The Salt Fix: Why the Experts Got It All Wrong—and How Eating More Might Save Your Life
By Dr. James DiNicolantonio
Harmony
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.
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Alexander Cranford says
I asked a doctor once. 9% of the population has high blood pressure; 10% of the population has naturally low blood pressure. There is some controversy to whether a someone with high blood pressure should reduce their salt intake. Even if we take that to be the case, to suggest the entire adult population should minimise their salt intake is false dichotomy.
Here is my story. Although I had a high IQ, I had mediocre results. As a teenager I had all the symptoms of low blood pressure: poor concentration, irritable,nauseous. Through my teenage and adult years I had attacks of Menieres. Circa 2000 I was hospitalised and was connected to an intravenous machine for several days. My electrolyte levels were far too low. In 2003 I had another attack . My GP noticed my blood pressure was too low.Since then I bumped up my salt consumption and have only had mild attacks that have not lasted more than one night. What all these anti-salt zealots don’t tell you is low blood pressure can be fatal. I never saw the wisdom of a person with low blood pressure minimising their salt intake.
Roy Bowers says
Thank you for all the great health information and would like to know if you have a recommendation for a healthy salt substitute?
Thank you.
Roy
Pierre Dalcourt says
There are many false and inaccurate claims in this article. That’s because it is based on the book The Salt Fix, which contains many false and inaccurate claims.
CLAIM: “Tiger nuts [contain] an astounding three thousand-plus milligrams of sodium per one hundred grams or 3.4 ounces.”
FACT CHECK: While his source does state that one sample of tiger nuts (a kind of tuber) bought at a Nigerian market were indeed that high in salt, every other source of nutrition information on tiger nuts that I consulted contained vastly less sodium—all under 10mg per 100g serving. Furthermore, having read thousands of nutrition facts labels for all kinds of processed and unprocessed foods over the years, I have never in my life seen any plant-based food remotely as high in sodium as the cited tiger nuts. The most rational explanation? That these tiger nuts had been heavily salted prior to being packaged and sold—or that the scientists’ sodium assay method was somehow faulty. (Sources: https://nutritiondata.self.com/facts/custom/4025015/2?print=true , https://www.nutritionix.com/i/organic-gemini/tiger-nuts/55023ce2e906be7f1ba08650 , https://www.myfitnesspal.com/food/calories/593348095 , https://www.eatthismuch.com/food/nutrition/tiger-nuts,2315955/ , https://yupik.com/en/organic-tigernuts-peeled-p33050 )
I also find it interesting that, out of the thousands of plant based foods our ancestors may have eaten, DiNicolantonio zeroed in on the one outlier that tested astronomically high in sodium.
CLAIM: “DiNicolantonio observes that our kidneys exist not to protect us from salt but to profit from it and its many benefits to our bodies.”
FACT CHECK: That’s what politicians would call “spin.” Yes, we need some salt to survive. But the kidneys’ job is is to maintain the sodium in our blood within a narrow optimal range (135 to 145 mEq/L)–not too low AND not too high. That’s why saltwater fish (who live and breathe in an approximately 3.5% saline solution) use their kidneys to ensure their sodium blood levels are BELOW the sodium levels in their environment. And freshwater fish kidneys do the opposite: they retain sodium to keep sodium blood levels ABOVE the sodium levels in their environment. ( Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1095-8649.1974.tb05098.x )
I’ve fact-checked 50+ claims made by DiNicolantonio in his book The Salt Fix, which you can read here (no ads, no affiliate links): https://rebelthoughts.org/fact-checking-the-salt-fix/
Take care and stay healthy!
anon says
“Fact checkers” are paid by the pharmaceutical and commercial food industries. They can be clever in spinning the truth. But the truth will always prevail. Why would anyone spend so much time and effort attempting to disqualify a book on salt? Because once we begin to realise just how valuable salt is to our health, we won’t need fake medicine and fake food. It is a huge threat to the big industries that rob us of our health and dignity, and of late, even our basic freedoms. The citizens of the world are waking up. Good morning!
Rita says
Agreed, when i was younger, I spent summers with family in Italy. Ate plenty of different freshly caught fish, pasta, wine, fruit, cakes, pastries, expresso, dairy (I think from either sheep or goat not cow), walked and swam in the local beach. Basically trying to say, that although my mother cooked everyday here, the food here wasn’t the same as in Italy, not even close, because ALL of the foods that I consumed in Italy containing a huge amount of real salt, I lost weight. I was shocked! When I returned home I gained the weight back and struggled to lose it. So I agree with what you say totally and for posted your message,
Ben says
“Fact checker” can often give you anything but facts. By claiming that they fact checked an issue, people start out with the premise that these “facts” can be trusted at face value, and consequently fail to look at the sources of said facts for themselves! 🤣
Dr. James is doing a great service to the public. I feel much better taking in salt than I do sugar. That’s not to deny that sugar gives me a dopamine hit and makes me feel good, but it’s temporary. The long-term effects of tooth decay and disease aren’t worth it.
If I noticed by blood pressure rising drastically on a higher salt diet, I would be concerned. But as far as I can see, I’m doing well!