What type of diet do I need to follow?
If you have been diagnosed with heart failure, paying close attention to your diet is extremely important if you want to feel your best. You can help control symptoms related to heart failure by following a low sodium diet and limiting your fluid intake. Knowing which foods are okay to eat when on a low sodium (salt) diet is not easy at first, but reading food labels is a fast way to learn. The following section explains more about how to follow a low sodium diet and understand food labels. Be sure to check recommended websites for additional information (including delicious heart healthy recipes!).
Low Salt (Sodium) Diet
Sodium makes your body retain fluid (store water) which can strain your heart and lead to heart failue (HF) signs and symptoms. The average American consumes between 4,000 and 10,000 mg of sodium per day. Most people with heart failure are advised to limit sodium intake to less than 2,000 mg a day in order to keep heart failure symptoms at a minimum. Since one teaspoon of table salt contains about 2,300 mg of sodium, you should not add salt to your foods even when cooking. Your nurse or dietitian can help review your current eating habits and make recommendations for a heart healthy diet tailored to your needs. Your healthcare provider may advise you to read food labels, which will make you a more informed consumer. Reading food labels will improve your ability to identify foods that are either high or low in salt. If you have trouble reading food labels, you may try following these basic rules for lowering sodium in your diet:
- Do not cook with salt (in fact, remove the salt shaker from your kitchen table since there is already enough salt in natural and processed foods)
- Eat fresh or frozen vegetables (beware of frozen dinners high in sodium)
- Season with fresh or dried herbs, lemon, onion, or no-salt seasonings (see list below)
- Bake, broil, steam, roast or poach foods without salt — avoid fried foods!
- Eat lean meats
- Drink low fat milk
- Eat reduced sodium cheese
- Eat cereals low in sodium
- Make your own meals when you can (fast foods are usually very high in sodium)
- Avoid salty seasonings (such as soy sauce, monosodium glutamate or MSG, salad dressings, ketchup, and BBQ sauce)
- Avoid canned soups and broths (low sodium soups okay if you measure salt content)
- Avoid processed meats such as hot dogs, bacon, bologna, and other packaged lunch meats or deli meats such as ham
- When going out to eat, ask for sauces and salad dressings on the side, choose items that are listed as “healthy choice” or “low sodium”, and avoid fried foods.
- Beware of foods labels with the following terms that indicate high sodium content:
- Pickled
- Brine
- Cured
- Smoked
- Corned
- Seasoned
- Breaded
- Au gratin
- Barbecued
- Canned
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American Heart Association chart to illustrate sodium in the diet |
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1/4 teaspoon salt |
= 575 mg sodium |
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1/2 teaspoon salt |
= 1,150 mg sodium |
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3/4 teaspoon salt |
= 1,725 mg sodium |
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1 teaspoon salt |
= 2,300 mg sodium |
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1 teaspoon baking soda |
= 1000 mg sodium |
Is reduced sodium the same as low sodium?
No, the “reduced salt” label identifies a food that has been reduced in sodium content by more than 25% but still might not be truly low in sodium. Food labels that read “sodium free”, “very low sodium”, and “low sodium” more accurately identify low sodium foods.
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Sodium Guidelines Set by the FDA: |
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“Sodium Free” |
Less than 5 milligrams per serving |
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“Very low sodium” |
35 milligrams or less per serving |
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“Low sodium” |
140 milligrams or less per serving |
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“Reduced Sodium” |
Usual sodium level is reduced by 25% |
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“Unsalted, no-salt-added, or without added salt” |
Made without the salt that is normally used, but contains the sodium that is a natural part of the food itself. |
Steps to Reading a Food Label:
- Identify the serving size (especially since products often contain more than one serving)
- Read the amount of sodium per serving since nutrition amounts are usually calculated per serving
- You will need to calculate the total amount of sodium in all the servings eaten
How much sodium is contained in a full cup of the following?
Answer:
- Serving size here is ½ cup.
- Sodium content per serving is 150mg.
- If you eat a whole cup then you will be eating 300mg of sodium (150mg for each ½ cup serving or 150mg X 2 servings = 300mg).
Recommended salt substitutes for seasoning your dishes:
Herbs and spices contain trace amounts of sodium, which is of little concern. Below are herb and spice recommendations to infuse into your current recipes in place of salt:
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Herbs for lean meats, stews, soups, tomatoes, stuffing, vegetables, fish, and sauces Basil |
Spices for lean meats (such as lamb, veal, chicken, fish), tomatoes, fruits, breads, pie crusts All Spice |
Fruits and Veggies for lean meats, salads, poultry, and potatoes Bell Peppers |
Oils, Vinegars, Syrups, and Sweeteners for salads, vegetables, puddings, fruits desserts, and sauces Honey |
Learn further ways to reduce sodium in your diet:
- American Heart Association Recommendation for Sodium
- Heart Failure Society of America: Following a Low-Sodium Diet with Heart Failure
How to fix your high salt diet:
If you currently eat |
Replace with these foods |
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Breakfast: |
Pastries or frozen waffles |
Whole grain bread or raisin bread |
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Grits |
Plain cooked cereal with fresh fruit or cinnamon and raisins. |
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Vegetable juice |
Fruit juice |
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Salted Butter |
Jam |
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Lunch: |
Lunch meat or salami |
Baked chicken or turkey |
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Potato salad or coleslaw |
Garden salad with low salt dressing |
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Chips or fries |
Unsalted pretzels or nuts |
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Crackers |
Unsalted crackers |
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Dinner: |
Cured, salted, canned, or smoked meats like bacon, sausage, ham, corned beef, salt pork, bologna, hot dogs, dried beef, and potted meat |
Lean, fresh or frozen meats like sirloin steak, London broil, pork tenderloin, skinless chicken or turkey breast, fish or seafood (not breaded or fried), and low sodium canned fish in water |
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Canned or bottled spaghetti sauce |
Homemade sauce, no added salt |
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Canned vegetables or beans |
All fresh vegetables prepared without salt Low sodium frozen or canned vegetables |
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Frozen or boxed potatoes |
Boiled or baked potatoes |
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Soups: |
Regular bouillon, broth, or consommé |
Low sodium bouillon, broth, or consommé Low sodium, low fat commercial canned or dehydrated soups Homemade soup prepared without salt |
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Desserts: |
Instant pudding, ice cream, gourmet frozen yogurt, commercial cake mixes (Duncan Hines, Betty Crocker, Pillsbury, etc.), chocolate and butterscotch candy, peanut butter or cheese crackers, fried fruits, fruit pies |
All fruits and fruit juices |
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Miscellaneous: |
Salt, Sea salt, rock salt, kosher salt |
Pepper, herbs and spices |
Fluid Restrictions
Heart failure (HF) medications and fluid restrictions often leave patients with HF feeling thirsty. Even if you are thirsty, do not drink more than the recommended allowance. Instead, you should suck on frozen lemon wedges or ice to quench your thirst. Also, small amounts of hard sugar-free candy may help with a dry mouth.
Your healthcare provider may tell you to drink no more than 2 quarts (64 ounces) of fluid per day (or less in some cases). This fluid restriction applies to beverages, high-moisture fruits, yogurt, pudding, ice cream, ice cubes and any food that melts into a liquid. Chilled beverages are more refreshing and may help you drink less. Try to drink only when you are thirsty.
Potassium
Potassium is an essential mineral that must be kept within a narrow range on your blood test. Many diuretics cause a loss of potassium in the urine, threatening your normal potassium levels and predisposing you to life-threatening cardiac arrhythmias. Although many foods you eat contain potassium, often increasing the potassium rich foods in your diet alone can’t replace the amount of potassium removed by the diuretic (“water pill”).
If you take diuretics regularly, you will require blood tests several times a year to help monitor your potassium level (and other electrolytes such as Magnesium). If your potassium (or other electrolyte) is out of range, your medication regimen may be adjusted. You should understand which foods are rich in potassium so that you can alter your diet as necessary or as advised by your healthcare provider.
Examples of foods that are rich in potassium:
Bananas, orange juice, potatoes, avocados, lima beans, cantaloupes, peaches, tomatoes, flounder, salmon, and cod (all containing more than 300mg of potassium per serving). Other good sources of potassium include chicken, meat, and various other fruits, vegetables, and fish.
Alcohol
Because alcohol weakens your heart muscle, your doctor may advise you to reduce or stop drinking alcohol. If you have an enlarged heart due to excessive amounts of alcohol intake, your physician will explain to you the benefits of no alcohol consumption. Ask your healthcare provider if you should limit your alcohol intake or avoid it completely.
