5 The Mouse That Roared: The Salt Institute

Salt is the flavor of life and this year we should all recognize its many benefits. . . . [Without salt] people will eat fewer vegetables, and by eating fewer vegetables, they will be less healthy.

—Lori Roman, Salt Institute president, quoted in USA Today1

If ever there was an entity worthy of the moniker “Big Salt”—an outspoken organization defending the reputation of salt and denying that typical consumption of salt causes death and disease—it was the Salt Institute. Don’t be fooled by the scholarly sounding word “institute”—the outfit was really the salt industry’s PR and lobbying arm. It was a nonprofit, but not a charity. The Internal Revenue Service categorizes it as a 501(c)(6) organization, one that aims to promote business interests.

Sounding as extreme as the most rabid conspiracy theorists, the Salt Institute took on the task of “promoting salt as a brand and educating the public on salt’s positive health and environmental impacts.”2 It variously bragged: “No single ingredient does more positive things for food than salt.”3 In fact, salt is “the essence of life,”4 “essential for life, health,”5 and “the flavor of life.”6 And, it contended in large boldface print, “LOW-salt diets may HARM you,”7 claiming as fact “that a low salt diet is significantly more harmful than a high salt diet.”8 I am glad to report that the organization did something in March 2019 that was wholly uncharacteristic of a trade association: it went out of business.

More than two decades ago seven prominent hypertension experts, including Paul K. Whelton at Tulane University School of Public Health and Tropical Medicine and Myron H. Weinberger at Indiana University School of Medicine, angrily charged that “basically, the Salt Institute, similar to the Tobacco Institute, is a group that attempts to manipulate scientific findings for its own commercial benefit, in this instance, to create doubt and confusion among Americans regarding the dangers of high sodium intake.”9

Big Salt’s members included Morton, Cargill, and other major salt manufacturers from around the world. (Ironically, some of the association’s major members, such as Morton and Cargill, actually market reduced-sodium salts, but they represent a trivial fraction of the companies’ overall sales.) But “big” it was not. The organization’s budget was only around $2 million to $3 million a year, half the cost of one 30-second Super Bowl commercial, and it had only four or five staff members.10 It was more like the “mouse that roared.”

Still, when salt came under attack, you could count on the group to issue—and journalists to quote—a pithy, often sassy, statement proclaiming that salt is either innocuous or positively healthful. And the Salt Institute could magnify its impact by calling on members such as Cargill (the nation’s largest privately held corporation with annual sales—from products such as sugar, refined oils, cotton, Diamond Crystal salt, and chocolate—of more than $100 billion) and friends throughout the food industry to defend salt.

Full disclosure: There was no love lost between the Salt Institute and my organization. The lobbying group once charged, for instance, “For years the Center for Science in the Public Interest has been using trumped up hysteria to try to get the federal government to control every recipe for almost every food manufactured in the United States.”11 And it accused me of being one of the leaders of the “anti-salt movement” (an accusation to which I proudly plead guilty).12

In 2010 I appeared on Comedy Central’s The Colbert Report with Lori Roman, the head of the Salt Institute.13 As Stephen Colbert prepared to introduce her, he explained how to distinguish between the Salt Institute and the Salk Institute, the research institute founded by Jonas Salk: the “Salk Institute cures polio; Salt Institute cures ham,” he joked. But Roman didn’t appreciate Colbert’s humor, or his role as devil’s advocate, when he gave me a chance to state some facts about salt and health. In response, she defended her organization’s members’ bread and butter by saying, “some of these facts have no basis in fact.”

Roman was the president of the Salt Institute from 2009 until 2019. Prior to that, between 2006 and 2008, she was the executive director of the American Legislative Exchange Council (ALEC), a group that campaigns for hard-right policies at the state level. Its members include conservative state legislators and corporate representatives. ALEC is an excellent training ground for someone who would be expected to challenge federal and local actions concerning salt. (Given that right-leaning position, it’s not surprising to learn that in 2019 Roman became the president of the conservative American Civil Rights Union.)

Notwithstanding the organization’s paramount goal of defending salt and salt manufacturers, the Salt Institute found room in its budget to support right-wing organizations.14 It gave $2,500 to the Education Action Group, which advocates for government aid to private and religious schools,15 and $15,000 to the Independent Women’s Forum (IWF). That group’s Board of Directors Emeritae, reflecting its political stance, includes Trump White House officials Kellyanne Conway and Larry Kudlow. In 2014, the IWF was railing against reducing sodium in school lunches16 and the expansion of the federally funded school-lunch program, while it also advocated for informing consumers about the benefits of meat and dairy products.17

The Salt Institute made much bigger investments, however, in two officials it paid handsomely to focus like a laser on protecting salt’s reputation and sales. Roman’s salary and other compensation amounted to $449,000 in 2018.18 That was one-seventh of the organization’s total annual budget of about $3.3 million. Wilfred Nixon, the vice-president for science and environment, received $263,000.

The Salt Industry Defends Its Product

I was long puzzled by the Salt Institute’s seeming preoccupation with defending salt in processed foods. After all, only 3 percent of the salt used in the United States finds its way into food.19 Almost half is used on roads and more than one-third by the chemical industry. But, as one industry insider told me, it was to be expected that the industry would defend every single use of salt—every company and every industry defends all of its products. Three percent of salt sales is still almost four billion pounds, and food-grade salt may be much more profitable per pound than less-purified industrial salt. Still, Richard Hanneman, who preceded Lori Roman as the Salt Institute’s president, told me that he spent most of his time on road salt and highway safety.20

But on food salt, Hanneman emphasizes that his organization concentrated on the science. He felt that neither side of the salt debate had conclusive evidence to support its position so that any “major change in diet was unjustified.” He believes that sodium intakes are genetically determined and that no matter how hard the government tried it would not be able to reduce those intakes significantly. And dangers were lurking in lower-sodium diets—people would eat more food to obtain the sodium they needed, and that would lead to obesity.

The Salt Institute, the self-proclaimed “world’s foremost authority on salt,”21 found myriad ways to portray salt as being nutritionally just this side of spinach. It produced a variety of videos, pamphlets, and website content aimed at undermining public health recommendations to cut salt intake (and maintain industry sales and profits). It enticed the news media to quote its defense of salt at every opportunity. More than 30 years ago, for example, it told Time magazine: “It’s easy to say cut back, but food just doesn’t taste good without it. If we eliminate salt, we’ll just see a lot more processed food being scraped into the garbage can.”22 Of course, no one advocates eliminating salt completely. A little bit is perfectly fine, and many manufacturers have reduced sodium substantially without sacrificing taste (see chapter 9).

In 2017, it sponsored a booklet called Salt for Dummies. Don’t try to track it down, though. The publisher of the Dummies series, John Wiley & Sons, began in 2015 to market the brand to potential corporate clients so they could create “custom content [that] speaks directly to your customers.”23 So the booklet might have looked like a bona fide Dummies book, but it was really part of the lobby group’s propaganda armamentarium.

The Salt Institute attacked the federal Centers for Disease Control and Prevention (CDC), one of the world’s premier disease-fighting agencies, saying that “the CDC is wasting all your money” by discouraging people from eating salty foods instead of fighting infectious diseases. “Only a rabbit can eat a salad without salt.”24 Sometimes it was hard to take the group seriously, but it was deadly serious in opposing salt reductions.

The institute’s rationale for doing nothing shifted as the science changed. In the 1980s, the group opposed lowering sodium in the general food supply, because only people who were salt-sensitive should worry about it.25 As is now recognized, most people do not fall neatly into a “salt-sensitive” or “salt-insensitive” category, and, in any case, testing everyone periodically to see who was salt-sensitive would be astronomically expensive and totally impractical. Later the Salt Institute’s argument shifted to the need for more research to prove that lowering sodium intakes would prevent, not promote, heart attacks and strokes.

More influential than the Salt Institute’s sophomoric attacks on health advocates, the lobbying group, well, lobbied. (See also chapters 8 and 9.) For instance, a 16-page 2016 letter to the Secretaries of Agriculture and Health and Human Services charged that the sodium recommendations in the “Dietary Guidelines for Americans” for 2010 and 2015 to 2020 were “fatally flawed” and “systematically flawed” and should be withdrawn.26 (Perhaps reflecting a keyboard with a stutter, “flawed” was used in that letter 14 times.) In 2018, the Salt Institute was already opposing any recommendation in the “Dietary Guidelines for Americans 2020–2025” to limit sodium when it said:

Contrary to the government’s current recommendations of a maximum of 2,300 mg/day of sodium, evidence indicates people on low sodium diets may place themselves at risk. Peer-reviewed research has shown that low-salt diets can lead to insulin resistance, congestive heart failure, cardiovascular events, iodine deficiency, loss of cognition, low birth weights, and higher rates of death.27

And should any local government dare to adopt sodium-reduction measures, the Salt Institute came down hard on it. In 2015, New York City became the first government to take regulatory action on salt. The city had the audacity to require menu warnings next to items at chain restaurants that contained more than a whole day’s worth of sodium. The Salt Institute called that effort “misguided,” “wrong,” “could be harmful,” “based on outdated, incorrect sodium guidelines,” and “unnecessary.”28 The Salt Institute supported the restaurant industry’s legal challenge to the law, but that gambit failed.29 Fortunately, the city listened to experts at the American Heart Association and elsewhere and ignored the industry’s pleas.

The Salt Institute sometimes bolstered its limited political muscle by hiring major Washington lobbying firms. For instance, it paid Patton Boggs a total of $220,000 in 2010 and 2011 and APCO at least $20,000 for lobbying to weaken or eliminate what the “Dietary Guidelines for Americans” said about salt (that effort failed).30 A decade earlier, the trade group apparently had better luck—it applauded the US Department of Health and Human Services for eliminating a specific sodium-reduction goal from its “Healthy People 2000” report.31

In September 1996, the Salt Institute petitioned the FDA to repeal a regulation that allowed companies to state on their labels that low-sodium foods, in the context of an overall low-sodium diet, could reduce the risk of high blood pressure. “Our purpose in doing this is to remove what has been an unfair discouragement for the general public to reduce dietary sodium in hopes that it would reduce their hypertension or their risk of hypertension,” said Hanneman.32 Three months later the institute withdrew its petition—before the FDA could reject it.33

In August 2006, Hanneman—along with two academic consultants, Michael H. Alderman of the Albert Einstein College of Medicine and Suzanne Oparil, a professor at the University of Alabama, Birmingham—met with John O. Agwunobi, the assistant secretary for health at the Department of Health and Human Services. The meeting came shortly after the FDA announced that it planned to hold a public workshop on the health risks of a salty diet. Hanneman urged the government also to review the health risks that might be caused by reducing salt intake.34

To obtain advice, gain spokespersons, and bolster its credibility, the Salt Institute relied on its Health Council, a group composed of well-known professors. Over the years members of the council included some of the staunchest defenders of salty diets: McCarron, Oparil, Alderman, John Laragh (New York–Presbyterian Hospital, Weill Cornell Medical College, New York City), Alexander Logan (Mt. Sinai Hospital, Toronto), and Judith Stern (University of California, Davis, nutritionist).

Academic scientists on industry committees typically claim to be independent and unbeholden to industry, but members of the Health Council certainly sang from the “Defending Salt” hymnal. At least two of those scientists have failed to disclose on multiple occasions their affiliation with the Salt Institute (see chapter 6).

The Salt Institute paid council members honoraria of up to $3,000 a year, though some did not receive any money, and encouraged them to get “out of the closet” and speak out more boldly and publicly about their views on sodium consumption.35 Two former institute officials I spoke to could not recall how much, if anything, they paid to the professors.

The lobbying group long maintained that a randomized controlled trial (RCT) was needed to end the salt wars. We saw in chapter 3 how conducting such trials could provide useful information, but they are widely seen as being unnecessary, probably prohibitively expensive, and, hence, unlikely ever to be funded. But advocating for more research sounds so sincere and neutral that it can distract from the fact that just calling for the research could block federal education campaigns or regulatory measures indefinitely.

In 2018, researchers published an article in Hypertension, a top peer-reviewed journal published by the American Heart Association. The article, which I discussed in chapter 3, called for the RCT on prisoners.36 At the end of the article, the authors declared “none” for conflicts of interest. But I discovered that the Salt Institute had given $25,000 to the professional organization of dietitians (the Academy of Nutrition and Dietetics, AND) for “development of a randomized controlled trial of cardiovascular outcomes.”37 Patricia Babjak, the CEO of the AND, told me:

A portion of the funds were released to support the efforts of Dr. David McCarron [a co-author of the Hypertension article] and the study group that was organized with Duke University to develop the paper. . . . The balance of the funding has been earmarked for the Academy to assemble an advisory group to support the development of a protocol for a RCT to address the relationship between sodium intake and cardiovascular events.38

One of the authors of the Hypertension article, who requested anonymity in order to speak candidly, told me that he was not aware that anyone in the group had received any funding from the Salt Institute.

The Mouse’s Last Squeak

On March 1, 2019, the Salt Institute quietly posted a little-noticed item on its website (see figure 5.1) to announce that it was disbanding! More than a century after its founding in 1914, and days before the publication of the National Academy of Medicine’s report that dismissed some of the research showing risks of reducing sodium that the group relied upon, the Salt Institute said: “After careful consideration, the board members of the Salt Institute have decided to pursue the dissolution of the trade association, effective March 31, 2019.”

Shortly after its announcement, I called the institute to ask why it was going out of business. All I got was an answering machine. (Members of the group’s board of directors and Roman also declined via email to talk to me.) It seemed like quite a coincidence that the decision was made within days of the release of the NAM’s report. But one knowledgeable person told me that the decision to disband had actually been made the previous October. It was likelier that the salt industry, along with many major food manufacturers, understood that their ultimate customers—the general public—were increasingly concerned about their diets, and that it was time for the salt manufacturers and the food industry to stop fighting old battles. My informant also suspected that the member companies just wanted to cut their expenses, though the amount they paid the institute was relatively trivial.

And so what did staffers think were the organization’s biggest accomplishments with regard to diet and health? Hanneman told me that they “defended the good name of salt.” Morton Satin, the group’s former vice president and science director, says the group succeeded in getting its message to the public and getting normally reticent scientists who are unconcerned about current sodium intakes to speak out more boldly. Roman, the president during its last decade, told me in her email: “We did our best to follow the science. Being ethical in every statement we made was of paramount importance to us. In the face of conflicting evidence, we called for more studies, which I feel was the logical and ethical thing to do.”39

The disappearance of the Salt Institute eliminated the main industry defender of salt. Time will tell whether other industry groups, such as SNAC International, the snack-food industry’s trade association, will fill in for it or if individual companies will take up the cudgels. But I doubt that any other trade association will defend salt with the zeal and persistence of the Salt Institute.

Salt Lobbyists Overseas

While the Salt Institute was laboring away in the United States, it had counterparts overseas. In France, Pierre Meneton, a cardiovascular disease researcher with the French National Institute of Health and Medical Research (Inserm), bearded the lion when he publicized the harmfulness of high-sodium diets. He blamed the salt producers’ lobby and the food industry for misinforming health professionals and the media and stymying efforts to reduce sodium consumption.40 Meneton estimated that high-salt diets were causing about 25,000 deaths per year in France.41

Around 2001, Meneton began to encounter some problems.42 French media reported that Meneton was labeled a national security threat and was spied upon by the country’s security services. The government allegedly bugged his office and cell phones and put his friends and relatives under surveillance, charges the government has denied but are supported by documents.43 In her book titled The French Vendetta, the journalist Sophie Coignard concluded that the French food industry, which has much greater resources and influence than the salt industry, had persuaded the government to surveil Meneton.44

To Meneton, not publicizing his concerns about salt was unconscionable. “When I started to take an interest in this question [of high-salt diets],” he said, “the question was ignored by everyone, public authorities, journalists, professionals. This posed a major problem for me: What is the purpose of a scientist?”45

Meneton’s troubles continued. In 2006, an official of the salt industry’s lobbying organization, Comité des Salines de France (Salt Association of France), wrote to the director of Inserm, saying: “Recently we have alerted you to the immoderate and indiscriminate attacks launched on salt with no scientific basis by the monomaniac, Pierre Meneton. . . . We are obliged to draw your attention to an interview that this researcher has just granted, associating your institute with his anti-salt rantings.”46

Meneton later said, “Another Inserm researcher, a nephrologist [kidney specialist] at the Necker Children’s Hospital in Paris, publicly questioned my work. Everyone knows that he is paid by the salt industry as a scientific adviser.”47

Clearly, Meneton had infuriated the salt industry by accusing it of deceiving the public about the health risks from salty foods. The industry also was angered that he gave an interview to TOC, a small-circulation French magazine, that was illustrated with an image of a salt packet emblazoned with the bold-lettered message “salt kills.”48 The industry then sued Meneton, the journalist who wrote the article, and TOC’s publisher for defamation.49 Ultimately, in 2008, a judge in the criminal court in Paris dismissed the case, saying that scientists who espouse a critical opinion cannot be sued under French defamation laws.50

Perhaps not surprisingly, when the industry organization presented its preliminary pro-salt position in court, its representative relied heavily on a few studies by Michael Alderman, the consultant to the Salt Institute in the United States.

Across the English Channel, the Salt Association has lobbied hard against the United Kingdom government’s precedent-setting sodium-reduction campaign. Sounding like its American sibling, the British group said, “Recent research suggests that consuming too little salt may actually increase the risk of heart disease.” It added:

The public is increasingly asking “what should be our relationship with salt?” People are confused by the conflicting evidence. The war on salt has continued for decades, without firm evidence of any long-term health benefits from restricted salt diets. . . . We are urging the Government in the strongest possible terms to undertake new, population wide studies to determine the real effects of salt consumption on our health. Until then, the Government will be continuing to take risks with public health by its failure to acknowledge the essential role salt plays in maintaining a fit and healthy body.51

The British government ignored the salt lobby when it mounted its campaign to lower sodium intakes and created a character named “Sid the Slug” to help send the message. The Salt Association actually filed a formal complaint with an ad industry watchdog, the Advertising Standards Authority, about the Sid campaign, calling it “incorrect and potentially very damaging”—but the complaint was dismissed.52 Lately, the Salt Association appears to be inactive (because of Sid or something else, I do not know).

I discuss in chapter 7 how the British government’s salt-reduction campaign (including the hilarious efforts of Sid) helped lower sodium intakes and improve health in the UK and inspired as well the efforts to lower consumption in a growing number of countries. But first, in chapter 6, I explain how industry funding might cloud a research professor’s objectivity.