Salt has played a significant role in culture, diet and health throughout human history.  Salt has been used to add flavor to foods, keep foods fresh, make icy roads and sidewalks safer and was even a form of currency in Ancient Rome (the word salary comes from the Latin word salarium – the money allowed to Roman soldiers for the purchase of salt). However, you may be hearing more about it recently as increasing concerns about how much salt we consume have prompted public health efforts to reduce intakes.

What is sodium and why do we need it?
Sodium is an essential mineral that the body is unable to make, so it must be supplied by the diet. Although the terms “sodium” and “salt” often are used interchangeably, salt is composed of 40 percent sodium and 60 percent chloride; one teaspoon of salt contains about 2,300 milligrams (mg) of sodium.

In the body, sodium is necessary for fluid regulation, nutrient transport and blood pressure regulation; in food it is important for preservation, texture, stability and flavor. For more information, check out IFIC Review: Sodium in Food and Health.

Why is sodium an important issue?
High sodium intake is associated with increased risk of high blood pressure, a major risk factor for heart disease and stroke for those individuals who are sensitive to sodium or are predisposed to hypertension. The U.S. Department of Agriculture estimates that the average American consumes 3,400 mg of sodium a day, which exceeds current dietary guidance.  For example, even though the 2005 Dietary Guidelines for Americans recommend that healthy Americans consume less than 2,300 mg.  Further, people who are hypertensive, middle-aged, elderly or African American should not exceed 1,500 mg (the Centers for Disease Control and Prevention estimated that 69.2 percent of U.S. adults fall within this special population). The World Health Organization recommends a maximum intake of 2,000 mg a day for adults.

It is critical to help consumers understand the importance of managing sodium intake and guidance on how to do so. IFIC research shows that most people are not personally concerned with their sodium intake, but they think others should be. Additionally, they know neither how much sodium they should have each day nor how much they typically consume.

However, people are interested in learning more about sodium and health, and it is important that they understand and incorporate all of the dietary and lifestyle factors, that, when coupled with reducing sodium intake, can help reduce the risk and treat hypertension. According to the National Heart, Lung and Blood Institute JNC7 (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) report, the most effective strategies are weight reduction, adoption of the Dietary Approaches to Stop Hypertension (DASH Diet) and engaging in regular physical activity. The DASH eating plan is rich in potassium, magnesium and calcium. Sodium reduction and moderation of alcohol consumption may also play a key role in hypertension management.

Many stakeholders are exploring ways to reduce sodium
At the federal level, the Institute of Medicine convened an expert committee examining strategies to reduce sodium intake, which is expected to release recommendations by February 2010. In addition, the Dietary Guidelines Advisory Committee, including a Subcommittee on Sodium, Potassium and Water, is in the process of developing a report based on scientific evidence-based reviews to inform the 2010 Dietary Guidelines for Americans.

The Center for Science in the Public Interest has called for increased government regulation of sodium in food products since the 1970s (the U.S. Food & Drug Administration currently regulates salt as a “Generally Recognized As Safe” substance), and the New York City Department of Health and Mental Hygiene is working with the food industry to launch a voluntary sodium reduction initiative.

Internationally, the United Kingdom’s Food Standards Agency has been encouraging voluntary reductions within food categories while running a consumer education campaign. Health Canada is developing a similar initiative.

The food industry has voluntarily been reducing the amount of sodium in its products incrementally and often without fanfare because consumers tend to shy away from products advertised as low- or reduced-sodium. Only 13 percent of consumers say they would choose a product indicating “low-sodium” compared to other front-of-pack claims or no claims, according to IFIC research.

A work in progress…
It is important to keep in mind that achieving a balanced, healthful diet means more than focusing on just one nutrient. The Dietary Guidelines recommend including all five food groups and abundant amounts of fruits, vegetables, whole grains and low-fat or fat-free dairy products while maintaining flexibility and variety. For more information (and CPE credit for dietitians), explore the IFIC Foundation learning module, Helping Consumers Get the “Big Picture:” Practical Approaches to Promoting a Healthful, Balanced Eating Pattern.

Be sure to read next month’s issue of Food Insight, which will include tips for managing sodium intake.