Sodium Shakeout: Salt and Health

On June 13, 2006, the American Medical Association (AMA), Chicago, issued a statement taking the food industry to task for, in the words of AMA board member J. James Rohack, “their current practice of adding unhealthy amounts of sodium to their products.” The group then outlined a list of remedies, including halving the sodium in foodservice and processed foods over the next decade, stepping up education efforts to inform consumers about the benefits of moderate sodium reduction, and clarifying labeling vis-à-vis sodium, with warnings added to the most egregiously saline offenders.

With 65 million American adults—almost one-third of us—suffering from hypertension, and with hypertension tied to America’s No. 1 killer, cardiovascular disease, stroke and other conditions, the implications for healthcare costs alone warrant taking the issue seriously. Thus, the National Heart Lung and Blood Institute, America Heart Association, and the 2005 U.S. Dietary Guidelines for Americans all recommend that healthy people consume no more than 2,300 mg of salt (about 1 teaspoon) per day. Groups at particular risk, such as African Americans, the middle-aged and elderly, and those with high blood pressure, should pare back even more, to fewer than 1,500 mg.

Unfortunately, such reductions are beyond what most Americans can effect simply by wrapping the salt shaker in duct tape. Widely cited figures from the Center for Science in the Public Interest (CSPI) lay about 77% of the sodium blame on processed and restaurant foods, with only 5%, 6% and 12% coming from cooking, table use and natural sources, respectively. Salt, quite frankly, is everywhere. In an analysis of more than 550 commercially prepared foods in 2005, CSPI found that even one dish could bump you near or over your daily recommendation, including: Swanson’s Hungry Man XXL dinners, 3,180 mg to 5,410 mg; and Denny’s Lumberjack Slam breakfast: 4,460 mg.

If these numbers make industry insiders blanch, imagine how they’d surprise consumers relatively untrained in label reading. They may not identify monosodium glutamate (MSG), sodium benzoate, disodium phosphate, or even baking powder and baking soda as sodium sources. Of those who do recognize deli meats, salty snacks, condiments and TV dinners as potential salt bombs, few would likely suspect “natural” foods such as artisan breads, cheeses and buttermilk of the same offense.

An excess of dietary sodium may be a symptom not only of the public’s willful ignorance as to the composition of their favorite prepared foods, but of their growing dependence on those same conveniences. As more countries become as rich, busy and impatient as we are, they’ll be eating more processed foods, too. That means the need to cut salt will extend beyond postindustrial societies in the United States and Europe to touch the whole globe.

In salute to salt

Before we get carried away, let’s step back and look at the bigger picture. It’s not for nothing that, upon suffering a heart attack, “the first thing they do is hook you up to a saline solution,” says Reid Wilkerson, president, McClancy Seasonings, Fort Mill, SC.

The science surrounding salt, sodium and health isn’t a closed case. “You’ll see an article one day that says that nobody should have sodium, and then the next one says that it’s good for you,” laments Naomi Novotny, vice president and co-founder, SaltWorks, Woodinville, WA.

“Sodium has been in discussion for many years, and the problem is that it’s a very controversial discussion,” agrees Markus Eckert, technical vice president, flavors, Mastertaste, Teterboro, NJ. “There have been studies for many years already showing that it can lead to cardiovascular health issues.” However, “there have been other published studies that followed subjects on low-sodium diets for several years and found that, actually, the risk for cardiovascular health issues is higher here than for regular diets.”

In one such study, published in 2006 in the online version of the American Journal of Medicine (119(3): 275.e7-275.e14), researchers at the Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, studied survey data from the second National Health and Nutrition Examination Survey (NHANES II) and found that, among 7,154 survey participants, those who consumed less than 2,300 mg of sodium per day were actually 37% more likely to have died from CVD. The researchers acknowledged it wasn’t a clinical trial, nor did they propose that the results dictate sodium nutrition policy. They did point out that their findings cast some doubt on across-the-board advice to lower sodium consumption.

“The critical consensus seems to be that, if you’re sensitive to sodium or you have certain risk factors associated with coronary health, sodium just adds to the problem,” says Otis Curtis, business development manager, DSM Food Specialties, Savory Ingredients, Eagleville, PA. For the rest of us, attention to nutrition labels might prove more prudent.

As George Lutz, technical services manager, quality assurance, Cargill Salt, St. Clair, MI, says: “Medical science has shown that the human body requires sodium and chlorine to live.” For sodium, that requirement tops out at about 500 mg—around 1/2 gram, or less than 1/3 teaspoon—per day. “Without the proper electrolytic balance of sodium in blood serum and potassium in cells, we can become ill,” he says. Thus, the elimination of salt from food is inadvisable. Ultimately, “the solution to health cannot focus on eliminating or decreasing any one component in the food chain,” he says. “The answer lies in living a balanced lifestyle and eating a variety of foods.”

So, following the AMA’s 2006 sodium statement, the Institute of Food Technologists, Chicago, offered a voice of reason by noting that we do not now consume substantially more (or, alas, substantially less) salt than we have over the past quarter century. Other food industry organizations, such as the Grocery Manufacturers/Food Products Association, Washington, D.C., and the Salt Institute, Alexandria, VA, issued rejoinders of their own, with the latter’s president, Richard L. Hanneman, going so far as to call the AMA’s recommendations “scientifically unjustified and a waste of time and money.” Ouch.

Web resources:

“Sodium Shakeout: Savory With Less Salt”

Salt Institute 

INTERSALT: International Study of Sodium, Potassium, and Blood Pressure 

“Worth Its Salt”

“The Many Benefits of Salt”

Additional resources:

Salt products

Salt substitutes