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Sometimes too much of a good thing is bad. Sometimes too little of a bad thing is not so great either. Most of us have heard the dietary advice to cut back on salt. And a new report out today affirms that modest reductions are a good idea, but how low do we need to go? Experts conclude that cutting sodium too much is risky.

NPR's Allison Aubrey reports.

ALLISON AUBREY, BYLINE: For years, people over the age of 50, as well as those who have elevated blood pressure or other risk factors for heart disease, have been told to aim for a very low sodium diet - down to 1500 milligrams per day. That's less than a teaspoon. But now, a panel of experts convened by the Institute of Medicine - made up of physicians, researchers and nutrition scientists - is questioning whether a diet that low in sodium is beneficial.

Brian Strom of the University of Pennsylvania chaired the panel.

DR. BRIAN STROM: The net conclusion is that people who are eating too much sodium should lower their sodium, but it is possible that if you lower it too much you might do harm.

AUBREY: Strom says that the panel reviewed a lot of studies evaluating the relationship between sodium and health outcomes. And he says some research from Italy stands out, when it comes to suggesting that ultra-low-sodium diets may be harmful. In the Italian study, people with congestive heart failure were put on either a low-sodium diet or a medium-sodium diet.

STROM: The people who were on the low-sodium diet actually did worse. They had more hospital re-admissions and they had a higher mortality rate.

AUBREY: Strom says the Italian study is not entirely conclusive, but the panel agreed that studies like this raise questions about whether current low-sodium recommendations should be moderated.

Now groups such as the American Heart Association, which recommends a low-sodium diet for all Americans, says it disagrees with the key findings of the new report.

DR. STEPHEN HAVAS: I think it's very unfortunate and it's going to confuse the American public.

AUBREY: That's Stephen Havas, a preventive medicine doctor from Northwestern University. He points out that most Americans are consuming excessive amounts of salt, way more than the experts are talking about here. He says quibbling over whether the ideal intake is 2300 milligrams or 1500 milligrams distracts us from the more important conversation, about how to get Americans to start consuming just a little less. Right now, the typical American consumes more than 3400 milligrams a day

HAVAS: We have lots of evidence showing that the more sodium people consume, the more likely it is that they will develop high blood pressure.

AUBREY: And this matters.

BONNIE LIEBMAN: I don't think people have no idea how much sodium they're eating.

AUBREY: To better understand just how much salt is found in the typical lunch out, I met nutrition advocate Bonnie Liebman at a food court. Our first stop was McDonald's, where I was surprised to learn that the French fries are not the saltiest item on the menu. Turns out a Quarter Pounder with cheese has more than three times as much salt as a medium fry.

LIEBMAN: Most burgers have a thousand milligrams. You can get up to 2,000 if you get the Angus burger with bacon.

AUBREY: Put the burger and fries together and you've already reached the recommended daily sodium intake.

Liebman says it's important not to pick on fast food. McDonald's, after all, has pledged to reduce sodium 15 percent across its menu by 2015. And as we stroll down the food court - from Subway to Chipotle to Pizzeria Uno - Liebman says it's a similar story at every chain.

LIEBMAN: Expect at least a thousand milligrams in a sandwich. It doesn't matter if it comes from Panera or Au Bon Pain.

AUBREY: So even though the new report raises questions about potential harms of ultra-low-sodium diet, with a food supply like ours, most of us should be concerned with eating too much salt, not too little.

Allison Aubrey, NPR News.

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