James DiNicolantonio



Our body has a superpower to excrete excess sodium but not excess sugar. If you get too much sodium, no harm no foul. If you get too much sugar that leads to diabetes, obesity, heart disease and cancer. Don’t fear salt. Fear sugar.

James DiNicolantonio is an American cardiovascular research scientist, conspiracy theorist, anti-sugar campaigner, anti-vegan and cholesterol denialist who is known for spreading misinformation about nutrition. He is best known for his view that salt has been unfairly demonized by the medical community and that eating more of it will save lives. He also promotes the oxidized linoleic acid hypothesis of coronary heart disease which is contradicted by evidence-based medicine.

As well as recommending an increased consumption of salt, DiNicolantonio is a low-carb advocate and fan of the ketogenic diet. In 2018, he co-authored, with alternative medicine guru Joseph Mercola, the food woo book Superfuel, published by Hay House.

DiNicolantonio claims on his website that he does "Evidence-Based Nutrition", but this is clearly not the case. On his social media accounts, DiNicolantonio promotes fear-mongering and tells people to avoid all seed and vegetable oils as they contain linoleic acid which he argues causes cancer, heart disease and many other chronic diseases. As of 2023 there is no strong evidence to support these claims.

DiNicolantonio says that by eating "real food" this will make "diseases disappear".

The Salt Fix
Not only have we gotten it wrong, we've gotten it exactly backwards: eating more salt can help protect you from a host of ailments, including internal starvation, insulin resistance, diabetes, and even heart disease. (The real culprit? Another white crystal—sugar.)

Similar to other low-carbers such as Gary Taubes, DiNicolantonio blames sugar for causing most chronic conditions. His health advice is to eat more salt and less sugar. His views on salt consumption are in opposition to conventional medical advice. The American Heart Association recommends that people cut down on salt consumption because of the risk of high blood pressure, as "the science behind sodium reduction is clear. Significant evidence links excess sodium intake with high blood pressure, which increases the risk of heart attack, stroke and heart failure." Health authorities who cite research from evidence-based medicine recommend that people eat no more than 6g (about a teaspoon) of salt each day.

DiNicolantonio is certainly correct in pointing out that sodium is an essential nutrient for the body, and that there are health risks from salt under-consumption. However, he takes the salt consumption thing to an irrational extreme, claiming that there is no link between salt consumption and the risk of high blood pressure. He claims, instead, that sugar is the real culprit. His advice to eat more salt has been condemned by medical experts as potentially dangerous. The claims in his book, The Salt Fix, were criticized by health authorities, including Public Health England (PHE). DiNicolantonio recommends that people eat 7.5g to 15g of salt a day. He says that this is a "normal" salt intake. Louis Levy, head of nutrition science at PHE, stated that "Diet is now the leading cause of ill health. By advocating a high-salt diet this book is putting the health of many at risk and it undermines internationally-recognised evidence that shows a diet high in salt is linked to high blood pressure, a known risk for heart disease."

In the book, DiNicolantonio bizarrely claims that early humans during the Paleolithic era ate a high-salt diet, in reality the opposite is true as salt in the diet was very low.

The book has been endorsed by various low-carb cranks including Marika Sboros and the Weston A. Price Foundation.

Cholesterol denialism
DiNicolantonio is a cholesterol denialist who argues against the scientific consensus. He claims that high blood cholesterol levels do not increase the risk of cardiovascular disease. He promotes a diet high in saturated fat and blames sugar and carbohydrates for causing high cholesterol and obesity.

DiNicolantonio has been accused of misrepresenting scientific evidence on saturated fat and its relationship to cardiovascular disease. His 2014 editorial for the journal Open Heart was criticized by Tom Sanders, Emeritus Professor of Nutrition and Dietetics:

Bruce Griffin, Professor of Nutritional Metabolism noted that "to suggest that the theory relating saturated fat to increased total cholesterol is flawed, is nonsense, and contradicts 50 years of evidence-based medicine."

Oxidized linoleic acid hypothesis
DiNicolantonio promotes the "oxidized linoleic acid hypothesis" of coronary heart disease (CHD) in opposition to the well supported low-density lipoprotein (LDL) oxidation theory. He wrote about this hypothesis in a paper in 2018. According to DiNicolantonio it is the essential omega-6 polyunsaturated fatty acid (PUFA) in vegetable oils and other foods that are to blame for causing coronary heart disease and many other diseases. According to his hypothesis "Dietary linoleic acid, especially when consumed from refined omega-6 vegetable oils, gets incorporated into all blood lipoproteins (such as LDL, VLDL and HDL) increasing the susceptibility of all lipoproteins to oxidise and hence increases cardiovascular risk". As of 2023, there is no data from evidence-based medicine to support his hypothesis, but plenty of data to contradict it.

All reviews of case-control studies, cohorts and randomized controlled trials (RCTs) to date contradict DiNicolantonio's hypothesis.

In contrast to what DiNicolantonio's claims, linoleic acid (an essential polyunsaturated fatty acid found in most nuts, seeds and vegetable oils) lowers risk of coronary heart disease. Linoleic acid is the major PUFA present in most types of nuts (40–60% of total fatty acid composition for Brazil nuts, pecans, peanuts and walnuts). Higher intake of these nuts has been shown to the lower risk of all-cause mortality, cancer, CHD mortality, inflammation and total CHD. This data contradicts DiNicolantonio's hypothesis.

DiNicolantonio has since clarified on Twitter that he has no problem with people consuming nuts or cold-pressed nut oils such as walnut oil that are high in linoleic acid if they are consumed cold and not heated as they are not oxidized. If DiNicolantonio's hypothesis is true then we would expect to see LDL-c levels significantly increase from intake of vegetable or seed oils high in linoleic acid, however the opposite is true. For example, rice bran oil which has about 30% linoleic acid has been shown to significantly decrease serum TC, LDL-c and TG levels. Canola Oil and sunflower oil have also been shown to significantly decrease LDL-c. Sunflower oil is about 65% linoleic acid. DiNicolantonio does not discuss this evidence but bizarrely claims in his paper without evidence that linoleic acid raises LDL-c.

In his paper, DiNicolantonio says that "An excess dietary intake of linoleic acid causes greater endothelial activation compared with an excess of saturated fat" but fails to back this up with any scientific evidence apart from an outdated study on rats. He also says "Linoleic acid is inflammatory to the vascular endothelium" but fails to support this claim with any data from clinical trials. Contrary to what DiNicolantonio says there is no reliable data to suggest that adding linoleic acid to the diet increases concentration of inflammatory markers. There is evidence indicating that linoleic acid is anti-inflammatory such as higher levels of linoleic acid lowering risk of rheumatoid arthritis.

DiNicolantonio's fanatical claim that "numerous lines of evidence show that the omega-6 polyunsaturated fat linoleic acid promotes oxidative stress, oxidised LDL, chronic low-grade inflammation and atherosclerosis, and is likely a major dietary culprit for causing CHD", is clearly unsupported by scientific evidence. Many of DiNicolantonio's references in his paper are out-dated studies on rats. Unfortunately his paper was picked up by 16 news outlets and promoted by cranks from the low-carb community on social media platforms.

Fatal flaw
Nutritional scientist Nick Hiebert has noted that DiNicolantonio's oxidized linoleic acid hypothesis suffers from a fatal flaw:

Cancer
A topic that DiNicolantonio never discusses is the link between high salt intake and cancer. High salt intake increases risk of gastric cancer, esophageal cancer and colorectal cancer.

Conspiracy theories
DiNicolantonio promotes irrational conspiracy theories on his Instagram and Twitter profiles claiming "big pharma" and the medical community lie about everything and try to control people:

The most nutritious foods on the planet -Meat & eggs

The most vilified foods on the planet -Meat & eggs

For 50 years they told us to stop eating the most nutritious foods.

Why? Because they want you weak and sick so they can control you.

Don’t be fooled. Eat meat/eggs!

They lied about tobacco They lied about sugar They lied about cholesterol They lied about asbestos They lied about mercury They lied about Vioxx They lied about fluoride They lied about aspartame They lied about glyphosate

Promotion of coconut and palm oil
On his social media accounts, DiNicolantonio promotes the consumption of coconut oil and palm oil whilst telling people to avoid all seed oils. However, coconut oil raises low-density lipoprotein cholesterol (LDL-C) levels which increases risk of cardiovascular disease and no clinical studies have shown that it improves the lipid profile.

Publications

 * The Salt Fix: Why the Experts Got It All Wrong--and How Eating More Might Save Your Life (2017) ISBN 978-0451496966
 * Superfuel: Ketogenic Keys to Unlock the Secrets of Good Fats, Bad Fats, and Great Health (with Joseph Mercola, 2018) ISBN 978-1401956356
 * The Longevity Solution: Rediscovering Centuries-Old Secrets to a Healthy, Long Life (with Jason Fung, 2019) ISBN 978-1628603798