Salty Politics

On April 20, the Institute of Medicine (IOM) released the report, “Strategies to Reduce Sodium Intake in the United States.” Like all IOM reports, it is the result of exhaustive research and provides recommendations based on consensus of an expert panel. The report starts with what we know already: High sodium intake can lead to multiple health problems, most often high blood pressure (hypertension), which, in turn, can lead to heart and blood vessel disease including stroke and heart attack.

Groups including the American Heart Association have been on the “cut your sodium intake” bandwagon for years. They proffer the usual admonitions about eating too much salt, cutting back on processed foods, reading labels to learn how much salt is actually in your food, not adding salt while cooking, etc. Yet Americans continue to consume way too much salt. The average American consumes more than 3,400 mg of sodium per day (about 1.5 teaspoons). That’s 1,000 mg more than the current recommendation of 2,400 mg per day.

The IOM committee points out something else: These “voluntary” efforts haven’t worked, largely because most sodium is added to foods before it ever reaches your table. Reduction of sodium intake, while partly a matter of consumer choice, is largely in the hands of food manufacturers and the restaurant industry. Unlike most other organizations issuing recommendations and guidelines on sodium intake, the IOM committee proposes significant policy-level changes in regulation of sodium, putting the onus on the food industry:

“As its primary strategy for sodium reduction, the committee recommends that the FDA [U.S. Food and Drug Administration] set mandatory national standards for the sodium content in foods—not banning outright the addition of salt to foods but beginning the process of reducing excess sodium in processed foods and menu items to a safer level.”

The IOM committee wants the the U.S. Food and Drug Administration (FDA) to regulate salt as a food additive. They propose “a new, coordinated approach” to reduce sodium content in food, requiring new government standards for the acceptable level of sodium.” That acceptable level, they suggest, is 1,500 mg per day — much lower than the current standard. They also cite a body of research showing that if changes are implemented slowly, tastebuds will adjust. Such a population-wide reduction in salt intake could save about 100,000 lives per year, according to the committee.

But the IOM committee recognizes that the choices individuals make about food intake do not occur in a vacuum, but in a complex system of food manufacture, distribution, and preparation. Consumers can only choose healthier foods if they are available.

“The current focus on instructing consumers to select lower-sodium foods and making available reduced-sodium ‘niche’ products cannot result in intakes consistent with public health recommendations. Without major change, hypertension and cardiovascular disease rates will continue to rise, and consumers, who have little choice, will pay the price for inaction.”

Oh my. The emperor has no clothes. Of course, salt industry representatives are squawking, and the FDA will have to wade through mountains of red tape to implement the recommendations, if they decide to do so. Many years will pass, and many cases of high blood pressure will be diagnosed, before such sweeping policy-level changes will be implemented (if ever).

In the meantime, consumers can make the usual changes to their diets — and would be well-advised to do so. Those changes include:

  • Shop primarily around the perimeter of your grocery store, where you’ll find most of the fresh, unprocessed foods.
  • Prepare your own foods, and don’t add salt as you cook.
  • Move the salt shaker from the center of the table to a far corner of the kitchen.
  • Read nutrition labels carefully. Pay attention not only to overall calorie content, but sodium content of foods. You may be surprised to that some foods that don’t even taste salty contain large amounts of sodium.
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