The Age Old Salt Controversy

Part One:

Part Two:

The two articles enclosed are realistic commentaries, pertaining to the ingestion of salt.
The conclusions stated, with which I concur completely, indicate that salt is essential in our diet for the maintenance of good health. Restriction of the use of salt can lead to physiological imbalances and accomplishes little of merit.

Salt is a vital ingredient in the maintenance of the body’s physiological functions. Specifically, it is integral to the maintenance of hydration and electrolyte balance. It has always been my presumption that unless one has significant renal or cardiac dysfunction, the liberal if not excessive use of salt is totally safe and probably essential.

The normal ingestion of fluids will invariably eliminate any excess that may remain. Without question, the restriction of salt in the diet creates more problems than it cures.

Many physicians advise salt-free regimens without adequate reflection. This trend is sometimes based on the commercial aspects of marketing salt-free products. In addition, the confusion that exists with regard to the treatment of hypertension is a significant factor. Hypertension is generally associated with an increase in age and is sometimes necessary in order to permit adequate arterial perfusion of the peripheral areas of the body including the brain. Focusing on the removal of stress in the environment undoubtedly is the best anti-hypertensive therapy available.

It must also be understood that most individuals’ blood pressures are highly labile, depending on circumstances. At rest, blood pressures generally return to normal, whereas in the stressful atmosphere of the physician’s office for example, they are invariably and inordinately elevated. Frequently, anti-hypertensives are prescribed on the basis of the prevalent, almost hysterical approach to what may be termed the “temporary” elevation of blood pressure and over the past decade particularly, this has become somewhat ingrained in routine medical practice.

Many patients monitor their blood pressures with devices purchased at their local drug store (some of which are highly inaccurate) many times each day and develop an obsession with the readings, resulting in a self-fulfilling prophecy. They may then consult a specialist who may prescribe an additional anti-hypertensive drug, resulting in the inappropriate management of hypertension, whether real or imaginary.

The controversy over salt utilization and the ingrained treatment of hypertension is not that dissimilar to the recent H1N1 crisis. These matters should provoke independent thought and one should be cautioned against the literature promulgated by pharmaceutical companies and governments. “Do not believe everything you may hear or read”; instead cultivate the ability to research widely and interpret correctly.

Whereas inoculation for polio and the other childhood diseases is extremely important, flu vaccination programs have a checkered history at best. Personally, I have never submitted to a flu shot and have been fortunate enough to avoid contracting these multiple disease entities, despite interacting daily with people who are infected and sometimes seriously ill. These contacts strengthen the immune system, much like inoculation.

It was interesting to note that during our recent flu epidemic, when the vaccine was unavailable to the public, panic reigned supreme. Stimulated by the media, the poorly informed clamored for the vaccine incessantly; once it became widely available, the demand evaporated instantly.

Medical fashion varies from one decade to the next as is well-illustrated by the history of the treatment of tonsillitis leading to almost routine tonsillectomies and once upon a time appendectomies were performed to prevent appendicitis. Today, fortunately these trends have fallen by the wayside.

Over the past hundred years, the management of psychiatric patients almost invariably resulted in long-term institutionalization. Beginning in the forties the advent of psychotherapy became the elitist approach. From an economic perspective however, it was problematic to apply this form of therapy widely.

Over the past twenty years, psychiatrists have found it easy to utilize psychomimetic drugs, as patient response can sometimes be dramatic and appears to be beneficial on a short-term basis. This trend, hopefully appears to be nearing its end as the complications engendered by this widely utilized and poorly monitored method are becoming better recognized.

Finally, rest assured that it is totally appropriate to use salt as required and no undue restriction is necessary, except in extreme circumstances.

Fred Kahn, MD FRCS(C)

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