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Sodium in the diet is a likely next target of federal regulation, but research that points blame at the restaurant industry may be somewhat exaggerated.
In an educational session at the National Restaurant Association Restaurant, Hotel-Motel show in Chicago on Saturday, NRA dietitian Joy Dubost and Adam Drewnowski, director of the University of Washington Center for Obesity Research, questioned whether regulation of sodium on restaurant menus would help more people meet the daily recommended limits — a goal very few appear to reach currently.
Americans on average consume about 3,400 milligrams of sodium per day, though the recommended limit is 2,300 milligrams for most people, Dubost said. For certain people, like older adults and those with health issues, doctors recommend limiting sodium to 1,500 milligrams.
Dubost said the link between sodium intake and hypertension is clear: Diets higher in sodium tend to drive up blood pressure, which can be a risk factor for heart attacks and stroke. And more people die of heart attacks than any other cause.
Still, is the restaurant industry to blame?
Some researchers point to a statistic that the restaurant industry share of the average American’s food dollar is about 48 percent, but that doesn’t correspond with calories, Dubost said. Americans are believed to consume about one-third of their daily calories outside the home, but that figure also includes a host of non-restaurant sources, such as vending machines and convenience stores, she added.
Drewnowski argued that it remains to be proven that, if sodium were reduced in American foods, more people would be able to meet the recommended limits.
Very few meet those limits now, however. In one long-term study that looked at 19,000 people under age 20 and their reported eating habits, only nine actually met the recommended guidelines of 2,300 milligrams.
Research on sodium levels in certain foods also fails to consider how frequently people eat those foods, Drewnowski said, as well as portion sizes and the fact that food choices change at different points in a person’s life. The Centers for Disease Control and Prevention in Atlanta, for example, estimates that about 40 percent of sodium in the diet comes from 10 commonly eaten foods. The top five are bread, cold cuts, pizza, fresh poultry and soups.
Drewnowski also said the CDC estimates that only about 25 percent of sodium and calories in the average American’s diet come from restaurants, where 66 percent comes from grocery stores.
Still, Dubost said the U.S. Food and Drug Administration has called for comments on regulating sodium in restaurants. “This is on the government’s radar,” she said.
The NRA has responded by arguing that any efforts should be made voluntary, and that any approach to reducing sodium on menus should be incremental, to allow consumer palates to adjust to less salt.
Dubost added that singling out one nutrient also might not be the best approach. The ratio of sodium to potassium should be considered. Diets higher in potassium can reduce the risks associated with higher levels of salt in the diet, she said.
Education is critical, said Dubost. “Consumers aren’t necessarily concerned about sodium the way government and public policy is,” she said.
So should restaurant operators be working to reduce sodium on their menus?
Yes, said Dubost. Public health may be getting ahead of the science, but regulations are coming down the pipeline.
Here are Dubost’s recommendations:
• Look at your inventory to see how much salt is in your ingredients.
• Limit the use of high-sodium seasonings and sauces.
• Work with vendors to find lower-sodium options.
• Incorporate more food groups, such as fresh fruit, vegetables and whole grains.
• Look at portion control as a way to reduce salt levels.
• Experiment with alternative flavorings, such as fresh herbs, spices and acidic ingredients like citrus and vinegar.
• Use salt as a finishing touch.
• Cut back on salt gradually.