By Marika Sboros

The next time your doctor or dietitian tells you to eat less salt, find another one – fast. Better still, buy a brave new book, The Salt Fix. In it, US cardiovascular research scientist Dr James DiNicolantonio shows how health experts have demonised the wrong white stuff for decades.

They have dished up dangerous lies about salt for your heart’s sake, or any other organ you care to mention. They allowed salt to “take the fall” for another, far more dangerous, addictive white crystal, he says.

That crystal is so sweet, you probably bought into the belief that it is benign. When consumed in excess, it can lead to high blood pressure, cardiovascular disease and kidney disease. It is sugar, DiNicolantonio says.

His book’s subtitle speaks volumes about the right white stuff: Why The Experts Got It All Wrong, And Why Eating More Could Save Your Life. He shows why salt reduces your risk of premature death from heart attack or stroke. And why it protects your kidneys and fertility levels. It is as good for your brain as for your body. Salt improves your thinking and sexual performance. It boosts your energy levels and mental focus and ensures restful sleep. It also stops you getting fat.

Dr James DiNicolantonio

That’s fighting talk, enough to raise cardiologists’ blood pressure in a heartbeat. It leaves heart foundations and dietitians’  and diabetes’ associations globally looking green around the gills. It flatly contradicts official dietary guidelines.

Many doctors and dietitians may advise that you take DiNicolantonio’s book with a big pinch of this white crystal. The many vested interests in food and drug companies that have made billions from low-salt advice probably hope you will too. I advise you to ignore that advice.

DiNicolantonio defends his views with effective weapons: good science and lashings of common sense.

He is a researcher at Saint Luke’s Mid-America Heart Institute, Missouri. He is also an associate editor of Open Heart. That’s a joint publication of the BMJ (British Medical Journal) and the British Cardiovascular Society. DiNicolantonio sits on editorial boards of other medical journals. He has also contributed extensively to health policy and medical literature.

In his book, he calls for the experts to restore salt to its former glory.

But doesn’t salt cause high blood pressure? That’s a good question – and the title of a chapter in his book. It’s at the heart of misinformation that doctors, dietitians, governments and health associations still feed the public about salt.

For starters, the experts told people for decades that eating salt increases blood pressure. They believed that it causes chronic high blood pressure (hypertension, in medical terminology). The only problem, says DiNicolantonio, was that these experts never had any scientific evidence to support that belief.



That was the case way back in 1977 when the US government launched its Dietary Goals. Among the goals was that Americans should restrict their salt intake. The “experts” claimed that a low-salt diet would prevent age-related increases in blood pressure. Yet even then, the US Surgeon General admitted there was no evidence to support it, DiNicolantonio writes.

Thereafter, he takes a surgically precise scientific scalpel to disembowel the guidelines. The first systematic review and meta-analysis of the effects of sodium restriction on blood pressure only came out in 1991, he says. However, the researchers based it on weak, non-randomised scientific data.

Thus, the “experts” had been telling Americans to eat less salt for nearly 15 years by that time. They had ingrained salt into people’s minds as a primary cause of high blood pressure.

That message remains in place today and it is still lethal. US science writer Gary Taubes identified it as the political science of salt. That was in Science magazine in 1998.

The wrong message stems largely from the most basic of scientific explanations, DiNicolantonio says. That is the salt–blood pressure hypothesis that eating higher levels of salt raises blood pressure levels.  As with so many old medical theories, “the real story was far more complex”, he says.

The real story is how too little salt really is bad for most people and not just for hearts. It can make them fat, he says. It also increases the risk of insulin resistance. As a result, it also increases the risk of diabetes.

DiNicolantonio is a brilliant scientific storyteller and easily makes this book reader-friendly. He gives the history of the past century’s “Salt Wars”. Those wars are in no small measure due to official dietary guidelines.

He shows how demands of modern living increase our essential physiological need for salt. He also shows why the risk of salt depletion and deficiency is greater than in the past.

And he shows how commonly prescribed drugs and caffeinated drinks actually increase it depletion. He also looks at disease states, and lifestyle choices that can lead to “salt wasting”. That’s to give you a better idea if you are at risk of deficit.


DiNicolantonio tells you how to increase your intake of the right kinds of salt strategically. By that, he means in amounts that your body needs. That’s because this is no one-size-fits-all prescription. It’s not rocket nutrition science to know that people differ in the salt needs.

There are many reasons that make this book special. Firstly, it gives permission to give in to your salt cravings. They are, after all, perfectly normal and instinctual. Secondly, the wisdom he imparts is ancient. In articles and on social media, DiNicolantonio says that we’ve known about it for at least 2000 years. He quotes Roman sage Pliny (AD 23 to AD 79): “Salted foodstuffs make people slim, whereas sweet ones make them fat.”

He also shows how dietary salt helps you to overcome addiction to sugar and other carbohydrates.

His introduction to the book is seductive. Headlined Don’t Fear The Shaker, it is a prime mover for the scientific journey to come – and lyrical. DiNicolantonio opens with a line from Scandinavian novelist Isak Dinesen: “The cure for anything is salt water: sweat, tears or the sea.”

There is “poetic truth” in those words, he says, as they are about our “biological reality as humans”. He writes:  “Our physical inner world was born of the sea, and we carry the saltiness of the ocean inside us.

“Salt is an essential nutrient that our body depends on to live. Its proper balance is an equilibrium that our bodies strive to return us to, again and again. ”