Eat more salt to stop sugar cravings, says heart scientist

In a controversial new book, The Salt Fix: Why the Experts Got it All Wrong and How Eating More Might Save Your Life, heart research scientist Dr James DiNicolantonio believes people should eat more salt to stop sugar cravings.

The American cardiovascular research scientist argues that a lack of salt is making people eat more sugar, and that people should eat more salt, not less.

James DiNicolantonio knows that government bodies and health agencies around the world tell people to reduce their salt intake to maintain a healthy heart.  However, he believes that this message may "predispose" people to sugar addiction.

He says "When we become deficient in this essential mineral our body has a  built-in safety mechanism [the reward centre in the brain] to make sure that we go out and get more salt so we don't die from salt deficiency," DiNicolantonio says. "The problem is that the other more harmful white crystal, sugar, can hijack this sensitised reward system, potentially making sugar more addictive during states of salt deficiency … Basically the more healthy white crystals we lose from our body [salt] the more cravings we can have for the other more harmful white crystal [sugar]."

"On the surface it appears everyone is getting to much salt but as I describe in my book The Salt Fix millions of people are at risk of salt deficiency," DiNicolantonio says.  

He maintains that low sodium levels [low salt levels] in the blood is the most common electrolyte abnormality in both inpatients and outpatients; “sleep apnoea, thyroid issues, kidney problems and excess caffeine consumption can cause people to lose more salt; inflammatory bowel diseases and coealic disease affect our ability to absorb salt; exercise and heat cause salt-loss through sweat and those on low-carb diets lose more salt out the urine. In other words, there are literally millions of people at risk of salt deficiency and thus sugar addiction," he says.

"The longest living populations in the world population also happen to have the lowest rates of death due to coronary heat disease," James DiNicolantonio says, mentioning Japan, South Korea, and France.

"The salt research base lacks a key piece of evidence and that's why there is this debate. The key piece of evidence it lacks is a big definitive outcome trial that randomises people to more versus less salt and looks to see what the effects are on stroke, heart attacks and the like," says Bruce Neal a senior director at The George Institute for Global Health and Australian chair of the World Action on Salt and Health. "We're doing that study at the moment – 21,000 people in China, two and a half years through, another two and a half years to go. It will answer that question."

In the meantime, Bruce Neal says there is "really strong evidence" that salt is associated with blood pressure and "really strong evidence" that blood pressure is associated with cardiovascular disease. "What we lack is that direct connection between salt and cardiovascular disease. Half of the studies will tell you salt is good, the other half will tell you salt is bad. It's simply not possible to tell."  

But Bruce Neal adds that if you asked 1000 experts whether eating more salt would cause harm or benefit, 950 would say "on balance, salt is more likely to be causing harm than benefit."

"The key to health is using real salt to get people to eat real food. I am not saying people can't use a little bit of sugar as long as this doesn't lead them to eating an entire bag of cookies," says DiNicolantonio. "The focus on salt being an addictive white substance gives people little options to flavour their food in a healthy way so that they can eat an overall healthy diet. Once people realise that they can use salt to eat real foods and cut back on the sugar then their overall diet and health can improve."

Bruce Neal insists that specific medical conditions aside, 99% of the world's population are not at risk of sodium deficiency. "There's some truth in some of those things" that DiNicolantonio claims. "If you just look at one aspect of the evidence you can run off with that conclusion, but the need is for people who can step back and look at the totality of what's going on – as with most things, the truth is somewhere in the middle. Even then, it's an imperfect truth."

MARTINA NICOLLS is an international aid and development consultant, and the author of:- Similar But Different in the Animal Kingdom (2017), The Shortness of Life: A Mongolian Lament (2015), Liberia’s Deadest Ends (2012), Bardot’s Comet (2011), Kashmir on a Knife-Edge (2010) and The Sudan Curse (2009).