How a New FDA Proposal Will Make Foods More Expensive and Make You Sicker

Billy D Manus II - 8/21/2023

Patient activists have raised concerns about a proposal put out by the FDA that would grant permission for the utilization of salt substitutes, as reported in a published by Stat News. The proponents argue that the adoption of this proposal might promote the widespread use of these alternatives, perhaps leading to substantial consequences for those suffering from renal disease, particularly within the Black American population.

The aforementioned plan was begun by the Food and Drug Administration (FDA) in April 2023 and is presently in the nascent phases of its development. The proposed measure seeks to permit the inclusion of salt substitutes in food products that adhere to defined criteria for identification. The identification criteria encompass legislation mandating the mandatory inclusion of specific components in commonly consumed food products, such as sauces, cheeses, and breads.

In accordance with prevailing legislation, food makers are subject to limitations regarding the inclusion of salt replacements in their goods due to the explicit requirement to utilize table salt.

According to the Dietary Guidelines for Americans, individuals are recommended to restrict their daily sodium consumption to a maximum of 2,300 mg, which is approximately equivalent to the quantity of sodium found in one teaspoon of table salt.

According to the criteria outlined by the National Institutes of Health, it is advised that males maintain a mean daily potassium consumption of 3,600mg, whereas females should strive for an average daily intake of 2,600mg.

Potassium chloride, alternatively referred to as potassium salt, has gained prominence as a widely used substitute for salt. Originally utilized as a fertilizer in the year 1861, the medical uses of this substance began to receive significant attention during the 1950s. In the realm of medicine, this substance is utilized for the management and prevention of hypokalemia, a medical illness characterized by decreased levels of potassium in the blood. This condition can arise due to various circumstances, including vomiting, diarrhea, and the use of specific medications. Potassium chloride demonstrates deadly characteristics when present in high amounts.

Potassium is classified as one of the seven indispensable macrominerals. Adequate hydration is vital for maintaining fluid balance throughout the body and for optimal functioning of essential organs such as the kidneys, heart, muscles, and nervous system.

A range of commercially accessible salt substitutes enriched in potassium are already available, but at a higher cost relative to regular salt alternatives. The price of a three-ounce container of Nu-Salt (potassium-chloride) at Walmart is $5.75, while a larger twenty-six ounce container is $49.83. In comparison, a twenty-six ounce container of table salt is priced at $0.64.

Kidney advocacy organizations have expressed apprehension regarding the potential consequences of the newly proposed regulation, highlighting the possibility of avoidable mortality due to the heightened utilization of potassium chloride, a commonly employed alternative to salt. Individuals who have received a diagnosis of acute kidney failure or chronic kidney disease, particularly those in the advanced stage referred to as end-stage renal disease, encounter challenges in the elimination of potassium. Consequently, this results in elevated levels of potassium in the bloodstream, a medical condition commonly referred to as hyperkalemia. The occurrence of this electrolyte imbalance possesses the ability to induce cardiac arrhythmias and initiate abrupt cardiac collapse.

There exists the possibility that an erroneous interpretation of medical tests could result in a false positive diagnosis of hyperkalemia. In such cases, the actual underlying condition may be an alternative ailment, such as Type 1 diabetes, excessive intake of potassium through supplements, erythrocyte loss due to burns or severe trauma, dehydration, Aginotensin, or Addison's disease.

The collective statement sent to the FDA by the American Association of Kidney Patients, the Academy of Nutrition and Dietetics, and the National Kidney Foundation highlights their shared concerns on the potential consequences of the plan. The plan's probable disparate impact on African Americans, Hispanics, and Asian Americans, who have historically exhibited elevated rates of renal illness, was explicitly underlined.

Sources:

Patient advocates sound warning on FDA proposal on salt intake - STAT. https://www.statnews.com/2023/08/15/patient-advocates-warn-fda-proposal-on-salt-intake-kidney-disease/.

Epocrates Web. https://www.epocrates.com/online

Medical News Today. https://www.medicalnewstoday.com/articles/potassium-chloride

Sodium in your diet, FDA. https://www.fda.gov/food/nutrition-education-resources-materials/sodium-your-diet

High Potassium, Mayo Clinic. https://www.mayoclinic.org/symptoms/hyperkalemia/basics/causes/sym-20050776

Race/ethinicity – Kidney Disease Risk Factors – American Kidney Fund. https://www.kidneyfund.org/all-about-kidneys/risk-factors/raceethnicity-kidney-disease-risk-factors

Potassium-Enriched Salt Substitutes as a Means to Lower Blood Pressure Benefits and Risks, Raquel C. Greer, Matti Marklund, Cheryl A.M. Anderson, Laura K. Cobb, Arlene T. Dalcin, Megan Henry and Lawrence J. Appel, Originally published16 Dec 2019https://doi.org/10.1161/HYPERTENSIONAHA.119.13241Hypertension. 2020;75:266–274