Workers inspect salt at the Exportadora de Sal plant in Guerrero Negro, Baja California Sur in Mexico. A recent Institute of Medicine report on sodium intake seemed to contradict the latest dietary guidelines that had been issued, leading to controversy.
Morton Satin, vice president of science and research for the Salt Institute, said he found the report shocking because of the IOM’s past positions and considers it to be a paradigm shift in his trade association’s favor. His group has been trying to bring this type of data to light, he said.
“There are people that are making recommendations that are not based on science,” Satin said. “They think that everything we’re saying has got to do with selling more salt. ... That’s not the issue. The issue is that we don’t want consumers being misled.”
However, Centers for Disease Control and Prevention Director Tom Frieden said that “the landscape hasn’t changed.” He noted that the CDC expects the 2015 dietary guidelines panel to consider the IOM report and additional evidence as it works on the new guidelines. His agency asked IOM to set up its sodium committee.
“The big picture is that Americans consume far too much sodium — 3,400 milligrams per day or more,” he said in a statement. “This increases blood pressure, stroke, heart attacks and early death. Reduction in daily sodium consumption would save lives and money.”
In the JAMA article, the three IOM committee members also cautioned against zeroing in on the disagreements about specific targets for sodium intake. The authors said that the IOM, American Heart Association, World Health Organization and dietary guidelines “are congruent in suggesting that excess sodium intake should be reduced, and this is likely to have significant public health effects.”
“Focusing the debate on specific targets misses the larger conclusion with which all are in agreement and may hinder implementation of important public health policy,” wrote Brian L. Strom, Cheryl A. M. Anderson and Joachim H. Ix.
Alice H. Lichtenstein, another member of the IOM committee who is also vice chairwoman of the 2015 dietary guidelines panel, echoed that sentiment in an interview.
“I think that the small aspects of the report were amplified and the general message of the whole report tended to be lost in a lot of the press coverage,” said Lichtenstein, a professor at the Tufts University Friedman School of Nutrition Science and Policy. “The committee clearly stated that the sodium intake currently is above the 2,300 [milligram] recommendation and should be reduced.”
Another thing to keep in mind, Lichtenstein noted, is that the committee’s task from the CDC was to examine sodium intake and health outcomes such as heart disease. However, some groups have expressed concern that blood pressure was not included.
In a June 6 letter to Sebelius, the CEO of the American Heart Association wrote, “It is imperative for blood pressure to be considered as an appropriate health outcome when considering national sodium policy and nutrition guidance.” CEO Nancy Brown also explained the basis for her group’s recommendation of 1,500 milligrams, which incorporates blood pressure and urged the administration to set the daily value for sodium at that level.
Satin of the Salt Institute, meanwhile, said the report’s conclusions about the 1,500-milligram level are in “total contradiction” to the AHA’s position. His concerns are about the makeup of the IOM and dietary guidelines panels rather than the recent report, and he said there’s a need for objective experts without committed opinions on sodium issues.