The laboratory evidence that carbohydrate-rich diets can cause the body to retain water and so raise blood pressure, just as salt consumption is supposed to do, dates back well over a century. It has been attributed first to the German chemist Carl von Voit in 1860. In 1919, Francis Benedict, director of the Nutrition Laboratory of the Carnegie Institute of Washington, described it this way: “With diets predominantly carbohydrate there is a strong tendency for the body to retain water, while with diets predominantly fat there is a distinct tendency for the body to lose water.” The context of Benedict’s discussion was the weight loss that occurs in the first few weeks of any calorie-or carbohydrate-restricted diet, and particularly the latter. As Benedict pointed out, this weight loss is to a large extent water, not fat, which has to be factored into any discussion of the apparent benefits of a reducing scheme. In the late 1950s, a new generation of investigators rediscovered the phenomenon, and it was then used to rationalize the popularity of carbohydrate-restricted diets as due not to the ease of losing fat, but entirely to the water lost in the first few weeks of the diet.

The “remarkable sodium and water retaining effect of concentrated carbohydrate food,” as the University of Wisconsin endocrinologist Edward Gordon called it, was then explained physiologically in the mid-1960s by Walter Bloom, who was studying fasting as an obesity treatment at Atlanta’s Piedmont Hospital, where he was director of research. As Bloom reported in the Archives of Internal Medicine and The American Journal of Clinical Nutrition, the water lost on carbohydrate-restricted diets is caused by a reversal of the sodium retention that takes place routinely when we eat carbohydrates. Eating carbohydrates prompts the kidneys to hold on to salt, rather than excrete it. The body then retains extra water to keep the sodium concentration of the blood constant. So, rather than having water retention caused by taking in more sodium, which is what theoretically happens when we eat more salt, carbohydrates cause us to retain water by inhibiting the excretion of the sodium that is already there. Removing carbohydrates from the diet works, in effect, just like the antihypertensive drugs known as diuretics, which cause the kidneys to excrete sodium, and water along with it.