From The Chicago Tribune
Doctors hoping to dash salt's `safe' label
Though 2,300 mg is the recommended upper limit, average Americans ingest 4,000-6,000 mg a day. Experts say enough.
By Bruce Japsen and John Schmeltzer
Tribune staff reporters
Published June 13, 2006
Sodium, one of the planet's oldest substances, may be the American diet's newest enemy.
The American Medical Association is expected this week to call for a 50 percent reduction in sodium in processed foods and restaurant meals with the goal of reducing hypertension and, ultimately, cardiovascular disease, the No. 1 killer of men and women.
The nation's largest doctor group also is urging the Food and Drug Administration to improve sodium labeling to help consumers lower their consumption. Some AMA members are urging the agency to go so far as revoking a regulation that considers salt to be "generally recognized as safe" and permits food manufacturers and restaurants to use it without limits.
The AMA's 544-member House of Delegates, meeting in Chicago this week to determine association policies, could vote on the matter as early as Tuesday.
Although an AMA policy stance cannot force action, the national group representing 250,000 physicians has clout in Washington. Its support could embolden health policymakers and make it hard for the FDA not to at least look into the sodium issue, observers say.
Strict sodium rules could have huge implications for foodmakers, many of whom are still retooling products to reduce the amount of transfat, the last dietary villain to join the band of outlaws that includes fat, carbohydrates and cholesterol.
"I think this is going to be like cholesterol was 25 years ago, because people know what cholesterol levels should be and they should know the same about salt," said Dr. J. Chris Hawk, a general surgeon and member of the AMA's Council on Science and Public Health, which wrote the AMA's proposed recommendations on sodium.
"We realize salt is bad even if you don't have high blood pressure. We need to get the word out to the public, but we need to encourage and work with the food manufacturers to lower what is generally accepted."
If sodium guidelines are lowered, U.S. consumers, food companies and restaurants might have some serious work to do. The AMA report found that modern food processing and preparation practices raised sodium levels in diets around the world.
The dietary guidelines introduced last year by the government call for a maximum of 2,300 milligrams of sodium, or a generous teaspoon of salt, per day for most adults. Someone who eats one of McDonald's new premium crispy chicken club sandwiches has reached 80 percent of their allowance. American adults average 4,000 to 6,000 milligrams daily.
The guidelines set an even lower limit of 1,500 milligrams of sodium per day for people with high blood pressure, blacks and middle-age and older adults.
Richard L. Hanneman, president of the Salt Institute, (an organization formed to market and promote salt), said the AMA is misguided in its efforts to reduce sodium levels in foods.
"There is no evidence that reducing dietary sodium will produce any beneficial health effects for the American public," he said (although there has been incontrovertible evidence).
"Only one study out of 13 had shown a link between a low-sodium diet and a reduced incidence of stroke or heart attack." (Mr. Hanneman was referring only to 13 studies he selected.)
At the very least, the AMA will discuss with the FDA ways to improve labeling to clarify the amount of sodium in foods and "develop label markings and warnings for foods high in sodium," indicates a 25-page report compiled by the AMA reference committee on science and public health issues on sodium intake.
Some AMA delegates believe food companies, restaurants and the FDA should highlight the amount of sodium in products just like they have done with transfat. It is not uncommon to see the words "transfat" highlighted or put in bold print on processed-food packaging or labels.
"It's amazing how successful that is," said Dr. John Schneider, a member of the Illinois State Medical Society board and chairman of the AMA's Council on Science and Public Health. "We hope the same thing happens with sodium. If we can reduce overall intake of sodium, we can help people live healthier lives."
Manufacturers say they already are seeking to reduce sodium levels in the foods they produce, though it could be harder than addressing the transfat issue, which required manufacturers to find a suitable oil to substitute. There is no substitute for sodium, which frequently is used as a flavor enhancer rather than to provide saltiness.
Later this summer, the Campbell Soup Co. is expected to introduce a line of soups using sea salt, which has naturally lower levels of sodium, dropping sodium levels by 25 percent in a serving of soup typically containing 700 to 1,000 milligrams.
"Reformulating products to reduce sodium is a top priority," said Stephanie Childs, a spokeswoman for the Grocery Manufacturers Association. "Some companies are increasing the level of potassium, a product that is known to blunt the effect of sodium."
Increasing the amount of potassium, magnesium and calcium, all of which cut the impact of sodium, was recommended last year by the government when it introduced the dietary guidelines.
Northfield-based Kraft Foods Inc. said it is reviewing its products to improve their nutritional profiles. It has rejected new products that don't meet certain health guidelines, according to the company.
"We have developed nutrition guidelines for new products establishing upper limits for calories, fats, cholesterol, sugars and sodiums," said spokeswoman Sydney Lindner.
Michael Jacobson, executive director of the Center for Science in the Public Interest, a Washington-based public interest group, applauded the AMA's efforts.
"The AMA is focusing on one of the biggest dietary problems in this country," he said, noting the center unsuccessfully sued the FDA last year seeking to force revocation of salt's "generally safe" rule.