From Our 2010 Archives

Experts Urge FDA to Mandate Salt Reduction

Institute of Medicine Asks for New Standards for Salt Content of Food Sold in Stores and Restaurants

By Kathleen Doheny
WebMD Health News

Reviewed By Laura J. Martin, MD

April 20, 2010 -- Experts are urging the FDA to set new federal standards for the amount of salt that food manufacturers, restaurants, and food service companies are allowed to add to their products, suggesting the standards be phased in gradually so salt-loving Americans can adjust over time.

Issued today by the Institute of Medicine (IOM), the new report, "Strategies to Reduce Sodium Intake in the United States," includes recommendations that are the consensus of an expert panel.

"If you look at salt intake over a number of decades, it has not gone down despite a number of efforts and it is still at a very high level," Jane E. Henney, MD, chair of the IOM's Committee on Strategies to Reduce Sodium Intake and a professor of medicine at the University of Cincinnati, said at a news conference about the new report.

The committee's report has a number of recommendations, but the primary one is a call for the FDA to set mandatory standards for safe levels of sodium, using their existing authority to regulate salt as a food additive.

Voluntary vs. Mandatory Salt Reduction

While health care providers and a consumer watchdog group applauded the report, industry groups did not.

The recommendation is overkill, according to Lori Roman, president of the Salt Institute, an industry group based in Alexandria, Va. "We would prefer voluntary effort," she tells WebMD, although experts on the side of mandatory salt reduction claim ongoing voluntary efforts have not been successful.

Roman says universal salt reduction is flawed. "We believe the whole premise, the whole idea of population-wide sodium reduction, is nonsensical. You don't have the federal government prescribe something for an entire population that may have a very small health benefit for a small population of people and may have negative consequences for a small percent of the population." Roman says. She contends that in some instances, too much salt reduction would have ill effects.

But proponents of mandatory salt reduction say lowering salt to more reasonable levels could reduce high blood pressure, improve health in other ways, and save 100,000 lives a year in the U.S.

Currently, the average American takes in more than 3,400 milligrams of sodium (equivalent to 8.5 grams or about 1.5 teaspoons of salt) a day, according to the IOM report.

That's far more than the maximum intake level of 2,300 milligrams or about 1 teaspoon established under the 2005 Dietary Guidelines for Americans. And a level of 1,500 milligrams per day is termed "adequate" by the Institute of Medicine.

Excess sodium is a major contributor to high blood pressure, according to experts. High blood pressure affects one in three U.S. adults, or about 75 million people age 20 or above, according to the FDA, and increases risk for heart attacks, strokes, heart failure, and kidney failure.

IOM Recommendations

The IOM recommends that the FDA gradually reduce the amount of salt that can be added to restaurant meals, foods, and beverages. Among the IOM's other recommendations:

  • Food labels should change to reflect the lower, more desirable salt intake. Now, the percentage of Daily Value for sodium on food labels, which tells how much of the recommended daily intake is in one serving, is based on 2,400 milligrams a day. IOM experts recommend it be changed to reflect the 1,500-milligram "adequate" level.
  • Food service providers as well as restaurants and food and beverage makers should step in and pursue voluntary efforts to reduce sodium, as the FDA effort is not expected to be finished in weeks or months, but rather years.

"The strategies in the report have the potential to greatly impact the lives of Americans," Henney said at the news conference. "Lowering salt intake will reduce adverse health effects such as high blood pressure, which is a major risk factor for heart attack and stroke."

"Once Americans reach their 50s, the risk of developing high blood pressure over the remainder of their lives is estimated to be 90%, even for those with healthy blood pressures [before then]."

The recommendation to phase in the changes gradually was done, she says, to allow consumers to adjust to a lower-salt diet over time and to increase the chances of consumers accepting the changes.

The report does not speak to an exact time frame, but the authors urge the FDA to view salt reduction as an urgent public health problem.

FDA Response

In a news release, the FDA says it plans to "more thoroughly review the recommendation of the IOM report and build plans for how the FDA can continue to work with other federal agencies, public health and consumer groups, and the food industry to support the reduction of sodium levels in the food supply."

"The FDA is not currently working on regulations nor have they made a decision to regulate sodium content in foods at this time," according to the statement, in an attempt to correct some news reports that the FDA regulation effort had begun.

At a news conference, the Center for Science in the Public Interest, a Washington, D.C.-based watchdog organization, called the recommendations "groundbreaking."

"This is not something Americans can fix by throwing out your salt shaker," said Rep. Rosa DeLauro, D-Conn., who supports the recommendations.

She predicts the public will embrace regulations reducing salt intake, much as they did the food label information on calories and other nutrition facts.

Industry Comment

Roman offers another criticism, claiming that the research on the benefits of salt reduction has focused too much on the effect of lowering blood pressure and not on the "big picture" outcome of salt levels on health and mortality.

"Should the federal government regulate consumption of very low levels of salt, they are effectively compelling the entire population to take part in the largest clinical trial ever carried out, without their knowledge or consent," she says.

"The FDA would do a better service to the public if they promoted a diet with more fruits and vegetables rather than focusing on a single magic bullet that the scientific evidence does not support."

But some food producers are attempting to cut salt content in their products. For instance, ConAgra Foods announced in October 2009 a pledge to reduce salt across its offering of food products by 20% by 2015. The Omaha-based food manufacturer says it removed more than 2 million pounds of salt from its products from 2006 to 2009.

What Consumers Can Do to Reduce Salt

The recommendations are welcome, according to Suzanne Steinbaum, DO, director of women and heart disease at Lenox Hill Hospital in New York. "For 40 years, we have known the correlation between salt intake and its negative effects on the body, but it has been an almost impossible goal for Americans to reduce their salt intake to only what is considered adequate."

The lowered intake of 1,500 milligrams, considered adequate by the Institute of Medicine, coupled with FDA regulation might be the only way to reduce chronic illness linked with high salt, she says.

Jeannie Gazzaniga-Moloo, PhD, RD, a spokeswoman for the American Dietetic Association and a dietitian in Sacramento, Calif., also favors the IOM recommendation. "It's encouraging to see the IOM addressing sodium."

The sodium issue, she predicts, will be as "hot" as the effort to reduce unhealthy trans fat from foods.

Meanwhile, as the FDA ponders the recommendations, consumers can do much to lower salt on their own, Gazzaniga-Moloo says. Her tips:

  • Buy lower-sodium options when you can.
  • Eat food in the most natural state possible.
  • Comparison shop among the same products for lower sodium content.
  • Cut back on processed foods in particular. "Three-quarters of the sodium in our diet comes from processed foods," she says.

Some examples of sodium content per customary serving size, according to the IOM report, are:

  • beef hot dog: 446 milligrams
  • salami: 748 milligrams
  • ham luncheon meat: 627 milligrams
  • pepperoni pizza: 935 milligrams
  • chicken noodle soup: 982 milligrams

SOURCES: Institute of Medicine Report: "Strategies to Reduce Sodium Intake in the United States," April 20, 2010.

Jeannie Gazzaniga-Moloo, RD, PHD, spokeswoman, American Dietetic Association; registered dietitian, Sacramento, Calif.

Suzanne Steinbaum, director, women and heart disease, Lenox Hill Hospital, New York City.

Lori Roman, president, Salt Institute, Alexandria, Va.

Jane E. Henney, MD, chair, Institute of Medicine Committee on Strategies to Reduce Sodium Intake; professor of medicine, University of Cincinnati.

Rep. Rosa DeLauro, D-Conn.

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