Putting away the salt shaker

The AMA is backing a new set of recommendations to reduce sodium intake and improve health.

Posted Aug. 28, 2006.

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Watch the salt!

It's an admonition that is not all that new. As a matter of fact, you likely repeat it to your patients many times a day.

What is new, though, is that the AMA House of Delegates endorsed during its Annual Meeting in June a set of recommendations to strengthen this plea by calling on the food and restaurant industries, as well as government regulators, to join forces to reduce the nation's collective salt intake.

The AMA has in the past called for reductions of sodium in processed foods. But this is the first time it has made such specific asks. It's a position that represents an amplification of long-standing worries that surround the link between sodium consumption and hypertension, which, ultimately, can lead to cardiovascular and kidney disease. It is also a timely step forward in efforts to curb one of the leading causes of death and disability in the United States.

According to the National Heart, Lung and Blood Institute, roughly 30% of U.S. adults have hypertension. In addition, more than 910,000 Americans die of cardiovascular disease each year.

Salt and sodium intake, of course, contribute to these staggering numbers. A Council on Science and Public Health report on the subject released at the June meeting concluded that, across populations, the level of blood pressure, its incremental increase with age, and the prevalence of hypertension are all related to salt intake.

Additionally, the council notes that the need to limit sodium intake to less than 2.4 grams daily, an amount equivalent to 6 grams of salt, is agreed upon by many scientific organizations and governmental agencies as a means to address this risk. However, a 2004 Institute of Medicine report found that 95% of men and 75% of women regularly surpass this upper limit of salt intake.

And much of this salt -- sodium -- is the result of amounts added during food processing and preparation.

The House of Delegates' action is an important step. The recommendations should be viewed as a green light encouraging the dialogue necessary to minimize this risk factor for hypertension to at long last begin.

According to AMA policy, this dialogue should involve the following goals: First, a minimum 50% reduction over the next decade in the amount of sodium in processed foods, fast-food products and restaurant meals without increasing levels of other unhealthy ingredients. Food manufacturers and restaurants should review their product lines and reduce sodium levels to the greatest extent possible.

But it doesn't stop there. The AMA also urges the Food and Drug Administration to revoke the "generally recognized as safe" status of salt and to develop regulatory measures to limit sodium in processed and restaurant foods. The AMA also will discuss with the agency ways to improve labeling to make clear the amount of sodium contained in processed food products and to develop label markings and warnings for foods high in sodium.

Last but not least, education is another key element. To this end, the Association will work with the FDA; the National Heart, Lung and Blood Institute; the Centers for Disease Control and Prevention; the American Heart Assn.; and other partners to help consumers understand the benefits of long-term, moderate reductions in salt or sodium in their diets.

This final piece may be one of the most significant if this public health goal is to be achieved. After all, success at reducing salt intake is only one part of a necessary comprehensive strategy to lower blood pressure.

Patients also need to increase their physical activity, consume a diet high in fruits and vegetables and low in saturated and total fat, and be moderate in their alcohol consumption. The combination of these actions will help people prevent or manage hypertension and also reduce its impact on cardiovascular disease.

The AMA's efforts to buttress these lifestyle efforts by urging change within the food and restaurant industries will go a long way to changing people's diet and health for the better.

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External links

"Promotion of Healthy Lifestyles I: Reducing the Population Burden of Cardiovascular Disease by Reducing Sodium Intake," report 10 of the AMA Council on Science and Public Health, June (link)

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