Shaking up our love of salt

Put down your saltshakers, America!

But do it quietly. A stealth war against salt may be in the offing.

Panelists at a School of Public Health (SPH) symposium on May 3 said the best way to get Americans to eat less salt may be to silently cut the amount used in the chips and dips and TV dinners and other processed and ready-to-eat foods we all love.

They suggested the stealth approach because a direct assault hasn’t worked. Research indicates that Americans’ high salt intake is a leading cause of high blood pressure. The research has also shown that reducing the amount of salt we eat will not only help those who already have a problem, but also reduce the natural slow increase in blood pressure as we age.

“Sodium reduction is an effective adjunct to therapy and for some, but not all, can replace medication entirely,” said Lawrence Appel, an associate professor at Johns Hopkins University whose research helped establish the link between salt and blood pressure.

The symposium was the eighth in the SPH’s “Future of Public Health” series. It featured Appel, Margo Wootan, director of nutrition policy for the Washington, D.C.- based consumer advocacy group Center for Science in the Public Interest, and Victor Fulgoni, former vice president for nutrition at Kellogg Co. and consultant to the food industry.

School of Public Health Dean Barry Bloom said that the panel was invited to highlight a case in which a health cause and effect are already known but where many people don’t take advantage of the available information to live healthier lives.

“Eighty to 90 percent of cardiovascular disease can be prevented with what we already know and perhaps 50 percent of cancers. How do we use this information to actually produce an improvement in health?” Bloom said in introducing the panel. “Rather than talk about this in generalities, we wanted a concrete case.”

Panelists said there are several reasons Americans aren’t getting – or aren’t listening to – the message on salt.

First is that a lot of the salt we eat comes from unexpected sources. Salt added in cooking or at the table makes up just 15 percent of the salt in the average diet. It is in processed, ready-to-eat, and restaurant foods that we get most of our salt – about 75 percent.

“Much of the salt intake in this country is out of our control and out of our knowledge,” Wootan said, adding that the average person eats 50 to 60 percent more salt than the recommended 2,400 mg. a day.

Another problem is the publication of recent studies that show that a reduction in salt in the diet may not help everyone lower their blood pressure. While there is individual variation in sensitivity to salt, the panel’s three members agreed that the evidence is overwhelming that eating less salt is beneficial.

The third problem is that the salt industry is a powerful advocate of its product and can finance and publicize its own studies and present enough of an alternate case to muddy the water around the issue.

Fulgoni, who represented the food industry’s point of view, said flatly that “taste rules” when making decisions about food, both by the food industry and by the consumer. And, though some food producers are interested in making healthier products, if it doesn’t sell, it won’t last.

“Taste rules. It is what matters in the food industry. That’s how they evaluate their products, with taste tests,” Fulgoni said. “[Food companies] are in the profit mode. If something doesn’t sell, it’s gone. You’re not going to see products hang around if they’re not making money.”

Though taste rules, you can’t always go by taste in judging the salt content of an item, particularly in restaurants where food doesn’t have an ingredient label. McDonald’s french fries, which taste salty, have less than 390 mg of salt, compared with a McDonald’s Quarter Pounder with cheese, which doesn’t taste obviously salty but which has 1,310 mg of salt.

“Customers can only guess how much sodium they’re actually getting,” Wootan said. “The studies we’ve done … indicate that people should guess very high numbers.”

Fulgoni said some food manufacturers are already dropping sodium levels in their food, but don’t want to publicize it because they’re afraid consumers will think the foods will be bland and never even try them.

Fulgoni and Wootan tangled over whether a national campaign to lower salt intake is the best way to go, with Fulgoni arguing that it would be better to urge people to look at their whole diet and make proper choices regarding nutrition. He urged a focus on “positive messages” that can be picked up and used to market products, such as Tropicana’s recent campaign publicizing the healthful benefits of potassium in its orange juice.

“The nice thing about positive messages is that companies will put significant money behind it. The food industry knows how to get a message out,” Fulgoni said. “If we get in a battle over sodium, I don’t think anyone wins.”

Wootan dismissed Fulgoni’s assertion, saying food makers are afraid that individual products will be singled out. Throwing too much information at consumers, she said, overwhelms them with dietary dos and don’ts, burying the important message.

“I think we have to be careful on this overemphasis of the total diet approach, which protects the food industry,” Wootan said.