Will New York’s ban on salt really make patients healthier?

Originally posted in MedPage Today

by Mike Himowitz

I have a libertarian streak that compels me to shout “Nanny State!” when local governments put up speed-trap cameras to extort money from otherwise law-abiding citizens who drive a few miles over artificially low limits. Same for legislators who want to make me a criminal for calling my wife on my cell phone to ask her if I should pick up anything at the store while I’m driving home. Same for the nicotine Nazis who want to ban all smoking outdoors.

So I’ll admit to the same knee-jerk reaction this week when I heard that New York City was launching yet another Nanny State crusade – this one to cut down the salt in the foods we buy at the supermarket and eat in restaurants.

As vices go, salt consumption doesn’t rank very high on the see-you-in-hell scale. Yes, I know, when you eat too much salt, you can wind up with high blood pressure, and that can lead to heart attacks, strokes, and so forth. Most of you are doctors – you know all this, too. So do the people who make metoprolol, valsartan and all the other drugs we take to bring that blood pressure down. But compared, say, to smoking, a handful of potato chips is small-time crime.

The problem is that unlike smoking – a sin you commit knowingly and with malice aforethought every time you light up — salt consumption is relatively transparent. According to New York health officials, only 11% of the salt most of us eat comes from our own saltshakers. More than 80% of it comes in the packaged and prepared foods we consume every day. Most of us don’t bother to look at the labels, and even if we did, we probably wouldn’t know how much is too much unless our doctors had already warned us off the stuff.

So New York officials, who have already attacked smoking and trans fats in the city’s restaurants, rounded up a bunch of other health departments, government agencies and nonprofit organizations in a group called the National Salt Reduction Initiative. It wants to persuade food manufacturers and restaurants to voluntarily cut the amount of salt in their products so that Americans are eating 20% less sodium five years from now than they eat now.

This is not exactly a draconian step (although the right wing conspiracy nuts are already using the salt issue to rant about left-wing, big government conspiracies on Fox news). In fact, the initiative is designed precisely to avoid the kind of consumer taste-backlash that killed off so many low-sodium foods when they first appeared in the 1980s.

“If you do it overnight, people notice the difference,” said New York Mayor Michael Bloomberg. “If you do it gradually, over three, four, or five years, people don’t notice. But you wind up with a lot less sodium in the food.”

In fact, the Wall Street Journal ran a fascinating article detailing how food manufacturers have quietly been doing just that. They’ve renewed their earlier efforts by gradually cutting back the salt content of many products in recent years — without advertising the fact.

In any case, the government says 1,500 milligrams of sodium a day is enough for most of us; while the average American consumes twice that amount.

Once I started looking at food labels in the pantry and freezer, I realized why. While we don’t use much salt when we cook at home from scratch, my wife and I don’t cook that much anymore. With our kids out of the house, we’re much more likely to eat prepared foods or semi-prepared foods, order takeout, or go to a restaurant.

Let’s start with a worst-case scenario: According to McDonald’s Web site, a Big Mac (1,040 mg) with medium fries (270 mg) will provide almost 90% of your recommended daily sodium intake. Add a hot fudge sundae (180 mg) and you’ve reached the RDA before you even think about the salt you’ve scarfed down at breakfast and lunch.

Okay, there are all sorts of reasons why a Big Mac, fries, and a sundae are bad for you, including sodium. But when it comes to salt content, you’ll find plenty of it in a lot less conspicuous places.

Consider one of those microwaveable, 15.4-ounce cans of Campbell’s Tomato Soup: 1,540 mg of sodium – more than the entire Big Mac meal. And Campbell’s says it’s using a lot less salt than it did a few years ago. A similar, ready-to-eat can of Progresso Chicken Noodle Soup had a whopping 1,950 mg.

Here’s a mind-blower: Which has more salt – an ounce of Utz’s Ripple Potato Chips or an ounce of heart-healthy Cheerios? Answer: Cheerios by a landslide, 190 mg to 95mg. In fact, most cereals are just as salty, or more so. Our kids’ old favorite, Cap’n Crunch, has 200 mg. And a serving of Kellogg’s Raisin Bran? A whopping 350 mg.

Here’s where I feel virtuous – the Post Shredded Wheat and Bran I eat every morning to keep up my fiber intake has zero sodium. That’s right, nothing, nada. But I make up for it the rest of the day.

Strangely, a lot of “savory” snacks (the industry’s term for “salty”) probably have less salt than you think. Consider the sodium content of the following:

Planter’s salted nuts (with pure sea salt), one ounce, 110 mg.

Frito-Lay Tostitos White Corn Scoops, one ounce, 120 mg.

Snyder’s Multi-Grain Pretzel Sticks (7), 160 mg

Elsewhere, you’ll find that salt and sugar go together. Those little Girl Scout Thin Mint cookies that everybody loves? Eat four of them and you’ll consume 120 mg of salt, the same as an ounce of Tostitos. Yeah, I know. Who can eat just four?

Plunk down your cash for a Starbucks blueberry scone and you’ll devour 420 grams of sodium – as much as an ounce of Tostitos, seven pretzel sticks and an ounce of salted nuts put together.

Bottom line: the New York Nanny-Staters are an obnoxious bunch on the whole, but they have a point here – nobody has the time to read every food label, and the salt content of many products is well masked from the taste buds. Or it may be that we’re so used to oversalted foods that anything else tastes intolerably bland.

Hopefully, the food manufacturers will get the message and cut back where they can. There’s also a near-foolproof escape hatch: If you think the meal in front of you is too bland, you can always pull out your own saltshaker.

Mike Himowitz is Deputy Managing Editor at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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