The Food and Drug Administration is lagging in a very important part of public health: reducing sodium consumption from salt. Other nations like Australia, United Kingdom and South African have implemented sodium-reduction initiatives to reduce the burden of heart attack and stroke, the United States lags far behind, having yet to enact any such initiative. Brands in America might want to reduce sodium decline to step forward due to a fear of being put at a competitive disadvantage if their competitors didn't do the same. 

A new report from the Center for Science in the Public Interest entitled: "Restaurants Can't Shake the Salt." Since 2012, America's top 25 restaurants did little to nothing to reduce the average sodium content in almost 3,000 menu offerings analyzed in the report. Needless to say, the restaurant industry has failed in making any real progress. the average decline was a measly 1%. 

Some restaurants have made some small reductions in sodium across items that appeared on their menus in both 2012 and 2014. Other restaurants increased the amount of sodium on average in items on the menu in both years. IHOP showed the biggest increase with a 9% average increase across 129 items. Furthermore, Applebees, Chili's, IHOP, Olive Garden served up as much or more sodium on average on each of their menu items in 2012 and 2014 than the majority of Americans should consume on a daily basis. 

So why should they do more?
 

The FDA has failed to provide a level playing field and tell the industry where the goal posts are. On average, an American consumes about 4,000 mg of sodium per day. The daily recommended intake is only 1500 mg per day. Cutting down sodium do to 2,000 mg would prevent 100,000 deaths each year according to the CDC. 

What's more surprising is most of that sodium intake is not coming from the salt shaker. About 80% of sodium we consume comes from the sale that restaurant chefs and food manufacturers added to their dishes. 

The Institute of Medicine in 2010 concluded that voluntary reductions over the previous four decades had achieved nothing. The IOM called on the FDA to reduce sodium in the food supply by mandating limits in restaurant and processed foods and by gradually reducing those limits over time in a common-sense fashion to give industry. New York City's Department of Health and Mental Hygiene used a method first used a method first used in the UK to show how that could be done. 

The city created a National Salt Reduction Initiative and developed targets in reducing sodium in 62 categories of packaged foods and 25 categories of restaurant food over a period of years. 

The U.K. has achieved a 15 percent reduction in per capita daily sodium consumption between 2001 and 2011. In 2013, South Africa set mandatory limits for variety of products. Again, the approach is gradual with interim targets to be met by 2016 and final target 2019. 

There are many paths towards reducing sodium and addressing the burden of heart attacks and strokes. Excess sodium intake can lead to almost tens of billions of dollars in excess medical costs. Government leadership is essential.