and meatballs.”

“Is fennel an Italian vegetable?” he’d ask.

“Definitely Mediterranean.” I didn’t know exactly the roots of the root but since it was a staple in Italian food - I figured I couldn’t be far off. I Googled to make sure.

“What are those?” he asked, pointing to a jar of Calbrian chilis. I told him.

“Are they hot?”

“Do you want to try some?” I handed him a small spoon so he wouldn’t dip the one he had been using in my new jar.

He recoiled a bit, “those ARE hot.”

He took an active part in every meal. He chopped his own vegetables, stirred the soup, stuck his fingers in the sauce to try it, and of course adorned everything with either his lemon olive oil - or his roasted red peppers. Like with my boys, I felt a mixture of pride and wonderment at his enthusiasm.

Some might think that was evidence of senility. Maybe it was somewhat. But cognitively, if we were talking about sports or finances, there was nothing childlike about his excitement. When experimenting with food, however, it was almost as if he were seeing it for the first time. And his eagerness to learn about everything food related - encouraged me.

But after he returned to Buffalo after one of his visits, his right foot became swollen, hot to the touch, and the slightest pressure caused extreme pain. The doctor diagnosed gout, which a prednisone pack would quickly take care of. Unfortunately, the culprit to gout was purines in his diet.

Purines can cause a chemical sensitivity. They break down into uric acid, which usually is filtered by the kidneys. But if your kidneys can’t flush it, the uric acid can create crystals that accumulates around joints. I knew that shellfish and alcohol could be culprits for gout. But he didn’t have any of those. So what foods was he having that had high amounts of purine?

Oh my god, in my zeal to increase his proteins, I served pasta fagioli and meatballs for almost every meal. The pork, beef, turkey and beans were loaded with purines! We switched up the meatballs to ground chicken - and I stirred up a pot of beanless, saltless pasta fagioli.

Dad rolled with these new changes. “Let me try that,” he said, pointing to the thyme I had collected from the garden. He declared that to be wonderful too.

It was smooth sailing for a few months, and then the next dietary set back came. His muscles in his throat were starting to weaken. We had an episode at the dinner table where he was choking on a piece of chicken and Tim had to administer the Heimlich maneuver - repeatedly. We were terrified from that episode. The only pasta we could use now was ditalini - and we overcooked them so they would practically dissolve.

He was getting ready to go back to Buffalo again, so I went shopping for items he could use on his own. I got cinnamon for his oatmeal, ditalini pasta, bottles of roasted red peppers, and fennel seeds to give to my brother who was on chicken meatball making duty.

I wish I could say there was a storybook ending. But the reality is, at 93, his body was just giving out. No matter what we eliminated, his body couldn’t handle it. Still, I have the memory of those months where we discovered something new every day. In our salt-free kitchen, we seasoned our time together not with sodium, but with joy.

He couldn’t have salt. But he had love—measured in honey, rosemary, roasted peppers, and every bite we made together.

The Fairy Tale

The fairy tale referenced above was one of many in a children’s book. When I searched for its title, I was surprised to find it was attributed to Shakespeare’s King Lear, which was later adapted into “Love Like Salt” folktales. There were several variations attributed to various locations around the world including a couple out of both England and Germany, France, Austria, Basque region, several out of Italy, India, and Pakistan. While I wasn’t sure which was the one I had read as a girl - it was fascinating to me that even with all those different types of cuisines - salt ruled.

Lessons From a Salt-Free Kitchen

People ask me what I prepared for Dad. Anything that was low salt and yet flavorful. Chris and John warned me to read labels.

Low salt cheeses: The cheeses that had the least sodium were ricotta, mozzarella, marscapone, and Swiss.

I had rye sourdough bread cooling on the counter, which Dad had been eyeing. I whipped some fresh ricotta into a smooth consistency, scooped it onto a serving plate and pooled Mike’s hot honey in the center, then added finely diced Calabrian chilis and flecked them into the honey.

I sliced the bread, handed him a plate and knife and pushed the cheese mixture toward him.

“What do I do?”

“Spread it on the bread.”

Since his swallow was weakening again, he cut off the crust. He used the soft inside of the bread to scoop up the cheese, honey, and chilis.

“THIS is delicious!” he proclaimed.

Pasta Fagioli

I normally make my past fagioli with pancetta, but obviously skipped it for the salt reasons. Instead, I sautéed root veggies of fennel, onion, carrots and celery in olive oil, added two cans of cannellini beans. When tender, I added a container of low-sodium chicken stock, ditalini pasta, and 2 cups of water. I seasoned with fresh sprigs of thyme and rosemary.

NOTE: Beans are loaded with protein and purines. People suffering from gout will want to avoid them.

Roasted Red Pepper

Roasted red pepper might be the second best magic ingredient.

Whatever I was cutting up - he would take a spoon and taste: Calabrian chilis, hot honey, fennel seeds, curries, and roasted red peppers. He loved them all. But his favorite was roasted red pepper.

I gave him the knife and the cutting board and he would chop them up to put them on - everything:

• Omelets filled with onion, peppers, a little bit of cheese

• Penne pasta added to a saute of olive oil, shallots, garlic and a little bit of Romano cheese

• Chicken breast pounded paper thin, covered in flour, egg, and salt free bread crumbs, fried

Roasted red peppers are colorful, tasty, and have some bulk.

What special foods have you made for a loved one so they didn’t feel deprived? A special treat? A filling food? Tell me in the comments.

What I Am Reading

I finished Ann Patchetts Truth and Beauty and was taken by how she handled the grittiness of her best friend’s life and death. I think often about how I would handle writing about my best friend – who died in a fiery call accident last fall. It’s easy to chalk up such stories as a co-dependency. Life is more complicated than that.

This week’s book is The Frozen River by Ariel Lawton, a historical fiction novel about an 18th century healer Martha Lawhon. Long before forensics, Lawhon strives to find the truth after a man is murdered. Her journals hold clues - and an amazing recounting of life in Maine. As a Claire Fraser (Outlander) fan, I can easily picture Martha birthing babies and mixing potions in her apothecary, and grabbing a quill to write in her journals.