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The keynote address at the Consumer Federation of America’s annual food policy conference was given by the FDA’s new Deputy Commissioner for Human Foods, James “Jim” Jones.

He talked about his priorities and what he’s hoping the FDA will do.  Fine.

But in the Q and A, he was pushed repeatedly by Mike Jacobson (former head of CSPI) to say what the FDA would be doing to pressure the food industry to reduce salt in the food supply, something the FDA has promised to do for years with little progress.

In response, Jones said: “…I wouldn’t say pressure.  Pressure is not our statutory authority…isn’t to pressure….it is to help manage the food supply in a way that makes it healthier for Americans.”

Oh dear.

Pressuring the food industry most certainly is in the FDA’s authority.  I can think of lots of things the FDA has done that directly oppose food industry interests despite plenty of industry pushback: food labels in general and trans fat and sugar labeling in particular, restrictions on health claims, food safety regulations, and anything else the agency has done to force food companies to behave in the interest of public health.

Food companies will act in the public interest, only when they have to.  Jones’ statement, if that’s what he meant, is an alarming indication of agency capture.

The FDA is a regulatory agency and part of the Public Health Service.  It’s not supposed to win popularity contests.  It’s not supposed to be an arm of the food industry.

It’s supposed to take whatever tough steps are needed to keep the food supply safe and healthy so as to improve the overall health of Americans.

Yes, the FDA should be pressuring food companies about salt (and sugar, for that matter), and as strongly as possible.

Maybe I am misunderstanding what he said.  I hope so.

Here’s the video of the session.  Jacobson’s questions begin at 19:30.  Watch and decide for yourself.

My distant but dearly loved cousin, Michael Kravit, has scored again: “Not Healthy.”

According to the company’s website, these things are “Tasty purffs.  Five flavors.  No health claims…So unhealthy, I bought 15 bags for my family and friends…If you are worried about FFUPs being healthy, you’re on the wrong website.  Go eat some carrots! [Not a bad idea, this last one].

I managed to find the Nutrition Facts for one of them.  They have a lot of salt—320 mg per ounce.  The ingredient list:

Besides salty, how do these things taste?  If you can find some, please let me know.

While we are at it, my daughter sent this photo from the new It’s Sugar store on Market Street in San Francisco.

OK.  Let’s give these companies high marks for truth in advertising.  But do these represent the latest trend?

Caveat emptor.

Members of the Academy of Nutrition and Dietetics get SmartBriefs sent to their email addresses.

The subject line of this one: “A Surprising Sodium Reduction Tool for Your Clients”

It is an advertisement; it even says so.  But it does not say who paid for it.

To find that out, you have to click on the subscribe or resource links.

Bingo!  Ajnomoto, the maker of MSG.

All of this is to convince dietitians to push MSG as a salt substitute:

 Extensive research has affirmed not only the ingredient’s safety, but its benefits for sodium reduction. Even the National Academies of Sciences, Engineering and Medicine has recognized MSG as a tool to reduce sodium in the food supply.

Is this a good or bad idea?  MSG still has sodium and its health effects remain under debate.

This kind of sponsorship should be disclosed, front and center, in ads like this, especially because much of the research demonstrating benefits of MSG was funded by guess which company.

The Academy of Nutrition and Dietetics should not permit ads that lack full disclosure.

Members: Complain to the Academy that you want these ads to stop.

Thanks to Jackie Bertoldo for alerting me to this one.

What with all the pressure to make foods healthier, food manufacturers have been tweaking their products to reduce less healthful ingredients, especially salt and sugar.

Reformulated ultra-processed foods are still ultra-processed.

They raise the question: is a slightly healthier ultra-processed food a good choice?

These articles come from FoodNavigator-Asia.com, which tracks the food industry in that part of the world.

• Reformulating for the region: Coca-Cola, Nissin, Kirin and Hoow Foods weigh in on sugar, salt and fat reduction in APAC: Major brands across the region are continuing to double down on their reformulation efforts across sugar, salt and fat reduction after COVID-19 led to a rapid increase in consumer awareness and demand for healthier products. Read more
• Not so sweet situation: More than half of packaged beverages sold in Singapore contain high levels of sugar: Sixty per cent of packaged non-alcoholic beverages (NABs) sold on the Singapore market contain high amounts of sugar and would be assigned under Grade C or D in the soon-to-be-implemented Nutri-Grade system. Read more
• High pressure: Aussie retailers urged to prioritise sodium reformulation for private label products: Retailers in Australia should prioritise the sodium reformulation of private label products, which could help prevent over 500 deaths annually, according to a modelling study. Read more
• Encouraging reformulation: South Korea tightens food labelling standards for products with reduced sodium and sugar: South Korea has announced new, tighter standards for food firms looking to label their products as being reduced or lower in sodium or sugar, starting with the nation’s most-consumed food product, ramen. Read more

On October 13, the FDA finally got around to finalizing its guidance for the food industry for voluntary, short-term (2.5 year) sodium reduction targets for lots of processed, packaged and prepared foods.

In a statement, the FDA says its new guidance

provides voluntary, short-term sodium reduction targets for food manufacturers, restaurants, and food service operators for approximately 160 categories of processed, packaged and prepared foods. The targets seek to decrease average sodium intake from approximately 3,400 milligrams (mg) to 3,000 mg per day—about a 12% reduction—over the next 2.5 years.

Reducing sodium has been on the FDA agenda for years.  It issued draft guidance in 2016.  On this, it received about 200 comments.  

The FDA’s idea for this first target is to reduce average daily sodium intake by about 12%—from approximately 3,400 milligrams (mg) to 3,000 mg per day—in 2.5 years.

This is still higher than the recommended 2300 mg.  Why so limited?

Politics, of course.

The FDA believes

• These targets are feasible.
• Gradual reduction will accustom people to lower sodium intake.
• Food companies might be willing to do this.

A quick review of the basics:

• Salt is 40% sodium (2300 mg sodium means about 6 grams of salt or 1.5 teaspoons).
• High salt diets are strongly associated with high blood pressure and stroke.
• We require less than 500 mg sodium a day; average diets are greatly in excess.
• Most salt in the diet comes from pre-prepared foods (70%); 20% is added at the table; 10% is innate in foods.
• The taste for high-salt is acquired; the more salt you eat, the more salt it takes to make foods taste right.
• For people used to high-salt diets, low-salt makes food taste bland.  It takes about three weeks to get used to low-salt.
• Once accustomed to low-salt, typical levels of salt make food taste too salty.

Thus, the FDA’s strategy is to gradually accustom people to lower salt intake.

The guidance is voluntary: “This voluntary, iterative approach is similar to approaches successfully implemented in other countries.”

By other countries, the FDA must mean Great Britain.  The UK did a big voluntary salt reduction campaign some years ago and got enough buy in from food companies to see a real difference in salt intake and blood pressure.

When the government changed and laid off the pressure, companies put back most of the salt (not all though). That history is here.

So this could work if food companies cooperate.  Presumably, the FDA will assess the results of this voluntary effort in 2.5 years.

The stick?  The implied threat of mandatory reductions if the voluntary ones don’t work.

2.5 years is a long time to wait for voluntary compliance.

My view

• These should have been mandatory to begin with.
• The target levels should be lower.
• The time scale should be faster.

Other than that, the FDA’s plan could be a useful first step.  We shall see.

Statements

• From FDA officials
• The American Heart Association  
• Center for Science in the Public Interest

Documents

• The FDA constituent update on sodium is available here.
• An FDA web page, “Sodium Reduction,” is available here.
• The FDA guidance for industry is available here.
• Dietary Guidelines for Americans  fact sheet on sodium
• A paper in JAMA from FDA officials on reducing sodium in the US

That’s my question when I see what food companies are trying to do to reduce the content of sugar and salt in their ultra-processed junk food products.

To put it another way, does making an ultra-processed food or beverage slightly better for you convert it to a good choice?

We can argue about this, but companies really are trying hard, as this collection of articles from FoodNavigator.com indicates.

Special Edition: Nutrition and reformulation strategies

Most shoppers say they want to reduce consumption of products that are high in fat, salt and sugar. But many struggle to cut HFSS foods and beverages from their diets and reformulation efforts often face the headwind of perceived quality issues. Meanwhile, the fortified food market in Europe is expected to see a CAGR of 5.2% through to 2025. While reformulation efforts take out the ‘baddies’ is there also an opportunity to add positive nutrients through fortification?

• What reformulation really looks like in 2021: ‘Reformulated products need to be better nutritionally and equally tasty, if not tastier’: With calls to reformulate food and drink products to reduce fat, sugar and salt, we explore: What influences prompt brands to reformulate? What does the process really entail? And can it be done successfully during a global pandemic?.. Read
• ‘No added sugar’: Fibre and stevia predicted to ‘shake up’ sugar reduction:  Fibre and next-generation stevia are expected to play key roles in sugar reduction as a growing number of manufacturers seek out ‘no added sugar’ claims, according to Mintel… Read
• How UK brands are reformulating to avoid the HFSS ad ban:  UK food brands are currently digesting planned government legislation coming next year which will prevent marketing and advertising of HFSS being shown on TV (pre-9pm) and online from 2022 and limit where these products can be placed in bricks and mortar stores… Read
• What does the future hold for reformulation?  With the impending publication of part two of the National Food Strategy in the UK, IGD convened major retailers, manufacturers, food service companies and members of the National Food Strategy team to discuss reformulation, the challenges, and opportunities. Here Hannah Pearse, Head of Nutrition and Scientific Affairs at IGD, shares an overview of the conversations from a series of roundtable discussions… Read
• Kellogg cuts sugar and salt across Europe and UK: ‘The process is trial and error’:  The Kellogg Company has pledged to remove at least 10% of sugars and 20% of salt from its children’s cereals across European and UK brands… Read
• Does the UK’s proposed junk food ad ban reduce the motivation to reformulate?  The Food and Drink Federation says UK plans to restrict in-store promotions of foods high in fat, salt and sugar will deter companies from developing lower sugar and fat alternatives… Read
• Cereal Partners Worldwide talks breakfast renovation: ‘Innovation can be less, rather than more’:  The joint venture between Nestlé and General Mills is taking a ‘dual strategy’ approach to cereal renovation that is ‘both reductionist and increasing’, says Gharry Eccles, Vice President UK and Oceania of Cereal Partners Worldwide… Read
• Snack sector looks to lentils, beans and insects as ‘health by stealth’ hits limit:  As the snack sector reaches its technological limits in cutting salt and fat from products, European manufacturers are accelerating reformulating efforts using lentils, beans, other vegetables — and even insects — as a way of meeting consumer demand for healthier snacking options… Read

New York City is taking big steps to improve its food system.   Two reports are worth noting, one from the Mayor’s office and one from the Health Department.

I.  Mayor Bill de Blasio and Kate MacKenzie, Director of the Mayor’s Office of Food Policy (MOFP) have released Food Forward NYC: A 10-Year Food Policy Plan.

Here’s how they introduce this impressive report:

Food Forward NYC is the City’s first ever 10-year food policy plan, laying out an comprehensive policy framework to reach a more equitable, sustainable, and healthy food system by 2031.

Food Forward NYC emphasizes the importance of equity and choice – enabling a food system where everyone should be able to access the food they want wherever they may want it. To enable this choice, we need to support both our food workers and our food businesses. To strengthen the sustainability and resiliency of our food system, we need to rethink our food infrastructure and deepen our connections with the region.

Food Forward NYC is organized around five overarching goals:

1. All New Yorkers have multiple ways to access healthy, affordable, and culturally appropriate food.
2. New York City’s food economy drives economic opportunity and provides good jobs.
3. The supply chains that feed New York City are modern, efficient, and resilient.
4. New York City’s food is produced, distributed, and disposed of sustainably.
5. Support the systems and knowledge to implement the 10-year food policy plan.

The full report is here.  It was prepared in response to Local Law 40 of 2020 and recommendations from the New York City Council’s 2019 report, Growing Food Equity in New York City.  

New York City is a complicated place and it’s wonderful to have all this information put together in such a coherent way.  Let’s hope everyone gets behind this and puts the recommendations into action.

II.  The Bureau of Chronic Disease Prevention at the NYC Health Department has an update on its  National Salt and Sugar Reduction Initiative (NSSRI).

In October 2018, the Bureau announced draft sugar reduction targets.  Now they have updated them and added targets for salt reduction, as well.  As I was informed in an e-mail,

The NSSRI is a partnership of over 100 local city and state health departments, associations, and health organizations, convened by the NYC Department of Health. We have set voluntary sugar reduction targets for 15 categories of food and beverages. The targets represent a 10% reduction in sugar content of products by 2023, and a 20% reduction by 2026 for food with a 40% reduction for beverages.

The current public health landscape demonstrates that diet remains critical, even during a public health emergency like COVID-19. Diet-related health conditions such as diabetes and heart disease, which can increase the risk of severe illness from COVID-19, are important to address right now.

Here’s what one of the sugar reduction targets looks like:

The objective of NSSRI is this:

To promote gradual, achievable and meaningful reductions in sugar content in packaged foods and beverages. This is because intake of added sugars is associated with increased risk of excess weight, type 2 diabetes, hypertension, stroke, heart disease and cavities.

The targets are indeed gradual; the hope it that they will be met by 2026.

The targets are, of course, voluntary.  The best NSSRI can do is to encourage companies to comply and hold them accountable.

It’s a start.

Michael F.  Jacobson.  Salt Wars: The Battle Over the Biggest Killer in the American Diet.  MIT Press, 2020.

Michael Jacobson was one of the founders of the Center for Science in the Public Interest, which he directed for more than 40 years.

His book comes with an introduction by Tom Frieden, former head of New York City’s Health Department and Director of the CDC.

I wrote a blurb for it:

Public health authorities advise eating less salt as a way to prevent high blood pressure, but a few scientists disagree. For anyone confused by these arguments, Salt Wars is a must read.  Michael Jacobson has been fighting these wars for decades, and his assessment of the research on both sides—and the policy implications–is exceptionally fair, balanced, and fascinating.

Here are a few excerpts:

• One reason that the debate has been so vigorous is that most journalists treat new reports supporting the conventional view on salt with a yawn.  Dog bites man?  Big deal.  What does capture the attention of journalists and headline writers are the man-bites-dog reports—those suggesting that eating less salt would be harmful—especially when they are conducted by credentialed researchers at prominent universities and published in respected journals…The poor consumer, lacking an advanced degree in epidemiology or nutrition, can get dizzy trying to follow the arcane biomedical and statistical jousting (p. xvi).
• I was sorely disappointed that the FDA was not setting mandatory maximum sodium levels.  Such limits for all foods in a category…have at least three advantages over a voluntary approach.  First, they would have teeth and ensure that all companies actually trimmed sodium in their saltiest products.  Second, the FDA could easily enforce them.  And third, they would provide a level playing field…I have since been persuaded that the voluntary approach was inevitable (p. 139).
• The process to propose sodium reductions was frustratingly slow, but there was no villain or cabal that sought to undermine the FDA’s effort to lower sodium consumption.  Rather, it was a case of how the Washington policy-making apparatus works when it comes to anything that is complicated, controversial, and consequential…It took the administration so long to propose the guidelines that there was no time to finalize them and the matter has languished for four years  (p. 143).