Sodium Shakedown

By Allison Mikita

The Institute of Medicine has just released a 280-page report on population-based sodium reduction strategies.  The New York City Department of Health is coordinating a National Salt Reduction Initiative to allow public control of the saltshaker.  Kraft Foods has committed to reduce the sodium content of all its American products by an average of 10% over the next two years. Sodium, tagged “the deadliest ingredient in the food supply” by the Center for Science in the Public Interest (CSPI), is once again a hot issue among policy makers, food manufacturers, and nutrition and public health professionals.  For over forty-years, sodium cutbacks have been attempted through public health initiatives and national dietary recommendations without success, but with new voluntary industry regulations and globe-spanning policy initiatives, will the reductions stick?

Sodium Low-Down

The call for sodium reduction is fueled by the growing prevalence of hypertension, increasing consumer sodium intake, and changing demographics of the US.  Hypertension affects 32% of the adult population and is linked to chronic heart disease (CHD), stroke, heart attack, and kidney failure.  In 2009 alone, hypertension was estimated to cost 73.4 billion dollars in direct and indirect costs.  Despite the dietary guidelines, about 87% of Americans consume more sodium than the recommended maximum of 2300 mg per day. Currently, the guidelines recommend that adults over age 40, African Americans, and individuals with high blood pressure consume no more than 1500 mg of sodium daily.  Two out of three adults in the US now fall into these subpopulations.

Sodium Reduction Challenges

Reducing sodium is not as easy as putting down the shaker.  Americans consume 77% of sodium intake through processed and restaurant foods, while only 6% is consumed through added table salt. The ubiquity of sodium in our foods makes sodium reduction interventions extremely difficult.  The IOM states, “Without an overall reduction in the level of sodium in the food supply…the current focus on instructing consumers to select reduced-sodium “niche” products cannot result in intakes consistent with the Dietary Guidelines for Americans.”

The greatest challenge inherent to sodium reduction is the taste preference for salt.  As taste is king, reducing salt is challenging for food manufacturers and restaurants, who fear that a label touting “Lower in Sodium” or a change in product taste will result in a drop in sales.  Some manufacturers have reduced sodium in their products silently and gradually for years to address the Dietary Guidelines on sodium.  Parke Wilde, PhD, of the Food Policy and Applied Nutrition program at Friedman School of Nutrition Science and Policy, further explains that “the food industry has limits on how much it can do voluntarily or they run the risk of undermining each other.  When one company reduces salt, the others can use it to their advantage.”  IOM recognizes this difficulty in their report, calling for a coordinated reduction of salt in foods across the board by all manufacturers and foodservice/restaurant operations to achieve a level playing field while avoiding consumer dissatisfaction.  The report also suggests that such coordinated action can mute the taste preference for salt, if reduction efforts are approached in a gradual and systematic step-wise process.

Critics of the sodium reduction issue argue that salt regulation is overreaching into personal choice  Alice Lichtenstein, Senior Scientist and Director, Cardiovascular Nutrition Laboratory,
Jean Mayer USDA HNRCA at Tufts University, addresses the issue, “I always think: what’s the default option? If the default option is the lower salt item and if you choose to add salt and you have to go out of your way to do it, so be it, but most people do not go that extra step.  The problem now is that the high salt option is the default option and you don’t have the option of taking it out.  That is the fundamental issue.”

Proposed Regulations

The IOM specifically recommends addressing reduction through the FDA and USDA regulations, which would change the Generally Recognized as Safe (GRAS) status of sodium and revise nutrition labeling.  Revoking the GRAS status of sodium would require food manufacturers to petition for approval prior to marketing foods and would allow FDA to regulate the quantity of sodium added.  IOM also recommends that the food industry voluntarily act to lower sodium before mandatory standards are implemented.

Food giants have already voluntarily committed to sodium reductions over the past few years. Kraft will reduce sodium by 10% across its North American portfolio, which will remove 10 million pounds of salt from some of America’s most popular foods.  Unilever committed to reduce salt content across its global range of 22,000 products, according to the World Health Organization’s recommendation of 5 g of salt per day.  PepsiCo has also committed to a reduction, aiming to reduce the average amount of sodium per serving in its products by 25% in five years.  In addition, sixteen companies have committed to The National Salt Reduction Initiative (NSRI), led by the New York City Department of Public Health.  The NRSI aims to trim sodium content in packaged and restaurant foods by 25% across categories of packaged food and 25 categories of restaurant food by 2014.

Sodium reduction is one issue among many in the American diet and US food supply. However, in a time of increasing regulation of the food industry and nationwide awareness of nutrition’s relationship to disease prevention, long-awaited sodium reduction efforts may finally come to fruition.

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