Rubbing salt in FDA’s wounds

The petition by the Institute of Medicine, an arm of the National Academy of Sciences, was persuasive. But its choice of the financially strapped FDA to implement a sweeping dietary change is more problematic — the agency has the expertise, but not the resources, to do the job properly.

The institute isn’t asking the FDA to step into America’s dining rooms and snatch the salt shaker away. Rather, the issue is with the nation’s food supply and the amount of salt that goes into it before anyone even sinks a fork into the plate.

Americans consume an average of 3,400 milligrams of sodium each day — about 1 1/2 teaspoons of salt — even though national guidelines suggest 2,300 milligrams and the emerging consensus sets the target at 1,500. Three-quarters of that salt comes from packaged foods or meals eaten in restaurants and fast-food chains.

The institute wants the FDA to reconsider salt’s longstanding status as a substance that is considered safe. Instead, the agency would classify salt as a food additive that is safe, but up to a point. Foods containing more than a certain percentage of salt would essentially be banned from the marketplace. By forcing an industrywide mandate, no manufacturer would fear losing customers because of its inevitably blander products. Everyone’s goods would taste equally milder.

There is little doubt the FDA is the best-suited government agency to marshal such a far-reaching effort. It certainly has the regulatory tools to achieve it. Whether it has the might is a different question.

The FDA is overwhelmed and underfunded. It regulates about $1 trillion worth of consumer products yet its budget is $2.4 billion — the same as that of the City of Boston and significantly less than those of the Centers for Disease Control and Prevention ($6.5 billion) or the National Institutes of Health ($31 billion). The agency can barely keep up with its current regulatory and surveillance tasks, which involve all of the nation’s medicines, food, and cosmetics.

For the FDA to regulate salt in the manner proposed by the Institute of Medicine would be a massive undertaking. To use the institute’s own words, it would be a “complicated and challenging process.’’ It would require a thorough analysis of the food supply, the use of models to figure out the right sodium levels to set, a meticulous look at food safety concerns (since removing salt would increase the chance for food spoilage), studies of economic impact, and much more. The agency could not successfully take on these responsibilities given its current state. Something would have to give.

In the meantime, alternative paths to salt reduction are being pursued. The Department of Health and Human Services is coordinating an interagency working group to explore strategies that would help reduce salt intake. This may provide a Plan B, especially if the FDA takes too long to implement a strategy, or is ultimately unable to.

That plan could look like the National Salt Reduction Initiative, a coalition of 18 national health organizations and 30 cities and states spearheaded by the City of New York. In January the initiative launched salt-reduction targets for 62 categories of packaged food and 25 restaurant categories. Sixteen food companies, including Heinz and Unilever, and restaurants such as Au Bon Pain and Starbucks, have joined the effort.

In the end, how salt is dealt with in this country will come down to priorities. The FDA’s new commissioner, Margaret A. Hamburg, used to be New York City’s health commissioner and was once lauded for the public health initiatives she carried out in spite of severe budgetary challenges. Perhaps she will see this endeavor as one worth moving to the top of FDA’s list. If so, hopefully Congress will back her up with much-needed cash.

Sylvia Pagán Westphal is a freelance health care/science writer and a columnist for Xconomy.com.