Bloomberg Businessweek (Europe)

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”

- −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.

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