Diet to help control heart failure
Diet is critical in the treatment of heart failure. Sodium is the key nutrient that must be controlled in order to improve the status of your heart failure (prevent fluid buildup), but some other nutrients or substances also play a role as well. Heart failure can become more severe if diet and medication recommendations for heart failure are not closely followed. Medication and diet therapy are most effective when used together in the treatment of heart failure.
How does my diet affect my heart failure? 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 the body.
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. In addition, 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.
The role of sodium. The role of sodium in the treatment of heart failure cannot be overemphasized, especially as the condition progresses. If you consume too much sodium, it will cause your body to retain excess fluid. Excess fluid in the body will cause swelling, breathing difficulties, fatigue, and other unpleasant side effects.
Sodium intake is generally limited to 2,000 mg or less per day. Sodium allowance in heart failure is not greater than 3,000 mg in any case. Even if you are taking diuretics to remove excess water from the body, you still need to limit sodium intake.
The initial step should be to get rid of salt at the table, followed by elimination of salt in cooking, and finally the start of a low-sodium diet (decreasing the amount of sodium obtained from packaged foods, beverages, and medicines). You should weigh yourself in the morning after urinating, but before you eat or drink anything. If your weight changes drastically [by more than 0.9 kg (2 lb) to 1.4 kg (3 lb) in a 2-day period or more than 2.3 kg (5 lb) in a week], you should call your doctor.
Why fluid intake is important. Fluid intake is not routinely restricted. It may be restricted in advanced cases (usually 1,000 to 2,000 mL per day) to maintain your body's 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.
The role of potassium. Some diuretics are potassium-sparing, others are not. The aggressive use of diuretics that are not potassium-sparing can cause your body to lose too much potassium. Potassium plays a major role in the regulation of your heartbeat, so it is essential that the proper balance of potassium be maintained in your body. If potassium is lost as a result of diuretic use, it must be replaced. Replacement of potassium can be achieved by including foods with a high potassium content in the diet or by using potassium supplements.
Significant sources of potassium in the diet include:
- Meats.
- Poultry.
- Fish.
- Legumes
- Nuts.
- Milk and milk products.
- Whole grains (bran cereals, pumpernickel bread).
- Fruits (bananas, oranges, cantaloupe, strawberries, apricots), and especially dried fruits (raisins and prunes).
- Vegetables (potatoes, greens, cabbage, broccoli, tomatoes, carrots).
Salt substitutes that contain potassium chloride can be used as a potassium supplement. However, these should be used only if your doctor recommends or approves them for you. Excess potassium can be as bad for your health as not having enough potassium. Your doctor will be able to tell you what level is safe for you; always ask your doctor before using any type of dietary supplement, including salt substitutes.
Other minerals and vitamins. Just like potassium, blood levels of magnesium are generally low with extensive diuretic use. Magnesium plays a role in holding on to potassium in the body; therefore, if you need to replenish potassium, you need to consume enough magnesium as well to optimize the body's ability to retain the potassium you are consuming.
Good food sources of magnesium include seeds, nuts, legumes, unmilled cereal grains, and dark green vegetables. 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, greens, and kale. Good food sources of zinc include meat, fish (especially oysters), poultry, and milk and milk products.
As mentioned previously, thiamine deficiency is a possible cause of heart failure, although this is extremely rare. Thiamine supplements of 200 mg per day have been shown to improve left ventricular function and removal of excess fluid and sodium from the body in people with moderate to severe heart failure who had been on large doses of diuretics for an extended period of time. Adequate intake of other vitamins thought to be important for general heart health (folic acid, riboflavin, and vitamins E, B6, and B12) is recommended as well. The following are good sources of these important vitamins:
- Vitamin E in wheat germ, vegetable oils (olive, canola, corn, sunflower, safflower, and soybean), nuts (especially almonds), and seeds
- Vitamin B6 in pork, poultry, whole grains, fortified cereals, bananas, and legumes
- Vitamin B12 in meat, fish, poultry, eggs, and milk and milk products. This vitamin is not found in plant foods; it is present only in animal products.
- Folic acid in dark green leafy vegetables, whole grains, legumes, nuts, and orange juice
- Riboflavin in milk and dairy products and dark green vegetables
A multivitamin/mineral supplement is often recommended for people with heart failure who are undernourished or are unable to completely meet their nutritional needs through dietary intake.
Restricting alcohol and caffeine. Drinking alcohol should be strictly limited (to no more than 1 drink
per day, and only if approved by your doctor) or eliminated altogether. Alcohol consumption can make high blood pressure worse and cause further damage to the heart. In addition, heart failure can often cause poor appetite due to the feeling of fullness that excess fluid accumulation causes and due to fatigue and breathing difficulties. If alcoholic beverages are consumed, they will likely take the place of foods or other beverages that would have provided nutrients that your body needs.
Caffeine can increase heart rate and cause changes in your heart rhythm. Intake of caffeine should, therefore, be limited as well.
About calories and protein. In severe heart failure, more calories are often needed because of the increased workload of the heart and lungs. Calorie requirements will vary, however, based on your current nutritional status.
If you are obese, a gradual weight loss will be beneficial for you, because it will help relieve some stress from your heart and make it easier for you to breathe. 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.
In individuals 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 with 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 medications used to treat it.
The body's increased energy demands along with the obstacles to sufficient intake can often lead to malnutrition in people with heart failure. It is estimated that between 50% and 68% of persons with heart failure are malnourished. 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 possible.
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 after meals.
- Use more of your sodium allowance at your best meal time of the day to maximize food intake.
- Avoid spicy foods and gas-forming vegetables (such as beans, broccoli, cauliflower, Brussels sprouts, cauliflower, cabbage, and onions) if they cause you discomfort (heartburn, feeling of fullness, and gas).
- Add non-fat dry milk to gravies, sauces, mashed potatoes (to increase protein intake).
- Add butter to vegetables, breads, hot cereals. Use olive oil to saute foods and top breads.
- Try nuts, peanut butter, and dried fruits for snacks.
- Talk to your doctor 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 per can will provide a lot of nutrition in a smaller volume.
Do I need to limit the fats I eat? Follow a low-fat, low-cholesterol diet if you have atherosclerosis.
Taking your medications 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 assist you in making needed dietary changes by providing meal-planning guidelines that are realistic and specifically tailored to your individual needs and preferences.
| Author: | Douglas Dana Robin Parks, MS | Last Updated: October 23, 2006 |
| Medical Review: | Adam Husney, MD - Family Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology | |
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