Take the Latest Low Sodium Advice With a Grain of Salt, Part 1

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July 26, 2003 | 34,279 views

[Part 1, Part 2]

ByPaul 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 ofThe AmericanInstitute of Stress

The "diet dictocrats" are at it again. The latestNHLBI (National Heart Lung and Blood Institute) warning isthat Americans are eating too much salt and are thereforeat increased risk for hypertension, stroke and heart attacks.Others claim that excess sodium is a poison that can alsocause cancer and osteoporosis. NHLBI recommends that not onlyhigh blood pressure patients but all Americans should sharplyreduce their sodium intake, regardless of age, gender or race.This is another example of the same, stupid "one sizefits all" cookie cutter approach of treating populationstatistics and laboratory measurements rather than people.

This latest ban on sodium seems strange since salt has alwaysbeen viewed as being very valuable. In ancient Greece, slaveswere traded for salt - hence the expression "not worthhis 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 agreementor contract and was called "the covenant of salt".Men wore a pouch of salt tied to their belt and when theymade a promise to someone, each put a pinch of salt into theother's pouch. If a man wanted to break his covenantfor reasons that did not seem fair, the other could respondby telling him "Yes, if you can retrieve your grainsand yours only from my pouch of salt". Salt was similarlyused to seal a deal in Arabic countries, where it also signifiedsafety and friendship. If you were offered and ate salt insomeone's home it meant they would never harm you in any wayand vice versa.

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

Participants at medieval feasts were seated in order of importancebased on the location of the salt dishes. Distinguished guestsdined at an elegant elevated banquet table "above thesalt." Lesser lights sat "below" in the boondocksin progressively lower trestle type tables.

Mystical, Sanctifying and PracticalUses

Salt was also considered to be a magical substance that couldbring good fortune and prevent illness. An old Latin proverbstated "There is nothing more useful than the sun andsalt" (Nil sole et sale utilius). Since it was essentialfor preserving food, spilling salt was a terrible waste thatwould surely bring bad luck. This led to the belief that Satanor some evil spirit must have been standing behind you tocause such an accident. The best thing to do was to immediatelythrow three pinches of the spilled salt over your left shoulderinto his eye to blind him and scare him away. (Any good spiritswould allegedly be behind you on the right.) I vividly remembermy mother doing this and suspect it is still a common practicein some parts of the world.

In "The Last Supper", Leonardo da Vinci placedan overturned dish of salt in front of the scowling JudasIscariot. Some suspect that Leonardo was aware that this representedan ill omen to prophesy the traitor's death by hanging himself.Others believe that the superstition may have started withthis painting, since in describing the event, the scripturestated "Satan entered into Judas" and "supperbeing ended, the devil having now put into the heart of JudasIscariot to betray him".

The Druids used salt in their Stonehenge rituals becauseit was believed to represent a symbol of the life-giving fruitsof the earth. In old Japanese theatres, salt was sprinkledon the stage before each performance to prevent evil spiritsfrom casting a spell on the actors and ruining the play. Saltwas also thought to provide sanctification. One of the fourprincipal tenets of the Shinto religion was the guaranteeof 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 clayof the Dohyo or sumo ring is considered a sacred spot andmust be purified the day before each tournament by the headreferee and a Shinto priest, who pour sake and salt in itscenter. The Dohyo is made of packed clay and consists of asquare platform with a circle made of dirt-packed straw balesimbedded in its surface. Salt is sprinkled on this beforeeach match to cleanse the ring of "bad spirit".During the warm-up period, it is not unusual to see a wrestlersprinkling salt on his foot, bandaged knee or elbow for furtherprotection, before throwing the rest into the ring.

In the Old Testament, Elisha also purified a spring by tossingsalt into it. Nathaniel Hawthorne, whose The Scarlet Letterand other works are noted for their treatment of guilt andthe complexities of making moral choices, similarly believedthat there was something sacred about salt and wrote, "Saltis white and pure, - there is something holy in salt."In some countries, it is customary to greet newlyweds withgifts of salt and bread to bring good luck instead of throwingconfetti or rice. Roman mothers rubbed salt on the lips ofinfants to protect them from illness and danger. Though nolonger common, for hundreds of years Roman Catholic priestswould place a pinch of salt on a baby's tongue during baptismand say, "Receive the salt of wisdom."

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

How Did the Low Salt Crusade Start?

If salt was believed to be so valuable and useful in so manyways for so many thousands of years by so many million peoplefrom so many different cultures, why is it that we have onlyrecently discovered that it is dangerous? Like the conspiracyagainst cholesterol and fat intake, the denunciation of sodiumbegan little more than 50 years ago. Low salt proponents pointout that over four thousand years ago, the Yellow Emperor'sCanon of Internal Medicine stated, "too much salt stiffensthe pulse." They interpret this as representing advancedarteriosclerosis due to hypertension. However, unlike acupuncture,magnets and herbal remedies that are mentioned and are stillpopular, there was no further reference to this.

About 100 years ago, French physicians reported that restrictingsalt and salty foods benefited patients with fluid retentionand hypertension. Shortly thereafter, it was found that mercurialcompounds used to treat syphilis often caused a significantdiuresis, which led to the development of mercurial drugsto treat edema. Although more effective than trying to eliminatesodium intake, they had to be injected and often had seriousside effects.

The advent of modern diuretics resulted from the equallyserendipitous observation that some patients being treatedwith sulfa drugs for rheumatic fever and bacterial infectionsalso often experienced a significant diuresis. In 1949, BillSchwartz reported that three patients with marked edema dueto heart failure who were given sulfonamides all showed dramaticimprovement but that these drugs were also "too toxicfor prolonged or routine use."

The first proof that reducing sodium intake could benefitsome patients with hypertension also came in 1949 when WalterKempner reported improvement in malignant hypertension associatedwith kidney disease and heart failure. The Kempner diet consistedsolely of rice and certain fruits that limited sodium intaketo less than 350 mg daily and had no fat. It was extremelyhard to adhere to for more than a week or two but was preferableto bilateral lumbar sympathectomy, the only other treatmentfor this lethal disorder.

Karl Beyer, a research chemist, tried several variationsof the sulfonamide formula and developed Diuril (chlorothiazide).It proved to be safer and more effective in reducing edemaand it also lowered blood pressure in hypertensive patientswithout evidence of significant fluid retention. Diuril andother thiazide diuretics like Hydrodiuril and Hygroton quicklybecame the treatment of choice for hypertension. Support fortheir use came from animal studies showing a correlation betweenincreased sodium content of arterial vessels and elevatedblood pressure.

Lewis Dahl was able to develop a strain of salt sensitiverats who routinely developed hypertension to support his firmbelief in the value of salt restriction. This was widely heraldedand cited by other low salt proponents as proof of the roleof salt in hypertension. What they often neglect to mentionis that these rats would have to be fed an amount of saltequivalent to over 500 grams daily for an adult human. Dahlalso demonstrated a linear relationship between salt intakeand blood pressure in different populations as noted below:

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


[Part 1, Part 2]