Nestlé Voluntarily Reducing Sodium in Processed Food, but Should the AHA Applaud?

The global food giant Nestlé announced this week they will reduce the amount of sodium in a number of their products, all with the goal of ensuring more of their drinks and processed food can be part of a diet containing less than 2,000 mg of sodium per day.

The move by Nestlé, a large transnational food and beverage company that produces everything from Kit-Kat and Butterfinger chocolate bars to Häagen-Dazs ice cream and frozen pizza, comes in advance of the voluntary sodium reductions expected from the US Food and Drug Administration (FDA).

Following the announcement, the American Heart Association (AHA) praised Nestlé for their sodium cutbacks. 

“The American Heart Association urges leaders across the food supply chain to commit to reducing sodium in their products to help people live healthier lives, free of cardiovascular diseases and stroke,” states an AHA press release. “Nestlé’s latest reduction commitment offers consumers healthier choices. Americans deserve the right to choose how much sodium they eat and not have it already determined for them in less-than-healthy levels in many prepackaged food and restaurant meals.”

In an interview with TCTMD, Yoni Freedhoff, MD (University of Ottawa, Canada), an expert in nutrition and obesity, said that rather than applaud companies for taking a stand on sodium levels in their food products, it would be better if organizations such as the AHA pushed for nonindustry players to set the agenda. While the goal of Nestlé is clear—to sell their products and protect that market share—he questioned whether the AHA and other organizations should be a “cheerleader” when a company makes changes to their product line.

“Maybe it is, maybe it’s not,” said Freedhoff. “I can’t help but imagine that the purpose of [Nestlé’s voluntarily reducing sodium] is ultimately direct sales or the protection of sales. That’s just a pragmatic way of thinking about the food industry, and I think a realistic one. Profits and health collide, and things happen. I’d be more enthusiastic if I thought there was a good pattern or precedent that actually revealed the food industry capable of being forward-thinking about this and following through with their regulatory promises, but that’s just not the case.”

Mark A. Creager, MD (Dartmouth-Hitchcock Medical Center, Lebanon, NH), the president of the AHA, said they have worked with many organizations—not just Nestlé—to achieve a moderate level of sodium in their food products. “Successful sodium reduction requires action and partnership at all levels—individuals, healthcare providers, professional organizations, public health agencies, governments, and industry,” he wrote in an email.

Nestlé is currently a member of the AHA’s Industry Nutrition Advisory Panel (INAP), a group of approximately 20 different companies, each paying a $10,000 annual membership fee. The program, in place since 1995, “provides a platform for open dialogue, sharing of information and planning cooperative programs in areas of mutual interest such as diet and nutrition and cardiovascular disease.” Its purpose is to keep the companies up to date about the AHA’s nutrition policies and programs while also keeping AHA informed on the “strategic needs, structure, and operations of the food industry.”

To TCTMD, Creager said Nestlé, its various brands, and its employees have given approximately $215,000 to the AHA in the past 5 years in the form of individual gifts, with most of the contributions through event sponsorships, or workplace giving/matching gifts programs. “These contributions in no way influence our scientific guidance, on any issue, which is rooted in the collective body of relevant scientific evidence,” said Creager.

Missing the Mark by a Longshot

The US Dietary Guidelines currently recommend that individuals consume no more than 2,300 mg of sodium daily while the AHA imposes even stricter targets, recommending no more than 1,500 mg per day to maintain heart health and low blood pressure. The World Health Organization (WHO) finds a middle ground, setting a daily maximum of 2,000 mg. Regardless of the target, most Americans overshoot the mark by a longshot. In the United States, average sodium consumption is 3,400 mg per day, according to the AHA.

The FDA is currently drafting voluntary recommendations for the food industry to lower sodium levels across their product lines. The exact recommendations have not yet been released by the agency, with the issue currently tied up by provisions in an agriculture bill approved in April by the US House Committee on Appropriations. The Grocery Manufacturers Association (GMA), a trade group that represents the food and beverage industry, and the Salt Institute are both against the voluntary sodium reductions, saying they prefer to wait until the Centers for Disease Control and Prevention and the Institute of Medicine release their recommendations on reducing industry sodium levels.

The move by Nestlé is unique as it breaks with the GMA (Nestlé USA is a member of the GMA). In April, Mars Inc, a company that makes the eponymous Mars bar, as well as a raft of processed foods, such as Uncle Ben’s rice, also urged the FDA to request voluntary sodium reductions across the food industry, with the company saying they will reduce the amount of sodium in their products by 20% by 2021. At the time, the AHA praised their move to get behind the coming FDA recommendations.  

To TCTMD, Freedhoff pointed out that voluntary efforts in regulating aspects of the food industry have historically failed, which makes him somewhat pessimistic this time will be any different. “Whenever I see a company being helpful, it’s more likely than not they’re being helpful because if they don’t, things will be worse off,” he said.

With a voluntary process, companies can forestall real regulatory action, one with strict follow-up to ensure compliance and significant penalties if the targets are unmet, he said. The bottom line is that if the AHA believes sodium reduction is an important public health goal, which it does, scientists and public health officials should decide what actions should be taken, and not the food industry, he said. 

The AHA said that any efforts to lower sodium—even voluntary ones initiated by the food companies—are “positive.” Creager noted that market demand will ultimately drive the reformulation of industry’s product line, pointing out that more and more consumers are asking companies to reduce the amount of sodium in their food. He said that when General Mills announced they had met sodium-reduction targets in seven different food categories, more than 1,400 individuals who had taken the AHA “sodium pledge” to reduce their intake wrote letters in support of the reduction.

In addition, Creager noted that sodium is just one part of the overall heart-healthy eating pattern recommended by the AHA. Healthy eating includes limiting not just sodium but saturated and trans fat, red meat, and sugar while increasing the amount of fruit, vegetables, whole grains, low-fat dairy, poultry, fish, and nuts.

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