Now that the Food and Drug Administration has moved to banish most trans fats from the nation's diet, some public health advocates are hopeful that two other beloved ingredients -- sugar and salt -- will be subject to similar scrutiny.
"Sodium is next," said Dr. Dariush Mozaffarian, a Harvard University epidemiologist and cardiologist at Boston's Brigham and Women's Hospital.
In acting to remove artificial trans fats from the food supply, Mozaffarian said, the FDA has acknowledged a scientific consensus that they are hazardous to the public's health. The same case could be said about excess dietary sodium, and that should be an equally powerful prod to FDA action, he said.
Tom Neltner, an analyst with the Natural Resources Defense Council in Washington, D.C., said that sugar, too, might become a target in the wake of Thursday's FDA action.
In regulating food additives, the FDA has historically focused on removing chemicals that cause death and acute injury, Neltner said. Now the agency has demonstrated that it's ready to step in when a food additive contributes to chronic diseases that kill many people slowly.
Even compared with saturated fat -- a frequent fellow traveler -- trans fatty acid is a bad actor, knocking the blood's lipid levels into dangerous territory on two fronts. Not only does it raise levels of LDL cholesterol, the bad kind; trans fat consumption depresses levels of HDL cholesterol, which is considered protective against heart disease.
While trans fats have no nutritional value, salt is an essential nutrient. And sugar, when consumed at reasonable levels, is not harmful, he said. If it is to act on mounting scientific concern about dietary sodium and sugar, the FDA will have to rethink the assumption that an additive it considers to be as safe "is safe in any amount," said Harvard University public health professor Walter Willett.
The FDA's regulation of food additives has come under growing criticism in recent years, and again on Thursday with the release of a three-year assessment of the FDA's program by the Pew Charitable Trusts.
As the number and variety of substances added to food in the U.S. has exploded, the agency's resources -- as well as its regulatory powers under the 1958 Food Additives Amendment -- have been overwhelmed, the Pew report concluded.
The FDA has the legal authority to scrutinize any new chemicals before they are added to food and are introduced to the market, and to approve or deny their use. But in 1997, the agency acknowledged it was sitting on an overwhelming backlog of requests, and announced that it would accept voluntary notifications of planned additive use from food manufacturers.
That policy would allow a food company pondering use of a new chemical in its product to make the case that the proposed additive was "generally recognized as safe," or GRAS. Unless the FDA challenged the company's argument, the company would then be free to use the additive as it saw fit.
The review by Pew's experts found that many manufacturers of foods and food additives have bypassed the voluntary notification process altogether. The result, the report estimates that about 1,000 new chemicals have been introduced into the U.S. food supply without any FDA oversight at all.