Mike Ja­cob­son wants to shake the salt out of you

▶▶A law­suit is putting pres­sure on the FDA to is­sue sodium lim­its ▶▶“The lev­els in our diet were and are very high”

Bloomberg Businessweek (Asia) - - Contents - −John Tozzi

Michael Ja­cob­son has spent al­most 40 years try­ing to make Amer­ica’s food less salty. A dis­ci­ple of con­sumer ad­vo­cate Ralph Nader and a co-founder of the Cen­ter for Science in the Pub­lic In­ter­est, a non­profit with a fo­cus on nu­tri­tion and health, Ja­cob­son says cut­ting sodium could save tens of thou­sands of lives a year in the U.S. In 1978, CSPI filed a pe­ti­tion with the U.S. Food and Drug Ad­min­is­tra­tion ask­ing it to cap salt in pro­cessed foods. A 1983 law­suit brought by the group helped pave the way for nu­tri­tion la­bels on pack­ag­ing dis­clos­ing the sodium con­tent of foods—but still no lim­its. CSPI re­vived its pe­ti­tion in 2005, and by 2014 the FDA seemed poised to pub­lish vol­un­tary guide­lines as a way to prod food com­pa­nies to lower salt. Then-Com­mis­sioner Mar­garet Ham­burg called it an is­sue “of huge in­ter­est and con­cern.” But noth­ing hap­pened.

So CSPI sued the FDA in Oc­to­ber in fed­eral court, seek­ing a re­sponse to its 10-year-old pe­ti­tion. (The fed­eral agency is sup­posed to act on such re­quests within 180 days.) Ja­cob­son spec­u­lates that the FDA wants to pub­lish new salt stan­dards, but the White House is drag­ging its feet for fear of a po­lit­i­cal back­lash from an­tireg­u­la­tion Repub­li­cans. “If the ad­min­is­tra­tion wants to get this done, they need to move fairly quickly,” Ja­cob­son says. “We thought a law­suit might help set a dead­line.” A White House spokes­woman di­rected ques­tions to the FDA. The agency, which faces a Feb. 12 dead­line to re­spond to the CSPI suit, “is de­vel­op­ing draft vol­un­tary tar­gets for sodium re­duc­tion in var­i­ous foods,” FDA spokes­woman Me­gan Mc­Sev­eney wrote in an e-mail. “We will con­tinue to work closely with all stake­hold­ers on sodium re­duc­tion, which has the po­ten­tial for ma­jor pub­lic-health gains.” The FDA has never moved to limit sodium in pro­cessed foods, even though the Cen­ters for Dis­ease Con­trol and Preven­tion and of­fi­cial U.S. di­etary guide­lines have for years called for dras­tic re­duc­tions in the amount of salt Amer­i­cans con­sume. About

90 per­cent of adults ex­ceed the gov­ern­ment’s rec­om­mended daily in­take of 2.3 grams of sodium—about one tea­spoon of ta­ble salt. The av­er­age is 3.6 grams. For blacks, peo­ple over 50, and those with diabetes, high blood pres­sure, or kid­ney dis­ease, the rec­om­men­da­tion is lower still: 1.5 grams a day.

Ex­cess salt con­trib­utes to high blood pres­sure, which puts about onethird of U.S. adults at el­e­vated risk of heart at­tacks, strokes, and other health prob­lems. Grad­u­ally re­duc­ing sodium by 40 per­cent could avert as many as 500,000 deaths over 10 years, ac­cord­ing to a 2013 anal­y­sis in the jour­nal Hy­per­ten­sion. Ja­cob­son’s group has been more ag­gres­sive in ad­vo­cat­ing for lim­its than doc­tors or pa­tient groups, says Mar­ion Nes­tle, a pro­fes­sor of nu­tri­tion and pub­lic health at New York Univer­sity and the au­thor of sev­eral books on food pol­icy. “They’re very in­volved in Wash­ing­ton pol­i­tics, they know how it works, and they’re will­ing to stick their necks out,” she says.

An MIT-trained mi­cro­bi­ol­o­gist, Ja­cob­son has used provoca­tive stunts to nee­dle gov­ern­ment of­fi­cials and food com­pa­nies. He once sent a bag of de­cayed teeth to fed­eral reg­u­la­tors to protest ads for sug­ary ce­real aimed at kids. CSPI be­gan ag­i­tat­ing against trans fats in the early 1990s; the FDA banned them this year. Salt lim­its would be an­other long-sought vic­tory. “The lev­els in our diet were and are very high,” Ja­cob­son says. “We con­tended that those lev­els were not gen­er­ally rec­og­nized as safe, but the op­po­site: gen­er­ally rec­og­nized as dan­ger­ous.”

Some food com­pa­nies are mov­ing to de­sali­nate their prod­ucts, spurred by con­sumers’ de­mand for health­ier fare. Walmart has said it has cut sodium in its house brands by 16 per­cent since 2011 and is press­ing sup­pli­ers of pack­aged foods to do their part. The Gro­cery Man­u­fac­tur­ers As­so­ci­a­tion “fully sup­ports vol­un­tary in­dus­try ac­tions to re­duce sodium,” ac­cord­ing to an e-mailed state­ment from Robert Burns, the trade group’s vice pres­i­dent for health and nu­tri­tion pol­icy. The group says new prod­uct for­mu­las and shop­pers’ pref­er­ence for low-salt ver­sions have re­sulted in a 16 per­cent de­cline in sodium pur­chased over five years.

In 2010, New York City in­tro­duced the Na­tional Salt Re­duc­tion Ini­tia­tive to get food com­pa­nies and restau­rant chains to com­mit to lower sodium lev­els. (The project was spear­headed by then-Mayor Michael Bloomberg, ma­jor­ity owner of Bloomberg LP, which pub­lishes this mag­a­zine.) The ini­tia­tive has se­cured com­mit­ments from com­pa­nies such as Boar’s Head and Heinz to re­duce salt in cold cuts and ketchup. Re­cently, the New York City Board of Health or­dered chain restau­rants to la­bel high-sodium items on their menus with salt shaker icons as a warn­ing to din­ers. The Na­tional Restau­rant As­so­ci­a­tion is fight­ing the la­bels in court.

A group of ex­perts as­sem­bled to look into salt by the In­sti­tute of Medicine, part of the Na­tional Acad­e­mies of Sci­ences, Engi­neer­ing, and Medicine, noted that 40 years of vol­un­tary ef­forts have barely made a dent. In 2010 the panel rec­om­mended in­sti­tut­ing na­tional stan­dards to grad­u­ally lower “salt lev­els across the food sup­ply.” The up­com­ing pres­i­den­tial elec­tion lends new ur­gency to Ja­cob­son’s cause. If the FDA pro­poses new guide­lines, it will take months of pub­lic com­ments and re­vi­sions be­fore they’re fi­nal. He es­ti­mates that if the agency doesn’t put them out this spring, they won’t be en­acted be­fore Obama’s suc­ces­sor takes over.

The lat­est salvos in the salt wars come as some sci­en­tists are reeval­u­at­ing how much is too much. A global study of more than 100,000 peo­ple pub­lished in the New Eng­land Jour­nal of Medicine in 2014 con­firmed the ben­e­fits of low­er­ing sodium in­take to 3 grams to 6 grams a day. But go­ing be­low 3 grams was as­so­ci­ated with a higher risk of death or car­dio­vas­cu­lar prob­lems. “There’s sur­pris­ingly lit­tle ra­tio­nale for the lower sodium tar­gets,” Aaron Car­roll, vice chair for health pol­icy and out­comes re­search at In­di­ana Univer­sity’s School of Medicine, wrote in the New York Times.

Ja­cob­son says the science on the links be­tween sodium, high blood pres­sure, and car­dio­vas­cu­lar dis­ease is clear, and he fears the chance to im­prove Amer­i­cans’ health might slip away. “What hap­pens will de­pend on the next ad­min­is­tra­tion,” he says. “I don’t think Don­ald Trump is very con­cerned with the lev­els of sodium in his food.”

The bot­tom line An acolyte of Ralph Nader has spent more than three decades try­ing to get salt reg­u­lated.

Ja­cob­son

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