Mar 23 2012

The arguments about sodium go on and on

Dietary sodium continues to generate much talk but little action.

The CDC issued a recent Vital Signs report on dietary sodium with this graphic:

In translation from the data tables:

  • 90% of Americans consume too much salt.
  • 44% of salt comes from 10 foods: breads and rolls, cold cuts and cured meats, pizza, poultry, soups, sandwiches, cheese, pasta dishes, meat dishes, and snacks.
  • 65% of salt comes from retail processed foods.
  • 25% comes from food served at restaurants.
  • 10% comes from salt added at the table.
  • 10% occurs naturally in foods.
  • $20 billion a year is the cost of salt-related chronic disease.

The bottom line?  Americans would be better off eating less salt.

But from the standpoint of the food industry, reducing dietary sodium is a big problem.  See, for example,  FoodNavigator-USA.com‘s recent articles about sodium in foods and health:

Sodium reduction: The science, the technology… and the business case It’s expensive, risky, and difficult, but manufacturers have made huge progress on sodium reduction in recent years. But how much further can they go, and where is the ROI if consumers are at best indifferent to their efforts, or at worst downright suspicious?.. Read

Bakers on sodium reduction: We can’t afford to make products consumers won’t buy Reducing sodium is expensive and difficult, and many bakers are beginning to wonder whether it is worth investing millions into reformulating products that consumers do not want to buy, according to the Association of Bakers (ABA)… Read

Risks of slashing sodium levels in cheese could outweigh benefits, US researcher A prominent US researcher says that government pressure to cut sodium in cheese could have serious food safety, taste and labeling consequences, and questions the necessity of such a move given minimal evidence of positive health effects and muted consumer demand… Read

Sodium reduction: To boldly go… lower and lower Food manufacturers are under increasing pressure to reduce sodium, but surveys suggest many shoppers are, well, not that bothered. So where does this leave firms plugging sodium reduction solutions? Elaine Watson asks Mariano Gascon, R&D chief at seasonings, flavors and spice specialist Wixon for his take on it… Read

Law professor: Sodium reduction only works if there is a level playing field If consumers are not demanding lower-sodium products, and the government does not mandate reductions, the food industry has “no incentive to be at the forefront of change”, according to one legal expert… Read

National Dairy Council: Low sodium cheese is not taking the market by storm While cheese makers remain committed to salt reduction, demand for low-sodium cheese remains pretty lackluster, according to the National Dairy Council (NDC)… Read

Academic: Government sodium targets are incompatible with rest of dietary guidelines Further evidence that government healthy eating guidelines are more ‘aspirational’ than achievable has been uncovered by researchers testing how easy it is to meet low sodium targets and get the rest of the nutrients we need… Read

IFT urges government to take a cautious approach to sodium reduction The Institute of Food Technologists (IFT) has submitted comments to government agencies suggesting that actions to reduce sodium should not go “too far, too fast”, and has raised concerns about consumer acceptance and the safety of reduced sodium foods… Read

American Heart Association blasts industry sodium reduction skeptics Suggestions by the Salt Association and other industry associations that sodium reductions could hurt rather than improve health are “not supported by science”, the American Heart Association (AHA) has insisted… Read

‘Processed’ foods are often high in sodium – but what’s a processed food? About 75% of the sodium in our diets comes from processed foods. It’s a regularly cited figure – but what exactly is a ‘processed’ food? Consumers might be surprised… Read

But this one just in:

  • http://www.stealthymom.com Laura @ Stealthy Mom

    Bottom line: Salt covers funky, cheap meats and enhances the taste of flavourless foods. It is an effective preservative because it dramatically lowers the available moisture in a food. Canning without salt can be dangerous.

    The solution to a reduced sodium diet? Cook for yourself, choose higher quality ingredients and avoid cans. Freeze produce in season (a safe alternative to canning) and learn new ways to add bold flavours.

    The makers of processed foods don’t want such simple solutions because it cuts them out of the loop. Too bad. My husband had a mini-stroke last year and dramatically cutting back our salt has improved his health a lot. His and our preschool-aged kids’ health is more important to me than the balance sheets of Big Food.

  • TJ

    It’s interesting how the debate is far from settled about sodium’s apparently evil role in hypertension and yet claims are made that nearly every American consumes “too much” sodium.

    There’s this big campaign to reduce salt consumption without any convincing evidence that salt reduction would result in any meaningful health improvement.

    Why are we acting like we’re past the point of research?

    The war on salt will end up going the way of the war on fat, a well-intentioned but ultimately ruinous path towards poorer health as chemical “alternatives” are developed.

    Where is the war on SUGAR?

    http://www.scientificamerican.com/article.cfm?id=its-time-to-end-the-war-on-salt

  • Margeretrc

    I agree with @TJ. High blood glucose contributes much more to high blood pressure and all it’s consequences than salt. Outside of processed meats and canned vegetables, all processed food contributes as much or more to BG–and thus increased blood pressure–as/than salt. I agree we should avoid processed foods, but not because of the salt content. Reducing the amount of insulin floating around (by reducing the amount of SUGAR entering the blood stream–and that means eating less of everything that results in a spike in blood sugar, not just sugar) automatically increases the amount of water (and sodium and other minerals) removed by the kidneys. Because insulin tells the kidneys to hold on to water and thus sodium and the rest.

  • http://twitter.com/cancerclasses cancerclasses

    It’s amazing how people that are all hysterical about eating 1 or 2 or even 3 or4 grams of salt on occasion don’t think twice about eating 50 or 100 grams of SUGAR every day, which is why diabetes & obesity are on the rise.
    I’ve found that salt is self limiting, any more than 2 or 3 grams make me start feeling like a pickle and sour inside so I naturally stop, but many people can eat a quart or even a gallon of ice cream with no problem. Hypochondriac hypocrites, all of them self righteous salt nannies.

  • Cathy Richards

    Our food industry keeps producing low sodium choices — alongside the high sodium ones!! Then they say “see it doesn’t sell as well, so we’re pulling the product”. In the UK, they had industry decrease the amount of sodium by a small amount each year in ALL products (except a few foods like blue cheese that can’t be produced without the traditional amount). The small reduction was virtually unnoticeable by the public and over the years they have reduced sodium in the average diet by 10%.
    The food industry doesn’t want to reduce salt – it is cheaper to make something with more salt as they can skimp on ingredients with real flavour. Also, making bread is cheaper the more salt you use, and their manufacturing plants will need to be tweaked to make bread etc with less salt (different temps and times for yeast growth, different leavening etc).
    They won’t do it until we make them do it. In the meantime they’ll purposefully make low sodium products they know they’ll eventually pull so they can “prove” to government that they will act without regulations. Yeah, they’ll “act”.
    Honest to gawd, I’m so frustrated with the lack of corporate and government (and candidates for government!!) responsibility right now. Need to leave the work/nutrition office and go out and enjoy a spring day.

  • Anthro

    @TJ

    http://www.foodpolitics.com/tag/salt/

    This link is to Marion’s comments on the Scientific American article you refer to. I found it by clicking on “Salt” in the column directly to the right of the screen. Please read the “addendum” as well.

    @ Margaret

    Alas, we wait in vain to know Margaret’s qualifications in either nutrition or public health.

    @ The Sugar Commenters

    This post is about salt, not sugar. If you look to the right you can read everything Marion has posted on this blog about sugar and the sugar industry and public health.

    @Laura@StealthyMom

    Hooray for you! Congratulations for putting your family first and ahead of the bottom lines of BigFood! This is public health in action. Put information out there and people are empowered to make changes that directly impact their health. It’s great to read that your husband has improved with your efforts.

  • Margeretrc

    @Cathy Richards, and does the UK government know that people didn’t buy those reduced salt products, take them home, and add salt to them to make them taste better? People bought them because they had no choice. I’m betting at least some of them took them home and added salt before eating. Me, I’m frustrated with the constant call on government to save us from ourselves. THAT IS NOT IT’S JOB. Industry will give people what they demand. If people want low salt food, industry will be only too happy to give it to them. They certainly didn’t/don’t hesitate to give us low fat foods! It’s not the job of industry or government to care about our health. It’s ours. The government should fund real science–unbiased science–to find real answers (not just ones they like) to the questions about what is healthy or not and leave it at that. The rest is up to us. Or should be.

  • Margeretrc

    Oops. I mean THAT’S NOT ITS JOB. I don’t like to make grammatical errors.

  • Margeretrc

    @Anthro, my qualifications include B.A.s in Chemistry and Biology and an M.S. in Biochemistry (I believe I’ve said that before–perhaps you missed it) and a lifetime of reading books and articles written by scientists and medical doctors.

  • Margeretrc

    BTW, @Anthro, I don’t expect you to be impressed. I certainly am not. People way more qualified than I have written the multitude of books and articles from which I get my information. I only give you this information to indicate that I do, indeed, have at least a modicum of intelligence with which to make sense of what I read and weigh it against what I know to be the methods of science.

  • Anthro

    Well, Margaret, IF that is the case, then it is truly extraordinary that you would make this statement:

    “The government should fund real science–unbiased science–to find real answers (not just ones they like) to the questions about what is healthy or not and leave it at that.

    Can you give a documented example of such activity of the part of the government? As far as grammar goes, I would suggest that “unbiased science” is an oxymoron, since science, by definition, is an unbiased discipline. If you are going to accuse the government of presenting false outcomes to the people, you really need to document that.

  • Michael Bulger

    Even if people in the UK added salt to processed foods once they brought them home, the point would remain that lower levels of salt were the default. At home, you have the choice to add more salt, but the rest of us don’t have the choice of taking sodium out of processed foods. Really, the best way to enable personal choice is to lower sodium levels.

  • TJ

    @Anthro, I’m well aware of the tag/search function, but it doesn’t change what is being said today. Even if Marion were to say definitively that salt is causing people to die, it doesn’t mean it’s true, and we are justified, if not obligated, in raising questions and spurring debates about the topics that she presents. How else do we advance intellectually?

    While the link you provided is nice, it does nothing to change the ambiguity of the research on sodium and its *relationship* with hypertension. In fact, Marion’s interview confirms my point further.

    Honestly, this is like a re-run of the lead-up to the Iraq war. Can’t get a real good look at what is going on? That’s implication by default! We must take action because that would surely be better than inaction!

    Sorry about that, but the attitude is eerily similar, and the consequences of acting on uncertain information are unknown.

  • Margeretrc

    @Anthro, You are right. Unbiased science is a bit of an oxymoron. As to the government’s bias, how much government funded research do you know of that investigates some other cause for heart disease than saturated fat and cholesterol? Since the government and mainstream medicine has already made up its mind that that sat fat and cholesterol is the primary cause, researchers who request grants to investigate some other line of evidence are generally hard put to get funding. After the A to Z trial (http://jama.ama-assn.org/content/297/9/969.full) which showed that the Atkins diet produced the best results for weight loss and CVD risk factors, the main investigator Chris Gardner requested funding to pursue that line of investigation further (to find out why the Atkins diet was improving CVD risk factors) and was denied. Which is why Gary Taubes et al have set up an independent, non profit funding organization for the kind of research that will not have the answer in mind ahead of time: “Among the projects we have in the works is a non-profit, the Nutrition Science Initiative (NuSI), to raise money for the kind of research we think is necessary to clarify the relationship between dietary nutrients, obesity. diabetes and their related chronic diseases.” http://garytaubes.com/2012/01/updates-for-2012/?utm_source=rss&utm_medium=rss&utm_campaign=updates-for-2012

    @Michael. I agree with you–the less salt in processed foods, the more choice we have. It’s the UK government dictate to reduce salt that I have a problem with, not the reduction in salt itself. As I said, if people here wanted less salt in their processed foods, they would have bought the reduced salt options in droves and industry would have been only too happy to provide more of it–as they did with low fat products. But that’s not what happened, is it? I repeat, it’s not any government’s job to save us from ourselves.

  • Michael Bulger

    You’re assuming the general public invests a substantial amount of time and energy into their own nutritional education and purchasing decisions. The Constitution mandates the government to promote general welfare. They need to step up and regulate the food industry so that all food manufacturers can scale back sodium in unison. Otherwise, no company is going to want to commit to the move by themselves, out of fear that their competition will take advantage of their product changes. This is absolutely the appropriate place for government to regulate the market. Their third-party role and authority allow them to provide a balanced regulatory intervention to assist businesses and to promote the general welfare of the people.

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  • Margeretrc

    @Michael, I’m not assuming anything. People have a right to choose how they invest their time. The fact that some/most, even, choose not to doesn’t make it the job of the government to step in and say “I know what’s best for you and this is the way it’s going to be, whether you like it or not.” Even if they could have foreseen what would happen to our food supply, I doubt that’s what the founding fathers meant by the “promotion general welfare.” And your competition argument doesn’t hold water anyway. The government did not need to regulate how much fat industry puts in processed foods. Industry provided low fat foods and people bought them thinking they were doing what was best for their health. It was the very competition you think we should get rid of that ensured that every food manufacturing company out there provided low fat options, because that is what people were buying. (I think low fat products are a travesty, but I’m not calling on government to tell industry to stop producing them. I simply don’t buy them.) Likewise, industry removed trans fats from their products before the government had time to act, because people demanded trans fat free products and bought them as soon as they became available. All the government needed to do was mandate that the amount of trans fat in the food be disclosed on the label and consumers took it from there. I’m fine with labeling–it gives people the information they need to be able to choose. Labels already tell the consumer how much sodium is products. Further regulation is not necessary and only takes away the freedom of choice. This is still supposed to be a free country–we need to remember that.

  • Michael Bulger

    You’re mistaking the government promoting personal choice (as in when you wrote “I agree with you–the less salt in processed foods, the more choice we have.”) with the government telling you how much salt you can have “whether you like it or not”. That’s quite a leap, Margaret.

  • Margeretrc

    Ok. On that you have a valid point. I think I was confusing taxing (which is also under discussion) with regulating. My bad. Nonetheless, I still say it’s better done by the free market, particularly with reference to salt since the jury is still very much out on that.

  • Margeretrc

    And TJ’s point is well taken. Whereas the link between salt and bad things is very much tenuous for all but the relatively few sensitive individuals, the link between sugar and bad things is much less tenuous. If we’re going to tackle anything (and I’m not saying we should) it should be that.

  • http://dontforgetthecinnamon.wordpress.com Jamie @ Don’t Forget the Cinnamon

    In a nutrition course I took last semester, we learned that reducing sodium intake is only beneficial–at least in terms of reducing blood pressure–for a certain percentage of the population that is salt sensitive. Is this true? And how would that play into the dietary guidelines regarding sodium and the efforts to reduce sodium in food products?

  • Michael Bulger

    Jamie,

    I can’t speak for everyone, but I think the idea is that reducing sodium across the whole population will protect all those people who are sensitive to sodium and will save lives. For all the other people, who don’t seem to have a sodium sensitivity, it won’t be a problem if they eat less salt. This is because Americans currently eat much more salt than their bodies need.

    Of course, some people and companies don’t want the government to get involved in the food industry. Other people don’t think the government and nutritionists have it right when it comes to the science.

  • Thurman Hart

    This is a great post – but the margins seem off. I seem to be missing a few words on the right hand margin from every few lines of text. I’ve tried in three browsers and still have the issue.

  • http://www.thurmanhart.com Thurman Hart

    I’m a couple days late, but here’s my thoughts:

    @TJ As with everything, every person needs a different amount of salt for their body to function. However, while the Institute of Medicine recommends no more than 1,500 milligrams, the Mayo Institute found the “average” American diet gives them 3,400 mg (http://www.mayoclinic.com/health/sodium/NU00284).

    The evidence that salt reduction would improve health: http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_sum.htm

    Why are we acting like we are past the point of research – well, if you read the above article, you’ll see that we are.

    @Margeretrc
    Well, removing salt from a hypertensive person’s diet results in an immediate reduction of blood pressure, whereas sugar does not correlate as highly.

    @cancerclasses
    The average American takes in over 3,000 mg of salt everyday – so it isn’t a once in a while problem. Your own statement, however, shows that salt intake is NOT self-limiting. Salt makes a person thirty and they drink…then they do not think twice about having more french fries. Come to think of it – how much of the extra sugar do you think is consumed BECAUSE extra sugar is added in drinks to chase overly-salty foods?

    @Cathy Richards
    I’ve given up on finding no-sodium or low-sodium choices at my corner market. I drive ten miles away so I can find them – and even there, they are sparse and I often have to ask for them to be stocked. If they are not on the shelves, they are not going to sell, right?

    @Margeretrc
    It seems a rather spurious argument to claim that someone would add just as much salt at home as was taken out in the processing. Generally, people don’t salt their sandwiches, pizza, or snack foods, do they? Even if “some” of them did, there would still be a net gain for public health, wouldn’t there?

    The idea that “industry will give people what they want” is hopelessly naive. I want an SUV that gets 70mpg…where is it? The relationship between supply and demand is not so easy, and each individual consumer has very little power.

    Actually, it IS the government’s job (in the US) to regulate interstate commerce in the interest of public health. Check Article I of the US Constitution where it is among the enumerated powers of Congress. This is the justification for child labor laws, workplace safety laws, and pure food and drug laws. In the UK, the government actually has MORE power to regulate industry.

    I agree, in the words of Oliver Wendell Holmes, Jr, “Every man has a right to go to hell in his preferred manner.” However, this implies that there IS an actual choice. While we should manage our own lives, we CANNOT manage industry standards, and without government regulation, there is always a rush to the bottom in order to cut costs and maximize profits. When that action puts public health at risk, it is definitely government’s job to step in.

    I agree that science should be funded to find wherever the answer leads us, though. And the only jury that would still “be out” is one that ignored the direct link between high blood pressure and salt intake. It would be like ignoring the direct link between high blood pressure and heart disease.

    You are completely correct, of course, that sugar is a massive problem. In a similar fashion, waiting for the free market to react to adding too much sugar is like waiting for a fish to complain about too much rain. BOTH sugar AND salt need to be reduced in the typical American diet. However, this is not going to happen naturally.

    First of all, humans sense salt and sweet directly. Biologically, we are programmed to seek these tastes. Secondly, not only does salt and sugar make food taste better, they actually are used to control the growth of bacteria in foods (traditionally ham is either salt- or sugar-cured, for example).

    I also agree with you on a point that is getting missed – salt is probably better than any chemical alternative we can come up with. What we need to promote is a HEALTHY diet, and not “low-salt, low-sugar, low-whatever-is-our-next-target.”

  • http://www.thurmanhart.com Thurman Hart

    @Clarence Darrow

    Article I, Section 8, clause 3 – also known as the Interstate Commerce Clause – “To regulate commerce with foreign nations, and among the several states, and with the Indian tribes”

    Seeing as how most food products are involved in crossing state lines – and even if it isn’t, the “food market” is – then Congress has the power to regulate it.

  • Cathy Richards

    @Margaretrc – my belief in changing the environment has grown over the years as I’ve researched behavioural science as it relates to our food environment, so it is based in science. But it’s still a new area of study and likely only public health people have the interest to read up on it a lot.

    Knowledge/education isn’t enough to change the majority of people’s behaviours in a significant enough way to impact health care outcomes and costs. The environment they live in needs to be supportive for wide-ranging & meaningful change. There is an enormous biological drive behind the desire for fat, carbohydrates, and salt that can easily override our “will power”. Brian Wansink says: “ ‘We believe we have all the free will in the world. We believe we overeat if the food is good or if we’re really hungry. In reality, those are two of the last things that determine how much we eat,’ Wansink says. What really influences our eating, he says, are visibility and convenience.” http://www.cnn.com/2007/HEALTH/diet.fitness/09/21/kd.mindless.eating/index.html

    The dollars invested in improving our environment are returned multi-fold.

    There are many examples of us giving this responsibility to governements and industry. We don’t just educate everyone to figure out where to drive and how fast to drive. We also paint lines on the road, we install stop signs and traffic lights, we enforce speed limits. I think everyone is supportive of the majority of these traffic control initiatives.

    We also mandated the installation of functional seat belts and then most jurisdictions have backed this up with legislation. Some people still choose to drive without their seat belts – there is still choice – but the majority of us benefit from the majority of us wearing seat belts (did you know that people who don’t wear seatbelts grip onto the steering wheel harder in a crash and subsequently cause more damage to their car and passengers?).

    Lines on the road, traffic lights, seatbelts – these safety/health measures are taken for granted now, but when they were implemented at first there was a big backlash.

    It’s a paradigm shift, absolutely, to apply these principles to food. But it needs to be done to prevent health care costs from going not just through the roof but throught the stratosphere.

    Education is not enough. Check out Brian Wansink’s study on dietitians and ice cream: http://doctorfoodtruth.wordpress.com/tag/brian-wansink/

    Science rocks!

  • Cathy Richards

    Re: only a small percentage of people being sensitive to salt: this old science keeps getting repeated. Those that are more sensitive include middle aged and elderly, those with diabetes, and renal dysfunction. That’s pretty much enough to justify a system wide change.

    Also, there is no test for sodium sensitivity. The only way you know is if once have high blood pressure — then if you change your sodium intake and see what happens you’ll know if you’re sensitive. But by the time you have high blood pressure, you’re in trouble. Blood vessels are like spandex – once they lose their elasticity, it’s gone.

    The recommendations for system wide sodium reduction were not made lightly. They were made by scientists, and the recommendations would have been even stronger if industry hadn’t pushed back.

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