SALT - GOOD, BAD OR WHAT? One of my first forays into the world of alternative medicine took place soon after my arrival in Japan when I was in my early 20’s. Not feeling particularly energetic and without any helpful feedback from conventional sources, I sought the advice of elderly Japanese man who placed me on a diet. The diet basically consisted of brown rice, beans, vegetables, fermented soybean products like soy sauce and miso, sesame oil and a few, mostly salty condiments.
Some people might recognize this as basic “Macrobiotic” fare. Macrobiotics was a diet and philosphy based on an idealized concept of the traditional Japanese food before the widespread use of milled white rice and foreign dietary influences. I was excited by the idea of feeling better and took up the challenge of changing the way I ate immediately. I remember standing on the train platform waiting to catch the train home after my first meeting with “my advisor”. I pulled out a cheese sandwich I had packed for the ride home and most ceremoniously dumped it in the garbage.
Looking back after over a quarter century of experience, I marvel at the consequences of my enthusiastic embrace of this idea. Admittedly, I will give myself a A for effort, but more importantly, I’d get a D- for common sense and an F for results.
The first 2 weeks were great. My energy increased, I felt light, I slept well... But after that initial honeymoon period of clean eating, the metabolic imbalances of insufficient protein, too many carbohydrates and especially too much salt gradually led to an ever decreasing level of health. My energy started to slide downward, my muscles felt tight and stiff, my emotional and mental outlook became increasingly narrow. Within six months I was a wreck and worst of all I had no understanding of how bad things were. I just wasn’t well enough in any sense of the word to see or evaluate my own condition.
Fortunately, a somewhat crazed American Zen devotee snapped me out of it. I hardly knew him, but through a mutual friend, it was arranged that he be put up at my house for a few days. At one point during his stay, he said to me, “The problem with you is that you aren’t eating any food at all, you are just eating theoretical concepts!” That comment, which I still remember with great clarity and appreciation, was like a lightening bolt, cutting through my dazed state and awakening in me a sense of perspective about my condition.
In retrospect it was a very destructive - and instructive episode in my life. Even after returning to an appropriate balanced diet, some of the symptoms that developed during that half year took years to disappear. Unfortunately, some of them still linger on in a ghost-like fashion, reappearing now and again.
The lessons I did learn have also stayed with me and I have had many occasion to share them with clients over the years. First and foremost, never delegate total responsibility for one’s own health to anyone else, even an “authority”. This is especially so in regard to dietary regimens. There are many ideas and theories, most of which worked for someone at some time, none of which work for everyone. It is important to keep an open mind, a sense of perspective and trust one’s common sense while trying out any diet. It might work marvelously for your best friend and be a disaster for you; and your mother might say you look too thin and pale, but you might feel absolutely fantastic.
Secondly, I experienced firsthand how diet is an extremely powerful tool, for better or for worse, to change one’s state of health and wellbeing. While I have studied and employed many different healing modalities over the years, there is no other tool as fundamental as considering the food a patient eats. It isn’t simply a matter of what is eaten, but also the amount that is eaten, the way it is eaten and, most importantly, the attitude with which it is eaten.
Third on the list is the necessity to consume adequate amounts of appropriate forms of protein. With all the publicity concerning the Atkins, Zone and other low carb diets, this certainly is a secret no longer. (When bakeries around the country are reporting that bread sales are off as much as 40% around the country and RJ’s Diner in downtown Bellows Falls advertises LOW CARB MEALS on the sign in front, you know the idea has taken hold...) Actually, it took me a long time to fully appreciate this particular lesson, but I firmly embrace it and written about it frequently over the years.
Lastly, it is important to respect the effect of salt on one’s health. Either too much or too little can make a critical difference in how one feels. The single most destructive aspect of my dietary adventure back in Japan was the over-consumption of salt. That is why I became so stiff and rigid - both physically and mentally. I was so dried out that it was nearly impossible to muster the energy to bend my legs to climb a flight of stairs.
My youthful “joie do vivre” was replaced by a rigid, narrow mindedness that I could no longer even see what was taking place. True excess salt intake and the fluid imbalances that it causes can also disturb the circulatory system and the function of the heart, resulting in elevated blood pressure, palpitations, headaches and a generalized anxiety.
Over the last 30 or more years, salt intake has become one of the standard tools of conventional medicine to regulate blood pressure. Next time we will explore this issue in greater detail.
PART II
Baseball is by far the most popular spectator sport in Japan - and nothing is followed with greater interest than the national high school tournament played every summer in one the most historical professional league ballparks. During the week or two (I can’t remember clearly how long it goes on anymore) that the teams representing each of the provinces fight it out in the single elimination tournament, the country’s attention is firmly fixed on these adolescent athletes.
Each day promises 3 or 4 consecutive games beginning around 9 am. Just about every office and public place has a TV or radio tuned in to the action. For the Japanese, this tournament is the embodiment of “ganbaru ki” or “fighting spirit”: true amateur athletics played with the intensity of samurai warriors. One might compare it with the Little League world series held every year in Pennsylvania or college basketball’s March Madness tournament, but the high school tournament has much higher skill levels than the former, the absence of the masqueraded professionals of the latter, as well as an intensity and a nearly universal popularity that is unequaled by both of them put together.
For all its appeal, I didn’t find high school baseball the most intriguing spectator sport during my time in Japan. For me, it didn’t have the same allure as the primeval, ritualized sport of Sumo wrestling. These modern day athletes still live by social and athletic traditions that originated several thousand years ago. They are descendants of ancient warriors who, it is said, fought until death.
At the professional level, the 6 major tournaments consist of two weeks of matches, every day beginning with the lowest ranked wrestlers in the morning and ending with the highest around 6 pm. Each wrestler has a precise rank based on his performance history, and that rank is re-evaluated after each tournament. The matches themselves are quite brief, lasting anywhere from a few seconds to two or three minutes - until the opponent is forced outside of a ring or is made to fall on his knee or back.
What takes just as much, or perhaps, even more time are the stylized rituals that the fighters perform. Some take place as a joint presentation when a group or class of wrestles is introduced, others as the two wrestles prepare to face off against each other. To my foreign eyes, they always had an almost mesmerizing effect. Naked except for special silk loin clothes with detachable aprons that display their place of origin and rank, these behemoths slowly perform a series of arm motions and various types of stomps with their legs, all the while maintaining the same expressionless demeanor which is there code of honor.
Compared to the self-aggrandizing, demonstrative athletes of contemporary american sport, Sumo wrestlers are trained to never show a hint of emotion. This is especially so after a match. Whether they have been humiliated by a lower ranked opponent or have won the tournament championship, these fellows never betray any feeling whatsoever.
An integral part of the Sumo ritual is the use of salt. This, no doubt, is due to the fact that one of the four basic principals of Japan’s native Shinto religion is that before praying or approaching a religious shrine, a person must be cleansed through the sprinkling salt and then washing.
Likewise, the Sumo ring, known as a Dohyo, which is a clay platform with a straw circle, is purified with salt and sake each day before each tournament by a tournament referee and a Shinto priest. And before each match, the ring is again ritually cleansed with salt to ward off evil spirits. As the wrestles warm up, stretch and go thru their stylized motions before they face off, they once more grab handfuls of salt, sprinkle it on various body parts to ensure their personal protection and then toss the remainder into the ring .
A similar ritual was performed in Japanese theaters, where salt was sprinkled on the stage before each performance to prevent evil spirits from casting a spell on the actors and ruining the play.
The central role of salt in these rituals is not unique to Sumo or Japan. A fascinating article about salt by Dr. Paul Rosch, many similar examples are given .1
Many people are familiar with the superstition of throwing three pinches of salt over your left shoulder. This was because it was considered so valuable a substance that spilling any was thought to bring on bad luck. The idea was that some evil spirit was behind you causing the accident, and thus throwing salt in its direction would blind it and send it away.
The Biblical covenant of salt gave the rule over Israel to David and his descendants forever, while the Law of Moses required that all offerings contain salt.
Leonardo da Vinci painted an overturned salt dish in in front of Judas which represented an ill omen for the traitorous act. Another example are the ancient Druid rituals performed at Stonehenge that incorporated salt because it was “a symbol of the life-giving fruits of the earth”.
The importance of salt originated not only from its nutritional value as a mineral source, but also from its usefulness in preserving foods for seasons when people would otherwise have starved.
It became so valuable that many societies used salt as a form of currency. The expression "not worth his salt" comes from the practice of trading slaves for salt in Greece. The word “salary” comes from “salis”, the Latin word for salt, with which Roman soldiers were sometimes paid. "Soldier" is a derivative of “sal dare”, meaning “to give salt”. .
Salt was used to seal an agreement or contract, in the way a signature is used today, in many cultures. In Arabic countries, it also signified safety and friendship.
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.
Indeed, as Rosch points out with the Latin saying “Nil sole et sale utilius”, there is nothing more useful than the sun and the salt.
PART III
For thousands of years, salt has been considered an irreplaceable component of the human diet. Without adequate amounts of salt, people suffered from mineral deficiencies and metabolic disorders. Yet, for the last several decades, instead of being celebrated as the essential, life-giving food that it is, salt has been gained notoriety as a cause for high blood pressure.
Dr Paul J. Rosch, a professor of Medicine and Psychiatry at the New York Medical College has written a fascinating overview of both the history of and our contemporary attitudes towards salt in an article entitled, “Take the Latest Low Sodium Advice With a Grain of Salt”.1
Millions of dollars have been spent on government sponsored salt related research. This generally negative attitude toward salt has been most famously codified by the 1979 "Surgeon General's Report on Health Promotion and Disease Prevention" which identified salt as a major factor in hypertensive conditions. Five years later, a huge government sponsored study concluded that in general societies with higher salt intake would also have higher average blood pressure.
Even more damning was a 1999 study that followed over 20,000 Americans for more than a quarter century. The results were that people who ate more salt “had 32 percent more strokes, a whopping 89 percent more deaths from stroke, 44 percent more heart-attack deaths, and 39 percent more deaths from all causes.”
What is most interesting about this research is that although the statistics were technically correct, the conclusion was actually false. It is a classic example how numbers can be manipulated to prove just about any preconceived opinion.
What an independent review of the data showed was that the correlation of high salt intake and cardiovascular disease was only true for persons who were overweight. If overweight persons were removed from the study, the correlation disappeared. In fact, Michael Alderman, an epidemiologist and past president of the American Society of Hypertension, concluded quite the opposite and wrote that for persons who were not overweight, "the more salt you eat, the less likely you are to die."
While it is undoubtedly true that certain hypertensive persons are sensitive to salt intake, it is simply impossible to conclude that high salt intake is a cause of high blood pressure. For instance, in one of the salt studies, one group of Chinese all from a particular province had the highest salt intake of any group in the study - and very low rate of hypertension. Conversely, another group from Chicago with low salt intake had above average incidences of high blood pressure. Another group, a Brazilian rain forest tribe had low salt levels also had mean blood pressures that ran 20 to 30 points lower than what is considered normal.
The fact of the matter is that while it is possible to manipulate or cherry pick the data to “prove” any number of theories that may contradict each other, restricting salt can also have negative health consequences. For instance, after reviewing data in a study of 3,000 people with relatively moderate hypertension, Dr. Alderman concluded that, “those who consumed the least sodium had the most myocardial infarctions and other cardiovascular complications.”
An article published in the Lancet, a prestigious British medical journal, in 1998 similarly concluded that people “who eat lots of salt live longer than those who avoid it.” The 25% of people who consumed the lowest amounts of salt had a higher risk of death compared with the 25% who consumed the highest amounts of salt (23 deaths per 1,000 compared to 19 per 1000 person-years). Likewise, in an eight-year study of hypertensives in New York, those on low-salt diets had more than four times as many heart attacks as people with normal sodium intake.
Rosch states that reduced salt intake actually has a number negative consequences including: increased levels of renin (an enzyme that is associated with hypertension), increased levels of LDL (Low density lipids - the “bad” type of cholesterol), insulin resistance (the cause of adult onset or “type II) diabetes), reduced sexual activity in men and cause cognitive difficulties and anorexia in the elderly.
Reductionist thinking, that is an attempt to reduce complex phenomena to a single simple factor, is always tempting because it makes things simple. But the human metabolism is too complicated to reduce the cause of cardiovascular disease to a single culprit, be it salt or anything else.
There are many factors that influence blood pressure. For instance, it is known that deficiencies of other minerals such as calcium, potassium, and magnesium, correlate with hypertension. Excessive dietary intake of carbohydrates can also have a similar influence.
Balancing the amounts of sodium, magnesium and potassium can reestablish a healthy blood pressure when it is raised. Sodium, potassium and magnesium also act to regulate fluid balance in the body, allowing nutrients and oxygen to reach necessary destinations within the body.
That is why for anyone concerned about blood pressure, it is important to use a high quality of salt such as Celtic Sea Salt from France or Real Salt from Utah, both of which contain not only sodium chloride, but a plethora of other minerals essential for maintaining a healthy metabolism. Unfortunately, most of the commercial salts commonly available, even those labeled as sea salt or kosher salt, are heated and bleached. This results in a chemically altered, mineral deficient product which, though inexpensive and easy to pour from a shaker, is best avoided.
1 Rosch, Paul J., M.D. “Take the Latest Low Sodium Advice With a Grain of Salt”, Health and Stress newsletter of The American Institute of Stress