The Trump administration’s top food and drug regulator is pushing for less salt in food, more nutrition information on labels and innovative ways to communicate healthy ways of eating, all of which Scott Gottlieb says could make more of a difference than anything else his agency could do, short of curing cancer.
Gottlieb, the Food and Drug Administration commissioner, has positively surprised critics of the administration’s regulatory agenda elsewhere.
“We spend a lot of time at the FDA on new technologies — cell and gene base therapies, regenerative medicine — that have curative potential and there is a lot of public health opportunity from what we’re seeing in the pipeline,” Gottlieb said in an interview at his FDA office.
“But when you think of where we’re going to have the most dramatic public health impact, it’s going to be getting back to the public health basics, trying to sharply reduce smoking rates, trying to improve diets and trying to increase vaccination rates,” Gottlieb said.
Gottlieb, a physician known as a free-market conservative, sounded to consumers advocates like he could have been an Obama or Clinton appointee during a recent nutrition speech. Told this, he made no attempt to backpedal, calling diet and nutrition apolitical and a needed focus he was proud to work on during his stint at the FDA in the George W. Bush Administration.
FDA doesn’t have a specific role determining where food is sold, but the agency thinks its work on labeling and health claims could help people people make smarter decisions no matter where they are shopping. The types of initiatives FDA is encouraging the food industry to make include better defining terms like “healthy,” and including when foods have a full serving of dairy, or vegetables, as part of the total day’s recommended servings of these food groups.
A frozen dinner, for example, could have a label that shows it contains one full serving of vegetables. FDA hopes claims will incentivize companies to innovate and compete with respect to healthy choice.
Gottlieb says cutting sodium in food is the single most effective public health action that could be taken. FDA proposed that industry voluntarily reduce sodium intake to 3,000 milligrams per day from the current average intake of over 3,400 milligrams.
While some say there’s a risk of reducing sodium too much, Gottlieb said that while salt has preservative functions, there are also ways to reformulate foods including salt that could make them healthier without sacrificing taste.
Researchers have estimated that reducing sodium by a half teaspoon a day could prevent nearly 100,000 premature deaths a year, and up to 120,000 new cases of coronary heart disease, 66,000 strokes, and 99,000 heart attacks. African Americans are at greater risk for hypertension and develop it at earlier ages.
But making food healthier and giving consumers more information doesn’t mean they can act on it, either because of where they live, how much money they have and what kinds of foods they were raised with.
“Dietary opportunities are not distributed evenly,” says Gottlieb. “A lot of neighborhoods have a lack of access to proper nutrition, which creates other inequities.”
The FDA plan would also encourage labeling that informs people about the ease of preparation or economical alternatives that don’t eliminate health benefits, as with canned vegetables or dried beans, he says.
In keeping with his background in industry and as a scholar at the conservative American Enterprise Insitute, Gottlieb’s approach to nutrition policy making is far more carrot than stick. Marion Nestle, the author and New York University nutrition professor, thinks it would be more effective to require companies to gradually reduce sodium as was done in Great Britain.
“I suppose ‘voluntary’ could work, but if sodium reduction isn’t across the board, companies will have little incentive to risk changing their formulas,” said Nestle, who was the Health and Human Services’ senior nutrition policy adviser in the late 1980s and editor of the Surgeon General’s Report on Nutrition and Health.
But Nestle wasn’t without hope.
“Gottlieb’s words reflect modern public health thinking (the good news) and it’s great that FDA is considering taking these actions (also good news),” she concluded. “Now, let’s see what the agency actually does.”