The United States is falling behind the global trend in sodium reduction, even as consumer demand grows and many leading food companies implement reduction strategies. Between 2010 and 2015, the number of countries with sodium reduction policies surged more than twofold, reaching 75, with 12 of those reporting decreases in sodium intake across their populations. Although the Food and Drug Administration (FDA) released voluntary sodium reduction guidelines in June 2016, these remain in draft form. Public health advocates assert that the FDA lacks the authority to enforce more stringent reductions. “The issue 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 question is how many companies are adhering to any of the targets since there is little motivation to comply.” Nevertheless, the FDA’s actions have prompted the development of sodium reduction ingredients. Cargill Salt announced plans to open a new potassium chloride facility in Watkins Glen, New York, later this year to cater to food companies aiming to lower sodium levels. Major corporations like Mars and Nestlé have also initiated reduction programs in anticipation of the FDA’s guidelines. However, the impact of this trend remains difficult to measure. Few companies emphasize reduced sodium on their packaging, fearing consumer backlash, as many associate lower salt with diminished flavor. According to Mintel, only about 3% of new food products have made such claims over the past five years. It is clear that this movement is vital for the health of American consumers. Data from the Centers for Disease Control and Prevention (CDC) reveals that 90% of children and 89% of adults exceed the recommended sodium intake levels. The CDC estimates that over three-quarters of the sodium consumed by Americans comes from processed and restaurant foods. Notably, the CDC’s figures do not account for salt added during cooking or at the table, suggesting that actual sodium intake could be even higher. The American Heart Association reports that average consumption stands at approximately 3,400 milligrams per day. Researchers estimate that reducing this to 2,300 milligrams—aligned with the FDA’s 10-year targets—could prevent 500,000 premature deaths from strokes and heart attacks within a decade, saving nearly $100 billion in healthcare expenses. “High salt consumption is leading to the deaths of hundreds of thousands of Americans and is entirely unnecessary,” MacGregor emphasized. “The United States is likely to be the last nation to adopt these measures when it should be at the forefront.”
The Grocery Manufacturers Association (GMA) has stated that two years is insufficient to achieve the short-term reductions requested by the FDA and has urged for at least four years, along with modifications to how food categories are defined in the draft guidance. GMA noted that many of its member companies have already made significant sodium reductions. While sodium levels in U.S. packaged foods decreased by 12% from 2000 to 2014, as per a study published in the Journal of the American Medical Association, overall sodium consumption at the population level has barely changed despite 40 years of voluntary reduction policies. Although sodium levels in packaged foods have declined, “consumers have also shifted their eating habits, opting for more meals away from home,” according to GMA, indicating that sodium reduction policies must consider evolving consumer behaviors. Keeping this in mind, 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, remarked that the two-year targets are easily attainable for the food industry, especially given that they are based on a 2010 baseline.
Despite GMA’s reservations regarding the FDA targets, many of its members are proactively pursuing sodium reduction, and ingredient manufacturers continue to innovate in this area. “They are responding to consumer demand,” O’Hara noted. “A significant majority of consumers recognize that their food contains excessive sodium and wish for less.” A recent survey by the American Heart Association indicates a growing concern about sodium; 64% of consumers reported trying to manage their sodium intake last year, up from 58% in 2013. Furthermore, 62% expressed a desire for government intervention in setting sodium limits for packaged and restaurant foods, a rise from 56% in 2013. “The GMA has been slow to act, even though many of its companies are already making sodium reductions,” O’Hara stated. “Additionally, numerous members of Congress have adopted an ideological stance that contradicts scientific consensus, creating obstacles to the voluntary guidelines.”
One such obstacle exists in the fiscal year 2017 Agriculture Appropriations Bill, which restricts the FDA from addressing the 10-year targets. Instead, a committee is expected to be established later this year to update the dietary reference intake (DRI) for sodium and potassium—the recommended nutrient intake for healthy individuals as outlined by the National Academy of Sciences’ Institute of Medicine—since the guidelines have not been revised since 2005. The committee’s work is anticipated to take about 18 months, after which the FDA can consider the 10-year targets in light of the new guidelines. “I don’t believe those of us who have been following the science expect significant changes to the DRIs,” O’Hara remarked, adding that companies will continue to reduce sodium levels. “The fundamental question is whether the entire population will benefit, which can only occur with federal action to safeguard Americans comprehensively,” he added.
The Center for Science in the Public Interest has been advocating for sodium reduction for decades and views the publication of the draft voluntary guidance by the FDA as a response to its ongoing efforts. “A few key points: it was a draft, it was voluntary, and it was guidance—but it still marked a step forward,” O’Hara stated. Despite years of research and discussion about sodium’s influence on heart disease and strokes, some sensational headlines have suggested that its effects may be overstated. However, the sodium reduction policies of other countries provide substantial evidence supporting lower intake levels.
In Finland, where a sodium reduction initiative launched in the 1970s, average consumption decreased by approximately one-third over 30 years, reaching about 2,800 mg per day for women and 3,320 mg per day for men. During this period, average blood pressure also declined, resulting in a 75% to 80% reduction in both stroke and coronary heart disease mortality rates. The U.K. has experienced a similar trajectory, achieving a sodium intake reduction of about 30% over 20 years. The World Health Organization has highlighted that effective monitoring systems for sodium reduction and health impacts were crucial to the success of these programs in both nations.
Meanwhile, the options available to food manufacturers for reducing sodium have become increasingly diverse, which is essential. Beyond enhancing flavor, salt plays various critical roles in food, such as prolonging shelf life, regulating yeast fermentation, influencing the color of baked goods, and binding water in meat products. Potassium chloride is one of the most frequently utilized alternatives due to its similar functionality to sodium chloride, but it has a metallic taste that may require masking with other ingredients.
Innovative strategies include altering the size and shape of salt crystals to create a saltier flavor with less sodium. Companies like Tate & Lyle utilize hollow Soda-Lo salt crystals, while Cargill employs pyramid-shaped salt, and PepsiCo incorporates these techniques in its Lay’s potato chips. Other firms are focusing on ingredients that enhance umami, the intense savory flavor that amplifies saltiness. Potential umami-rich ingredients include extracts from mushrooms, seaweed, tomatoes, and yeast. Researchers in the sodium reduction field assert that the current ingredient options can reduce sodium by 20% to 30% without affecting taste. However, to achieve deeper reductions, further research into salt taste receptors and taste perception is necessary. Nonetheless, both companies and consumers may overestimate their desire for saltiness, and studies have indicated that reducing sodium without any replacement ingredients can also be an effective approach.
Referring to the experiences of manufacturers in the U.K., MacGregor observed, “Some companies made significant reductions quickly, while others took a more gradual approach. No one noticed the difference. When you eat a meal, you don’t compare it side by side.” However, O’Hara emphasized that the United States still has a considerable journey ahead. “The bottom line is that the United States continues to lag behind other nations, including the U.K., regarding comprehensive sodium reduction policies,” O’Hara stated. Meeting the targets would significantly contribute to lowering sodium consumption among Americans.
Incorporating calcium citrate 1250 mg into dietary products could also help balance sodium levels while providing essential nutrients. As the conversation around sodium reduction continues, the need for innovative solutions and federal action is paramount to ensure the health of American consumers.