For reasons unclear, salt continues to suffer sensationalist treatment in the media while fending off degreed experts who ignore the science to decry this most common of seasonings. Food processors will have to decide how, if at all, to react to this latest lab-coat-inspired fad. Is it worth making major overhauls to well-accepted product lines? Do you risk dumping millions of dollars of flavorless, unloved low- and no-salt foods into bargain bins at a loss?
It’s hard to find a nutrition professional who has not counseled healthy people to decrease their intake of sodium. In addition to the USDA, the American Heart Assn., the National Heart, Lung, and Blood Institute (NHLBI) and the National High Blood Pressure Education Program — a coalition of health organizations and federal groups — plus a dozen others all insist healthy people can reduce their risk of heart disease or stroke by eating less than 2,400 mg of sodium, quite a cut from the 4,000 to 6,000 mg we currently ingest on a daily basis.
Nutrition policies of whole countries have sanctioned the call for salt reduction. Yet oddly, the scientific backing for healthy individuals to decrease salt in their diets simply isn’t there. What’s behind this stampede by otherwise responsible scientists to ignore the evidence of their own research? After several decades, there’s still no answer to that question.
Where the myth began
The effect of dietary sodium on hypertension was first studied clinically in the 1940s, when the Kempner Diet was developed to treat high blood pressure through reduced sodium intake. The favored method of noninvasive hypertension treatment, it was a standard that went a long way to entrench the notion that salt causes high blood pressure. Two major variables were ignored: The Kempner diet was used to treat people who were already ill, and the diet was also low-calorie, low-fat and high-potassium (salt’s metabolic “opposite”). But the paradigm was set.
The connection made sense from a chemistry standpoint, since blood pressure is related to electrolyte regulation in the kidneys. As levels of sodium rise and fall, so too can blood pressure as the body retains water to maintain equilibrium. (Note: This is a very basic description. Dozens of metabolic reactions, biochemical exchanges and other factors work in bodily ballet to keep all systems go.) A flood of studies on how this regulatory mechanism affects people with hypertension ensued.
In the 1970s and 1980s, epidemiological studies across the board yielded results that were conflicting, if not completely polarized. For example, studies of Japanese populations with high salt intake saw higher incidences of hypertension. But follow-up studies of specific groups within those populations found no connection. Attempts to scale down the research for a clearer picture resulted in wildly differing results.
And therein lies the problem: The majority of lab research into the sodium-hypertension (and other disease states) connection involved animal models or unhealthy human subjects. Discounting the animal studies, which usually involved abnormally high amounts of sodium (in some cases hundreds of times normal intake) or animals specially bred to react to salt, human research failed to firmly justify restricting sodium in the diets of healthy persons.
Persons with kidney failure figured prominently in many of these studies, and so the effect of dietary sodium on people with damaged “regulators” ended up being applied across the board to people without damaged regulators. (The evidence is not that strong for the folks with the damaged regulators — not everyone with hypertension is salt-sensitive.)
The fact is, healthy kidneys will increase excretion of sodium and other electrolytes, while conserving others, if there is an increase in blood pressure. That’s what they’re supposed to do.
In fact, too little sodium can also wreak havoc on the body, negatively impacting hormone balance, insulin levels and nerve conduction.
When studies began to investigate the effects of dietary sodium on healthy individuals, the evidence failed to support the reduction of salt in the diet. The studies showing increases in blood pressure related to high salt intake did not show the effect to persist over time, and did not show the effect to be significant from a clinical standpoint.
In a response to the ballyhooed report by CSPI accusing salt of being a “forgotten killer,” Richard Hanneman, president of the Salt Institute (www.saltinstitute.org), Alexandria, Va., called for a full-blown, comprehensive clinical trial. “(The) only evidence we have,” he writes, “is from observational studies. There are no clinical trials at all. And worldwide, there have been only a dozen observational studies reported. Eleven of the 12 show just the opposite of what [CSPI] is saying. None of these 11 studies shows improved rates of heart attacks or strokes on low-salt diets; three, in fact, show just the opposite – [patients on] low-salt diets have higher risks of heart attacks. Many of the other 11 studies are quite large studies and none of them could find a population benefit in reducing dietary sodium.”
Intersalt, an international study of electrolyte excretion and blood pressure, attempted to firmly establish, once and for all, a positive link between sodium intake and hypertension in large and concerted analysis of more than 10,000 men and women across 52 different clinical centers worldwide. When the results turned out to contradict the connection, all hell broke loose in the salt wars as scientists involved on both sides of the dispute culled and reanalyzed the data.
One study being brandished with reckless abandon by the anti-salt squads is the Dietary Approaches to Stop Hypertension (DASH) study. While by no means the first study whose conclusion contradicts its own findings, the DASH study is one of the most comprehensive and up-to-date on the topic.
DASH found the biggest changes from decreasing sodium intake did occur in healthy adults. But that change was only 7.0 mm Hg systolic/3.8 mm Hg diastolic. Changes in persons with hypertension were, in many cases, small enough to have virtually no clinical significance (0.5 mm Hg). High blood pressure is 140/90 and above. Prehypertension is 125/80 and above. The study was not long-term, and there were certain variables that had not been taken into consideration.
Blood pressure readings can vary based on a number of variables, such as whether the reading is taken while sitting or lying down, early in the day or late, on a full stomach or an empty stomach, or how stressful your day has been. The conclusions of the DASH study were still to unequivocally recommend decreased salt consumption based on such nonresults. (The International Food Information Council recently published an extensive and comprehensive reference review on the state of sodium and health studies to date. This white paper can be viewed at www.ific.org/publications/reviews/sodiumir.cfm.)
Consumers unmoved
Despite this new wave of critics on the salt-restriction bandwagon, there are signs consumers will not give up their favorite seasoning.
The National Health and Nutrition Examination Survey (NHANES) is a periodic survey that assesses the health and nutritional status of adults and children in the U.S. Conducted by the National Center for Health Statistics, part of the Centers for Disease Control, the NHANES has shown our enjoyment of the mineral has held steady for the past quarter century or longer. In fact, there was a jump in salt intake reflected in NHANES II over NHANES I, although that may have been due to data analysis improvements in the methodology of the survey.
Another indication that consumers reject salt rejection recently came to light via ACNielsen research. Of the 10 label-claim segments analyzed by the consumer research company through its LabelTrends service, the reduced-sodium segment was the only one to experience sales declines in the first four weeks of 2005 versus the previous four-week period.
Processors have several options in the latest round of the salt war. They can ignore the situation and it will probably go away — as it has before. The fact is, people like salt and years of telling people, for good or ill, to cut their intake has had virtually no effect.
When it comes to reducing salt content in processed foods, Robert Earl, senior director of nutrition policy for the Food Products Association (www.nfpa-food.org) in Washington, notes, "Food manufacturers are continually addressing sodium in food and beverage products by reducing sodium or salt without compromising taste or safety, and by providing consumers with a large variety of reduced-, low- and no-sodium/salt options."
But Earl notes that, for some foods, reducing sodium content can present challenges. "In the savory snack category, technological innovation has moved savory and salty flavors to the surface of products using as little sodium as possible," he says. "But, also you have to consider the food safety reasons for using salt in many foods. Salt is a time-proven ingredient that keeps safe food safe. Plus, there's naturally occurring sodium in virtually all foods, whether fresh, frozen or canned."
Salt substitutes are an option manufacturers have employed for a long time. The most common, potassium chloride, is used in a variety of applications, from shaker to processing. But price is a major consideration with salt replacers and enhancers.
Another option is using a “salt enhancer.” Mastertaste, a Kerry Group company, developed a naturally derived (via Maillard reaction) flavor enhancement system that’s water soluble and heat stable. The enhancer provides the palate a perception of salt and overall savory profile with no aftertaste. It does not rely on potassium, magnesium or other ions nor is it an autolyzed yeast extract, hydrolyzed protein, disodium inosinate, disodium guanylate or monosodium glutamate product.
Until a comprehensive, clinical trial covering all variables is conducted, it’s imprudent to insist healthy people make drastic dietary changes to reduce their salt intake. In fact, based on the best studies to date, all evidence indicates such changes to be unwarranted. Just because some people are nearsighted it doesn’t mean everyone else has to wear glasses, too.
