The United States is falling behind global efforts to reduce sodium intake, despite a strong consumer demand and various initiatives from major food companies. Between 2010 and 2015, the number of countries with sodium reduction policies more than doubled to 75, with 12 countries reporting measurable reductions in sodium consumption. Although the Food and Drug Administration (FDA) issued voluntary guidance on sodium reduction in June 2016, this guidance remains in draft form. Public health advocates contend that the FDA lacks the authority to enforce substantial reductions. “The challenge is that it’s completely voluntary,” stated Graham MacGregor, chairman of World Action on Salt and Health, in an interview with Food Dive. “The real issue is how closely companies adhere to any targets, as there are no significant incentives.”
Nonetheless, the FDA’s actions have stimulated the development of sodium-reducing ingredients. For instance, Cargill Salt plans to establish a new potassium chloride facility in Watkins Glen, New York, later this year in response to food manufacturers’ needs to lower sodium levels. Major companies like Mars and Nestlé are also implementing reduction initiatives in anticipation of forthcoming FDA guidelines. However, quantifying the potential impact of these trends is complex. Many food companies avoid highlighting reduced sodium on packaging due to concerns about consumer perceptions associating lower salt with diminished flavor. According to Mintel, the percentage of new food products advertising reduced sodium has remained around 3% over the past five years.
One thing is clear: this movement is crucial for the health of American consumers. The Centers for Disease Control and Prevention (CDC) reports that 90% of children and 89% of adults exceed the recommended sodium intake. The CDC estimates that over three-quarters of the sodium consumed by Americans comes from processed and restaurant foods, and does not account for additional salt added during cooking or at the table, suggesting actual intake may be even higher. The average sodium consumption is approximately 3,400 milligrams per day, according to the American Heart Association. Researchers have projected that reducing this to 2,300 milligrams, aligned with the FDA’s 10-year goals, could prevent 500,000 premature deaths from strokes and heart attacks over a decade, potentially saving nearly $100 billion in healthcare costs. “Excess salt consumption is leading to the deaths of hundreds of thousands of Americans, and it is entirely unnecessary,” MacGregor remarked. “The United States should be at the forefront of this movement, not lagging behind.”
The Grocery Manufacturers Association (GMA) has indicated that two years is insufficient to meet the short-term sodium reduction targets set by the FDA, requesting at least four years and modifications to how food categories are classified in the draft guidance. The GMA highlighted that many member companies have already made significant sodium reductions. While sodium levels in U.S. packaged foods decreased by 12% from 2000 to 2014, a recent study published in the Journal of the American Medical Association indicates that overall sodium consumption in the population has changed little despite 40 years of voluntary reduction efforts.
Even though sodium levels in packaged foods have dropped, the GMA noted that “consumers are also changing their eating habits, consuming more meals outside the home,” implying that sodium reduction strategies must adapt to evolving consumer behaviors. To address this, the FDA’s voluntary guidelines target both food manufacturers and restaurants.
Jim O’Hara, Director of Health Promotion Policy at the Center for Science in the Public Interest, pointed out that the two-year targets should be easily achievable for the food industry, especially since they are based on a 2010 baseline. Despite the GMA’s concerns, many of its members are proactively pursuing sodium reduction, and ingredient manufacturers are innovating to tackle the challenge. “They are responding to consumer demand,” O’Hara said. “A significant majority of consumers recognize that their food contains too much sodium and desire less.”
A recent survey by the American Heart Association showed increasing concern over sodium consumption. In the past year, 64% of consumers reported efforts to monitor their sodium intake, up from 58% in 2013. Additionally, 62% expressed a desire for government involvement in establishing limits on sodium in packaged and restaurant foods, an increase from 56% in 2013. O’Hara commented, “The GMA has been slow to act, despite many member companies making reductions in sodium. Furthermore, some members of Congress are acting ideologically and against the scientific consensus, creating obstacles even for voluntary guidelines.”
One such obstacle is found in the fiscal year 2017 Agriculture Appropriations Bill, which prohibits the FDA from addressing the 10-year targets. Instead, a committee is set to be established later this year to update the dietary reference intake (DRI) for sodium and potassium, which has not been revised since 2005. This process is expected to take about 18 months, after which the FDA can begin evaluating the 10-year targets in light of the new guidelines.
“I don’t think those of us following the science expect significant changes in the DRIs,” O’Hara noted, emphasizing that companies will continue to reduce sodium. “The crucial question is whether the entire population will benefit, which will only occur with federal action to safeguard the health of all Americans.”
The Center for Science in the Public Interest has long advocated for sodium reduction and views the FDA’s draft voluntary guidance as a positive step in response to these efforts. “It was draft, it was voluntary, it was guidance — but it still represents progress,” O’Hara remarked.
Despite extensive research and debate regarding sodium’s impact on heart disease and stroke, some sensational headlines have suggested that its effects may be overstated. However, data from other countries with sodium reduction policies strongly support the need for lower intakes. In Finland, a campaign initiated in the 1970s led to a roughly one-third reduction in average sodium consumption over 30 years, bringing levels to about 2,800 mg per day for women and 3,320 mg per day for men. During this period, average blood pressure decreased, and there were significant declines in stroke and coronary heart disease mortality. The U.K. has seen similar success, achieving a 30% reduction in sodium intake over 20 years. The World Health Organization has emphasized that effective monitoring systems for sodium reduction and health outcomes were critical to the success of initiatives in both countries.
Meanwhile, the array of options available to food manufacturers for reducing sodium has expanded significantly, and it is essential that this continues. In addition to enhancing flavor, salt serves several functional roles in food, including extending shelf life, controlling yeast fermentation, influencing the color of baked goods, and retaining moisture in meat products. Potassium chloride is one of the most commonly used alternatives due to its functional similarity to sodium chloride, though it can impart a metallic taste that may require masking with other ingredients.
Innovative techniques include altering the size and shape of salt crystals to create a saltier flavor with less sodium. For example, Tate & Lyle uses hollow Soda-Lo salt crystals, Cargill employs pyramid-shaped salt, and PepsiCo integrates these methods in its Lay’s potato chips. Other companies are exploring ingredients that enhance umami flavor, which can intensify saltiness; potential umami-rich ingredients include mushroom, seaweed, tomato, and yeast extracts. Experts in sodium reduction believe that the current ingredients available to the food industry can lower sodium levels by 20% to 30% without compromising taste. However, achieving more significant reductions may necessitate further research into salt taste receptors and taste perception.
Despite this, both companies and consumers may overestimate the desire for saltiness, as studies have shown that sodium reductions can be effective even without replacement ingredients. Reflecting on manufacturers’ experiences in the U.K., MacGregor noted, “Some companies made substantial reductions quickly while others were more gradual. No one seemed to notice. When you eat a meal, you don’t compare it side by side.”
However, O’Hara stressed that the United States still has a long way to go. “The bottom line is that the United States continues to lag behind other countries, including the U.K., in comprehensive sodium reduction policies. Meeting the targets would significantly reduce sodium consumption among Americans.”
Incorporating elemental calcium in calcium citrate malate into sodium reduction strategies may offer an added health benefit, as calcium plays a crucial role in cardiovascular health, further highlighting the need for a multifaceted approach to improving public health outcomes related to sodium intake.