David Cohen, M.D.·Published 17 April 2012·9 min read
Key points
Fast food may often be high in salt, but the exact levels seem to vary based on the country you live in, according to a study published Monday.
Of course, any foods to which you add table salt (sodium chloride) will be high in salt.
But Campbell said the study is not an attack on the fast-food industry.
A recent research review of 167 studies found that while salt reduction helped lower people's blood pressure, it may also boost levels of certain hormones and blood fats that could be harmful to the heart.
Fast food may often be high in salt, but the exact levels seem to vary based on the country you live in, according to a study published Monday.
Looking at fast-food menu information in six countries, researchers found that the same item sometimes had different salt levels in different countries.
In general, certain foods had less salt in the UK than in the U.S. or Canada - like McDonald's chicken nuggets and some chain-restaurant pizzas.
One serving of Chicken McNuggets, for example, came with 1.5 grams of salt (or 600 milligrams of sodium) in the U.S. and 1.7 grams of salt (680 mg of sodium) in Canada. That compared with just 0.6 grams of salt (240 mg of sodium) in the UK.
The chicken nuggets served up in Australia, France and New Zealand had salt levels that fell somewhere in between.
Salt was pervasive regardless of location, however. Overall, fast-food burgers served up an average of 1.3 grams of salt (or 520 grams of sodium) across all countries, with only small national differences.
According to the World Health Organization (WHO), people should get less than 2,000 mg of sodium over a whole day.
It's not clear why salt content in some fast-food items varied by country, said Dr. Norman Campbell of the University of Calgary in Canada, who worked on the study. He and a few of his co-authors are members of the World Action on Salt and Health, which according to its website "works to encourage multi-national food companies to reduce salt in their products and with Governments in different countries highlighting the need for a population wide salt reduction strategy."
Foods High in Salt
Of course, any foods to which you add table salt (sodium chloride) will be high in salt.
In addition, foods that are usually high in sodium (more than 400mg per serving) include:
- Onion soup - Foods made with seasoned bread crumbs - Sauerkraut - Spaghetti sauce (ready to serve) - Potato salad - Cheese sauce - Baked beans with franks - Macaroni and cheese - Pizza slice - Cheeseburgers, hamburgers, hot dogs, tacos, and many other fast foods - Beef stew (from a can) - Cottage cheese - Minestrone soup - Submarine sandwiches - Tunafish salad - Pretzels, potato chips, and other snacks
Written and revised by
David Cohen, M.D.
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health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
This is just a partial list, but reviewing it and then getting in the habit of reading food labels can help you spot other foods high in salt. As you can now see, high-salt items are typically many canned foods (especially soups), cold cuts, snack foods, and fast food.
One factor in the country differences could be UK government efforts, the researchers write in the Canadian Medical Association Journal. The UK has set voluntary salt-reduction "targets" for the packaged food industry.
The targets do not yet extend to fast food. But some fast-food companies were part of the "roundtable discussion" that helped set the goals, noted Elizabeth Dunford, a researcher at the George Institute for Global Health in Australia who led the study.
The bottom line, the researchers say in their report, is that salt reduction does appear feasible for fast food. The food industry has argued in the past that salt reduction is difficult because it requires new processes and technologies.
And a McDonald's spokesperson pointed out that the study used data from 2010.
"We have already reduced sodium by 10 percent in the majority of our national chicken menu offerings in the U.S. - most recently Chicken McNuggets - a Happy Meal favorite," the spokesperson said. "Sodium reductions will continue across the menu and by 2015, we will reduce sodium an average of 15 percent across our national menu of food choices."
"Some fast foods are very low in salt, so it is technologically possible for all foods to have a low salt content," said Dr. Norm Campbell, a co-a-author and professor of medicine, community health sciences and physiology and pharmacology at the University of Calgary in Alberta, Canada. Several of the other researchers work with the World Action on Salt and Health, an international group whose goal is to gradually reduce salt intake around the world.
The 2010 U.S. Dietary Guidelines recommend that most adults consume no more than about a teaspoon of sodium daily, and studies have found that reducing sodium in the diet can lower blood pressure and the risk of heart disease. Other research, however, has called those findings into question, suggesting that lowering salt intake can actually have the opposite effect on the risk for heart disease.
Despite the controversy surrounding salt, Campbell and his co-authors argued that global salt consumption is much too high, and that the best strategy for reducing the public's salt intake is for governments to intervene and regulate salt content. Other attempts to lower salt consumption have been unsuccessful. "Federal governments have a mandate for the safety of our food supply," he said.
SODIUM HIGH IN ALL FOODS
But Campbell said the study is not an attack on the fast-food industry.
Country-to-country variations are seen in packaged food, too. And heavy salt use is not unique to fast food, Campbell noted.
"Yes, salt in fast food is very high," he said. "But if you went to an expensive restaurant, the sodium levels would be very high. If you buy packaged foods, the levels would often be very high."
In the U.S., it's estimated that almost 80 percent of people's sodium intake comes not from their saltshakers, but from the salt that foodmakers add to their products.
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Campbell argued that it's up to governments to rein in sodium levels in the food supply.
Companies, he said, answer to shareholders, and they are out to make the most profitable products. "The big issue here is not the companies. The big issue is the governments."
A "structured, voluntary approach" - where the government works with industry to set lower salt targets - is probably the most feasible, Campbell said.
That's the approach that's been taken in the UK. In the U.S., New York City has led the way, coordinating the National Salt Reduction Initiative.
The NSRI is a coalition of local and state governments and health groups working with industry to cut sodium in packaged foods and restaurants. More than two dozen food companies, including Heinz, Kraft Foods and Starbucks, have signed on to meet certain salt-reduction targets.
"The (NSRI) has set targets for restaurant foods and we hope that other countries will follow a similar path," Dunford said in an email.
The public, Dr. David Katz, director of the Yale University Prevention Research Center, said in an email, "needs to know that they don't just 'prefer' higher salt levels; they only prefer higher salt levels because they are used to them."
Despite the debate about the best method for reducing salt intake on a broad scale, all the experts suggest gradual changes. Diekman advocates teaching people to gradually decrease their salt intake so their palates can adjust to the change. Campbell believes companies should also progressively decrease salt content over several years so people may not notice the changes.
"Everyone can gradually get used to lower salt levels, come to prefer lower salt levels, and wind up with a far greater opportunity of loving foods - that love them back," Katz said.
The Salt Institute, a North American non-profit trade organization, responded to the study by saying that taste preferences in different countries dictate how foods are made, meaning that salt, sugar and other ingredients will naturally vary.
Lowering salt content also "holds great risks for the public," argued Morton Satin, the Salt Institute's vice president of science and research. "The preponderance of peer-reviewed medical studies recently published, have cautioned against population-wide salt reduction, including the latest one demonstrating that anyone who follows the 2010 Dietary Guidelines for sodium will end up with a highly unbalanced and nutritionally inadequate diet."
The National Restaurant Association said in a statement that restaurants are attempting to reduce sodium content in their foods.
Exactly what such efforts will do for public health is not clear yet.
Cutting down on salt is known to help lower blood pressure. And many experts believe that wide-scale cutbacks on salt in the food supply will lower rates of heart disease and stroke. The WHO lists salt reduction as one of its top 10 "best buys" for lowering rates of chronic disease.
IS LOWERING SALT ALWAYS GOOD?
Not everyone is convinced, though. A recent research review of 167 studies found that while salt reduction helped lower people's blood pressure, it may also boost levels of certain hormones and blood fats that could be harmful to the heart.
None of the studies had long-term information on whether salt reduction actually prevented, or contributed to, heart attacks or strokes.
The review was published by the Cochrane Collaboration, an independent, international organization that evaluates medical research.
But Campbell pointed to some other figures.
A 2010 study in the New England Journal of Medicine estimated that if Americans cut 3 grams of salt out of their daily diets - or 1,200 mg of sodium - it would save up to 92,000 lives each year. The typical U.S. man downs more than 10 grams of salt per day, while women average about 7 grams.
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According to Dunford, the message for individuals is to eat fewer high-sodium foods - not only fast food, but the many processed foods that harbor added salt, from breads and cereals, to processed meats, to soups and sauces.
But both Campbell and Dunford said that consumers should not bear all the responsibility.
"We've been badgering people about salt for years, and it's not working," Campbell said. "They are out there in a sea of fast food and processed foods."
"We really need to tackle this at a societal level."
The variability of reported salt levels in fast foods across six countries: opportunities for salt reduction
Results: We saw substantial variation in the mean salt content for different categories of products. For example, the salads we included in our survey contained 0.5 g of salt per 100 g, whereas the chicken products we included contained 1.6 g. We also saw variability between countries: chicken products from the UK contained 1.1 g of salt per 100 g, whereas chicken products from the US contained 1.8 g. Furthermore, the mean salt content of food categories varied between companies and between the same products in different countries (e.g., McDonald's Chicken McNuggets contain 0.6 g of salt per 100 g in the UK, but 1.6 g of salt per 100 g in the US).
Interpretation: The salt content of fast foods varies substantially, not only by type of food, but by company and country in which the food is produced. Although the reasons for this variation are not clear, the marked differences in salt content of very similar products suggest that technical reasons are not a primary explanation. In the right regulatory environment, it is likely that fast food companies could substantially reduce the salt in their products, translating to large gains for population health.
Elizabeth Dunford, Jacqueline Webster, Mark Woodward, Sebastien Czernichow, Wen Lun Yuan, Katharine Jenner, Cliona Ni Mhurchu, Michael Jacobson, Norm Campbell, Bruce Neal
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