Nutritional Guidelines for Heart Failure

Written with: Melissa Stevens, MS, RD, LD, Nutrition Program Coordinator, Preventive Cardiology and Rehabilitative Services

This guide provides basic information to help you start or continue following your heart failure diet. This diet can help you when recovering from heart failure, and it is useful for heart failure prevention as well. 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 start a personal action plan.

Here are some basic guidelines that will help you get started.

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.

Eat a variety of foods to get all the nutrients you need.

Your health care provider may advise you to eat foods that are high in potassium such as:

If you are taking certain diuretics, your potassium levels may drop. Review the signs and symptoms of low potassium with your health care provider. The signs of low potassium include fatigue, weakness, severe thirst, excessive urination, and heart beat changes. Always talk to your doctor or nurse about the diuretic you are taking and call your provider if you have any signs of low potassium.

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 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.

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.

A. The serving size represents the typical amount eaten by an adult.

B. The sodium content is listed on the food label per serving size. Ignore the % daily value and focus on the amount of mg sodium per serving. Decreasing the total amount of sodium you consume to 2,000 milligrams (mg) or 2 grams (g) per day is one of the most important ways to manage heart failure.

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 2,000 mg (2g) of sodium per day. A low-sodium diet means more than just eliminating the salt shaker from the table! However, it is a good start since one teaspoon salt = 2,300 mg of sodium. Before using a salt substitute, check with your doctor. Salt substitutes generally contain other ingredients that can be just as harmful.

Please note: These are sodium content ranges - the sodium content in certain food items may vary. Please contact your dietitian for specific product information. Source: Food Values of Portions Commonly Used, 16th edition, 1994 Bowes & Church.

Sodium Guidelines: Foods to Choose

Protein - Choose 2-3 servings per day

• 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

Dairy Products - Choose 2 or more servings/day

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

Vegetables and Fruits - Choose 5 or more servings/day

• 1/2 cup 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

Bread and Grains - Choose 6 or more servings/day

• Low-sodium breads, rolls, bagels and cereals (1 serving = 1 slice bread, 1 small roll, 1/2 bagel, ½ 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)

Sweets and Snacks (include sparingly)

• 1 ounce ounces 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

Fats, Oils and Condiments (use sparingly)

• 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

Fats, Oils and Condiments (can use freely)

• Lemon juice
• Vinegar
• Herbs and spices without salt

Sodium Guidelines

• 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

Recipes for seasoning blends

Directions: Combine all ingredients in a small bowl and blend well. Spoon into shaker. Store in a cool, dark place.

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
• 1 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

Restaurant Dining Tips

Appetizers

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

Salads

• 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

Main Courses

• Select meat, poultry, fish or shellfish 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

Desserts

• 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.