New Jersey Dining | Health Club Cafes: Cafes at Health Clubs Stress Eating Right

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Following is a sampling of such cafes in New Jersey; all are open to nonmembers.

At the sprawling, two-year-old Life Time Athletic club in Berkeley Heights, which includes a spa, a rock-climbing wall and an outdoor water park, “everything we put out meets our ‘healthy way of life’ standard,” said Brian Wilkes, 25, the department head of the Life Cafe, the restaurant at the front of the club. A dietitian at Life Time Fitness, the national chain, based in Minnesota, that owns the club, helped develop the menu for the cafe.

The wood-and-earth-toned space has about a dozen granite-topped tables. Customers order at the counter, where the menu includes a hummus wrap with avocado, spinach and romaine lettuce on a whole-wheat tortilla ($6.59) and a tossed salad topped with grilled salmon drizzled with a rémoulade sauce ($8.29), for example, as well as quesadillas and pizzas.

All meals are “smart-sized,” Mr. Wilkes said, meaning they fall roughly in the 400- to 600-calorie range, and everything is available to go; there are also sandwiches and salads packaged for take-out. The menu also lists the carbohydrate, fat and fiber content of dishes, which are prepared in the open kitchen.

In Scotch Plains, the Muscle Maker Grill in the RWJ Rahway Fitness and Wellness Center turns out salads and snacks like edamame ($3.79), as well as more substantial fare like whole-wheat penne with reduced-fat vodka sauce and chicken ($9.99), turkey burger wraps ($7.99) and protein shakes and bars. Meals can be eaten at one of several tables in the cafe, which is tucked inside the entrance to the center and decorated in the chain’s signature red-and-black style; there are more than three dozen Muscle Maker Grill locations in the state. A pamphlet available at the counter lists information like which entrees are vegetarian, gluten-free or low in carbohydrates.

The 55,000-square-foot fitness club, affiliated with the Robert Wood Johnson University Hospital at Rahway, has abundant cardio machines and an aquatic center; there are also rehabilitation services, including physical therapy.

“You get a lot of opportunity to introduce people to healthy eating,” said Patrick Nardone, 50, who opened this branch of the Muscle Maker Grill in 2009. “Most people come here to work out, but if you diet and eat properly, it helps with your goal, whatever that is.”

At the Café at the Atlantic Club in Manasquan, the menu is not entirely geared to the post-workout set.

“We went at one point to a very healthy menu, but we got some pushback from people who wanted their French fries,” said Jan Vasys, 52, the controller and head of the food and beverage department at the club.

Still, alongside the burgers and fries there are options like vegan hummus flatbread ($5.95) and seared tuna steak ($10.95), along with salads and freshly squeezed juices.

When the club, which sits on 48 acres and offers facilities including 18 all-weather tennis courts and a spa, opened in the late 1970s, the cafe was more like a snack bar, Ms. Vasys said. Now it is a full-service restaurant with modern décor next to the airy atrium on the ground level of the club and seating up to 120 people. It also serves beer and wine.

At the Healthy Choice Cafe at Can Do Fitness in Princeton, which opened for dining in late October, the owners, Michael Naidrich and Chris and Amy Woods, “wanted to strike a middle ground,” Mr. Naidrich said. Members of the club with no previous restaurant experience, they didn’t want to run a place that was “too fancy,” he said, and they didn’t want to focus on supplements and shakes, as some gym cafes do. Previous restaurants in the fitness center have included a high-end place and a Muscle Maker Grill location.

“Here’s what we stress: high quality and healthy,” Mr. Naidrich said on a recent day at the casual counter-service spot, which is near the club’s main desk, drawing a lot of foot traffic. Food can be taken to go (packaged options are available) or eaten at one of the tables and booths, which seat a total of 40; televisions overhead and WiFi provide entertainment.

The menu has options like spinach salad with turkey bacon and light honey mustard dressing ($8.50) and the cafe’s version of a sloppy Joe with turkey, low-fat Swiss cheese, coleslaw and homemade light Thousand Island dressing ($8), as well as breakfast sandwiches, soups, muffins and the like.

Mr. Naidrich said the owners were working with a nutritionist to make the menu compatible with the Weight Watchers system for calorie-conscious customers. They also hope to offer seminars on health-related topics.

“We’re trying to educate in a lifestyle we promote,” Mr. Naidrich said.

Not for Members Only

BERKELEY HEIGHTS Life Cafe at the Life Time Athletic Club, 25 Connell Drive; lifetimefitness.com or (908) 665-5911. Open Monday to Friday, 6 a.m. to 10 p.m.; Saturday, 8 a.m. to 7 p.m.; Sunday, 9 a.m. to 7 p.m.

MANASQUAN The Café at the Atlantic Club, 1904 Atlantic Avenue; (732) 223-2100 or theatlanticclub.com. Open Monday to Friday, 7 a.m. to 9 p.m.; Saturday, 8 a.m. to 5 p.m.; Sunday, 8 a.m. to 4 p.m.

PRINCETON Healthy Choice Cafe located at Can Do Fitness, 121 Main Street, Princeton Forrestal Village; (609) 452-8400. Open Monday to Friday, 6 a.m. to 8 p.m.; Saturday and Sunday, 8 a.m. to 4 p.m.

SCOTCH PLAINS Muscle Maker Grill at RWJ Rahway Fitness and Wellness Center, 2120 Lamberts Mill Road; musclemakergrill.com; (908) 232-5810. Open Monday to Friday, 10 a.m. to 8 p.m.; Saturday and Sunday, 10 a.m. to 3 p.m.

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Personal Health: The Twice-Victimized of Sexual Assault

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Yet few told anyone about it at the time, or reported it to the police.

I have clear memories of three such episodes from my childhood, one of which involved a man who owned a store in my neighborhood. Not knowing at age 11 anything about reproduction (in 1952, expectant teachers had to take leave when they “showed”), I was terrified that I could become pregnant from having been forced to touch his penis.

I had trouble sleeping, and I avoided the block where the store was. Yet, fearing that the assault was somehow my fault, I said nothing to my parents.

Experts on sexual assault and rape report that even today, despite improvements in early sex education and widespread publicity about sexual assaults, the overwhelming majority of both felony and misdemeanor cases never come to public or legal attention.

It is all too easy to see why. More often than not, women who bring charges of sexual assault are victims twice over, treated by the legal system and sometimes by the news media as lying until proved truthful.

“There is no other crime I can think of where the victim is more victimized,” said Rebecca Campbell, a professor of psychology at Michigan State University who for 20 years has been studying what happens legally and medically to women who are raped. “The victim is always on trial. Rape is treated very differently than other felonies.”

So, too, are the victims of lesser sexual assaults. In 1991, when Anita Hill, a lawyer and academic, told Congress that the Supreme Court nominee Clarence Thomas had sexually harassed her repeatedly when she worked for him, Ms. Hill was vilified as a character assassin and liar acting on behalf of abortion-rights advocates.

Credibility became the issue, too, for Nafissatou Diallo, an immigrant chambermaid who accused the head of the International Monetary Fund, Dominique Strauss-Kahn, of forcing her to perform fellatio in a Manhattan hotel room. Prosecutors eventually dropped the case after concluding that Ms. Diallo had lied on her immigration form and about other matters, though not directly about the encounter with Mr. Strauss-Kahn.

When four women, two of whom identified themselves publicly, said they had been sexually harassed by Herman Cain, the Republican presidential hopeful, they, too, were called liars, perhaps hired by his opponents.

Charges of sexual harassment often boil down to “she said-he said” with no tangible evidence of what really took place. But even when there is DNA evidence of a completed sexual act, as there was in the Strauss-Kahn case, the accused commonly claim that the sex was consensual, not a crime.

“DNA technology has not made a dramatic change in how victims are treated,” Dr. Campbell said in an interview. “We write off a lot of cases that could be successfully prosecuted. It’s bunk that these cases are too hard to prosecute.”

Victims must be better supported with better forensics, investigations and prosecutions, Dr. Campbell said. “This is a public safety issue. Most rapists are serial rapists, and they must be held accountable.”

In one study, published in 1987 in the Journal of Interpersonal Violence, 126 admitted rapists had committed 907 rapes involving 882 different victims.

Rapists are not the only serial sexual offenders. Witness the all-too-frequent revelations of sexual abuse of children involving multiple victims and persisting for decades even when others in positions of authority knew it was going on.

In the latest such scandal, an assistant football coach at Penn State University stands accused of molesting 10 boys. The charges led to the firing of a revered head coach, Joe Paterno, and forced the resignation of the university president for failing to take more immediate action.

The Risks

Last year, according to the Department of Justice, 188,280 Americans were victims of sexual violence.

Among female victims, nearly three-quarters are assaulted by men they know — friends, acquaintances or intimate partners, according to federal statistics.

But fewer than 40 percent of rapes and sexual assaults are reported to the police. Underreporting is more common among male victims and women raped by acquaintances or domestic partners. Only one-quarter of rapes are committed by strangers.

The result of underreporting and poor prosecution: 15 of 16 rapists will never spend a day in jail, according to the network. Dr. Judith A. Linden, associate professor of emergency medicine at the Boston University School of Medicine, reported in The New England Journal of Medicine in September that in the United States, “fewer than half of rape cases are successfully prosecuted.”

Victims may be reluctant to report a rape because they are embarrassed, fear reprisals and public disclosure, or think they won’t be believed. “Victims often think they somehow brought it on themselves,” said Callie Rennison, a criminologist at the University of Colorado in Denver. “Rape is the only crime in which victims have to explain that they didn’t want to be victimized.”

These feelings are especially common among college women who may have been drinking alcohol or taking illicit drugs when raped by a date or acquaintance.

Victims may not realize that any form of sexual behavior that is not consented to and that causes discomfort, fear or intimidation is considered sexual assault in most jurisdictions. That includes indecent exposure, unwanted physical contact (including kissing and fondling) and lascivious acts, as well as oral and anal sex and vaginal rape, whether with a body part or an instrument.

A minor — in general, 16 or 17, depending on the state — can legally consent to sexual activity. A person of any age who is forced or threatened, developmentally disabled, chronically mentally ill, incapacitated by drugs or alcohol, unconscious or preparing to undergo a medical procedure cannot legally consent to sexual activity.

Among young children, girls and boys are equally at risk of being sexually abused. But as they age, girls increasingly become targets; among adults, women represent about 90 percent of cases.

Experts have long debated whether rape should be seen as an act of aggression and control or the product of an irresistible sexual urge. To the victim, the distinction is moot.

The consequences can include pregnancy and sexually transmitted disease; feelings of helplessness, hopelessness and low self-esteem; self-blame and depression; substance abuse and eating disorders; fears of intimacy; numbness; post-traumatic stress disorder (nightmares, flashbacks, anxiety attacks, difficulty functioning); borderline personality disorder; unexplained physical problems; and even suicide.

Thus, even if rape victims choose not to report the attacks, prompt medical attention and psychological counseling can be critically important to their long-term well-being.

Next week: care for victims of sexual assault.

This article has been revised to reflect the following correction:

Correction: December 15, 2011

The Personal Health column on Tuesday, about factors that stifle the reporting of sexual assault, described the law on sexual activity involving minors incorrectly. The legal age of consent in many states is 16 or 17, so it is not the case that “a minor cannot legally consent to sexual activity.”

This article has been revised to reflect the following correction:

Correction: December 17, 2011

The Personal Health column on Tuesday , about factors that stifle the reporting of sexual assault, using outdated information from an advocacy group’s Web site, misstated the number of Americans who were victims of sexual violence last year, according to the Department of Justice. It is 188,830 — not 272,350, the corresponding figure from 2006. (The error was repeated on Thursday in an article about a survey by the Centers for Disease Control and Prevention on sexual violence and domestic abuse.)

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Recipes for Health: Soba With Black-Eyed Peas and Spinach — Recipes for Health

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1 cup (6 ounces) black-eyed peas, rinsed

1 quart water

1 onion, cut in half

3 garlic cloves, minced

A bouquet garni made with a bay leaf, a Parmesan rind and a sprig each of parsley and thyme

Salt to taste

2 tablespoons extra virgin olive oil

1 red bell pepper, cut in small (1/4-inch) dice

1 12-ounce bunch spinach, stemmed and washed, or a 6-ounce bag of baby spinach

Freshly ground pepper

8 ounces soba

Freshly grated Parmesan

1. Combine the black-eyed peas and water in a large saucepan or soup pot and bring to a gentle boil over medium-high heat. Skim off any foam, then add the onion, 2 of the minced garlic cloves, the bouquet garni and salt to taste. Reduce the heat to low, cover and simmer 40 minutes, or until the beans are thoroughly tender but intact. Taste the broth and adjust salt. Remove the onion and bouquet garni and discard.

2. Fill a large pot two-thirds of the way full with water (soba will bubble up, and if you fill the pot too full the foamy water will overflow) and bring to a boil.

3. Meanwhile, heat the olive oil over medium heat in a large, heavy skillet and add the red pepper. Cook, stirring often, until it is just tender, 3 to 5 minutes. Add the garlic and cook, stirring, until it is fragrant, 30 seconds to a minute. Add the beans with their liquid to the pan and bring to a boil. Boil over medium-high heat until the broth reduces a bit, and stir in the spinach. Stir just until it is wilted, and remove the pan from the heat. Add salt and freshly ground pepper to taste.

4. When the soba water comes to a boil, add salt to taste and the soba. Let the water bubble up until it is just about to reach the top of the pot, then turn the heat down to low so that the water retreats. Turn the heat up again and let the water come back up, then turn the heat back down. Repeat one more time. The soba should be cooked by the end of the third round. If it is not, repeat one more time. Drain and toss with the bean and spinach mixture, either in the pan or in a wide bowl. Serve with freshly grated Parmesan.

Yield: 4 servings.

Advance preparation: The black-eyed peas can be cooked ahead through Step 1 up to 4 days ahead and stored in the refrigerator.

Nutritional information per serving (4 servings): 410 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 71 grams carbohydrates; 12 grams dietary fiber; 124 milligrams sodium (does not include salt to taste); 19 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Recipes for Health: Albacore Roasted in a Bed of Lettuce — Recipes for Health

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1 1/2 pounds albacore steaks, the thicker the better

4 anchovy fillets, rinsed and cut in 1/4-inch pieces (optional)

2 tablespoons extra virgin olive oil

1 large onion, cut in half lengthwise, then sliced thinly across the grain

4 garlic cloves, minced

1 14-ounce can chopped tomatoes

Pinch of saffron (optional)

Salt and freshly ground pepper to taste

2 heads soft green lettuce, like bibb or green oak leaf, leaves separated and washed

1 large or 2 small lemons, sliced very thin

3/4 cup dry white wine

1. Preheat the oven to 400 degrees. Make small slits in the tuna steaks with the tip of a paring knife and slide the anchovy pieces into the slits. Season the steaks with salt and pepper and set aside. Measure the thickness of the tuna steaks; this will determine the roasting time.

2. Heat 1 tablespoon of the olive oil over medium heat in a large, heavy skillet or saucepan and add the onions. Cook, stirring, until onion is tender, about 5 minutes. Add the garlic, stir until it is fragrant, 30 seconds to a minute, and stir in the tomatoes, optional saffron, salt and pepper to taste. Bring to a simmer and cook, stirring often, until the tomatoes have cooked down slightly and smell fragrant, about 10 minutes. Taste and adjust seasoning.

3. Heat a large, heavy ovenproof casserole over high heat and add the remaining tablespoon of olive oil. Season the tuna steaks on both sides with salt and pepper and sear for 30 seconds on both sides (make sure the pot is hot when you add them or they will stick). Transfer to a plate. Stir in half the tomato sauce, scraping the bottom of the pan to deglaze, and remove from the heat.

4. Lay half the lettuce leaves over the tomato sauce and place the tuna steaks on top of the lettuce leaves in a single layer. Cover the steaks with the lemon slices, and spoon on the remaining tomato sauce. If there are any more lemon slices, lay them over the tomato sauce. Top with the remaining lettuce leaves. Pour the wine into the pot.

5. Cover tightly and place in the oven. Bake 1 1/2-inch thick steaks for 15 minutes, 2-inch thick steaks for 20 minutes.

6. To serve, remove the lettuce to a cutting board and slice in thin strips. Transfer the tuna to a warm platter. Remove the lemon slices and discard if desired. Bring the sauce in the pan to a simmer over high heat and reduce for about 5 minutes. Stir the sauce, and spoon over the tuna. Garnish with the lettuce, or serve it separately in a bowl. You can also discard it, but I like the taste and texture. Slice the fish across the grain and serve.

Yield: 4 servings.

Advance preparation: You can prepare the tomato and onion sauce through Step 1 several hours ahead.

Nutritional information per serving (4 servings): 427 calories; 4 grams saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 65 milligrams cholesterol; 12 grams carbohydrates; 4 grams dietary fiber; 252 milligrams sodium (does not include salt to taste); 46 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Recipes for Health: Lucky Foods to Ring in the New Year — Recipes for Health

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The notion of thrift wouldn’t apply to some of the other foods that symbolize good luck or prosperity in certain cultures – fish, for instance, or saffron. I’ve taken traditions from different places this week and thrown some of them together, focusing mainly on lentils, beans, greens and fish. These are simple dishes that I hope will help you to begin 2012 on a happy, healthy note. Look for more New Year’s dishes ?in the Recipes for Health index.

Baked Giant Limas With Winter Squash and Sage

Baking in a slow oven is the best way to cook large lima beans, which can fall apart easily if boiled too hard. This dish is luxuriously creamy (though there’s no cream in it) and comforting.

2 tablespoons extra virgin olive oil

1 medium onion, chopped

4 garlic cloves, minced

1 pound (about 2 1/2 cups) dried giant lima beans, rinsed

2 quarts plus 1 cup water

A bouquet garni made with a bay leaf, a Parmesan rind and a sprig each of sage, thyme and parsley

1 pound winter squash, peeled and cut in small dice

Salt to taste

Freshly ground pepper

2 tablespoons slivered fresh sage leaves

Freshly grated Parmesan for serving (optional)

1. Preheat the oven to 325 degrees. Heat the olive oil over medium heat in a large, heavy ovenproof casserole or Dutch oven and add the onion. Cook, stirring often, until it is tender, about 5 minutes. Stir in half the garlic and cook, stirring, until it is fragrant, 30 seconds to a minute. Add the beans, water and bouquet garni and bring to a simmer. Cover and place in the oven for 45 minutes.

2. Remove the casserole from the oven and stir in the remaining garlic, the winter squash, and salt to taste. If the mixture seems dry, add a little more water. Return to the oven and bake an hour longer, or until the beans and squash are very tender. Remove from the heat and remove the bouquet garni. Adjust salt, add pepper to taste and stir in the slivered sage.

Yield: 4 to 6 servings.

Advance preparation: The dish will keep for 3 or 4 days in the refrigerator, but it changes, as the limas fall apart and the dish turns into a sort of semi-mashed bean and squash dish. It’s still delicious, but it will be thick enough to eat with a fork.

Nutritional information per serving (4 servings): 436 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 72 grams carbohydrates; 22 grams dietary fiber; 12 milligrams sodium (does not include salt to taste); 24 grams protein

Nutritional information per serving (6 servings): 291 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 48 grams carbohydrates; 15 grams dietary fiber; 8 milligrams sodium (does not include salt to taste)l 16 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Recipes for Health: Light Lentil Soup With Smoked Trout — Recipes for Health

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1 cup (6 ounces) lentils, rinsed

1 onion, cut in half

2 garlic cloves, minced

A bouquet garni made with a Parmesan rind, a bay leaf and a sprig of parsley

7 cups water

Salt to taste

Freshly ground pepper

4 ounces smoked trout, drained and rinsed if canned

2 tablespoons chopped fresh parsley

1. Combine the lentils, onion, garlic, bouquet garni, water, and salt to taste in a soup pot or a large saucepan and bring to a boil. Reduce the heat, cover and simmer 45 minutes, or until the lentils are tender. Add pepper, taste and adjust salt. Remove the onion halves and bouquet garni and discard. Stir in the parsley.

2. Divide the smoked trout among 4 bowls. Ladle in the soup and serve.

Yield: 4 servings.

Advance preparation: The cooked lentils will keep for up to 4 days in the refrigerator and can be frozen.

Nutritional information per serving (4 servings): 220 calories; 0 grams saturated fat; 1 gram polyunsaturated fat; 1 gram monounsaturated fat; 12 milligrams cholesterol; 32 grams carbohydrates; 12 grams dietary fiber; 199 milligrams sodium (does not include salt to taste); 19 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Personal Health: High Sodium-to-Potassium Ratio in Diet Is a Major Heart Risk

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Well, think again. A major study, based on data from more than 12,000 American adults, took into account all those risk factors for death from heart disease. The researchers found that while a diet high in sodium — salt is the main source — increases your risk, even more important is the ratio of sodium (harmful) to potassium (protective) in one’s diet.

When people whose meals contained little sodium relative to potassium were compared with those whose diets had a high sodium-to-potassium ratio, the latter were nearly 50 percent more likely to die from any cause and more than twice as likely to die from ischemic heart disease during a follow-up period averaging 14.8 years.

Although there has been on-and-off controversy about the value of limiting dietary salt, there is no question that a high level of sodium in the diet raises blood pressure and the risk of chronic hypertension by stiffening arteries and blocking nitric oxide, which relaxes arteries. Hypertension, in turn, contributes to heart disease and stroke, leading causes of death.

Potassium, on the other hand, activates nitric oxide and thus reduces pressure in the arteries, lowering the risk of hypertension.

“We controlled for all the major cardiovascular risk factors and still found an association between the sodium-potassium ratio and deaths from heart disease,” said Dr. Elena V. Kuklina, a nutritional epidemiologist at the Centers for Disease Control and Prevention and an author of the study, published earlier this year in Archives of Internal Medicine. “With age, the risk of high blood pressure increases. The lifetime risk in this country is 90 percent. If you live long enough, you’re at risk.”

According to an Institute of Medicine report on sodium released last year, “No one is immune to the adverse health effects of excessive sodium intake.”

Our High-Salt Diet

Ninety percent of the sodium in the American diet comes from salt, three-fourths of which is consumed in processed and restaurant foods. Salt added in home cooking and at the table accounts for only a minor proportion of sodium intake.

The body’s requirement for sodium is very low — only 220 milligrams a day — but the average American consumes more than 3,400 milligrams daily. The current Dietary Guidelines for Americans recommend a maximum of 2,300 milligrams (about a teaspoon of salt) for people over age 2, but only 1,500 milligrams for the 70 percent of adults at high risk of sodium-induced illness: people older than 50, all African-Americans, and everyone with high blood pressure, diabetes or chronic kidney disease.

Despite widespread efforts to get people to consume less sodium, intake of this nutrient has increased significantly since the early 1970s as consumption has risen of processed and restaurant foods, which rely heavily on salt as a cheap way to enhance flavor and texture and preserve food. Because salt is categorized by the Food and Drug Administration as G.R.A.S., or “generally recognized as safe,” there is no limit to the amount food producers can use in a product.

To make matters worse, not only does the amount of sodium rise precipitously when foods like tomatoes and potatoes are processed, but the natural potassium in these foods declines significantly, worsening the sodium-potassium ratio.

The profligate use of salt in foods prepared outside the home has created an American preference for a salty taste, a preference that can be reversed with no loss of consumer pleasure if done slowly, said Dr. Thomas A. Farley, commissioner of New York City’s Department of Health and Mental Hygiene.

His department is leading a national effort started in 2008 to get food producers and restaurants to gradually reduce the salt in their products. Thus far, 28 national food companies, retailers and supermarket chains, including Kraft, Subway, Target and Delhaize America, have made a commitment to the National Salt Reduction Initiative to cut sodium in their products by an average of 25 percent by 2014.

But Dr. Jane E. Henney, chairwoman of the committee that produced the Institute of Medicine report, said this is still just a voluntary effort, and to make a lasting nationwide difference in sodium intake, the government needs to push harder for change. The report said, “What is needed is a coordinated effort to reduce sodium in foods across the board by manufacturers and restaurants — that is, create a level playing field for the food industry.”

Dr. Henney, a public health specialist at the University of Cincinnati College of Medicine, said it is time to modify the G.R.A.S. status of salt because it can no longer be considered safe under current conditions of use. This would allow the Food and Drug Administration to place limits on the amounts of salt that can be used commercially in preparing various types of foods.

The report stated that “population-wide reductions in sodium could prevent more than 100,000 deaths annually.”

It can be done, if there is a will. Through decades of voluntary efforts and regulation, Finland managed to cut sodium intake by one-third, which has resulted in a decrease in hypertension and premature deaths from stroke and coronary heart disease.

What You Can Do

Dr. Kuklina recommends eating fewer processed foods, especially processed meats, and more fresh fruits and vegetables and dairy products that are low in sodium, like yogurt and milk. Increase your potassium intake not by taking supplements, but by eating more cantaloupe, bananas, oranges, grapes, grapefruit, blackberries, yogurt, dried beans, leafy greens, potatoes and sweet potatoes.

When ordering in a restaurant, she suggests, ask that your food be prepared without added salt and your vegetables steamed, and always request that salad dressings and sauces be served on the side, enabling you to use far less than the chef might. Consider splitting an order between two people, which would cut the salt intake in half. And if a dish arrives that is too salty, send it back to the kitchen.

Avoid fast-food restaurants, where a single meal can contain a day’s worth of sodium.

When shopping, Dr. Farley said, “read labels and compare products, then choose those with lower sodium.” He acknowledged that products labeled “low sodium” or “no added salt” can turn off consumers, who think they’ll be tasteless. But you can always add a modest amount of salt at the table.

He also suggested asking food companies to use less salt in your favorite products and supporting the government’s efforts to reduce sodium consumption by commenting on a proposal published on Sept. 15 in the Federal Register (Docket No. FDA-2011-N-0400 and Docket No. FSIS-2011-0014). The easiest way to comment is through the American Heart Association’s Web site: www.heart.org/sodium, then click on “Send your comment letter today.”

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Greeks Reeling From Health Care Cutbacks

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Four days earlier, she had run out of insulin and, without insurance and unable to pay for more, she had gone from drugstore to drugstore, pleading for at least enough for a few days. It took her three hours to find a pharmacist who was willing to help.

“I tried a lot of them,” she said, gazing at the floor.

Greece used to have an extensive public health care system that pretty much ensured that everybody was covered for everything. But in the last two years, the nation’s creditors have pushed hard for dramatic cost savings to cut back the deficit. These measures are taking a brutal toll on the system and on the country’s growing numbers of poor and unemployed who cannot afford the new fees and co-payments instituted at public hospitals as part of the far-reaching austerity drive.

At public hospitals, doctors report shortages of all kinds of supplies, from toilet paper to catheters to syringes. Computerized equipment has gone unrepaired and is no longer in use. Nurses are handling four times the patients they should, and wait times for operations — even cancer surgeries — have grown longer.

Access to drugs has also been affected, as some drug manufacturers, owed tens of millions of dollars, are no longer willing to supply Greek hospitals. At the same time pharmacists, afraid that the government might not reimburse them, are asking for cash payments, even from those with insurance.

Many experts say that Greece’s public health system was bloated and corrupt and in dire need of reform. But they say also that the cuts have been so deep and have come so fast, that they have hit like a tsunami.

In just two years, the government has cut spending on health care to $17 billion from $19.5 billion — a 13 percent decrease. And under its agreement with its creditors, Greece must find even more health care savings next year — as much as $915 million, government officials said.

At the same time, public health facilities have seen a 25 to 30 percent increase in patients because so many Greeks can no longer afford to visit private clinics.

Dr. Olatz Ugarte, an anesthesiologist at the Saint Savvas Cancer Hospital in Athens, said that breast cancer patients often have to wait three months now to have tumors removed. “Waiting that long can be life or death for these patients,” she said.

In a recent letter to the medical journal The Lancet, a team of English researchers warned that a “Greek tragedy” could be in the making, pointing to rising suicide and H.I.V. rates and deterioration of services at hospitals under financial pressure. “In an effort to finance debts,” the researchers said, “ordinary people are paying the ultimate price: losing access to care and preventive services, facing higher risks of H.I.V. and sexually transmitted diseases, and in the worst case losing their lives.”

At the Perama clinic, which is run by the international nonprofit Doctors of the World, doctors say they are seeing many families that cannot afford bus fare, let alone the new $6.50 fee at public clinics.

Technically, those Greeks who cannot pay are entitled to free care. But the bureaucracy can be overwhelming. Ms. Ragamb, a former hairdresser whose unemployment benefits and health insurance ran out six months ago, said she was still waiting to get the right papers.

The story did not surprise Dr. Liana Mailli, the pediatrician who was seeing Ms. Ragamb’s son, Elias. The 3-year-old got a diagnosis of diabetes only a few months ago, after he fell into a coma. Dr. Mailli has heard of such bureaucratic troubles from many patients. Even more often, she said, parents have fallen behind in paying their health insurance contributions, or their employers do not pay and so they are no longer covered.

One development that Dr. Mailli said she found particularly disturbing was that a growing number of children had not had their basic vaccinations.

If nothing is done, she said, polio, diphtheria and whooping cough could all return to Greece. “This is such a serious thing,” she said. “But these vaccines are expensive.”

At the start of its debt crisis, Greece was spending about 6 percent of its G.D.P. on health care — about average for Europe. But the system was far from efficient. It includes many small hospitals and a reliance on expensive brand name drugs.

Moreover, there was widespread corruption. Experts say doctors often had lucrative deals with drug manufacturers that led them to vastly overprescribe, and many expected cash payments on the side for timely and attentive care.

Since the debt crisis began in 2009, the government has frozen hiring, cut salaries and focused on tracking prescriptions and new procurement procedures. About 20 doctors have been arrested for corruption.

But little has gone smoothly.

Government officials acknowledge some problems, but say that the system was simply unsustainable. In the next year, they say, adjustments can be made.

“We have had two years of emphasis on the financial, now we will pass to evaluation,” said Nikos Polyzos, the secretary general of the Health Ministry.

But many doctors say the new emphasis on cutting costs has gone too far. In addition to shortages, they say that the supplies they do have are of poor quality. They complain that bugs have been found in new syringes imported from China, sutures fall apart and generic drugs do not seem to do the job. And the hiring freeze has caused such a shortage of nurses, some doctors said, that procedures frequently have to be postponed.

Dimitris Bounias and Nikolas Leontopoulos contributed reporting.

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Recipes for Health: Red Lentil Kofta With Spinach — Recipes for Health

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1/2 cup red lentils, rinsed

1/2 onion

2 garlic cloves, minced

3 cups water

Salt to taste

1 12-ounce bunch spinach, stemmed, cleaned and roughly chopped, or 1 6-ounce bag baby spinach, stems removed, roughly chopped

2/3 cup fine or medium (No. 1 or No. 2) bulgur

2 tablespoons extra virgin olive oil

1 teaspoon cumin seeds, toasted and ground

1/2 teaspoon allspice, ground

Aleppo pepper to taste (optional)

Scallions, radishes, small romaine lettuce leaves and lemon wedges for garnish

1. Combine the red lentils, onion, garlic and water in a large saucepan and bring to a boil. Skim off any foam, reduce the heat, add salt to taste and simmer 30 minutes, or until the lentils are soft. Remove the onion half. Add the spinach and simmer for another minute, until it is wilted. Taste and adjust salt.

2. Stir the bulgur into the pot, turn off the heat and cover. Let sit for 30 minutes, until the bulgur is tender and has absorbed all the liquid.

3. Meanwhile, heat 2 tablespoons of the olive oil over medium-low heat and add the ground cumin and allspice. Stir for about 15 seconds, until fragrant, then stir into the lentil/bulgur/spinach mixture. Allow to cool, in the refrigerator if you’re leaving for more than an hour.

4. Moisten your hands with water and knead the mixture in the bowl for 3 to 5 minutes, or stir with a rubber spatula. Each time it begins to stick to your hands, moisten them again. For a spicier mixture, add 1/4 to 1/2 teaspoon Aleppo pepper. Taste and adjust salt.

5. Moisten your hands and shape the mixture into walnut-size balls (about 1 inch). You’ll have to moisten your hands again whenever the mixture begins to stick to them. Place on a platter, garnish with scallions, radishes, romaine lettuce leaves and lemon wedges, and serve, or chill for several hours. Serve cold or at room temperature.

Yield: 4 to 6 servings, about 30 kofta

Advance preparation: You can make these a day ahead and keep them in the refrigerator.

Nutritional information per serving (4 servings): 238 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 35 grams carbohydrates; 11 grams dietary fiber; 52 milligrams sodium (does not include salt to taste); 11 grams protein

Nutritional information per serving (6 servings): 159 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 23 grams carbohydrates; 7 grams dietary fiber; 34 milligrams sodium (does not include salt to taste); 7 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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