By Paul J. Rosch, M.D.
President, The American Institute of Stress
Clinical Professor of Medicine and Psychiatry
New York Medical College
Originally published in the Health and Stress newsletter of The American Institute of Stress

The "diet dictocrats" are at it again. The latest NHLBI (National Heart Lung and Blood Institute) warning is that Americans are eating too much salt and are therefore at increased risk for hypertension, stroke and heart attacks. Others claim that excess sodium is a poison that can also cause cancer and osteoporosis. NHLBI recommends that not only high blood pressure patients but all Americans should sharply reduce their sodium intake, regardless of age, gender or race. This is another example of the same, stupid "one size fits all" cookie cutter approach of treating population statistics and laboratory measurements rather than people.

This latest ban on sodium seems strange since salt has always been viewed as being very valuable. In ancient Greece, slaves were traded for salt - hence the expression "not worth his salt." Roman soldiers were sometimes paid in salt (salis) and their salarium is the origin of our word "salary". "Soldier" actually comes from the Latin (sal dare), which means, "to give salt".

In Biblical times, salt was also used to seal an agreement or contract and was called "the covenant of salt". Men wore a pouch of salt tied to their belt and when they made a promise to someone, each put a pinch of salt into the other’s pouch. If a man wanted to break his covenant for reasons that did not seem fair, the other could respond by telling him "Yes, if you can retrieve your grains and yours only from my pouch of salt". Salt was similarly used to seal a deal in Arabic countries, where it also signified safety and friendship. If you were offered and ate salt in someone's home it meant they would never harm you in any way and vice versa.

The Bible refers to the covenant of salt by which God gave the rule over Israel forever to David and his sons and in the Law of Moses requiring that all cereal offerings contain salt. Salt was valuable since it preserved foods and being called the "salt of the earth" meant that you were a valuable person. It could also refer to a group of people on whom one could rely, as when Jesus told his disciples "Ye are the salt of the earth, ... Ye are the light of the world." In other words they were preservatives against the damaging and spoiling effects of worldly sin.

Participants at medieval feasts were seated in order of importance based on the location of the salt dishes. Distinguished guests dined at an elegant elevated banquet table "above the salt." Lesser lights sat "below" in the boondocks in progressively lower trestle type tables.

Mystical, Sanctifying and Practical Uses

Salt was also considered to be a magical substance that could bring good fortune and prevent illness. An old Latin proverb stated "There is nothing more useful than the sun and salt" (Nil sole et sale utilius). Since it was essential for preserving food, spilling salt was a terrible waste that would surely bring bad luck. This led to the belief that Satan or some evil spirit must have been standing behind you to cause such an accident. The best thing to do was to immediately throw three pinches of the spilled salt over your left shoulder into his eye to blind him and scare him away. (Any good spirits would allegedly be behind you on the right.) I vividly remember my mother doing this and suspect it is still a common practice in some parts of the world.

In "The Last Supper", Leonardo da Vinci placed an overturned dish of salt in front of the scowling Judas Iscariot. Some suspect that Leonardo was aware that this represented an ill omen to prophesy the traitor's death by hanging himself. Others believe that the superstition may have started with this painting, since in describing the event, the scripture stated "Satan entered into Judas" and "supper being ended, the devil having now put into the heart of Judas Iscariot to betray him".

The Druids used salt in their Stonehenge rituals because it was believed to represent a symbol of the life-giving fruits of the earth. In old Japanese theatres, salt was sprinkled on the stage before each performance to prevent evil spirits from casting a spell on the actors and ruining the play. Salt was also thought to provide sanctification. One of the four principal tenets of the Shinto religion was the guarantee of physical cleanliness before praying or approaching a shrine, which required lots of sprinkling with salt and then washing.

This is still practiced in Sumo wrestling. The hallowed clay of the Dohyo or sumo ring is considered a sacred spot and must be purified the day before each tournament by the head referee and a Shinto priest, who pour sake and salt in its center. The Dohyo is made of packed clay and consists of a square platform with a circle made of dirt-packed straw bales imbedded in its surface. Salt is sprinkled on this before each match to cleanse the ring of "bad spirit". During the warm-up period, it is not unusual to see a wrestler sprinkling salt on his foot, bandaged knee or elbow for further protection, before throwing the rest into the ring.

In the Old Testament, Elisha also purified a spring by tossing salt into it. Nathaniel Hawthorne, whose The Scarlet Letter and other works are noted for their treatment of guilt and the complexities of making moral choices, similarly believed that there was something sacred about salt and wrote, "Salt is white and pure, - there is something holy in salt." In some countries, it is customary to greet newlyweds with gifts of salt and bread to bring good luck instead of throwing confetti or rice. Roman mothers rubbed salt on the lips of infants to protect them from illness and danger. Though no longer common, for hundreds of years Roman Catholic priests would place a pinch of salt on a baby's tongue during baptism and say, "Receive the salt of wisdom."

Salt was so valuable that caravans carried it across the Sahara to Eastern trading centers to exchange for gold, ivory, slaves and skins. Salt bars were the coin of the realm in Ethiopia for over a thousand years and cakes of salt stamped to show their value were also used as currency in countries from Borneo to Tibet.

How Did the Low Salt Crusade Start?

If salt was believed to be so valuable and useful in so many ways for so many thousands of years by so many million people from so many different cultures, why is it that we have only recently discovered that it is dangerous? Like the conspiracy against cholesterol and fat intake, the denunciation of sodium began little more than 50 years ago. Low salt proponents point out that over four thousand years ago, the Yellow Emperor's Canon of Internal Medicine stated, "too much salt stiffens the pulse." They interpret this as representing advanced arteriosclerosis due to hypertension. However, unlike acupuncture, magnets and herbal remedies that are mentioned and are still popular, there was no further reference to this.

About 100 years ago, French physicians reported that restricting salt and salty foods benefited patients with fluid retention and hypertension. Shortly thereafter, it was found that mercurial compounds used to treat syphilis often caused a significant diuresis, which led to the development of mercurial drugs to treat edema. Although more effective than trying to eliminate sodium intake, they had to be injected and often had serious side effects.

The advent of modern diuretics resulted from the equally serendipitous observation that some patients being treated with sulfa drugs for rheumatic fever and bacterial infections also often experienced a significant diuresis. In 1949, Bill Schwartz reported that three patients with marked edema due to heart failure who were given sulfonamides all showed dramatic improvement but that these drugs were also "too toxic for prolonged or routine use."

The first proof that reducing sodium intake could benefit some patients with hypertension also came in 1949 when Walter Kempner reported improvement in malignant hypertension associated with kidney disease and heart failure. The Kempner diet consisted solely of rice and certain fruits that limited sodium intake to less than 350 mg daily and had no fat. It was extremely hard to adhere to for more than a week or two but was preferable to bilateral lumbar sympathectomy, the only other treatment for this lethal disorder.

Karl Beyer, a research chemist, tried several variations of the sulfonamide formula and developed Diuril (chlorothiazide). It proved to be safer and more effective in reducing edema and it also lowered blood pressure in hypertensive patients without evidence of significant fluid retention. Diuril and other thiazide diuretics like Hydrodiuril and Hygroton quickly became the treatment of choice for hypertension. Support for their use came from animal studies showing a correlation between increased sodium content of arterial vessels and elevated blood pressure.

Lewis Dahl was able to develop a strain of salt sensitive rats who routinely developed hypertension to support his firm belief in the value of salt restriction. This was widely heralded and cited by other low salt proponents as proof of the role of salt in hypertension. What they often neglect to mention is that these rats would have to be fed an amount of salt equivalent to over 500 grams daily for an adult human. Dahl also demonstrated a linear relationship between salt intake and blood pressure in different populations as noted below:

This surely confirmed the dangers of salt for everyone and prompted the 1979 "Surgeon General's Report on Health Promotion and Disease Prevention" condemning salt as a clear cause of high blood pressure. Since then, the government has spent untold millions in a vain attempt to justify this claim. Their expensive and lengthy crusade to prove a link between sodium and hypertension began in 1984 with the $1.3 million INTERSALT study of 10,000 subjects in 52 centers around the world. As anticipated, researchers reported that societies with higher sodium intakes also had higher average blood pressures. A similar relationship was also allegedly shown in individuals, thus clinching the government's case.

Continue to Part 2