IOM Report Urges FDA to Set Standards for Sodium Content

With 32 percent of U.S. adults combating hypertension -- and another one-third of the adult population dealing with prehypertension -- the Institute of Medicine, or IOM, is calling on the FDA to set mandatory national standards for the sodium content in foods.

In a report released April 20, the IOM said Americans consume an average of more than 3,400 mg of sodium chloride, or about 1-1/2 teaspoons, per day. That's significantly higher than the daily maximum value of 2,300 mg, or about 1 teaspoon, established in 2005 by HHS and the Department of Agriculture in Dietary Guidelines for Americans.

Those 2005 guidelines set an even lower maximum of 1,500 mg per day for at-risk groups, including people with hypertension, blacks, and middle-aged and older adults. The lower recommendation applies to 69 percent of U.S. adults, according to the CDC's 2005-06 National Health and Nutrition Examination Survey.

The IOM report, which was developed by a committee convened at the request of Congress in 2008, notes that a daily intake of 1,500 mg of sodium is adequate for most adults, with those age 50 or older needing even less.

Hypertension increases the risk for heart disease, stroke, congestive heart failure and renal disease. Heart disease is the largest cause of death in the United States, accounting for more than one-quarter of deaths in 2006, and stroke is the third-largest underlying cause of death, at 5.7 percent, according to the report.

Overall, says the report, excessive sodium intake accounts for $73.4 billion a year in direct and indirect costs.

Past initiatives to reduce sodium intake that included education and awareness campaigns aimed at consumers largely have failed to change dietary behaviors, as have efforts to make the food industry change its product development and manufacturing practices voluntarily. As food industry representatives told the IOM committee, they cannot sell products that are "less palatable than those of their higher-sodium competitors."

However, says the report, the amount of salt used at the table and during cooking in the home has remained fairly stable and is relatively small compared to sodium levels in processed and restaurant foods.

In an April 20 news release announcing the issuance of the IOM report, committee chair and former FDA Commissioner Jane Henney, M.D., said that lowering sodium levels through federal regulation would provide food companies with a level playing field.

"For 40 years, we have known about the relationship between sodium and the development of hypertension and other life-threatening diseases, but we have had virtually no success in cutting back the salt in our diets," said Henney, who also is professor of medicine at the University of Cincinnati College of Medicine. "This report outlines strategies that will enable all of us to effectively lower our sodium consumption to healthy levels."

Americans have become accustomed to saltier foods as the amount of sodium in the food supply has increased, the report says. However, research indicates that this trend can be reversed, and people's tastes can be "reset" to prefer healthier foods through subtle, gradual reductions in sodium.

"The goal," says the report, "is to carefully achieve, over time, and without loss of consumers' acceptability of foods, the 'safe' levels of sodium in the diet that are consistent with public health recommendations."

The FDA does have the authority to regulate substances added to foods, unless those substances have been accorded "generally recognized as safe," or GRAS, status. Currently, manufacturers' addition of salt and other sodium-containing compounds to foods is considered a GRAS use of these substances, and no standard level that constitutes "safe use" has been set.

The IOM report suggests the FDA modify the GRAS status of salt, setting such a safe use standard.

The report also includes the following recommendations:

In addition, the report suggests that health care professionals -- along with government agencies, public health and consumer organizations, the food industry, and public-private partnerships -- should continue or expand efforts to support consumers in making behavior changes to reduce sodium in their diets.