When it comes to salt, how much is too much?

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    (Kimberly Paynter/for The Pulse)

    (Kimberly Paynter/for The Pulse)

    Philly health officials want you to cut the salt—most of us anyway.

    The city’s new sodium-reduction campaign features a middle-aged African American man with a distinctive droop on one side of his face. 

    The poster plastered on buses around the city says: “Having a stroke can change your life. Eating too much salt is part of the problem.”

    In some people, too much sodium makes the body hold on to excess fluid. That pushes up blood pressure and puts an extra burden on the heart.

    Lots of the food that Philly loves is full of salt says Giridhar Mallya, director of policy and planning at the Philadelphia Department of Public Health.

    “A typical hoagie, 12-inch hoagie with all the usual fixin’s—so, cold cuts, cheese, mayo, other things. That has more than a day’s worth of salt,” Mallya said.

    Most of the salt Americans eat comes from food prepared by someone else, and Americans are eating more and more of their meals away from home, he said.

    “We need folks in the city to know where their salt is coming from,” Mallya said “Whether it’s a chef in a restaurant, or whether it’s a big food company that has processed and packaged something for you.”

    How much salt is healthy? 

    That’s a big point in the city’s campaign to cut salt, but that message is up against some confusing headlines about how much salt is healthy.

    In a report issued last summer, the Institute of Medicine studied the science on salt and health and found no benefits or harms to support a bid to lower the U.S. dietary guidelines for sodium.

    “The message that got sent was: ‘Oh, we can eat as much salt as we want–and it will be fine,'” Mallya said. But he and many other public health experts say that’s the wrong takeaway.

    In the wake of the Institute of Medicine report there was a big debate—and a string of commentaries.

    For the general population, the Food and Drug Administration recommends limiting sodium to less than 2,300 mg a day. The guideline is less than 1,500 mg a day for people older than age 50, African Americans and anyone with high blood pressure or certain other health conditions.

    Last summer’s debate was about lowering the recommendation, but very few people are following the current dietary guideline. 

    The average American eats about 3,400 hundred milligrams of salt per day—or about one and a half teaspoons.

    “That’s the average,” Mallya said, “which means about half are eating even more than that.”

    ‘It’s a matter of balance’ 

    Consuming extremely high–or low–levels of salt is linked to health problems. But beyond that, Morton Satin says the science on salt is far from settled.

    Satin is a food scientist and vice president, science and research for the industry trade group The Salt Institute.

    Asked about what level of salt is healthy, Satin said he starts with the presumption that most people are healthy—and that around the world other cultures and populations—consume more salt than the U.S. average.

    “Consuming the levels of salt that we are consuming is perfectly compatible with a long life,” Satin said.

    He said “bland bureaucrats” selected the current 1500 mg to 2300 mg guidelines without the research to back the choice.

    Consider the Mediterranean diet, he said, which includes many more vegetables, salads and olive oil than the typical American diet.

    “This is the little, dirty secret of the Mediterranean diet that nobody’s ever mentioned is that their salt intake is almost 40 percent higher than the American salt intake,” Satin said.

    It’s a matter balance, he says, not demonizing any one thing—be it sugar, or fat—or salt.

    “We don’t eat a bag of nutrients, we eat foods,” he said.

    Our evolving taste buds  

    Smell and taste researcher Gary Beauchamp says as humans, we evolved in an environment without much salt.

    “We ate mostly plants and fruit, and there wasn’t much salt there, and we need sodium for our bodies, so we developed special mechanisms to detect it and to make it delicious,” said Beauchamp, director of the Monell Chemical Senses Center.

    Fast forward to modern times and salt is baked and processed into much of the food we eat.

    He said it’s probably a good idea to stop using your saltshaker so much, but if you are trying to reduce salt in your diet it may not help much.

    “You are going to have to change the food environment,” Beauchamp said.

    A few years ago, he served a science panel that recommended that the government change the rules and force food makers to reduce the salt they put in food.

    “That hasn’t happened,” he said.

    Should government officials have a say? 

    There doesn’t seem to be any plans to regulate salt but the government may set some guidelines and ask food companies and restaurants to make voluntary changes.

    This week, when news of coming guidelines surfaced again, the National Center for Public Policy Research spoke out against the change.

    “Government regulators are paving the way toward federally-imposed limits on sodium,” the group’s press statement said. It called the expected move “rooted in politicized science that will further reduce consumer choice and potentially hurt public health.”

    There is research–some of it conducted at Monell in Philadelphia—that suggests that when you gradually reduce sodium in people’s diet, their preferences adjust and they begin to like the taste of less salt.

    Philadelphia health policy director Giridhar Mallya said companies such as Kraft Foods, ConAgra and PepsiCo have pledged to reduce the salt in some of their products.

    Beauchamp sees those efforts but says many companies have decided not to trumpet the changes. “Because when people see the advertisement ‘low salt’ they just immediately think: ‘Not going to taste good.'”

    In 2011, Campbell Soup in Camden, N.J., got jeers from some public health people when the company decided to add salt to some of its once lower-sodium soups.

    The CEO said Campbell was responding to complaints about taste.

    Finding a low-sodium product on the shelf can be tricky. Food makers use many different labels to attract sodium conscious shoppers but each means something different—from ‘low sodium’ to ‘less sodium.”

    Beauchamp said food companies have resisted ‘bully pulpit’ attempts to get them to cut salt. It’s a challenge he said because salt balances out the bitterness of food—especially packaged foods–and it has lots of uses beyond taste.

    It can help to preserve freshness, color even the texture of food—making it even more valuable to manufacturers.

    “Compared to even a few hundred years ago, salt is incredibly cheap, it’s the cheapest thing you can put in food, with the exception, perhaps of water,” Beauchamp said.

    Shaking the habit 

    So who really needs to shake the salt habit? And who are health experts most worried about?

    Giridhar Mallya says the city’s campaign was especially designed to speak to people with high blood pressure, people at risk for stroke, and blacks.

    “African Americans are more salt sensitive, meaning that even a half teaspoon more of salt per day can increase the blood pressure of African Americans on average by 6 to 9 points, whereas it might only be 3 to 6 points among Caucasians,” Mallya said.

    About 40 percent of black adults in the United States have high blood pressure. Hypertension is often a precursor to heart disease, kidney disease and stroke.

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