In today’s interview I get to speak with medical researcher, Dr James DiNicolantonio, about why eating more salt everyday is actually better for our cardiovascular health & myth busting health concerns about salt intake.
James is a respected cardiovascular research scientist & doctor of pharmacy at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri.
He is also an associate editor of British Medical Journal’s (BMJ) Open Heart plus he has authored or coauthored approximately 200 publications in medical literature.
James new book called The Salt Fix blows the lid off the mainstream nutritional advise that we must all eat a low salt diet.
I’ve read his book cover to cover and it has revolutionised the way I see salt. My review is you’ve got to read this one!
When you listen to what he has to say and you read his book you will understand why I had to get James on the show.
I wanted him to talk about why the causation link between salt & high blood pressure (hypertension) is weak & how too many people get sick from not having enough salt in their diet.
I discuss with James why we were told salt was bad for us in the first place and how that is wrong. We then talk about how much salt can we eat in a day, what happens if you have low sodium levels and how we lose too much salt from simple things like drinking coffee/tea and especially when eating a LCHF or keto diet.
Top Tip: The best sea salt to use, according to James, is Redmond Real Salt.
Special thanks to James for joining me on the show. Enjoy the episode!
Show Notes with Timestamps
Highlights of what we talk about during the interview:
Click on one of the timestamp links in the brackets to jump to that point in the interview audio.
[00:23] – Dr. James DiNicolantonio’s biography.
[01:21] – Where low salt, low fat, high carb eating guidelines come from. How those 1977 recommendations demonising salt, along with cholesterol and dietary fat, were based on opinion without the evidence to back it up.
[02:11] – Talking about the weak science behind the salt causing blood pressure problems hypothesis and the significant impact it had on changing dietary guidelines.
[02:54] – Have we been ‘duped’? Is evidence being ignored? How these guidelines are not always based on the best evidence out there. We need to understand that a lot of the guidelines are based on opinions rather than fact. There is not a single clinical study proving that cutting salt intake reduces cardiovascular events or premature death.
[04:25] – The story behind the initial low salt experiment, where 200 hypertensive patients were used as subjects and the resulting benefits to blood pressure were extrapolated to the entire population. But what happens when we take a closer look at what was going on? Why didn’t we look at harmful effects that result from lowering salt intake, such as heart rate increase and blood volume depletion.
[05:17] – In his book, James talks more about these studies and how vital scientific data is being excluded.
[05:44] – The difference between the salt intake needed for basic survival and the salt intake needed to thrive. The optimal intake level is somewhere between 1 1/3 tsp – 2 2/3 tsp/day but we are told to take less than 1 tsp/day. How restricting salt to less than 3000mg/day causes artery stiffening hormones such as renin, angiotensin II, and aldosterone to sky-rocket and also activates stress hormones noradrenaline and adrenaline.
[07:16] – By restricting our salt intake, we are causing harm to our adrenal glands – leading to hypertrophy and adrenal insufficiency (fatigue). James explains how cutting out too much salt from our diet can cause/lead to a myriad of conditions harmful to our health, including insulin resistance and diabetes. Could we also be in danger of iodine deficiency and hypothyroidism?
[09:47] – Are sodium levels the same as salt levels? Salt is composed of sodium and chloride (essential micronutrients). James discusses the importance of chloride in our systems and gives us a useful formula to remember: Salt = 2.5 * sodium.
[11:15] – The idea behind having a salt thermostat and how everyone’s individual needs for salt vary. James explains how salt cravings are different to sugar cravings and why we shouldn’t fear our cravings for salt. Our body has mechanisms in place to control these cravings.
[12:40] – An interesting case report illustrating the importance of listening to our body when it is signalling us for more salt; we should not be restricting our intake.
[13:20] – Why going overboard on salt and reaching a fatal dose is extremely unlikely. How a lack of refrigeration meant that for the last 8000 people have consumed much higher levels of salt then they do today. Studies have shown that healthy kidneys are capable of excreting excess salt very efficiently.
[14:31] – Why we should be more concerned about having low sodium in the blood much more than having high sodium in the blood. Understanding that most kidney issues result in the loss of their ability to reabsorb salt, leading to salt loss.
[15:38] –Up to 42% of people admitted to hospital emergency departments have symptoms related to low sodium in the blood. A lot of these can be due to gastrointestinal losses from conditions such as celiac disease, Crohn’s disease or even a bad bout of diarrhoea.
[16:23] – Is there truth behind the arguments that high salt raises blood pressure which in turn damages our kidneys? This is not the cycle we are seeing. How a high salt diet can be a relief on the kidneys. The many ways the body deals with excess salt in the event retention does occur and debunking the myth of water retention.
[18:00] – The ‘Storage Silo’ analogy – it’s preferable to have a full storage unit to constantly running low and being in crisis mode. James reiterates that our bodies are capable of getting rid of excess salt. How the process of trying to retain salt is taxing on our bodies in terms of energy. More salt could potentially mean more energy!
[19:11] – Could a salty drink first thing in the morning help with adrenal fatigue? How people suffering from sleep apnoea suffer from significant salt loss at night. The rejuvenating effects people experience when drinking salt and water. Some of the reasons not reducing your salt intake results in a great boost in energy. Could the resulting decreased heart rate (up to 10 beats/min lower) extend our lives?
[20:45] – James explains how a low salt diet (according to guidelines this is less than 2300 mg) affects your magnesium levels, which is essential for good energy levels. When there is a negative sodium balance, the body responds by pulling sodium as well as magnesium and calcium from the bones. There is also magnesium loss through sweat and urine. Low salt = low magnesium = low energy!
[22:09] – Discussing how people taking magnesium supplements could potentially benefit from upping their salt intake. Highlighting the importance of maintaining your salt levels at an optimum level and in turn preventing the stripping down of other nutrients in your body.
[23:29] – Are you a coffee (or tea) drinker? Why you should ensure you are getting enough salt to replenish your salt levels; caffeine flushes out the kidneys of sodium and in particular chloride. Consuming four cups of coffee results in a loss of ½ to 1 tsp of salt.
[24:26] – How Gary uses the bio-hack of having some salt and water (or some other salt source) with his morning butter coffee to counteract the salt loss. Discussing the negative cycle of taking caffeine and being on a low salt diet which boosts your sympathetic nervous system, burning it out in the process.
[26:00] – Hyponatremia is 43% more prevalent in nursing homes than in general populations and more than 50% of people living in nursing homes will have at least one episode of low sodium in their blood every year. Could part of the reason for this be due to the low salt, high carb diet and increased secretion of salt due to their intake of tea/coffee? Would changing these parameters improve cognitive function of this population base?
[27:47] – Understanding the important functions sodium performs the body. Could then this mild hyponatremia in elderly patients be leading to the cognitive decline resulting in falls, fractures and gait disturbances.
[28:19] – More about sodium’s role in bone health and how the negative magnesium and calcium balance can potentially lead to osteoporosis and other bone weakening diseases.
[29:34] – A drop in blood pressure is a perceived positive effect of a low salt diet, but how significant is this effect? What are reverse responders? When we look at the numbers and take into account the increase in heart rate all people experience, most people will be harmed by following the low salt advice.
[31:12] – When considering all the benefits of salt, reducing our intake for a trade-off of a 1mm reduction in blood pressure for a 4 beat/min increase in heart rate makes no sense.
[32:56] – James talks about the common ways we waste salt; including through exercise (through sweat), disease states that result in damage to the intestines or damage to the kidneys, medications (diuretics, high blood pressure pills), low carb diets (insulin levels drop and cause salt loss via kidneys).
[35:01] – The difficulty of initiating a ketogenic/low carb diet due the Atkins Flu, which is brought about by the salt depletion. James explains why the drop in insulin results in increased salt loss and why increasing salt intake is beneficial. People tend to underestimate the amount of salt necessary on a low carb diet.
[36:46] – Illustrating the point of how important it is for us to listen to our bodies.
[37:43] – James shares some of the ways you can tell if you are low on salt. The symptoms to look out for including: feeling dizzy, an elevated heart rate and feeling fatigued. Interpreting your lab results; what does it mean if you are eating lots of salt but nothing is coming out in the urine or if you are not restricting your water intake but your BUN is elevated? It could be another indicator of salt depletion.
[39:31] – Are blood draws for sodium levels useful and what do they tell us? It’s not always indicative of total body sodium depletion, however, in these cases salt restriction can make things worse.
[39:52] – In dilutional hyponatremia we blame athletes for over-consuming water but is their low sodium intake to blame? James explains how the low salt diet causes sensitivity in the kidneys to anti-diuretic hormones. Are disease states or overconsumption of water always to blame for Is over-retention of water? Should we simply be taking in more salt.
[40:31] – How athletes confusing salt hunger with thirst leading to overconsumption of water when they should be replenishing the salt lost through sweat. Even sports drinks contain only a fraction of salt that is lost through exercise.
[41:24] – How endurance runners could benefit from salt tablet supplements in lieu of simply drinking water. During the 60’s, 70’s, before salt was demonised, using slow releasing sodium tabs for training and events was common place with athletic teams.
[42:33] – How salt also helps mitigate the risks of heat stroke. James talks about his love-hate relationship with Ancel Keys. Keys’ study showed how consuming enough salt can lower body temperature and the role salt plays in helping with thermoregulation. In hypothyroidism patients, salt can be beneficial helping with cold intolerance.
[44:29] – The Salt Fix book is an excellent reference for anyone wanting to find out more about the amazing benefits of getting enough salt in their diet. It also contains the five-step plan in helping people with sugar addiction and how salt can help with sugar and refined carbohydrate addiction. James talks about how salt depletion leads to sugar and drug addiction.
[45:55] – There are two editions of the salt fix; the British and the US editions have different covers but the information inside is the same.
[46:02] – Could taking too much salt while breastfeeding cause harm to the child? There’s no study showing that there are any resulting issues to the child’s health due to overconsumption of salt – most likely due to the effective regulation of levels of salt in the body. Again, it is actually, low salt intakes in pregnant women that can cause significant issues.
[46:57] – James talks about a study done in over 2000 pregnant women showing concerning outcomes resulting from a low salt diet; miscarriages doubled, perinatal death tripled, and there was an increase in preeclampsia. How increasing salt intake help prevent a lot of these issues. Reinforcing the point that intake of enough salt can resolve a lot of the issues that are usually blamed on salt itself.
[48:35] – There is further information on this subject matter, in James’ book The Salt Fix, as well as additional topics such as cartilage, cholesterol and other interesting points about salt and its benefit. (Listen Dave Feldman biohack high cholesterol levels)
[48:57] – To follow his work or contact him, James recommends finding him on Twitter (@drjamesdinic), his website (thesaltfix.com) – where you can purchase his book – or you can friend him on Facebook. He tends to be active in low carb/ketogenic groups where he helps people understand the need to increase their salt intake when cutting carbs. You can easily buy “The Salt Fix” book on Amazon as a paperback, kindle or audiobook.
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