Local and State Governments Call for Federal Action to Reduce Salt Levels in Food

Cutting Salt Could Save 150,000 Lives Each Year, Officials Say

August 25, 2008

WASHINGTON—With high-salt diets increasingly being recognized as a major cause of high blood pressure, heart attacks, and strokes, health officials from around the country have called on the Food and Drug Administration to press food manufacturers and restaurants to cut back on salt. The comments were made in response to the FDA’s request for public input on a petition filed by the Center for Science in the Public Interest urging the agency to revoke the "generally recognized as safe," or GRAS, status of salt and to limit sodium levels in various food categories.

The comments included:

• Los Angeles County Department of Public Health’s commissioner Jonathan Fielding, M.D., reported that the prevalence of diagnosed high blood pressure in the county increased from 18 percent in 1997 to 25 percent in 2005. "Action by the FDA and others is urgently needed to prevent unnecessary deaths and illnesses due to excessive salt in our diet," said Fielding. "We strongly urge that the FDA remove salt from the GRAS list and support efforts to implement a national program to reduce salt consumption."

• The National Association of County & City Health Officials, which represents approximately 2,850 local health departments, said it “strongly urges the Food and Drug Administration to examine carefully and thoroughly how its policies can reduce the sodium content of food and to act accordingly.”

• The Association of State and Territorial Health Officials (ASTHO), which represents state and territorial public health agencies of the United States, the U.S. territories, and the District of Columbia, wrote: "The amount of salt consumed by Americans is a major public health issue. As the major source of excess dietary sodium is found in processed foods, ASTHO urges the FDA to consider ways to encourage food manufacturers to limit the amount of sodium added during food processing."

• The Alameda County, Calif., Public Health Department wrote: "The FDA has the responsibility to ensure the safety of the food supply, but has done little with regard to salt." The letter, signed by Diane Woloshin, Nutrition Services Director of the county, cited health experts’ estimate that 150,000 lives could be saved annually if sodium levels in packaged and restaurant foods were cut in half….and that that "would save tens of billions of dollars in health care costs."

• Chicago’s Commissioner of Health, Terry Mason, M.D., supported a 50-percent reduction in sodium over ten years. He endorsed public education campaigns by government and voluntary action by industry, but noted: "In the absence of voluntary sodium reduction, a regulatory approach would become necessary including the development of a mandatory national warning label system to inform consumers of high sodium content foods."

• The Boston Public Health Commission’s executive director, Barbara Ferrer, expressed her "deep concern about the harm being caused by excessive amounts of sodium in the American diet" and applauded the FDA for holding its hearing last November. She supported CSPI’s proposals to revoke the GRAS status of salt and limit sodium levels in packaged foods.

• Baltimore’s commissioner of health, Joshua M. Sharfstein, M.D., advised the FDA that nutrition labeling of foods hasn’t been sufficient to reduce the risk of cardiovascular disease and urged the agency "to develop a strategy to support a more healthy diet and save lives."

• Commissioner Joshua Lipsman, M.D., of the Westchester, NY, County Department of Health told the FDA about the vigorous efforts of the British government to lower sodium levels and said that "salt reduction should be a top health priority of our government also….I urge the FDA to take further steps by implementing the proposals outlined in the CSPI petition and improve the diet and health of the American public."

• Also citing the British experience was Henry A. Anderson, M.D., Wisconsin’s State Health Officer. He emphasized that "The United Kingdom’s Food Standards Agency (FSA) has made sodium reduction a top priority….The FSA is also exerting strong pressure on the food and restaurant industries to gradually lower sodium levels by about one-third over five years. Sodium in our food supply should be a top health priority of our government."

Graham MacGregor, of St. George’s Hospital Medical School in London, perhaps the world’s leading campaigner to reduce sodium consumption, told the FDA that the British government’s salt initiative has already lowered sodium consumption by 10 percent, and that that "is calculated to have reduced the number of strokes and heart attack deaths in the UK by approximately 6,000 a year."

The FDA’s request for comments on salt reduction was a follow-up to the agency’s November 2007 hearing on CSPI’s salt petition. At that time, New York City health department officials urged the FDA to require warning labels on high-sodium foods and said that "recommended maximum limits of sodium in processed foods must be established and formalized as recommended targets for industry." If industry did not achieve those targets, said the health officials, "a regulatory strategy addressing sodium content should be implemented." New York City led the nation in phasing out trans fat from restaurants and requiring calorie labeling on the menus and menu boards of chain restaurants.

As another indication that local health officials are no longer waiting for the FDA to act on salt, Baltimore’s city health department announced the convening of a Salt Task Force to "review and make recommendations to address excessive salt consumption in the city." The task force is part of the city’s efforts to prevent cardiovascular disease, especially among African Americans, who have the highest rates of high blood pressure.

CSPI has pressed since 1978 for government action to lower sodium consumption. The following year, an FDA advisory committee concluded that there was insufficient evidence to consider salt to be GRAS, but the FDA has taken no action. CSPI’s 2005 publication Salt: The Forgotten Killer has helped galvanize concern about Americans’ high sodium intake. CSPI recently cosponsored, with NACCHO and ASTHO, a meeting of state and local health officials interested in reducing sodium levels to prevent cardiovascular disease.


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