How can salt be reduced?

Following the long-awaited new Institute of Medicine (IOM) report on salt released this week, here's a quick summary of a debate that I would find awful tiresome.

Institute of Medicine: "FDA should regulate salt."

Critics: "Big brother should not tell me what to eat."

To me, the more interesting questions are: (1) Is it important for Americans to consume much less salt; and (2) if so, how can this reduction be achieved in an economically sensible way?

The IOM report explains clearly why sodium reduction is important for our health and even for the national economy. It is apparently a myth that salt reduction is only important for a small number of people predisposed to hypertension. If you still hold that view, we'll have to postpone arguing about it until another day. The rest of the post assumes the answer to question (1) is "yes, salt reduction is important." The food industry, which is pursuing some voluntary efforts to reduce sodium in the food supply, concedes this point.

The interesting question is how salt reduction can be achieved. In calling for FDA participation in salt reduction efforts, IOM explains the collective action problem that limits the effectiveness of voluntary measures:

Regulatory action is necessary because four decades of public education campaigns about the dangers of excess salt and voluntary sodium cutting efforts by the food industry have generally failed to make a dent in Americans' intakes, the committee said. The industry's voluntary efforts have fallen short because of lack of a level playing field for all products. Companies have feared losing customers who could switch to competing products or brands with higher salt content.

[Update Apr 26, 2010: This sentence has been toned down, because of the next update below.] Moreover, the food industry's imagination on salt reduction could be more ambitious. For example, the input of the Grocery Manufacturers Association on the federal government's revision of the Dietary Guidelines emphasizes the limited options for high-tech salt replacements and claims that consumers would not accept less salty foods:

[F]ood processors have no alternatives with which to replace the sodium, and must simply accept a less salty flavor in lowered sodium products. But the consumer will not accept such products.

[Update Apr 26, 2010: Although the link above is to the GMA site and seems to have today's date, a reader tells me that the letter is actually GMA's comments on the 2005 Dietary Guidelines. I regret my error in reading. To be more current, here is the corresponding passage from the GMA comments to the 2010 Dietary Guidelines Advisory Committee.

There is no perfect "salt substitute " currently available. Sodium reduction in foods is often a complex, highly technical, expensive and labor intensive task that must frequently be undertaken "silently" without consumer's knowledge.]

Contrast this assessment of the consumer's tolerance with the fascinating and quite well-written Chapter Three of the IOM report, which marshals the evidence for a more optimistic conclusion:

The food supply contains a vast array of commercially successful products and ingredients – fresh, prepared, and manufactured – whose sodium levels range from very high to moderate to very low. The fact that the same individual for example, might be fully satisfied with two snacks of widely varying sodium levels – one a fresh apple and the other a handful of salted pretzels – reminds us how dependent the sodium taste issue is on wider flavor contexts.... [T]he salt taste challenge might be as much a matter of reconsidering flavor options in recipe selection and menu development ... as needing to overcome technical challenges with salt substitutions.

[Update Apr 26: This sentence has been edited to remove an implication that the food industry didn't know these insights. The good food scientists probably recognize these points.] Here are some marketing insights that I draw from the IOM report (my paraphrase):

• Consumers can become happily acclimated to a lower sodium environment over time, just as it took time for them to become accustomed to the current strangely high-sodium environment.
• We could give consumers greater freedom of choice by reducing salt in processed foods and letting everybody use salt shakers; it turns out that people add only 20% as much sodium when they are free to make their own choices.
• There is a difference between "taste" and "flavor." Salt is a "taste." Real "flavors" can be used to make less salty foods delightful.
• Many foods can have less sodium without tasting less salty, by modifying the size of salt particles and their placement on the surface of a food.

Although consumers might eat less processed foods, and more real whole foods, we might enjoy life just fine with less sodium.

Agricultural economics of strawberries

This year, cold weather in Florida delayed the strawberry harvest, so the berries came to market at the same time as California berries. With both sources of strawberries on the market at the same time, the price dropped to levels so low that some Florida farmers tore up their strawberry fields.

Steve Osunsami and colleagues at ABC News described this news in outraged tones (sorry about the ad in the clip below). Neighbors complain about the misuse of environmental resources. Soup kitchen participants rail against the crime of wasting food in a hungry world. The farmer in the interview is on the defensive.



Bobbie O'Brien at NPR takes a different perspective. The NPR story notes more prominently that Florida farmers tore up worthless unusable strawberries to get an early start on planting melons. The plain-spoken farmer in the interview astutely summarizes the relevant agricultural economics.

The two versions of the story offer a lot to think about for readers who care about local and national food sourcing, fresh and processed/preserved food, and the tension between farmer incentives and the public good.

One very small and partial solution, which is also fun and yummy, is to buy some strawberries this week and make some jam. It makes great gifts. In my house, in past years, my daughter has been my partner in this project.

Many public health associations speak up about antibiotics

Many leading medical and public health associations have taken a strong stand in favor of sensible limitations on non-therapeutic antibiotic use in farm animals.

The leading bill, known as the Preservation of Antibiotics for Medical Treatment Act (PAMTA), would continue to permit veterinarians to use antibiotics to treat disease, but it would prevent farmers from using some classes of antibiotics on healthy animals in advance of illness simply to increase production.

The Union of Concerned Scientists has a nice summary of the concerns about non-therapeutic antibiotic use in farm production. Mainly, overuse of antibiotics may increase resistance, causing the medicines to work less well in the future when they are needed to treat diseases in people.

The list of medical and professional associations that support PAMTA includes the American Medical Association, American Public Health Association, American Academy of Family Physicians. This legislation is not a marginal environmental cause, but a very mainstream policy measure supported by sensible skeptical scientists and medical experts who have given it detailed scrutiny for reasonableness.

A notable omission from the list is the American Dietetic Association. According to information and correspondence provided by Ashley Colpaart, a long-time contributor to this blog, the Association's policy group considered a recommendation from the Hunger and Environmental Nutrition (HEN) practice group, but ultimately decided neither to endorse nor oppose PAMTA.

One issue in question is whether PAMTA is food safety legislation, since food safety issues are within ADA's purview but other environmental issues might be considered further afield. The CDC explains why it believes "antibiotic resistance is a food safety problem."

Another issue is that ADA reviewers may have thought mistakenly that the list of endorsers included only state affiliates of major public health associations, rather than the national offices. But, in fact, the most important national associations are on the list (it is an understandable mistake -- the state identification in parentheses is just the state where the national office is located).

For a long time, PAMTA has been opposed by the meat production industries and by the American Veterinary Medical Association, which has financial interests at stake. Among more independent public health and medical associations, the ADA's reluctance to take a position on this important and moderate legislation stands out like a sore thumb. Some years from now, if the serious concerns about antibiotic resistance are shown correct and these powerful medicines are weakened, ADA may be embarrassed about its lonely silence.