The Food and Drug Administration’s drive toward salt substitutes, aimed at reducing dietary sodium, faces mounting skepticism from top health experts.
FDA’s Salt Swap Initiative
The FDA is currently revising the “standards of identity”—essentially the official blueprints that determine the ingredients and processes required for a product to bear a specific label, such as “bread” or “mayonnaise.” With these updates, the agency proposes that certain foods can now include “safe and suitable” low-sodium salt alternatives, marking a shift from the traditionally stricter guidelines.If the proposal moves forward, its impacts could reach every corner of our pantries. Everything from canned goods to the assortment of condiments, down to the very bread that we use for our sandwiches, might be affected by this guidance.
Replace Salt With What?
Salt substitutes, such as Nu-Salt or Morton Salt Substitute, primarily contain ingredients that mimic the familiar salty taste without sodium. While sodium chloride forms the essence of regular table salt, these substitutes typically employ potassium chloride. However, some might blend in other components, such as herbs, spices, or amino acids.The FDA’s draft doesn’t pinpoint specific allowable substitutes but simply labels them as “safe and appropriate,” hinting at alternatives beyond potassium chloride.
“Other ingredients listed in the scientific literature include herbs and spices, yeast extracts, monosodium glutamate, amino acids, and dairy extracts,” the brief reads.
Health Organizations Caution Against Salt Substitutes
In a collaborative letter dated Aug. 8, leading health organizations, including the American Association of Kidney Patients (AAKP), the Academy of Nutrition and Dietetics, and the National Kidney Foundation, raised significant concerns about the FDA’s recent proposition to use potassium-based salt substitutes in standardized foods.The concerns revolve around the potential health risks to the 37 million Americans who have been diagnosed with chronic kidney disease (CKD). Many CKD patients, they note, are unable to adequately process excess potassium, making them susceptible to hyperkalemia, a dangerous condition that can lead to severe cardiac complications and even sudden death.
While these organizations laud the FDA’s efforts to mitigate the high sodium consumption among Americans, they stress the need for a more cautious approach. The letter pointedly highlights that adding “hidden potassium” in foods, especially without clear labeling, could inadvertently imperil a significant portion of the population.
Potassium—crucial for muscle contraction, especially in the heart—must be carefully balanced. When this balance is disrupted, it can cause muscle malfunction, including in the heart. While kidneys manage about 80 percent of the potassium that we consume, other organs such as the adrenal glands and pancreas, as well as many medications, can also affect potassium levels.
Dr. Stephen Z. Fadem, chair of AAKP’s Medical Advisory Board and clinical professor of medicine at Baylor College of Medicine, cautions against unchecked potassium in food products. “If potassium is indiscriminately added to foods, it will result in many patients ingesting more than their body can handle. This is ill-advised and against the U.S. FDA’s mission of shepherding safe and effective care,” he told The Epoch Times.
The letter further warns that the dangers extend beyond those with kidney disease. “Other populations vulnerable to excessive potassium and associated health risks, because they too are unable to normally excrete it, include those with heart failure, diabetes, adrenal insufficiency, and those taking medications that impair potassium excretion.”
The letter strongly urges the FDA to pivot toward alternate strategies in light of these potential health ramifications. This could include developing flavor enhancers that aren’t potassium-based, intensifying public health education about safe sodium reduction, or enhancing food labeling. The collective plea underscores the need for both public safety and transparent communication in any forthcoming regulatory changes.
Paul Conway, AAKP’s chair of policy and global affairs, highlighted the significant impacts of kidney disease on patients and the economy.
“Kidney disease is a health care and workforce issue because of the amount of disability it can create. Beyond the personal toll on patients and their families, it’s a financial strain, costing America $130 billion a year for kidney care. This figure doesn’t even account for the repercussions of disability, job loss, and unemployment due to the disease,” he told The Epoch Times.
Mr. Conway also took issue with the FDA’s approach to formulating its proposal, noting that crucial organizations, such as his own, were sidelined from the outset, leading to a policy with unintended consequences.
“We should have been at the forefront of this policy. If you release regulations for public comment and are met with surprise feedback, you’ve gone about it wrong. We don’t always weigh in on such matters. When we do, our voice carries significant weight due to the severity of the disease we address and its associated mortality rates,” he said.
The Great Salt Debate
Salt—essential for our bodily functions—has long been a topic of debate among health experts.Despite significant investments in research, definitive evidence remains hard to come by. The central question revolves around whether prolonged high salt intake, culminating in hypertension, ultimately escalates to graver health complications.
James DiNicolantonio, a cardiovascular research scientist and author of “The Salt Fix,” offers a critical perspective on this issue.
“It’s more than likely that replacing nature’s oldest food preservative and essential mineral with a salt substitute will lead to more harm than good and unintended consequences, such as kids no longer eating their bitter vegetables, eggs or meat because there’s no salt (flavor) to go with it and now consuming more refined carbohydrates and refined sugars,” he said.
“Additionally, when it comes to storing food, low salt versions dramatically increase food spoilage (they don’t last as long) and food borne illness.”
Mr. DiNicolantonio further adds to the salt debate, saying, “There is no proof that lowering sodium intake will lead to definitive improvements in high blood pressure, target organ function, strokes, heart attacks, etc. Salt is an essential mineral and the body can’t make it.”
A Medical Perspective: Health Professional Weigh In
The call to cut sodium has sparked a spectrum of medical opinions. While many in the health care realm view this as an important step toward bolstering public health, the lurking hazards of high salt consumption remain ever-present.“Lowering salt intake carries significant public health advantages, especially in reducing average blood pressure,” Dr. Richard J. Solomon, medical director of nephrology at the University of Vermont Medical Center, told The Epoch Times.
He underscores the urgent need for precise product labeling and robust public education. Dr. Solomon believes that labels should indicate if foods contain potassium chloride—an essential warning for those with kidney issues. He advises the public to “consult with a physician” before reaching for products laden with salt substitutes.
Nephrology specialist and dietician Desiree De Waal emphasizes the importance of clear labeling, akin to “added sugars.” However, she highlights pitfalls in potassium labeling. Labeling such as “good source of potassium” aids those with kidney ailments, but poses risks for the unaware.
“Those uninformed of their kidney disease risk hyperkalemia, which can lead to cardiac arrest. I’ve seen many patients misled by this, with dangerously high potassium levels resulting in hospitalizations,” Ms. De Waal told The Epoch Times.
She expressed concerns about the long-term risks of food additives, especially harmful preservatives such as phosphorus additives. “We need to focus on herbs and spices. Our salt-centric society has lost the authentic taste of food,” Ms. De Waal said.
Amid ongoing debates about salt substitutes, Dr. Fadem suggests a return to the basics.
“People who eat more fresh foods will not only be healthier but will not have to rely on salt substitutes for flavor,” he said.
This viewpoint underscores the idea that a return to natural, unprocessed foods may hold the key to navigating the contemporary salt dilemma, as well as the many health concerns tied to diets high in processed and ultra-processed foods.
According to Mr. DiNicolantonio: “The FDA needs to go after actual harmful substances like refined seed oils, refined sugars and processed junk food. Leave salt where it should be, on the kitchen table.”