The Salt Fix: Why the Experts Got It All Wrong—and How Eating More Might Save Your Life
By Dr. James DiNicolantonio
Isak Dinesen once said, “The cure for anything is salt water: sweat, tears or the sea.” For much of human history, Isak Dinesen’s quote wasn’t just novelistic embellishment, it was part of accepted truth. Salt wasn’t just good for us; it was good to us. We needed salt. At least, we thought we needed salt until the mid-1900s, when salt—along with saturated fat, cholesterol and a host of other health-promoting, traditional food components—came under assault from the nutritional establishment.
Bias, bad research and billions of dollars resulted in the demonization of traditional foods and diets. Meanwhile, many of the real contributors to modern diseases (especially refined carbohydrates and sugar) got a pass to continue their carnage on the populace. Without fat and salt, sugar use exploded, as no one really wanted to eat cardboard calories. Thus, the wrong white crystal was put in nutritional jail, while its lookalike walked free, committing uncountable additional crimes against humanity.
Over the past twenty years, the tides have turned regarding cholesterol and fat, to some extent, but if you peruse various medical and health sites, the advice to restrict salt intake is still rampant. Many still consider salt as dubious and something to minimize instead of embracing it as an important part of a healthy diet.
In The Salt Fix, Dr. DiNicolantonio wants us to realize that salt isn’t just neutral but actually plays a critical role when dealing with many modern diseases and dietary scourges, from sugar cravings to heart disease. His book begins by showing us how we ended up on the wrong side of salt. Why did governments and researchers turn against salt? Here’s his guess: “We essentially gambled that the small benefit to blood pressure that we see in some patients would extend to large benefits for the whole population. And while taking that gamble, we glossed over the most important point: why salt may increase blood pressure in some people but not in others.”
This gamble came with significant dangers. Salt restriction is known to increase heart rate, and it can also lead to increased insulin levels and all the problems that elevated insulin creates. Elevated insulin levels play a part in carbohydrate and sugar cravings and overall mood and energy, helping to explain why those who seek to reduce salt intake often struggle so much with refined carbohydrates and weight. Salt makes food taste better and sweeter without needing to add any additional sugar. Salt restriction also can lead to reduced sex drive and reproductive potential, sleep problems and many other health issues.
How much salt do we need? Based on clinical and historical research, DiNicolantonio recommends three to four thousand milligrams per day. However, not all salts are created equal, and some people may need more salt than others. He reminds us that it isn’t surprising that we need salt. The earth is “salty,” and so are we. The mineral concentration of the seas roughly mirrors the mineral content of our blood. The earth is roughly 70 percent water, and we are almost that much water as well. Our relationship with salt isn’t adversarial but advantageous. DiNicolantonio observes that our kidneys exist not to protect us from salt but to profit from it and its many benefits to our bodies. The rest of creation is similar—animals of all kinds, but especially those that hunt sea animals, take in large amounts of salt.
Historically, the biological drive for salt also benefited humanity in other ways. Many foods that provide salt, such as fish and other seafood, also supply valuable nutrients that are otherwise hard to come by. The diets of non-seafood-eating people also could be high in salt, featuring foods such as tiger nuts (clocking in at an astounding three thousand-plus milligrams of sodium per one hundred grams or 3.4 ounces).
The historical evidence doesn’t end there. People who couldn’t find foods naturally high in salt sought out salt to add to their foods. Humans have mined salt for at least eight thousand years. Trade, food preservation and even commerce itself (the word “salary” comes from sal for salt) were all built on salt. The Romans and many other groups consumed as much as ten thousand milligrams of salt per day. Daily intakes of forty to seventy grams were not uncommon before the advent of refrigeration, since salted fish and cured meats were dietary staples for hundreds of years across many parts of the world. Until recently, these high-salt-intake groups had little to none of the ills now tenuously linked to salt, despite consuming five, ten and even twenty times the modern recommendations. Seems they must have missed the memo—and all the diseases that went with it!
How, then, did we end up with the idea that our ancestors didn’t consume much salt? Bad science. DiNicolantonio comments on one paper: “The authors of the paper estimated…our intake of sodium was just 700 milligrams per day. But this figure was based on the sodium content of select land animals as well as land plants…and does not include the sodium that would have been obtained from tiger nuts, insects, or aquatic vegetation or prey, nor does it include the other large stores of sodium found in animals besides their meat, such as that found in the skin, interstitial fluid, blood, and bone marrow.” Not only did our ancestors add salt to their food, they ate the parts of the animals already naturally highest in salt. Researchers ignored, didn’t understand or just didn’t care about these facts, and the war on salt has continued apace.
The middle chapters are what you would expect of a book unpacking the bad science and bogus claims based on the research of the 1900s. One of the more fascinating finds is how we went from viewing salt as a necessary nutrient to treating it as a mere condiment, thanks largely to the hypertension research of Lewis Dahl. Here, we see the role the media played (and still play) in taking tidbits of science and blowing them up into inaccurate proportion. The media’s “salt leads to hypertension” headlines were a watered-down version of just one facet of Dahl’s research, which concluded that a high-salt, low-potassium diet might lead to hypertension in the genetically susceptible. At the time (late 1970s), all it took was “expert” opinion rather than sound evidence to get new salt guidelines incorporated into George McGovern’s 1977 “Dietary Goals for the United States”—which recommended restricting salt intake to just three grams per day (or 1.2 grams of sodium).
The war on salt had one notable victor: sugar. Whereas the 2010 dietary guidelines recommended only five grams of salt, the same guidelines permitted a whopping one hundred and forty-three grams of added sugars per day. The updated 2015 guidelines did nothing to undo the war on salt but moderated the sugar intake recommendations to fifty grams per day (about forty pounds per year). Americans are not getting the message, as annual average sugar intake is over three times that amount. It seems that without fat and salt, people continue to turn to sugar to turn modern industrial foods into something culinarily bearable to consume.
DiNicolantonio’s recommendations are a fascinating read unto themselves and cover conditions and causes that may require you to increase your salt intake. From pregnancy and lactation to certain medications and genetic conditions, this section provides comprehensive information to help you achieve a salt intake level that promotes overall wellness. This section also significantly emphasizes using salt to help dial back and bring sugar consumption under control, something with which many Americans sorely need assistance. Here, we find no fear of saturated fats and traditional foods. Instead, DiNicolantonio writes, “Think of the olives, sardines, anchovies, salted and cured meats, aged cheeses, soups and so on! Go ahead and bring back those previously verboten high salt foods. Dig into the nuts, pickles, sauerkraut, seafood, shellfish, beets, Swiss chard, seaweed and artichokes—all are highly nutritious and a natural source of sodium.”
The book takes the time to go over the major, real salts now easily available to most consumers. DiNicolantonio does not recommend table salt, partly because of its poor nutrient profile but especially because of its highly processed nature. For those interested in learning more, the book contains both an appendix and ample footnotes to primary and other resources. If you are into salt, then The Salt Fix will serve as a good springboard to further research. Overall, DiNicolantonio’s book is easy to read, enjoyable to work through and makes a great companion to Mark Kurlansky’s 2002 Salt, A World History. Two thumbs up.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Fall 2018.