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The divine salt
- BM Hegde (28 April 2007)
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Stil no proper evidence to go so hard against salt intake
- Sam Tait (29 April 2007)
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It's got to be the salt
- Margaret E Allen (30 April 2007)
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Medical evidence mismatched with culinary reality
- Jonathan H Peterson (1 May 2007)
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BM Hegde, Retd. Vice Chancellor Mangalore 575 004, India
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Dear Editor, Your editorial is very timely. It was Indian Ayurveda which proclaimed to the world that high salt intake is the root cause of many of our ills especially of the blood vessels. “Lavana (salt) ……raktha pitta prakopayeth (blood gets disturbed and becomes angry)”. The next recorded connection between salt and disease came from a Chinese monk Huang Ti Nei Ching way back in 1700 BC, a translated version by Wan Ping was available around AD 762. The experimental work in France by Ambard and Beaujard in 1904 showed equivocal results of dietary salt and hypertension. William Harvey had hinted that salt could be the cause of vessel hardening and heart thickening around 1628 AD. Richard Bright later took up this at the Guys’ Hospital to show the link between high pressure, kidney and salt. (1) (2) Salt was considered divine by Homer and Plato. French thinkers, led by Jean de Marguanille Percheron, wrote that “the sacredness and dignity of salt…it is like the four elements-earth, air, fire and water, so universal to life, it is the fifth element.” However, our hunter gatherer forefathers never ate salt and were healthy all the same. Eaton and his colleagues, at the anthropology department of Emery university, feel that salt is the cause of our modern ills thus. “From a genetic standpoint, humans living today are Stone Age hunter-gatherers displaced through time to a world that differs from that for which our genetic constitution was selected. Unlike evolutionary maladaptation, our current discordance has little effect on reproductive success; rather it acts as a potent promoter of chronic illnesses: atherosclerosis, essential hypertension, many cancers, diabetes mellitus, and obesity among others. Although our genes have hardly changed, our culture has been transformed almost beyond recognition during the past 10,000 years, especially since the Industrial Revolution. There is increasing evidence that the resulting mismatch fosters "diseases of civilization" that together cause 75 percent of all deaths in Western nations, but that are rare among persons whose life ways reflect those of our pre-agricultural ancestors”(3) The present study referred to in your editorial settles the question for the time being but the industry will have their own studies in future to refute this as salt is a very powerful commercial commodity which, in the olden days, was abused by rulers and priests to keep their salt hungry subjects under their thumb! Salary (solarium) comes from salt as salary in Rome of the past. Phosgene gas (chlorine) in association with sodium is the most powerful germicidal and as such will not be abandoned by the food industry for increasing their products’ shelf life. Good example is the morning breakfast cereal, cornflakes, which has much more salt than sea water! The salt taste is masked with some other chemicals. Commerce takes precedence over health. Dietary salt is another important cause of premature osteoporosis, especially in sedentary women not exposed to enough sun light. Calcium supplements to treat osteoporosis is another of those commercial myths. Exogenous extra calcium intake pushes more calcium from the distal kidney tubule, calcium induced calcium loss, resulting in negative calcium balance. Salt, thus, is our enemy numero uno. (4) I remember my days at the Middlesex in the 60s where we used to see refractory heart failures referred to us. My chief, Late Walter Somerville, used to first ask the patient as to how many biscuits a day s/he had consumed. Along with bread and preserved food biscuits, even glucose biscuits, have very high salt content as biscuits have to be baked twice (bis=twice, queet=bake) Cutting down biscuits, common ingredient of a sick person’s diet, used to make those resistant failures come under diuretic control very easily! I have been following that lead even to this day in my patients. Yours ever,
References: 1) Graham A Macgregor and HE de Wardner. Salt, Diets and Health. Cambridge University Press. 2) Loren Cordain, S Boyd Eaton, Anthony Sebastian, Neil Mann, Staffan Lindeberg, Bruce A Watkins, James H O’Keefe and Janette Brand-Miller. Origins and evolution of the Western diet: health implications for the 21st century. American Journal of Clinical Nutrition, 2005; 81: 341-354. 3) Eaton SB, Konner M, Shostaky M. Stone agers in fast lane. Am. J. Med 1988; 4: 739-749. 4) Bobrow et. al. Thiazide use and reduced sodium intake for prevention of osteoporosis. JAMA; 285: 2323-2324. Competing interests: None declared |
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Sam Tait, former researcher Bucks
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I think the case against salt is overstated for a number of reasons. First,the prospective studies concerned do not conclusively confirm a higher incidence of cardiovascular disease among high salt-takers.At best those sutdies indicate such possibility in selective populations.Hence, it would be wrong to apply information derived from those studies to the entire global population or exaggerate the salt-cardiovascular connection.It is not clear from the studies referred to under editorial whether: (a)the renal function of the cohorts studied were tested at regular intervals during the life of the study. (b)endocrine-related conditions which could have an impact on sodium balance were looked for or excluded. (c)what measures were taken to ensure the accuracy of sample subjects' claims of the amount of salt intake throghout the studies. Competing interests: None declared |
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Margaret E Allen, Physician Assistant East Palo Alto, California
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Man! am I miserable if I can't get my hands on salt - sea salt, Maldon salt, iodized, non-iodized, Kosher, Esprit du Sel salt. I'd even eat halite or road salt - er, in a pinch. But I have "essential" hypertension, and it's just got to be that salt. I don't eat meat, fish, or processed foods; I hike, bike, and like to do aerobics; I practice yoga; I don't smoke. Tomorrow, though, I'm going to check my 24 hour urinary sodium and then start my own study. I just hope it doesn't take thirty- six months to lower my BP a couple of points. Who knows what, deprived of the divine salt, I might be driven to. Competing interests: None declared |
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Jonathan H Peterson, Software BMA House, WC1H 9JR
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The poor and uninformed public are these days strongly encouraged to cook fresh food, eat more vegetables and generally avoid the evils of processed, pre-prepared food. However, at the same time, they are being told not to add salt to anything. If a meal is cooked, from raw, fresh, basic ingredients, and no salt is added at any stage, it will taste bland almost to the point of being inedible. This is no way to encourage healthy eating and a return to real cooking. It is traditional that medicine should taste bad if it is to do you any good, but this approach to dietary salt seems extreme. Perhaps a spoonful of refined high-fructose corn syrup, added to every meal, will help the medicine go down? Competing interests: I work in a technical capacity for the BMJ Publishing Group |
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