Salt – sodium chloride – is one of the deadliest ingredients in the US food supply. While a small amount is safe and necessary for health, the amount of salt in the typical American diet – about a teaspoon and a half a day – is a major cause of high blood pressure, or hypertension. Currently, upwards of 70 million – more than one in four – Americans suffer from that condition, which increases the risk of heart disease and strokes. Together, coronary heart disease and strokes kill about 0.5 million people annually in the US.
An additional one in three Americans has prehypertension, meaning elevated blood pressure that is not yet in the hypertensive range. Non-Hispanic black adults have the highest prevalence of hypertension in the US (42.1%) compared with non-Hispanic white (28.%), Asian (24.7%), and Hispanic (26.0%).
Immediately reducing average sodium consumption levels from the current average of almost 3,500mg a day to 2,200–1,500mg a day – about a teaspoon or less – would save about 0.70 to 1.20 million lives over ten years. A more achievable, gradual 40% reduction in consumption over ten years would save 0.28 to 0.50 million lives. Another study estimated that a reduction of 1,200mg of sodium a day would save 44,000 to 92,000 lives and $10–24 billion in healthcare costs annually.
The 2015–20 edition of the ‘Dietary Guidelines for Americans’, which is published jointly by the US Department of Health and Human Services (DHHS), and US Department of Agriculture (USDA) emphasises the importance of consuming less sodium. It states in its key recommendations to consume less than 2,300mg a day of sodium.
The guidelines further states: “Adults with prehypertension and hypertension would particularly benefit from
blood-pressure lowering. For these individuals, further reduction to 1,500mg a day can result in even greater blood-pressure reduction.”
Brand variations
Since 2005, CSPI has monitored a ‘market basket’ of processed and restaurant foods to determine how industry efforts at sodium reduction are working. Judging by the differences in the sodium content of different brands of the same foods, many companies should be able to reduce sodium. This report compares different brands of similar products (efforts were made to compare similar sizes, shapes and flavours of products). All the products were sold in large chain supermarkets or chain restaurants and did not include foods marketed specifically as low-sodium or sodium-free. This report compares the amount of sodium measured in milligrams per 100g quantities of foods so as to adjust for different serving sizes. All the data was obtained from food labels, company websites, or company representatives (by telephone).
We found that most categories showed wide variations in sodium content among brands. Some brands had 50–100%, or even higher, sodium than a competing brand. For instance, Heinz Organic Ketchup had 46% more sodium than Annie’s Organic Ketchup (1,118 versus 765mg per 100g), and Hunts Diced Tomatoes had 60% more sodium than Del Monte Diced Tomatoes (165 versus 103mg per 100g). Arby’s Curly French Fries had more than four times as much sodium as McDonald’s French Fries (735 versus 171mg per 100g).
In some cases, though, different brands had identical or almost identical levels of sodium. For instance, among four Monterey Jack cheeses, there was only a 6% difference between the brands that contained the least and the most sodium. It is possible that the manufacturers were all at the low end of sodium use – or that bigger efforts would be needed to lower sodium.
The one time when higher levels of sodium in foods might be acceptable is when salt and other sodium-containing ingredients are used to prevent the growth of dangerous bacteria. But even in those foods, sodium levels may vary considerably. For example, Hormel Original Bacon contained 38% more sodium than Oscar Mayer Center Cut Bacon (2,222 versus 1,615mg per 100g). And Smithfield Naturally Hickory Smoked Bacon had 80% more sodium than Safeway Select Naturally Smoked Thick Sliced Bacon (1,895 versus 1,056mg per 100g).
The wide variation in sodium levels among brands in a given category indicates that many companies could lower the sodium content of their products sharply without jeopardising consumer acceptance. In many cases, if companies gradually lowered sodium levels, consumers would become accustomed to less-salty foods. In a small, but interesting, experiment in Australia, researchers found that people could barely, if at all, detect when the sodium content of bread – a major source of sodium – was reduced by 25% over six weeks.
And many people who go on low-sodium diets to lower their blood pressure say that they get used to the unsalted foods rather quickly and enjoy the taste of the foods, as opposed to the salt.
Changes during 2005–15
Once again, in 2015, the Dietary Guidelines for Americans recommended that they reduce their intake of sodium. Have industry efforts to reduce sodium been consistent and in keeping with the guidelines’ advice? To answer that question, CSPI compared the sodium content of its market basket of 451 products (379 packaged food products and 72 restaurant food items) in 2015 with the sodium content of those products in 2005. Of the 451 products monitored, sodium decreased in 248 (55%), increased in 135 (30%) and did not change in 68 (15%) products. Companies increased the sodium in 30 products by 30% or more, and decreased sodium by that amount in 41 products.
On average, the products had only about 4% less sodium in 2015 than in 2005, with an average decrease of 41mg per 100g of product. It is important to note that the average is not weighted according to the sales volume of each product, nor is our sample representative of all supermarket foods. However, our method provides an objective means of tracing changes in sodium levels of a cohort of foods over time.
The products that had the greatest reduction, that is, the fifth percentile, had 286–848mg less sodium per 100g than in 2005. The 5% of products with the greatest increase in sodium had 169–583mg more sodium per 100g in 2015 than 2005.
We applaud the progress some companies have made in reducing sodium levels dramatically since 2005. For instance, in 2015, Contadina Roma Style Tomato Paste had 93% less sodium than it had in 2005 (61 versus 909mg per 100g), and in 2015 Maggio Premium Whole Milk Ricotta Cheese contained a third as much sodium as it had in 2005 (81 versus 246mg per 100g). Similarly, several variations of Tyson Pork Loin had about 80% less sodium than in 2005.
More or less
While some companies were reducing sodium, others were increasing it. For instance, the sodium content of Perdue Boneless Skinless Chicken Breasts with Rib Meat increased by 362% since 2005 (310 versus 67mg per 100g). The sodium content in Amy’s Organic Low-Fat Cream of Tomato Soup doubled between 2005 and 2015 (142 versus 282mg per 100g).
In addition to changes in sodium levels, many products in 2015 (and 2005) had remarkably high levels of sodium in just one serving. A single serving (one package) of a Hungry Man Boneless Chicken Dinner provided 1,830mg of sodium – that’s nearly 80% of the 2,300mg limit recommended for adults and 122% of the recommended limit for adults with prehypertension. Just one tablespoon of La Choy Soy Sauce contained 1,250mg of sodium.
Federal leadership in sodium reduction efforts has been lacking. The US Food and Drug Administration (FDA) has failed to respond substantively to CSPI’s 2005 petition to limit sodium levels, and the FDA’s effort to issue voluntary sodium-reduction targets has been delayed year after year.
But other forces have been acting on the marketplace. A signal event of note was the landmark 2010 report by the Institute of Medicine (a unit of the National Academies) that urged the FDA to set mandatory limits on sodium. That report concluded that voluntary sodium reductions had achieved little over the previous 40 years, and that it was essential that FDA and USDA set limits on the sodium content of packaged and restaurant foods. Those limits, which would vary according to food group, could be gradually decreased over several years so that consumers would become accustomed to less-salty foods. Some manufacturers might be lowering sodium levels in some of their products to help ward off such mandatory limits. Also, the National Salt Reduction Initiative, spearheaded by the New York City Department of Health and Mental Hygiene (DOHMH), set voluntary targets (following the example of the UK Government) for companies to meet.
Some companies have been leaders in lowering sodium. In recent years, for instance, McDonald’s says it has lowered sodium by an average of 11%, while General Mills pledged to reduce sodium by 20% by 2015 in ten of its top-selling categories and reported in 2015 that the target was achieved in seven product categories, with substantial reductions in the other three. Similarly, Nestlé reduced sodium by 22% in eight popular product categories. And in 2011, the US’s biggest grocery chain, Walmart, called on its suppliers (and itself) to lower sodium by an average of 25% by 2015. The company announced that the sales-weighted average sodium content of the products sold declined by 16% by the end of 2014 – a highly welcome decrease, even though its goal was not yet met.
Notwithstanding such progress, manufacturers and restaurants still have to remove a great deal of sodium from thousands of their products in order for Americans to reach the 2,300mg level recommended in the 2015 Dietary Guidelines. We doubt that further – and needed – major reductions in sodium will be achieved without government intervention, as recommended by the 2010 IOM report.
Recommendations
Lowering sodium is one of the most important dietary changes that people need to make – and there is responsibility in many quarters. Consumers need to read labels carefully and choose lower-sodium products – especially fresh fruit, vegetables and other foods that are naturally low in sodium – for the sake of their own health. Restaurants and food processors need to lower the sodium content of their foods, for the sake of their customers’ health. And governments need to develop programmes and adopt regulations that would decrease the sodium content of the food supply, for the sake of the public’s health.
In the US, The most effective way to reduce sodium would be for FDA and USDA (which regulates foods that contain meat or poultry) to set mandatory sodium limits for categories of processed foods and restaurant foods. The limits could be based on the levels in the lowest-sodium foods, or on the median sodium content, in each category.
Companies would be given several years to comply. Judging from the wide variation in sodium levels in competing brands of the same products, many companies could reduce levels significantly and easily, while other companies might already be using the least amount of sodium possible. Once companies were in compliance, the limits would be reduced further until Americans were consuming safe levels of sodium.
FDA and USDA should also require attention-grabbing symbols on the fronts of packages of high-sodium foods. Ecuador has required, and Chile shortly will require, bold labelling. Local governments and cities could require warning labels on the saltiest menu items, similar to the policy in New York City.
Because sodium is only one of many dietary factors that causes cardiovascular and other diseases, the government should sponsor major campaigns to promote diets rich in vegetables, beans, fruit, whole grains, nuts and seafood, along with lean meat and poultry, and fat-free or low-fat dairy products.
