Below the Salt: “Chinese Restaurant Syndrome” and the Perils of Anecdotal Evidence

“Is one bite worth a thousand pains?”

That is the question journalist Linda Mathews asked in response to a 1968 letter to the New England Journal of Medicine regarding a mysterious food ailment.  In the letter, Robert Ho Man Kwok, a Chinese-American doctor living in Maryland, complained of experiencing dizziness and muscle aches each time he ate out at a Chinese restaurant. “The syndrome,” Kwok wrote, which usually begins 15-20 minutes after I have eaten the first dish, lasts for about two hours, without any hangover effect. The most prominent symptoms are numbness at the back of the neck gradually radiating to both arms and the back, general weakness and palpitation.” In following issues of the journal, other readers began to send in accounts of similar experiences with this “Chinese restaurant syndrome,” or CRS.

“A thousand pains” turned out to be an insightful description of the hysteria that ensued. Soon, the syndrome’s list of supposed symptoms grew to include dizziness, fainting, incontinence, changes in personality, and a slew of other horrifying effects. Dr. Kwok himself suggested that the problem had to do with a common seasoning ingredient called monosodium glutamate – MSG.  At a typical Chinese restaurant at the time, MSG could be found in almost every item on the menu.

A stock photograph of MSG crystals

An image of MSG crystals

Restaurant owners scoffed at the idea that MSG was harmful. “There are 700 million Chinese on earth who eat Chinese food every day and nothing has ever happened to them,” remarked the manager of General Lee’s restaurant in Los Angeles. In San Francisco, another man suggested that CRS was “a rumor spread by Italians.” As spiteful as his comment was, he had exposed an obvious double standard – why were only Chinese restaurants being singled out for MSG when the ingredient was used in many other types of cuisine?

Japanese chemist Ikeda Kikunae

Japanese chemist Ikeda Kikunae

MSG was first created in a laboratory in 1908 by Japanese chemist Ikeda Kikunae, who isolated the ingredient that gave flavor to a broth called konbu dashi. Ikeda dubbed his invention umami, derived from a Japanese word meaning “tasty.” The flavor became particularly appealing to Chinese-American cooks, who called it “gourmet powder.” It was also heavily used in processed foods such as canned tomatoes and parmesan cheese. According to food historian Jordan Sand, “had Japanese, Taiwanese, or perhaps any other East or Southeast Asian cuisine made the inroads into North American diets that Chinese food had made in the middle decades of the twentieth century, the syndrome might just as easily been called Japanese, Taiwanese, or What-Have-You Syndrome.”

In 1962, the publication of Rachel Carson’s landmark book Silent Spring brought environmental concerns to the forefront of American politics.  Espousing the dangers of synthetic pesticides made by chemical companies, the work is credited with causing changes in pesticide policy and the creation of the U.S Environmental Protection Agency.  Ordinary people all across the United States also became more conscious about what kinds of things were in their food. Monosodium glutamate sounded like just another synthetic chemical additive that could poison Americans.

Except that it wasn’t. Though a flood of research was conducted on MSG in the wake of Dr. Kwok’s letter, studies have been unable to reveal a correlation between MSG and adverse side effects.  According to the FDA website, “FDA considers the addition of MSG to foods to be “generally recognized as safe” (GRAS). Although many people identify themselves as sensitive to MSG, in studies with such individuals given MSG or a placebo, scientists have not been able to consistently trigger reactions.”  Yet the myth still lingers. One of the top Google results in a search for MSG returns a 2009 article from alternative medicine website Mercola entitled, “MSG Is This Silent Killer Lurking in Your Kitchen Cabinets.”

Food anxiety and fad diets are nothing new, and are still widespread today.  On April 26, 2015, Chipotle announced that it has become the first major restaurant to completely remove ingredients made from GMOs (genetically modified organisms) from its menu. Said by the New York Times to “symbolize the tastes of the millennial,” Chipotle has been quite skillful in catering to consumer concerns, pulling a billion dollars of revenue in the first quarter of 2015. While customers are “always right” when it comes to economics, they are not always so savvy when it comes to science. Umami flavor, MSG’s close glutamate relative, is currently a darling of cooking shows and some of the world’s trendiest restaurants.

In 2014, a restaurant owner in San Francisco blasted customers concerned about MSG (via San Francisco Eater)

In 2014, a restaurant owner in San Francisco lashed out at customers concerned about MSG (via San Francisco Eater)

Self-diagnoses from individuals who got sick from Chinese food fueled rumors that defied scientific consensus. Chinese restaurants proved to be adaptable to the tide against MSG. Many stores now display signs in their front windows saying “No MSG.” Chinese Restaurant News magazine estimates that there are roughly 41,000 Chinese restaurants in the United States, outnumbering all of the largest five fast-food companies put together. These establishments won’t be going out of business any time soon. But the stigma that food served in Chinese restaurants is less trustworthy than others shows that CRS accounts perpetuated a troublesome stereotype rooted in collective social concerns.


Food and Drug Administration, “Monosodium glutamate,” FDA Medical Bulletin (Jan 1996): 3–4.

Jordan Sand, “A Short History of MSG: Good Science, Bad Science, and Taste Cultures,” Gastronomica 5:4 (Fall 2005): pp. 38-49.

Linda Mathews, “Doctor Seeks More Facts on Chinese Food Syndrome,” The Spokesman Review, June 16, 1958, p. 18.

Natasha Geiling, “It’s the Umami, Stupid. Why the Truth About MSG is So Easy to Swallow,”, November 8, 2013.

Robert Ho Man Kwok, “Chinese-restaurant syndrome [letter],” New England Journal of Medicine 278 (April 1968): 796.

Stephanie Strom, “Chipotle Posts Another Quarter of Billion-Dollar Sales,” New York Times, April 21, 2015.

One thought on “Below the Salt: “Chinese Restaurant Syndrome” and the Perils of Anecdotal Evidence

  1. Pingback: Desperation Pies: A Slice of Seasonal History | The History Bandits

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s