Nutritional Success for People Living with Heart Failure
Alicia Boggs is a Physician Assistant with Centra Heart & Vascular Institute. She recently answered some of our questions about nutritional success for people living with heart failure.
Most people are aware that the foods they eat can affect their heart health. Information about “heart healthy” diets is everywhere. However not all heart conditions are the same, and people living with different heart conditions have different dietary needs. For instance, someone who recently had a heart attack may have different dietary needs and considerations than someone who has an irregular heart rhythm. Someone with “high cholesterol” or high blood pressure may need to limit certain foods to live their healthiest life.
For people living with heart failure, many of the typical “heart healthy” diet recommendations hold true. A diet rich in fruits and vegetables, with an emphasis on consuming “healthy fats,” and lean meats is generally recommended. However, people living with heart failure do have some special dietary considerations that deserve their attention.
People living with heart failure may wonder:
Can what I eat affect my fluid buildup?
Why is everyone so worried about salt?
What foods should I avoid?
If I can’t have much salt, then what are some options to make my food taste good?
Can I still eat at traditional restaurants and fast-food restaurants?
Can what I eat affect my fluid buildup?
Yes! In general, the concern is that increased salt/sodium intake can increase fluid build-up. Therefore it is recommended that most people living with heart failure limit their intake of salt (also called sodium on nutrition labels) to less than 2000 mg per day. Your healthcare provider may have different recommendations depending on your individual circumstance, but taking in less than 2000 mg of sodium per day is a good general guideline for people living with heart failure.
Try to limit your sodium intake to 600 mg per meal. If you have 3 meals per day, this still allows 200 mg for snacks or drinks containing sodium throughout the day.
Why is everyone so worried about salt?
This is a question that has a complex (detailed scientific) answer. In short, the more salt you take in through your diet, the more your body tends to retain or hold onto fluid. Due to their heart, people living with heart failure often have trouble with excess fluid build-up. This can cause swelling in the legs or abdomen, or shortness of breath (when fluid builds up in the lungs). Limiting salt in your diet can help prevent excess fluid from building up. On the flip side, taking in a lot of salt in your diet can lead to increased fluid build-up (and therefore increased heart failure symptoms).
What foods should I avoid?
In general, foods that are high in sodium should be limited. This doesn’t mean that you can never have a salty snack, such as chips or crackers. However, indulging in these salty treats should be an exception, and you should try to limit the amount you consume. One good idea is to set out a specified amount of the salty snack, so you are sure not to eat too much of the snack and exceed your salt limit for the entire day. Another option is to look for “lower sodium” options. If you like salty almonds or peanuts, try looking for a “lower sodium” or “lightly salted” variety.
As a general rule, preserved foods or pre-packaged foods (such as canned goods or boxed foods) tend to have more salt than fresh foods. Salt is often used not only to flavor food, but also to help preserve it. For instance, deli meats and cured meats (sausage, bacon, etc.) contain a high amount of sodium. This is in part to add flavor, but it is also to help preserve the food. These foods should be avoided or eaten in limited quantities.
Typically, fresh vegetables have less salt than frozen vegetables, and frozen vegetables have less salt than canned vegetables. Note that salt content can vary depending on whether or not the vegetables are flavored, and can also vary from brand to brand. Read and compare the nutrition labels of similar items, and you will be surprised at how different the amounts of sodium can be! As with salty snacks, look for the “lower sodium” or “no salt added” varieties of canned vegetables to keep your salt intake low.
When eating meats, buy plain fresh or frozen meats, and season them yourself. Don’t buy pre-seasoned burgers, chicken breasts, or other pre-seasoned meats, as it can be difficult to determine how much salt they contain, and you can generally season them yourself using less salt!
If I can’t have much salt, then what are some options to make my food taste good?
With a little creativity, you can still make flavorful food, without using much salt. Other spices generally do NOT affect fluid retention in the same way as salt/sodium. Herbs such as basil, parsley, oregano, cilantro, and rosemary are okay to use to season your food, and won’t lead to fluid retention. Likewise spices such as pepper, garlic, cinnamon, nutmeg, and ginger are acceptable. Look to add other fresh foods to help make your food flavorful (for instance using onions to add flavor to burgers or other meat).
Combination spices such as “steak seasoning” or “fish seasoning” can vary in their sodium content. In general, these should be avoided, unless you carefully review the label for the sodium content. Keep in mind that the sodium content listed is the amount of sodium in a serving size, which can be a small amount, such as a teaspoon. If you use 4 teaspoons of the seasoning, then the sodium content would be 4 times the listed amount. Notably, Mrs. Dash brand makes many combination spices with little to no sodium in them. On the label these are clearly marked as being “salt-free.”
A word of caution – some “salt alternatives” or “salt substitutes” contain high amounts of potassium, which in combination with heart failure medications can raise potassium in your body to unsafe levels. Examples include “Nu-Salt,” “NoSalt,” and “Morton Salt Substitute.” Try to avoid using these salt substitutes. If you are unsure if a salt substitute or spice is safe, contact your healthcare provider before using it.
Can I still eat at traditional restaurants and fast-food restaurants?
Yes. In recent years many restaurants and fast-food establishments have added healthier options to their menus. In addition, many restaurants now print some of the nutritional information for meals on their menu or have this information available upon request. Often nutritional information is accessible online, which means that you can look it up prior to going to the restaurant, so that you have an idea of what the healthiest options are before you get to the restaurant. A quick online search can also bring up many blogs and menus showing low sodium options at specific restaurants.
Finding low sodium options can take a little time and effort up front, but being able to sit down and eat at a restaurant without jeopardizing your health or worrying that you will feel poorly later is worth the effort.
Over time you will learn which low sodium foods you enjoy, and how to cook low sodium foods that taste wonderful!
- Alicia Boggs, PA-C
