Book Report: The Salt Fix

The Salt Fix: Why the Experts Got It All Wrong–and How Eating More Might Save Your Life by James DiNicolantonio

This was easily one of the most impactful and actionable books I have read. I personally utilize recommendations made within and share with clients and friends alike.

My goal is to keep these book summaries brief, which means I won’t be able to cover all the highpoints, just because there are too many!

The Salt Fix expertly sheds light on the “salt is bad” dogma. However, it doesn’t stop there; the evidence presented shows not only is it good for you but deficiences experienced by following public recommendations actually CAUSE the very things that they say excess does. Wow.

I will list a few of the notes I saved that I keep coming back to:

• On average, our kidneys may filter between 3.2 and 3.6 pounds of salt (1.28 and 1.44 pounds of sodium) per day.42 This is about 150 times the amount of salt we ingest per day. To put this into perspective, most health agencies tell us that consuming just 6 grams of salt (around 2,300 milligrams of sodium or 1 teaspoon 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.43 This reabsorption requires us to use up adenosine triphosphate (ATP), the energy created from the food we ingest that’s utilized by our cells to facilitate many bodily functions. Our sodium pump uses approximately 70 percent of the basal energy expended by the kidneys,44 making a low-salt diet an energy hog and a tremendous stress to the kidneys. This is one way that low-salt diets can lead to weight gain, by slowly depleting our energy stores and leading us to become more sedentary.
• Cortisol, perhaps the most famous “stress hormone,” is the primary glucocorticoid produced by our adrenal glands during times of stress. Cortisol also seems to be involved in the release of sodium from our skin stores to aid us during stressful times. Remember how insects can apparently fly faster if they are saltier? Well, the same thing may occur with humans who are trying to avoid being eaten by a lion. Aldosterone, another hormone released by our adrenal glands, socks sodium away into our skin and allows us to reabsorb more salt from the kidneys in times of deficit or need. So aldosterone is a “salt storer” whereas cortisol seems to be a “salt releaser,” with the interplay of both hormones helping to determine our overall salt status.
• Similar to the way a low-salt diet depletes the energy of the kidneys, it does the same to the heart.45 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.46 Any one of these effects, all produced by a low-salt diet, could increase our risk of having a heart attack.
• Almost every important Roman city was located near a source of salt, and the average Roman consumed 25 grams of salt, equivalent to 10 grams (10,000 milligrams) of sodium per day, more than 2.5 times our current average intake.
• Insulin resistance and diabetes, both consistently found to coincide with both salt sensitivity and high natriuretic hormone levels. In fact, both type 1 and type 2 diabetes were associated with increased levels of marinobufagenin (the natriuretic hormone).46 One group found that, in diabetics, disrupted Na-K-ATPase function was associated with insulin resistance, renal sodium retention, and the development of hypertension.47 In other words, whatever was causing diabetes was also impairing the Na-K-ATPase (via increases in marinobufagenin) and causing salt-sensitive hypertension. And the dietary substance causing diabetes was…(drumroll, please): sugar.
• Reducing salt has been found to accelerate hardening of the arteries and raise cholesterol and triglycerides in animals.113 Salt restriction in humans with hypertension also increases plasma lipoproteins and inflammatory markers.114 In people with chronic high blood pressure, cutting salt increased low-density lipoprotein (LDL; “bad” cholesterol) levels in the blood.115 But other studies found that restoring higher levels of salt (going from 2 grams of salt per day to 20 grams per day for five days) significantly lowered plasma total cholesterol, esterified cholesterol, beta-lipoprotein, low-density lipoprotein, and uric acid in people with hypertension.116 Even the famous DASH-Sodium trial—the foundation of the most well-known low-salt diet—found that salt restriction increased triglycerides, LDL, and the total-cholesterol-to-high-density-lipoprotein ratio (TC:HDL).117 Even in people who had normal weight and regular blood pressure, low-salt diets have been found to compromise kidney function, decrease high-density lipoprotein (HDL; “good” cholesterol), and reduce adiponectin, a substance released by fat cells thought to improve insulin sensitivity.118
• Another health risk, increased blood viscosity—“thickening” of the blood—has been thought to occur during salt restriction.
• So, on average you will sweat out around 1,437 milligrams of sodium per hour when exercising in moderate climates and around 2,875 milligrams of sodium per hour when exercising in hot climates. Depending on exercise intensity and ambient temperature, you could easily lose more than an entire day’s worth of salt intake in just one hour of exercise. In hot climates like India, you could lose up to 14,720 milligrams of sodium per day.26 How would consuming just 1,500 milligrams of sodium per day (or even 2,300 milligrams of sodium) help you survive these conditions, let alone improve your health?

So, my face to palm moment was this quote; “As we’ve also seen, many people with normal blood pressure, prehypertension, and hypertension may even get a rise in their blood pressure if they restrict their salt intake.18 This is because when salt intake is severely limited, the body begins to activate rescue systems that avidly try to retain more salt and water from the diet. These rescue operations include the renin-angiotensin aldosterone system (well known for increasing blood pressure) and the sympathetic nervous system (well known for increasing heart rate)”

The reason this hit me so hard was that one of the most common medication classes I dispense as a pharmacist are drugs that work to block the renin-angiotensin-aldosterone system (lisinopril or ACE inhibitors). Is salt restriction causing the need to prescribe these drugs?

And to wrap things up, the recommendations:

• Scientific research suggests that the optimal range for sodium intake is 3 to 6 grams per day (about 1⅓ to 2⅔ teaspoons of salt) for healthy adults, not the 2,300 milligrams of sodium (less than 1 teaspoon of salt) per day that’s commonly advised. And some people need even more.
• HOW TO CONSUME YOUR DOSE OF SALT PRIOR TO AND DURING EXERCISE Measure out your dose of salt using a teaspoon and consume dry, then rinse your mouth out with water (or pickle juice) Eat three large dill pickles (or five large olives) washed down with some pickle/olive juice Dissolve a chicken bouillon cube(s) in warm water and consume Dissolve ½ teaspoon of salt in 1 liter of water (tastes like sweat, not recommended) Dissolve salt in a mixture of lemon/lime/orange juice or lemonade and consume (preferred method). If you are an avid exerciser, I recommend that you use a salt that also contains iodine, such as Redmond Real Salt, but iodized table salt will also work. RECOMMENDATIONS FOR SALT DOSING PRIOR TO AND DURING EXERCISE Exercising in moderate climates (below 80°F) Consume ½ teaspoon of salt prior to exercise and every hour thereafter Exercising in hot climates (80°F to 89°F) Consume ½ to 1 teaspoon of salt prior to exercise and every hour thereafter Exercising in very hot climates (90°F or above) Consume 1 to 2 teaspoons of salt prior to exercise and every hour thereafter *These are only estimates. The salt dose will depend on how much you sweat, which is determined by genetics, clothing, level of exercise intensity, and ambient temperature. And, of course, always get your doctor’s approval first before changing any of your diet or lifestyle habits.
• ADDING SALT TO A LOW-CARB DIET Most patients who start a low-carbohydrate diet (less than 50 grams of carbohydrates per day) will lose between 4 and 8 grams of sodium in ten days, but some may lose up to 20 grams during this time. That’s why it’s a good idea to increase your sodium intake by at least 1 gram per day for the first two weeks of a low-carbohydrate diet or by 2 grams per day for the first week. You can do this by eating three large dill pickles, five large olives, or one chicken bouillon cube dissolved in water per day.

This is a fraction of the notes I saved from this incredible book, written by a pharmacist! I will revisit on this page in other areas, but please reach out if you want more info on how to evaluate salt utilization; I have found these recommendations very useable.

This Book Report collection is meant to provide some of the best take-home points from the health and science genre I read. I will continue to go thru my notes of the 160+ and counting (as of January 2019) Kindle books I have on file. To view ALL the notes I saved on this one AND many others without a Book Report post yet, THAT IS ALSO SEARCHABLE, please click here.