Opinion

Time to pinch off the salt

The AMA calls on the FDA to revoke salt's "generally recognized as safe" status to allow more regulation of sodium in food.

Posted Jan. 14, 2008.

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One in three Americans has hypertension. The condition puts them at greater risk of developing two of the country's major killers -- heart disease and stroke.

Excess salt, as it so happens, increases a person's chance of getting high blood pressure. Research shows that most Americans consume two to three times the healthy level of sodium, which is 1.5 grams a day. Indeed, more than 95% of men and 75% of women regularly consume more than the tolerable upper intake level of 5.8 grams a day, according to the Institute of Medicine.

"The deaths attributable to excess sodium intake represent a huge toll -- the equivalent of a jumbo jet with more than 400 adults crashing every day of the year, year after year," noted Stephen Havas, MD, MPH, American Medical Association vice president for science, quality and public health.

The link between salt and hypertension, with its risks of death and disability, has led to a call by the AMA, along with other health and consumer organizations, to reduce the amount of salt added to food.

The overconsumption problem isn't caused by the salt shaker at the dinner table. The sprinkle on the plate and the pinch added during cooking account for only about 5% to 10% of a typical person's sodium intake. The main culprits are restaurant and processed foods -- responsible for about 75% of salt in the American diet. (Sodium that is naturally present in foods makes up the rest.)

This reality means that strict limits on salt in restaurant and processed foods are needed. The AMA recommends that the Food and Drug Administration revoke the "generally recognized as safe" status of sodium, a position the Association has held since 2006. This move would allow the agency to develop regulatory measures to restrict the amount of salt in processed foods.

The FDA is weighing this approach now as the result of a legal petition by the Center for Science in the Public Interest. It asks the agency to end sodium's "safe" status and treat salt as a food additive subject to more regulation.

The FDA held a hearing in late November seeking input from the various interested parties. The AMA testified in favor of the center's petition.

Association policy also calls on the FDA and manufacturers to work toward a minimum 50% reduction of the amount of sodium in processed foods, fast foods and restaurant meals over 10 years. Achievement of this goal could save at least 150,000 lives annually, Dr. Havas says.

The AMA wants interested stakeholders to create partnerships to educate consumers on the short- and long-term benefits of reductions in sodium intake. It also calls for the FDA to improve labeling and develop front-of-package warnings for high-salt foods.

Organizations fighting against more regulation argue that sodium is necessary for food safety and would not be easy to replace in processed foods. Reducing salt too much can have negative health effects, such as increased insulin resistance, according to these groups. The flaw in this logic, however, is that no one is calling for sodium's elimination.

Advocates for salt restrictions recognize sodium's importance in the human diet and as a food preservative. The AMA, the American Public Health Assn. and others are simply arguing for bringing salt levels within the healthy range. The risks are so high that the time for action is now.

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External links

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

Institute of Medicine Report, "Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate" (link)

"Reduce Salt and Sodium in Your Diet," part of the National Heart, Lung and Blood Institute guide to lowering blood pressure. (link)

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