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Salt has become one of the largest health concerns for consumers and the food industry alike, joining the ranks of trans fats and high fructose corn syrup. Why? High sodium intake has been linked to high blood pressure, one of the leading risk factors for heart disease. That said, salt is essential for survival and makes our food taste good. While there are studies on decreased salt consumption and a lot of talk about the pros and cons on health, the right path toward establishing the right balance of salt in our diets is still being debated. Most recently, the FDA proposed lowering the Daily Value of sodium from 2400 to 2300 mg – no where near the 1500 mg amount recommended by advocacy groups like The Center for Science in Public Interest (CSPI). We talked to Michael Jacobson, Executive Director of CSPI, and Lori Roman, President of the Salt Institute, about the salt conversation, the confusing path for consumers, and what lies ahead for the much-used mineral substance we call salt.
There seems to be conflicting scientific information out there on the topic of salt. For example, some say reducing sodium can help with blood pressure. Others voice concerns that lowering sodium could increase insulin resistance. How can consumers make sense of all this?
Lori Roman (Salt Institute): There have been studies in recent years that have looked at sodium intake across 45 countries over 50 years showing that virtually everyone in the world eats within a range of 2600 to 4800 mg of sodium a day which has been shown to be the safe zone. The safe zone is that area where you are not so low in sodium intake you are hurting yourself and not so high you are causing any harm. It doesn’t matter the culture or what food they eat, they are in that safe zone. So now we know this, but the U.S. Dietary guidelines drop Americans right into the middle of the danger zone. Their recommendations of 1500 mg are in the danger zone.
Michael Alderman, M.D. and Hillel Cohen, Dr.P.H., M.P.H did a study that showed cardiac patients on low salt diets had a higher number of cardiac events. And Harvard did a study concluding that low salt diets brought the immediate onset of insulin resistance in just seven days. You might think what does it matter what the government says because we know our bodies answer to an authority higher than the FDA. They can tell people to eat only 1500 mg of sodium, but no one is following those guidelines. So one would think the guideline is harmless, but there are people in settings where their salt is restricted based on those guidelines.
Michael Jacobson (CSPI): We are focused on sodium as the single most harmful substance in our food supply. If we could knock sodium levels in half, that would save about 100,000 lives a year. Salt is not a little contaminant. It’s a blockbuster. We base our conclusions on scientific evidence and with sodium, it’s crystal clear. Practically every health agency in the world has identified salt as a problem. We can cut extensive medical costs with lower sodium in the diet especially with packaged and restaurant foods. The Salt Institute has concerns about profits for their companies that manufacture salt.
Lori Roman (Salt Institute): The elderly in nursing homes and assisted living facilities may be harmed because they cannot answer to their biological authority. They are under the nutritional mandate of the nursing home or care facility. They are subject to people answering to a government authority not based in science. This concerns me.
Before I came to the Salt Institute, my dad went into the nursing home because of dementia, no other health problems, and they restricted his sodium intake. He became dehydrated, resulting in kidney infections, eventually resulting in renal failure. When he went into the hospital, he was put on a saline drip with hydration and sodium.
The Food and Drug Administration has begun to look at regulating the amount of salt in processed and restaurant foods as they contribute to 77% of our salt intake. How are fast food restaurants and companies that make consumer packaged responding to this discussion?
Michael Jacobson (CSPI): We did a study in 2013 and found virtually no change since 2005. Since then some of the bigger companies have said they’re lowering sodium content from 10-20% between 2011 and 2015 so it is possible there will be some reductions. Walmart, which sells 20% of all groceries in this country, has told its suppliers that it wants them to lower sodium levels by 2015. In this case, packaged foods can make change faster than the government can impose new regulations. It is critical for companies to address the problem but also critical for the FDA to address the problem.
Lori Roman (Salt Institute): The misinformation from the government and food activists has affected the public perception in such a way that of course companies have to respond to the needs of the marketplace. If the marketplace is demanding lower sodium products because the government and food activists are demanding low sodium diets, then companies are going to satisfy the needs of the consumers. That is normal. That’s just the right thing to do if you are in business. Meanwhile on the other side, one would hope that the government and food activists will acknowledge the research and advocate for science based public policy, not alarmist public policy. They have not gotten the message yet but they are starting to.
Where do consumers fit into all of this? How are they making sense of all the different messaging?
Michael Jacobson: (CSPI) There is very little publicity about the importance of putting away the salt shaker and reading labels carefully. The Center for Disease Control should publicize that kind of message. In absence of a big campaign, consumers have to rely on companies, or even better, not wait for companies, and change their diet. Look for a pasta sauce or a breakfast cereal with lower sodium. Switch from packaged foods to fresh fruits and vegetables. Consumers need to make the change. I understand that a lot of people are holding down two jobs and bringing their kids to McDonalds. That is why we have to lower sodium levels in restaurants and packaged foods. The FDA needs to rattle the food industry’s cage with this.
Lori Roman (Salt Institute): We live in a sound bite society but life isn’t a sound bite. It is more complicated than that. It makes great press for the activists and government bureaucrats to find the ingredient villain of the day. There is no basis in science for this activism going on against a single ingredient that is so essential for life.
Is the government doing enough?
Lori Roman (Salt Institute): It’s probably not surprising that the government is ten years behind on salt research. It is a little scary to think about policy makers ignoring ten years of very solid research showing that the current sodium guidelines are not supported by science. In fact the government guidelines, if followed, could cause great harm. Decades of misinformation have been out on salt, and it will take time for the general public, the medical community and the government to catch up and acknowledge. But it is happening.
Labels should be accurate but when the government is editorializing in a short hand on the label, it sends the wrong message. The government shorthand creates misinformation. You need salt to live, and if you don’t have it you die. For brevity sake, the government inadvertently sends a message that a single ingredient is bad when in the case of salt, that single ingredient is vital to your health.
Michael Jacobson (CSPI): Ten years ago we petitioned the USDA to set limits in cheese, bread and candy to name a few foods. That petition is still sitting at the USDA. The Institute of Medicine said forty years of voluntary action has led to nothing. It’s time for the FDA to regulate sodium. Set some limits, and when the industry has met those limits, lower the limits in some food categories where it is practical. The FDA has not done that yet.
What are the next steps in this debate on salt? More research? Regulations?
Lori Roman (Salt Institute): We learn a lot from animal nutrition when it comes to salt. Ranchers who want to fatten up their livestock reduce the sodium content of the food. For the animal, the natural biological instinct for salt will make them eat more calories to get up to the natural sodium level that they need. If you want to make your animal eat less, you increase the sodium content of the food so they will eat less food to get to their sodium satisfaction level.
We need to take what we have learned from animals and see if a low salt diet makes you eat more calories and therefore contributes to obesity. We had the same situation with the low fat craze. People thought they could eat ten low fat cookies, but it was the calories that made them fat. It is a simple formula – calories in versus calories used – but for awhile the “experts” convinced everyone that low fat foods were the solution, and as a society, we got fatter eating lots and lots of low fat foods.
Michael Jacobson (CSPI): There is talk about the FDA issuing targets, which would urge voluntarily lowering sodium. The problem with voluntary is companies may feel if they lower sodium it would affect the taste of food, and competitors who would not lower sodium will have better tasting products. With regulations, it would be a level playing field, where everybody in the industry is going to do it.