Salt Industry Calls for Repeal of Sodium Guidelines

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WASHINGTON -- The salt lobby has accused the federal government of bias and of breaking federal law by disregarding scientific literature in its recommendations that Americans consume less sodium.

In a 17-page letter sent to the U.S. Department of Agriculture and the Department of Health and Human Services (HHS), the Salt Institute -- a trade group for salt companies -- called on the federal government to scrap the recommendation in the 2010 U.S. Dietary Guidelines that called for Americans to significantly reduce their sodium intake.

"The Dietary Guidelines on sodium should be withdrawn and all legislative or regulatory actions based on them reversed or halted in order to protect the health of Americans," the Salt Institute's letter read.

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In 2005, the federal government set the recommended daily allowance for sodium intake at 2,300 mg per day for the general population and 1,500 mg for high-risk populations.

But in 2010, a government panel suggested intake of less than 1,500 mg a day for people older than 50, African-Americans, and anyone who has hypertension, diabetes, or chronic kidney disease. That covers about half of the U.S. population.

Earlier this year, the American Heart Association (AHA) took that recommendation further, saying that no one should consume more than 1,500 mg of sodium in a given day, and recently, leading epidemiologists called for a global reduction in salt intake. Reducing dietary salt intake by 3 grams of salt per day would reduce cardiovascular morbidity and mortality and save up to $24 billion in healthcare costs, according to their analysis published online in the British Medical Journal.

What does 1,500 mg of sodium look like? A cup of canned re-fried beans and a slice of wheat bread contain about 1,500 mg of sodium, as would a quarter-pounder with cheese and medium fries from McDonald's.

The Salt Institute said 1,500 mg of sodium per day is too low, and may actually have "potentially fatal consequences"

"To survive and thrive, the body needs salt. That's a medical fact," Salt Institute President Lori Roman wrote in a Monday press release. "But the official food policy of our federal government aims to radically reduce salt levels, violating the medical mandate to 'first, do no harm.' We oppose 300 million Americans being treated like lab rats in a risky trial."

The group argues that the government is violating federal law because dietary guidelines should be based on "the preponderance of the scientific and medical knowledge," but instead the recommendations cherry-pick studies that vilify salt, while ignoring those that suggest a negative consequence of reducing sodium, including those that connect low-salt diets to premature death; insulin resistance, which is a precursor to diabetes; and an increased likelihood of falls in the elderly.

The Salt Institute also said that the committee that promulgated the dietary recommendations failed to consider the impact of salt consumption on the production of plasma renin which plays a key in the regulating blood pressure, thirst, and urine production. Disruption of the renin-angiotensin system kicks in when sodium intake falls below 3,450 mg daily, which is more than double the amount of salt the government is recommending people consume each day.

A spokeswoman for the American Heart Association declined to comment on the letter sent by the Salt Institute. In January, however, the group laid out the science behind lowering salt intake in an advisory statement published in the group's journal, Circulation.

Two key components of improving cardiovascular health are population-wide lowering of blood pressure below 120/80 and reducing sodium chloride intake below 1,500 mg per day, according to the statement. The group said there is ample evidence -- more than 50 randomized clinical trials -- that link reducing sodium to lowering blood pressure. Aside from affecting blood pressure, consuming too much sodium affects the heart, kidneys and blood vessels, the AHA said.

The Salt Institute doesn't dispute salt's connection to high blood pressure.

"We're not saying that reduction of blood pressure is bad, we're just staying that using salt as the main lifestyle reduction strategy to obtain that reduction is a dangerous strategy," Morton Satin, the vice president of science and research at the Salt Institute told MedPage Today.

In addition, the Salt Institute argues that in an effort to cut down on salt, Americans are actually consuming more calories. When people eat a lot of "low salt" packaged foods they still have a salt craving and will eat more calories to satisfy that craving, Satin said.

As a result, actual sodium consumption hasn't changed at all over time, despite the government recommendations, Satin said.

He said he would like the government to sponsor a large-scale clinical trial to see how a reduction in salt intake affects overall health, not just blood pressure levels.

"Are we better off or worse off for salt reduction?" he said. "Before anybody tries to change the American diet around one simple item -- which is salt -- we really ought to have a trial. We are in territory that is uncharted. No society in the world that eats that low a level of salt."

A spokeswoman for HHS defended the dietary guidelines.

"The Dietary Guidelines for Americans provides science-based advice to promote health and reduce the risk of major chronic diseases through diet and physical activity," the spokeswoman said.

The Salt Institute also filed a Freedom of Information Act request with the federal government requesting all documents related to the sodium-reduction decision from the 2010 federal nutrition guidelines.