Salt Shakedown: Institute of Medicine Urges FDA to Regulate Sodium

April 20, 2010— -- An Institute of Medicine report that urges the government to set limits on the amount of salt in processed foods could spur a new wave of food regulation -- one that could save hundreds of thousands of American lives from heart attack and stroke, doctors say.

The new report calls on the U.S. Food and Drug Administration to regulate the amount of salt added to foods and gradually decrease sodium content as American palettes adjust to the change.

The authors of the report said such industry-wide regulation -- which they suggest could take place gradually, to allow consumer tastes to adjust -- will be necessary to cut salt consumption among the general public, as education campaigns have not worked.

"There have now been three of four analyses done differently about this, but have all reached the same conclusion -- if you reduce sodium, you'll be healthier," said Dr. Lawrence Appel, a professor at Johns Hopkins and a member of the IOM committee that drafted the report. "This is the first report that provides a roadmap on how to actually accomplish the reduction."

Physicians applauded the report.

"I think the impact could be considerable," said Dr. Howard Weintraub, clinical director of the New York University Center for the Prevention of Heart Disease at the NYU Langone Medical Center. "When you think about it, the major cause of death in this country is cardiovascular disease... Decreasing the number of cardiovascular events in this way is a move that costs the government not a penny, and it will not make the American public feel as if they are inhibited or being subjected to a culinary concentration camp."

"We have known for years from scientific studies about the conditions that are brought about by excess sodium consumption, like heart attack and stroke, so there is no controversy there," said Dr. Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic in Rochester, Minn. "There is no controversy about how reducing sodium levels in the diet can also reduce these events."

Salt Limits May Save American Lives, Doctors Say

Hayes said that even a 10 percent reduction in sodium intake across the U.S. population could save a million people from heart attack and stroke each year, and it could rack up billions in cost savings from preventable illnesses.

Likewise, lawmakers who championed the effort said the recommendation is a good one.

"Removing the barriers to healthy living leads to longer, healthier lives and lower health care costs down the road," said Senator Tom Harkin, D-Iowa, during a press conference held by the consumer group Center for Science in the Public Interest. "It is difficult for Americans to control the amount of sodium they consume when dangerously high amounts are being added to processed foods. Nearly 80 percent of our daily sodium intake isn't added at the table or during cooking -- it's added in processing plants before it ever gets to us.

"When sodium is so clearly linked to heart disease and strokes, it's time to give Americans more information and better control over their daily intake.

Specifically, the IOM wants the FDA gradually to reduce the level of salt consumption generally recognized as safe. Currently, the agency recommends no more than 2,300 mg per day, which amounts to about a teaspoon.

Most Americans, however, get 50 percent more than that, or about 3,400 mg per day.

So far, the FDA has said it is not currently working on regulations, nor has it made a decision to regulate sodium content in foods yet.

"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 agency said in a statement. "The Department of Health and Human Services will be establishing an interagency working group on sodium at the Department that will review options and next steps."

The IOM says 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."

Will Industry Push Back Against Regulation?

The report is not the first time that the amount of salt in processed food has been thrown into the spotlight. Most recently, a study in January by researchers at the University of California, San Francisco, suggested that trimming salt intake by a teaspoon a day could prevent 32,000 strokes and 54,000 heart attacks a year. Other studies have estimated that population-wide reductions in sodium could prevent more than 100,000 deaths annually.

Because much of Americans' salt intake comes from high concentrations in processed foods and foods prepared in restaurants, consumer organizations like CSPI have long pushed for regulation of sodium levels in these foods.

"Limiting salt in packaged and restaurant foods is perhaps the single most important thing that the Food and Drug Administration could do to save hundreds of thousands of lives and save billions of dollars in health-care expenses," said CSPI executive director Michael Jacobson. "The FDA and U.S. Department of Agriculture should quickly implement the Institute of Medicine's recommendations, starting with mandatory limits on salt, which could be phased in gradually over time."

Meanwhile, some local governments have launched efforts to decrease sodium consumption and raise awareness. New York City, for example, has asked food manufacturers and chain restaurants to reduce sodium by 25 percent in their products over the next five years.

Regardless, many said a certain amount of industry pushback against and broad regulation is to be expected.

"There's probably going to be resistance from the manufacturers, as industry in general is usually resistant to changes," said Dr. Charles Mouton, professor and Chair of the Department of Community Health and Family Practice at Howard University College of Medicine in Washington, D.C.

Appel, however, said that some in the sector may even support the limits.

"There will be pushback, but since the evidence is strong, there is going to be less pushback than you think," he said. "I can see some pushback from industries saying we don't want to do it, but other industries will be saying, 'Health care costs are going through the roof, and this could save us several billions of dollars on health care.'"

Industry-Wide Salt Regulation Could Gain Support

Hayes said that making the regulation an industry-wide initiative could lead to greater acceptance.

"If we work with having all [manufacturers] do this at one time, we will be leveling the playing field, and we can make them feel like they are doing a good thing," she said. "I don't think that the industry wants to be the bad guy."

Scott DeFife, Executive Vice President of Policy and Government Affairs for the National Restaurant Association, which represents the restaurant industry, said in a statement that the organization would be supportive of efforts to lower salt content in foods served in restaurants, provided the changes are gradual.

"We appreciate the Institute of Medicine's (IOM) recommendations to take an incremental approach to decreasing sodium in the nation's food supply and we are committed to working with our members, partners throughout the supply chain, and the Food and Drug Administration (FDA) to address this important issue," DeFife said, adding however that the industry "would have concerns about any potential government mandate that creates a one-size-fits-all rule to ingredient standards or sets arbitrary per item limits that do not reflect the complexity of addressing the nations eating habits and improving overall wellness."