The Food and Drug Administration is going from a world leader to a world laggard in at least one area of public health: reducing sodium consumption, mostly from salt.
While nations from the United Kingdom to South Africa to Australia to Argentina and many in between mount sodium-reduction initiatives to reduce the burden of heart attack and stroke, the United States lags far behind, having yet to enact any such initiatives.
American companies that might want to reduce sodium decline to step forward because they fear being put at a competitive disadvantage if their competitors don't do the same.
The restaurant industry's failure to make any real progress is clearly documented in a new report, "Restaurants Can't Shake the Salt," from the Center for Science in the Public Interest (CSPI). Since 2012, the nation's top 25 restaurants did little to nothing to reduce the average sodium content in almost 3,000 menu offerings analyzed by CSPI. The average decline was a measly 1 percent. Some restaurants made small reductions in sodium across items that appeared on their menus in both 2012 and 2014, with Outback Steakhouse showing the biggest decrease (9 percent average decline across 80 items). However, other restaurants increased the amount of sodium on average in items on the menu in both years. IHOP showed the biggest increase, with a 9 percent average increase across 129 items. Furthermore, Applebee's, Chili's, IHOP, and Olive Garden served up as much or more sodium on average in each of their menu items in 2012 and 2014 than the majority of Americans should consume on a daily basis. But why should they do more? FDA has failed to provide a level playing field and tell the industry where the goal posts are.
The average American consumes about 4,000 milligrams of sodium a day, far beyond the 1,500 mg a day recommended for the majority of the population by the Centers for Disease Control and Prevention. Cutting sodium down to 2,000 milligrams would prevent about 100,000 deaths each year.
Most of that extra sodium doesn't come from turning salt shakers upside down when people cook at home or eat out. Almost 80 percent of the sodium we consume comes from the salt that restaurant chefs and food manufacturers add to their dishes.
In 2010, the Institute of Medicine concluded that voluntary reductions over the previous four decades had achieved nothing. The IOM called on the FDA to reduce sodium in the food supply by mandating limits in restaurant and processed foods and by gradually reducing those limits over time in a common-sense fashion to give industry -- and consumers' taste buds -- time to make changes. And, in fact, New York City's Department of Health and Mental Hygiene used a method first used in the United Kingdom to show how that could be done. The city created a National Salt Reduction Initiative and worked with industry to develop targets for reducing sodium in 62 categories of packaged foods and 25 categories of restaurant food over a period of years. To date, 27 companies both big and small have signed up for at least some of their products.
Moreover, country after country is showing how to cut sodium, while the FDA and policy makers at the Department of Health and Human Services and the White House dither.
For instance, the United Kingdom achieved a 15 percent reduction in per capita daily sodium consumption between 2001 and 2011. The U.K. approach is voluntary, but, with government pushing hard, it has been working. Initial targets were set in 2006 for 85 food categories such as processed meats, bread, cheese, and convenience food. In 2008 the Food Standards Agency set new targets for 2012.
In 2013, South Africa set mandatory limits for a variety of products. Again, the approach is gradual, with interim targets to be met by 2016 and final targets by 2019. The targets include a 28 percent sodium reduction for breads from 2010 levels, 37 percent for cereals, and 46 percent for cured meats.
How difficult is it to reduce sodium? Let's take a look at recently-reported data from World Action on Salt & Health, a nonprofit group based in the U.K. The researchers reviewed the sodium levels in several products, including cereals, sold in various countries. The sodium levels in Kellogg's Special K are instructive: 710 mg/100g (3.5 ounces) in the United States; 650 mg/100g in South Africa; 536 mg/100g in Australia; and 450 mg/100g in the United Kingdom. Clearly, sharp reductions in at least some products should be easily achievable in the United States.
Australia has chosen the voluntary approach and in 2009 set 20 reduction targets in nine food categories. Participating companies determined which products to reformulate and by how much each year to meet the targets. Among the companies involved are several quite familiar to the American consumer: Kraft Foods, PepsiCo, Mars, and Nestle. Again, Australian companies are making progress. A 2014 study reported that between 2010 and 2013 sodium was reduced by 9 percent in bread products, 25 percent in cereals, and 8 percent in cured meats.
Argentina began with a voluntary program, and since has passed legislation mandating sodium reductions. Its "Less Salt, More Life" initiative began in 2011 and had targets to be achieved by 2015. As in Australia, companies familiar to American consumers signed on: Nestle and Kraft, for instance. In 2013, Argentina made the reductions mandatory through legislation, calling for limits in 18 categories of meats, bread products, and soups.
As can be seen, there are many paths toward sodium reduction and addressing the burden of heart attacks and strokes -- and the tens of billions of dollars in excess medical costs -- caused by excessive amounts of salt in the food supply. But it takes government leadership, and in the United States that has been sadly lacking.