Should I be adding salt to my food, or cutting it?

Stephen D. PhinneyMD, PhD · physician-scientist; co-founder and former Chief Medical Officer, Virta Health

If you are in sustained nutritional ketosis, add it: about 5 grams of sodium a day, and standard low-salt advice becomes actively harmful in that state.

What it rests onHe argues nutritional ketosis increases renal sodium excretion, so sodium needs rise above what standard guidance assumes, and that inadequate sodium in that state drives compensatory aldosterone, cortisol and adrenaline, which people experience as keto flu and mislabel as adrenal fatigue. He cites mortality data on which risk of death rose sharply below 4 g of sodium a day and nearly doubled at 2 g, against a 15 percent increase at 8 g. He carries an explicit carve-out for hypertension, fluid retention and interacting medications (phi-sodium-carveout). Published by the company he co-founded.

Gil CarvalhoMD, PhD · nutrition and aging researcher, creator of Nutrition Made Simple!

Cut it. Stop adding salt to food; most Westerners already overconsume sodium.

What it rests onQuoted in full from his newsletter, because the exceptions are the load-bearing part: 'We don´t need to add salt to food. Sodium is an essential nutrient but we need small amounts and it´s present in plants and animal foods. Endurance athletes who lose more sodium through their sweat may benefit by adding more in their drinks or food. Otherwise, most Westerners overconsume sodium (mostly in ultraprocessed foods) and would benefit by cutting back. Bear in mind this varies person to person as some are more salt sensitive than others.' He grants exactly two exceptions, endurance athletes and individual salt sensitivity, and he does not address ketogenic diets at all. No commercial relationship found.