We can't see most of the salt we eat.
We didn't ask for it and we don't even know it's there.
It's hidden in the processed, packaged food we buy at the grocery store
or in the meals we order at restaurants.
Hidden salt leads most US adults to eat many times
more sodium than we need.
Even those who try to watch what they eat
may not realize just how much salt is in our food.
Many Americans don't know that unseen salt drives up their
blood pressure, increasing the risk of heart disease and stroke,
which are the first and third leading causes of death in the United States.
We've made great progress lowering blood pressure across the nation,
but we're not even close to ending the problem.
One-third of US adults have high blood pressure
and another quarter have levels above the desirable range.
We know what works. We can take action now.
Scientific evidence and demonstrated success in other countries
show that reducing sodium in the food supply is the single
best community strategy to reduce the prevalence of high blood pressure.
I am doctor Tom Frieden, Director of the Centers for Disease
Control and Prevention. Please join public officials, medical experts,
and others dedicated to improving the health of people throughout the
United States as we commit to cut the salt and save lives.
Salt. The chemical name for it is Sodium Chloride.
About 90% of the sodium we eat comes in the form of salt.
The rest comes from food additives like MSG and baking soda.
Some occurs naturally in foods.
So how much salt do we eat, and how much do our bodies really need?
How much is too much?
Current dietary guidelines say Americans age 2 and up should eat
less than 2300mg of sodium, or about 1 teaspoon of salt per day.
However, about half the population
should get even less than that.
A diet even lower in sodium—1500mg per day
is recommended for persons 51 and older and
those of any age who are African American, or have high blood pressure,
diabetes, or chronic kidney disease.
Yet, the body's needs are far outpaced by a food supply
that's full of salt. Studies show that adults eat an average of
3400mg of sodium every day. That's more than
twice the recommended limit for most American adults. And far more
than the body needs. But the salt shaker is not the major problem.
Nor is the pinch of salt tossed into the spaghetti sauce.
The overwhelming majority of the salt we eat, about 3/4 of it,
is already in foods we buy from grocery stores and restaurants.
12% occurs naturally in fruits, vegetables, and whole grains.
And only 6% is added at the table, 5% during cooking.
Sodium is being added to your product not because you like it, or want it,
but because they think that it has some benefit.
Maybe in terms of incrementally changing taste, or maybe it actually
adds water and weight, and therefore it costs more.
The food industry uses salt to add or enhance flavor, to preserve foods
for extended shelf life and for functional purposes. Such as helping meat
to retain moisture, or bread to rise while baking.
But it's not only present in salty foods like cured meats, chips, and pickles.
It's also hidden in foods that may not even taste salty,
like cereal and condiments.
And it's these hidden sources that make reducing salt intake challenging
for individuals, and for society.
I know what I am supposed to do, and yet I also find it very difficult
despite all the knowledge that I have
to eat a diet that's within the recommended daily limit of salt.
I go to the grocery store, I look at products,
and I have very limited choices.
Well, unfortunately among the general populations we deal with
there are very few nowadays, if any,
who are eating a low intake of processed foods.
We got to start with that, and the food industry in every
part of the globe and to varying degrees
in processing food, throws in salt.
The breads, the rolls, the other baked goods, dry cereals.
The problem becomes that many individuals would
select a lower sodium product, but they don't have a choice out there.
So what choices do we have?
And what can be done to expand the options?
And how do those choices effect the health of our families,
our communities, and our entire country?
We have it from every source concurrently
in regard to salt and blood pressure.
The evidence is extensive, consistent, strong,
and worthy of the designation, it's a causative effect.
The modification of sodium intake for individuals
who have excessive consumption is incredibly important,
whether or not individuals are hypertensive,
whether or not they're African American,
whether or not they're middle aged or older adults.
This is a public health problem
and one that's important for all Americans.
High blood pressure is a major contributor to heart disease and stroke,
which represent the 1st and 3rd most common
causes of death in the United States.
Once present, high blood pressure can become
a life long problem, for individuals, and for society.
Nearly 1 in 3 US adults has high blood pressure.
Almost 1/5 of adults with high blood pressure
are unaware that they have it.
Less than half of adults with high blood pressure have it under control.
The tremendous burden of high blood pressure, hardened arteries,
heart attack, heart failure, and even blindness,
is accompanied by an alarming economic toll.
According to recent estimates, US costs for heart disease and stroke,
to which high blood pressure is a major contributor,
were an estimated $444 billion in 2010.
This includes spending on health care, lost productivity, death, and disability.
Although the current statistics are sobering,
they are not set in stone.
And it's incumbent upon us not to settle for the status quo.
We need to revitalize an aggressive strategy
to address sodium and its role in high blood pressure.
More than 50 studies from around the world have shown
that as sodium intake rises, blood pressure rises as well.
These investigations include epidemiological and clinical evidence
of the link between salt and heart disease.
The good news is that a wide body of published studies
also points to the opposite effect.
That is, the benefit of lowering sodium intake and its positive impact
on blood pressure and prevention of heart disease and stroke.
For example, even people with blood pressure in the normal range
benefit from reducing high salt intake,
because your risk for heart disease and stroke increases as blood pressure increases,
even if you don't have high blood pressure.
Overall for most adults, reducing the amount of sodium
in the diet to at, or below, currently recommended limits is projected
to reduce the prevalence of high blood pressure by as much as a quarter,
and in turn save tens of thousands of U.S. lives annually.
How can tens of thousands of lives be saved?
What are the choices that individuals and society can make?
As individuals, we can try to read labels.
We can try to refrain from picking up the salt shaker.
And we can try to order carefully at restaurants.
But the barriers remain numerous.
Lower sodium choices such as fresh fruits and vegetables
aren't always accessible.
Reading food labels can sometimes be confusing.
And packaging claims such as low sodium, reduced sodium,
lightly salted, or no salt added are sometimes unclear.
We have people who have hypertension
who report to us that they are trying to
put together a dietary pattern that meets the guideline,
who fall way short, and you can see this here in the United States
through data sources such as the INTERMAP study.
If you look in other research databases you'll see
the story over and over and over again. I think it's incredibly important,
given the health ramifications, that we take a public health approach
to ensuring that everyone can meet their daily requirements.
It's avoidable, it's preventable, it's correctable
and that's what the public health effort is all about.
And the public health effort is underway.
It's happening on local, national, and international levels.
As we've seen, changing individual behavior is very hard,
even among the most motivated.
That's why improving the available choices
remains part of the public health effort... along with education.
We've seen that it can be done.
Lessons from other countries reinforce that goverment and industry
can work together to make salt reduction a successful public health strategy.
For example, since 2003 the United Kingdom has encouraged
food manufacturers to voluntarily work towards lowering sodium content to
targets within specific food categories.
The effort was also supported by national advertising campaigns
to raise public awareness.
This combined public / private effort
led to a decline in sodium consumption by as much as 10%.
In addition to the UK, France, Australia,
Portugal, Finland, and Canada have each undertaken
various sodium reduction efforts.
We can make similar gains here in the United States,
and we already have a head start.
Some manufacturers bury the level of sodium in their foods
based on the country in which it's produced, or where it will be sold.
In fact, some identically named products have as little
as half the sodium content, depending upon location.
An initiative by the New York City
Department of Health and Mental Hygiene to cut the salt
is among the country's first and most visable efforts.
In addition to working on public education and outreach
with local restaurants, New York City has launched a coalition
of health organizations and public agencies.
So in New York City in 2008,
we launched the national salt reduction initiative.
This initiative includes a partnership of over 40 cities, states,
and public health organizations working with industry
to set targets by food category.
We've created over 60 processed food categories
that we proposed and discussed targets for with industry,
and we have an additional over 20 categories that we're working
with restaurants to set and propose categories to propose targets for.
Efforts are also underway in Los Angeles County
and states such as New York, Kansas, and California
where health officials are developing salt reduction strategies
for their areas and partnering nationwide.
And what happens when these salt reduction targets are met?
Does better public health mean bland food?
One of the very important things that we've learned
from discussions with industry very early on,
was that products that have sodium reduced in isolation,
can be difficult for consumers to accept.
If you eat a food that is very high in sodium and suddenly you get
served a lunch with very low in sodium you really notice the difference.
So the approach that we are using is one that gradually reduces sodium
in the huge amount of foods in our food supply gradually over time.
That way not one single product and not one single company
stands out as an outlier as one that has too low salt or too high salt.
If we reduce it over time we all become accustomed to it
and we prefer those sorts of diets.
So individuals will never lose their ability to choose
how they put their meals together and how they enjoy foods,
which we all know is an important part of our eating behaviors.
So govermental efforts again to ensure
that we have the opportunity to eat well, particularly
our subgroups that are struggling to be within
the recommendations of less than 1500mg per day, is incredibly important.
The pleasure of eating is a very important pleasure of civilized human beings.
None of us who have any sense would think of interfering with that pleasure.
That pleasure is fully enjoyable. You just re-educate your taste buds.
We can reduce sodium intake, decrease blood pressure,
and prevent heart attack and strokes.
We'll continue to encourage people to make healthier food choices,
but it also makes sense to change the foods by gradually reducing
salt levels to achieve an immense public health benefit.
In 2009, Congress charged the CDC to work with food manufacturers
and chain restaurants to reduce sodium in their products.
Salt reduction in our food not only requires a new mind set,
but a new environment. One in which healthier foods
are the accessible and affordable default option for everyone.
Salt matters. We must act and act now.
For more information, please visit www.cdc.gov/salt