Sodium Reduction: Time for Choice

Sodium Reduction: Time for Choice


>>>GOOD AFTERNOON, EVERYBODY,
IT’S 1:00, WELCOME TO THE CDC PUBLIC HEALTH GRAND ROUNDS. TODAY WE ARE TALKING ABOUT SALT
OR AS OUR SPEAKERS ARE GOING TO EDUCATE US, SODIUM IN
PARTICULAR. NOW AS YOU WILL SEE AND HEAR, IT
SEEMS WE ARE DRENCHED IN SALT NO MATTER HOW YOU TAKE IT. BUT I WANT YOU TO KNOW THAT IT’S
NOT THAT EASY FOR THE SALT ITSELF. IT ALSO HAS ITS OWN CHALLENGES
IN ITS LIFE, AS YOU SEE FROM THIS PARTICULAR SLIDE. SO WE HAVE TO HAVE SYMPATHY FOR
BOTH SIDES AND HAVE A FAIR AND BALANCED PRESENTATION HERE. FOR THOSE OF YOU WHO ARE
WATCHING US AT OUR IPTV OR INTRANET, THIS IS THE WEB PAGE
THAT HAS BEEN REDESIGNED RECENTLY WHERE YOU CAN FIND ALL
THE INFORMATION ABOUT THE WEB — ABOUT THE GROUND ROUNDS, WHERE
YOU CAN RECEIVE E-MAIL UPDATES, EVEN USE IT AS YOUR SCREEN AND
HOME PAGE. FOR THOSE OF US WHO ARE JOINING
US FROM OUTSIDE, AND THAT IS USUALLY THE VAST MAJORITY OF
PEOPLE, UPWARDS OF 10,000 TO 12,000 EACH TIME, THIS IS OUR
INTERNAL INTERNET — EXTERNAL INTERNET SITE ON WHICH YOU CAN
FIND ALL THE ARCHIVE EDD SESSIONS
AND DETAILED INFORMATION ABOUT THE 19 SESSIONS THAT WE HAVE HAD
SO FAR. WE CONTINUE TO COORDINATE
SESSIONS WITH OUR SCIENCE CLIPS, AND THIS TIME THE SELECTION WAS
MADE BY ONE OF OUR SPEAKERS, TO WHOM WE THANKS FOR THAT EFFORT. WE ARE VERY FORTUNATE TO BE
GETTING — CONTINUE TO BE GETTING A LOT OF INTEREST AND A
LOT OF VIEWERSHIP FOR OUR GRAND ROUNDS. SO FAR OVER 200,000 PEOPLE HAVE
ACTUALLY WATCHED THE GROUND ROUNDS, MAINLY THROUGH INTERNET,
BUT ALSO IN THE PAST FEW MONTHS WE HAVE START EDED USING
YOUTUBE, AS WELL. AND THERE IS A LOT OF
INTEREST –NOT AS MUCH AS SOME OF THE STUPID THINGS, HOW MANY
TIMES YOU CAN HIT THE BALL OR WHATEVER, YOU KNOW, SOME
DANCING. BUT GIVEN THAT THIS IS SCIENCE,
I WOULD SAY STILL A LOT. THIS TIME ONE OF THE THINGS THAT
I WANTED TO SAY, WE HAVE HAD REALLY COOL AND LOVELY PEOPLE IN
THE PAST 18 SESSIONS, BUT THIS IS PROBABLY THE BEST LOOKING AND
ON AVERAGE YOUNGEST LOOKING, YOUNGEST BUNCH OF PEOPLE. AND —
[ LAUGHTER ]>>AND EVEN MY ASSISTANT WHO
WORKED OVER THE PHONE WITH ME AND TALKED TO ALL OF THEM WHEN
THEY SHOWED UP IN PERSON, SHE CAME AND SAID, OH, MY GOD,
THEY’RE SO GOOD LOOKING. I SAID, HEY, WHAT CAN I SAY? SOME OF THEM ARE CDC PEOPLE,
SOME COME FROM FDA, AND THEN SOME FROM NEW YORK CITY. I KNOW THAT WE MAY BE ABUSING
NEW YORK CITY A LITTLE BIT, AND I HAVE NO IDEA WHY WE MAY HAVE
SOME SPECIFIC AFFILIATION WITH THAT CITY, BUT, YOU KNOW, WE DO. AS YOU KNOW, THE PREPARATIONS
FOR THIS EVENT ARE INTENSE. AND EACH TIME WE CHOOSE A
SPECIFIC SPORT. THIS TIME IS WAS DOUBLES TENNIS. YOU SEE CHRISTINE GIVING THE
FINAL HIT AS SHE WILL BE DOING IT IN OUR SESSION TODAY. NOW, WE WORK PRACTICALLY DAY AND
NIGHT TO MAKE THIS INTERESTING TO PEOPLE AND PAY ATTENTION,
THIS IS TODAY, 11:35 A.M., A PICTURE TAKEN IN MY OFFICE, OF
OUR FDA COLLEAGUE, JEREMIAH PASSANO, WHO WANTED TO CHANGE A
COUPLE OF SMALL THINGS TO MAKE SURE THAT HIS TALK IS PERFECT. AND I WANTED TO END THIS BY
SAYING THAT EVERY SESSION HAS ITS ANGEL GUARDIAN, AND IN THIS
CASE, IT WAS NICOLE BLAIR WHO MANAGED TO PULL THE RABBIT OUT
OF THE HAT MANY, MANY, MANY TIMES, AND WHO HAS REALLY BEEN
INSTRUMENTAL IN COORDINATING WITH SO MANY COLLEAGUES AND SO
MANY OF US WHO CONTRIBUTE IN SOME WAY. AND I REALLY WANTED TO THANK HER
AND RECOGNIZE HER FOR THAT CONTRIBUTION. SO AS ALWAYS, BEFORE OUR
SPEAKERS BEGIN, WE WILL HAVE BRIEF COMMENT BY OUR DIRECTOR
WHO IS NOT HERE WITH US TODAY BUT HAS TAPED HIS COMMENTS.>>WELCOME TO PUBLIC HEALTH
GRAND ROUNDS, CARDIOVASCULAR DISEASES IS THE LEADING CAUSE OF
DEATH IN THE UNITED STATES. NEARLY 70 MILLION U.S. ADULTS
INCLUDING MORE THAN 2/3 OF PEOPLE OVER AGE 65 HAVE HIGH
BLOOD PRESSURE. THE LEADING RICK FACTOR FOR
CARDIOVASCULAR DISEASE. IN 2010 ALONE, WE SPENT ABOUT
$70 BILLION IN DIRECT MEDICAL COSTS ON HYPERTENSION AND THE
DISEASES IT CAUSES. DESPITE THIS OUR SYSTEM FAILED
TO HELP MORE THAN HALF OF PEOPLE WITH HYPERTENSION TO CONTROL IT. IT’S ESTIMATED THAT EXCESS
SODIUM CONSUMPTION ACCOUNTS FOR UP TO 1/3 OF ALL CASES OF
HYPERTENSION AND THAT ALMOST EVERYONE IN THE UNITED STATES
CONSUMES TOO MUCH SALT. SODIUM REDUCTION IS A TOP
PRIORITY TO PREVENT HEART DISEASE AND STROKE BOTH IN THIS
COUNTRY AND AROUND THE WORLD. IN THE UNITED STATES, ONLY
ABOUT.1 OF THE SODIUM WE CONSUME IS ADDED AT THE KITCHEN
TABLE, WITH MOST COMING FROM PROCESSED FOODS. MAKING A CHOICE OF HOW MUCH
SODIUM TO CONSUME LITERALLY OUT OF THE HANDS OF INDIVIDUALS. SETTING TARGETS IN SPECIFIC
PROCESSED FOODS CAN RESULT IN REDUCED SODIUM IN INTAKE, SAVING
100,000 LIVES AND BILLIONS OF DOLLARS IN MEDICAL COSTS. THIS SESSION OF PUBLIC HEALTH
GRAND ROUNDS WILL EXPLORE THE HEALTH BURDEN OF EXCESS SODIUM
AND STRATEGIES TO REDUCE SODIUM INTAKE, REDUCING SODIUM INTAKE
WILL REQUIRE INVOLVEMENT OF THE FOOD INDUSTRY, POLICY
INTERVENTIONS, AND RIGOROUS MONITORING. IF WORKING TOGETHER GOVERNMENT
AND INDUSTRY CAN ACHIEVE SUBSTANTIAL REDUCTIONS IN SODIUM
INTAKE, WE WILL TRULY HAVE SHOWN THAT WE’RE WORTH OUR SALT.>>GOOD AFTERNOON, AND THANK
YOU, DR. POPOVICH AND DR. FREIDEN, I’M DARWIN LAVAR. I WILL EXPLAIN WHY EXCESSISODES
YUM IS A SIGNIFICANT HEALTH PROBLEM. THE CAUSE AND EFFECT
RELATIONSHIP OF SODIUM INTAKE AND BLOOD PRESSURE, THE BENEFIT
OF REDUCINGISODES YUM IN THE– REDUCINGISODES SODIUM AND FOOD
CHOICE AND SOME OF THE MYTHS AND
MISCONCEPTIONS ABOUT SODIUM. SODIUM CHLORIDE IS THE CHEMICAL
NAME FOR DIETARY SALT. IT CONTAINS 40% SODIUM AND 60%
CHLORIDE. NEARLY ALL OF THE SODIUM
AMERICANS CONSUME IS IN SALT FROM OUR FOOD. THE VAST MAJORITY IS ALREADY IN
OUR PREPARED, PROCESSED, AND RESTAURANT FOODS. THE WORD SALT AND SODIUM ARE
OFTEN USED INTERCHANGEABLY BUT ARE NOT THE SAME. THE ONE TO WATCH IS SODIUM ON A
NUTRITION FACTS LABEL OF PACKAGED FOODS. EXCESS SODIUM CAUSES
HYPERTENSION. NEARLY ONE IN THREE U.S. ADULTS,
68 MILLION PEOPLE, HAVE HYPERTENSION. OF THOSE WHO REACH MIDDLE AGE,
NINE IN TEN WILL DEVELOP IT BY THE TIME THEY REACH OLDER AGE. MORE THAN ONE IN TWO PEOPLE WITH
HYPERTENSION, 34 MILLION AMERICAN ADULTS, DO NOT HAVE IT
UNDER CONTROL. WITH THE FURTHER ADDITION OF
PEOPLE WITH PREHYPERTENSION, THOSE WITH BLOOD PRESSURE
ELEVATED ABOVE NORMAL BUT NOT ENOUGH FOR MEDICAL INTERVENTION,
REDUCING SODIUM INTAKE CAN HAVE A MAJOR PUBLIC HEALTH IMPACT. SODIUM THROUGH HYPERTENSION IS A
MAJOR CONTRIBUTOR TO DEATH, DISABILITY, DISPARITIES, AND
COSTS ATTRIBUTABLE TO CARDIOVASCULAR DISEASES OR CVDs. CVDs ARE LEADING CAUSES OF
DEATHS, KILLING SOME 800,000 ADULTS EVERY YEAR. CVDs ARE ALSO LEADING CAUSES OF
HEALTH DISPARITIES BY RACE AND ETHNICITY. TREATMENT ACCOUNTS FOR ONE IN
EVERY SICK U.S. HEALTH DOLLARS SPENT. ABOUT $273 BILLION EVERY YEAR. IN 23 DEVELOPING COUNTRIES, MORE
THAN EIGHT MILLION DEATHS COULD BE AVERTED OVER TEN YEARS IF
AVERAGE SODIUM INTAKE WERE REDUCED BY JUST 15%. THE BODY ONLY REQUIRES ABOUT 230
MILLIGRAMS OF SODIUM PER DAY. A HEALTHY DIET CONTAINS NO MORE
THAN 1,500 MILLIGRAMS SODIUM A DAY AT ANY AGE. IN FACT, ONLY 1,000 MILLIGRAMS
PER DAY FOR CHILDREN. THAT’S THE ADEQUATE INTAKE OR
A.I. THE 2010 DIETARY GUIDELINES FOR AMERICANS RECOMMENDS 1,500
MILLIGRAMS PER DAY FOR PEOPLE AGE 51 AND OLDER,
AFRICAN-AMERICANS, AND THOSE WHO HAVE HIGH BLOOD PRESSURE,
DIABETES, OR CHRONIC KIDNEY DISEASE. THAT IS VIRTUALLY HALF THE U.S. POPULATION. AND THE MAJORITY OF ADULTS 18
YEARS AND OLDER. ALL OTHERS SHOULD REDUCE SODIUM
INTAKE TO LESS THAN 2,300 MILLIGRAMS PER DAY. BUT THE CURRENT SODIUM INTAKE OF
U.S. ADULTS IS MORE THAN 3,400 MILLIGRAMS PER DAY. THERE IS A SOLUTION. SOLID SCIENTIFIC EVIDENCE SHOWS
A DIRECT CAUSAL RELATIONSHIP BETWEEN SODIUM INTAKE AND BLOOD
PRESSURE LEVELS. WHEN PEOPLE REDUCE THEIR SODIUM
INTAKE, THEIR BLOOD PRESSURE DECREASES, AND ALMOST EVERYONE
BENEFITS FROM LOWERING THEIR BLOOD PRESSURE. FOR EXAMPLE, IN MIDDLE AGED MEN,
DECREASING POPULATION SYSTOLIC BLOOD PRESSURE BY FIVE
MILLIMETERS MERCURY CAN LEAD TO A ONE IN SEVEN REDUCTION IN
STROKE DEATHS AND ONE IN 11 REDUCTION IN CORONARY HEART
DISEASE DEATHS. REDUCING SODIUM INTAKE IS A KEY
PUBLIC HEALTH STRATEGY TO PREVENT AND CONTROL HIGH BLOOD
PRESSURE. DECREASING AVERAGE POPULATION
INTYKE 1,500 MILLIGRAMS PER DAY COULD RESULT IN 16 MILLION FEWER
CASES OF HIGH BLOOD PRESSURE AND AN ESTIMATED SAVING OF $26
BILLION EVERY YEAR. EVEN IF AVERAGE INTAKE WERE ONLY
REDUCED TO 2,300 MILLIGRAMS PER DAY, WE COULD STILL EXPECT TO
SEE A DECREASE OF 11 MILLION CASES OF HIGH BLOOD PRESSURE AND
OF COST SAVINGS OF $18 BILLION IN HEALTH CARE EXPENDITURES. AGAIN, EVERY YEAR. NEARLY 80% OF THE SODIUM IN OUR
FOOD IS ALREADY THERE, AND MOSTLY INVISIBLE. IT COMES FROM FOODS WE BUY IN
STORES AND RESTAURANTS. ONLY 12% IS NATURALLY OCCURRING
IN FRUITS AND VEGETABLES AND WHOLE GRAINS. AND ABOUT 11% IS ADDED IN
COOKING AND AT THE TABLE. MORE RECENT UNPUBLISHED DATA
SUPPORT THE SAME ESTIMATE. SO IT IS NOT JUST THE
SALTSHAKER. GIVEN OUR CURRENT FOOD SUPPLY,
IT’S EXTREMELY DIFFICULT FOR PEOPLE TO REDUCE THEIR SODIUM
INTAKE. FINDING LOW SODIUM OR NO SODIUM
SODIUM-ADDED OPTIONS IN THE GROCERY STORE CAN BE DIFFICULT. IDENTIFYING LOW SODIUM
RESTAURANT FARE CAN BE AN EVEN GREATER CHALLENGE. ONCE SODIUM HAS BEEN ADDED TO
YOUR FOOD, YOU CAN’T TAKE IT OUT. REDUCING THE SODIUM CONTENT OF
RESTAURANT AND PROCESSED FOODS IS A KEY APPROACH TO REDUCING
SODIUM INTAKE. THE FOOD SUPPLY MUST CHANGE EVEN
IF GRADUALLY TO ENABLE CHOICE AND SUPPORT OUR NATIONAL DIETARY
GOALS. OTHER APPROACHES INCLUDE MORE
INFORMATION FOR CONSUMERS AT THE POINT OF PURCHASE, BOTH ON FOOD
LABELS AND ON RESTAURANT MENUS. THE FOOD INDUSTRY CAN HELP, AND
THERE ARE SIGNS OF CHANGE. YOU’LL HEAR MORE ABOUT SOME
INNOVATIVE PROGRAMS FROM CHRISTINE JOHNSON IN JUST A FEW
MINUTES. LET ME DISPEL SOME OF THE MYTHS
AND MISCONCEPTIONS THAT HAVE CONTRIBUTED TO DELAYS IN
REDUCING SODIUM INTAKE. FIRST, THERE’S NOT ENOUGH
EVIDENCE TO ACT. A VERY LARGE BODY OF STRONG
SCIENTIFIC EVIDENCE SHOWS THAT INCREASING SODIUM INTAKE
INCREASES BLOOD PRESSURE AND REDUCING SODIUM INTAKE REDUCES
BLOOD PRESSURE. AND MOREOVER, CURRENT SODIUM
INTAKE FAR EXCEEDS SAFE AND HEALTHY LEVELS. RECENT EXAMPLES OF THE NUMEROUS
BODIES THAT HAVE SUPPORTED SODIUM REDUCTION BEGINNING 40
YEARS AGO ARE LISTED IN THIS SLIDE. SECOND, POPULATION SODIUM
REDUCTION IS A RISKY EXPERIMENT. THE EXPERIMENT WITH SODIUM HAS
BEEN ITS INCREASE IN OUR FOOD SUPPLY, COINCIDING WITH OUR
INCREASED RELIANCE ON FOODS PREPARED FOR US RATHER THAN BY
US. EITHER PACKAGED FOR RETAIL
PURCHASE OR IN RESTAURANTS. REDUCING SODIUM INTAKE HAS BEEN
SHOWN TO BE SAFE AND EFFECTIVE. THIRD, SODIUM REDUCTION IS ONLY
IMPORTANT FOR PEOPLE WITH HIGH BLOOD PRESSURE. ON THE CONTRARY. THE RECOMMENDED LEVELS OF SODIUM
INTAKE ARE IMPORTANT FOR EVERYONE. LOWER SODIUM INTAKE HELPS
PREVENT HIGH BLOOD PRESSURE IN THE FIRST PLACE AND HELPS
CONTROL HIGH BLOOD PRESSURE WHEN IT IS HIGH. BOTH HYPERTENSION AND
PREHYPERTENSION CAN BE PREVENTED BY REDUCING SODIUM INTAKE. THE RISK OF HAVING A HEART
ATTACK OR STROKE GOES DOWN WHEN BLOOD PRESSURE DECREASES. THIS REDUCTION IN RISK CONTINUES
EVEN BELOW THE RANGE OF WHAT IS CONSIDERED NORMAL BLOOD
PRESSURE. THERE IS NO BASIS TO RECOMMEND
SODIUM CONSUMPTION THAT EXCEEDS THE ADEQUATE INTAKE LEVEL. FOURTH, THERE’S NO JUSTIFICATION
FOR GOVERNMENT ACTION. QUITE THE OPPOSITE. THERE IS NEED AND JUSTIFICATION
FOR GOVERNMENT ACTION. VOLUNTARY ACTION BY THE FOOD
INDUSTRY HAS BEEN INADEQUATE DESPITE 40 YEARS OF CALLS TO
ACTION. CONSUMERS DESERVE MORE CHOICES
AND MORE CONTROL OF THE SODIUM LEVELS IN THE FOODS THEY NEAT. THE GOVERNMENT CAN’T PROMOTE OR
REQUIRE CHANGES IN SODIUM CONTENT OF FOODS THROUGH FOOD
PROCUREMENT POLICIES, PUBLIC INFORMATION, INDUSTRY
REGULATION, AND OTHER STRATEGIES ALL COUPLED WITH MONITORING AND
SURVEILLANCE. ONE EXAMPLE IS THE GENERAL
SERVICES ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN
SERVICES, HEALTH AND SUSTAINABILITY GUIDELINES FOR
FEDERAL CONCESSIONS AND VENDING OPERATIONS RELEASED LAST MONTH
WHICH SET STANDARDS FOR FOODS CONTRACTED THROUGH GSA AND
SERVED AT HHS FACILITIES, INCLUDING CDC. AND GOVERNMENT MUST SHARE ITS
ROLE WITH INDUSTRY, POLICYMAKERS, MEDIA, AND THE
PUBLIC AT LARGE. FINALLY, FOOD WILL LOSE ITS
TASTE. IN REALTY, EXCESS SALT MASKS
OTHER FLAVORS. SO WE LOSE THE REAL FLAVOR OF
FOODS. THE APPEAL OF SALTY TASTES COMES
FROM BECOMING ACCUSTOMED TO UNHEALTHY, UNSAFE SALT INTAKE. IT’S EASILY REVERSED, ESPECIALLY
WITH GRADUAL CHANGES. WITH LESS SODIUM IN OUR FOOD, WE
CAN APPRECIATE, AGAIN, THE WIDE VARIETY OF NATURAL FLAVORS. SO TASTE THE TOMATO. EXCESS SODIUM INTAKE IS TAKING A
TOLL ON THE HEALTH OF THE POPULATION. MOST OF US EXCEED OUR
RECOMMENDED DAILY LEVELS OF SODIUM INTAKE. ONCE SALT IS ADDED TO YOUR
FOODS, YOU CAN’T TAKE IT OUT. CHANGES IN FOOD PROCESSING AND
PREPARATION CAN BRING CHOICE AND CONTROL BACK TO THE CONSUMER. WE BELIEVE GOVERNMENT HAS A
CLEAR ROLE TO IMPROVE THE FOOD SUPPLY BY WORKING WITH DIVERSE
PARTNERS TO INCREASE ACCESS TO HEALTHIER FOOD OPTIONS. OUR SUBSEQUENT SPEAKERS WILL
ADDRESS SOME ISSUES IN MORE DETAIL. DR. FAZANA WILL FOCUS ON FOOD
TECHNOLOGY ISSUES RELATED TO SODIUM IN OUR FOODS. DR. COGSWELL WILL TALK ABOUT
MONITORING SODIUM LEVELS IN BOTH THE FOOD SUPPLY AND THE
POPULATION. AND MISS JOHNSON WILL DISCUSS
THE NATIONAL SALT REDUCTION INITIATIVE AND OTHER EFFORTS TO
SUPPORT SODIUM REDUCTION AT THE STATE AND LOCAL LEVEL. DR. FASANO?>>I’M JEREMIAH PASSANO. I’M PLEASED TO BE THEY’RE
PARTICIPATE IN THIS EVENT. IT’S BEEN MENTIONED THE SERIOUS
PUBLIC HEALTH CONCERNS THAT ARE ASSOCIATED WITH EXCESS SODIUM
INTAKE. FDA FULLY SUPPORTS THESE
CONCERNS. TODAY I’M GOING TO PROVIDE A
LITTLE BIT OF TECHNOLOGICAL CONTEXT FOR THE WIDESPREAD USE
OF SALT IN FOOD, AND WHAT SUBSTANCES CAN POTENTIALLY BE
USED TO REPLACE SALT. I’LL ALSO SPEAK A BIT ABOUT PAST
AND CURRENT ACTIVITIES AT FDA RELATING TO THE USE OF SODIUM IN
FOOD AND EFFORTS TO REDUCE SODIUM INTAKE AS WELL AS THE
RECOMMENDATIONS OF THE INSTITUTE OF MEDICINE REGARDING SODIUM
REDUCTION. THERE ARE THREE PRIMARY REASONS
THAT SODIUM CHLORIDE OR SALT IS USED IN FOOD. FIRST, FOR FLAVOR. SECOND, FOR SAFETY. MICROORGANISMS GENERALLY DON’T
GROW WELL IN SALTY CONDITIONS. THIRD, FOR FOOD PROCESSING. SALT CAN CHANGE THE PROPERTIES
OF OTHER FOOD COMPONENTS IN WAYS THAT ARE USEFUL TO FOOD
MANUFACTURES. SALT’S UNUSUAL IN THAT IT OFTEN
SERVES MORE THAN ONE FUNCTION IN THE FOOD AT THE SAME TIME. NOW I’LL TALK ABOUT THESE
FACTORS IN MORE DETAIL. SALT’S ONE OF THE FIVE PRIMARY
TASTE. SWEET, SALTY, SOUR, BITTER. THE SODIUM IRON IS THE SUBSTANCE
THAT’S ACTUALLY RESPONSIBLE FOR THE PERCEPTION OF SALTINESS. A RECENT RESEARCH SUGGESTS THAT
OUR PERCEPTION OF SALT TASTE DEPENDS ON A DEDICATED TASTE
CELL THAT RESPONDS ONLY TO THE SODIUM ION. THERE APPEARS TO BE A SECOND
CELL TYPE THAT’S ACTIVATED AT HIGHER CONCENTRATIONS BY A
NUMBER OF SIMILAR IONS SUCH AS POTASSIUM AND CALCIUM. THIS POINT WILL BE RELEVANT
LATER WHEN WE DISCUSS SALT SUBSTITUTES. SALT TASTES ALSO ALTERS OUR
PERCEPTION OF OTHER TASTES, MOST NOTABLY MASKING BITTER INNOCENCE
A FOOD, AND CAN ENHANCE THE SWEETNESS OF A FOOD. SALT’S THE OLDEST FOOD
PRESERVATIVE. THE PRIMARY REASON IT’S SO
EFFECTIVE IS THAT IT KEEPS WATER IN THE FOOD LOCKED UP SO THAT
IT’S NOT AVAILABLE FOR MICROORGANISMS. WITHOUT SUFFICIENT WATER, MOST
MICROORGANISMS CAN’T GROW WELL. THE SALT CONCENTRATIONS HIGH
ENOUGH, IT CAN KILL MICROORGANISMS OUTRIGHT THROUGH
HYPERASMODIC SHOCK. SALT CAN INTERFERE WITH THE
ENZYMES THAT MICROORGANISMS USE TO BREAK DOWN FOODS THEY’RE
GROWING ON. FINALLY, IT’S WORTH NOTING THAT
SODIUM’S A COMPONENT OF COMMONLY USED PRESERVATIVES SUCH AS
TRISODIUM PHOSPHATE AND SODIUM LACTATE. SALT ALSO AIDS IN THE PROCESSING
OF FOODS IN A NUMBER OF WAYS. FOR EXAMPLE, A T CAN TENDERIZE
PROTEIN-RICH FOODS SUCH AS MEAT. PARADOXICALLY IT CAN CAUSE
PROTEINS TO LOSE THEIR NATIVE CONFORMATION AND STICK TOGETHER
WHICH HELPS SOME FOODS HOLD THEIR SHAPE. SALT CONCENTRATIONS CAN REGULATE
THE GROWTH IN ACTIVITY OF BACTERIA AND ENZYMES USED IN
FOOD MANUFACTURE. FOR EXAMPLE, CHEESEMAKING IS A
RIPENING STEP THAT IMPARTS FLAVOR AND CHARACTER TO THE
FINISHED PRODUCT. IT’S CAUSED BY BACTERIA AND
ENZYMES PRESENT IN THE FOOD. ALSO A KEY CONTROL POINT IN THIS
STEP. FINALLY, SALT’S HELPFUL FOR
RETAINING MOISTURE AND ALTERING TEXTURE IN A FOOD. LET ME ILLUSTRATE THESE ROLES
I’VE DISCUSS WITH A FEW EXAMPLES. IN BREAD, THE MOST IMPORTANT
EFFECT INVOLVES STRENGTHENING OF THE GLUTEN NET THAT ALLOWS
RISING AND INFLUENCES TEXTURE, AND SALT ALSO AFFECTS THE
ACTIVITY OF YEAST IN YEAST BREADS. CHEESEMAKING INVOLVES THE
ACTIVITY OF BOTH ISOLATED ENZYMES AND OFTEN ENTIRE
MICROBES, BOTH OF WHICH ARE INFLUENCED BY SALT. CHANGE IN MILK PROTEIN
PROPERTIES ARE ALSO IMPORTANT. SALT’S AN ESSENTIAL REGULATOR OF
CHEESE STRUCTURE AND RIPENING AND DRAWS THE MOISTURE OUT OF
THE KURD. IN MEATS, SALT’S A LONGSTANDING
PRIRVEIVE AND THINGS LIKE SAUSAGE DISINTEGRATE WHEN THE
SALT IS TOO LOW BECAUSE OF THE EFFECTS ON PROTEIN AGGREGATION. FINALLY, FLAVORED SNACKS OFTEN
USE SALT AS A VEHICLE FOR OTHER ADDED FLAVORINGS. REPLACEMENT ARE AVAILABLE FOR
VARIOUS SALT FUNCTIONS, ALTHOUGH IN GENERAL, NO ONE SPANS CAN
COMPLETELY REPLACE SALT. HERE’S SOME INGREDIENTS THAT
HAVE BEEN USED AS SODIUM SUBSTITUTES. OTHER SALTS CAN BE USED AS
DIRECT REPLACEMENTS FOR SOME OF THE SODIUM CHLORIDE ADDED TO A
FOOD. MOST COMMONLY USED TODAY IS
POTASSIUM CHLORIDE, CALCIUM, AND JAPANESE
MAGNESIUM ALSO USED. THEY HAVE A BITTER TASTE AND ARE
MIXED FOR THIS REASON. AND SODIUM SEA SALTS ARE ALSO
USED. ON A HISTORICAL NOTE, LITHIUM
CHLORIDE IS THE SALT MOST SIMILAR TO SODIUM CHLORIDE AND
UNLIKE OTHERS CAN FULLY ACTIVATE THE SODIUM TASTE SALT. UNFORTUNATELY IT TURNED OUT TO
BE TOXIC, AND USE WAS ABANDONED AFTER ABOUT 1940. IN SOME CASES, OTHER SUBSTANCES
CAN AMPLIFY EXISTING FLAVORS OR SUBSTITUTE A SIMILAR OVERALL
TASTE. HOWEVER, IT CAN BE DIFFICULT TO
MAINTAIN A SIMILAR FOOD — FLAVOR PROFILE. FINALLY, ANTI-MICROBIAL
FUNCTIONS OF SALT CAN BE TAKEN OVER BY A VARIETY OF INGREDIENTS
SUCH AS LACTATE SALT, BACTERIA. HOWEVER THE NEED TO MAINTAIN
FOOD SAFETY MEANS YOU HAVE TO DO EXTENS
EXTENSIVE VALIDATION FOR EVERY USE SCENARIO. A VARIETY OF NEW TECHNOLOGIES
ARE BEING DEVELOPED THAT MAY BE USEFUL FOR SODIUM REPLACEMENT. FOR EXAMPLE, SOME FIRMS ARE
DEVELOPING MICROCAPSULES OF POTASSIUM CHLORIDE THAT CONTAIN
A DEBITTERING AGENT. ANOTHER PRODUCT THAT’S ENTERING
COMMERCE IS A HOLLOW MICROSPHERE OF SODIUM THAT IMPARTS A SIMILAR
TASTE EXPERIENCE AT LOWER ABSOLUTE SALT CONCENTRATION. FINALLY, SOME FIRMS ARE
EXPERIMENTING WITH INGREDIENTS THAT DIRECTLY MANIPULATE THE
PROPERTIES OF THE ION CHANNELS IN THE TASTE RECEPTOR CELLS TO
AMPLIFY, FOR EXAMPLE, THE SENSORY SIGNAL OF A GIVEN
ABSOLUTE AMOUNT OF SODIUM CHLORIDE. HOWEVER, THE COST IMPACT OF
CURRENTLY AVAILABLE SUBSTITUTES AND NEW TECHNOLOGIES REMAINS AN
ISSUE. FOR SOME SUBSTITUTES,
AVAILABILITY OF APPROPRIATE SAFETY DATA MAY BE AN ISSUE. FDA’S ENGAGED IN VARIOUS EFFORTS
THE PAST FEW DECADES AIMED AT PROMOTING AWARENESS OF SODIUM
CONTENT AND ENCOURAGING REDUCED SODIUM INTAKE. EFFORTS INCLUDE SODIUM CONTENT
LABELLING ON PACKAGING AS EARLY AS 1984 AND PROMULGATION OF
STANDARD SODIUM CONTENT FLAMES. FDA ARRANGED A PUBLIC HEARING IN
2007 TO SOLICIT INFORMATION ON WAYS TO REDUCE SODIUM INTAKE. FINALLY, RECENT WORK ON PACKAGE
LABELING AND THE UPCOMING MANDATORY MENU LABELING MANDATED
BY THE PATIENT AND AFFORDABLE CARE HELICOPTER MAY INCREASE
CONSUMER AWARENESS OF SODIUM INTAKE. IN 2010, THE INSTITUTE OF
MEDICINE ISSUED A REPORT ENTITLED “STRATEGIES TO REDUCE
SODIUM INTAKE IN THE UNITED STATES.” IN THIS REPORT THEY CONCLUDED
THAT LABELING AND EDUCATION EFFORTS IN ISOLATION HAD NOT
SIGNIFICANTLY REDUCED SODIUM CONSUMPTION IN THE U.S. INSTITUTE OF MEDICINE HAD A
NUMBER OF RECOMMENDATIONS. THE PRIMARY RECOMMENDATION WAS
TO PURSUE BROAD, GRADUAL REDUCTIONS IN SODIUM CONTENT OF
BOTH PACKAGED AND PREPARED FOODS IN THE UNITED STATES. THE INSTITUTE OF MEDICINE
RECOMMENDED THE PROMOTION OF VOLUNTARY INITIATIVES AS AN
INITIAL STEP INVOLVING COLLABORATION OF INDUSTRY,
GOVERNMENT, AND OTHER STAKEHOLDERS, AS WELL AS
INITIATION OF A PROCESS TO SET MANDATORY STANDARDS. THE INSTITUTE OF MEDICINE ALSO
RECOMMENDED REVISIONS AND EXTENSIONS TO CURRENT LABELING
OF FOOD TO SUPPORT SODIUM REDUCTION EFFORTS. FINALLY, THE INSTITUTE OF
MEDICINE RECOMMENDED EFFORTS TO MONITOR CHANGE IN SODIUM INTAKE
AND SALT TASTE PREFERENCE IN THE U.S. POPULATION AS WELL AS
CHANGES IN THE SODIUM CONTENT OF FOOD OVER TIME. AT THIS TIME, FDA IS CAREFULLY
CONSIDERING ALL THE RECOMMENDATIONS PROVIDED BY THE
INSTITUTE OF MEDICINE. THANK YOU. OUR NEXT SPEAKER, DR. MARY
COGSWELL.>>I’M MARY COGSWELL FROM CDC. I WILL DESCRIBE CDC’S EFFORTS TO
ADDRESS THREE QUESTIONS — HOW MUCH SODIUM IS IN THE FOODS WE
EAT, HOW MUCH SODIUM DO WE CONSUME, AND ARE WE READY FOR
NATIONWIDE ACTION TO REDUCE SODIUM INTAKE. CDC’S DATA ON SODIUM IN FOOD AND
PEOPLE COMES FROM MULTIPLE SOURCES. SOURCES PRIMARILY FOCUSED ON
SODIUM IN FOODS ARE CIRCLED IN BLUE, ON SODIUM INTAKE AND
EXCRETION, ARE CIRCLED IN RED. AND ON CONSUMER AND HEALTH CARE
PROVIDER, KNOWLEDGE, ATTITUDES, AND PRACTICES ARE CIRCLED IN
GREEN. TODAY I WILL FOCUS ON THE LATEST
DATA FROM USDA’S FOOD AND NUTRIENT DATA BASES, THE
NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY. THE BEHAVIORAL RISK FACTORS
SURVEILLANCE SYSTEM, AND TWO MARKET RESEARCH SURVEYS. AS PART OF A COLLABORATION WITH
THE USDA, CDC UPDATED SODIUM VALUES TO FOODS THAT ARE MAJOR
CONTRIBUTORS TO THE U.S. DIET. THEY REVIEWED APPROXIMATELY
1,300 MAINLY PROCESSED FOODS AND UPDATED 450 DUE TO A DIFFERENCE
WITH PREVIOUSLY PUBLISHED VALUES. THESE NEW VALUES ARE INCLUDED IN
THE 2010 NATIONAL NUTRIENT DATA BASE WHICH PROVIDES THE
FOUNDATION FOR MOST U.S. PRIVATE AND PUBLIC FOOD COMPOSITION DATA
BASES, INCLUDING THAT USED WITHIN HANES. THERE’S LABORATORY ANALYSIS OF
SENTINEL FOODS THAT CONTRIBUTE HIGH PROPORTIONS OF ADDED SODIUM
TO THE U.S. DIET. ONE FINDING IS THAT MEAN SODIUM
VALUES CAN VARY UP TO TENFOLD FOR DIFFERENT BRANDS OF THE SAME
FOOD, SHOWING THAT SODIUM DECREASES IN THE FOOD SUPPLY ARE
POSSIBLE EVEN NOW.>>LABORATORY ANALYSIS FOR
SODIUM ARE ESSENTIAL AS THE LABEL ONLY HAS TO BE WITHIN 20%
OF THE ACTUAL VALUE. DIFFERENCES IN ACTUAL AND
LABELED SODIUM VALUES ARE SHOWN HERE FOR THREE BRANDS OF PASTA
SAUCE THAT WERE ANALYZED IN 1999 AND 2009. AS IT SHOULD BE FOR BRAND A,
ACTUAL AND LABELED VALUES DECREASED ABOUT THE SAME AMOUNT. FOR BRAND B, ACTUAL VALUES DID
NOT CHANGE, BUT LABEL VALUES DECREASED 24%. AND FOR BRAND C, ACTUAL VALUES
DECREASED, BUT LABELED VALUES DID NOT CHANGE. THEREFORE, RELYING ON LABELED
SODIUM VALUES COULD RESULT IN WRONG CONCLUSIONS ABOUT CHANGES
IN THE FAD SUPPLY OF SODIUM OVER TIME. NOW FOCUSING ON SODIUM INTAKE. IN 2003 THROUGH 2008, THE VAST
MAJORITY OF U.S. ADULTS WHICH MEANS ALL OF YOU IN THIS ROOM AS
WELL ALMOST, CONSUMED MORE SODIUM THAN RECOMMENDED
REGARDLESS OF RECOMMENDED LEVEL, AGE, SEX, OR RACE ETHNIC GROUP,
SUGGESTING THE NEED FOR WIDESPREAD POPULATION
INTERVENTION, EVEN AMONG WOMEN WHO CONSUME THE LEAST AMOUNT OF
SODIUM, OVER 98% CONSUMED MORE THAN 1,500 MILLIGRAMS PER DAY
AND MORE THAN 75% CONSUMED MORE THAN 2,300 MILLIGRAMS PER DAY. I’LL NOW FOCUS ON READINESS TO
REDUCE SODIUM INTAKE. IN 2007, REGARDLESS OF AGE, OVER
50% OF ADULTS WITH SELF-REPORTED HYPERTENSION REPORTING BEING
ADVISED TO REDUCE THEIR SALT INTAKE, AND AMONG THOSE ADVISED,
THE VAST MAJORITY REPORTED THAT THEY WERE CURRENTLY REDUCING
THEIR SALT INTAKE. THE NEXT FOUR SLIDES SHOW 2010
DATA ON CONSUMER READINESS TO REDUCE SODIUM FROM A NATIONAL
MARKET PANEL SURVEY OF 10,000 U.S. CONSUMERS AS SHOWN HERE
REGARDLESS OF AGE OR RACE ETHNIC GROUP, THE MAJORITY OF U.S. CONSUMERS EITHER MODERATELY OR
STRONGLY DISAGREED WITH THE STATEMENT. SALT REALLY ISN’T THAT BAD FOR
YOU. SO ADDRESSING THAT, CONSUMERS
UNDERSTAND THE RELATIONSHIP OFISODES YUM INTAKE AND HEALTH. WHEN ASKED THINKING ABOUT YOUR
SALT INTAKE WHICH OF THE FOLLOWING BEST DESCRIBES YOU AS
SHOWN ON THE LEFT, THE MAJORITIES OF CONSUMERS AGED 18
TO 50 YEARS REPORTED EITHER THINKING ABOUT LOWERING THEIR
SALT INTAKE OR HAVING TAKEN ACTION, THAT IS TAKING STEPS TO
LOWER THEIR SALT INTAKE OR HAVING ALREADY LOWERED THEIR
SALT INTAKE. AS SHOWN ON THE RIGHT, A GREATER
PERCENTAGE OF OLDER CONSUMERS, 68%, REPORTED EITHER THINKING
ABOUT OR HAVING TAKEN ACTION TO LOWER THEIR SALT INTAKE. UNFORTUNATELY, GIVEN THE STATE
OF THE FOOD SUPPLY TODAY, IT’S ALMOST IMPOSSIBLE FOR
INDIVIDUALS TO LOWER THEIR OWN SODIUM INTAKE. SO IT MAKES A BIG DIFFERENCE,
ACTUALLY. REGARDLESS OF AGE, SEX, OR RACE
ETHNICITY, THE MAJORITY OF U.S. CONSUMERS AGREED WITH THE
STATEMENT “I THINK IT’S A GOOD IDEA FOR GOVERNMENT TO KEEP FOOD
MANUFACTURES FROM PUTTING TOO MUCH SALT IN FOOD.” THE GREATEST SUPPORT CAME FROM
BLACK CONSUMERS, ALMOST 70% AGREED A SLIGHTLY LOWER
PERCENTAGE OF CONSUMERS AGREED WITH GOVERNMENT REGULATION OF
TOO MUCH SALT IN RESTAURANT FOODS, WITH THE STRONGEST
SUPPORT FROM BLACK CONSUMERS. TRANSITIONING TO HEALTH CARE
PROVIDERS, THIS SLIDE SHOWS 2010 DATA FROM A WEB-BASED SURVEY OF
FAMILY PRACTITIONERS, INTERNISTS, AND NURSE
PRACTITIONERS REGARDLESS OF SPECIALTY, OVER 80% AGREED MOST
OF MY PATIENTS SHOULD REDUCE THEIR SODIUM REDSKIN TAKE. IN SUMMARY, THE VAST MAJORITY OF
U.S. ADULTS CONSUME EXCESS SODIUM REINFORCING THE NEED FOR
WIDESPREAD POPULATION INTERVENTIONS. LABORATORY ANALYSIS OF SODIUM IN
FOODS IS ESSENTIAL FOR ACCURATE MONITORING OF REDUCTIONS IN
SODIUM INTAKE AND CONSUMERS AND HEALTH CARE PROVIDERS SEEM READY
FOR REDUCTION OF SODIUM IN FOOD, IN PARTICULAR THE MAJORITY OF
CONSUMER AGREE WITH GOVERNMENT REGULATION OF TOO MUCH SALT IN
MANUFACTURED FOODS, AND GREATER THAN 40% AGREE WITH REGULATION
OF TOO MUCH SALT IN RESTAURANT FOODS. FUTURE ACTIONS INCLUDE
COMPLETION AND IMPLEMENTATION OF THE USDACDC SENTINEL FOOD
MONITORING SODIUM SYSTEM TO ALLOW EARLY DETECTION OF
NUTRIENT CHANGES IN THE U.S. FOOD SUPPLY. DETERMINING AND IMPLEMENTING THE
OPTIMAL METHOD FOR POPULATION MONITORING OF U.S. SODIUM INTAKE
THROUGH BIOLOGICAL MARKERS. AND FINALLY, CONTINUED
MONITORING OF CONSUMER READY NOT AND ACCEPTANCE IS ESSENTIAL IF
WE ARE TO ELIMINATE EXCESS SODIUM AND TO DECREASE
HYPERTENSION, HEART DISEASE, AND STROKE. OUR NEXT SPEAKER IS CHRISTINE
JOHNSON.>>GOOD AFTERNOON, I’M CHRISTINE
JOHNSON FROM THE NEW YORK CITY DEPARTMENT OF HEALTH AND MENTAL
HYGIENE. I’LL TALK ABOUT THREE MAJOR
EFFORTS TO REDUCE SODIUM CONTENT OF FOODS THAT WORK INGESTICALLY
IN NEW YORK CITY. THE NATIONAL SALT REDUCTION
INITIATIVE, SODIUM REDUCTION ACTIVITY AND SODIUM REDUCTION
GRANT. THE NSRI IS A NATIONAL
INITIATIVE WITH THE OVERALL GOAL OF REDUCING POPULATION SODIUM
INTAKE BY 20% IN FIVE YEARS BY DECREASING THE SODIUM IN
PACKAGED AND RESTAURANTS FOODS BY 25% OVER THE NEXT FIVE YEARS. THIS IS CONSISTENT WITH CALLS
FROM THE AMERICAN MEDICAL ASSOCIATION AND THE AMERICAN
PUBLIC HEALTH ASSOCIATION FOR A 50% REDUCTION IN THE SALT
CONTENT OF PACKAGED AND RESTAURANT FOODS WITHIN TEN
YEARS. WE CHOSE A SHORTER TIME FRAME IN
ORDER TO FOCUS DISCUSSIONS WITH INDUSTRY AND TO ALLOW FOR THE
ASSESSMENT OF INDUSTRY PROGRESS. NEW YORK CITY HEALTH HAS
DISCUSSION WITH INDUSTRY ABOUT REDUCING SODIUM. WHILE THEY EXPRESS SUPPORT, THEY
NOTICED THEIR INTEREST IN A NATIONAL APPROACH. IN RESPONSE, THE NSRI WAS
LAUNCHED IN OCTOBER, 2008, BY THE NEW YORK CITY HEALTH
DEPARTMENT, WHICH COORDINATES THE INITIATIVES. THIS PARTNERSHIP HAS GROWN TO
OVER 70 HEALTH ORGANIZATIONS AND HEALTH DEPARTMENTS, INCLUDING 29
STATES, 15 CITIES, AND 28 NATIONAL ORGANIZATIONS SUCH AS
THE AMERICAN HEART ASSOCIATION. PARTNERS SIGN ON TO A STATEMENT
COMMITTING TO REDUCING POPULATION SALT INTAKE BY AT
LEAST 20% OVER FIVE YEARS, BY SETTING TARGETS AND MONITORING
INDUSTRY PROGRESS THROUGH A TRANSPARENT, VOLUNTARY PUBLIC
PROCESS. THE NSRI STRATEGY IS MODELED ON
THE U.K.’S EVIDENCE-BASED MODELS FOR SODIUM REDUCTION WHICH
INCLUDES SETTING SODIUM TARGETS, WORKING WITH INDUSTRY TO CONFIRM
COMMITMENTS, AND MONITORING PROGRESS OVER TIME. THE NSRI CREATED NATIONAL
NUTRITION DATA BASES FOR PACKAGE AND WOULD RESTAURANT FOOD TO
INFORM THE DEVELOPMENT OF THE FOOD CATEGORIES AND THE SODIUM
CONTENT TARGETS, WHICH WERE REFINED BASED ON INDUSTRY
FEEDBACK. WE HAVE TWO MECHANISM FOR
MONITORING INDUSTRY PROGRESS. THE FIRST ARE THE NATIONAL
NUTRITION DATA BASES WHICH ALLOW US TO ASSESS DETAILED
INFORMATION ABOUT EACH CATEGORY IN 2012 AND 2014. IN ADDITION, WE ASKED FOR
COMPANY-SUBMITTED REPORTING FORMS TO THE RELEVANT FOOD
CATEGORIES. FINALLY, WE’VE DEVELOPED A
SEPARATE EVALUATION TO ASSESS SODIUM INTAKE IN THE NEW YORK
CITY POPULATION. THE NSRI DATA BASES FOR PACKAGED
AND RESTAURANT FOOD WERE CREATED BASED ON PUBLICLY AVAILABLE
NUTRITION INFORMATION AND PROPRIETARY SALES DATA. THE PACKAGED FOOD DATA BASES
MERGES BOTH SETS OF DATA WITH ALLOWS US TO ASSESS THE MEDIAN
RANGE OF SODIUM CONTENT BY CATEGORY, BRAND, AND PRODUCT
TYPE, WHICH INFORMED HOW WE DEFINED FOOD CATEGORIES AND SET
THE TARGETS. ADDITIONAL DETAILS ARE PROVIDED
HERE AND IN THE ILM REPORT ON STRATEGIES TO REDUCE SODIUM. BASED ON THE DATA BASE ANALYSIS,
THE MSRI DEVELOPED VOLUNTARY TARGETS FOR 2012 AND FOR 2014
FOR 62 PACKAGED FOOD CATEGORIES AND 25 RESTAURANT FOOD
CATEGORIES. TYPES OF PACKAGED FOOD
CATEGORIES INCLUDE BREAD AND ROLLS, CRACKERS, PROCESSED
CHEESE, CANNED BEANS, AND RESTAURANT FOOD CATEGORY
EXAMPLES INCLUDE HAMBURGERS WITH CHEESE, SANDWICHES WITH LUNCHEON
MEAT, SOUP, AND PIZZA. DISCUSSIONS ON THESE TARGETS
OCCURRED WITH A WIDE RANGE OF PACKAGED AND RESTAURANT FOOD
COMPANIES AT THE TABLE. INCLUDING PRIVATE LABEL
COMPANIES, FOOD DISTRIBUTORS, TRADE ASSOCIATIONS, AND FOOD
SERVICE COMPANIES. COMPANIES ALSO HAD AN
OPPORTUNITY TO PARTICIPATE IN CATEGORY-LEVEL MEETINGS,
INDIVIDUAL MEETINGS, AND TO SUBMIT WRITTEN COMMENTS. THE TARGETS WERE PROPOSED BASED
ON ANALYZING THE NSRI DATA BASES AND ASSESSING TECHNICAL
FEASIBILITY. AND THEN WERE REFINED BASED ON
COMPANY COMMENTS AND ONGOING DISCUSSIONS WITH THE INDUSTRY. WE TALK ABOUT USING THE SALES
WEIGHTED MEAN FOR THE NSRI TARGETS WHICH MEANS THAT THE
CONTENT OF MORE POPULAR PRODUCTS INFLUENCES THE MEAN MORE THAN
THE SODIUM CONTENT OF PRODUCTS WITH LOWER SALES. AS AN EXAMPLE, LET’S LOOK AT THE
BREAD AND ROLLS CATEGORY. COMPANIES CAN COMMIT TO A 2012
TARGET OF 440 MILLIGRAMS OF SODIUM PER 100 GRAMS OF FOOD. TO MEET THIS TARGET, THE MEAN
SODIUM CONTENT OF ALL THE COMPANIES’ PRODUCTS IN THIS
CATEGORY WEIGHTED BY THEIR SALES MUST BE AT OR BELOW THE TARGET
BY JANUARY, 2012. ALTHOUGH THERE MAY STILL BE SOME
PRODUCTS THAT ARE ABOVE THE SPECIFIED TARGET. WHAT’S IMPORTANT HERE IS THE
AVERAGE. RESTAURANT TARGETS WORK IN A
SIMILAR WAY. SINCE WE ANNOUNCED THE NSRI
TARGETS IN APRIL, 2010, 28 COMPANIES HAVE SIGNED ON TO NSRI
TARGETS, INCLUDING 19 MAJOR PACKAGED FOOD COMPANIES, FOUR
SUPERMARKETS AND FOOD DISTRIBUTORS, AND FIVE
RESTAURANT CHAINS LISTED HERE. COMPANIES HAVE RECEIVED ONGOING
PRESS ATTENTION BECAUSE OF THEIR INVOLVEMENT IN THE NSRI,
PARTICULARLY AROUND THE THREE PRESS ANNOUNCEMENTS, AND HAVE
CAPITALIZED ON IT IN OUR OWN ADVERTISING AND THEIR PRESS
RELEASES. THE NSRA’S DIFFERENT FROM PAST
CALLS FOR VOLUNTARY INDUSTRY REDUCTIONS BECAUSE IT PROVIDES A
CLEAR AND TRANSPARENT WAY TO MONITOR CHANGES IN THE FOOD
SUPPLIES. WE WILL RECREATE THE PACKAGED
AND RESTAURANT FOOD DATA BASES DESCRIBED EARLIER IN BOTH 2012
AND 2014. THIS WILL ALLOW US TO TRACK
INDIVIDUAL COMPANY AND OVERALL FOOD INDUSTRY PROGRESS FOR EVERY
CATEGORY. IN ADDITION, WE ASK COMPANIES
THAT HAVE COMMITTED TO NSRI TARGETS TO SUBMIT PRODUCT-LEVEL
DATA FOR EACH CATEGORY THEY COMMIT TO. WE’RE ALSO EVALUATING NSRI BY
MEASURING CHANGES IN THE NEW YORK CITY SODIUM INTAKE THROUGH
THE GOLD STANDARD, 24-HOUR URINE ANALYSIS. WE CONDUCTED A BASELINE STUDY IN
2010 WHERE WE RECRUITED PARTICIPANTS FROM THE NEW YORK
CITY COMMUNITY HEALTH SURVEY. A TELEPHONE SURVEY MODELED ON
THE BRSSS. THE STUDY WAS CONDUCTED WITH A
REPRESENTATIVE SAMPLE OF JUST UNDER 1,800 NEW YORK CITY
ADULTS. DATA COLLECTED INCLUDED SODIUM,
POTASSIUM, AND CREATNINE IN ADDITION TO VALUES ON THE SLIDE. 3,150 MILLIGRAMS PER DAY WAS
FOUND, ONLY 11% OF HIGH-RISK NEW YORKERS WHOSE RECOMMENDED DAILY
LIMIT IS 1,500 MILLIGRAMS OR BELOW WERE AT OR BELOW THAT
LEVEL. FURTHER, ONLY 21% OF ALL NEW
YORKERS MET THEIR RECOMMENDED LIMIT, WHETHER IT WAS 1,500 OR
2,300 MILLIGRAMS PER DAY. RESULTS ARE WEIGHTED TO BE
REPRESENTATIVE OF NEW YORK CITY AS A WHOLE, AND FURTHER ANALYSIS
IS UNDERWAY. IN TERMS OF FUTURE PLANS, A
FOLLOWUP WILL BE CONDUCTED IN 2014 TO TRACK CHANGE IN SODIUM
INTAKE. IN ADDITION TO COORDINATING
NATIONAL ACTION THROUGH THE NSRI, NEW YORK CITY IS WORKING
ON SODIUM REDUCTION LOCALLY. NEW YORK CITY IS THE FIRST LARGE
CITY IN THE U.S. TO SET STANDARDS FOR ALL FOODS
PURCHASED AND SERVED BY CITY AGENCIES WHICH WERE OFFICIALLY
PUT IN PLACE BY MAYORAL EXECUTIVE ORDER IN 2008. THE NUTRITION STANDARDS WERE
ESTABLISHED FOR ALL CITY AGENCIES, WHICH AFFECT OVER 260
MILLION MEALS AND SNACKS SERVED EACH YEAR. AT SCHOOLS, SENIOR CENTERS,
DAYCARES, HOMELESS SHELTERS, AND OTHER CITY PROGRAMS. WE ALSO DEVELOPED STANDARDS FOR
BEVERAGE VENDING MACHINES. BOTH SETS OF STANDARDS ARE
AVAILABLE ON THE NEW YORK CITY HEALTH DEPARTMENT WEB SITE. HERE ARE A FEW SPECIFIC EXAMPLES
OF SODIUM REQUIREMENTS FOR PURCHASED FOOD THAT ARE SET BY
THE STANDARD FOR MEALS AND SNACKS. CEREAL MUST CONTAIN LESS THAN
215 MILLIGRAMS OF SODIUM PER SERVING. CANNED AND FROZEN VEGETABLES
MUST CONTAIN LESS THAN 290 MILLIGRAMS PER SERVING OR HAVE
NO SALT ADDED. AND PORTION CONTROLLED ITEMS AND
OTHER CONVENIENCE FOODS MUST CONTAIN LESS THAN 480 MILLIGRAMS
PER SERVING. AS A NOTE, THE FEDERAL
GOVERNMENT RECENTLY RELEASED CONCESSION AND VENDING
STANDARDS. THE NUTRIENT STANDARDS OUTLINED
IN THE HEALTH AND HUMAN SERVICES POLICY MENTIONED BY DR. LABARTH
IN HIS PRESENTATION APPLY TO ALL FOOD CONCESSION OPERATIONS AND
VENDING MACHINES MANAGED BY HHS AND THE GENERAL SERVICES
ADMINISTRATION. THE HHS POLICY INCLUDES NUTRIENT
REQUIREMENTS RELATED TO SPECIFIC FOOD CATEGORIES, AS WELL AS
MEALS SERVED. IN COMPARISON, THE NEW YORK CITY
STANDARDS ARE FOCUSED ON MEALS AND SNACKS SERVED BY CITY
AGENCIES AND ALSO INCLUDE NUTRIENT STANDARDS FOR PURCHASED
FOOD, AS WELL AS FOR THE OVERALL MEAL. BOTH THE HHS AND THE NEW YORK
CITY VENDING STANDARDS REQUIRE CALORIE WIGGLING, RESTRICTS
TRANSFAT, AND SET LIMITS ON THE NUMBER OF HIGH-CALORIE BEVERAGES
IN ADDITION TO OTHER REQUIREMENTS. IN TERMS OF THE STANDARDS FOR
BEVERAGES FOR VENDING MACHINES APPLY TO ALL IN THE CITY. STANDARDS HAVE FIVE CRITERIA. IN TERMS OF PRODUCT MIX, TWO
VENDING MACHINE SLOTS MUST STOP WATER. HIGH-CALORIE BEVERAGES ARE
LIMITED TO TWO SLOTS. WATER MUST BE PLACED IN THE AREA
WITH THE GREATEST SELLING POTENTIAL, AT EYE LEVEL. HIGH-CALORIE BEVERAGES MUST BE
PLACED IN THE AREA WITH THE LEAST SELLING POTENTIAL. IN TERMS OF PRODUCT SIZE, ALL
BEVERAGES EXCEPT WATER ARE LIMITED TO 12 OUNCE OR LESS, AND
WATER MUST BE AT LEAST 12 OUNCES. MARKETING ON THE OUTSIDE OF THE
MACHINE MUST PROMOTE HEALTHY LIFESTYLES OR HEALTHY BEVERAGES,
AND ALL MACHINES MUST POST CALORIES PER CONTAINER FOR EACH
PRODUCT. ALTHOUGH NOT REQUIRED, WE
RECOMMEND AGENCIES USE PRICING MODELS AS AN INCENTIVE FOR
PEOPLE TO PURCHASE HEALTHIER BEVERAGES. WE HAVE CONDUCTED A BASELINE
OBSERVATIONAL SURVEY AND ARE PLANNING A FOLLOWUP SURVEY THIS
YEAR. IN SEPTEMBER, 2010, NEW YORK
CITY WAS ONE OF FIVE CITIES AND STATES AWARDED A THREE-YEAR
SODIUM REDUCTION IN COMMUNITY GRANT FROM THE CDC. THIS GRANT SUPPORTS THREE
SEPARATE ACTIVITIES. THE FIRST IS AN INDEPENDENT
RESTAURANT INITIATIVE. NEW YORK CITY HAS APPROXIMATELY
2,000 INDEPENDENT RESTAURANTS WHICH ACCOUNT FOR 90% OF THE
CITY’S RESTAURANTS. WE PLAN TO WORK CLOSELY WITH A
SELECT GROUP OF RESTAURANTS AND SUPPLIERS TO DEVELOP AN APPROACH
FOR REDUCING SODIUM THAT’S SCALEABLE AND SUSTAINABLE. OUR ACTIVITIES WILL INCLUDE
EDUCATION AND OUTREACH THROUGH MAILING, A WEB SITE, AND A
SODIUM MODULE IN NEW YORK CITY’S FOOD SAFETY COURSE. THE SECOND INITIATIVE IS FOCUSED
ON HOSPITAL RETAIL FOOD STANDARDS, WITH A GOAL FOR NEW
YORK CITY HOSPITALS TO PROVIDE ACCESS TO HEALTHIER FOODS,
INCLUDING LOWER SODIUM OPTIONS. WE PLAN TO DEVELOP STANDARDS
WHICH WILL ALLOW US TO BUILD ON OUR CURRENT WORK WITH NEW YORK
CITY PUBLIC HOSPITALS AND SUPPORT US REACHING OUT TO NEW
YORK CITY PRIVATE HOSPITALS. FINALLY, THE THIRD ACTIVITY IS A
NEW YORK CITY MEDIA CAMPAIGN FOCUSED ON INCREASING CONSUMER
AWARENESS OF THE HIDDEN SALT AND PROCESSED FOODS — IN PROCESSED
FOODS AND BROADENING AWARENESS OF A HEALTH IMPACT HIGH-SODIUM
DIET. THE FIRST PHASE INCLUDES A PRINT
AD CAMPAIGN IN NEW YORK CITY SUBWAYS, LOCAL NEWSPAPERS, AND
ONLINE ADS. THIS IS ONE OF TWO SUBWAY
POSTERS. THE MAIN TAGLINE IS — MANY
FOODS PACK A LOT MORE SALT THAN YOU THINK, WITH THE CONSUMER
MESSAGE TO COMPARE LABELS AND CHOOSE LESS SODIUM. A HEALTH BULLETIN ON SALT THAT
WAS PART OF THE CAMPAIGN IS AVAILABLE BY CALLING NEW YORK
CITY’S 311. THE SECOND PHASE OF THE MEDIA
CAMPAIGN WILL BE DEVELOPED THIS YEAR AND WILL LAUNCH IN FALL,
2012. THE FIRST TWO CONCLUSIONS ON THE
SLIDE YOU MAY HAVE ALREADY PICKED UP ON. BUT THEY’RE WORTH REPEATING. AVERAGE DAILY SODIUM INTAKE FOR
U.S. ADULTS IS MORE THAN DOUBLE WHAT IS RECOMMENDED AS A SAFE
LEVEL. CHANGES IN THE FOOD SUPPLY ARE
NEEDED TO LOWER SODIUM INTAKE TO RECOMMENDED LEVELS. WE’VE ALSO HEARD TODAY ABOUT HOW
THE NSRI IS PROMISING THE COLLABORATIVE AND VOLUNTARY
PROCESS BECAUSE IT REQUIRES INDUSTRY COMMITMENT AND INCLUDES
A MECHANISM FOR MONITORING INDUSTRY PROGRESS OBJECTIVELY. AND FINALLY, WE SEE THAT
GOVERNMENT HAS A CRITICAL ROLE TO PLAY AT FEDERAL, STATE, AND
LOCAL LEVELS. THANK YOU VERY MUCH. [ APPLAUSE ]
>>THANK YOU TO JEREMIAH, TO MOLLY, AND TO CHRISTINE. WE HAVE AN OPPORTUNITY NOW FOR
PARTICIPATION FROM OUR AUDIENCE. AND WELCOME COMMENTS OR
QUESTIONS FOR THE PANEL. WE WOULD ASK THAT YOU KEEP YOUR
COMMENTS OR QUESTIONS BRIEF AND FOCUSED. THAT YOU IDENTIFY YOURSELF BY
NAME AND YOUR ORGANIZATION. AND PLEASE FEEL FREE TO POST
QUESTIONS FOR THE PANEL. PLEASE.>>LEONARD ORMAN, CDC. ONE HEARS THAT THE JAPANESE
CONSUME A LOT OF SALT BUT DON’T HAVE AS MUCH PROBLEM WITH
HYPERTENSION AND CARDIOVASCULAR DISEASE. HOW WOULD YOU RESPOND TO THAT
STATEMENT?>>THERE HAS BEEN A VERY
VALUABLE HISTORICAL EXPERIENCE IN JAPAN WHICH FROM THE LATE
’50s HAD AMONG THE HIGHEST RATES OF STROKE MORTALITY OF ANY
COUNTRY IN THE WORLD. SODIUM REDUCTION HAS DECREASED
SHARPLY IN JAPAN, AND CORRESPONDING REDUCTIONS IN
STROKE MORTALITY. I THINK THIS IS ONE OF THE
LEADING EXAMPLES OF WHAT CAN BE ACHIEVED AT A NATIONAL LEVEL BY
SYSTEMATIC EFFORTS TO REDUCE SODIUM INTAKE. THANKS FOR THE QUESTION. OTHER COMMENTS? ONE QUESTION THAT I COULD
MENTION JUST WHILE OTHERS ARE THINKING OF POINTS THEY’D LIKE
TO RAISE, CHRISTINE REFERRED TO THE EXPERIENCE OF THE NEW YORK
SALT REDUCTION INITIATIVE IN SETTING A BASELINE FOR SODIUM
EXCRETION THROUGH USE OF 24-HOUR URINE COLLECTION. THERE’S BEEN A LOT OF DISCUSSION
OF THAT STRATEGY. WE ARE DISCUSSING IT WITH OUR
COLLEAGUES IN NCHS, AS TO A POSSIBLE ADDITION TO THE
NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY. SO IT WOULD BE INTERESTING TO
KNOW WRUR EXPERIENCE WITH NEW YORKERS IN COLLECTING 24-HOUR
URINE SAMPLES WHICH YOU APPARENTLY INSTITUTED WITH SOME
SUCCESS.>>SURE. THIS IS THE EXCITE — THIS IS
EXCITING BECAUSE IT WAS THE FIRST TIME IT HAD BEEN DONE IN
SORT OF AN URBAN SETTING AND IN A WAY THAT WASN’T CLINIC BASED. SO OFTEN 24-HOUR URINE
COLLECTION HAS S BEGUN IN A CLINIC AND THEN PEOPLE CONTINUE
IT AT HOME, BUT YOU WE WERE ACTUALLY MAILING THE COLLECTION
KITS TO PEOPLE IN THEIR OWN HOMES WHICH IS AN UNUSUAL
PROTOCOL AND REQUIRED A LOT OF KIND OF SUPPORTING MATERIALS AND
DEVELOPMENT TO MAKE SURE THAT PEOPLE COULD FOLLOW THE PROTOCOL
AT HOME AND THEN A TECHNICIAN CAME TO THEIR HOME AT THE END TO
TAKE THE WEIGHT, HEIGHT, AND BLOOD PRESSURE MEASUREMENTS. AND WE’LL REAL — WE’RE REALLY
PLEASED THAT WE HAD A GREAT RESPONSE RATE. WE FEEL LIKE PEOPLE FOLLOW THE
PROTOCOL WELL BASED ON OUR ABILITY TO LOOK AT THE VOLUME
AND THE TIME FOR COLLECTION, AND WE THINK IT SHOWS THAT IT CAN BE
DONE IN OTHER SETTINGS.>>GOOD. THANK YOU. OTHER QUESTIONS?>>QUESTION FROM ENVISION.>>PLEASE. THE QUESTION FOR CHRISTINE
JOHNSON — I WONDERED IF YOU HAD ESTIMATED WHAT LEVEL OF IMPACT
YOUR INTERVENTION MAY BE EXPECTED TO HAVE AND WHETHER
YOU’LL ANTICIPATE BEING ABLE TO DETECT THAT, EITHER FROM THE
SURVEY THAT YOU DESCRIBED OR FROM BROADER POPULATION MEASURES
SUCH AS TRENDS IN CARDIOVASCULAR DISEASE.>>SURE. SO IT’S KIND OF TWO PIECES. ONE IS WHEN WE THINK ABOUT OUR
OVERALL GOAL, THAT 20% REDUCTION IN POPULATION SODIUM INTAKE, WE
HAVEN’T — WE’RE REALLY LOOKING AT THE NATIONAL LEVEL, TO BE A
NATIONAL LEVEL IMPACT. AND WE HAVEN’T MODELLED IT
SPECIFICALLY, BUT WE REFER OFTEN TO THE VIVEN DOMINGO PAPER FROM
LAST YEAR THAT LOOKED AT REDUCTIONS OF ONE, TWO, AND
THREE GRAMS OF SALT PER DAY. AND WHAT THE IMPACT WOULD BE IN
TERMS OF LIVES SAVED AND ALSO HEALTH CARE COSTS SAVINGS. AND THAT 20% REDUCTION IN SODIUM
IS ABOUT A 1.7-GRAM REDUCTION IN TERMS OF SALT. SO YOU CAN KIND OF USE THAT TO
SEE WHAT THE IMPACT MIGHT BE AT A NATIONAL LEVEL. IN TERMS OF THE NEW YORK CITY
LEVEL, WE DID LOOK AT SORT OF THE PERCENTAGE CHANGE THAT WE
WOULD BE ABLE TO DETECT OVER FOUR OR FIVE YEARS, AND WE BASED
THAT ON A CHANGE SEEN IN THE U.K. AND AS I MENTIONED IN MY
PRESENTATION, THE U.K. HAD A SALT REDUCTION CAMPAIGN THAT’S
BEEN IN PLACE WITH ABOUT — FOR ABOUT THE LAST FIVE YEARS. WE MODELLED IT AFTER THEM. ONE OF THE THINGS WE WERE
IMPRESSED BY IS THAT THEY COLLECTED 24-HOUR URINE, AND
THEY’D SEEN A DECREASE. AND SO WE LOOKED AT THE DECREASE
THEY SAY WHICH WAS ABOUT 4% AND LOOKED AT THAT AS A POTENTIAL
EFFECT THAT WE MIGHT SEE.>>THANK YOU. MOLLY, DID YOU WANT TO ADD
SOMETHING ABOUT MONITORING AND SURVEILLANCE TO ASSESS THE
IMPACT OF FUTURE INTERVENTIONS?>>SURE. SO AT CDC, SOME OF THE EFFORTS
THAT WE’RE CARRYING FORTH INCLUDE ADDING BIOLOGICAL
MARKERS TO THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY
AS DR. LEBARTH HAD HAD INDICATED EARLIER. BUT WE’RE ALSO LOOKING AT THE
POSSIBILITY OF USING SPOT URINE FROM EITHER PREVIOUS N-HANES OR
GOING FORWARD TO MEASURE SODIUM OR CHANGES IN SODIUM OVER TIME
JUST BECAUSE THESE MEASURE DON’T RELY ON SELF-REPORT.>>THANK YOU. SO I HAVE TWO QUESTIONS. ONE OF THEM HAS TO DO WITH ANY
CHANCE THAT WE MIGHT SEE SOME OF THE MAJOR CONVENIENCE STORES ON
THE LIST OF VOLUNTEERS. I QUICKLY SCANNED THE LIST, AND
I DIDN’T SEE BURGER KING, McDONALD’S, OR OTHERS. I WONDER WHAT THE —
[ INAUDIBLE ]>>IS THE SALT IS AN IMPORTANT
VEHICLE FOR FORTIFICATION FOR IODINE? I’M WONDERING WHAT OUR
STRATEGIES ARE TO MAINTAIN IODINE FORTIFICATION AS WE TRY
TO MOVE AWAY FROM SALT, IS ENCOURAGING THE INDUSTRY TO USE
I IODIZED SALT ONE OPPORTUNITY? MOLLY?>>I’LL DO MY BEST TO TACKLE THE
IODIZED SALT ISSUE. IN TERMS OF CHANGES IN THE
IODINE STATUS OF THE U.S. POPULATION AND SOME SUBGROUPS,
FOR EXAMPLE, PREGNANT WOMEN, THEY’RE ON THE LOW END AT THIS
POINT IN TIME. IN PROCESSED FOODS, FOOD
MANUFACTURES DO NOT ADD — DO NOT USE IODIZED SALT. SO IF WE’RE REDUCING THE AMOUNT
OF SODIUM IN SALT USED IN PROCESSED FOODS, WE’RE NOT GOING
TO AFFECT THE IODINE INTAKE. ON A GLOBAL BASIS, THERE ARE
EFFORTS. WE RECENTLY HAD A MEETING WITH A
PAN AMERICAN HEALTH ORGANIZATION TO TALK ABOUT GLOBAL EFFORTS
WHEN WE’RE REDUCING SALT IN EITHER PROCESSED FOODS OR SALT
ADDED AT THE TABLE THAT WE NEED TO INCREASE THE IODIZATION OF
SALT. SO I THINK IN THE U.S., IT’S NOT
SO MUCH AN ISSUE. BUT GLOBALLY IT IS AN ISSUE AND
SOMETHING THAT WE HAVE TO THINK ABOUT AND EFFORTS WILL BE MADE
IN THAT DIRECTION.>>I MIGHT ADD FOR THOSE WHO
WANT TO PURSUE THIS FURTHER, THE WORLD HEALTH ORGANIZATION WEB
SITE PROVIDES REPORTS OF TWO CONSULTATIONS. ONE IN LATE 2006 PUBLISHED IN
APRIL OF ’07, AND A SUBSEQUENT ONE IN MAY OF ’07 THAT WAS
PUBLISHED LATER THAT YEAR. THE FIRST OF THOSE WAS A
REITERATION OF WHO’S LONG-STANDING RECOMMENDATION
THAT COUNTRIES SHOULD ADOPT POLICIES SEEKING CONSUMPTION OF
SALT, LESS THAN FIVE GRAMS PER DAY, OR LOWER IF THAT POLICY WAS
ALREADY IN PLACE. BUT THEY GAVE ATTENTION TO THE
IODINE ISSUE. THE SECOND MEETING WAS
SPECIFICALLY TO BRING EXPERTS TOGETHER FROM BOTH THE
CARDIOVASCULAR SIDE AND THE IODINE-DEFICIENCY DISEASES SIDE,
TO TRY TO RECONCILE THEIR POLICIES. THE IODIZATION POLICY REQUIRES
CONSUMPTION OF TEN GRAMS OF SALT. CONTAINING IODINE IN ORDER TO
MEET THE DAILY IODINE REQUIREMENT, WHERE THAT IS PART
OF THE PUBLIC HEALTH STRATEGY. CLEARLY, THAT IN ADDITION TO
WHATEVER SALT IS CONTAINED AND PROCESSED IN RESTAURANT FOODS
REPRESENTS A POLICY COLLISION. A DETAILED DISCUSSION AND
SUBSTANTIATED BY DOCUMENT IN THE REPORT MAKE CLEAR THAT THIS IS
NOT AN UNAVOIDABLE CONFLICT. THAT IT IS POSSIBLE TO INCREASE
THE SATURATION OF IODINE IN SALT TO ACHIEVE THE TARGET INTAKE OF
IODINE WITHIN A FIVE-GRAM SALT INTAKE. BUT IT DOES REQUIRE UNIVERSAL
SALT IODIZATION WHICH IS USE OF IODIZED SALT IN THE PREPARATION
OF MANUFACTURED FOODS. TO YOUR FIRST QUESTION, MAJOR
PROVIDERS OF FOOD, YOU MAY OR MAY NOT HAVE SEEN, ABOUT TWO
WEEKS AGO AN ANNOUNCEMENT BY WALMART THAT THEY WOULD BE
SEEKING A MAJOR REDUCTION IN THE SODIUM CONTENT OF THEIR
PRODUCTS. AND THEY ARE BY ALL ACCOUNTS THE
LARGEST FOOD RETAILER IN THE UNITED STATES, ACCOUNTSING FOR
ABOUT 20% OF ALL RETAIL FOOD SALES. SO THERE’S A BIG ONE MAKING A
VERY IMPORTANT PROMISE OF CHANGE.>>AND MORE RECENTLY SUBWAY
ANNOUNCED REDUCTIONS IN THEIR PRODUCTS WHICH ARE STILL QUITE
HIGH, BUT –>>OTHER QUESTIONS OR COMMENTS? YES? [ INAUDIBLE ]
>>WE VERY MUCH APPRECIATE YOU BRINGING FORWARD A NATIONAL
INITIATIVE SO THE ENTIRE COUNTRY CAN BENEFIT FROM THIS WORK. A NUMBER OF THE COMPANIES ON
YOUR LIST AND A GROWING LIST, I PRESUME, ARE INTERNATIONAL IN
SCOPE. IS IT ANY DISCUSSION AT ALL OF
OTHER PARTS OF THE WORLD BENEFITING FROM THE PROGRESS
THAT YOU’RE MAKING? AND I PRESUME THE PROGRESS YOU
ARE MAKING IS A COMMITMENT TO NATIONAL CHAINS SO IT’S NOT A
DIFFERENT SET OF CHEERIOS BEING DISTRIBUTED IN L.A. VERSUS NEW
YORK. BUT I MEAN, SORT OF EXTENDING
THAT, IS THIS ANY WAY TO GET COMMITMENTS FOR OTHER PARTS OF
THE WORLD? I PRESUME CANADA AND OTHERS ARE
INTERESTED IN JOINING FORCE.>>YES. ALL THE COMMITMENTS ARE FOR
NATIONAL CHANGES. THAT’S WHY IT’S KEY THAT WE HAVE
CITIES AND STATES RUSSIA THAT HAVE SIGNED ON LIKE CALIFORNIA,
NEW YORK STATE, AND MASSACHUSETTS REPRESENTED AT THE
TABLE WHEN THEY’RE — THEY WOULD NOT MAKE CHANGE FOR JUST ONE
REGION. WE STAY THIS CLOSE TOUCH WITH
BOTH THE U.K. AND CANADA AND HAS BEEN DISCUSSED, REDUCTION WITH
AUSTRALIA, BECAUSE THERE ARE A LOT OF DIFFERENT INITIATIVES ON
SODIUM REDUCTION. THAT SAID, THERE’S KIND OF TWO
COMPONENTS. ONE AS COMPANIES LEARN A LOT
ABOUT SODIUM REDUCTION WHEN THEY DO IT IN ONE COUNTRY AND IT
TRANSFERS. ALL THE COMPANIES HAVE DIFFERENT
PRODUCT FORMULATIONS FOR EACH COUNTRY, SO IT ISN’T IF THEY
MAKE A CHANGE IN ONE PRODUCT, CRACKERS HERE, THIS EXACT BRAND
IN CANADA, THEY HAVE THROUGH THE OWN TESTING AND CONSUMER
APPROVAL PROCESS THERE. SO THERE AREN’T TARGETS THAT
COULD REALLY BE ACROSS THE BOARD, BUT I THINK THE MORE THAT
WE DISCUSS AND KEEP IN TOUCH THE MORE THE CATEGORIES CAN BE
ALIGNED AND THE MORE THAT WE HAVE THE SAME PROCESS SO IT
HELPS COMPANIES FOCUS ATTENTION ON THE KEY CATEGORIES TO REDUCE
SODIUM.>>THANK YOU VERY MUCH FOR YOUR
QUESTIONS AND FOR YOUR ATTENTION. WE’D JUST LIKE TO CLOSE WITH
THREE MESSAGES. FIRST, AS PRONOUNCED BY THE
INSTITUTE OF MEDICINE IN THEIR 2010 REPORT, THE LEVELS OF
SODIUM IN THE FOOD SUPPLY OF THE UNITED STATES TODAY ARE SIMPLY
NOT SAFE. WE HAVE HEARD THAT THEY ARE
NEITHER NECESSARY, THAT A WIDE RANGE OF SODIUM CONTENT OF THE
SAME FOOD PRODUCTS POINTS TO THE POTENTIAL TO REDUCE THE SODIUM
CONTENT OF OUR FOOD SUPPLY BY A LARGE DEGREE. WE’D ADD FINALLY THAT IT IS NOT
DEFENSIBLE. IF WE’RE IMPROVING CONDITIONS IN
WHICH PEOPLE LIVE, ENSURING THE ENVIRONMENT IN WHICH PEOPLE CAN
BE HEALTHY, WE WILL BE WORKING TOGETHER TO REDUCE THE SODIUM
CONTENT OF OUR FOOD SUPPLY AND HELP THE U.S. POPULATION AS WELL
AS OTHERS AROUND THE WORLD TO REDUCE THEIR SODIUM INTAKE. THANK YOU VERY MUCH. TONYA?>>THANK YOU ALL FOR COMING. LET ME JUST REMIND YOU THAT OUR
NEXT TOPIC NEXT MONTH IS LYME DISEASE. SO WE’RE MOVING A LITTLE BIT
BACK TO INFECTIOUS DISEASES. I WOULD LIKE YOU TO GIVE ANOTHER
ROUND OF APPLAUSE TO THIS SMART AND GORGEOUS TEAM. [ APPLAUSE ]
>>THANK YOU.>>SEE YOU NEXT MONTHS.

4 thoughts on “Sodium Reduction: Time for Choice

  1. @MrTakeBackAmerica hahaha good luck with that quest buddy….i agree the fluoride in drinking water makes no sense…its in tooth paste we dont need to drink that shyt…..they claim its in water because kids dont brush their teeth…wtf that is stupid

  2. also fluoride kill bacteria which cool cause lethal infection or serious gastrointestinal distress, you way out that vs drinking fluoride i think fluoride is the lesser evil.

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