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We’re Overdosing On Sodium: Whose Responsibility Is It?

I confess to loving Campbell’s tomato bisque soup. I mix it with 1 percent-fat milk and it’s hot and delicious and comforting, but one of the worst food choices I could make because one cup contains more sodium than I should have in a day. Knowing this, I have already relegated it to an occasional treat. But by the end of this blog post I will do more.

We are overdosing on sodium and it is killing us. We need to cut the sodium we eat daily by more than half. The guidelines keep coming. The U.S. government has handed out dietary guidelines telling Americans who are over 50, all African Americans, people with high blood pressure, diabetes, or chronic kidney disease to have no more than 1,500 milligrams (mg) — or two thirds of a teaspoon — of sodium daily. That’s the majority of us — 69 percent. Five years ago the government said that this group would benefit from the lower sodium and now it made this its recommendation. The other 31 percent of the country can have up to 2,300 mg a day, say the guidelines from the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS).

Or should they? The American Heart Association (AHA) recommends that all Americans lower sodium to less than 1,500 mg a day. Excessive sodium, mostly found in salt, is bad for us because it causes high blood pressure which often leads to heart disease, stroke, and kidney disease and can also cause gastric problems. People with heart failure are taught to restrict salt because water follows salt into the blood and causes swelling of the ankles, legs, and abdomen and lung congestion that makes it difficult to breathe.

I saw one recommendation by an individual on the Internet to just drink a lot of water to flush the sodium out of your body rather than worry about eating foods that have less sodium. BAD idea, especially for people with heart problems who need to restrict fluids to help prevent fluid accumulation in their bodies. The salt will draw the water to it.

But cutting our salt consumption by half is quite a tall order for an individual consumer because Americans have been conditioned from childhood to love salt and we on average consume 3,436 mg — nearly one and a half teaspoons — a day. Sodium is pervasive in our food supply. We get most of our sodium from processed foods and restaurant and takeout food, sometime in unexpected places.

The report of the 2010 Dietary Advisory Guidelines Committee had this to say:

While some foods are extremely high in sodium, the problem of excess sodium reflects frequent consumption of foods that are only moderately high in sodium. The major sources of sodium intake among the US population are yeast breads; chicken and chicken mixed dishes; pizza; pasta and pasta dishes; cold cuts; condiments; Mexican mixed dishes; sausage, franks, bacon, and ribs; regular cheese; grain-based desserts; soups; and beef and beef mixed dishes (NCI, 2010). Collectively, this group of foods contributes about 56 percent of the dietary sodium, or nearly 2000 mg per person per day. A major new concern is the excessive sodium added to products such as poultry, pork and fish through injections or marination.

In April, 2010, after 40 years of studies and reports from various groups about the health hazards of excessive sodium, the Institute of Medicine (IOM) took a major step, urging the federal Food and Drug Administration (FDA) to regulate salt in processed food and prepared meals.

But a check with the FDA this morning found that the agency still has not decided to regulate salt. Spokesman Siobhan DeLancey sent me this comment by e-mail: “Reducing sodium levels in food nationwide is an enormous undertaking; one that will require partnership with industry, states, and consumers. There are many complexities to consider, and as the IOM recognized in its report, it will require an iterative approach over time. FDA recognizes the enormous need to lower sodium levels and thereby save tens of thousands of lives each year. The Agency is exploring the full range of options available to reduce sodium levels nationwide.”

Why is it taking so long to get action? Sodium is killing tens of thousands of people every year.

Read the labels of canned goods and processed foods before you buy them. The back of the Campbell’s tomato bisque can tells me that the serving size is 1/2 cup and there are 880 mg of sodium in that serving. But when have I ever had half a cup of tomato bisque? I could easily eat a cup and a half, and feel I am reigning myself in to have only exactly one cup. So in the few minutes it takes to drink a cup of soup, I have devoured 1,760 mg. of sodium. But I should only have 1,500 mg all day long. While I have for some time made it a rare treat, today I am publicly pledging, and it hurts me to write these words, that I will never bring another can of Campbell’s tomato bisque soup into my home. I think that is my personal responsibility. I am smart enough and, as a health journalist, knowledgeable enough, to know better.

But whose responsibility is it to keep sodium away from a four-year-old in Appalachia or a woman who is diabetic with heart failure in Harlem or a 30-year-old construction worker who takes a lunch to work every day in Chicago or a teenager in San Francisco? Or, for that matter, the business executive or college student or anyone else who eats on the run and frequently has two or three slices of pizza? Why can you always find pizza in hospital cafeterias? Do you know how much sodium is in pizza? Too much. It varies, depending on thin or thick crust and toppings, but it is not a health food. And don’t even mention Chinese food.

Keep in mind what the advisory report found: It is repeated eating of foods moderately high in sodium that is the biggest source of our sodium overdose.

Who is responsible for cutting back the sodium available in so many foods in the United States? Well, I think lots of people are. But on the front lines, leading a take-no-prisoners revolt should be the physicians of this country. It is not enough to issue guidelines or make a statement or even publish a Call to Action in a medical journal that the public doesn’t read. Dr. Barry Massie, president of the Heart Failure Society of America, wrote a comment to a heart failure blog post of mine on CardioExchange that I shared on this blog. Dr. Massie had just referred to transplants, left ventricular assist devices, implantable defibrillators, and stem cells as treatments for heart failure that draw media attention. And then he said:

“My plea would be that we shift our focus to prevention. Heart failure is relatively easy to prevent but will take a shift in our behavior. Early detection and effective treatment of hypertension (high blood pressure) can prevent up to 50 percent of all new heart failure cases. Prevention of heart attacks with changes in diet, life style, and smoking cessation will prevent another large number of heart failure cases. A decrease of 1 (1,000 milligrams) to 3 grams of daily salt would save more lives than all of these high-tech interventions taken together.”

That is a strong statement.

And Daniel Levy, M.D., director of the Framingham Heart Study, said of heart failure: “In the majority of cases, it is preventable.”

In the January 13, 2011 issue of Circulation, the AHA issued a “Call to Action” on reducing population-wide sodium to prevent cardiovascular disease and stroke. But the AHA stopped short of asking the FDA to move ahead regulating sodium in processed food and prepared meals. Why?

I ask physician leaders and the American Heart Association who says all Americans should have no more than 1,500 mg of salt daily to not just write a call to action, but to take action. Tell the FDA it’s time to regulate. Mount a campaign, pressuring food manufacturers and chefs and fast-food outlets to prepare food responsibly, meet with state governments and the federal government. Place prominent ads that educate about sodium and emphasize personal responsibility for choosing to eat a healthy diet. Go on talk shows, ask scriptwriters to include lines about avoiding high-sodium food in popular television shows.

Heed the words in the 2010 Report of the Dietary Guidelines Advisory Committee that point out the Institute of Medicine said efforts to urge lower sodium in diets short of regulating it have failed.

Individuals should take part of the responsibility, but should not be asked to do it all.

The current focus on individuals selecting lower-sodium foods and availability of reduced-sodium niche products cannot result in intakes consistent with the Dietary Guidelines for Americans by themselves. They must be accompanied by an overall reduction of the level of sodium in the food supply. In other words, the level of sodium to which consumers are exposed on a daily basis from processed and restaurant foods must be reduced. To date, efforts by food processors and the restaurant and foodservice sectors to voluntarily reduce the sodium content of the food supply face obstacles, are not consistently undertaken by all, are not readily sustained, and have proven unsuccessful in lowering overall sodium intake.

As for taking personal responsibility, we all need to step up. Why is it so hard for many of us to do?

I’ve been talking with a number of people about why some of us look after our health by eating right and exercising and some of us don’t. And I think people who take care of their health all do two things. To start with they get an attitude. Two people who have that attitude you know from their guest posts on this blog. Jody Schoger says “We get the attitude by doing.” Something makes you take that first step and then you keep going. With regard to exercising, Jody says you take “a step forward, a walk, the next one, the one after that, the attitude will grow.”

Then they develop a habit.

Brian Mossop has the habit not just of exercising, but eating right. “My wife and I eat healthy,” he said. “Shop at our local farmers market, stay away from processed foods. Cooking healthy dinners together is a fun way for us to unwind at the end of a long day, it’s something we both very much enjoy. I don’t ‘stay away’ from any foods, rather I focus on eating smaller portions. I stay far, far away from processed foods.”

We all should.

But the IOM wisely points out that this is not happening:

The current focus on instructing consumers to select lower-sodium foods and making available reduced-sodium “niche” products cannot result in intakes consistent with public health recommendations. Without major change, hypertension and cardiovascular disease rates will continue to rise, and consumers, who have little choice, will pay the price for inaction. (Bold emphasis is mine.)

What is your responsibility, doctors? If you really believe that simply lowering sodium in our food could save 100,000 lives, how can you not lead the charge as the Egyptians are doing? What are you going to do, doctors? What are you going to do, FDA?

*This blog post was originally published at HeartSense*

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