Diet is critical in the treatment of
Limiting sodium is typically recommended to limit fluid build-up. But
some other nutrients or substances also play a role as well. Heart failure can
become more severe if diet and medicine recommendations for heart failure are
not closely followed. Medicine and diet therapy are most effective when used
together in the treatment of heart failure.
Taking your medicines and following the diet your doctor has
recommended for you will make it easier for you to breathe and help you feel
better and be able to do more of your normal daily activities. A registered
dietitian can help you make needed dietary changes by providing
meal-planning guidelines that are realistic and specifically tailored to your
individual needs and preferences.
Ask your doctor if a cardiac rehab program is right for you. Rehab can give you education and support that help you build new healthy habits, such as limiting sodium and eating heart-healthy foods.
Why do you need to limit sodium or fluid?
If you consume too much sodium, it will cause your body
to retain excess fluid. This extra fluid increases swelling in your legs and makes it harder for your heart to pump. Eating too much sodium can even trigger sudden heart failure.
Limiting sodium can help you feel better and prevent sudden heart failure.
Your doctor will tell you how much sodium you can eat each day. You may need to limit sodium to less than 2,000 mg each day.
Fluid intake is not routinely restricted. It may be
restricted in advanced cases to maintain your
electrolyte balance. Closely following your low-sodium
diet will help to decrease or eliminate the need for fluid restriction. It is
very important that you watch for any signs of fluid gain (swelling or increase
in body weight) and report them to your doctor.
You can usually get all of your vitamins and minerals by eating a heart-healthy diet that is rich in fruits and vegetables.
Your doctor might recommend a multivitamin/mineral supplement if you are undernourished or cannot completely
meet your nutritional needs through food.
If you take a diuretic (water pill) for heart failure, this medicine might change your dietary needs for potassium, magnesium, calcium, and zinc. Ask your doctor if you should take supplements or eat certain foods to get enough of these minerals.
If you take a diuretic, ask your doctor if you need to take a potassium supplement or if you need to watch the amount of potassium in your diet. If you take a loop diuretic or thiazide diuretic, your doctor may suggest that you get extra potassium because these medicines lower your potassium levels. But if you take a potassium-sparing diuretic, you might not need to get extra potassium in your diet.
As with potassium, blood levels
of magnesium are typically low with extensive diuretic use. Magnesium plays a
role in holding on to potassium in the body. So if you need to
replenish potassium, you need to consume enough magnesium also to optimize
the body's ability to retain the potassium you are consuming.
food sources of magnesium include seeds, nuts, legumes, unmilled cereal grains,
and dark green vegetables.
Calcium and zinc
Long-term use of diuretics can also deplete your
body of calcium and zinc. Adequate calcium must also be consumed to prevent
bone loss, which can occur in people who are not able to be physically
active. Good food sources of calcium include milk and milk
products, calcium-fortified foods and beverages, broccoli, and kale.
Good food sources of zinc include meat, nuts, legumes, fish (especially oysters), poultry, and
milk and milk products.
Should you limit alcohol?
Limit alcohol to no more than
1 drink a day, and only if approved by your doctor. Alcohol consumption can make high blood pressure worse and cause
further damage to the heart.
What if you need extra calories and nutrients?
In severe heart failure, more calories are often
needed because of the increased workload of the heart and lungs. But calorie
requirements will vary, based on your current nutritional status.
If you are underweight or malnourished, you will
need to increase your intake to obtain sufficient calories and protein to
prevent the loss of muscle tissue, maintain or gain weight, and achieve a
healthy level of protein (albumin) in the blood.
whose activity is very limited (those who are bedridden), it is important to
obtain sufficient calories and protein to prevent the development of pressure
ulcers (bed sores). Increased food intake is often difficult for individuals
who have moderate to severe heart failure because of the congestion, poor appetite,
shortness of breath, and nausea that are often caused by this condition or by
the medicines used to treat it.
The body's increased energy
demands along with the obstacles to sufficient intake can often lead to
malnutrition in people who have heart failure. The following is a list of
suggestions to help you boost your appetite (by reducing fatigue) and to help
you increase your calories and protein with as little volume and discomfort as
Tips for increasing your calorie and protein intake
Eat small, frequent meals (five or six) rather
than three large meals each day.
Eat foods with a soft texture to
minimize the amount of chewing you need to do.
Rest before and
Use more of your sodium allowance at your best mealtime of the day to maximize food intake.
Avoid spicy foods and
gas-forming vegetables (such as beans, broccoli, cauliflower, brussels sprouts,
cabbage, and onions) if they cause you discomfort (heartburn,
feeling of fullness, and gas).
Drink milk and juices.
Eat higher-fat meats, milks, and cheeses.
Add nonfat dry milk to gravies,
sauces, and mashed potatoes (to increase protein intake).
Add butter or margarine to
vegetables, breads, and hot cereals. Use olive oil to saute foods and to top
Try nuts, peanut butter, and dried fruits for
snacks. Eat fruits canned in syrup.
Talk to your doctor or registered dietitian about including nutrition supplement
beverages in your diet if you are malnourished and not able to take in enough
food to meet your calorie and protein needs. Those that provide the most
calories and protein in each can will provide a lot of nutrition in a smaller
How does heart failure change how your body regulates and uses nutrients?
As heart failure progresses, the
heart loses its ability to pump strongly, and blood flow throughout the body
decreases. This causes a number of reactions throughout the body. Decreased
blood flow to the kidneys hinders their ability to remove excess sodium from
Reduced cardiac output from ineffective pumping
stimulates the kidneys to retain fluid. Retained fluid causes congestion in the
lungs and difficulty breathing. Excess sodium in the body results in the
release of a hormone called aldosterone that causes the body to retain fluid as
well. Fluid builds up in the body and causes congestion in the lungs, which
makes breathing difficult. Also, fluid may build up in the wall of your
intestines, which can make it difficult to absorb nutrients from your food. If
your body does not receive the nutrition that it needs, you will lose muscle
tissue and your body will not be able to fight off infections.
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