AMA Balks at a Low-Salt Diet for All

From the WebMD Archives

June 19, 2001 (Chicago) -- The nation's largest doctor association decided not to recommend that all people with normal blood pressure adopt a low-sodium diet to prevent the development of hypertension, or high blood pressure.

The controversial proposal raised at the annual meeting of the American Medical Association's House of Delegates had claimed that evidence is now convincing that Americans' "huge salt load is a major cause of hypertension." The resolution also backed a low-sodium diet for those with high blood pressure as a major part of treatment against the condition.

But without debate today, the House -- the AMA's policymaking body -- did not support the plan. According to the AMA's public health reference committee, "While there was uniform agreement regarding the need to reduce sodium intake for hypertensive persons, concern was expressed regarding the lack of data for extrapolating the results to all normotensive individuals."

The proposed recommendations would have involved more than just telling Americans to stop up those salt shakers at the dinner table.

According to the proposed resolution from the American College of Preventive Medicine, "The pervasive addition of salt to American food by the processed food and restaurant [industry] now makes it very difficult for even motivated individuals and patients to comply with optimal levels of dietary sodium intake."

The preventive medicine doctors wanted the AMA to work with the nation's restaurants, the FDA, and others to cut back on how much salt is added to food. It claimed that there are many alternatives to salt for the preservation of food.

AMA trustee Herman Abromowitz, MD, tells WebMD that existing association policy features support for the food industry to reduce the sodium content of processed food, as long as it doesn't compromise safety or nutrition.

Meanwhile, Americans' salt intakes have risen significantly. Upwards of 70% of the salt in the average American's diet is due to what the industry adds to processed foods.

Studies suggest that U.S. adults eat an average of 3,300 mg of sodium each day, even though government standards recommend 2,400 mg per day.

To establish their case, the preventive medicine doctors had cited landmark clinical study results published last January in TheNew EnglandJournal of Medicine. According to the study, lowered dietary salt -- 1,500 mg per day -- cut blood pressure in both individuals with and without hypertension.

But in discussions yesterday at the AMA session, the resolution faced opposition among doctors. Some said that the study gives no evidence that adding salt causes high blood pressure. For example, Edward Jones, MD, representing the Renal Physicians Association, noted that the study only addressed removing salt from people's diets.

Sally Trippel, MD, a Minnesota preventive medicine doctor, also raised objections to the proposal. Claiming that obesity is a greater risk factor for high blood pressure than dietary salt, she voiced her concerns that advising most Americans to lower their salt intake could lead obese Americans to believe that not salting their french fries will keep them from developing hypertension.

According to the Salt Institute, an industry group, some individuals are "salt sensitive," and should be advised to a lower-sodium diet. Those who are salt sensitive, it says, don't eat enough fruits, vegetables, and low-fat dairy products.

But Richard Hanneman, president of the Salt Institute, told WebMD that a universal salt restriction would be ill-advised. He said that it would not benefit everyone and noted that monitoring a low-salt diet costs $1,500 per year.