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    New Research Calls Salt Guidelines Into Question

    Study Suggests Reducing Sodium May Increase Unhealthy Blood Fats; Critics Say Study Is Flawed

    Should People Worry About Salt, or Not?

    Experts who reviewed the study for WebMD say its conclusions are flawed because it relies too heavily on small, short-term studies.

    In some cases people in the studies that were included in the review were only on low-sodium diets for a few days.

    "This is a key issue. When there is a large, abrupt reduction in sodium, it takes time to acclimate," says Lawrence Appel, MD, PhD, professor of medicine, epidemiology, and international health at Johns Hopkins Medical Institutions in Baltimore.

    "It's very convenient for somebody to summarize a complex area in one paper. But the truth is in the details, and much of that is obscured by the fact that many of these studies are poorly done," says Appel, who is also a spokesman for the American Heart Association.

    Other experts agree that the study has some limitations. But they say it raises interesting questions that deserve further study.

    "This doesn't change our practice, but it does raise questions about low-sodium diets," particularly for people with normal blood pressure, says Jonathan Whiteson, MD, director of the cardiac and pulmonary rehabilitation at New York University's Langone Medical Center in New York City.

    "This is not one-stop shopping. We know that no one medication is the same for one group as it is for another in terms of its effects; therefore, we can't assume that one diet is the same for one population as it is for the next," Whiteson says.

    Other doctors say the study is probably correct that changes to sodium are going to affect more than just blood pressure. But they question whether that matters.

    "The question is: What does this translate into?" says Tara Narula, MD, a cardiologist at Lenox Hill Hospital in New York City. "Over time, does that mean that somebody has a problem, or is that OK?"

    "Certainly I would not tell my patients not to lower their sodium because it might then raise your cholesterol," Narula says. "I haven't seen enough information at this point to make me change my practice, and I'd be hard pressed to find other cardiologists who would say that based on this study that they would not recommend low-sodium diets to people, especially those that have hypertension and heart failure."

    "Over 50 public health organizations can't be wrong on this one," says Appel.

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