Beyond the shaker: Salt consumption is often out of your control

Washington Post Staff Writer
Tuesday, February 8, 2011; 1:02 PM

The day before two federal agencies announced the new 2010 Dietary Guidelines, Marion Nestle, the noted nutrition and public health professor at New York University, suspected the government would lower the sodium recommendations to a maximum of 1,500 milligrams a day for all Americans.

It didn't quite go that way on Jan. 31 when Tom Vilsack and Kathleen Sebelius, secretaries for the departments of Agriculture and Health and Human Services, respectively, announced the official guidelines. The sodium recommendations remained mostly unchanged from 2005, when the government suggested no more than 2,300 milligrams of sodium for most healthy Americans and no more than 1,500 milligrams for African Americans, those with hypertension and those middle-aged and older. What apparently did change was the government's awareness that about half of U.S. residents fall into one of those three sodium-sensitive groups, meaning that millions of Americans are considered at risk for hypertension and other health problems.

Whatever the number, for most Americans the sodium recommendations remain a large mountain to climb. "This is not an achievable target," Nestle said, referring to 1,500 milligrams of sodium a day in the American diet. "2,300 [milligrams] is not an achievable target."

The problem? Americans don't have much control over their sodium consumption.

Michael F. Jacobson is the executive director of the Washington-based Center for Science in the Public Interest, but more important, he has been studying salt since 1977. Jacobson says a 20-year-old study showed that more than 75 percent of our sodium consumption comes from outside the home: from restaurants, vending machines, packaged foods, processed foods, cafeterias and the like. That number is still solid today, he adds.

What's not as solid, nutritionists and scientists say, is the food industry's desire to reduce sodium in the American diet, both in restaurants and in processed foods. The federal Dietary Guidelines Advisory Committee's report last June spelled out the problem starkly, noting that efforts to reduce sodium over the past 40 years have been unsuccessful. Americans still consume about 3,400 to 3,500 milligrams of sodium a day, well above recommended levels.

"A major reason is that these efforts were not broad enough in scope to fully address the public health problem of excessive sodium intakes," the DGAC report noted. "The level of sodium to which consumers are exposed on a daily basis from processed and restaurant foods must be reduced. To date, efforts by food processors and the restaurant and food-service sectors to voluntarily reduce the sodium content of the food supply face obstacles, are not consistently undertaken by all, are not readily sustained, and have proven unsuccessful in lowering overall sodium intake."

A broad range of nutritionists, scientists, public-health advocates and even the independent Institute of Medicine have been pushing for Food and Drug Administration rules to regulate the amount of sodium allowed in processed foods. Some, such as Jacobson, have been pushing for regulations for decades, with no success. The FDA maintains that salt is "generally recognized as safe," which means the ingredient can be used in food without prior agency review and approval.

Food manufacturers, of course, "think we can deal without" regulations, notes Melissa Musiker, director of science policy, nutrition and health with the Grocery Manufacturers Association, a Washington-based group that represents 300 food, beverage and consumer product companies. Manufacturers, after all, already have first lady Michelle Obama pressing them for more meaningful nutrition labels.

Musiker acknowledges that, historically, some food manufacturers were reluctant to reduce sodium, lest sales fall, but have since listened to public demand. Some, in fact, have been stealthily reducing sodium levels for decades. "They recognize it," she says, "and they're definitely working on it."

There are at least two significant obstacles to reducing sodium, Musiker says. One is that salt, unlike sugar, doesn't have adequate substitutes; cutting sodium chloride, for example, with too much potassium chloride can make foods taste bitter and not salty enough. The other is the consumer's palate, which has been trained over years of high sodium intake to crave lots of salt.

"You don't want to get too far ahead of the consumer," Musiker says. "You could change their willingness to purchase your product."

So food manufacturers are working with their research and development departments to gradually reduce sodium, Musiker says. Some are looking at sea salts, which can be lower in sodium but have more flavor from trace minerals. Others are developing "hollow" salts, which are exactly that: crystals with hollow centers to deliver saltiness to the tongue without as much sodium. Others still are stealing pages from the professional culinary world: They're buying better base ingredients and relying on reduced unsalted stocks, fresh herbs and citrus, rather than salt, to add flavor.

If food manufacturers are heeding the call to reduce sodium, it's unclear whether chefs and restaurateurs are. Morton Satin, vice president for science and research at the Salt Institute in Alexandria, recalls attending a session last year at the Research Chefs Association conference in Phoenix during which chefs discussed how to reduce sodium in dishes. Satin says he offered them some evidence downplaying the effects of salt on human health that got the chefs fired up. One told Satin that if he were shipwrecked on an island and allowed to keep only five ingredients, salt would be the first.

The first lady has been talking to the National Restaurant Association to persuade its members to produce more healthful meals outside the home, and it might be having an impact. New Hampshire-based chef Damian J. Martineau, head of the government relations committee with the American Culinary Federation, says chefs are sensitive to the issue. They also have plenty of tools to reduce salt in restaurant meals. Besides herbs and citrus, rubs and spice blends can deliver more flavor without the salt, he notes. But he says consumers, too, must adjust to lower salt levels: Too many diners still want to indulge themselves at restaurants, not look for healthful foods.

Heart-healthy logos on menus can actually dissuade some diners from ordering the dishes, Martineau says: They think, "I don't want that unless I'm going to die tomorrow."

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