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Salt & Stupidity

Avoiding salt has to be the most stupid idea ever produced out of the nutrition mainstream. Why ? One word – ‘homeostasis’ - the body’s ability to establish and maintain an equilibrium, something it does in relation to anything important for its proper functioning, and which includes sodium levels.

Homeostasis is the very first concept taught in nutrition, in anatomy and physiology. The very first, in the very first class, in the very first subject. It is considered fundamental to everything that follows. The rationale for reducing sodium intake violates this most basic of principles, and yet, in spite of this, it has found acceptance for decades within the same nutrition establishment. This calls for some explanation.

James Dinicolantonio’s “The Salt Fix” tells the story of how this state of affairs came to be. Its subtitle includes the phrase, “why the experts got it all wrong”, and the book has the clear goal of attempting to undo the damage caused by years of advice to minimise sodium in the diet. Instead,

Rather than denying yourselves the pleasures of this essential mineral, now is the time to welcome salt back to the table and embrace it as something that could make your body feel and function better.” (p. 185)

As Dinicolantonio relates, the case against sodium rested on the ‘salt-blood pressure hypothesis’. At this point, readers familiar with Gary Taubes’ ‘Good Calories, Bad Calories’, or Nina Teicholz’s ‘The Big Fat Surprise’ will have a pretty good idea how this tale is going to unfold, and their instinct will be correct. Like theirs’, this is a story of bad science underpinning dietary recommendations that have done far more harm than good. In this case,

The hypothesis went like this… when we eat salt, so the theory goes, we get thirsty – so we drink more water. In the salt-high blood pressure hypothesis, that excess salt then causes the body to hold on to that increased water, in order to dilute the saltiness of the blood. Then, the resulting increased blood volume would automatically lead to increased blood pressure.” (p. 8)

There are several problems with this hypothesis. The first is that it confuses a short term spike in blood volume with the medical condition of chronic hypertension (p. 8). There is no clear evidence that the former is harmful in any way, or even that it leads to an increase in blood pressure (p. 72). This is because of the mechanisms in place that maintain homeostasis. Salt and electrolyte content in the blood and the body’s tissues is tightly regulated, as is blood pressure, and these are easily capable of handling excessive intakes. The kidneys, for example, are able to excrete excess sodium quickly and efficiently (pp. 72-3), while the skin acts as a depository for salts not required immediately (p. 119), and blood vessels dilate to accommodate any rise in volume (p. 74). In fact, as Dinicolantonio spells out in detail, a low level of sodium creates far more problems and requires much greater regulatory intervention than does a high one. This includes the question of blood volume – too little sodium can lead to serious dehydration, higher blood pressure, and an elevated heart rate (p. 74).

If the salt-high blood pressure hypothesis runs directly counter to the principle of homeostasis, how did it come to be accepted ? In fairness to the nutrition mainstream, the idea did not go unchallenged, and for long periods during the twentieth century it fell into disrepute. The main reason for this lay in the inability of its supporters to produce reliable and convincing evidence for the theory. The initial claim rested on “findings from just six patients” (p. 35) and was almost immediately contradicted by others. Here too we see a parallel with the ‘diet/heart hypothesis’, around which exists a vast body of conflicting findings that pretty much cancels itself out. In spite of this, however, both hypotheses did gain traction, at almost exactly the same time – 1960/1, and for much the same reason. Dinicolantonio describes it this way,

The sad and simple truth is this: people were looking for easy answers. Explaining to patients and the lay public that blood pressure reductions from low-salt diets may actually indicate low blood volume and dehydration, and could place additional hormonal stress on the body, would require a great deal of detailed description. But the simple equation of Salt + Increased Thirst + Water Retention = Increased Blood Volume = Increased Blood Pressure is much easier. This simple equation just makes ‘logical’ sense. This idea was something the media, medical communities, the public, and government/health agencies could easily understand and get behind. And that’s exactly what happened – salt was demonised as a toxic, blood-pressure-raising addictive substance.” (pp. 73-4)

The idea that fat clogs your arteries was able to capture the popular imagination in much the same manner, with a similar impact on dietary cholesterol and saturated fats. It does not necessarily follow, however, that the reason these ‘simple equations’ were so successful lay in their easily understandable or logical nature. This was a necessary, but not a sufficient, condition, something else was needed. This is a theme I have investigated before, and in my opinion it is Nina Teicholz who gets to the heart of it when she argues that it is our disconnection from tradition that has exposed us to easy manipulation of this kind (see here). This was the basis of Crisco’s success (see here), where it replaced traditional cooking fats such as lard or tallow, and is also what allows processed food marketers and promoters of the official dietary guidelines alike to get away with their spurious claims as to what is healthy to eat and what is not. Having broken with our traditions, we are lost, without moorings or bearings, and as such open to any idea or slogan that appears to us as plausible or ‘logical’.

'in a scientific age, science becomes impossible'

Where do these ideas come from ? At first glance, it seems they come from ‘science’. In the case of the salt-high blood pressure hypothesis two Frenchmen Ambard and Beauchard in 1904 (p. 35). Later the theory was taken up by Frederick M. Allen and Walter Kempner. The critical role, however, was played by Lewis K. Dahl, who was the first to get the theory adopted as the basis of official recommendations and by food manufacturers (p. 44). All of these individuals rested their claims on ‘scientific evidence’, but on closer examination their ‘science’ turned out to be either flawed or downright fraudulent. Once again we have a close parallel with the diet/heart hypothesis, with Dahl playing an identical part to Ancel Keys. in fact, the same pattern turns up again and again, not only in the nutrition space, but across almost every scientific discipline in Modern times.

This is a reality we have to recognise. We live in an era that believes it rests on a foundation of Reason and Science, on the strength of which it is progressing towards an ever more rational order. But when we look closely at what is really going on, we find a very different picture, time and time again. What we uncover is a tale of arbitrariness, randomness, in which ideas that are more or less stupid triumph over their rivals for no obvious reason other than the sheer drive, tenacity, and talent of their proponents. We are stuck with the diet/heart hypothesis, not because of ‘science’, but because of Ancel Keys, who in his own way was a genius, at political manipulation, just as Lewis Dahl was. Every scientific field, without exception, has its Keys and Dahl figures, and a history as arbitrary and random as the nutrition space.

The problem we have is that because our social order derives its sense of legitimacy from being ‘evidence-based’, scientific, genuine science becomes hopelessly compromised, pushed to the margins. In a scientific age, science becomes impossible. It does so because it is entangled with too many other things – careers, ideologies, commercial interests, political struggles, institutional dynamics, in any scientific dispute, THERE IS SIMPLY TOO MUCH AT STAKE for the ‘truth’ to get a second glance. In the case of salt, a crucial element in the story is the part taken up by sugar, and the commercial interests of the sugar industry. Dinicolantonio recounts this in full, with some again familiar characters taking centre stage, the unfortunate John Yudkin for instance, who correctly saw that it was sugar, not salt, that was to blame for the epidemic of hypertension. This ‘correctness’ did not help him, or us, any more than it did in the debate over heart disease.

The salt-blood pressure hypothesis was always based on bad science. It is certainly a worthwhile venture to tackle this bad science, especially when better science does exist and always has. This, however, is not enough. Our task is also to RESCUE science, and scientists, from an era when too much is asked of them, where the search for truth and knowledge is bound up with the realities of life, with all its struggles and interests. At the same time, we also need to free society from its current state of disconnection, its lack of roots, and the disorientation this brings, so that it can no longer be so easily be manipulated by unscrupulous forces using slogans or memes that push our buttons in ways that turn out to hurt us. We need to find our way back to tradition, even if this means creating new traditions, as a counter-weight to ‘the experts’ that ‘got it all wrong’, that always get it all wrong.

Dinicolantonio helps us ‘find our way back’, not only through his telling the tale of ‘The Salt Wars’, but also in a chapter of the book he calls, ‘We Are Salty Folk’. This is my favourite section of ‘The Salt Fix’, it is where he traces our connection to this mineral, going right back to our origins as marine animals, reflected in parts of our anatomy such as the design of our kidneys. What he achieves through this discussion, as with the book as a whole, is to rehabilitate salt as our friend, no longer the villain, one we can embrace, and enjoy, a vital element within us, of us. This stands in sharp contrast with sugar, a substance we have to handle with care, with caution. Dinicolantonio highlights the difference between the two in this way – we can trust our cravings for salt, but we can’t trust our cravings for sugar, which is a point I have also made (see here) and used as an ethical argument against sugar. If we can’t trust our bodies’ natural inclinations when it comes to a food, then there is something wrong with that food, perhaps it is not even a food at all, but a drug or poison even.

One of the problems we have in the current nutrition debate is a conflation of salt, fat, and sugar, all of which can be subject to cravings, but which nonetheless possess a fundamentally different status when looked at from a nutritional perspective. Dinicolantonio makes a strong case for salt in this respect, and in doing so helps lay a different foundation for our relationship to food, one very different from the Puritanical thread also present in the mainstream attitude (see here), namely that because something is delicious it must somehow be bad for us. It is the legacy of this sensibility that also accounts for the general acceptance as ‘logical’ of the idea that both salt, and fat, are essentially the same as sugar.

Dinicolantonio sums up all these themes with some excellent culinary advice, he recommends,

Emulate the world’s most delicious cuisines. Many populations that eat a high-salt diet live long and in good health, such as those of France, Italy, South Korea and Japan. The difference is that these cultures eat real unprocessed food and add salt, rather than consuming processed foods (that also happened to be high in salt) The Mediterranean diet, widely considered the most heart healthy, is not low in salt – think of the olives, sardines, anchovies, salted and cured meats, aged cheeses, soups, and so on ! Go ahead and bring back these previously verboten high-salt foods.” (p. 171)

James Dinicolantonio, ‘The Salt Fix’, Piatkus, 2017

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