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The Forgotten Killer

... and FDA’s Failure to Protect the Public’s Health

Center for Science in the Public Interest

The Forgotten Killer
Michael F. Jacobson, Ph.D.

Center for Science in the Public Interest Washington, D.C.

The author is pleased to acknowledge Mari Cohen, who did the initial excellent research for this report, and Dr. Stephen Havas of the Universityof Maryland School of Medicine, who provided wise counsel and thoughtful reviews of drafts, for their crucial assistance. Drs. Feng Jun He, Jiang He, Norman Kaplan, Graham MacGregor, Richard Mattes, and Myron Weinburger also provided advice or reviewed portions of the manuscript. CSPI staff members Ben Cohen, Bonnie Liebman, Steve Gardner, Bruce Silverglade and Margo Wootan commented on all orparts of this report and served as a collective institutional memory; some of them were involved in February 2005 in filing a lawsuit against the Food and Drug Administration for failure to regulate salt adequately. My assistant, Jessica Emami, helped research and proofread the report.

Copyright © 2005 by Center for Science in the Public Interest Second Edition, First Printing: January 2005Update: July 2009 Printing: 10 9 8 7 6 5 4 3 2 1 The Center for Science in the Public Interest (CSPI), founded in 1971, is a non-profit healthadvocacy organization. CSPI conducts innovative research and advocacy programs in the area of nutrition, food safety, and alcoholic beverages and provides consumers with current information about their own health and well-being. CSPI is supported by the 900,000subscribers in the United States and Canada to its Nutrition Action Healthletter and by foundation grants.

Center for Science in the Public Interest 1875 Connecticut Ave. NW #300 · Washington, DC 20009 Tel: (202) 332-9110 · Fax: (202) 265-4954 E-mail: · Internet:

Salt: The Forgotten Killer 2009 Update


alt reduction has been very much in the news sinceSalt: The Forgotten Killer was first published in 2005. There have been both scientific and policy developments.

Two important studies provided the strongest evidence ever that lowering sodium intake not only lowered blood pressure, but also prevented cardiovascular disease. • In a study of 1,981 elderly Taiwanese military veterans living in a retirement home, researchers replaced regular saltwith potassium-enriched salt, thereby boosting the men’s potassium intake while lowering their sodium intake. 1 After almost three years of follow-up, those men who reduced their sodium and increased their potassium intake enjoyed a 41-percent reduction in cardiovascular disease deaths compared to men who continued using regular salt. Another important study was a long-term (10 to 15 years)follow-up of prehypertensive subjects in the Trials of Hypertension Prevention (TOHP). Lower sodium intake led to a 30 percent reduction in cardiovascular events. 2 There was also a reduction of 20 percent in cardiovascular disease deaths, though that reduction did not reach statistical significance.

Those studies should satisfy critics who had long charged that no studies showed a direct effectof lower sodium intake on cardiovascular disease risk. While most of the concern regarding sodium has focused on adults, a 2008 British study found a correlation between sodium and blood pressure in children and teenagers. 3 For each 400 milligram (mg) increase in sodium, systolic blood pressure increased 0.4 mm Hg and diastolic by 0.6 mm Hg. The same researchers wondered if a high salt intakewould encourage children to consume more fluids, including in the form of soft drinks. Soft drinks are of concern because they promote weight gain. The researchers found that fluid and soft-drink intake, indeed, was directly correlated with sodium intake. 4 They estimated that if British children consumed half as much salt (mean decrease of 3 grams per day), they would consume an average of about...
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