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The Great Salt Wars: How Much Is Too Much?

Don't blame the shaker; blame the can, box and drive-through for all that sodium

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Are Americans addicted to salt? And are U.S. food companies responsible?

At least one group of health experts and consumer advocates say yes to both questions, and they want the government to mandate cuts in the sodium content of all that salty packaged and processed food we keep eating. Doing so, they contend, could prevent 100,000 deaths a year from heart disease and hypertension.

On the other hand, some authorities believe that, while our love affair with salt is worrisome for high-risk groups including people over 50, it’s unnecessary “to put all of the U.S. on a low-sodium diet,” as one nutrition expert put it.

For 40 years, doctors and dietitians have tried—unsuccessfully—to get us to reduce the salt in our diet and food companies to reduce the salt in their products. And yet salt intake is increasing.

A study released last month by the Institute of Medicine found that Americans still consume twice as much salt as the government recommends. “Sodium has so permeated the food supply that it’s hard to reduce it in our diet,” says Jane E. Henney, M.D., chair of the IOM study committee and a professor of medicine at the University of Cincinnati.

From the age of 2 on, most people only need 1,500 mg of salt or the equivalent of half a teaspoon a day, Henney says. Adults in general should consume no more than 2,300 mg (about 1 teaspoon of salt), but currently most are eating 3,400 mg, or about 1 1/2 teaspoons. The study estimated that 100,000 deaths annually could be prevented if the country could reduce its sodium intake.

Cutting back, hard to do

Americans aren’t even quite sure how to cut back on the salty stuff. A recent survey showed that more than half think that using less salt at the table is an effective way to reduce sodium, even though the salt we add while cooking or eating represents only 10 percent of our daily intake. The bulk comes from processed and prepared food, often hidden in unexpected places. Who would guess, for example, that a cup of corn flakes has more salt than an ounce of potato chips? Or that two slices of American cheese on two slices of white bread totals almost 1,000 mg of salt?

While the human body needs some sodium to function properly, the food that comes from a can, bag, box or drive-through frequently has much more salt than necessary.

This is particularly troublesome for people who are salt-sensitive, meaning older Americans, African Americans and those with high blood pressure. For people in those categories—nearly 70 percent of the U.S. population, according to the Centers for Disease Control and Prevention—cutting back on sodium is essential to reducing the risk of heart disease.

Too much salt holds excess fluid in the body, causing the heart to work harder and blood pressure to rise. The risk of heart attack and stroke is increased in those who eat a high-salt diet.

Addicted to salt?

The problem is, the food industry relies heavily on sodium to enhance taste and texture and act as a preservative. Beginning in childhood, we get accustomed—some might say addicted—to the taste of these high-salt processed foods. Food companies argue that cutting back on salt too much will turn foods bland (or worse) and drive away customers. As proof, they point to surveys, like one by market research company NPD Group in April, that show that foods labeled low-sodium are unpopular with consumers.

Consumers themselves are conflicted. Nearly two-thirds are concerned about sodium intake, according to a recent HealthFocus International study, but only 29 percent consistently check the sodium content of foods they eat.

But things may be changing. The FDA last month called on food companies to reduce salt content, and several of the industry’s biggest names–Kraft, Heinz, General Mills, Sara Lee and Campbell’s–have announced slow rollbacks of 10 to 25 percent of sodium content over the next five years.

On Tuesday the Department of Agriculture issued new preliminary dietary guidelines, including lowering the recommended maximum daily intake of salt from 2,300 mg to 1,500 mg. In 2005, the lower figure was recommended for African Americans, people with high blood pressure and middle-age and older adults.

Because 70 percent of the U.S. population falls into one of those categories, the government panel of experts extended the recommendation to the general population.

Henney and others, such as the Washington, D.C., consumer advocate group Center for Science in the Public Interest, say voluntary efforts by industry aren’t enough. The government should set mandatory limits on how much salt can be added to packaged and restaurant food.

Others strongly disagree. “I think we’re overreacting to the dangers of salt. I don’t think we need to put all of the U.S. on a sodium-restricted diet,” says nutrition expert Judith S. Stern of the University of California, Davis, and coauthor of a study last year that questioned the scientific reasoning behind the campaign against salt.

The study, published in October in the Clinical Journal of the American Society of Nephrology, examined sodium consumption studies from 30 countries, as well as research on humans’ innate salt appetite.

The researchers found that, in general, the human body self-regulates its salt intake, keeping it within a safe range and excreting the excess.


Of course, some people are salt-sensitive, Stern notes, and consuming too much salt causes their blood pressure to rise. “Those people should see a doctor,” she notes.

“But if you ask me whether sodium is really an important medical issue, I’d say obesity is my top priority. If you’re overweight and your blood pressure is high, losing weight is going to have much more of an effect” than just cutting back on salt.

Cardiologist Edward M. Geltman, M.D., director of the heart failure program at Barnes Jewish Hospital in St. Louis, takes a middle stance. “If you have normal blood pressure, no heart disease or heart failure, you probably can be reasonably careful about your salt intake,” he says.

But people with borderline high blood pressure “in the high 120s and 130s, need to be careful.” He warns those patients to avoid canned foods, fast food and Asian foods that are high in salt and MSG.

Treating people with high blood pressure can become very expensive, he notes. “It makes sense as public health policy to have people take care of their sodium consumption so that we keep our health costs lower.”

And while he says he’s not averse to government regulation, he thinks better food labels and more education is a more effective tactic. “To regulate how much salt can be added to a pizza is going too far.”

Candy Sagon writes about health and nutrition for the Bulletin.