#193: James DiNicolantonio, PharmD- High Salt Diets Are Back & The Salt Fix

by Deanna Mutzel, DC




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About James J. DiNicolantonio, Pharm. D.

James J. DiNicolantonio, Pharm. D., is a respected cardiovascular research scientist, doctor of pharmacy at Saint Luke's Mid America Heart Institute in Kansas City, Missouri, and the associate editor of British Medical Journal's (BMJ) Open Heart. He is the author or coauthor of approximately 200 publications in medical literature. His research has been featured in The New York Times, ABC’s Good Morning America, TIME, Fox News, U.S. News and World Report, Yahoo! Health, BBC News, Daily Mail, Forbes, National Public Radio, and Men’s Health, among others.

Connect with James

Twitter @ Dr James DiNic
The Salt Fix

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

Redmond Real Salt, Ancient Fine Sea Salt, Unrefined Mineral Salt, 26 Ounce Pouch (2 Pack)

Gerolsteiner Naturally Sparkling Mineral Water, 6 Per Pack (Pack of 4)

Related Interview:Burning Fat w/ Fat Plus Food Quality Tips w/ Dr. James DiNicolantonio



Show Notes

01:57 Dr. DiNicolantonio’s Salt Journey: He had always been into fitness and knew that his fitness suffered if he didn’t have salt. Salt restrictive dietary guidelines made no sense and spurred his research into salt. He has published over 200 papers.

02:53 Losing Salt: We forgot that it is an essential nutrient. We forgot all of the things that cause salt loss throughout the day. Caffeine is one of the biggest factors that causes salt loss, chloride and sodium. Salt is made of both chloride and sodium. Four cups of coffee causes the loss of a teaspoon of salt.

03:57 Table Salt: Minerals like iodine, magnesium, calcium and others is missing from table salt. Celtic sea salt is the highest in magnesium. Redmond Real Salt is Dr. DiNicolantonio’s number 1 go to salt because it is from an ancient dried ocean, as well as lacking today’s ocean’s pollution and microplastics. It has stable amounts of iodine.

04:48 Losing Minerals in Sweat: We lose up to 100 micrograms of iodine per hour of exercise. We are supposed to consume 150 micrograms each day. Lack of iodine can lead to hypothyroidism and can effect metabolism. We lose .5 mg of copper per hour of exercise.

06:19 Different Salts/Different Minerals: Himalayan salt is the highest in potassium. The most important minerals we use from salt are iodine, magnesium and calcium. Celtic sea salt has 40 mg of magnesium per 10 gram of salt. Celtic and Hawaiian sea salts are low in iodine. Dr. DiNicolantonio has a chart of which salts contain which minerals.

07:42 Chronic Low Salt Diet: When salt levels are lowered, blood pressure goes down, restricting your water intake, raising your heart rate. When you go below 3,000 mg of sodium per day, your stress hormones, noradrenaline and adrenaline, as well as artery stiffening hormones renin, angiotensin, and aldosterone, are chronically elevated. Your adrenals constantly pumping aldosterone can cause adrenal hypertrophy, burning out your adrenals (adrenal fatigue/insufficiency). The counter-regulatory hormones are upregulated because there is not enough blood volume. Low salt diets can burn out your sympathetic nervous system.

10:05 Indications of Salt Deficiencies: Symptoms can include an elevated heart rate or you are dizzy/light headed, especially when standing from a seated position. POTS/ postural orthostatic tachycardia syndrome is common, primarily in women. It can be treated by increasing salt intake. Symptoms for salt deficiency can also include slow capillary refill and increase in uric acid. It also causes an increase in insulin levels. Insulin helps kidneys retain more salt. You can store more fat per calorie you consume when you are cutting your salt. Triglycerides go up. HDL goes down and LDL goes up.

11:49 Blood Markers: Over 6 million Americans have hyponatremia/low blood sodium levels. This is tested with a 24 hour urinalysis or fractional excretion of sodium. If you have high fractional excretion, you could be wasting salt because you have damage to the kidneys. If you have a low fractional excretion despite adequate salt intake, your body is holding onto the salt. It shows a salt deficiency or you are not absorbing salt because of intestinal damage from things like Crohn’s disease, IBS, ulcerative colitis or Celiac. BUN (blood, urea and nitrogen) can be elevated from low salt intake.

14:14 High Salt Diets: Over the past 8,000 years, we have eaten a high salt diet. Our main food preservative was salt. Ancient Romans consumed an average of 25 gm of salt per day. If you have normal kidneys, they can flush out 100 gm of salt per day, as consumed by Swedes in the 1600s. We generally consume 10 gm per day. When blood is filtered in the kidneys, salt is lost in the tubules and your kidneys need to reabsorb the salt, utilizing 60% of the energy used by the kidneys each day. Eating lots of salt is a relief helpful for the kidneys. The concentration of blood in our bodies is the same as the ocean, 90%. Dr. DiNicolantonio believes that high salt content in processed foods is not an issue, if you have healthy kidneys.

16:52 Salt and Sugar: Salt and sugar look the same, but have opposite effects upon the body. Sugar causes insulin resistance and low salt causes insulin resistance. Ancient Romans put salt on their gums and teeth to prevent inflammation and dental caries and sugar is a primary cause of dental caries.

20:27 Primal Salt Intake: Historically sodium intake estimates in regards to evolutionary times in humans were 1400 mg for a meat diet and 400 mg for a vegetarian diet. However, this calculation did not take into consideration that we consumed the entire salt laden organism. Insects are high in salt. If you only eat muscle meats and vegetables, you need to supplement with salt.

22:47 Athletic Performance: On average, we lose ½ teaspoon to 1 teaspoon of salt per hour of exercise. Dr. DiNicolantonio doses himself with salt about 20 minutes prior to his workouts, the amount depending upon duration and intensity. He and others find a dramatic improvement in performance. Salt is the best substance to increase blood circulation and the best vasodilator. Salt decreases cramping and rids the cell of acids. In order to excrete hydrogen from the cell, you need to absorb sodium. When you exercise in the heat on a low salt diet, your body temperature is higher. Salt increases sweat production, your body’s cooling mechanism. Salt reduces your heart rate. Over training syndrome is a depletion of salt in your tissues.

26:10 Too Much Salt? Dr. DiNicolantonio uses lots of salt on his food. We salt to taste. It is the gateway to eating healthy. If you overdo it, your body will compensate. You have a built in safety mechanism. The taste receptors on your tongue will give you an aversion signal if you get too much, unlike sugar, where the desire grows stronger as you consume more.

27:37 Salt Deficiency and Sugar/Drug Addiction: When an animal becomes depleted in salt, they seek out a salt lick. It applies to humans as well. When we are depleted in salt, the reward system in the brain is activated, driving us to seek salt. It even gives us a greater high and it tastes better. When our dopamine reward system is activated, it can be hijacked by substances of abuse or sugar. Low salt can be a contributor to addiction.

30:02 Your Bones and Kidneys and Salt: It is hypothesized from study results that low salt levels cause the body to pull salt from the bone. Calcium and magnesium are pulled at the same time. This may lead to osteoporosis, osteopenia and weaker bones. We used to blame osteoporosis on a high salt diet, but salt increases the absorption of calcium. We blamed salt on kidney stones because of high levels of calcium in the urine. Giving more salt reduces the risk of kidney stones. When salt levels are increased, you drink more, your urine volume increases and the concentration of calcium oxalate goes down.

32:11 Gerolsteiner Mineral Water: Tap water has no salt in it. Gerolsteiner has the highest magnesium contents of all water. It also has sodium bicarbonate. Don’t add salt to your water or it will taste like sweat. Try adding it to lemonade, lemon juice or lime juice, or consume it dry and wash it down with water. Dr. DiNicolantonio puts a pinch of salt in his coffee to take away the bitterness.

35:16 Resistant Starch: Dr. DiNicolantonio had good results from a low carb diet, but after 2 years began putting inches into his waist. Restricting carb intake even more only made this worse. He learned about fiber, resistant starch, which feeds our good gut bacteria, thus improving insulin resistance. His health improved when he started eating beans, Ezekiel bread, and cooled cooked potatoes (which quadruples the resistant starch).  He has included resistant starch, but still eats low carb.

37:52 GLP-1: Your intestinal cells will produce GLP-1 when you feed them resistant starch. It improves insulin resistance, reduces blood pressure, helps cardiovascular health, kidney health and helps you get rid of extra salt. If you eat salt and your legs swell, your blood vessels are leaky and salt is going from the blood into the interstitial fluid. This is due to a diet high in sugar and refined carbs causing high insulin levels and insulin resistance.

39:37 Culinary Salt: Salting your bitter greens make them much more palatable.

40:40 Stomach Acid: Salt brings chloride. Your stomach acid is hydrochloric acid. Your stomach acid will go down if you don’t have enough salt in your body. You can have bacterial overgrowth because low HCL from restricted salt intake.

41:47 Micronutrients: We focus on macronutrients, but micronutrients are important for many things. Many disease states are caused, in Dr. DiNicolantonio’s view, by subclinical micronutrient deficiencies. Magnesium, manganese, and copper are big ones that we are lacking because we eat few plant foods.

43:26 Dr. DiNicolantonio’s Favorite Micronutrient: Magnesium is his choice because ATP cannot be activated without magnesium. Magnesium controls sodium, potassium and calcium in the body. Beans and nuts are high in magnesium.

44:52 Dr. DiNicolantonio’s Favorite Exercise: Pushups are important for muscular strength. If you do a slow correct pushup, you hit many muscles and muscle groups. High intensity exercise is important too. He prefers resistance training to cardio.

47:04 Dr. DiNicolantonio’s Morning Routine: He eats 3 pastured eggs, over easy, with a piece of toasted sesame Ezekiel bread. He may have a handful of almonds (for omega 3s) in the morning with some dark chocolate. Dark chocolate is a micronutrient powerhouse.

50:04 Dr. DiNicolantonio’s Elevator Pitch: We need to revamp how nutrition guidelines are written today, with its closed door policy. Guidelines should be evidence based. Nutrition has become more politics than science.


Join the conversation

  1. Just a brief comment. Like everything else in life, treatment with salt use is best individualized as increased levels may not be appropriate for everyone. For example . . . I happen to have the gene (homozygous) that holds onto salt and excretes potassium. Eating salt causes ankle and lower leg swelling with pitting edema. It is also a burden on my kidneys as I have to drink more water and I end up with bags under my eyes. Normally, my water intake is appropriate without the additional burden of my body having to dilute the excess salt. So please remember to individualize your choices as we are each a unique creation. The explosion of information can be confusing to those new to the functional medicine field. Since your body’s response is appropriate to you, everyone would be good to take the take all this information ‘with a grain of salt.’ Please listen to your body with discrimination and it will guide you.

  2. Thank you so much for the interview! I’m on my second reading of the book. Since I’ve increased my salt intake (and potassium and magnesium), I no longer get cramps in my calves nor those annoying minor hip and knee injuries, which I think are connective tissue-related. I also have more stamina when I exercise, and can sleep through the night without having to pee. The book is an amazing and wonderful revelation!


  4. Thanks Mike,

    I really enjoyed this interview and will look into the book.

    At the end of the interview, you mentioned another salt that the interviewee had emailed you about, but I can’t find the name anywhere. What is it?


  5. Loved the episode. I tried a small dose of salt before my workout this morning and although I was sweating more, I also felt great.

    I will definitely be experimenting with this more.

    Thanks for providing such great information.

  6. Great episode! Learned a lot and it provided science for things I have been experiencing and wondering about for a long time. Great tips on gerolsteiner water and salting to counteract bitter flavor. My GF may be harming herself with her salt avoidance. Not sure about lectins in beans and nuts though, also the high omega 6 ratios in nuts versus omega 3. Sounds like he should eat more seafood instead. It tastes good if fresh.

  7. Hi Mike,

    This doctor seem to be ignorant of the fact that we humans each have unique biochemical individuality (based upon genetics, epigenetics, diet, exercise, sleep, stress levels, etc.) and, in the case of sodium sensitive hypertension, even slight variations in renin-angiotensin-aldosterone system can cause salt-sensitive hypertension. About 38% of the general population carries an ACE gene variant that causes increased activity of this system, which leads to greater blood pressure increase in response to increased sodium in the blood. These people are therefore salt-sensitive. Two other genes associated with salt sensitivity are the NOS3 gene and the AGT gene. Hence even slight variations in renal function, endothelial, function, or an overproduction of aldosterone, cortisol, epinephrine or norepinephrine levels (salt stimulates the adrenal glands, especially the medulla) can cause this condition.

    Even people who can handle a significant amount of salt in their diet without hypertension are not doing themselves any favors because too much salt depletes intracellular potassium and can cause many other imbalances including insulin resistance (it takes a molecule of potassium to ferry a molecule of glucose through the cellular membranes via GLUT4). By the time serum potassium levels show up borderline low the problem has been brewing for many years due to too much sodium intake. I’ve looked at thousands of intracellular (RBC) mineral tests comparing these to serum tests.

    Here is just one article to get you started on a more balanced perspective.



  8. Your very naughty book does not teach the difference between cheap processed refind toxic TABLE salt & healthy salt, when one uses too much toxic salt one gets high blood pressure, it has been said one can not have too much healthy salt, early this year NEW ZEALAND news media did not know difference

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