Low-Sodium Guidelines for Heart Failure

This guide provides basic information to help you start or continue following your heart failure diet. Planning what you eat and balancing your meals are important ways to manage your health. Eating healthy often means making changes in your current eating habits. A registered dietitian can provide in-depth personalized nutrition education, tailor these general guidelines to meet your needs, and help you begin a personal action plan.

Here are some basic guidelines that will help you get started. These guidelines are explained in more detail inside this handout.

• Control the sodium in your diet. Decreasing the total amount of sodium you consume to 2,000 mg (2 g) per day is one of the most important ways to manage heart failure.
• Learn to read food labels. Use the label information on food packages to help you to make the best low-sodium selections.
• Include high-fiber foods such as vegetables, cooked dried peas and beans (legumes), whole-grain foods, bran, cereals, pasta, rice and fresh fruit. Fiber is the indigestible part of plant food that helps move food along the digestive tract, better controls blood glucose levels and may reduce the level of cholesterol in the blood. Foods high in fiber include natural antioxidants, which reduce the risk of cardiovascular disease. The goal for everyone is to consume 25 to 35 grams of fiber per day.
• Carefully follow your fluid management guidelines. Reduce your fluid intake if you have advanced heart failure or if you become more short of breath or notice swelling. General rule: limit fluids to 8 cups or less per day (which is equal to 2 liters or less OR 64 ounces or less), even if you feel thirsty.  If you sweat a lot with vigorous exercise, you may need to drink one cup of extra fluid. Your health care provider will give you specific fluid guidelines that may be more or less than 64 ounces per day.
• Maintain a healthy body weight. This includes losing weight if you are overweight. Limit your total daily calories, follow a low-fat diet and exercise regularly to achieve or maintain your ideal body weight.

Learning to read food labels
Food labels are standardized by the U.S. government's National Labeling and Education Act (NLEA).  Nutrition labels and an ingredient list are required on most foods so you can make the best selection for a healthy lifestyle.  Review the food label below.  If you do not know how much total sodium is in this product, ask your dietitian, or health care provider, to show you how to read food labels and apply the information to your personal needs.

Sodium guidelines
Sodium is a mineral found in many foods.  It helps keep normal fluids balanced in the body.  Most people eat foods containing more sodium than they need.  Some foods may be high in sodium and not taste salty.  Eating too much sodium causes the body to keep or retain too much water, worsening the fluid build-up in heart failure.  Following a low-sodium diet helps control high blood pressure (hypertension), swelling and water build-up (edema), and/or decrease breathing difficulties for people who have kidney, heart or liver problems. In heart failure, the heart will not have to pump as hard if there is less fluid to move through the blood vessels.

You should consume no more than 2,000mg (2g) of sodium per day.  A low-sodium diet means more than just eliminating the salt shaker from the table!  However, that is a good start since one teaspoon salt = 2,300mg of sodium. It is important to keep a record of the amount of sodium you consume every day. Write down the amount in mg after each meal or snack.

• 2-3 ounces of fresh or frozen fish, shellfish, meat (beef, veal, lamb, pork) or poultry
• 1/2 cup cooked dried beans or peas
• 1/2 cup low-sodium canned fish (such as salmon or tuna)
• 1 low-sodium frozen dinner (less than 600mg sodium per meal) - Limit to one per day
• 1 egg (no more than 3 whole eggs per week)

• 1-1/2 ounces of low-sodium cheese
• 1 cup milk (non-fat or 1% recommended)
• 1/2 cup low-sodium cottage cheese
• 1 cup soy milk

• 1/2 cup fresh whole, chopped, cooked, frozen or canned fruit 
• 1/2 cup chopped, cooked, frozen or no-salt added canned vegetables
• 1/2 cup low-sodium tomato juice or V-8 juice
• 1/2 cup low-sodium tomato sauce
• 1 cup raw leafy vegetables

• Low-sodium breads, rolls, bagels and cereals (1 serving = 1 slice bread, 1 small roll, 1/2 bagel, 1/2 English muffin or a 4-inch pita
• 1/2 cup pasta (noodles, spaghetti, macaroni)
• 1/2 cup rice
• Low-sodium crackers (read label for serving size)

• 1 ounce unsalted nuts
• 1/2 cup low-sodium pretzels or chips
• 3 cups popped low-sodium popcorn
• 3 fig bars or gingersnaps
• 1 slice angel food cake
• 1 tbsp jelly or honey
• 1 cup sherbet, sorbet or Italian ice; 1 popsicle
• 8-10 jelly beans; 3 pieces hard candy

• Olive and canola oils
• Low-sodium butter and margarine
• Low-sodium soups 
• Low-sodium salad dressing
• Homemade gravy without salt 
• Low-sodium broth or bouillon 
• Low-sodium catsup 
• Low-sodium mustard 
• Low-sodium sauce mixes

• Lemon juice
• Vinegar
• Herbs and spices without salt

• Use fresh ingredients and/or foods with no salt added.
• For favorite recipes, you may need to use other ingredients and delete or decrease the salt added.  Salt can be removed from any recipe except from those containing yeast.
• Try orange or pineapple juice as a base for meat marinades.
• Avoid convenience foods such as canned soups, entrees, vegetables, pasta and rice mixes, frozen dinners, instant cereal and puddings, and gravy sauce mixes.
• Select frozen entrees that contain 600 mg or less of sodium.  However, limit to one of these frozen entrees per day.  Check the Nutrition Facts label on the package for sodium content.
• Use fresh, frozen, no added salt canned vegetables, or canned vegetables that have been rinsed before they are prepared.
• Low sodium canned soups may be used.
• Avoid mixed seasonings and spice blends that include salt, such as garlic salt.
• Don’t use a salt substitute unless you check with your doctor first.

Spicy blend
2 tbsp dried savory, crumbled
1/4 tsp freshly ground white pepper
1 tbsp dry mustard
1/4 tsp ground cumin
2 1/2 tsp onion powder
1/2 tsp garlic powder
1/4 tsp curry powder

Saltless surprise
2 tsp garlic powder
1 tsp basil
1 tsp oregano
1 tsp powdered lemon rind or dehydrated lemon juice

Spicy seasoning
1 tsp cloves
1 tsp pepper
2 tsp paprika
1 tsp coriander seed (crushed)
1 tbsp rosemary

Herb seasoning
2 tbsp dried dill weed or basil leaves, crumbled
1 tsp celery seed
2 tbsp onion powder
1/4 tsp (pinch) dried oregano leaves, crumbled freshly ground pepper

• Select fresh fruit or vegetables
• Avoid soups and broths
• Stay away from bread and rolls with salty, buttery crusts

• Select fresh fruits and vegetables
• Avoid pickles, canned or marinated vegetables, cured meats, seasoned croutons, cheeses, salted seeds
• Order salad dressings on the side and use small amounts of them

• Select meat, poultry, fish or shellfish choices that includes the words broiled, grilled or roasted
• Select plain vegetables, potatoes and noodles
• Ask the server about the low sodium menu choices, and ask how the food is prepared
• Request food to be cooked without salt or monosodium glutamate (MSG)
• Avoid restaurants that do not allow for special food preparation (such as buffet style restaurants, diners or fast food chains)
• Avoid casseroles, mixed dishes, gravies and sauces
• At fast food restaurants, choose the salad entrees or non-fried and non-breaded entrees (such as a baked potato) and skip the special sauces, condiments and cheese*

* Avoid salted condiments and garnishes such as olives and pickles

• Select fresh fruits, ices, ice cream, sherbet, gelatin and plain cakes

Alcohol guidelines
Because alcohol can slow your heart rate and worsen your heart failure, your health care provider may tell you to avoid or limit alcoholic beverages. Alcohol may also interact with the medications you are taking. Ask your health care provider for specific guidelines regarding alcohol.

© Copyright 1995-2006 The Cleveland Clinic Foundation. All rights reserved

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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