[acb-diabetics] lower sodium standards
plawolf at earthlink.net
Sat May 15 16:32:31 GMT 2010
In its new report, the IOM explains that such a strategy would make it
easier for American consumers to consume less sodium, because the vast
salt intake comes from prepared meals and processed foods.
A number of other countries have instituted policies to try to reduce the
amount of salt in the diet of their whole populations, and many experts have
calling for the US to institute similar initiatives.
Incoming president of the American Society of Hypertension (ASH) Dr. George
Bakris (University of Chicago Pritzker School of Medicine, IL) said, "I take
my hat off to the IOM. ASH, along with the AHA and other societies, has been
actively campaigning against high salt in the diet, but there needs to be
a partnership with the government in doing this; otherwise physicians will
The report says the FDA has the authority to regulate salt as a food
additive and is recommending that the agency should gradually reduce the
of salt that can be added to foods, drinks, and meals, so that consumers are
unlikely to notice the change in taste. Previously, salt has been treated
as "generally recognized as safe," and there have been no regulatory limits
on its use as an additive, the report explains.
The report was made public last week following a front-page story in the
print edition of the Washington Post, which is believed to have broken the
The Post report contained erroneous information, giving the "mistaken
impression" that the FDA has already begun the process of regulating the
sodium in foods, the agency said in a statement yesterday.
"The FDA is not currently working on regulations, nor have they made a
decision to regulate sodium content in foods at this time. Over the coming
the FDA will more thoroughly review the recommendations of the IOM report
and build plans for how the FDA can continue to work with other federal
public-health and consumer groups, and the food industry to support the
reduction of sodium levels in the food supply," it states.
The chair of the IOM committee that compiled the report, Dr. Jane E
Henney(University of Cincinnati College of Medicine, Cincinnati, OH), said,
years we have known about the relationship between sodium and the
development of hypertension and other life-threatening diseases, but we have
no success in cutting back the salt in our diets." This report "outlines
strategies that will enable all of us to effectively lower our sodium
to healthy levels," she noted.
Henney says the best way to accomplish this is to provide companies with
"the level playing field they need so they are able to work across the board
reduce salt in the food supply." But the committee appreciates that the FDA
will need time to gather and assess sufficient data to determine what limits
to set and what the incremental decreases should be.
Taking this into account, she says that the committee is recommending that
restaurants, food-service firms, and food and beverage manufacturers should
voluntary sodium-reduction efforts in the meantime.
Asked to address the concerns of naysayers, who argue that there is little
proof that reducing salt in the diet will have an effect on health outcomes
who say that the administration should not get involved in "nanny-state"
activities like regulating the amount of sodium people consume, Bakris said
government-backed salt-reduction campaigns "have been very effective in the
UK, in Finland (with a dramatic improvement in mortality) and in Japan, and
there is absolutely no reason we should not do this.
"The reality is that there needs to be some guidance to the general public
about this -- most people do not read labels, most people don't pay
and they don't know how much salt is too much -- so the availability needs
to be regulated. Clearly, the FDA does have a role as a regulatory body to
sodium standards in foods so that they are in keeping with the current
"It's certainly true that people who are in their 20's and teens don't need
salt restriction for blood-pressure control," he acknowledges, "but it is an
acquired taste. And so if you don't learn from a young age, it's going to
catch up with you in your 40's, 50's, and 60's, when you actually will need
salt restriction, so it is a lifestyle issue."
In response to what Bakris calls the "outcomes mafia, who say that unless we
have an outcomes study it's impossible to make any conclusions," he
"While there is some truth to this, common sense has to prevail. The FDA as
a regulatory body has accepted the notion that lowering of blood pressure is
a validated surrogate for a reduction in cardiovascular mortality and
morbidity... To do an [outcomes] clinical trial as is being requested, you
need well over 100 000 people, so it's not feasible. Let's be reasonable."
"If you are telling me that reducing BP by 5 to 7 mm Hg, which is what most
of these salt restrictions will do, is not going to translate into a
then I think we have to throw out all the clinical trials we have to date,"
he adds. "There is no meta-analysis of any clinical trials that fails to
that a reasonable reduction in blood pressure has not been associated with a
benefit, certainly on stroke and to a lesser degree on coronary events, but
nevertheless the data are very consistent."
"I think the conflict of interest here needs to be established," he points
out. "With all due respect, many of the people who are saying this are also
to the Salt Institute, they are lobbyists in their own right. They spin the
data to make it suit what their needs are."
The IOM report was requested by Congress and sponsored by the US Centers for
Disease Control and Prevention; the FDA; the National Heart, Lung, and Blood
Institute; and the Office of Disease Prevention and Health Promotion of the
US Department of Health and Human Services.
Henney JE, Taylor CL, and Boon CS, eds. Institute of Medicine. Strategies to
Reduce Sodium Intake in the United States; Washington, DC: National
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