James DiNicolantonio

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DiNicolantonio with Joseph Mercola
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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 in 2021[1]

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.[2] 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.[3][4] In 2018, he co-authored, with alternative medicine guru Joseph Mercola, the food woo book Superfuel, published by Hay House.[4][5]

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, inflammation and many other chronic diseases.[6] As of 2023 there is no strong evidence to support these claims. Contrary to what DiNicolantonio claims, the evidence has shown that linoleic acid intake decreases risk of chronic disease.[7][8][9]

DiNicolantonio says that by eating "real food" (a ketogenic diet) this will make "diseases disappear".[10] He has appeared on many pseudoscientific podcasts with Eric Berg, David Perlmutter and Paul Saladino.

The Salt Fix[edit]

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.)
—James DiNicolantonio[11]

Similar to other low-carbers such as Gary Taubes, DiNicolantonio blames sugar for causing most chronic conditions.[12] 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."[13] Health authorities who cite research from evidence-based medicine recommend that people eat no more than 6g (about a teaspoon) of salt each day.[14][15][16][17]

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.[18] 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.[12][19] His advice to eat more salt has been condemned by medical experts as potentially dangerous.[20] The claims in his book, The Salt Fix, were criticized by health authorities, including Public Health England (PHE).[20] DiNicolantonio recommends that people eat 7.5g to 15g of salt a day. He says that this is a "normal" salt intake.[20] 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."[20]

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.[21][22]

The book has been endorsed by various low-carb cranks including Marika Sboros and the Weston A. Price Foundation.[23][24]

DiNicolantonio has promoted his views about diet and salt on many low-carb pseudoscientific podcasts:

Cholesterol denialism[edit]

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.[33] He promotes a diet high in saturated fat and blames sugar and carbohydrates for causing high cholesterol and obesity.[33][34]

DiNicolantonio has been accused of misrepresenting scientific evidence on saturated fat and its relationship to cardiovascular disease.[33] 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."[33]

Open Heart[edit]

DiNicolantonio is an associate editor of a BMJ journal, Open Heart which has published papers supportive of cholesterol denialism.[35] The Editor-in-Chief Pascal Meier is a cholesterol denialist, who has co-authored a paper with Aseem Malhotra.[36][37]

DiNicolantonio has authored papers for Open Heart, disputing the evidence that saturated fat increases risk of heart disease.[38][39] He has also published a paper with Zoë Harcombe.[40]

His 2014 editorial for Open Heart was criticized by Tom Sanders, Emeritus Professor of Nutrition and Dietetics:

This article rubbishes the relationship with saturated fat and CVD, misrepresents the scientific evidence and then goes on to put the blame on sugar. It is beyond reasonable doubt that elevated LDL (low density lipoprotein) cholesterol is a major determinant of risk factor for cardiovascular disease. The saturated fatty acids palmitic, myristic and lauric acids raise LDL cholesterol in increasing order in meta-analysis human experimental studies.[34]

Oxidized linoleic acid hypothesis[edit]

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.[41] According to DiNicolantonio it is linoleic acidWikipedia 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".[41] 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.

SourceFinding
2012 systematic review of RCTs on the effect of dietary linoleic acid on markers of inflammation.[42]"Virtually no evidence is available from randomized, controlled intervention studies among healthy, noninfant human beings to show that addition of LA to the diet increases the concentration of inflammatory markers."


2014 review and meta-analysis of prospective cohort studies.[43]Intake of linoleic acid (LA) is inversely associated with CHD risk in a dose-response manner.


2014 cardiovascular health study with 2792 participants.[44]High circulating linoleic acid was inversely associated with total and CHD mortality in older adults.


2016 cohort that investigated 83 349 women from the Nurses’ Health Study (July 1, 1980, to June 30, 2012) and 42 884 men from the Health Professionals Follow-up Study (February 1, 1986, to January 31, 2012).[45]"Intake of ω-6 PUFA, especially linoleic acid, was inversely associated with mortality owing to most major causes".


2017 systematic review and meta-analysis of RCTs.[46]"Increasing dietary LA intake does not have a significant effect on the blood concentrations of inflammatory markers".


2018 Cochrane review of RCTs.[47]Increasing omega-6 fatty acids including LA reduces blood cholesterol (high-quality evidence).


2019 pooled analysis of 30 cohort studies.[48]Higher in vivo circulating and tissue levels of LA are associated with lower risk of major cardiovascular events.


2020 review of 70 studies.[49] Decreased risk of cancer from LA intake.


2020 systematic review and meta-analysis of dietary intake and biomarkers of linoleic acid and mortality.[50]Higher LA intake was associated with a "modestly lower risk of mortality from all causes, CVD, and cancer".


2020 systematic review and meta-analysis on dietary linoleic acid and risk for stroke.[51]Higher LA levels were associated with a reduced risk for ischemic stroke.


2021 review of human intervention trials.[52]Linoleic acid decreases lipid risk markers for CVD in healthy individuals and LA decreased LDL-C compared to saturated fatty acids.


2021 review of RCTs.[53]"Omega-6 PUFAs supplementation did not affect the risk for CVD morbidity and mortality".


2021 review and meta-analysis of prospective cohort studies.[54]"High intake of dietary LA and elevated concentrations of LA in the body were both significantly associated with a lower risk of T2DMWikipedia."


2022 review on blood levels of omega-6 fatty acids.[55]Linoleic acid reduces the risk of coronary heart disease.


2022 study on 2450 men.[56]Higher circulating concentration and dietary intake of PUFA, mainly linoleic acid are associated with lower risk of atrial fibrillation.


2023 review on dietary fatty acids and inflammation.[57]LA intake is associated with CVD risk reduction.


2023 systematic review and meta-analysis of 40 RCTs.[58]LA intake significantly reduced blood lipid profiles compared with saturated fatty acids.


2023 systematic review and dose-response meta-analysis of prospective cohort studies.[59] Higher tissue levels of LA were associated with a reduced risk of prostate cancer.


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.[60] 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).[61] Higher intake of these nuts has been shown to the lower risk of all-cause mortality, cancer, CHD mortality, inflammation and total CHD.[62][63] 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.[64] 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.[65] Canola Oil and sunflower oil have also been shown to significantly decrease LDL-c.[66][67][68] 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 unreliable study on rats.[69] He also says "Linoleic acid is inflammatory to the vascular endothelium" but fails to support this claim with any data from clinical trials.[41] Contrary to what DiNicolantonio says there is no reliable data to suggest that adding linoleic acid to the diet increases concentration of inflammatory markers.[70] There is evidence indicating that linoleic acid is anti-inflammatory such as higher levels of linoleic acid lowering risk of rheumatoid arthritis.[71][72]

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"[41], is clearly unsupported by scientific evidence. Similar to Ray Peat, DiNicolantonio's takes a lot of his data from unreliable animal studies. Animal model findings are not considered strong evidence in clinical medicine, nor do they translate consistently into clinical effects in human beings. 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[edit]

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

That is, holding to the hypothesis that something increases the risk of cardiovascular disease if, and only if, that something facilitates the oxidative modification of LDL particles, leads one to affirm the absurd position that omega-3 fatty acids, such as alpha-linolenic acid, must also be atherogenic and increase cardiovascular disease risk. Evidence for this flaw is that not only do omega-3 fatty acids also produce MDA when oxidised, they actually produce more MDA than linoleic acid. So why do DiNicolantonio and O’Keefe declare in their review that omega-3 fatty acids are cardioprotective? (which they are). This straightforwardly entails a contradiction of their hypothesis, leaving them with a position that affirms it both is and is not the case that omega-3 fatty acids protect against cardiovascular disease. And it should go without saying that a hypothesis that entails a contradiction should not be given much credence.[73]

Cancer[edit]

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.[74][75][76][77]

Conspiracy theories[edit]

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!
—James DiNicolantonio[78]
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
—James DiNicolantonio[79]

Promotion of coconut and palm oil[edit]

On his social media accounts, DiNicolantonio promotes the consumption of coconut oil and palm oil whilst telling people to avoid all seed oils.[64] 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.[80][81]

Connection to Joseph Mercola[edit]

DiNicolantonio is a close friend of anti-vaxxer quack Joseph Mercola. In 2018, they co-authored Superfuel: Ketogenic Keys to Unlock the Secrets of Good Fats, Bad Fats, and Great Health, published by Hay House.[82]

In 2023, Joseph Mercola denounced the ketogenic diet that he spent decades promoting and all of the videos featuring DiNicolantonio and Joseph Mercola have been removed from his website. The only videos that remain are on Facebook.[83] DiNicolantonio has not publicly commented about this.

Publications[edit]

  • 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

See also[edit]

References[edit]

  1. James DiNicolantonio on Twitter.
  2. #400: Quack Asylum – Part 1: Malhotra & DiNicolantonio
  3. Dr James DiNicolantonio: Beneficial Effects of Salt on Improving Blood Pressure
  4. 4.0 4.1 Dr. Mercola and Dr. Nicolantonio Discuss ‘Superfuel’ and the Importance of Healthy Fats
  5. 'Superfuel’ — Your Definitive Guide to Dietary Fats. Joseph Mercola.
  6. James DiNicolantonio's posts on linoleic acid.
  7. See studies listed at James DiNicolantonio#Oxidized linoleic acid hypothesis
  8. Do Seed Oils Make You Sick?
  9. Higher circulating and tissue levels of Linoleic Acid associated with lower risk of major cardiovascular events
  10. https://archive.is/p4KgJ
  11. The Salt Fix
  12. 12.0 12.1 Pass the salt: The myth of the low-salt diet
  13. Get the Scoop on Sodium and Salt. American Heart Association.
  14. Salt. British Heart Foundation.
  15. Salt: the facts. NHS.
  16. Use the Nutrition Facts Label to Reduce Your Intake of Sodium in Your Diet. U. S. Food and Drug Administration.
  17. Shaking the Salt Habit to Lower High Blood Pressure
  18. How Much Sodium Should You Have per Day?
  19. The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. James DiNicolantonio.
  20. 20.0 20.1 20.2 20.3 A danger to public health? Uproar as scientist urges us to eat more salt
  21. Salt and Hypertension: An Evolutionary Perspective
  22. Uric acid and evolution "The salt content of the diet at the beginning of the Palaeolithic period, in the mid-Pleistocene (1–2 million years ago), was very low, ∼690 mg/day (1.9 g NaCl) compared with a mean of 4000 mg/day (10 g NaCl) in the current American diet."
  23. Salt Fix: Right White Stuff for Hearts, Minds, Sex Lives. Marika Sboros.
  24. The Salt Fix by James DiNicolantonio. Weston A. Price Foundation.
  25. Dr James DiNicolantonio
  26. Hacking Health | Dr Shawn Baker & James DiNicolantonio
  27. Why You Need More Salt in Your Diet
  28. Dr. Gundry Interviews Dr. James DiNicolantonio | Ep15
  29. For better brain health... "superfuel" yourself? | Dr. Gundry Clips
  30. Is Sodium Bad For You? - with Dr. James DiNicolantonio | The Empowering Neurologist EP. 77
  31. James DiNicolantonio: supplementation and nutrient deficiencies, eggs vs. bagels, creatine and diet
  32. Carnivore vs Omnivore part III. A friendly debate with James DiNicolantonio, PharmD
  33. 33.0 33.1 33.2 33.3 Saturated fat is not bad for health, says heart expert. The Telegraph.
  34. 34.0 34.1 Expert reaction to editorial on saturated fats
  35. "Editorial Board". Open Heart. BMJ.
  36. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions
  37. Backlash after report claims saturated fats do not increase heart risk
  38. The cardiometabolic consequences of replacing saturated fats with carbohydrates or Ω-6 polyunsaturated fats: Do the dietary guidelines have it wrong?
  39. Effects of dietary fats on blood lipids: a review of direct comparison trials
  40. Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis
  41. 41.0 41.1 41.2 41.3 Omega-6 vegetable oils as a driver of coronary heart disease: the oxidized linoleic acid hypothesis
  42. Effect of dietary linoleic acid on markers of inflammation in healthy persons: a systematic review of randomized controlled trials
  43. Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studies
  44. Circulating Omega-6 Polyunsaturated Fatty Acids and Total and Cause-Specific Mortality
  45. Association of Specific Dietary Fats With Total and Cause-Specific Mortality
  46. Dietary linoleic acid intake and blood inflammatory markers: a systematic review and meta-analysis of randomized controlled trials
  47. Omega-6 fats to prevent and treat heart and circulatory diseases
  48. Biomarkers of Dietary Omega-6 Fatty Acids and Incident Cardiovascular Disease and Mortality
  49. N-6 Polyunsaturated Fatty Acids and Risk of Cancer: Accumulating Evidence from Prospective Studies
  50. Li J, Guasch-Ferré M, Li Y, Hu FB. (2020). "Dietary intake and biomarkers of linoleic acid and mortality: systematic review and meta-analysis of prospective cohort studies". The American Journal of Clinical Nutrition 112 (1): 150–167. doiWikipedia:10.1093/ajcn/nqz349. PMC 7326588. PMID 32020162. 
  51. Biomarker of dietary linoleic acid and risk for stroke: A systematic review and meta-analysis
  52. The Effects of Linoleic Acid on Lipid Risk Markers for Cardiovascular Disease
  53. Omega-6 fatty acids and the risk of cardiovascular disease: insights from a systematic review and meta-analysis of randomized controlled trials and a Mendelian randomization study
  54. Dietary Intake of Linoleic Acid, Its Concentrations, and the Risk of Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of Prospective Cohort Studies
  55. Blood levels of omega-6 fatty acids and coronary heart disease: a systematic review and metaanalysis of observational epidemiology
  56. Serum n-6 polyunsaturated fatty acids and risk of atrial fibrillation: the Kuopio Ischaemic Heart Disease Risk Factor Study
  57. Dietary Fatty Acids and Inflammation: Focus on the n-6 Series
  58. Effects of Dietary Linoleic Acid on Blood Lipid Profiles: A Systematic Review and Meta-Analysis of 40 Randomized Controlled Trials
  59. Dietary intake and biomarkers of linoleic acid and risk of prostate cancer in men: A systematic review and dose-response meta-analysis of prospective cohort studies
  60. https://www.hsph.harvard.edu/nutritionsource/2014/11/05/dietary-linoleic-acid-and-risk-of-coronary-heart-disease/
  61. Biomarkers of food intake for nuts and vegetable oils: an extensive literature search
  62. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0730-3
  63. https://bmjopen.bmj.com/content/7/11/e016863
  64. 64.0 64.1 James DiNicolantonio on Twitter
  65. The impact of rice bran oil consumption on the serum lipid profile in adults: a systematic review and meta-analysis of randomized controlled trials
  66. Effects of Canola Oil Consumption on Lipid Profile: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials
  67. How canola and sunflower oils affect lipid profile and anthropometric parameters of participants with dyslipidemia
  68. Effects of oils and solid fats on blood lipids: a systematic review and network meta-analysis
  69. Excessive dietary linoleic acid induces proinflammatory markers in rats
  70. Effect of dietary linoleic acid on markers of inflammation in healthy persons: a systematic review of randomized controlled trials
  71. High erythrocyte levels of the n-6 polyunsaturated fatty acid linoleic acid are associated with lower risk of subsequent rheumatoid arthritis in a southern European nested case-control study
  72. Study reveals surprising link between linoleic acid and occurrence of rheumatoid arthritis
  73. Misinformation: “Vegetable Oils Cause Heart Disease”
  74. Association between Habitual Dietary Salt Intake and Risk of Gastric Cancer: A Systematic Review of Observational Studies
  75. Dietary Salt Intake and Gastric Cancer Risk: A Systematic Review and Meta-Analysis
  76. Associations of dietary carbohydrate and salt consumption with esophageal cancer risk: a systematic review and meta-analysis of observational studies
  77. Dietary Sodium (salt) Intake and Risk of Colorectal Cancer: A Systematic Review
  78. James DiNicolantonio on Twitter
  79. James DiNicolantonio on Twitter
  80. Neelakantan, Nithya; Seah, Jowy Yi Hoong; van Dam, Rob M. (2020-03-10). "The effect of coconut oil consumption on cardiovascular risk factors: A Systematic Review and Meta-Analysis of Clinical Trials". Circulation 141 (10): 803–814. doiWikipedia:10.1161/circulationaha.119.043052. ISSN 0009-7322. PMID 31928080. 
  81. The effects of coconut oil on the cardiometabolic profile: a systematic review and meta-analysis of randomized clinical trials
  82. Superfuel: Ketogenic Keys to Unlock the Secrets of Good Fats, Bad Fats, and Great Health
  83. Dr. Mercola and Dr. Nicolantonio