James DiNicolantonio

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.#400: Quack Asylum – Part 1: Malhotra & DiNicolantonio 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.Dr James DiNicolantonio: Beneficial Effects of Salt on Improving Blood Pressure Dr. Mercola and Dr. Nicolantonio Discuss ‘Superfuel’ and the Importance of Healthy Fats In 2018, he co-authored, with alternative medicine guru Joseph Mercola, the food woo book Superfuel, published by Hay House.'Superfuel’ — Your Definitive Guide to Dietary Fats. Joseph Mercola.
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.James DiNicolantonio's posts on linoleic acid. As of 2024 there is no scientific evidence to support these claims. Contrary to what DiNicolantonio claims, the evidence has shown that linoleic acid intake decreases risk of chronic disease. Higher in vivo circulating and tissue levels of linoleic acid are associated with a lower risk of major cardiovascular events.See studies listed at James DiNicolantonio#Oxidized linoleic acid hypothesisDo Seed Oils Make You Sick?Higher circulating and tissue levels of Linoleic Acid associated with lower risk of major cardiovascular events
DiNicolantonio says that by eating "real food" (a ketogenic diet) this will make "diseases disappear".https://archive.is/p4KgJ He has appeared on many pseudoscientific podcasts with Eric Berg, David Perlmutter and Paul Saladino.
==The Salt Fix==
Similar to other low-carbers such as Gary Taubes, DiNicolantonio blames sugar for causing most chronic conditions."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.Pass the salt: The myth of the low-salt diet 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."Get the Scoop on Sodium and Salt. American Heart Association. Health authorities who cite research from evidence-based medicine recommend that people eat no more than 6g (about a teaspoon) of salt each day.Salt. British Heart Foundation.Salt: the facts. NHS.Use the Nutrition Facts Label to Reduce Your Intake of Sodium in Your Diet. U. S. Food and Drug Administration.Shaking the Salt Habit to Lower High Blood Pressure
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.How Much Sodium Should You Have per Day? 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.The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. James DiNicolantonio. His advice to eat more salt has been condemned by medical experts as potentially dangerous.A danger to public health? Uproar as scientist urges us to eat more salt 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 lowSalt and Hypertension: An Evolutionary PerspectiveUric 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."—which incidentally is why we enjoy consuming it.
The book has been endorsed by various low-carb cranks including Marika Sboros and the Weston A. Price Foundation.Salt Fix: Right White Stuff for Hearts, Minds, Sex Lives. Marika Sboros.The Salt Fix by James DiNicolantonio. Weston A. Price Foundation.
DiNicolantonio has promoted his views about diet and salt on many low-carb pseudoscientific podcasts:
*Shawn BakerDr James DiNicolantonioHacking Health | Dr Shawn Baker & James DiNicolantonio
*Eric BergWhy You Need More Salt in Your Diet
*Steven GundryDr. Gundry Interviews Dr. James DiNicolantonio | Ep15For better brain health... "superfuel" yourself? | Dr. Gundry Clips
*Max Lugaverehttps://podcasts.apple.com/us/podcast/7-why-you-probably-need-to-eat-more-salt-james-dinicolantonio/id1379050662?i=1000410485982https://podcasts.apple.com/us/podcast/32-fats-that-heal-fats-that-kill-james-dinicolantonio/id1379050662?i=1000422489558
*David PerlmutterIs Sodium Bad For You? - with Dr. James DiNicolantonio | The Empowering Neurologist EP. 77
*Paul SaladinoJames DiNicolantonio: supplementation and nutrient deficiencies, eggs vs. bagels, creatine and dietCarnivore vs Omnivore part III. A friendly debate with James DiNicolantonio, PharmD
==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.Saturated fat is not bad for health, says heart expert. The Telegraph. He promotes a diet high in saturated fat and blames sugar and carbohydrates for causing high cholesterol and obesity.Expert reaction to editorial on saturated fats
DiNicolantonio has been accused of misrepresenting scientific evidence on saturated fat and its relationship to cardiovascular disease. 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."
===Open Heart===
DiNicolantonio was a former associate editor of a BMJ journal, Open Heart, which has published papers supportive of cholesterol denialism.Editorial Board Open Heart (archived from October 4, 2023). As of 2024, he is no longer on the editorial board."Editorial Board". Open Heart. BMJ. The former Editor-in-Chief Pascal Meier is also a cholesterol denialist, who co-authored a paper with Aseem Malhotra.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 interventionsBacklash after report claims saturated fats do not increase heart risk
DiNicolantonio has authored papers for Open Heart, disputing the evidence that saturated fat increases risk of heart disease.
The cardiometabolic consequences of replacing saturated fats with carbohydrates or Ω-6 polyunsaturated fats: Do the dietary guidelines have it wrong?Effects of dietary fats on blood lipids: a review of direct comparison trials He has also published a paper with Zoë Harcombe.Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis
His 2014 editorial for Open Heart was criticized by Tom Sanders, Emeritus Professor of Nutrition and Dietetics:
==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.Omega-6 vegetable oils as a driver of coronary heart disease: the oxidized linoleic acid hypothesis 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, cohort, mendelian randomization 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.https://www.hsph.harvard.edu/nutritionsource/2014/11/05/dietary-linoleic-acid-and-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).Biomarkers of food intake for nuts and vegetable oils: an extensive literature search Higher intake of these nuts has been shown to the lower risk of all-cause mortality, cancer, CHD mortality, inflammation and total CHD.https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0730-3https://bmjopen.bmj.com/content/7/11/e016863 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.James DiNicolantonio on Twitter 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.The impact of rice bran oil consumption on the serum lipid profile in adults: a systematic review and meta-analysis of randomized controlled trials Canola Oil and sunflower oil have also been shown to significantly decrease LDL-c.Effects of Canola Oil Consumption on Lipid Profile: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical TrialsHow canola and sunflower oils affect lipid profile and anthropometric parameters of participants with dyslipidemiaEffects of oils and solid fats on blood lipids: a systematic review and network meta-analysis 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.Excessive dietary linoleic acid induces proinflammatory markers in 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.Effect of dietary linoleic acid on markers of inflammation in healthy persons: a systematic review of randomized controlled trials There is evidence indicating that linoleic acid is anti-inflammatory such as higher levels of linoleic acid lowering risk of rheumatoid arthritis.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 studyStudy reveals surprising link between linoleic acid and occurrence 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. Similar to Ray Peat, DiNicolantonio's takes a lot of his data from unreliable animal model 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===
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.Association between Habitual Dietary Salt Intake and Risk of Gastric Cancer: A Systematic Review of Observational StudiesDietary Salt Intake and Gastric Cancer Risk: A Systematic Review and Meta-AnalysisAssociations of dietary carbohydrate and salt consumption with esophageal cancer risk: a systematic review and meta-analysis of observational studiesDietary Sodium (salt) Intake and Risk of Colorectal Cancer: A Systematic Review
==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:
==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.The effects of coconut oil on the cardiometabolic profile: a systematic review and meta-analysis of randomized clinical trials
==Connection to Joseph Mercola==
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.Superfuel: Ketogenic Keys to Unlock the Secrets of Good Fats, Bad Fats, and Great Health
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.Dr. Mercola and Dr. Nicolantonio DiNicolantonio has not publicly commented about this.
==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
==See also==
*Malcolm Kendrick
*Aseem Malhotra
==References==
Category:Authors
Category:Cholesterol and statin denialists
Category:Food woo promoters
Category:Living people
Category:Low-carb fanatics
Category:Physicians