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“Some people just love salty foods, and they’re going to go ahead and eat those foods regardless of whether they have a salt icon next to them,” Rakower said. “It’s not a ban. It’s information. It’s a warning.”

S. Preston Ricardo, an attorney for the National Restaurant Association, which challenged the rule, said the group plans to appeal.

Questioning authority

Ricardo told Rakower the issue isn’t whether high levels of sodium lead to hypertension and heart disease but whether the city’s Board of Health had the authority to enact the rule.

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Allowing the salt labels would enable the city to issue similar warnings for other "lifestyle choices" that might have negative health effects, such as watching television for extended periods of time or sitting too long while working, Ricardo said.

"It would basically open up the floodgates," Ricardo said. "The sodium mandate is nothing like the board has ever done."

The Board of Health acted on its own with no guidance from legislators and makes decisions based on "political and economic aspirations," Ricardo said. The rule is more likely to confuse consumers and push them toward restaurants that aren’t part of a chain and whose menus don’t have a salt-shaker symbol, which Ricardo likened to a warning symbol for dangerous materials such as poisons or biohazards.

"It’s way too overbroad and it advises people of things that may not apply to them," he said.

Teaspoon’s worth

The threshold of 2,300 milligrams of sodium, about a teaspoon’s worth, is the recommended daily limit for adults in the U.S. High sodium levels can lead to high blood pressure and increase the risk of heart attack and stroke, New York City’s Health Department said, citing U.S. dietary guidelines and the Institute of Medicine studies. One in three New York City deaths is due to heart disease, the department said.

The Washington-based restaurant group, which represents more than 500,000 businesses, sued the city two days after the mandate took effect in December, saying the Board of Health had exceeded its authority and opening yet another front in the industry’s battle against increasing government regulation.

The requirement was crafted by Mayor Bill de Blasio’s administration and continues the efforts of his predecessor, Michael Bloomberg, to improve public health through government mandates, such as banning trans fats, requiring calorie counts on menus and limiting the size of sugary sodas.

Soda fight

While the trans-fat bans and calorie counts survived similar legal challenges, the state’s highest court blocked the soda measure. Bloomberg, the founder and majority owner of Bloomberg LP, the parent company of Bloomberg News, had asked restaurants and food makers to voluntarily reduce the amount of salt in their menu items.

Mark Muschenheim, an attorney for the city, told Rakower that consumers frequently underestimate the amount of sodium in their meals because the levels can vary widely among individual menu items. The rule doesn’t limit the amount of sodium in foods or dictate its sale, he said.

Several chains have already started posting the labels on their menus, said Thomas Merrill, another lawyer for the city.

"This tells me that when I go in, if I buy that item, I’m going be getting a whole day’s worth of sodium simply by buying that Parmesan sub," Merrill said. "This is a warning. It doesn’t deal with personal autonomy."

Better decisions

After the ruling, de Blasio said on Twitter that too many New Yorkers are at risk of high blood pressure, heart disease, and stroke due to high sodium intake and that the icon will help them make better decisions about their diets, which would lead to longer lives.

"If your meal has so much sodium that it merits a salt shaker on the menu, then--for the sake of your health--order something else," said the mayor, a Democrat.

The city won’t start fining chains that don’t comply with the requirement until next month. Violators could face as much as a $200 fine for each infraction.

The case is National Restaurant Association v. New York City Department of Health, 654024/2015, New York State Supreme Court, New York County (Manhattan.)

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