NYC vs. Salt: It’s ON!!

Dr. Thomas Frieden, the commissioner of New York City’s Department of Health and Mental Hygiene, has put some serious notches on his public health pistol in recent years.

First, New York City banned smoking indoors, a revolutionary act that soon spread to almost every other major American city. The ripple effects even crossed the Atlantic: it’s now illegal to smoke inside in freakin’ PARIS.

Having wiped out a cultural trend almost single-handedly, and slashed the number of NYC smokers by hundreds of thousands, Dr. Frieden probably could have rested on his laurels as a public health hero.

Not so much.

Next victim: trans fats. New York banned ‘em, and surprise surprise, the restaurant biz didn’t collapse. There were already healthier substitutes available, it was just cheaper to poison their customers with the vile substance.

Again, the ban spread quickly to other cities and appears to be another major coup for Dr. Frieden.

The commissioner has also tightened up health inspections and mandated the sale of low-fat milk in NYC bodegas.

Now he’s poised for his next major strike.

New York City is about to force food manufacturers and restaurant chains to cut their sodium (salt) levels.

The tone of a recent meeting, and a media push led by a NYTIMES article out today, send a clear message:

Cooperate and slash salt content, or we will drop regulation on you FOR REALS.

DR. THOMAS R. FRIEDEN invited some of the biggest names in food processing to lunch last October. Grilled salmon and green salad were on the menu, but the subject was salt.

After a string of victories over smoking, trans fats and calories, Dr. Frieden, the commissioner of New York City’s Department of Health and Mental Hygiene, is waging a new campaign: to lower the amount of sodium America eats.

But don’t go hiding your saltshakers. The city isn’t going after the seasoning people add at the table or in the kitchen. That makes up only about 11 percent of the salt people eat, Dr. Frieden says.

His targets are packaged foods and mass-produced restaurant meals, which contribute 80 percent of the sodium in the average American diet.

When the food company executives had finished lunch, Dr. Frieden made his pitch: Over the next five years, identify the foods that are contributing the most sodium to people’s diets and cut the level of salt by 25 percent. In a decade, cut it by another 25 percent. And do it in unison with your competitors.

If they refuse?

“If there’s not progress in a few years, we’ll have to consider other options, like legislation,” he said in an interview last week.

The last two times Dr. Frieden stepped into the nutrition wars, he gave muscle to nationwide moves to ban trans fats and post calorie counts on restaurant menus. That means you could soon be hearing more about salt than you have in a long time.

“The one thing that’s disturbing is that he seems to be able to do just about anything he wants in New York City, and New York City serves as a model for the rest of the world,” said E. Charles Hunt of the New York Restaurant Association and a veteran of legal wars over Dr. Frieden’s food policies.

Commish Frieden may have a battle on his hands this time, as the restaurant and food industries realize that he’s been kicking their asses for some time now, and eventually they need to draw a line in the sand and fight.

Frieden: “Don’t get salty with me.”

The scope of Frieden’s plan is ambitious and enormous. Instead of effecting change through regulation of small businesses like restaurants, bars and bodegas, he’s attempting to coordinate a national sodium-reduction project that would primarily be implemented by large corporations, few of whom fall under NYC jurisdiction.

Frieden’s only hammer here is the clear power of New York City regulation to influence regulations in other cities, and the threat that sweeping legislation could prove more deleterious to the food/restaurant industry’s bottom line than a voluntary program would.

Because other nutritional culprits have gotten more attention lately, salt and the case against it has faded into the background. Most of the nation’s heart researchers agree that high blood pressure is a leading factor in the incidence of heart attack and stroke. And in some people, but not everyone, salt causes high blood pressure. While drugs can treat hypertension, not everybody has access to medication. And although doctors have been telling people to watch their salt for years, it hasn’t been working.

That’s why Dr. Frieden says a quiet, mass reduction in sodium levels — stealth health, they like to call it around the department — might be more effective. Lower sodium levels by 50 percent, and 150,000 American lives a year might be saved, he said.

Under his plan, which is based on one in the United Kingdom, targets for sodium reduction will be set for certain food categories. The prime suspects include cheese, breakfast cereals, bread, macaroni and noodle products, cake mixes, condiments and soups. The final list of sodium targets will be based on a formula that takes into account the amount of sodium in a product as well as how much food in that category people eat.

The idea isn’t to force small bakers or high-end chefs to salt less liberally. Health officials believe it’s the big companies that can have the biggest effect on sodium.

“If they bring it down by 5 percent, that is going to do more than Danny Meyer bringing it down by 50 percent,” said Geoffrey Cowley, an associate commissioner of the Health Department, referring to the New York restaurateur.

Although he has jurisdiction over only New York City, Dr. Frieden is presenting the plan as a “national salt-reduction initiative” that includes support from a half-dozen other health departments around the country and organizations like the American Medical Association.

To take his idea beyond the city, Dr. Frieden convened his series of salt talks. The first was in late October, when he asked companies like Unilever, PepsiCo and Goya to Gracie Mansion. In February, he and a team from the Health Department will meet with the leaders of chain restaurants.

People in the Health Department thought the lunch was such a success they celebrated over drinks later that day. Some industry leaders had a different perspective.

“I would say the invitations to come to Gracie Mansion weren’t very inviting,” said an executive with a food manufacturer who was not authorized to speak for the company about the New York Health Department. “There was definitely a feeling of ‘Don’t make us shame you.’ ”

Robert Earl, vice president for science policy, nutrition and health of the Grocery Manufacturers Association, said his members would prefer a national sodium strategy that included a wider range of players, including consumer and advocacy groups.

There are other problems, he said. Getting many companies to do something at the same time might have antitrust implications. And more research is needed to understand what consumers want and the complex health implications of sodium reduction.

One significant hurdle is the absence of a decent salt substitute. Whereas restaurants that had previously used trans fatty oils were easily, if not inexpensively, able to switch to more healthy oil substitutes, there is no salt-Splenda that can be quickly subbed in to provide the same great taste with less sodium-riffic fallout.

Therefore, the possibility exists of a public backlash if food becomes abruptly less salty at the Sizzler.

Currently, the guidelines suggest people eat no more than 2,300 milligrams of sodium a day (although on food labels the upper limit of sodium for a 2,000 calorie diet is 2,400 milligrams). That’s about a teaspoon of salt, and half of what many people actually eat. Those more prone to high blood pressure, like African-Americans and older people, are advised to eat much less.

The food industry, too, has taken up sodium reduction with new energy. The grocery manufacturers’ group and the National Restaurant Association each held sodium conferences recently. At both gatherings, how to find a good salt substitute was a central topic.

“It’s frankly been one of those holy grails in the food industry for a number of years,” said Todd Abraham, a senior vice president for Kraft foods.

Kraft alone has spent $20 million on sodium reduction research, studying chemicals that block taste receptors and experimenting with yeast or potassium as substitutes.

It’s relatively easy to reduce salt that is applied topically, like that on potato chips. But those chips, while they may taste saltier, usually contain less sodium than items like muffins. That’s because salt’s role in processing packaged foods goes beyond flavor. It helps create structure in breads and encourages browning in baked goods. Salt helps emulsify the ingredients in bologna and American cheese, and keeps pathogens at bay.

As disturbing as this may sound, we recall similar arguments being raised when the trans fat ban came down…”your donuts will be flaccid without those sweet, sweet trans fats, people!!!”

Still, it’s clear that companies have been looking into this issue on their own, and would like to address it if they can.

However, we summon to mind the Ford EcoBoost program: when it appeared last year that they would finally be forced to raise fuel efficiency by the federal government, Ford suddenly came up with an amazing new futuristic program to reduce fuel consumption by 20%.

Turns out that this technology was not at all new and had been in use by European carmakers for years. It simply took the threat of tough regulation to kick Ford’s ass into gear.

Could Kraft et al require a similar boot to the bottom to start thinking seriously about implementing salt substitution/reduction, as opposed to simply throwing money at it?

One important caveat noted by the Times story notes is that there is not a rock-solid medical research consensus on the health threats posed by sodium. Public health officials are of one mind, but academics aren’t so sure.

Beyond the technical hurdles, Dr. Frieden might encounter resistance on scientific grounds. Some medical researchers question whether a mass reduction in sodium is the best way to spend public-health resources when losing weight and quitting cigarettes would do more for the country’s heart health.

Genetics dictate that different people have different reactions to sodium. Some people are more sensitive to high levels of salt. For others, low levels of sodium can be unhealthy.

But public health officials say there is a strong consensus that salt leads to higher rates of heart attacks and strokes.

That consensus alarms Dr. Michael Alderman, editor in chief of the American Journal of Hypertension, who thinks more clinical studies need to be done. And, he says, wild swings in dietary regulation haven’t always worked out.

Even trans fat, in the form of margarine, was once promoted by health officials as healthier than butter. It turns out that trans fats were worse for heart health than saturated fats.

“Diet is an incredibly complicated business,” Dr. Alderman said.

Whether you think this proposed sodium-reduction plan is the tastiest fruit of the genius tree, or consider it damnable nanny-state meddling, you can get at Dr. Thomas Frieden in an ongoing public Q & A on the Times website.