It has been forty four years since the White House Conference on Food, Nutrition and Health issued recommendations that highlighted the role of sodium in the development of hypertension---a major risk factor for heart disease and stroke and four years since the Institute of Medicine (IOM) released its report, “Strategies to Reduce Sodium Intake in the United States.”
Excessive salt intake robs many Americans of good health and a long life but its economic impact affects us all. Estimates of the direct and indirect costs of hypertension alone have been calculated in excess of 73 billion dollars annually.
Over the years, individual companies such as Kraft, Campbell’s and Walmart have voluntarily lowered the amount of salt in their products, while acknowledging that the playing field needs to be leveled so that they will not be competitively disadvantaged. Similarly, many cities have undertaken initiatives to have the food industry, both the producers and the restaurant industry, lower salt in their products or meal offerings. Such attempts are to be commended but suffer often from sustainability. In the United States, we still seem to be satisfied with these modest voluntary reductions and future commitments by individual companies.
The average American now consumes between 3,500 and 4,000 milligrams of sodium a day—a far cry from the 2,300 mg (about one teaspoon of salt) recommended by the Dietary Guidelines for Americans. Nearly 75 percent of the sodium we consume daily comes from processed foods or restaurant meals—and it is found in food we don’t commonly think of as “salty” such as bread, cottage cheese and breakfast cereals. Even unprocessed fresh lean meats increasingly have been injected with salt or phosphate containing brines to enhance taste.
The IOM committee that I chaired recommended that the Food and Drug Administration use its regulatory authority to require industry to lower the sodium content in our nation’s food supply overtime. We called for the Secretary of Health and Human Services to work with other government agencies and non-government groups to design and implement a nationwide educational campaign to meet the goal of achieving overtime the levels established by the Dietary Guidelines while acknowledging that an educational campaign alone would not be enough without the primary strategy of having mandatory regulations in place. Monitoring the reduction of sodium and measuring and evaluating and making adjustment to the framework if and when necessary were also seen as critical factors in undertaking such an initiative. The need for reductions in sodium in the food supply would likely spur further innovation. New products or technologies would no doubt provide food companies with new alternatives.
Critics of sodium reduction have sought to cast doubt on the science and medical evidence base. However, the studies cited by those with contrarian views have been shown to be flawed. Whether it is the World Health Organization’s guidelines for reducing sodium around the globe or the U.S. process for developing the Dietary Guidelines for Americans, each independent assessment of the science by an authoritative agency leads to a call for strong action.
The nomination of Sylvia Mathews Burwell as Secretary of Health and Human Services provides the Obama Administration with a reset opportunity to move forward on this critical public health goal. Clearly, Burwell is being tasked with preserving the president’s health care reform legacy. Moving forward on sodium reduction, in fact, would complement that with a bold dose of prevention and cement it with a public health legacy of lives saved.
Henney is a former commissioner of the U.S. Food and Drug Administration and chaired the Institute of Medicine’s committee on strategies to reduce sodium in the nation’s food supply.