By AMERICAN HEART ASSOCIATION NEWS

0601-News-FDA_WP

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The federal government has proposed voluntary new targets for restaurants and food manufacturers to gradually lower the amount of salt in their products, the latest in a series of significant moves aiming to reduce sodium in the U.S. food supply.

High sodium intake has become an increasingly important health issue because of its proven link to high blood pressure, a leading cause of heart disease, stroke, kidney disease and other problems. According to the landmark 2010 report from the Institute of Medicine, population-wide sodium reduction could prevent 100,000 deaths a year.

Federal officials say Wednesday’s announcement is an important step toward lowering salt in processed and restaurant foods, where Americans get more than three-quarters of the sodium in their diets.

“Many Americans want to reduce sodium in their diets, but that’s hard to do when much of it is in everyday products we buy in stores and restaurants,” U.S. Health & Human Services Secretary Sylvia Mathews Burwell said in a news release. “Today’s announcement is about putting power back in the hands of consumers, so that they can better control how much salt is in the food they eat and improve their health.”

Most Americans consume more than 3,400 milligrams of sodium a day, which far exceeds recommendations from the government (2,300 milligrams) and the American Heart Association (1,500 milligrams for ideal heart health). The Food and Drug Administration’s new targets are intended to help Americans achieve a daily goal of no more than 3,000 milligrams in two years, and 2,300 milligrams in a decade.

The voluntary targets are “draft,” meaning the FDA may alter them based on input from industry, public health organizations and the public.

Mark Creager, M.D.

Mark Creager, M.D.

“This is a movement in the right direction,” said AHA President Mark A. Creager, M.D., director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center. “There’s been substantial scientific research that shows when individuals consume a low-sodium diet compared to a high-sodium diet, their blood pressure is lower. We encourage the public to reduce their intake of sodium to lessen their risk of high blood pressure and its consequences.”

There currently is no limit on how much salt a food producer can put in a product. For example, a single slice of pepperoni pizza could have more than 800 milligrams. Two slices of sandwich bread could total over 300 milligrams.

The FDA has been mulling the voluntary sodium levels for years. Last year, the Center for Science in the Public Interest sued the agency for its failure to answer its 10-year-old petition asking for restrictions on salt.

“While this is a voluntary approach as opposed to the mandatory approach we asked for and that the Institute of Medicine endorsed, it provides clear goals by which companies can be held accountable,” said Michael F. Jacobson, the center’s president, who added that he hopes industry will work cooperatively with the FDA and health experts toward these goals.

Asked by reporters why the move was voluntary instead of mandatory, officials pointed to the need for further work with food makers.

It’s a complex discussion because sodium is used in many different products for flavor, texture and preventing microbial growth in foods, said Susan Mayne, Ph.D., director of the Center for Food Safety and Applied Nutrition at the FDA.

“Some of the targets may require technological advances, which is why time is given to manufacturers,” she said. “We don’t know the exact cost to the food industry. The health benefits will outweigh any costs that occur.”

FDA Commissioner Robert Califf, M.D., said he expects food producers to help the reduction process along.

“I don’t expect industry to sit on the sidelines on this,” he said. “They’ll do themselves well if they participate.”

Plus, voluntary reduction has been shown to work before, said Thomas Frieden, M.D., director of the Centers for Disease Control and Prevention. He pointed to the 15 percent drop in daily sodium among Britons when the United Kingdom set voluntary targets between 2003 and 2011.

“There’s a very robust body of evidence that supports the benefit of sodium reduction,” he said.

Meanwhile, numerous U.S. manufacturers already have been working toward lower-sodium options. Among the major companies that have recently joined the long and growing list are Nestlé, which is the world’s largest food and beverage company; Mars Food; General Mills; Unilever; and PepsiCo.

AHA CEO Nancy Brown, whose organization has long advocated for lower salt levels in the food supply, applauded the FDA’s move and urged the agency to finalize the targets soon.

“These new targets will spark a vital, healthy change in our food supply, a change consumers say they want,” Brown said in a statement, adding that lowering sodium levels could eliminate 1.5 million cases of uncontrolled hypertension and save billions of dollars in healthcare costs over the next decade.

“This gradual reduction will not only give industry the time it needs to update products, it will also give consumers time to adjust their taste buds and better digest the changes,” Brown said. “If the industry embraces these new voluntary targets, they can level the playing field and provide the public with better choices.”

Some critics question whether sodium reduction truly results in a health impact.

Lori Roman, president of the Salt Institute, an industry trade organization that advocates benefits of salt, in April urged federal officials not to make the recommendation. She also questioned sodium limits set by a vast number of health and governmental organizations, saying they were not based on a “thorough, unbiased evaluation of available science.”

The Grocery Manufacturers Association, which represents food and beverage makers, also has questioned the link between sodium and health but says it is committed to adding healthier choices.

Leon Bruner, the association’s chief science officer, said member companies have offered 6,500 options with lower sodium since 2002.

“We welcome a dialogue with FDA on its sodium reduction targets and look forward to working with the agency to ensure the best and most recent science is taken into account when determining sodium intake levels for optimal health for all Americans,” Bruner said in a statement.

Cheryl Anderson, Ph.D.

Cheryl Anderson, Ph.D. (Courtesy of UCSD)

The CDC says about nine in 10 U.S. adults and children eat more sodium than is recommended.

The voluntary targets could help address that and are certainly merited based on the science, said Cheryl Anderson, Ph.D., associate professor in the Department of Family Medicine and Public Health at the University of California San Diego.

“I don’t know that anyone who has read the literature and comprehends it properly can doubt that there’s a direct, established and progressive relationship between sodium and blood pressure – it’s not up for debate,” she said.