New York City Starts Push To Reduce Dietary Salt

After a series of victories that include a smoking ban, a ban on trans fats and mandating restaurants to post the calorie contents of their foods, New York City is now waging a new campaign to clamp down on the amount of sodium New Yorkers consume.

Dr. Frieden, the commissioner of New York City’s Department of Health and Mental Hygiene, said the initiative would be aimed at packaged foods and mass-produced restaurant meals, which contribute 80 percent of the sodium in a typical American’s diet.

During a luncheon last October, Dr. Frieden made his case to some of the biggest names in food processing, telling executives the city sought to reduce sodium levels by 25 percent within the next five years, and 50 percent within a decade.

During an interview last week, Frieden suggested he might seek legal action against companies that don’t comply.

“If there’s not progress in a few years, we’ll have to consider other options, like legislation,” he said.

Dr. Frieden’s last foray into the nutrition arena involved his support of a nationwide move to ban trans fats and to list calorie counts on restaurant menus.

“The one thing that’s disturbing is that he seems to be able to do just about anything he wants in New York City, and New York City serves as a model for the rest of the world,” said E. Charles Hunt of the New York Restaurant Association told the New York Times.

However, this campaign will likely prove more difficult for Dr. Frieden in both practical and political terms.  For one thing, salt is harder to remove from the nation’s food supply, and its link to cardiovascular disease is less understood.  Also, the food industry claims it is already addressing sodium levels.

Furthermore, the scale and scope of Dr. Frieden’s plan, which seeks to enlist a majority of the major food and restaurant companies to do the same thing simultaneously, is ambitious.

Reducing salt consumption and quitting smoking are two areas in which a broad public health effort can have the most impact on the most people, the New York Times quoted Dr. Frieden as saying.

The gradual reduction of sodium levels, so customers don’t notice the difference, is a critical component of the plan. 

“We’ve created a whole society of people accustomed to food that is really, really salty. We have to undo that,” Dr. Sonia Angell, director of cardiovascular health for the city, told the New York Times.

Because other nutritional culprits have been in the spotlight lately, sodium reduction has often lingered in the background.  And while most heart researchers agree that high blood pressure is a leading factor in the incidence of stroke and heart attack, salt does not cause high blood pressure in everyone.

But supporters of a salt reduction campaign say that while hypertension is often treated with medications, not everyone has access to the drugs.  And many patients ignore their doctors’ recommendations to cut back on consumption of salt.

That’s why Dr. Frieden says a subtle, large-scale reduction in sodium levels  might be a more effective approach.  Lowering sodium levels by half, he said, would save up to 150,000 American lives each year.

Dr. Frieden’s plan is modeled after one in Britain, which sets sodium reduction targets for certain categories of food like breakfast cereals, cheese, bread, pasta products, cake mixes, soups and condiments.  The ultimate targets will be based on a formula that factors in the amount of sodium in a product as well as how much food in that particular category people consume.

However, the Dr. Frieden’s goal is not to force small bakers or high-end chefs to abstain from using salt.  Rather, health officials believe large food companies can have the most significant impact on sodium consumption.

“If they bring it down by 5 percent, that is going to do more than Danny Meyer bringing it down by 50 percent,” Geoffrey Cowley, an associate commissioner of the Health Department, told the New York Times, in reference to the New York restaurateur.

Although Dr. Frieden’s jurisdiction includes only New York City, he is touting his plan as a “national salt-reduction initiative”.  Indeed, the campaign has the support of six other health departments around the country, along with organizations like the American Medical Association.

Dr. Frieden convened his series of salt talks to expand his idea beyond the city.  The first discussions took place last October,  when he asked companies like PepsiCo, Unilever and Goya to Gracie Mansion.   And he plans to meet with a number of chain restaurant executives in February.

Some in the Health Department thought the October luncheon was so successful they celebrated over drinks later that day.   But some industry leaders took a different view.

“I would say the invitations to come to Gracie Mansion weren’t very inviting,” a New York Times report quoted a food company executive as saying. 

There was certainly a sense of “ËœDon’t make us shame you.’ “

Robert Earl, the Grocery Manufacturers Association’s vice president for science policy, nutrition and health, said his members would prefer more of a national campaign that includes a broader variety of players, including consumer and advocacy groups.

There are other problems as well, he said. Getting many companies to do the same thing simultaneously could have antitrust implications.   And further research is required to understand what consumers are seeking, as well as the complex health implications of sodium reduction.

The association issued its own sodium policy paper on January 12.

“We need to look at these things more holistically and over the long term,” Mr. Earl told the New York Times.

The federal government has been looking at sodium levels for years. During the 1980s, federal dietary guidelines advised against excess sodium.  Shortly thereafter, the U.S. Food and Drug Administration (FDA) called on the food industry to voluntarily cut sodium levels in processed foods.

However, that didn’t work, and by 2000 men consumed 48 percent more salt than they did in the early 1970s, according to the most recent data from a large national study.  Women consumed 69 percent more sodium. The trend was due, in part, to saltier foods, along with the growing consumption of calories the average person consumed during that time.

The federal Institute of Medicine is expected to release a comprehensive study on sodium this year that could alter national dietary guidelines.  Current guidelines call for people consume no more than 2,300 milligrams of sodium a day.  However, some food labels set an upper limit of sodium of 2,400 milligrams for a 2,000 daily calorie diet.   That’s equivalent to teaspoon of salt, half of what many people typically consume.  African-Americans, older people and others prone to high blood pressure are advices to consume much less sodium.

The food industry is also considering the issue of sodium reduction.  The grocery manufacturers’ group and the National Restaurant Association each held sodium conferences recently in which finding an attractive salt substitute was a central theme.

“It’s frankly been one of those holy grails in the food industry for a number of years,” Todd Abraham, a senior vice president for Kraft foods, told the New York Times.

Kraft has invested $20 million on sodium reduction research, experimenting with yeast or potassium as potential substitutes and studying chemicals that block taste receptors.

Although it’s fairly easy for food makers to reduce topically applied salt, such as that on potato chips, salt’s role in processing packaged foods goes beyond flavor. For instance, while potato chips may taste saltier, they typically contain less sodium than foods such as muffins.  Such items use salt to create structure and to encourage browning.  Salt also helps emulsify ingredients in foods such as American cheese and bologna, and helps keep pathogens at bay.

Nevertheless, sodium levels can vary greatly within food categories.  For instance, Sam’s Choice Thick and Chunky salsa has about twice the amount sodium as Muir Glen organic salsa.

Beyond other obstacles, Dr. Frieden might see some scientific resistance in his battle against salt.   Some medical researchers question whether mass sodium reduction is the best way to allocate scarce public-health resources when weight loss and smoking cessation would do more for the country’s heart health.

People’s reactions to salt are often based on their genes, and some are more sensitive than others.  In fact, for some people even relatively low levels of sodium can be unhealthy.

However, public health officials say there is a broad consensus that salt leads to higher rates of heart attacks and strokes.

That view concerns Dr. Michael Alderman, editor in chief of the American Journal of Hypertension, who believes more clinical studies are needed, and emphasizes that wild swings in dietary regulation haven’t always produced results.

For instance, health officials once promoted the trans fat form of margarine as healthier than butter, a belief later found untrue.  Indeed,  it turns out that trans fats were far worse for cardiovascular health than saturated fats.

“Diet is an incredibly complicated business,” Dr. Alderman said.

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