Doctors endorse push to shake the salt habit

The American Medical Association on Tuesday overwhelmingly agreed to back a campaign to halve the amount of sodium in restaurant and processed foods over the next 10 years.

At the same time, the nation's largest doctors group urged the Food and Drug Administration to revoke rules that have allowed sodium to go unregulated for decades. The rule has allowed salt and its component sodium to be treated as "generally recognized as safe."

The move by the AMA's 544-member House of Delegates to back revocation of the special status salt has enjoyed is similar to a petition filed last fall by the Center for Scientists in the Public Interest, a Washington-based advocacy group, seeking to void the rule.

Americans consume about 4,000 milligrams to 6,000 milligrams of sodium per day, and the resulting hypertension and cardiovascular disease costs the health-care system "tens of billions of dollars," AMA officials said.

Dietary guidelines released last year set the maximum daily consumption of sodium at 2,300 milligrams, while 1,500 milligrams was set as the maximum for people with high blood pressure, blacks and middle-aged and older adults.

"Cardiovascular disease remains the No. 1 killer of Americans. People who reduce dietary sodium intake are taking an important step in preventing future health problems," said Dr. J. James Rohack, a cardiologist and an AMA board member.

Rohack said congestive heart failure is the leading reason people over 65 who are covered by the Medicare health insurance program are admitted to the hospital. Just one overnight stay in a hospital for a Medicare patient can cost the government insurance program several thousand dollars.

The AMA is now on board with the National Institutes of Health, which also has recommended a 5 percent per year reduction in sodium by manufacturers, restaurants and consumers during the next 10 years to cut sodium use in packaged and restaurant food in half.

The AMA's decision was decried by the Salt Institute, an industry trade group.

"The American Medical Association has misread the science, confusing blood pressure effects with health outcomes," said Richard L. Hanneman, the institute's president. "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."

Report cites risks

The AMA, however, rejected that argument, saying in a committee report that "excess sodium greatly increases the chance of developing hypertension, heart disease and stroke."

"Just one cup of canned soup can contain more than 50 percent of the FDA recommended daily allowance," said Rohack. "A serving of lasagna in a restaurant can put a diner over their recommended daily sodium allowance in just one meal. These examples stress the importance of a national reduction in the amount of sodium in processed and restaurant foods."

"You can't deal with this on your own," said Michael Jacobson, executive director of the Center for Scientists in the Public Interest. "At least 80 percent of the sodium consumed by Americans is in restaurant and processed food. ... The FDA needs to put pressure on the entire food industry to gradually reduce sodium levels."

AMA officials said the FDA needs to improve requirements for the labeling of sodium in processed foods, just as it did three years ago when it pressured foodmakers to list the amount of artery-clogging trans fatty acids in each serving.

The labeling prompted a three-year scramble by the industry to reformulate foods to avoid listing high levels of heart damaging fat in each product. The FDA estimated the food industry spent $140 million to $250 million determining the amount of trans fat in food products, relabeling the "nutrition facts" panel and reformulating products voluntarily to decrease or avoid listing trans fat.

Similar efforts expected

Efforts to reformulate foods to reduce sodium levels are likely to be similar. The British government, which also is seeking to drive down the use of sodium, estimated in 2003 that it would cost food manufacturers $65,000 to $185,000 per product line to reformulate their offerings with lower levels of sodium.

The amount of sodium contained in a serving is required on food labels, along with the percentage of the daily allowance in the dietary guidelines that it represents. But no explanation is provided, and the maximum recommended daily amount of sodium is not listed.

Just as the removal of trans fat was estimated to save billions of dollars and hundreds of lives, reducing sodium consumption by 50 percent could have a similar effect, according to the AMA and the Center for Scientists in the Public Interest.

The center estimates that cutting salt consumption by 50 percent would save 150,000 lives per year and reduce medical care and other costs by $1.5 trillion over 20 years.

High sodium levels are key components in high blood pressure and cardiovascular disease, according to the AMA, which said it must "help change the way Americans think about salt."

Although an AMA policy stance cannot force action, the national group, representing 250,000 physicians, wields considerable clout in Washington. Its support could embolden health policymakers and make it hard for the FDA not to at least look at the issue, observers say.

But imposition of strict sodium rules could have huge implications for food manufacturers, many of whom are still attempting to retool products to reduce trans fat.

Stephanie Childs, a spokeswoman for the Grocery Manufacturers Association, which represents the nation's food processors, said most companies already are working on reducing sodium levels.

"Heart-healthy food is a competitive factor amongst the food industry," she said. "Companies are investing in nutrition more than ever and putting it to use in reformulation for trans fat and other nutrients."

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Doctors endorse push to shake the salt habit