The Cardiac Diet:
You may have read that reducing salt intake from food is important for preventing high blood pressure, and kidney disease, but do you know why it is particularly important for people with heart failure?
Heart Failure is a medical condition in which the heart cannot fill with blood or pump blood effectively. When this happens, this creates a backup of blood that is not circulating through the body as it should which is called congestion. This backup can create a pooling of fluid in the legs and lungs, producing the symptoms of heart failure that are most bothersome including:
- Edema – most often swelling from fluid in the legs and ankles
- Shortness of breath – excess fluid in the lungs and poor oxygen exchange
Salt – sodium chloride – is made up of two elements that our bodies require to be kept within normal range. These electrolytes help regulate our water balance, namely our thirst and urination. Some salt is necessary, but most of us are getting too much. The American Heart Association recommends limiting daily sodium intake to 1,500 mg for patients with heart disease. Unfortunately, the average American diet contains about 3,400 mg – more than double the recommendation! To put this in perspective, 1 teaspoon of salt has 2,300 mg of sodium which is an acceptable daily amount for people without heart disease, but patients with heart disease should limit their daily intake to 2/3 of a teaspoon of salt which has 1,500 mg of sodium.
While some sources of salt such as fast food and french fries are more obvious, most of this excess salt actually comes hidden in processed and packaged foods. You might be surprised to learn how much salt is hidden in sweets like cookies or foods that are marketed as healthy like salted nuts. This is why it is important for patients with heart failure to read food labels and be aware of their salt intake.
Common suggestions for reducing salt intake:
- Remove the saltshaker from the kitchen table
- Exchange canned vegetables for fresh or frozen vegetables
- Reduce the times per week that you eat out at restaurants by cooking more at home
- Add flavor to food with spices and herbs or lemon and vinegar
If you are used to a high salt diet try to work in changes gradually. Trying to make all the changes listed above all at once and quit salt cold-turkey can result in cravings which make sticking to your new habits even harder!
Excess sodium intake is especially concerning in patients with heart failure because:
- Heart failure makes you particularly sensitive to fluid backup and retention because the heart is pumping less efficiently
- Certain medications for heart failure work in the kidneys where salt and water are regulated
- Similarly, some salt substitutes contain potassium which is known to interact with certain medications for heart failure. Some potassium can be beneficial for high blood pressure, but potassium can also cause heart problems when used in excess. Do not use salt substitutes before discussing it with your provider.
Self-Monitoring in Heart Failure and When to Call
If you have heart failure, fluid retention can be gradual over time or rapid after a salty meal so it is important to monitor yourself at home. You can self-assess for fluid retention by noting when you feel bloated or by looking and feeling for swelling in your legs and ankles. This can be somewhat subjective, so a more objective measure is your weight. For patients with heart failure it is recommended that you take a daily weight and monitor the trend to assess for fluid retention. Be as consistent in your measurements as possible! Take your weight at the same time each day, ideally naked or with the same clothes on, and keep a record.
If you record a weight increase of more than 3 pounds in a day or 5 pounds in a week it’s time to call your provider. They may want to see you in an appointment for a more throughout assessment or give you instructions on the phone of how to take your medicines. Either way it is best to be proactive and inform your provider of early signs of fluid retention so that the issue does not continue to get worse. Excess fluid is a common reason patients with heart failure are admitted to the hospital. The key is to be proactive and get instructions from you provider before that point.
When it comes to managing salt intake, you we more likely to stick with a change if it is viewed as a long-term lifestyle change rather than a restrictive diet. It takes time to for our tongue to become accustomed to less salt just like it takes time to build new healthy habits.