by Marion Nestle

Currently browsing posts about: Salt

Oct 22 2010

The latest salvos in the sodium debates

Scientific debates about the role of sodium in high blood pressure go on and on.  Committees of scientists reviewing the research invariably conclude that people would be healthier if they ate less salt (salt is sodium chloride).  The 2010 Dietary Guidelines Advisory Committee is only the most recent group to urge population-wide reductions in sodium intake.

The Institute of Medicine has just issued a new report on reducing sodium.  Its Report in Brief gives a quick summary

As its primary strategy for sodium reduction, the committee recommends that the FDA set mandatory national standards for the sodium content in foods…beginning the process of reducing excess sodium in processed foods and menu items to a safer level. It is important that the reduction in sodium content of foods be carried out gradually…Evidence shows that a decrease in sodium can be accomplished successfully without affecting consumer enjoyment of food products if it is done in a stepwise process that systematically and gradually lowers sodium levels across the food supply.

But wait!  Hypertension rates have been increasing for years without any change in sodium excretion, says a report in FoodNavigator.com.  The report refers to new study in this month’s American Journal of Clinical Nutrition reviewing trends in sodium excretion from 1957 to 2003.

Sodium excretion, a precise reflection of intake, say Adam Bernstein and Walter Willett of the Harvard School of Public Health, has not changed in the last half century, despite rising rates of high blood pressure.   Instead, they suggest that rising rates of obesity might be the cause.

The accompanying editorial, by David McCarron and his colleagues, takes the argument even further as can be seen just from its title: “Science trumps politics: urinary sodium data challenge US dietary sodium guideline.

The editorial says that this new study provides:

plausible, scientific evidence of a “normal” range of dietary sodium intake in humans that is consistent with our understanding of the established physiology of sodium regulation in humans. This scientific evidence, not political expediency, should be the foundation of future government policies….Guidance for sodium intake should target specific populations for whom a lower sodium intake is possibly beneficial. Such an approach would avoid broad proscriptive guidelines for the general population for whom the safety and efficacy are not yet defined.

Is this review likely to change the Dietary Guidelines due out later this year?  The Advisory Committee was convinced that the preponderance of evidence favors the importance of sodium as a causative agent in high blood pressure.

Because so much is at stake for the processed food industry, this argument is not likely to be resolved quickly.  Stay tuned.

Jul 2 2010

The latest on salt for the 4th of July

In preparation for eating over the 4th of July weekend, here’s what’s happening on the salt frontier.

The CDC says fewer than 10% of Americans meet sodium recommendations. Only 5.5% of adults who should be consuming low sodium diets(≤1,500 mg/day) actually do so.  Less than 20% of adults consume the amount currently recommended for healthy adults, ≤2,300 mg/day. Overall, only 9.6% of adults met their applicable recommended limit.

The British Food Standards Agency (FSA) says the U.K. is making great progress on reducing salt consumption. Even though UK salt intakes are still above the target of 6g/day after seven years of campaigning, FSA is happy about what the campaign achieved: a 10% reduction in average daily intakes from 9.5g/day to 8.6g/day.  This is substantial progress, given “the complexity of the task and the FSA’s modest budget.”

The New York Times explains part of the complexity: food industry resistance.  In an article titled, “The hard sell on salt” (May 29), the Times interviews food company executives who talk about why they must, must use salt and lots of it in processed foods.

The Salt Institute attacks the Dietary Guidelines Advisory Committee report. The report recommends a limit of 1,500 mg/day sodium because 70% of the U.S. population is at risk of high blood pressure. According to Food Chemical News (June 16), the Salt Institute claims that reducing salt intake to recommended levels would only make the obesity epidemic worse: “Most nutritionists agree that reduced sodium in food preparations will very likely increase the obesity crisis because individuals will consume more calories just to satisfy their innate sodium appetite.”

Most?  I don’t think so.  Because 77% of salt (sodium chloride) is in processed and restaurant foods, I see the salt issue as one of consumer choice.  Consumers can always add salt to foods.  They cannot take it out.

Enjoy a happy, healthy, safe, and lower salt 4th of July!

Jun 2 2010

Salt is under siege

In April, the Institute of Medicine published a study concluding that salt poses so serious a health hazard that the FDA should start regulating it as a food additive.

Last week, Mitchell Moss produced a lengthy piece in the New York Times, “The hard sell on salt,” detailing the food industry’s resistance to salt reduction:

The industry is working overtly and behind the scenes to fend off these attacks, using a shifting set of tactics that have defeated similar efforts for 30 years, records and interviews show. Industry insiders call the strategy “delay and divert” and say companies have a powerful incentive to fight back: they crave salt as a low-cost way to create tastes and textures. Doing without it risks losing customers, and replacing it with more expensive ingredients risks losing profits.

Now we have Judith Shulevitz’s piece in The New Republic, Is salt the new crack?”  She concludes:

We need to stop ingesting all these substances in ludicrous amounts…We need to be taught not just what’s in processed food, but how historically anomalous its manufacture and our consumption of it are. We need to understand the mechanisms that addict us to it. We need to relearn how to prepare real meals, and we need to start rethinking the social dynamics of that chore (it can’t just be up to wives and mothers anymore). It’s pretty hard to imagine the government conducting that education campaign, but, 20 years ago, it may have been just as hard to imagine the “truth campaign” that exposed the tobacco industry’s marketing techniques and the transformation of social norms that made it déclassé to smoke.

As I keep saying (see previous posts), the salt issue is one of personal choice.  If I want to eat less salt, I cannot eat processed foods or restaurant foods because that’s where 80% of the salt in American diets comes from.  As Moss explains, PepsiCo cannot make Cheetos without salt.  I can just say no to Cheetos, but eating out is a challenge.

No, salt is not the new crack, but I’m glad that changing food social norms is becoming part of the national conversation.

Apr 27 2010

16 companies say they will reduce salt

New York City Mayor Michael Bloomberg announced yesterday that sixteen food companies have agreed to join the National Salt Reduction Initiative spearheaded by the city’s health department.  The companies have volunteered to reduce the sodium in their products by 25% within the next five years.  Mostly, they say they will do this by 2012 or 2014 (see summary table).

Nation’s Restaurant News points out that four of these companies are restaurant chains – Starbucks, Au Bon Pain, Subway, and Uno Chicago Grill.  One, Boars Head, is a deli chain.  And some food product companies – Mars, for example - are issuing their own press releases.

This is all good news and should encourage many more companies to take the low-salt pledge.

As the New York Times points out, salt lurks in unexpected places in processed foods.  The article came with a great graphic, well worth a look.

To translate the numbers, recall that salt is 40% sodium.  This means that 400 mg sodium = one gram of salt, 200 mg sodium = half a gram of salt, and 4 grams of salt = 1 teaspoon.

Apr 21 2010

FDA to regulate salt? If not now, when?

The Washington Post reported yesterday that the FDA is about to launch an initiative to get food companies to reduce the amount of sodium in their foods.

If true, this would be a major big deal.  But by late afternoon, the FDA had issued a press release denying the Washington Post’s report (and see note below):

A story in today’s Washington Post leaves a mistaken impression that the FDA has begun the process of regulating the amount of sodium in foods. The FDA is not currently working on regulations nor has it made a decision to regulate sodium content in foods at this time.

Over the coming weeks, the FDA will more thoroughly review the recommendations 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 referring to a report also issued yesterday by the Institute of Medicine: Strategies to Reduce Sodium Intake in the United States. According to the IOM Summary, voluntary efforts by the food industry to reduce sodium intake have failed.  The report’s first recommendation is for the government to set standards for the sodium content of packaged foods.  And that sounds like what the Washington Post thought the FDA was about to do.

The idea is to get all companies to start reducing sodium.  USA Today quotes Jane Henney, the previous FDA Commissioner who chaired the IOM committee: “The best way to accomplish this is to provide companies the level playing field they need so they are able to work across the board to reduce salt in the food supply.”

The IOM is doing a public briefing on the report at 10:00 a.m. today, at the National Press Club in Washington DC.  You can listen to it via audio webcast at www.nas.edu.

The Center for Science in the Public Interest (CSPI) first asked the FDA to start regulating salt in processed foods in 1978.  Its press release and report, Shaving Salt, Saving Lives, explain why the FDA’s action would be such good news for public health.

Salt is as controversial as any nutrition issue can get.  I expect plenty of pushback from the Salt Institute and other industry trade groups if there is any hint that FDA might be about to regulate salt content.  Could the FDA’s denial be the result of industry pressure?  It would be interesting to find out.

Some basic facts: Recall that sodium is 40% of table salt (sodium chloride).  Too much raises the risk of high blood pressure and stroke.  Nearly 80% of salt is in processed and pre-prepared foods that are salted before they get to you.

The recommended maximum for adults is 2300 mg or about a teaspoon a day.  If you are at risk for high blood pressure, the maximum is just 1500 mg, or two-thirds of a teaspoon.  Americans consume more than twice that much on average.

Note added April 20: the FDA has produced a Q and A on its salt regulatory policy.

Additions April 21: Here’s the New York Times story on the IOM report.  The LA Times reports on the amounts of sodium in fast food restaurant meals.  Impressive.

Apr 14 2010

The big push to reduce salt

The Institute of Medicine’s long awaited study,  Strategies to Reduce Sodium Intake in the United States, will be released next week at a public briefing in Washington, DC.

According to study director Chris Taylor, the briefing will be held Wednesday, April 21, from 10:00 a.m. to 11:00 a.m. at the National Press Club, 529 14th Street, NW, Washington, DC.  Those who cannot attend can listed to a live audio Webcast at http://www.nationalacademies.org/.  Anyone who wants to attend should register at http://www.iom.edu/Activities/Nutrition/ReduceSodiumStrat.aspx.  For information, contact the news office at the National Academies, (202)-334-2138 or onpi@nas.edu.

In what can hardly be a coincidence, General Mills has announced that it will be reducing the sodium in several lines of its products by 20% between now and 2015.

The great majority, perhaps 80%, of the salt in U.S. diets comes from processed and pre-prepared foods.  If salt is to be lowered, the processed food and restaurant industries must do it.  Just about everyone agrees that salt reduction has to occur gradually and across the board.  It’s great that General Mills is signing on to this effort.

Feb 3 2010

The research on salt

Since Mayor Bloomberg started going after salt, my inbox is overflowing with commentary on all sides of the salt debates.

First a review of the research: FoodNavigator.com has published a series of pieces on the importance of salt reduction to health and the implications of doing so for the food industry:

  • January 15: a summary of a Japanese study linking high salt diets to cancer.
  • January 26: a review of studies on several conditions affected by salt intake.
  • January 27: a discussion of the economic effects of reducing salt intake.
  • January 28: an overview of how the salt issues are viewed in Europe.
  • January 29: a discussion of the purported benefits of sea salt.
  • Also on January 29: a report on Kellogg’s salt-reduction initiative in Europe.
  • February 1: a review of the arguments over the science.
  • February 2: an account of how Ireland is dealing with the salt issue.

Jane Brody of the New York Times weighed in on the benefits of salt reduction.

Salt in restaurant meals: On January 31, an intrepid New York Times reporter had the bright idea of sending some restaurant meals off to a lab to test for sodium.  Ouch.  Large clam chowder 3100 mg, two slices of pizza 2240 mg, steak with creamed spinach 2660 mg, Katz’s corned beef with pickles 4490 mg.  Stroke anyone?  No wonder it’s so hard to avoid sodium.

The “leave salt alone” crowd: JAMA has just run an editorial from Michael Alderman arguing that salt reduction does no good, might do harm, and should be tested in clinical trials before moving forward.  And Greg Miller of the National Dairy Council sent me this piece from Dr. Judith Stern of U.C. Davis, a member of the advisory board of the Salt Institute, saying much the same thing.

These are old arguments. What I find remarkable about them is that despite such individual opinions, every committee that has ever reviewed the research over the years has consistently come to the same conclusion: salt reduction is a good idea.  Are the committees delusional?  I don’t see how.  As for clinical trials, how could anyone do one?  There is already so much salt in the American diet that it will be hard to find a population of people able (even if willing) to reduce salt intake to a level where differences in health will be measurable.  The research disputes are difficult to sort out I don’t see how they can be easily resolved.

Under these circumstances, you could take your pick of whose research interpretation to believe – if you actually had a choice.  But you don’t.  If you eat processed food or in restaurants, you are eating a lot more salt than you need.

I’d like the default to  be a lower salt environment.  Drs. Alderman and Stern can always add more salt to their food.  I have no way of removing it from mine.

Stay tuned.  We will be hearing a lot more about this one.

Jan 23 2010

The new salt study

The current issue of the New England Journal of Medicine has an article from investigators at the University of California San Francisco School of Medicine (where I worked from 1976 to 1986) and Columbia using computer models to predict the effect of relatively small reductions in salt intake on health.  Their conclusion:

Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.

The article also is discussed in an accompanying editorial, and was the topic of a long discussion in the New York Times.

I never know what to make of computer models, but one thing is clear: many people consume two or three times the amount of salt recommended.  It’s hard to avoid doing so.  Australian investigators surveyed processed foods and found more than 60% of them to contain salt above recommended levels.  Ours are unlikely to be any different.

While we are on the subject of salt in processed foods:  Juli Mandel Sloves of Campbell Soup correctly points out that my observation that the company’s kids’ soups contain 480 mg sodium per 4 ounce serving is incorrect.  A serving of soup is 8 ounces, not 4.  I see how I made this mistake.  The label states that a serving is half a cup (4 ounces) and that one serving contains 480 mg sodium.   But you are supposed to dilute what’s in the can with another can of water.  That makes it 480 mg sodium per 8 ounces, the same amount of salt but diluted.  The confusing serving sizes are another good reason to rethink and redesign the Nutrition Facts label.

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