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Shake the Sodium, Doctors Say

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Doctors have been warning Americans to watch their sodium for years. Now health authorities say that wasn't enough.

The problem? Stealth salt.

Concerned about rising rates of high blood pressure, the American Public Health Association is calling for food manufacturers and restaurants to reduce the sodium in their fare by half over the next decade.

The 50,000-member organization says such a radical reworking of the national palate is needed because of the spread of convenience foods seasoned before they enter the home.

An estimated three-quarters of the sodium in Americans' diet comes from processed foods and restaurant and take-out meals. "If we cut the sodium in those by half, we could save 150,000 lives a year," said Stephen Havas, a University of Maryland epidemiologist who helped write the proposed new food policy.

"So many people I work with think they're OK because they don't salt their own food," said Nancy Anderson, a dietitian with the Heartwise program at Emory University. "But they get way too much sodium from potato chips and canned soup and spaghetti sauce. We're living under a false sense of security."

The public health recommendations were underscored last month by new federal guidelines on high blood pressure that lower the threshold of readings considered potentially damaging to 120/80. The new standard reclassifies 45 million Americans as "pre-hypertensive," joining the 50 million who already are considered to have high blood pressure.

Consuming too much sodium, which makes up 40 percent of salt, has long been associated with high blood pressure. While many health-minded Americans have backed off from the salt shaker, Agriculture Department surveys show average salt consumption rose by 7 percent during the 1990s.

Despite the numbers, sodium seems to have slipped as a dietary concern. The Food Marketing Institute, a supermarket trade group, reports concern over salt has dropped in its consumer polling and now ranks far below fat and sugar as a nutritional worry.

"Salt isn't considered as fashionable as trans fatty acids and some of these other things," said George Mensah, chief of the cardiovascular health program at the Centers for Disease Control and Prevention in Atlanta. Worst in the South

The body needs about 500 milligrams of sodium a day --- less than a quarter teaspoon of salt --- to regulate fluids. Americans consume an average of 1 2/3 teaspoons; federal nutritionists have set 1 teaspoon as an upper daily limit.

Epidemiologists blame excessive sodium, along with obesity, physical inactivity and smoking, for the increasing rate of hypertension. After decades of decline, the trend line turned up during the late 1980s.

The statistics are of particular concern in the South, which has traditionally had the highest rates of hypertension and stroke. The region is home to the nation's largest concentrations of African-Americans, who are far more likely to develop high blood pressure than whites, as well as some of the most heavily seasoned food in America.

The combination vexes lovers of traditional Southern cooking.

"I don't see how you can do this kind of cooking without seasoning it," said James Paige of the Collard Green Cafe in Decatur. "I'd just as soon go out of business as give up salt."

The National Heart, Lung and Blood Institute, the federal agency charged with educating the public on cardiovascular disease, has long advised people with high blood pressure to reduce their salt intake. But the admonition broadened to others in the 1990s as more studies confirmed a cause-and-effect relationship between salt and hypertension.

Sodium can constrict vessels and swell the volume of blood, making the heart push harder. Even a small rise in pressure can have deadly implications. Starting at 115/75, every 20/10 increase doubles the chance of death from stroke or heart disease, the institute says.

Not everyone is convinced that the science on sodium is so clear.

"We don't dispute that salt has a hypertensive effect and that some of the population needs to reduce sodium," said Richard Hanneman, president of the Salt Institute, an industry group. "But we disagree that the evidence supports such an unprecedented intervention for the general public." Conventional wisdom

The Salt Institute's Web site is densely footnoted with studies that call the conventional wisdom into question. But conventional wisdom it is: Most health organizations agree that Americans would be better off eating less salt.

"There will always be studies that show this group or that can eat a lot of salt and not develop high blood pressure," said Mensah, of the CDC. "But we can't make public health plans based on the fringes. If you look at the totality of evidence, there's enough to call for a general reduction."

The food industry has offered low-sodium products since the 1970s, but they haven't been big sellers. Some companies have reduced sodium in marquee brands --- General Mills took some of the salt out of Hamburger Helper, for instance. But the industry is reluctant to tinker too much.

"The first reason a consumer buys a product is taste," said Stephanie Childs, a spokeswoman for the Grocery Manufacturers of America. "If you take 50 percent of the sodium out of food products, they won't taste the same and customers will take them home and go, 'Bleh!' "

Edward Roccella, coordinator of the National High Blood Pressure Education Program, said that's why the new recommendation was spread out over 10 years. "All we're asking for is a gradual reduction," he said. Hard to swallow

Perhaps no food maker has wrestled with sodium more than the Campbell Soup Co. As the nation's largest purveyor of soup --- one of the saltiest items in the store --- Campbell's is to sodium what Coca-Cola and Pepsi are to sugar.

"We've been the whipping boy on this issue," acknowledged spokesman John Faulkner.

Campbell's markets 26 low-sodium or reduced-sodium soups, but sales account for less than 5 percent of its ready-made soup business. At the same time, the company has taken steps to cut back on the salt in its core products.

"Our chefs and R&D people have been under instructions for years to reduce sodium," Faulkner said. "The taste for saltiness in our society has been declining, and we try to respond to the market."

In the past four years, Campbell's chicken noodle soup, its flagship variety, has gone from more than 1,000 milligrams of sodium per serving to 890. A 10 3/4-ounce can contains 2 1/2 servings, so if you eat the whole can --- and who doesn't? --- that's still 2,225 milligrams, nearly the entire daily allowance of sodium in one meal.

But Campbell's has found that if it removes too much sodium --- 60 milligrams at a time seems to be the limit --- tasting panels complain.

Americans seem stuck in a love-hate relationship with the ubiquitous mineral.

Perhaps no one in Atlanta embodies the mixed emotions better than Paul Luna. The flamboyant chef caused a stir a decade ago when he openly quarreled with customers over the seasoning at his first restaurant, Luna Si, once going so far as to moon one of them. Luna loves salt, but he simply couldn't bear to hear diners ask for shakers when he had salted everything just so in the kitchen.

At his latest restaurant, Lunatique, the chef relented and placed mills of coarse-grained sea salt on the tables. Older and wiser, he tries not to say anything when customers start grinding away.

It's hard.

"I think, oh my God, shouldn't I tell them to stop?" he said. Reluctantly, he has come to agree with the doctors. "We eat too much salt in this country."

Copyright 2003 The Atlanta Journal-Constitution

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