Aldosterone plays a major role in the maintenance of electrolytes and fluid balance and subsequent blood pressure control. Epidemiological studies that explore the connection between hypertension and cancer have found a higher rate of cancer-related mortality in hypertensive patients that have an elevated level of aldosterone. Recent research indicates that this may be the result of aldosterone-mediated damage to chromosomes and DNA in kidney cells.
For most people, the renin-angiotensin-aldosterone system is activated when our salt consumption drops below current levels. Although cardiovascular issues were always considered to be a possible unintended consequence of salt reduction, this study is one of the preliminary indications that an increase in cancer-related mortality may be a consequence as well. The Salt Institute will maintain a watching brief on the clinical research carried out in this area.
The impact of salt on health has been reviewed on a number of occasions over the years with mixed results. The latest meta-review of the evidence was commissioned by the German Ministry of Health just last year and concluded that population-wide salt reduction was not justified from a public health point of view. The controversial nature of the evidence will have great significance for international trade if salt reduction policies are ever enacted. This month's Food Technology Magazine features an OpEd I wrote on this issue.
When the World Trade Organization (WTO) was established in 1995, an international agreement on sanitary and phytosanitary measures (SPS) to reduce risks arising from additives, contaminants, toxins, or pathogens in foods took effect. Intimately linked to the SPS is an additional agreement on Technical Barriers to Trade (TBT), signed in the same year and designed to restrict the use of unjustified measures for the purpose of trade protection.
The aim of the SPS and TBT Agreements is to ensure that regulatory actions are not misused for protectionist purposes and don't result in unnecessary barriers to international trade. The intent is to reduce arbitrary decisions by requiring all health protection measures to be based upon an objective analysis of the preponderance of scientific evidence.
Import regulations that fall under the provisions of TBT or SPS Agreements are typically complex and frequently employ standards that create a high hurdle for imports. Exporters, whose own governments do not implement similar standards, find it difficult to understand the logic or need behind the regulations, so an objective evaluation of the science supporting them goes a long way in resolving disputes.
The core strategy of the recent Institute of Medicine (IOM) Committee report on "Strategies to Reduce Sodium Intake in the United States" is the FDA removal of GRAS (generally recognized as safe) status from salt and the regulation of the amount to be added to each food category. Removing the GRAS status of salt and regulating what is an essential nutrient and arguably the oldest and most ubiquitous food additive in the world will be a monumental task and will undoubtedly have enormous consequences for food and food trade around the world.
Several European countries are major exporters of traditional food products to the U.S. Breads, olives, ham, sausages and cheeses--produced through processes standardized centuries ago--are typical examples. These products and processes are so well established that many are protected with geographic origin designations. Not only are products such as Parmesan and Gorgonzola cheeses, olives, anchovies, prosciutto, and pepperoni consumed directly, but they are also key ingredients in many other products such as pizza and pasta dishes.
These traditional products were developed long before refrigeration. Many employ high salt levels for debittering (olives), curing (hard cheeses), mold culturing (blue-veined cheeses), water activity control (black forest and prosciutto hams, corned beef, salamis, etc.), and storage (anchovies, capers, fish roe, salt fish). The intent of the IOM report makes it unlikely that these traditional products will be permitted. While it is impossible to say whether low-salt variations of these products will achieve market success or whether salt replacement additives will themselves come under regulatory analysis for potential health issues, one thing can be predicted with a fair degree of certainty. Regulation of the salt content of foods will be carefully scrutinized regarding its impact as a non-tariff trade barrier.
For exporters of traditional French, Greek, and Italian foods, the health benefits of the high salt content Mediterranean Diet have been acknowledged for centuries. Despite Americans' stable consumption of salt for the past three decades, ischemic heart disease death rates in the U.S. have fallen precipitously. All of the above are rational reasons to invoke the SPS and TBT Agreements to challenge whether the regulation of salt in foods is an arbitrary measure and an unjustified barrier to trade or one supported by the preponderance of scientific evidence.