Take It with a Grain of Salt
Tuesday, February 19, 2008
The low-sodium campaigners should focus their efforts on consumer demand, not on new FDA regulations.
If the Center for Science in the Public Interest (CSPI) had its way, salt would be the new trans fat. For three decades now, the CSPI has been trying to convince the Food and Drug Administration to change its official classification of salt from “generally recognized as safe” (GRAS) to “additive.” In response to the CSPI’s most recent citizen petition, the FDA held a hearing on salt late last year.
The CSPI, lobbying in tandem with the American Heart Association (AHA), is concerned about the serious health risks posed by overconsumption of sodium. The FDA’s recommended daily allowance of sodium is currently 2,300 mg; the CSPI contends that Americans consume much more than that—about 4,000 mg per day. Along with the AHA, it is lobbying to have the recommended level reduced to 1,500 mg. The two groups attribute roughly 150,000 deaths per year to excessive salt consumption. In an attempt to curb the risk of heart attacks and strokes, they recommend regulating the major source of most Americans’ sodium: the salt in processed and restaurant foods. The CSPI suggests including front-label symbols identifying high-sodium foods, posting nutrition disclosures on chain restaurant menus and brochures, encouraging manufacturers to make foods with less sodium, establishing a “division of sodium reduction” at the FDA, and spearheading a major heart-healthy education initiative.
The CSPI has cited various studies showing that, while a low-sodium diet can reduce blood pressure, people are less likely to choose such a diet voluntarily if other options are available. Lowering an individual’s blood pressure would then lower his or her risk of stroke or heart attack. Lower blood pressure would allow Americans to save money on blood pressure medications and overall health care, as the likelihood of kidney disease, nonfatal strokes, heart attacks, and other problems are linked to high-sodium diets. Citing the Framingham Heart Study, the CSPI contends that the costs and benefits of community-wide education would be competitive with current treatment options, but costs could be reduced even further if the food industry reduced sodium levels.
In response to these claims, industry groups, including the Salt Institute (a nonprofit trade association) and the Grocery Manufacturers Association, have called for voluntary sodium reductions instead of federal regulation. According to these groups and the nonpartisan International Food Information Council Foundation, the direct impact of sodium reduction on human health is still unclear. The most widely cited study, the DASH-sodium trial, did not indicate that an isolated reduction in sodium would reduce blood pressure in both hypertensive and non-hypertensive adults; the study said that only a diet rich in fruits, vegetables, and low-fat dairy products could do that.
Differentiating among products that use salt for taste, physical effect, fermentation, preservation, or character is challenging. Salt is often necessary for food safety, which makes it even harder to determine where to draw the line.
The Salt Institute cites a study from the University of Indiana which shows that, while some individuals may respond strongly to a reduction in their sodium intake, most people are unaffected. For that matter, even if people are affected by high sodium levels, the Salt Institute contends that the blood pressure and health risks can be eased by eating a well-balanced, quality diet.
The biggest problem for industry groups seems to be the lack of adequate demonstrative studies. Ambiguity about the utility of reducing sodium content without other dietary changes, coupled with uncertainty about the problems associated with low-salt diets, adds to the confusion.
For its part, the FDA is concerned about the practical difficulties involved with implementing some of the CSPI’s recommendations. While new dietary guidelines and packaging requirements may be easy to enact, sodium content regulations could be very costly to develop and enforce. This is why the FDA rejected the idea back in 1982 and allowed salt to keep its GRAS status. After all, it has not been demonstrated that salt is a “poisonous or deleterious substance.”
Whether or not sodium can be linked to high blood pressure, the FDA’s regulatory difficulties remain real. Differentiating among products that use salt for taste, for physical effect, for fermentation, for preservation, for character, or for a host of other purposes could prove very challenging and time consuming. Indeed, salt is often necessary for food safety, which makes it even harder to determine where to draw the line.
The CSPI attributes the lack of consumer interest in existing low-sodium products to high costs and taste differences. But the research and development necessary to improve the quality of low-sodium products will likely raise their costs, which will be passed on to consumers. As the Salt Institute points out, small manufacturers will be hit the hardest, as they do not necessarily have the facilities and “technical resources” to perform the research.
Sodium levels in foods have stayed the same over the last 20 years. In fact, the CSPI and the AMA freely admit that higher sodium levels detected in consumption have come from the ingestion of more food in general. Even if the FDA were to reclassify salt as an additive and mandate lower sodium levels in food, the regulation might not be effective—people might simply add salt to enhance the flavor of their food, or they might just eat more food. The Salt Institute suggests that salt could be a “feed limiter,” and that people, like animals, may have an unconscious appetite for it.
The food industry and trade associations advocate a voluntary reduction of sodium levels while manufacturers develop the necessary technology. The CSPI doubts the plausibility of this approach: sodium amounts have been mandatory on nutritional labels since 1992, and yet the majority of manufacturers have not voluntarily reduced sodium content.
But it is not unprecedented for consumer demand to compel industry changes. For example, as the Atkins diet grew in popularity, the food industry created a panoply of low-carb products. Low-fat products, sugar-free products, and portion-control products have all proliferated in response to diet fads. And in the United Kingdom, the combination of a successful education campaign, a media blitz, and a clear and effective labeling system forced manufacturers to start making food products with less sodium.
A similar effort in the United States, if backed by both sides of the salt debate, could effectively motivate consumers and manufacturers to demand and produce lower-sodium products, and thus nullify the need for new regulations. It would probably be the least costly, least controversial, and most effective strategy.
Sara Wexler is a research assistant at the American Enterprise Institute.