Worth its salt?
One reason we can’t quit ‘tabletop staple’: sodium-laden packaged foods
The recently released 2020-2025 Dietary Guidelines from the Agriculture Department remind Americans that they should consume less than 2,300 milligrams of salt a day — equivalent to about a teaspoon. Instead, we eat nearly 50 percent more than that, according to the Centers for Disease Control and Prevention.
The recommendation is the same as in the earlier 2015-2020 guidelines, yet the average American has not cut down on salt, still consuming an average of more than 3,400 mg daily, according to the CDC.
Even though the vast majority of public health experts regard too much salt as a killer and urge you to cut back, Americans find that difficult. One reason is that more than 70 percent of salt in the American diet comes from packaged and prepared foods, according to the Food and Drug Administration, not from the salt shaker.
“We are awash in foods that are high in sodium,” says Thomas Frieden, former director of the CDC. “Sodium reduction is one of the most neglected and under-implemented public health interventions. Yet, there is absolutely no doubt that excess sodium is resulting in deaths.”
The villain in table salt — sodium chloride — is sodium, which makes up about 40 percent of salt.
Excess sodium narrows and stiffens blood vessels, raising blood pressure, which can lead to heart disease, stroke and other serious medical conditions. The World Health Organization (WHO) estimates that 2.5 million deaths annually could be prevented if global sodium consumption were reduced to recommended levels.
That position is based on decades of scientific evidence (including analyses of hundreds of published studies that underscore sodium’s health dangers) that remains unchanged despite several studies in recent years that have challenged it.
Several years ago, controversy arose after several studies suggested that the amount of sodium most people consume won’t hurt them.
“Really, the science at this point is settled and there is no doubt,” Frieden says. “It’s surprising and disappointing that these scientists have ignored definitive evidence that their studies are wrong.”
Most people have a tough time cutting back to the amount of salt that health experts recommend.
That’s because food manufacturers add salt to a vast array of their products, including bread, soups, processed meats, and even in the unexpected, such as fresh meat, poultry, and fish and breakfast cereal.
“It’s unrealistic to ask millions of Americans to worry about long-term concerns, when there are immediate ones, such as a pandemic,” says Michael Jacobson, co-founder and senior scientist with the Center for Science in the Public Interest — and author of a new book “Salt Wars.” “The whole food environment is loaded with sodium. It’s impossible.”
Moreover, even when consumers pay attention to food labels it’s difficult. Sodium is listed by serving amount, which can be difficult when serving sizes are small.
Jacobson suggests that consumers shun processed foods and prepare meals from scratch, using “lite” salt, which contains 50 percent less sodium. Read labels, and compare different brands of similar products to find the one with the least amount of sodium, he advises. And eat out less often, perhaps easier now with many pandemic restrictions. If you do go to a restaurant, however, “split large entrees into two meals when possible,” he says.
In 2010, the Institute of Medicine called upon the FDA to regulate the amount of sodium permitted in processed foods, saying the agency should require manufacturers to gradually reduce sodium levels over time to allow Americans’ taste buds to adjust. In 2016, the FDA proposed voluntary guidelines, but they were never finalized.
“The challenge for the FDA under the Biden administration will be to finalize the guidelines and pressure industry to enact them,” Jacobson says.
Such a plan worked in the United Kingdom, where the food industry voluntarily dropped sodium levels in many food products over 15 years by between 20 to 50 percent, MacGregor says.
“Blood pressure fell and death rates fell,” he says. “About 20,000 strokes and heart attacks a year were prevented, of which an estimated 10,000 would have been fatal. Such a simple thing, but it was amazing. It just tells you that you can do it. Salt taste receptors adjust to reduced salt intake. The public doesn’t even know it, but we’ve got them eating less salt.”
Many public health experts like the idea of resetting the palate.
“When you are used to eating large quantities of salt, your salt thermostat adjusts upward, so people don’t realize when they are consuming large quantities,” Freeman says. “After a couple of weeks without any added salt, you will notice how salty your food has been.”