James DiNicolantonio is a doctor of pharmacy, a cardiovascular research scientist at Saint Luke's Mid America Heart Institute, the associate editor of British Medical Journal's (BMJ) Open Heart, and author of The Salt Fix: Why the Experts Got It All Wrong—and How Eating More Might Save Your Life.
What I discuss with James in this episode:
What are the symptoms of salt deficiency?
Who should be on a salt-restricted diet?
Why might someone on a ketogenic diet notice an increased craving for salt?
With so many options now available, what's the healthiest salt you can buy?
How much is too much salt?
And much more!
Salt has been demonized and blamed for many of the Western world's medical ailments—from hypertension to heart failure—existing in such ubiquitous abundance that, we've long been told, we could all afford to do with less of it. But what if, like an urban legend that captivates popular imagination without any basis in fact, the reality is actually the opposite of what we've been led to believe? What if, as a society, we're not getting enough salt?
In this episode, we get to pick the brain of a cardiovascular research scientist and doctor of pharmacy who some might consider a devil's advocate on the topic of salt: Dr. James DiNicolantonio, author of The Salt Fix: Why the Experts Got It All Wrong—and How Eating More Might Save Your Life. He'll explain how salt become demonized in recent history, why too little sodium is far worse for us than too much, symptoms of salt deficiency, and a whole lot more.
Salt: How Low Can You Go?
As a research scientist for Saint Luke's Mid America Heart Institute in Kansas City, James has published more than 200 papers on nutrition and how it relates to cardiovascular health. When he was a community pharmacist, he noticed an influx of patients who complained of dizziness, fatigue, exercise intolerance, and high heart rates.
What they had in common was high blood pressure, a doctor-prescribed low-salt diet, and overwhelming sadness from eating exclusively flavorless food.
As a high school athlete, James knew his physical performance suffered if he didn't ingest enough salt, so he recommended these patients revisit the doctor to get their sodium levels checked. Of no surprise to James, it turned out they were low.
And so began James' quest to discover if, rather than being a society overfed on salt, we might in fact be a society suffering from an epidemic of salt depletion.
The Demonization of an Unappreciated Nutrient
"You talk to anyone back in the '50s, '60s, '70s, it was really well known in athletic performance that you take a salt tablet," says James. "After we demonized salt [in 1977's Dietary Goals for the American People], virtually no one that I've talked to in the athletic world really understands the benefits of salt, and that really was something very eye opening in my research."
According to James, this demonization came about from an oversimplified test.
"Basically, just like with dietary fat—how we oversimplify the LDL cholesterol leading to heart disease type of pathway—we oversimplified it with salt. We took one surrogate marker blood pressure and we fell at the feet of it...it was a very simple hypothesis that if you consume more salt, you are going to raise your sodium levels, you're going to activate thirst, you're going to drink more water to dilute those higher sodium levels, so that's going to raise blood volume and lead to high blood pressure. We based these low salt guidelines on complete hypothesis."
A hypothesis that James believes causes more damage than taking the exact opposite action of the one prescribed.
"If we don't get enough salt, so many other harms outweigh any type of potential benefit and in the book I show that even if you get a reduction in blood pressure when you cut your salt intake, you're just volume depleting yourself and raising your heart rate."
Hyponatraemia and Cognitive Impairment
Sodium is crucial to many human biological functions, not the least of which is the transport and absorption of vitamin C into the brain, our bones, and the intestinal tract. Hyponatremia—caused by abnormally low sodium levels in the blood—can result in a number of dangerous disorders on a cellular level. Not surprisingly, cognitive impairment is just one of the symptoms observed from this type of sodium deficiency as vitamin C is instrumental in the synthesis of neurotransmitters.
"There's actually studies showing that if you induce low sodium levels in animals, you can actually cause cognitive impairment and memory impairment," says James. "Literally, they can't follow through the maze as well..."
Listen to this full episode to learn more about the difficulties in gauging ideal—but ever-fluctuating—blood sodium levels, how greater quantities of salt counterintuitively ensure we remain hydrated, how overtraining syndrome and headaches during a workout are tied to salt deficiency of the tissues, what a Blood Urea Nitrogen (BUN) marker can tell you about your sodium levels, if there are people who actually shouldn't be taking in more salt, how caffeine affects our sodium levels, why James believes people with type two diabetes should be eating more salt rather than the recommended less, why people observing a ketogenic diet especially crave salt, the salt James himself uses, and lots more.
Resources from this episode:
The Salt Fix: Why the Experts Got It All Wrong—and How Eating More Might Save Your Life by Dr. James DiNicolantonio
Association between Antidepressant Drug Use and Hyponatraemia: A Case-Control Study by Kris L.L. Movig et al., British Journal of Clinical Pharmacology
Association between Dietary Sodium Intake and Cognitive Function in Older Adults by Toni M. Rush et al., The Journal of Nutrition Health and Aging
Hyponatremia: Symptoms and Causes, The Mayo Clinic
Blood Urea Nitrogen (BUN): What It Is and Why Is Yours High (or Low) by Jade Teta, Metabolic Effect
A Low-Salt Diet May Be Bad for the Heart by Nicholas Bakalar, The New York Times
Salt: The Prize Jewel Of Keto by Anita Aldridge, Ketovangelist
Could So-Called 'Healthy' Vegetable And Seed Oils Be Making Us Fat And Sick? by James J. DiNicolantonio and Sean C. Lucan, Forbes
Genius Foods: Become Smarter, Happier, and More Productive While Protecting Your Brain for Life by Max Lugavere and Paul Grewal M.D.
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