FDA Begins Efforts to Reduce Salt Consumption

The Washington Post

The Food and Drug Administration is planning an unprecedented effort to gradually reduce the salt consumed each day by Americans, saying that less sodium in everything from soup to nuts would prevent thousands of deaths from hypertension and heart disease. The initiative, to be launched this year, would eventually lead to the first legal limits on the amount of salt allowed in food products.

The government intends to work with the food industry and health experts to reduce sodium gradually over a period of years to adjust the American palate to a less salty diet, according to FDA sources, who spoke on condition of anonymity because the initiative had not been formally announced.

Officials have not determined the salt limits. In a complicated undertaking, the FDA would analyze the salt in spaghetti sauces, breads and thousands of other products that make up the $600 billion food and beverage market, sources said. Working with food manufacturers, the government would set limits for salt in these categories, designed to gradually ratchet down sodium consumption. The changes would be calibrated so that consumers barely notice the modification.

The legal limits would be open to public comment, but administration officials do not think they need additional authority from Congress.

"This is a 10-year program," one source said. "This is not rolling off a log. We're talking about a comprehensive phase-down of a widely used ingredient. We're talking about embedded tastes in a whole generation of people."

The FDA, which regulates most processed foods, would be joined in the effort by the U.S. Department of Agriculture, which oversees meat and poultry.

Currently, manufacturers can use as much salt as they like in products because under federal standards, it falls into the category deemed "generally recognized as safe." Foodmakers are merely required to report the amount on nutrition labels.

But for the past 30 years, health officials have grown increasingly alarmed as salt intake has increased with the explosion in processed foods and restaurant meals. Most adults consume about twice the government's daily recommended limit, according to the Centers for Disease Control and Prevention.

Until now, the government has pushed the food industry to voluntarily reduce salt and tried to educate consumers about the dangers of excessive sodium. But in a study to be released Wednesday, an expert panel convened by the Institute of Medicine concludes that those measures have failed. The panel will recommend that the government take action, according to sources familiar with the findings.

Although the specifics of the government's plans have not been made public, the food industry has been bracing for a federal initiative.

"We're working on it voluntarily already," said Melissa Musiker, senior manager of science policy, nutrition and health at the Grocery Manufacturers Association. In recent months, Conagra, Pepsico, Kraft Foods, General Mills, Sara Lee and others have announced that they would reduce sodium in many of their products. Pepsico has developed a new shape for sodium chloride crystals that the company hopes will allow it to reduce salt by 25 percent in its Lay's Classic potato chips.

Morton Satin, director for technical and regulatory affairs at the Salt Institute, which represents salt producers, said regulation "would be a disaster for the public." He said that the science regarding sodium is unclear and that consumption does not necessarily lead to health problems.

"If you consume a lot of salt, you also get rid of a lot of salt -- it doesn't mean it's an excess," he said. "I want to make sure they're basing this on everything that is in the scientific literature, so we don't end up being guinea pigs because someone thinks they're doing something good."

Michael Jacobson of the Center for Science in the Public Interest, which first petitioned the FDA to regulate sodium in 1978, said voluntary efforts by industry are laudable, "but they could change their minds tomorrow. . . . Limiting sodium might be the single most important thing the FDA can to do to promote health."

In January, New York City launched a campaign against salt, urging food manufacturers and chain restaurants to voluntarily reduce sodium by 25 percent in their products nationwide over the next five years. Baltimore, Boston, Los Angeles, Chicago and the District are among a list of cities supporting the New York initiative.

A recent study by researchers at Columbia and Stanford universities and the University of California at San Francisco found that cutting salt intake by 3 grams a day could prevent tens of thousands of heart attacks, strokes and cases of heart disease.

Most salt eaten by Americans -- 77 percent -- comes from processed foods, making it difficult for consumers to limit salt to healthy levels, experts say.

"We can't just rely on the individual to do something," said Cheryl Anderson, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health who served on the Institute of Medicine committee. "Food manufacturers have to reduce the amount of sodium in foods."

Reducing salt across the food supply will be a massive and technically challenging project. Although many artificial sweeteners have been discovered, there is no salt substitute.

Humans have an innate taste for salt, which is needed for some basic biological functions. But beyond flavor, salt is also used as a preservative to inhibit microbial growth; it gives texture and structure to certain foods; and it helps leaven and brown baked goods.

Gary K. Beauchamp, a psychobiologist and director of the Monell Chemical Senses Center in Philadelphia, said salt also provides another, less understood quality. "It gives something that food people refer to as 'mouthfeel,' " said Beauchamp, who also served on the Institutes of Medicine committee. "For some soups, for instance, it's not just the salty taste -- sodium makes the soup feel thicker."

Policymakers will have to decide whether to exempt inherently salty foods, such as pickles, while mandating changes in other products to reduce the overall sodium levels in the food supply.

Above all, government officials and food industry executives say, a product with reduced salt must still taste good, or it will flop in the marketplace, as evidenced by several low-sodium products that had abysmal sales.

"Historically, consumers have found low-sodium products haven't been of the quality that's expected," said Todd Abraham, senior vice president of research and nutrition for Kraft Foods. "We're all trying to maintain the delicious quality of the product but one that consumers recognize as healthier."

Study Shows Benefits of Cutting Salt Intake

The Wall Street Journal

A national program to reduce dietary salt could prevent tens of thousands of heart attacks, strokes and deaths and trim as much as $24 billion from the U.S. health-care tab, according to a study published Wednesday in the New England Journal of Medicine.

The study, a computer simulation, suggests the impact would be similar to prevention strategies such as quitting smoking, lowering cholesterol or modest weight-loss.

But significant cuts in salt from the diet could be challenging for individuals without action from food manufacturers. Some 75% of dietary salt intake comes from processed foods, according to the researchers.

Their findings add to a growing body of research suggesting that lowering dietary salt could be an effective weapon against high blood pressure and cardiovascular disease. "The time is right now to consider efforts to…achieve population wide reduction in salt" intake, says Kirsten Bibbins-Domingo, first author of the study and an associate professor of medicine and epidemiology at the University of California, San Francisco.

Last week, the New York City Health Department said it would encourage packaged food makers and restaurants to cut salt by 25% over five years. Many food manufacturers have long sold "low sodium" versions of products, but generally they haven't been popular with consumers. Some companies have recently begun cutting sodium content without highlighting it on product labels.

Morton Satin, technical director of the Salt Institute, a nonprofit group of salt producers, says few data exist linking salt intake and disease. He is skeptical that reducing salt will yield important health benefits.

Americans consume far more than the recommended daily salt intake. The average adult male consumes more than 10 grams of salt a day, according to the U.S. National Health and Nutrition Examination Survey. On Wednesday, the American Heart Association published new guidelines calling for all Americans to reduce their daily intake of sodium—a key component of salt—to 1,500 milligrams, equivalent to 3.8 grams of salt. Previously, that was the recommended limit for higher risk individuals; the regular limit had been 2,300 milligrams of sodium, or 5.8 grams of salt.

A typical sandwich, with two slices of bread and meat or peanut butter, has about half the daily recommended amount of salt, Dr. Bibbins-Domingo says.

In the computer simulation, which included data from the U.S. Census, the Centers for Disease Control and Prevention and other national studies, Dr. Bibbins-Domingo and her colleagues estimated the effect of lowering salt in the daily American diet by a small amount—up to three grams a day—in adults age 35 and older.

Based on other research, they assumed a three-gram reduction in salt would lower systolic blood pressure by 3.6 to 5.6 millimeters of mercury; a one-gram reduction would reduce the level by 1.2 to 1.9 millimeters. (Systolic is the higher number in a blood-pressure reading. People whose level is 140/90 or more are considered to have high blood pressure.) Such modest blood-pressure reductions are associated, in other studies, with significant lowering of risk of death, heart attack and stroke.

In the current study, researchers found that lowering salt intake by three grams a day would cut new cases of heart disease annually by a third—an estimated 60,000 to 120,000 cases per year—heart attacks by 54,000 to 99,000 cases and strokes by 32,000 to 66,000 cases. It would reduce about 100,000 deaths a year in the U.S.

Based on a cost of $1 a person for salt-reduction strategies projected by the World Health Organization, researchers estimated a U.S. program could save from $10 billion to $24 billion in annual health costs. Such projections can be imprecise because they are based on assumptions that may differ from disease that would develop in real life.

But even if these numbers are off, the results still indicate that sodium reduction is important, said Clyde Yancy, president of the American Heart Association and medical director of the Baylor Heart and Vascular Institute in Dallas. "We can go beyond saying that too much salt is a bad thing," said Dr. Yancy. "We can say, yes, too much sodium is related to disease. By reducing sodium we can reduce disease."

Mayor Bloomberg Urges New Yorkers To Shake The Salt

ABC News

New York Mayor Michael Bloomberg — who is known to shake salt on his pizza — is focusing on sodium as the next unhealthy enemy in his crusade to coax people into eating better.

Bloomberg's health department has already banned trans fats in restaurant meals and forced chain eateries to post calorie counts on menus. On Monday, the city set guidelines recommending maximum amounts of salt for a variety of restaurant and store-bought foods, with the goal of cutting salt levels in food by a quarter overall in five years.

"I use a lot of salt," Bloomberg admitted Monday. Despite any personal eating habits he may have, the mayor is fixated on nutrition as a public health concern.

"We're trying to extend the lives and improve the lives of people who live in this city," he said.

Unlike the city's trans fat ban and calorie count rule, the salt initiative is voluntary.

The recommendations posted on the city health department's Web site call for substantial reductions in the salt content of many products, from a 20 percent drop in peanut butter to a 40 percent decline in canned vegetables.

The targets include a 40 percent reduction in breakfast cereals and flavored snack chips, and a 25 percent reduction for cold cuts, processed cheese and salsa.

Not even the mayor's favorite foods — popcorn and hot dogs — were spared: The city wants food manufacturers to work on reducing salt by 30 percent in popcorn and 20 percent in wieners.

Health officials say Americans now eat about twice the amount of salt they should. Too much sodium contributes to high blood pressure, which can cause heart attack and stroke.

New York City's program is modeled in part after a similar initiative in Britain that has been under way since 2003.

Seventeen national health organizations and 25 other city or state health agencies have endorsed New York City's effort, called the National Salt Reduction Initiative.

Food industry representatives reacted cautiously to the program Monday

"It's something I'm sure our members will be taking under consideration," said Nevin Montgomery, president and chief executive of the National Frozen & Refrigerated Foods Association.

The guidelines suggest that manufacturers lower salt content gradually over several years so consumers won't notice, and they aren't asking for big changes in every category.

For example, under the city's standards, by 2014 no restaurant hamburger should contain more than 1,200 milligrams of salt. Nearly every burger sold by McDonald's already meets that guideline, although there are exceptions like the double quarter pounder with cheese, which has 1,380 milligrams of salt.

ConAgra Foods Inc., which makes products including Chef Boyardee canned pasta meals, Healthy Choice frozen dinners and Swiss Miss hot chocolate, has pledged a 20 percent reduction of salt in its consumer food products by 2015, in part because of consumer demand. The company, based in Omaha, Neb., said its initiative would eliminate about 10 million pounds of salt per year from the American diet.

Even though there will be no penalties for companies that ignore the guidelines, health officials say they think some manufacturers may be motivated to make changes.

"They all fully recognize that sodium is a major health problem that they need to address," said the city's health commissioner, Dr. Thomas Farley.