My Interview with James J. DiNicolantonio on The Salt Fix

Dr. Nicolantonio, how did we get it so wrong about salt? How did we go from thinking that it was the enemy to now you're saying it's not?

Yeah, I mean, so, I mean, basically all our nutritional whiplash that we're dealing with that, you know, all of a sudden fat's good and cholesterol's okay and now salt might be okay. It's, you know, really stems from those 1977 dietary goals where Senator George McGovern, he basically tasked Nick Modern, who really had no scientific background, no nutritional background, to write basically dietary guidelines for all Americans back 40 years ago before we had any evidence on salt or anything. And really it just comes down to those dietary goals were put out for everybody to go on a low salt diet and it really just carried over into the dietary guidelines, which gets updated every five years.

Was it based on any science or was it just sort of like, I think salt's bad, we should stop eating it? Was it more than that? Isn't there studies that show that salt was linked to hypertension and chronic disease? What about all that data that was used to make those recommendations?

It kind of similar with the demonization of fat. We had Lewis Dahl who was kind of like the Ancel Keys of salt. I don't know what was in the water in the 1950s but with Doll did the same thing with salt that Ancel Keys did with fat. Cherry-picking populations and drawing a straight line showing that in just five populations, as salt intake increased, the prevalence of hypertension increased. Of course, 20-30 years later, we had INTERSALT, which looked at 48 countries, not just five, and actually as salt intake increased, blood pressure actually decreased. Studies went back and forth, and there was all these salt wars back in the 1900s. In the book, I go through how we had some doctors saying, yep, when I put my patients on low-salt diets, their blood pressure goes down. Then we had other doctors saying it didn't happen. We never really had any good, solid proof that a low-salt diet prevents high blood pressure or strokes or heart attacks.

I mean, like the DASH diet, well, that's the diet, but it's also low salt, right? Which is dietary approaches to stop hypertension.

Part of that was a low salt diet.

Right.

And so that's a good point. And kind of what's been happening, Mark, is they've been hyper-focusing on the minimal benefits of a reduction in blood pressure when we cut our salt intake. And in the book, I kind of show you're just dehydrating that person. It's not even a good thing that you're lowering their blood pressure when you cut your salt intake because heart rate goes up and you're just reducing their blood volume. It's not a good reduction in blood pressure. Dr. Pompa:Yeah. Dr. Justin:Actually, vascular resistance in the arteries actually stiffen on a low salt diet. We become insulin resistant. Even that famous DASH study showed that the total cholesterol to HDL ratio worsened on a low salt diet and triglycerides went up. Dr. Pompa:Because low salt diets cause metabolic syndrome. Dr. Justin:And one of the reasons why it does that is because low salt diets cause insulin resistance because that's our body's defense mechanism.

Dr. Pompa:What's the mechanism of that?

Yeah, so the kidneys can retain more salt, the body becomes insulin resistant to elevate insulin levels because insulin helps the kidneys to not just retain more salt, but it also obviously causes us to store fat.

That's a really important point. I found when writing my book and doing the research on it, Eat Fat, Get Thin, with my patients that when they change their diet and cut out the starch and sugar, which causes also insulin resistance and makes you retain salt and water, because the insulin retained salt, they started dumping salt. They started dumping water. They lost weight. But they didn't feel so good. And so I always tell people who are eating a higher fat diet and very low carbohydrate diets to actually dramatically increase their salt intake.

Yeah, no, that's a huge point. A lot of people are suffering with the keto flu. And really, it's mainly due to salt deficiency, right? Because when insulin levels drop, when you cut your carbohydrate intake, that just flushes the kidneys out with salt. And, ketone bodies are negatively charged. They'll pull positively charged sodium ions with them. And so, really, the first few weeks of a low-carb diet, you dramatically lose a lot of salt and water, but also the reduction in dietary glucose reduces the absorption of salt. And so, there's this chronic mechanism where you're not even absorbing salt when you.

Cut your carbohydrate intake as well. Dr. Yeah. Dr. Yeah. That's very interesting. So, we've all learned about the harms of eating too much salt, but you're saying there's harms from having not enough salt in your diet. What's with that?

Right, yeah. So, when you look at all of the studies, even those who are consuming the highest amounts of salt, like 6, 7, even 8,000 milligrams of sodium, the increase in coronary heart disease mortality is only like 20%. But if you look at actually following the American Heart Association advice or the CDC, going below 2300 milligrams, you can see a doubling in coronary heart disease mortality. So even when you look at the harms of a very high salt diet, it's much less dramatic than the harms of a low salt diet. And so some of the reasons is because the kidneys can just flush out any salt that they don't need. So we have a lot of mechanisms, safety mechanisms, to either absorb and down regulate the amount of salt we absorb if we have too much. The kidneys can signal the kidneys to also flush out more salt when we don't need it. The problem is we can't manufacture an essential mineral, right? So when you don't have enough salt, you're kind of out of luck. And because it's an extracellular mineral, it can be flushed out of the body very easily. So caffeine, just four cups of coffee, can cause us to lose over a full teaspoon of salt in just four hours. And we sweat it out, right? I mean, exercise is one of the best things we can do for our health. and yet we can sweat out a half a teaspoon to a full teaspoon.

Of salt per hour of exercise. Wow, so exercise and coffee are out, right?

No, exactly. What's so funny is the American Heart Association tells people to exercise. They want them to exercise an hour a day, and yet they're telling them to eat basically less than a half a teaspoon of salt. You lose more than a half a teaspoon of salt in an hour of exercise. Literally, when you do the math, you're just depleting someone of salt if you follow both the American Heart Association's low-salt advice and their advice to exercise an hour a day.

A lot of people are dehydrated, and then their intracellularly dehydrated, meaning their cells don't have enough fluid in them, which makes you feel like crap.

Will salt help that?

Yeah, absolutely.

And electrolytes? Yeah, so sugar's one of the worst offenders at the depleting intracellular volume. and so basically glucose pulls water from the tissue into the blood vessel. So really, should we blame the wrong white crystal? Absolutely, sugar is what's causing an over retention of fluid, not salt. It's crazy to think. And I mean, there's studies even by Tim Noakes who showed that when you're exercising, consuming 2300 milligrams per liter of volume intake does improve hydration. And that's because Without salt, you can't hold on to water. And so salt absolutely hydrates the body.

Yeah, so salt gives you more ability to actually maintain your hydration because it's like the glue that holds the water in your cells. So who does need to consume more salt?

Yeah, so in the book, I go through some of the main populations that are at risk of salt deficiency. But starting out, I know you're really into the gut health. inflammatory bowel disease. And people with Crohn's and ulcerative colitis, they do not absorb salt well at all because of the damage to the intestine, right? Because we absorb salt in the intestine and the colon. And so, people with celiac as well, who have damage to the intestine, and people with IBS don't absorb salt very well. Then you also have people who've had part of their small intestine removed or people who've had part of their colon removed. are at our very high risk of salt deficiency because they don't absorb it well. And then you have people that are losing salt via kidney damage. So what people don't understand is that the kidneys, their main job, 60 to 70% of the kidneys function every single day is to reabsorb the three and a half pounds of salt that they filter. And so when you eat more salt, the kidneys are like, Thank you. I can just let any extra salt go. I don't have to actively reabsorb it. When you get damage to the kidneys from consuming a diet high in refined carbs and sugar, you're damaging those tubules that help you reabsorb the salt. You can start spilling salt in the urine.

Adrenal insufficiency that causes us to lose salt.

Dr. Justin Stress, right? Stress. Dr. Justin Untreated sleep apnea at night, those patients lose twice the amount of salt at night.

Dr. Justin Hypothyroidism. Thyroid hormones are extremely important for the kidneys to reabsorb salt. That's amazing. So you said something in the book that was sort of fascinating to me, that sort of salt is sort of the antidote to sugar addiction, which I talk about a lot. I've written a lot about how sugar is biologically addictive, that we get hooked on it, that it affects the brain the same way as cocaine or heroin. And you're suggesting that we can use another white powder, white crystal, to actually fix that problem.

How does that work? Yeah, no, that's a great point. And there is definitely this yin and yang between salt and sugar. I mean, literally salt seems to be that good white crystal and the antidote to the bad white crystal sugar. Nature has given us this natural white substance to combat this other one. What ends up happening is how does an animal know to go out to a salt lick and eat salt when it's depleted? What ends up happening is the reward system in the brain gets hyperactivated when we become deficient in salt. Unfortunately, sugar can hijack that activated reward system. And so studies and animals have shown that salt deficiency can cross-sensitize with substances of abuse like Adderall, cocaine, and potentially makes those substances even more addictive because they're more rewarding. And so reward drives dopamine release and drives crashes of dopamine, which can lead to that vicious cycle of dependency and addiction. And so literally adding more salt can potentially reduce sugar cravings and our preference for sweet foods.

That's unbelievable. So essentially being salt deficient makes your brain more sensitive to addictive substances. It makes you crave them more like sugar, which is pretty unbelievable. And I think, you know, we don't think about that. We don't, we're afraid of the salt shaker. You know, it's like the devil. And yet, we, we just have this thing right at our disposal, which is pretty amazing. So, you know, there's lots of salt out there, right? We have iodized salt, Morton's salts, whatever he uses. There's sea salt, there's Himalayan salt, there's black salt. I mean, it's confusing. So even I'm confused. What salt should we be using?

Yeah, so I mean, taking it a step back, just regular old table salt is highly processed. And I didn't even realize this until a few years ago. I mean, if you look at the back of your regular table salt, there's dextrose added to it. It's highly refined and they treat it with very high heat and it's just pure sodium chloride. There's no other minerals in it. And when you look at other salts, what I recommend in the book is this Redmond Real Salt. It's from an ancient ocean. And so a lot of people are really into these sea salts, right? But the problem is, is they're from modern day oceans and there's been numerous studies done now that sea salts from modern day oceans can contain modern day pollution. So they literally can have microplastics, nanoplastics, even traces of heavy metals. And, if you can source it from an ancient ocean, like Redmond Real Salt, then you're not dealing with any of those type of contaminants.

Where is an ancient ocean?

Well, this particular ancient ocean is in Utah, in Redmond, Utah. And, so it's actually pretty cheap for being an unrefined salt and it actually has really good amounts of iodine and calcium, which is why I like it as well. And, I use it to dose myself exercise.

So how much do you take before exercise? Yeah, so what I like to do.

Is generally I work out for about 45 minutes to an hour and depending on it doesn't even matter if I'm running or lifting heavy weights, I will use about half a teaspoon of redmond real salt and I'll add just enough lemon juice to coat it and I'll put about two ounces of water and take it like a lemon shot. Some people can just take it straight. Kind of depends on your palate, right?

Yeah, salty water. Wow, that's impressive. A half teaspoon. Seems like a lot.

Yeah, but I mean, that's what we lose on average per hour of exercise is a half a teaspoon of salt, and none of the sports drinks even come close to having that amount of salt.

Yeah, I notice when I take an electrolyte cocktail of magnesium, sodium, and potassium, and it's like you get a huge boost of energy. and the fatigue goes away. If you're playing tennis in the hot sun or something and you go for a bike ride, it's just phenomenal in terms of how different it makes you feel almost instantly. And I think most people don't realize that they could use electrolytes and salt to help them actually feel better, have more energy, perform better in so many ways. So what about the iodine issue? Because we take away the iodine, you talk about the Redmond Salt, which is got iodine, but most salts that people are using that are not iodized salt don't have iodine. We had a whole epidemic of goiters and issues. How do you reconcile that?

Yeah, no, it's a great point. A lot of people think that sea salt is very high in iodine because sea food is high in iodine. It's actually the exact opposite. Salt actually has virtually no iodine. Even the iodized table salt The actual iodine is artificial iodine. It's potassium iodide. And some studies have shown that the bioavailability might be less than 10%. Whereas if you can get real iodine, which is found in Redmond Real Salt, the bioavailability of that iodine may actually be like 100%. It always goes to show you, when we try to artificially copy nature, we never seem to even come close to what the real benefits are of a natural mineral contained in salt.

Kind of messes us up, right?

It does.

So, iodine from fish and seaweed is probably better to add to your diet. What about the patients who have heart failure, who have salt-sensitive hypertension, which you can actually look at the genes for? Are those people more at risk for salt issues?

Yeah. So really what my book is about is using real salt to eat real food and exercise more. If you have heart failure, what ends up happening is 25% of people with heart failure actually are at risk of low sodium levels in the blood. They actually generally need more salt, even though they're retaining salt more, they're actually over-retaining water and are at risk of hyponatremia. What ends up happening is patients with high blood pressure and salt-sensitive high blood pressure, generally, it's due to the insulin resistance caused by this high carbohydrate high sugar diet, and you cut the sugar and you can fix the salt-sensitive hypertension. It's such an easy fix.

Yeah, it's powerful. The other thing you sort of wrote about was fasting was about putting salt in your coffee. I remember being in Tibet, and they had salty butter tea. What's up with that?

Yeah, salt kind of cuts bitterness. Coffee can be a little bitter, and a lot of restaurants actually, people don't know this, they're always like, man, I love this coffee when I go to this restaurant. Because generally they use just a little bit of salt. And that's because it cuts the bitterness of it and actually can provide a little bit of sweetness. And so, yeah, I mean, you can use up to probably 1/8 of a teaspoon of salt per three cups of coffee. I wouldn't go more than that. But, yeah, some people like a little.

Pinch of mineral salt in their coffee in the morning. So I should put it in my coffee, they're ground up and put it.

In the coffee machine. Is it going to mess up the coffee machine? Yeah, I don't know if you, yeah, I don't think it would mess up the coffee machine, shouldn't.

That's pretty amazing. So what are great ways to include more salt in your diet and how much should we be including? Do we want two, five teaspoons a day? How much?

Right. Well, if you look at Japan and South Korea who live the longest, they consume between 4,000 and 5,000 milligrams of sodium per day. They're the highest salt eating populations in the world and yet they live the longest and have the lowest rates of coronary heart disease mortality. Just from that perspective, I don't even know why we ever feared salt. Even the Mediterranean diet is not a low salt diet, right? It's high in seafood and clams and cheese and olives and anchovies and all these salty foods, right? Really, that's how you want to integrate salt in your diet. It's eating real salty foods or you can add real salt to taste. My kids, any parent out there knows. Their kids are not going to eat bitter vegetables or nuts or seeds without adding some salt to it, right? But we're so afraid of salt, we'd rather give them low-salt junk food.

Yeah. Now, what about Michael Moss's book, Salt, Sugar, and Fat, about the role of the food industry putting these ingredients in our foods to make them more addictive? Do you know about that book? And what's your take on the whole salt thing? Because it is something that's added heavily to processed food.

Correct. And really what I always come back to, Mark, is don't blame salt for what the sugar did. Yes, processed foods are high in salt, but that's not—the salt isn't the issue. It's the carbs and the sugar that are causing you to overretain the salt. If you drop the processed carbs and sugar, the salt should be completely fine.

That's amazing. So what were the most surprising things to you that you found in writing the book, the Salt Fix, which by the way is a pretty amazing book. I encourage everybody to go get a copy because you know it'll turn your world upside down and also make you feel a lot better when you change from salt restriction to including salt. And by the way, I got like five different kinds of salt in my kitchen. I use it liberally with all the food I cook. I sprinkle it on. I've got crystals, Himalayan salt, black salt, all kinds of salt. And it's like It just makes food taste good and I don't worry about it and my blood pressure is like 90 over 60.

That's awesome. That's such a testament and it sounds.

Like you got the salt mixology going on and really, you know, yeah. And I'm an old guy, like 50, you know, 57. I, you know, most guys my age have blood pressure is like 140 over 90 but I don't eat sugar and starch very much and I include a.

Lot of salt and it just seems to work. Yeah, I think honestly one of the, the most impressive things that I found is that people that have been messaging me after reading the book saying, Dr. D, I had muscle cramps, muscle spasms, or heart palpitations for three years. No one knew what was going on. Within three days of upping my salt intake, it all went away. That was actually the catalyst which started me writing the book is when I was a community pharmacist, my patients were coming up to me with these symptoms of salt deficiency because their doctors had put them on on low salt diets for high blood pressure. And yet, within a few days of upping their salt intake, boom, everything kind of went away. These muscle cramps, especially at night, so many people have messaged me. They go away when they increase salt intake. Really, it's because we don't realize how much salt we lose through sweat, through caffeine, through these low carb diets, and medications and disease states that cause salt loss. One of the really cool things I think you'll appreciate this is If we don't have enough salt, we actually lose magnesium and calcium from the body. What ends up happening is—More magnesium and calcium.

Yeah.

No, exactly. When we go on a low-salt diet, in order to maintain a normal sodium level in the blood, the body starts pulling sodium from other places. One of the places it pulls sodium from is the bone. Yet, these osteoclasts, they're not smart enough to just strip sodium. They end up pulling magnesium and calcium with them. So what I like to try to, a lot of people are like, well, magnesium and potassium, those are the best minerals. Well, you actually can't maintain your magnesium status unless you have ample amounts of salt. And so we even sweat out more magnesium and calcium on low salt diets because it's the body's defense mechanism to hold onto the salt in sweat and start sweating out more magnesium and calcium.

So really, low salt diets are like the worst thing you can do for your magnesium and calcium levels in your body. And by the way, so many people are low in magnesium, which has so many different symptoms from headaches to constipation to insomnia to anxiety to palpitations to muscle cramps, all of which are common symptoms that people have and they don't realize it's a magnesium deficiency. And all the things we do in our culture, alcohol, caffeine, sugar, stress, all cause us also to deplete magnesium. So we're in this kind of mineral deficiency state most of the time, sodium, magnesium, potassium, potassium from plant foods, vegetables, which most of us don't eat enough of. Who eats eight cups of vegetables a day? I do, but probably most people don't. So I think that's really a groundbreaking, paradigm shifting book, which by the way, you really rarely see a book like this, in my view, that it's so groundbreaking and so paradigm shifting because it's so against our conventional wisdom. It's so against what the government recommends, what American Heart Association recommends, what your doctor recommends, what nutritionists recommend. And we've had all these unintended consequences from this, just like we've had from the low-fat diet craze. And it's a very similar story, it sounds like, of how we got it so wrong and you sort of really brought to light why we got it wrong and what to do about it. And the good thing is it's an easy fix. What I'm telling people to do is hard, which is stop eating sugar. You're saying just add salt, which makes.

Your food taste good.

So hard sell.

No, exactly.

I appreciate that. Yeah, it's great. Any last thoughts you have that you want to share, what you found in your work that we should know about?

Yeah, the other interesting thing is—which I think you'll appreciate—is a lot of people understand that salt equals sodium, but they forget about the other essential mineral in salt, chloride. Chloride is what makes up hydrochloric acid. When you go on low-salt diets, studies have literally shown that you There's a reduction in stomach acid. You're probably not able to digest food as well, absorb nutrients as well, and potentially prevent bacterial overgrowth. These minerals are essential. If we don't get enough of them, we can't just manufacture them.

It's very important that we're getting an Optimal Omega. That's unbelievable. It's something that we don't even think about, which was the other side of the equation, which is chloride in your gut. It's all connected, which is really powerful and beautiful. what research are you most excited about that you're engaged in right now that we're going to look for coming forward from you?

Yeah, so we're doing a lot with Omega-3s, how they're beneficial and how Omega-6s are harmful. So I have a few research papers that are submitted and also magnesium deficiency. I have a large review paper on that coming out and all the way, what are the real ways that we should be kind of testing for magnesium deficiency because I think there is a, There's a lot of misinformation out there on how to diagnose it.

Yeah, how do we diagnose it?

One of the best ways, the gold standard, is actually an IV magnesium load test, but that requires someone to 24-hour urinalysis and literally an IV magnesium load in the hospital. Probably the easiest way is mononuclear cell magnesium.

Not red cell magnesium.

No, actually in our paper, red blood cell magnesium is actually worse than serum magnesium. Because there's these shifts that happen in the body. If you exercise, a lot of the magnesium will go into the red blood cell and it seems to be this reservoir. There's shifting a lot of magnesium into the red blood cell, not very reflective.

Of a true deficiency. Is that something you can order, a mononuclear Red magnesium level?

You know, I honestly don't even know of a lab that... Does it?

Yeah.

So, it's interesting that some of the best ways that we should be diagnosing mineral deficiencies, we don't even have access to it. And that's part of the problem that no pharmaceutical industry is really diving in and trying to figure out what are the best tests for probably what's driving 80% of chronic disease nowadays is these mineral and vitamin deficiencies.

Yeah, it's true. I mean, but the thing is, you know, getting magnesium, it's not patentable. You know, it's cheap and it's accessible, but yeah, I think magnesium deficiency is one of the biggest things I've seen in my practice. And honestly, I diagnose it through symptoms. The ones I said, you know, symptoms are a great, great model for actually diagnosing it because they're obvious. They have headaches. anxiety, palpitations, insomnia, constipation, muscle cramps, palpitations, all that stuff. People can report to you and you can just ask and you'll figure it out.

Dr. Yeah, no. I think you hit the nail on the head is that we really need to look at symptoms. Even with salt deficiency, low sodium levels in the blood is not even that great of a way to know if someone is deficient in salt. It's really symptomatology, right? If you're dizzy when you go from a seated to a standing position or just integrating salt back into your diet and all of a sudden these symptoms of muscle cramps and spasms go away, that's a much better way to diagnose yourself than even looking at sodium levels.

Yeah, you do see those sort of classic salt deficient patients. Often they're tall, thin women who have anxiety and who have palpitations, feel dizzy when they stand up. and you give them salt and they do so well. I often give them licorice, which actually helps you retain salt. It's got a mineral, a corticoid effect. So it's very, very powerful. Now what about something you just mentioned? I want to just take another couple minutes because you piqued my curiosity. Now the current recommendations, and I'm going to talk about fat because it's one of my favorite subjects. The current recommendations from the American Heart Association from top scientists around the world is we should be cutting saturated fat and we should be increasing our vegetable oils, corn oil, canola oil, soybean oil, safflower oil, all these oils that we never consumed a hundred years ago. And you sort of mentioned briefly that you're doing a paper on the dangers of Omega-6s, which is these refined vegetable oils. And it's okay to eat them from nuts or seeds, but you can't get that much from those. How much nuts can you eat? But you can down a lot of vegetable. I mean, in fact, 10% of our calories are these soybean vegetable refined Omega-6 oils. So, what is it that you're finding about these? And how would you counter someone who says, well, all the data show that PUFA's are better for you and you should increase your vegetable oil consumption to reduce heart disease because it lowers LDL?

Right, exactly. And you kind of just kind of answered it, right? We've literally just demonized saturated fat due to it potentially raising LDL, and we've kind of given a health halo to these vegetable oils simply based on this one surrogate marker. because it lowers LDL. Kind of like salt, right? The one surrogate marker, it lowers blood pressure, so we think it's going to translate into a reduction in strokes and heart attacks. It's just not as simple as A leads to B, leads to C. But even if you look at any of the randomized studies, any study that has actually replaced saturated fat with vegetable oils has almost always shown an increase in coronary heart disease mortality. What was unfortunate, the 2015 Dietary Guidelines, Did not include Chris Ramsden meta-analysis that showed that replacing saturated fats with vegetable oils actually led to harm. They excluded the meta-analysis. I don't know how you do that. That's selective reporting. What ends up happening with these Omega-6s, like you said, if you get it from nuts and seeds, you have this protective coating protecting the Omega-6 from going rancid. Nature is very smart. It packs those nuts and seeds with vitamin E. to prevent that Omega-6 from going rancid. That is so different than something that is being stripped of, let's say, seeds, and now it's being exposed to high heat. It's already full of these lipid peroxides before you even ingest it. Even if you get an oil...

It's like rancid fat you're eating.

You're honestly just drinking rancid fat. Exactly. Even if you consume an organic Omega-6 that hasn't been high heat extracted. The problem is your stomach is a bioreactor. When that Omega-6 without a coating from nuts or seeds is hitting the low pH of your stomach, it forms lipid hydroperoxides and it forms all these other harmful effects, especially these aldehydes which can bind to DNA and protein and severely damage our bodies. You're consuming this oil that is very susceptible to oxidation. And that's why, and that those harms are much worse than a reduction, any type of benefit you would get from a reduction in LDL.

What you're saying is it's such a contradiction because guys like Walter Willett from Harvard, they've done huge population studies. Now they don't prove cause and effect, but they've taken all that data and go, we really should be eating more vegetable oils and less saturated fat. And it's sort of really going counter to the prevailing wisdom. How do you reconcile that? What would you say to Walter Willett when-- that's such a good question.

I love it. And so there's a couple of things going on, right? Most of the studies combine Omega-6 intake totally. They don't just look at vegetable oils. So they combine Omega-6 from nuts and seeds and everything and say, okay, those who are consuming the highest amounts are at the lowest risk of heart disease. They don't ever actually tease out and say, no, who's the population consuming high amounts of vegetables? oils. So they don't really strip the two out in general. The part is that everybody's consuming high amounts of omega-6. And so the population studies never actually find a population that are consuming a low amount.

Lower amount. Right.

Exactly. Consuming basically someone who's consuming high amounts with very high amounts. And then the other factor is they look at blood omega-6 levels and they say people with the lowest blood omega-6 are at the highest risk of heart disease. The problem is, is inflammation reduces omega-6 in the blood because it's susceptible to inflammation and oxidation. And so it's actually reverse causation is what's going on. People with low omega-6 in the blood that are at higher risk of cardiovascular events is due to the underlying inflammation.

That is lowering their omega-6 in the blood. It's not the intake. It's amazing, yeah. The other thing I think, you know, you might have noticed is that a lot of the studies that showed benefits of these polyunsaturated fats exclude Omega-3s. And when you separate out the studies that just look at Omega-6s without Omega-3s, they actually show harm, which is what you're talking about, the Rams and meta-analysis and the Sydney Heart Trial. And even, you know, even the most recent Minnesota Coronary Experiment review of the data was, was where they looked at saturated fat. This was a study that could never be done now because it was, you know, there's, there's, it's very hard to do nutritional studies. Most of them are population studies, which look at food frequency questionnaires, they don't prove cause and effect, they find associations, there's other things that can explain it, but a randomized controlled trial is a more definitive study. And it's almost impossible to do those nutritionally because you've got to lock people up, feed them different diets for a long period of time and see what happens. But free-living humans don't behave. They go out and eat ice cream when they're not supposed to or they do other things. So what they did was they took a population of mentally ill patients in a mental hospital which now would be unethical to do. They gave half of them saturated fat, high saturated fat diet, and half of them omega-6 diet, corn oil. They found that even though the cholesterol was lowered for the corn oil, in fact, for every 30-point drop of the LDL, they found a 22% increase in heart attacks and deaths. so even though their cholesterol quote got better, they died and they got heart attacks compared to the saturated fat group, which at that time was like close to 20% saturated fat in that group, which was pretty striking. And they increased the vegetable oil to like 300 times, 300%, I mean, in the, in the Omega-6 group. So that was a compelling study for me because it's very hard to do those studies. We're probably not going to get them again. And the data was really good. And these studies are very well done. It was an NIH funded study. very rigorously done by great scientists who actually believed the opposite and didn't publish the data. They hid it in the basement for 40 years until Drs. Ramson and Hiblin actually started to ask questions and dig around. There's a great, I don't know if you heard it, James, there's a great podcast by Malcolm Gladwell on his podcast Revisionist History exactly about this story, looking at how this got buried, what happened, and the data around it. It's pretty fascinating. Very cool stuff.

It's great.

Any parting words you want to share? Just stay salty.

Stay salty. All right.

So everybody get the Salt Fix. Check out Dr. Nicotiana's work. His research papers are amazing. I love them. And his website is what? TheSaltFix.com TheSaltFix.com. Okay, great. Well, great to have you on the show, and we'll talk to you soon.

Okay. See you, Mark.