Angell and Farley Respond

In his letter, Lucan argues that the relationship between excess sodium consumption and adverse health effects is not supported by the evidence. He concludes that public health actions to improve population health should instead focus on sugar. The body of evidence demonstrates that excess sodium consumption is an important population-level risk for high blood pressure and is strong and conclusive. The issue has been considered with various study designs, from clinical trials and meta-analyses of those studies, to ecologic and longitudinal observational studies. Scientific bodies gathered to consider the totality of the evidence have concluded that this risk of high sodium intake is real and important.1,2 Accordingly, the US Dietary Guidelines follow the evidence and recommend that Americans reduce sodium intake for their health.3 The National Salt Reduction Initiative, a partnership of more than 80 organizations, is simply taking public health action that is consistent with this recommendation by working with the food industry to achieve voluntary reductions in the sodium levels of packaged and restaurant food, which is the source of more than three quarters of sodium consumed daily.4 This puts control back in the hands of consumers, allowing them to add as little or as much salt as they like. While we agree that excess sugar intake is also a health problem needing attention, this is a separate issue. We can address both.