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
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
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
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
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.