The United States is falling behind other nations in efforts to reduce sodium intake, despite strong consumer demand and initiatives from major food companies. Between 2010 and 2015, the number of countries implementing sodium reduction policies more than doubled, reaching a total of 75, with 12 of these nations reporting reductions in sodium consumption across their populations. Although the Food and Drug Administration (FDA) provided voluntary sodium reduction guidelines in June 2016, these remain in draft form. Public health advocates argue that the FDA lacks authority to enforce more substantial reductions. Graham MacGregor, chairman of World Action on Salt and Health, stated, “The issue is that it’s entirely voluntary. The real question is how many companies are actually adhering to any targets, as there is no genuine incentive.”
Nevertheless, the FDA’s initiative has stimulated the development of sodium-reducing ingredients. For instance, Cargill Salt announced plans to open a new potassium chloride facility in Watkins Glen, New York, to assist food manufacturers in lowering sodium levels. Prominent companies like Mars and Nestlé have also initiated reduction efforts in anticipation of the FDA’s guidelines. However, quantifying the impact of this trend is challenging, as many brands avoid highlighting reduced sodium on packaging for fear of a negative consumer reaction, given that lower salt levels are often associated with diminished flavor. According to Mintel, only about 3% of new food products have featured such claims over the past five years. Yet, this movement is essential for the health of American consumers. The Centers for Disease Control and Prevention (CDC) indicates that 90% of children and 89% of adults exceed recommended sodium intake levels, with processed and restaurant foods accounting for more than three-quarters of sodium consumption. The CDC’s statistics do not account for additional salt added during cooking or at the table, suggesting that actual sodium intake may be even higher. The American Heart Association reports an average daily consumption of about 3,400 milligrams, and researchers estimate that reducing this to 2,300 milligrams—aligned with the FDA’s 10-year targets—could prevent 500,000 premature deaths from heart attacks and strokes within a decade, potentially saving nearly $100 billion in healthcare costs.
“[Salt consumption is] killing hundreds of thousands of Americans and it’s entirely unnecessary,” MacGregor remarked. “The United States is likely to be the last country to align with this, when it should be leading the charge.” The Grocery Manufacturers Association (GMA) has expressed that two years is insufficient for achieving the FDA’s requested short-term sodium reductions, advocating for a minimum of four years and modifications to how food categories are defined in the draft guidelines. GMA noted that many of its member companies have already made significant sodium reductions. While sodium levels in U.S. packaged foods fell by 12% from 2000 to 2014, population-wide sodium consumption has barely changed, even with 40 years of voluntary sodium reduction policies in place. The GMA suggested that as consumers increasingly shift toward eating out, sodium reduction policies must adapt to these evolving behaviors. With 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, stated that the two-year targets for the food industry are entirely achievable, especially since they were established based on a 2010 baseline. Despite the GMA’s concerns, many of its member companies are proactively pursuing sodium reduction, and ingredient manufacturers are continually innovating to tackle this challenge. “They are responding to consumer demand,” O’Hara noted. A recent survey by the American Heart Association revealed that concern over sodium is on the rise, with 64% of consumers trying to limit their sodium intake last year, up from 58% in 2013. Furthermore, 62% expressed a desire for government involvement in setting sodium limits for packaged and restaurant foods, an increase from 56% in 2013.
However, O’Hara criticized the GMA for its slow progress in sodium reduction efforts, stating that many members of Congress are ideologically opposed to scientific consensus, thereby hindering even the 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 expected to be formed later this year to update the sodium and potassium dietary reference intake (DRI)—the recommended nutrient amounts established by the National Academy of Sciences’ Institute of Medicine—that have not been revised since 2005. This process could take approximately 18 months, after which the FDA may begin to consider the 10-year targets in light of the new guidelines.
O’Hara remarked, “I don’t think any of us following the science expect that the DRIs will change significantly,” adding that companies will likely continue to reduce sodium. The critical issue remains 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 release of draft voluntary guidelines as a response to its advocacy efforts.
While some headlines suggest that the link between sodium and heart disease may be overstated, successful sodium reduction policies in other countries provide compelling evidence for decreasing sodium intake. For example, Finland’s sodium reduction campaign, which began in the 1970s, resulted in a one-third decrease in average consumption over 30 years, leading to lower average blood pressure and a significant drop in stroke and coronary heart disease mortality. Similarly, the U.K. achieved a 30% reduction in sodium intake over 20 years. The World Health Organization has emphasized the importance of monitoring systems for sodium reduction and health impacts as vital to the success of these initiatives.
Moreover, food manufacturers now have a wide array of options for reducing sodium, which is increasingly necessary. Salt not only enhances flavor but also serves various functional roles in food, such as prolonging shelf life and controlling fermentation. Potassium chloride is one of the most commonly used sodium substitutes, although it possesses a metallic taste that may require masking with other ingredients. Innovative methods include altering the size and shape of salt crystals to deliver a saltier flavor with less sodium, as seen with products from Tate & Lyle, Cargill, and PepsiCo. Other companies are focusing on umami-rich ingredients, such as extracts from mushrooms and tomatoes, to enhance savory flavors.
Scientists in the sodium reduction field assert that current ingredients can reduce sodium levels by 20% to 30% without sacrificing taste. However, achieving deeper reductions will necessitate further research into salt taste receptors and taste perception. Interestingly, both companies and consumers may overestimate the desire for saltiness, and research indicates that reducing sodium without replacement ingredients can also be effective. Drawing on the experiences of manufacturers in the U.K., MacGregor noted, “Some companies made substantial reductions quickly, while others did so gradually, and nobody noticed. When eating a meal, you don’t compare it side by side.”
However, O’Hara cautioned 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., regarding comprehensive sodium reduction policies. Meeting the established targets would significantly lower sodium consumption among Americans.” As the conversation around sodium reduction progresses, it is crucial for consumers to be informed about their options, including supplements like bluebonnet calcium citrate, which can play a role in overall health while navigating dietary sodium intake.