Nov. 30, 2007 -- Public health experts urged regulators Thursday to consider instituting tighter restrictions on salt content in processed and prepared foods, claiming that limiting sodium could save more than 150,000 lives annually.
The call for salt limits and beefed-up warning labels on packaging came during a U.S. Food and Drug Administration public hearing. And the public advocacy group Center for Science in the Public Interest (CSPI) was at the forefront of the charge.
"Salt is probably the single most harmful thing in our food," said CSPI executive director Michael Jacobson, "contributing to high blood pressure, which causes heart attacks and strokes." CSPI also called on the FDA to revoke salt's "generally recognized as safe" status and to instead regard it as a food additive.
The hearing came at a time when medical experts are becoming increasingly concerned over the amount of salt "hidden" in many foods on grocery store shelves, including products not normally associated with salt.
For example, said Dr. Randall Zusman, associate professor of medicine at the Harvard Medical School, a bowl of one popular cereal brand may pack more of a sodium punch than many consumers realize.
"One cup of Cheerios -- frequently advertised as heart healthy -- has 300 milligrams of salt," he explained.
"No one eats only one cup, so two to three cups each morning would be nearly 50 percent of your daily allotment. Yet, the FDA allows Cheerios to be advertised as a healthy alternative."
But while most agree that the excess salt in the diets of many Americans poses significant health risks, experts in the medical community remain divided over what should actually be done to address the problem.
Some agree with advocacy groups and believe that the FDA should require stricter labeling for manufactured foods. Such labeling could take the form of warnings placed prominently on the packaging of high-sodium foods.
But others think the focus on salt regulation is misdirected and say that the FDA should address more harmful elements of the American diet and lifestyle, such as obesity.
The American Dietetic Association, for one, has spoken out in favor of stricter product labeling to tackle the problem.
"Allowing manufacturers to include the amount of sodium found in a food on the front of the package along with claims that are currently allowed such as 'reduced,' 'lite' or 'low' sodium will help people better understand how the claim relates to the actual amount of sodium found in the food," said ADA spokeswoman Lona Sandon.
But the American Medical Association wants a stronger approach, urging the FDA to take direct action by cutting in half the amount of salt allowed in processed foods and food served in restaurants.
Doing so, it said, could save 150,000 lives in the United States every year.
"The need for immediate action is clear," said Dr. Stephan Havas, AMA vice president for science, quality and public health, in a press release issued Thursday.
"The deaths attributed to excess salt consumption represent a huge toll -- the equivalent of a jumbo jet with more than 400 passengers crashing every day of the year, year after year."
Martin Binks, assistant professor of medical psychology at the Duke University Medical Center, agreed.
"In terms of self-regulation, the food industry has proven itself incapable of acting in the best interests of public health time and time again," he said. "So yes, I do feel that well-crafted and sensible regulation could go a long way in promoting better public health."
Still, others feel that though the public should be informed about the amount of sodium in foods, the ultimate choice should be left up to the consumer.
"I do not think the FDA should regulate the amount of sodium," said Mary Beth Kavanagh, instructor in the department of nutrition at Case Western Reserve University in Cleveland.
"The FDA should make certain that consumers are aware of the sodium content of processed foods and let consumers decide."
Does Obesity Trump Salt Fears?
Despite the strong sentiments of various medical groups, some diet experts believe salt should be put on the back burner so that attention can be focused on more important public health issues, such as sugar intake and obesity.
"Sodium in food is not as big a problem as the use of sugar and high fructose corn syrup in foods and drinks," said Dr. Jana Klauer, who's in private practice in New York.
"Sugar in its various disguises -- table sugar, high fructose corn syrup, and refined carbohydrates -- is making America fat," she added. "The AMA would be wise to address the ubiquitous use of sugar before crusading against salt."
And even Binks agreed that salt should take a back seat to what he feels are greater dietary evils.
"While I agree that sodium is important, I am not sure it should be the primary target of regulatory efforts," he said.
"Portion sizes and caloric density of foods and foods high in sugars and fats that provide little satiety but plenty of calories contribute immensely to the obesity epidemic, which is responsible for 400,000 deaths per year."
For the most part, however, medical experts resoundingly agree that too much salt is a public health concern.
"It certainly contributes to high blood pressure, heart disease and stroke," said Dr. David Katz, director of the Prevention Research Center at the Yale University School of Medicine.
"It likely contributes to osteoporosis, and because hidden salt stimulates the appetite center, it contributes to overeating and obesity, too -- which means that indirectly, it contributes to diabetes. It's a very significant problem."
And while most of us may not reach for a salt shaker at every meal, it doesn't mean we aren't at risk for consuming too much sodium.
"Much of the problem is that foods not thought of as salty, such as breakfast cereals, are more concentrated in salt than the overall diet is supposed to be," said Katz. "How can you keep your total dietary salt intake down to recommended levels when even nonsalty foods bring you up above that level?"
How Much Salt Is Too Much?
According to the American Heart Association, adults should consume no more than 2,300 milligrams of sodium each day, about a teaspoon of salt. But many consume between two and three times that amount.
And Sandon said that recent research reveals that virtually everyone consumes more than the 1,500 milligrams that the Institute of Medicine describes as adequate.
"Adults also exceed the 2005 Dietary Guidelines for Americans of an upper-intake level of 2,300 milligrams of sodium per day," she added. "Most of this sodium is found in processed and preprepared foods, so people are often unaware of how much they are getting."
The FDA has not said how quickly it will decide whether or not to intervene -- so we may continue to be unaware of our sodium intake for some time.
But in the meantime, eating fresh foods and reading nutrition labels closely to avoid products with more sodium could help many improve their health for now -- particularly with regard to high-blood pressure.
"Data from the two Dietary Approaches to Treating Hypertension studies have clearly shown that eating a diet that is high in fruits and vegetables, low in fat and low in sodium will significantly lower blood pressure," said Bonnie Jortberg, senior instructor of family medicine at the University of Colorado at Denver and Health Sciences Center.