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Thursday, June 3, 2010

Regulating Salt

On Wednesdays I like to go to McDonald’s for lunch. This Wednesday, as usual, I ordered a double cheeseburger meal. With medium fries and a Diet Coke this is a good value at $2.99, and it keeps me filled up until dinner. For kicks, today I flipped the place mat and read the nutritional content: 440 calories in my double cheeseburger, 23g of fat, 11g of saturated fat, 80mg of cholesterol and 1150mg of sodium. In my medium fries I consumed 380 calories, 19g of fat, 2.5g of saturated fat and 270mg of sodium. Generally, I don’t worry too much about this tasty weekly bargain, given my relatively healthy diet, daily exercise and normal body mass index. However, some may not agree with my lack of alarm.

Increasingly we’re hearing about government regulation of food. Yesterday I read the May edition of Atlantic Monthly. Its article, “Beating Obesity,” was about the obesity epidemic, comparing and contrasting excess food as a social ill, with tobacco. Much like the tobacco industry, the food industry has been under recent attack for formulating and marketing the addictive processed foods that our children snack on. As we all know, these foods are rich in sodium, sugar and fat, and contribute to obesity and chronic health problems including, hypertension, diabetes and cardiovascular disease, among others. Salt is the most recent of these nutritional poisons to come into the limelight.

There is epidemiological evidence from the NHANES Trial and others that high salt intake is linked with hypertension and an increased risk of cardiovascular disease. A recent meta-analysis published in the British Medical Journal demonstrated worse outcomes in those who consumed a high salt diet. The recommended daily allowance of sodium for people at low risk is 2300 mg. For those at high risk, which I am sorry to say includes healthy me, the recommended daily allowance is less than 1500 mg. “High risk” is defined as: over age 40, people who have high blood pressure or slightly elevated blood pressure, people who have diabetes, and African Americans. This constitutes 70 percent of Americans. Perhaps I should think twice about my weekly meal.

On April 20, 2010 the Institute of Medicine released the report, “Strategies to Reduce Sodium Intake,” recommending that the FDA work with the food and restaurant industry to set new standards for reducing the sodium content of marketed foods. The argument goes that if we all get used to a low sodium diet (less than 1500 mg) at a young age we will change our palates and reduce our cardiovascular risk. OK fine, I’ll give up the double cheeseburger, but not my Kalamata olives, those are Mediterranean, they must be healthy.

A recent New York Times article noted the challenge to the food industry. Salt works synergistically with sugar and fat to mask the taste of foods that without enough salt have the consistency of “damp dog hair.” That doesn’t sound good.

It seems to me that the food industry is in trouble. Regulation of food has become increasingly popular. In 2006 the New York City Board of Health made New York City the first to ban trans fat from restaurant food. Bill Clinton has campaigned to get sugary soft drinks out of schools, which has been demonstrated to be an effective means of combating childhood obesity, Michelle Obama’s current agenda. The movie Food Inc. certainly showed the ugliness of food industrialization in our country, portraying the big business aspect, with its primary focus on mass production. The implication was that the FDA and USDA have been negligent.

In my neighborhood of Decatur, Georgia, located less than two miles from the CDC and Emory University, a new restaurant, Farm Burger, is a big hit, featuring locally-produced hormone-free hamburgers. Farm Burger has very good burgers, but I am a personal fan of burgers at the Brick Store Pub, though admittedly it could be could be its extensive beer list and English pub atmosphere that flavors my preference. I wonder how the sodium content of burgers in these restaurants compares. Should governmental regulatory agencies be getting more involved?


  1. In terms of ill effects on the body, can you minimize the impact of a high sodium diet if you increase your water intake? It seems to me that as long as you maintain a certain ratio of water to electrolytes, things should run smoothly. You probably know how bad you feel when you work out hard on a hot day and sweat out all your electrolytes. Just drinking water won't cut it. So then does it stand to reason that an athletic person who sweats a lot can afford to eat more sodium (alongside with potassium, calcium, magnesium, etc.) given that they also make sure their fluid intake is also increased?

    I suppose I never paid much heed to high sodium warnings. Indeed, I probably eat way more sodium than is recommended, but I also drink 3+ cups of fluids per meal. I have low blood pressure and am still a few years away from 40.

  2. The relationship between salt ingestion and cardiovascular disease is complex. Some of its detrimental effects are related to hemodynamic overload (more fluid in your blood vessels). This occurs precisely because the excess sodium ingested pulls water into the blood vessels to maintain its correct physiologic concentation. However, high salt intake seems to have other independent deleterious effects. It appears to have a direct effect on the heart muscle causing "hypertrophy" and fibrosis of the ventricle and a condition called diastolic dysfunction, which impairs the filling and relaxation of the heart. There may be other effects as well. But drinking water to maintain your electrolyte balance is likely not protective, though it's true that if you lose salt and water through sweating you do need to replete both the electrolytes (salt, potassium) and water lost. Here is a link to a very interesting article explaining the possible mechanisms for the observed increase in cardiovascular risk related to the consumption of a diet that is high in salt.