September 13, 2006
New York Times
The War Over Salt
By MELANIE WARNER

FRANK HALL knows he probably should not eat Hungry-Man dinners. The frozen meals have as much as 2,230 milligrams of sodium per serving — far more than the government’s recommended daily allowance for older people — and Mr. Hall’s doctors have advised him to strictly limit salt consumption to help keep his blood pressure down.

But once a week, when grocery shopping with his granddaughter, Mr. Hall, who is 80 and has heart disease, tosses one or two of the big blue packages in his cart anyway.

Sprinkled into everything from bread to cheese, soups and breakfast cereal, just about every fast-food restaurant meal and now even fresh cuts of meat, salt is ubiquitous in the American food supply. And according to government data, Americans eat far too much of it.

Now the nation’s largest doctors’ group, the American Medical Association, is going after the government and the food industry to reduce what it sees as a persistently high level of salt in many processed foods.

Specifically, the medical association, which had never before called for regulation of a food ingredient, asked the F.D.A. to revoke salt’s long-time status as a substance that is “generally recognized as safe,” a classification that warrants little oversight. Instead, the F.D.A. should regulate salt as a food additive, the medical group said.

If the recommendation were adopted, packaged-food companies would have to adhere to limits on allowable sodium levels for various categories of food, and speed up the search for an alternative to salt as a preservative and flavor enhancer.

The initiative has thrust salt into the limelight as a public health concern and raised questions over how attentive the F.D.A. has been to the problem of excess sodium consumption.

In response, the F.D.A. says that within the next few months it will solicit comments in preparation for a hearing or workshop on the health concerns about salt, something the agency has never done before. The food industry, which adamantly opposes any regulation of salt, is lobbying the government to stop any attempts to force companies to limit salt in food.

Last month, the head of the Salt Institute, Richard L. Hanneman, met with Dr. John O. Agwunobi, the assistant secretary for health at the Department of Health and Human Services, to lobby against salt regulation by the F.D.A.

Mr. Hanneman said he argued that the science did not support reductions of salt across the board. He is in the same camp as a minority of scientists, some of whom are consultants to the Salt Institute, who question whether lowering salt consumption would benefit large numbers of people.

Mr. Hanneman instead pushed for the health agency to finance a comprehensive study on the overall health effects of reducing salt.

“There are a variety of effects that can happen with lowering sodium, some of them negative, so I don’t think we should be just considering the one effect of lowering blood pressure,’’ said Dr. Michael H. Alderman, professor of epidemiology at the Albert Einstein College of Medicine in the Bronx. Dr. Alderman says he is a consultant to the Salt Institute but that he is not paid for his work.

Dr. Agwunobi did not return calls seeking comment.

Most other health experts, however, long ago accepted that excessive sodium consumption leads to various health problems. Along with the American Medical Association, groups like the National Academy of Sciences’ Institute of Medicine and the government’s National Heart, Lung and Blood Institute say it has been known for at least two decades that salt-induced high blood pressure, or hypertension, is a significant contributor to heart disease and stroke, the No. 1 and No. 3 causes of death in the United States. (Cancer ranks second.)

In 2004, researchers at the National Heart, Lung and Blood Institute published a study in The American Journal of Public Health concluding that 150,000 lives could be saved annually if sodium levels in packaged and restaurant foods were cut in half.

The government’s dietary guidelines say that the average young adult should eat less than 2,300 milligrams of sodium a day and that the threshold should be 1,500 milligrams for certain people — those with high blood pressure, African-Americans (who are at higher risk for hypertension) and anyone middle-aged or older. Yet, on average, Americans consume more than 3,300 milligrams of sodium a day, compared with 3,100 milligrams in 1994, according to the Centers for Disease Control and Prevention.

About three-quarters of the salt Americans consume comes from processed food, according to the Department of Agriculture. No more than 10 percent comes out of the salt shaker, and another 10 percent is contained naturally in foods.

“Many thousands of Americans die each year due to cumulative health effects from the excessive sodium in our food supply,” said Dr. Stephen Havas, vice president of science, medicine and public health at the medical association and one of the champions of the salt project. “There have been repeated calls over the last 25 years for the F.D.A. and the food industry to take actions that would reduce these unnecessary deaths. As a physician, it’s very hard for me to understand why these groups have not addressed this critical public health problem.”

Laura M. Tarantino, director of the office of food additive safety at the F.D.A., called the prospect of rescinding salt’s “safe’’ status difficult because it would require writing regulations for a “very complex issue.” At the American Medical Association meeting in June, an agency representative urged the association not to recommend removal of sodium’s safe status, and instead to allow the F.D.A. to “explore all options.”

Ms. Tarantino said that the F.D.A. had been attentive to the salt issue. Sodium must be listed on the nutrition label of all packaged food, she said, and in 1993 the agency created an official definition for low-salt products.

Some critics are skeptical that the F.D.A. will do much beyond hold a hearing. Michael F. Jacobson, executive director of the Center for Science in the Public Interest, a nutrition advocacy group often critical of the agency and the food industry, said he first tried to get the F.D.A. to do something about salt in processed food 23 years ago.

“Sodium should be way at the top of the list at the F.D.A. and it’s not even on it,” said Mr. Jacobson. The agency’s Center for Food Safety and Applied Nutrition has never included salt on its annual list of priorities, he said.

Mr. Jacobson says he thinks such passivity stems from a lack of resources and an unwillingness among top agency officials to take on the food industry. “They know that if they say they’re going to regulate salt, they’re going to have a battle on their hands,” he said.

Others in the food industry who have worked with the F.D.A. see an agency faced with a shrinking budget and a growing number of priorities. “My impression is that there are a lot of well-meaning people at the agency who have a lot on their plate,” said Cynthia Harriman, director of food and nutrition strategies at Oldways Preservation Trust, a policy research organization that focuses on food issues, which, along with the industry-supported Whole Grains Council, has developed standards for the use of the words “whole grain” on food packages, largely because the F.D.A. was not moving to create a formal definition.

In recent years, financing for the agency’s Center for Food Safety and Applied Nutrition, the division where most food regulation takes place, has declined to a projected $25 million for fiscal 2007, which begins Oct. 1, from $47.6 million in 2003.

Food companies say that reformulating foods with less salt while still making them tasty is extremely challenging. “Unlike the mechanism for sweetness, the science of salt taste is not well understood, so it’s really difficult to find a substitute,” said George Dowdie, vice president of research and development at Campbell’s Soup.

Mr. Dowdie says that Campbell’s Soup has been searching for decades for the aspartame or sucralose of salt — an ingredient that is not the real thing, but tastes very much like it.

The company has devised other, less perfect solutions. One is a concoction of naturally lower-sodium sea salt and various flavorings that allow for 25 percent salt-reduced versions of several of the company’s popular condensed soups.

ConAgra Foods says that, within the last year, it has quietly cut sodium by 18 percent in its Kid Cuisine frozen meals, by 14 percent in its Chef Boyardee products and by 19 percent in its Banquet brand of frozen dinners.

Those reductions might be even greater were it not for a long history of consumer rejection of lower-sodium products. In 2003, ConAgra says, it abandoned a version of its Healthy Choice Chicken Noodle soup that had 360 milligrams of sodium per serving because sales were dismal. Similarly, in 2001 General Mills introduced three varieties of Hamburger Helper that had 25 percent less sodium, only to withdraw the products from shelves less than a year later.

The War Over Salt - New York Times