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derived largely from processed and restaurant foods, and include many foods not commonly perceived as sources of sodium. Data also dispel the misconception that excess salt intake is due to salt added by the consumer at the table. Such use appears to account for only about 5 percent of sodium consumed. Evidence suggests that reductions in sodium intake may be achieved by reducing salt in food and allowing people to use a salt shaker. A study has shown that on average, participants added back less than 20 percent of the sodium removed from the food when allowed unlimited use of salt shakers.

A key factor in the limited success of efforts to reduce sodium intake is that salt—sodium chloride, the primary source of sodium in the diet—has desirable characteristics from a culinary perspective. Added salt improves the sensory properties of foods that humans consume and is inexpensive. Americans rely heavily on processed foods and menu items prepared outside the home, making such foods the predominant source of sodium intake in the United States. Clearly, efforts to reduce the sodium content of the food supply are needed to improve public health. However, food industry representatives indicate that they cannot sell or serve products that are less palatable than those of their higher-sodium competitors; food flavor is the major determinant of food choice and usually overrides other factors that influence food selection. What is lacking is a way to coordinate reduction of salt in foods across the board by all manufacturers and restaurant/foodservice operations—a level playing field. The key question is: How can a level playing field be achieved while avoiding consumer dissatisfaction?

Importantly, the preference for added salt in food is mutable. Sensory preferences for salt can be decreased. This preference, which is beyond known physiological need, may be due in part to evolutionary pressures to consume salt that have shaped an innate liking for its taste and due in part to learning, particularly early learning. Indeed, a high-salt diet may actually increase the liking of salty foods, and the U.S. food supply, with its high salt content, may work against consumers successfully changing their flavor preferences and impede their acceptance of lower-sodium foods. Existing experiences with decreasing the sensory preference for salt suggest it could be successfully accomplished through a stepwise process that systematically and gradually lowers salt levels across the food supply.

Thus, if strategies to reduce sodium intake in the United States are to be successful, they must embrace an approach that emphasizes the entire food system and emphasizes sodium intake as a national concern. This report recommends the use of regulatory tools in an innovative and unprecedented fashion to gradually reduce a widespread ingredient in foods through a well-researched, coordinated, deliberative, and monitored process. The current level of sodium added to the food supply—by food manufacturers, foodservice operators, and restaurants—is simply too high to be “safe” for



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