Sodium reduction standards proposed

by Jay Sjerven
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A panel of the Institute of Medicine (I.O.M.) on April 20 urged the Food and Drug Administration to establish new federal standards for the amount of salt

food manufacturers, restaurants and food service companies may add to their products. The aim was to lower over time per capita consumption of sodium to 2,300 mgs, the maximum level recommended in the Dietary Guidelines for Americans. Currently, Americans on average consume daily 3,400 mgs of sodium, the panel asserted. Excessive consumption of sodium has been associated with the risk of hypertension, heart disease and stroke.

The panel’s report, “Strategies to Reduce Sodium Intake in the United States,” recommended a “stepwise” approach in which the F.D.A. over a period of years would set increasingly lower maximum limits on the allowed sodium content of various foods.

“It is important that the reduction in sodium content of foods be carried out gradually, with small reductions instituted regularly as part of a carefully monitored process,” the I.O.M. panel said. “Evidence shows that a decrease in sodium can be accomplished successfully without affecting consumer enjoyment of food products if it is done in a stepwise process that systematically and gradually lowers sodium levels across the food supply.”

The I.O.M. panel said the reduction in sodium consumption should be accomplished by means of the F.D.A. modifying the generally recognized as safe (GRAS) status of salt, which would require no legislation. Currently, the GRAS status of salt allows it to be used at any level in processed foods or food prepared in restaurants. The panel said the GRAS status should be modified to accommodate steadily decreasing limits on salt content in foods. The panel said the F.D.A. would have to gather and assess “an ample body of data to determine what limits it sets on the mineral’s use in processed foods and prepared meals and what the incremental decreases should be.”

The panel asserted regulatory action was necessary because four decades of public education campaigns about the potential dangers of excess salt and voluntary sodium-cutting efforts by the food industry have “failed to make a dent in Americans’ intake.” One issue has been the fear of food companies seeking to lower the sodium content of their products that they might lose customers to competing products or brands with a higher salt content.

Jane E. Henney, professor of medicine at the University of Cincinnati College of Medicine and chair of the I.O.M. panel, said, “This report outlines strategies that will enable us to effectively lower our sodium consumption to healthy levels. The best way to accomplish this is to provide companies the level playing field they need so they are able to work across the board to reduce salt in the food supply. Lowering sodium by the food industry in a stepwise, monitored fashion will minimize changes in flavor and still provide adequate amounts of this essential nutrient that are compatible with good health.”

The panel also made recommendations on efforts to support the primary objective of lowering the sodium content of food. They included a broad educational campaign in support of the government’s effort, attention to updating food labeling requirements during the transition and enhancing research and monitoring capabilities at the F.D.A. and the U.S. Department of Agriculture.

A story that appeared in the April 20 issue of The Washington Post, just before the panel’s report was officially released, cited sources with the F.D.A. who claimed the agency, along with the U.S.D.A., is set to implement a 10-year program that would phase-down salt use. The initiative would launch later this year, The Washington Post said.

The F.D.A. in response stated, “A story in today’s Washington Post leaves a mistaken impression that the F.D.A. has begun the process of regulating the amount of sodium in foods. The F.D.A. is not currently working on regulations nor have they made a decision to regulate sodium content in foods at this time.

“Over the coming weeks, the F.D.A. will more thoroughly review the recommendations of the I.O.M. report and build plans for how the F.D.A. can continue to work with other federal agencies, public health and consumer groups, and the food industry to support the reduction of sodium levels in the food supply. The Department of Health and Human Services will be establishing an interagency working group on sodium at the Department that will review options and next steps.”

I.O.M. panel members fielded questions about the report during a public meeting at the National Press Club on April 21.

A reporter, pointing to concerns over the extent of obesity among Americans and especially children, asked whether per capita sodium consumption might be more a factor of the volume of food eaten as opposed to the sodium content of individual foods. Dr. Henney said while it certainly would be appropriate to recommend individuals reduce their consumption of foods high in both fat content and sodium, the amount of sodium consumed exceeded the limit specified in the Dietary Guidelines for Americans by such a wide margin it required the special attention.

An individual from ConAgra Foods, Inc. asked what evidence there was the panel’s proposed approach of ratcheting down maximum allowable levels for sodium would work. Panel member Gary K. Beauchamp, Monell Chemical Senses Center, Philadelphia, answered saying there were several studies and clinical trials supporting the assertion if sodium levels in foods were to be reduced gradually, in a step-by-step process over the course of years, individuals might not detect the change in sodium content from one step to the next. Over time, it was expected there would be a population-wide change in taste preference with regard to the amount of sodium people would require or desire in their food for it to taste good.

A questioner from General Mills, Inc. asked if there was a timeline for the adjustments down to the 2,300-mg limit to be accomplished. Dr. Henney pointed out the panel made no recommendation with regard to a specific timeline, but she said the panel did urge the F.D.A. to act expeditiously to begin the process and encouraged the food industry to continue voluntary steps to reduce sodium content in their foods in the interim.

In response to a question about the costs of the proposal, panelists acknowledged there would be costs borne by industry related to reformulating food to reduce sodium content, and some of the increased costs might be passed on to the consumer. At the same time, they said those costs must be weighed against the expected benefits from decreased health care costs.

A reporter asked how the panel proposed to secure restaurant compliance and cooperation with the initiative. Dr. Henney said restaurant chains with menus that apply to several outlets should not find compliance difficult, especially if the ingredients they purchase follow the step-by-step reduction process, but she acknowledged there would be more difficulties with regard to stand-alone restaurants. Dr. Henney said there must be outreach to owners and chefs of such restaurants to educate them on why the sodium issue is so important.

Senator Tom Harkin of Iowa, chairman of the Senate Committee on Health, Education, Labor and Pensions, welcomed the I.O.M. panel’s recommendations.

“Removing the barriers to healthy living leads to longer, healthier lives and lower health care costs down the road,” Mr. Harkin said. “It is difficult for Americans to control the amount of sodium they consume when dangerously high amounts are being added to processed foods.  Nearly 80% of our daily sodium intake isn’t added at the table or during cooking. It’s added in processing plants before it ever gets to us. When sodium is so clearly linked to heart disease and strokes, it’s time to give Americans more information and better control over their daily intake.  This is good commonsense and it is a wise investment in our public health, too.”

The Grocery Manufacturers Association said in a statement that it shares the I.O.M.’s goal of helping consumers reduce their sodium intake.

“For years, food companies have been introducing a wide variety of new products into the marketplace, including reduced sodium, containing no sodium or low sodium, or with no added salt,” the G.M.A. said. “During that time, food companies have been very successful at making incremental reductions in sodium levels in food products that maintain consumer taste preferences.”

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