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Salt Initiative Backed by Health Professionals

But call for warning labels on high-salt foods draws fire from food industry

WEDNESDAY, June 14, 2006 (HealthDay News) -- Health-care professionals applauded the American Medical Association's move on Tuesday to slash the nation's sodium intake in half over the next decade.

"Sodium or salt intake is a growing problem in this country, and high-salt foods are associated with a lot of processed foods which, in general, aren't necessarily the healthiest foods," said Dr. Christine Gerbstadt, a spokeswoman for the American Dietetic Association. "Any education or labeling is always helpful."

"I think it would be helpful to the American public to have a better understanding of the amount of sodium in foods they consume. There is hidden sodium in many foods, for example baked goods and bagels," added Samantha Heller, senior clinical nutritionist at New York University Medical Center in New York City.

Spotting these high-salt items isn't always easy, since many pass the "taste test," Heller said.

"High-sodium foods do not necessarily taste salty, because sodium is used not just for taste but as a preservative, flavor enhancer and for texture," she said. "More than 75 percent of the sodium Americans consume comes from processed food, not the salt shaker on the table."

That much salt in the American diet increases the risk of hypertension, the AMA noted in its initiative, which recommends that the federal government add warning labels on food high in salt and that the food industry cut the amount of salt used in processed foods and restaurant fare.

"When we take a look at treatable causes of hypertension, sodium intake is the No. 1 cause, in the United States, that causes an elevation in blood pressure, because of increased consumption," AMA board member and cardiologist Dr. James Rohack said Tuesday during the group's policy meeting, in Chicago. "If you reduce your sodium intake as well as increase your exercise, within one year 50 percent of the people can control their blood pressure with diet and exercise alone and don't necessarily need to be on medications. The problem we have in America is that wherever you turn, people are being exposed to foods that have a high sodium content."

Another expert agreed. "Among the common disorders are two major categories where salt intake is very important, and that's high blood pressure and heart failure. People who have those conditions really need to know about salt content," said Dr. Robert Myerburg, professor of medicine and physiology at the University of Miami Miller School of Medicine. "It might be better to have better labeling for those categories of patients."

The AMA initiative dovetails with one from U.S. National Institutes of Health, which has recommended a reduction in sodium by manufacturers, restaurants and consumers of 5 percent per year over the next 10 years.

Americans consume 4,000 to 6,000 milligrams of sodium per day, while the maximum daily consumption of sodium set by the American Heart Association is 2,300 milligrams (1,500 milligrams for those with high blood pressure or those at high risk for hypertension).

"I tell my patients that if you look at any label and salt is listed in the first four ingredients, it's got too much and stay away from it," Rohack said. "About 2,000 milligrams a day is about the recommended amount that you need."

Roughly one-third of U.S. adults have high blood pressure, and cardiovascular disease stubbornly remains the nation's leading killer.

But the AMA is apparently picking its battles carefully because, at the same meeting, delegates voted not to back a tax on sugar-sweetened soft drinks, opting instead to further study the issue. The association also voted to end alcohol advertising on college sports telecasts, and to put warning labels on video games.

The AMA council report that led to the vote on salt recommended that foods with more than 480 milligrams of sodium per serving be given labels with the word "high" and red exclamation marks. Such high-sodium foods would include hot dogs, some canned soups and a cheeseburger.

The vote also called for the AMA to petition the U.S. Food and Drug Administration to remove salt from the list of foods "generally recognized as safe," or GRAS.

"We have to ask the FDA to say that sodium is no longer recognized as safe," Rohack said. "It is a potentially harmful substance, especially when used in high quantities."

"The No. 1 discharge diagnosis among Medicare patients is congestive heart failure. This report will not only help with hypertension but with reducing the hidden sodium in congestive heart patients," he added. "The ultimate goal is if we can start to reduce the hidden salt exposure to patients, patients are going to be better off."

While those in the health-care field supported the move, the food industry decried the AMA recommendations.

"Rather than additional government requirements, what is needed is consumer education. For example, advice on sodium consumption can be found in the 2005 Dietary Guidelines for Americans," Robert Earl, senior director of nutrition policy for the Food Products Association, said in a statement.

"It is important for consumers to know that the amount of sodium in foods is clearly labeled on food packaging, and that a broad range of foods containing no sodium or low sodium, or with no added salt, are widely available," he added. "This broad range of food products on the market -- coupled with the information contained on the Nutrition Facts panel and food labels -- are critical components that enable consumers to choose food products that are appropriate for their dietary needs."

The Salt Institute was similarly chagrined.

"The American Medical Association has misread the science, confusing blood pressure effects with health outcomes. Of the 13 studies that have examined whether cutting salt will reduce heart attacks or improve mortality -- what AMA calls 'the population burden of cardiovascular disease' -- not a single study supports the AMA resolution," institute president Richard L. Hanneman said in a statement. "Following the AMA recommendation is scientifically unjustified, and a waste of time and money. What we really need is a controlled trial of the health outcomes of salt reduction."

More information

Visit the American Medical Association for more on the annual meeting of its House of Delegates.

SOURCES: J. James Rohack, M.D., trustee, American Medical Association; Christine Gerbstadt, M.D., R.D., spokeswoman, American Dietetic Association, Altoona, Pa.; Samantha Heller, R.D., senior clinical nutritionist, New York University Medical Center, New York City; Robert J. Myerburg, M.D., professor, medicine and physiology, University of Miami School of Medicine; June 13, 2006, statement, Robert Earl, R.D., senior director, nutrition policy, Food Products Association; June 13, 2006, statement, Richard L. Hanneman, president, Salt Institute
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