The Salt Fix: A Summary of the Book That Busted the Low-Salt Myth

Dr James DiNicolantonio’s bestselling book The Salt Fix rigorously and successfully challenges the low-salt myth which has been a staple of health policy for decades.

An experienced cardiovascular research scientist, Dr DiNicolantonio cogently explains why the advice to reduce our salt intake was based not only on wrongheaded perceptions but – most egregiously – on bad science.

As well as demonstrating that the benefits of reducing salt have been dramatically overstated and oversold, the author bemoans that we have completely ignored the health risks associated with such a move. These include, but are not limited to, increases in renin, aldosterone, triglycerides, cholesterol, LDL, insulin and heart rate.

Clocking in at 258 pages (including 49 pages of clinical references), The Salt Fix exhaustively taps into decades of research to underscore the dangers of blindly believing ‘inherited wisdom’ and, rather than showing that salt is one of the causes of chronic disease worldwide, it illustrates ways in which salt could actually be a solution to many widespread conditions.

Rather than review the book, we felt it best to select some excerpts which give an insight into what you can expect. It is an eye-opening volume that deserves to be read cover to cover, and hopefully these snippets will whet the appetite.

• Until the low-salt dogma is successfully challenged, we’ll be stuck in this same perpetual loop that keeps our bodies salt-deprived, sugar-addicted and ultimately deficient in many critical nutrients.

• There was never any sound scientific evidence to support the idea that consuming salt increases blood pressure and thus causes chronic high blood pressure.

• Low-salt guidelines are based on inherited wisdom, not scientific fact. All the while, the real culprit has been sugar.

• The first systematic review and meta-analysis of the effects of sodium restriction on blood pressure did not occur until 1991 and it was almost entirely based on weak, non-randomized scientific data.

• A massive public health dictum that radically impacted food policy, industry regulations, school lunch programs, and physicians’ standard of care for subsequent decades was, in essence, based on the opinions of just a few scientists (and nonscientists, for that matter).

• The Consensus Action on Salt and Health (CASH) and World Action on Salt and Health (WASH) always concluded that “lowering salt will save lives” based only on reductions in blood pressure, but never by computing the harms of the higher heart rate, triglycerides, cholesterol and insulin levels – all factors with much more thoroughly and rigorously documented links to heart disease.

• In general, the intake of salt in the United States and in Europe around 1950 and onward is probably half of what was consumed in the prior several hundred years. So it’s unlikely that a rise in salt intake parallels the rise in chronic disease in the Western world.

• In addition to the salt we lose by following our low-carb, ketogenic or paleo diets, we’re also taking more medications that cause salt loss; we’re enduring more damage to the intestine that causes decreased salt absorption (including Crohn’s disease, ulcerative colitis, IBS and leaky gut); and we’re doing more damage to the kidneys by eating more refined carbohydrates and sugar (decreasing the kidneys’ ability to retain salt).

• Recent research suggests that chronic salt depletion may be a factor in what endocrinologists term ‘internal starvation.’ When you start restricting your salt intake, the body starts to panic. One of the body’s defense mechanisms is to increase insulin levels, because insulin helps the kidneys to retain more sodium. Unfortunately, high insulin levels also ‘lock’ energy into your fat cells, so that you have trouble breaking down stored fat into fatty acids or stored protein into amino acids for energy.

• When we restrict our salt intake, our heart rate goes up, reducing our blood and oxygen circulation throughout our body and increasing the heart’s need for oxygen. Any one of these effects, all produced by a low-salt diet, could increase our risk of having a heart attack.

• In 1776, the intake of refined sugar in the United States was just 4 pounds per person per year – the equivalent of having just over 1 teaspoon of sugar in your coffee per day – which increased to over 76 pounds of sugar by the timeframe of 1909 to 1913… A similar increase in sugar intake occurred in England. In 1700, the average intake of refined sugar was just 4 pounds per person per year. That figure increased to 100 pounds by 1950… The intake of sugar, not salt, has paralleled the rise of chronic disease in Europe, and the same thing occurred in the United States.

• The intake of refined sugars in the United States increased thirtyfold from 1776 to 2002. Interestingly, this parallels the rise in chronic diseases such as hypertension, diabetes, obesity and kidney disease.

• Evidence in the medical literature suggests that approx 80% of people with normal blood pressure (less than 120/80 mmHg) are not sensitive to the blood-pressure-raising effect of salt at all. Among those with prehypertension (a precursor to high blood pressure), roughly 75% are not sensitive to salt. And even among those with full-blown hypertension, about 55% are totally immune to salt’s effects on blood pressure.

• Heart rate is proven to increase on a low-salt diet. This harmful effect occurs in nearly everyone who restricts his or her salt intake.

• Unfortunately, the serious risks of low-salt diets are rarely, if ever, mentioned in any guidelines recommending them, despite the pleas of many researchers about the weakness of the salt-blood pressure hypothesis.

• I should clarify that a few of us should be concerned about consuming and retaining too much salt, such as people who have the following conditions: Hyperaldosteronism; Cushing’s disease; Liddle syndrome. These folks should monitor and possibly limit their salt intake because they may be especially sensitive to the negative effects of sodium on their blood pressure. But even for these individuals, salt isn’t the main issue; if you treat the underlying disease effectively, you can treat the excessive salt retention.

• We are essentially salty people. We cry salt, we sweat salt and the cells in our bodies are bathed in salty fluids. Without salt we would not be able to live.

• Humans have been consciously producing salt, by scraping salt from dried desert lake beds or mining salt from the earth, for at least eight thousand years.

• Salt cravings are totally, biologically normal, akin to our thirst for water. Scientists have found that across all populations, when people are left to unrestricted sodium consumption, they tend to settle in at 3,000 to 4,000 mg of sodium per day. This amount holds true for people in all hemispheres, all climates, all ranges of cultures and social backgrounds – when permitted free access to salt, all humans gravitate to the same threshold of salt consumption, a threshold we now know is the sodium-intake range for optimal health.

• Sodium chloride, aka salt, constitutes 90% of the entire ocean’s mineral content, the same percentage of mineral content found in our blood.

• Your body drives you to eat several grams of salt every day to remain in homeostasis, an optimal state in which you put the least amount of stress on your body. But you could literally live the rest of your life – and probably a much longer one – if you never ingested another gram of added sugar.

• By the 16th century, Europeans were estimated to consume around 40g of salt per day; in the 18th century, their intake was up to 70g, mainly from salted cod and herring, an amount four to seven times the current intake of salt in the Western world… All of this suggests that the consumption of salt throughout Europe during the last several hundred years was likely at least twice, and even up to ten times, what it is today.

• In the animal kingdom, there are no dietary guidelines – no medical directives to create a conscious effort to restrict salt intake. Indeed, many animals (especially those hunting in the sea) ingest large amounts of salt simply as a matter of course during their daily lives. Take, for example, reptiles, birds and marine mammals, such as the sea lion, sea otter, seal walrus and polar bear, that hunt prey living in the ocean. These animals take in large amounts of salt, both from the animal itself and from salt water, during a kill, particularly if they eat oceanic invertebrates, which have the same salt concentration as the ocean. For these marine mammals, the salt content of their blood is not very different from that of terrestrial mammals – and since they are ingesting sea water, which is four to five times as salty as their blood, that salt must be excreted via their kidneys. Or, to say it bluntly: their kidneys must be able to excrete massive amounts of salt.

• Most health agencies tell us that consuming just 6 grams of salt is too high, yet our kidneys filter this amount of salt every five minutes… In fact, the stress on our kidneys mainly comes from having to conserve salt and reabsorb all of the 3.2 to 3.6 pounds of salt that we filter every day.

Given the fundamental flaws in the science which gave rise to the official dietary recommendations for salt, a major overhaul is long overdue. It is doubtful, however, that the conventional view on salt will change in the short-term.

As noted by Dr DiNicolantonio, “Just as the demonization of salt will take decades to reverse, the halo affect of unethical sugar research took (and will continue to take) years to reveal as well.”

What you can do, on a personal level, is recalibrate your relationship to salt. Eat good, health-promoting, unprocessed sea salt and ignore those who demonise one white crystal (salt) while giving the other (sugar) a pass. 

Not convinced? Read The Salt Fix and our guess is, you will be.