Nutrition and Heart Failure: How to Manage Sodium Intake

When you have heart failure, your heart doesn’t pump enough blood to meet your body’s needs. As a result, you can experience a ripple effect of health issues.

“When you think about nutrition, the degree of your heart failure is relevant,” says Mary Hyer, RD, LDN, CCRP, a Mass General Brigham cardiac rehabilitation dietitian. “While nutrition is important at every stage of the condition, the more severe your heart failure, the more you have to consider your nutrition.”

Hyer cares for heart patients at the Elfers Cardiovascular Center at Newton-Wellesley Hospital, helping them develop healthy eating strategies to manage heart failure and other conditions.

Heart failure and sodium intake

Too much sodium (salt) causes your body to hold on to extra fluid. In heart failure, your body can retain more fluid than usual, which strains your heart. In advanced stages, fluid can accumulate, underscoring the importance of blood pressure control. That’s why it’s extra important for people with heart failure to manage their salt intake.

General dietary guidelines recommend limiting sodium to 2,300 milligrams or less per day. If you have a heart condition such as heart failure, your provider may advise that you keep your sodium intake even lower.

For context, the Food and Drug Administration reports that the average American consumes about 3,400 milligrams of sodium daily. When you consider that 2,300 milligrams is just one teaspoon of table salt, you quickly realize how challenging it can be to meet the recommendations.

Tips to lower sodium intake

The first step to controlling your sodium intake is to cook more of your meals at home so you can control how much salt is in your food. “Be mindful of how much salt you’re cooking with,” Hyer says. “Your palate is adaptable, and you can get used to using less.”

There are several other steps you can take to control how much sodium you eat:

Use herbs and spices

Learn to season your foods with more herbs and spices and experiment with using garlic, onions, or chili flakes. Or add fresh peppers for heat. Resist the urge to reach for a bottled sauce—they are some of the most common sources of hidden sodium in the American diet.

Learn to read nutrition labels

Every time you pick up a packaged food, look at the Nutrition Facts. In particular, notice three key parts of the label:

1. Ingredients: Does the ingredients list mostly contain whole foods? If there are many ingredients you don’t recognize, the food likely contains additives that may not be good for your heart health.
2. Sodium contents: Each nutrition label should say how many milligrams of sodium are in each serving. Less than 140 milligrams of sodium per serving is considered on the low side.
3. Serving size: At the top of the label, you should see the recommended serving size and how many serving sizes the package contains. Understand that the indicated milligrams of sodium are per serving. If an item contains 2 serving sizes and you eat the whole package, you’re eating double the amount of sodium listed on the label.

Beware food advertising claims related to sodium

Words like “reduced” and light” don't mean the food is considered low in sodium. They simply mean the item contains less sodium than similar products. And “no salt added” simply means the manufacturer didn’t use extra salt during finishing. It doesn’t speak to the amount of natural sodium used before finishing. It’s important to learn to read food labels so you don’t get tricked by these advertising buzzwords.

Mind your habits at restaurants

When you eat at a restaurant, it’s hard to know exactly how much sodium is in your food. This doesn’t mean you can’t ever go out to eat. But you should reserve a restaurant meal for special occasions and not for every day.

“It’s okay to want to enjoy yourself, just try to keep your health toward the front of your mind,” Hyer says. She recommends asking for higher-sodium ingredients, such as salad dressings, to come on the side, so you have more control over your intake.

Portion control is also crucial, and you may request that your server box up half your order before they even bring it to the table. “Don’t be afraid to ask for adjustments,” Hyer advises. “People with life-threatening allergies make special requests all the time. Restaurants are used to it, and it’s important for you to prioritize your health.”

Minding overall nutrition with heart failure

Sodium is one of the most important parts of your diet when you have heart failure. But it’s also essential to eat a nutritious diet overall. In particular, be mindful to:

• Avoid or limit alcohol: Even light to moderate alcohol intake can affect your heart. Specifically, it can affect your heart’s electrical system and the heart muscle itself. Because heart failure already affects how well your heart muscle works, people with the condition should consider abstaining from alcohol.
• Focus on fiber: Many people experience constipation as a side effect of heart failure medications, reduced physical activity, and fluid restrictions. Choose fresh fruits, vegetables, and whole grains to increase your fiber intake. Fiber supports better digestion as well as overall heart health.
• Lower sugar intake: Excessive sugar increases your risk of heart problems and other health conditions, such as insulin resistance and type 2 diabetes. The American Heart Association recommends limiting added sugars to less than 30 grams per day. On food labels, look at the “total sugars” to find “added sugars.”
• Stay hydrated: Staying properly hydrated, especially with water, is essential. However, as heart failure progresses, your doctor may instruct you to monitor your fluid intake and limit the amount you drink. Try to minimize caffeine, juices, sweetened beverages, and artificial sweeteners. Consider adding a slice of lemon to your water, drinking carbonated water, or sipping herbal teas.
• Watch for foods high in saturated fats: Your body needs some fats, but you should be aware of how much fat you eat to help manage your weight. It’s also important to limit saturated fats, such as red meats, dairy products, and processed meats, which can raise cholesterol. High cholesterol increases your risk of many heart problems and complications. Choosing healthy fats such as nuts, seeds, and fatty fish helps you maintain healthy cholesterol levels.

Managing heart failure long-term

Consistency is key to managing heart failure. Most heart failure-related hospital admissions are related to fluid retention and high sodium intake, Hyer notes. While an overall healthy diet is important for heart failure management, big changes can sometimes feel overwhelming. Focusing on just one key factor such as sodium can make a significant difference.

If you’ve been diagnosed with heart failure, ask your doctor if you qualify for cardiac rehabilitation. A cardiac rehabilitation dietitian can offer personalized guidance for managing heart failure. They look at your diagnosis, blood work, medications, and lifestyle to offer an individualized diet plan.