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.