The Institute of Medicine recently released a report urging the federal government to finally do what the food service and processing industries have not — curb salt in the American diet that has been surging alongside rates of hypertension and cardiovascular disease.
The cry from libertarians and salt lobbyists has been unsurprising. No one wants Big Brother at the dinner table, they say, dictating our diets and dulling down our food. And it's a powerful image: Uncle Sam standing with an empty saltshaker over your meatloaf and mashed potatoes.
The predictable debate over paternalism suggests the IOM's supporters must now win a public relations battle as much as a scientific and regulatory one. They'll have to take a fight about slippery government overreach and turn it into one about health — or, rather, death and money. Other fronts in this gastronomical conflict include trans fats and sugary drinks.
This may be a discussion Americans are primed for after year of intensive national attention on health care premiums, pre-existing conditions and preventive care. If our tax dollars will soon be picking up more of the tab for subsidized health care, will our government be more invested in keeping people healthy in the first place?
And if Americans are now more attuned than ever to the concept of pooling risk — that someone else's unhealthy lifestyle adds to your monthly premium — will we be more likely to support federal nutrition regulation like that urged by the IOM?
The report proposes reclassifying salt, currently considered by the Food and Drug Administration to be GRAS, or "generally recognized as safe." This means there's no particular "safe level" recognized by the government, although the Dietary Guidelines for Americans recommend we should have no more than about a teaspoon per person a day, or 2,300 milligrams. Most of us, in fact, should be consuming closer to 1,500 mg.
What we're actually eating: about 3,400 mg of salt per day.
The vast majority of that doesn't come from our own saltshakers, but from preprocessed foods and restaurant meals. The National Salt Reduction Initiative estimates that only 11 percent of our daily intake comes from salt we add to food ourselves. About 80 percent is added for us, by someone else, before we even buy the food.
As such, the IOM isn't necessarily saying that government should dictate how much salt we eat on a daily basis, but that industry shouldn't get to dictate that either to an unhealthy level. A microwaveable meal of Grilled Bourbon Steak Strips from Hungry-Man, for example, contains 1,990 mg of salt (topping a list of the saltiest packaged foods in America from the Center for Science in the Public Interest). New regulation would gradually ratchet down that level — but you're still welcome to return every grain of it yourself at home.
The more concrete arguments, beyond debate about personal choice and who is really dictating your daily nutritional intake, come from the numbers. A study released last fall by the RAND Corporation calculated that Americans would save $18 billion annually in health care costs by trimming their salt intake to recommended levels. We'd also eliminate 11 million cases of high blood pressure and save 312,000 "quality adjusted life years" (years people would remain alive as a result of healthier lifestyles).
"I think that framing it that way does make sense," said Julie Greenstein, CSPI's deputy director of health promotion policy. "Most people still think that unless they have hypertension, unless they have family history of high blood pressure, this is not an issue they need to focus on. But now people are coming around to that a little more than they used to when you look at the facts of reducing sodium consumption."
The IOM is proposing a slightly different kind of public education campaign, one that would bypass our rational brains and go right for our palates.
"The goal is to slowly, over time, reduce the sodium content of the food supply in a way that goes unnoticed by most consumers," the report's authors wrote, "as individuals' taste sensors adjust to the lower levels of sodium."
This may not be the best way to counter claims of paternalism, suggesting the government can retrain our taste buds without us even noticing.
Advocates should maybe try asking this instead: What's more important to you — Hungry-Man's right to put as much salt as it wants in your food, or your personal share of $18 billion in health care savings?