Nutrition Guide for Heart Failure

Following a low-sodium diet and drinking less fluid (2,000 mg sodium and fluid limited to 1.5 to 2 L per day) can help you feel better and allow your heart failure medicines to work better. A low-sodium diet may even keep you out of the hospital.

It is not an easy diet to follow. You may find eating with heart failure is a bit of a balancing act. While you don’t want to eat too much, you have to be sure to eat enough to maintain good nutrition. 

Nutrition and Heart Failure

Salt

Salt is a mineral that is made of sodium and chloride. It is found in food, table salt and sea salt. Sodium acts like a sponge and makes the body hold water. Eating too much sodium can cause fluid buildup in your legs, stomach, and lungs and force your heart to work harder. 

Most of the sodium we eat is hidden in foods. Even food that does not taste particularly salty can contain a lot of sodium.

You should restrict the amount of sodium you eat to 2,000 mg or less each day. Try to keep the sodium content of each meal to less than 600 mg. This helps spread out your sodium intake over the day to prevent excessive fluid retention.

You can take a few basic steps to reduce the amount of sodium in your diet: 

  • Don’t add salt when you cook or at the table 
  • Learn to read food labels 
  • Choose more foods that are lower in sodium 
  • Limit high sodium foods

Did You Know?
One teaspoon salt = 2,300 mg of sodium, more than your daily limit of sodium!
Two-thirds of the salt in the Canadian diet is hidden in processed foods.

How to Read a Food Label for Sodium

Reading food labels is the best way to be sure of the sodium content of foods. The sodium content must be listed on the package—check the Nutrition Facts panel. Follow these easy steps to read the label.

How to Read a Food Label: Step 1: Look at the serving size. Step 2: Look at the sodium/serving. Compare that serving with the amount you might be eating. Step 3: Choose foods with less than 200 mg sodium/serving or 8% Daily Value (DV).

  • This food has 250 mg of sodium in ½ cup. 
  • This food is not a good choice. 
  • If you eat 1 cup of this product, you will be eating 500 mg of sodium.

Avoid or Limit These High-Sodium Foods

Salt, fast foods, hot dogs, smoked meats, pizza, cheese, canned beans, sauces and seasonings, snack foods, salted crackers, vegetable juice, bouillon cubes or powder, pickles, olives, Chinese food, cold cuts, bacon, sausages, canned soup, frozen meals, canned vegetables, soy sauce

Choose These Low-Sodium Foods More Often

Fruit, fresh fish and seafood, fresh meats (roasted, baked, boiled or poached), yogourt, milk, fresh & frozen vegetables, lemon, oils, vinegars, dried beans, whole oats, unsalted crackers, eggs, unsalted nuts and nut butters, rice and pasta, spices and herbs, onion and garlic, canned low-sodium soup, angel food cake, hard or soft rolls, plain bread or toast, sherbet and fruit sorbet

When You Eat at Home

  • Reduce your salt gradually to give your taste buds time to adjust.
  • Instead of adding salt to food when you cook or eat, season foods with herbs and seasonings that do not have salt.
  • Avoid “instant” foods that come in a bag or a box.
  • If you must eat canned goods, rinse the foods before cooking and eating them.
  • When grocery shopping, choose items from the outer aisles, where most of the fresh foods are found.
  • Plan your meals ahead of time (e.g., grill an extra chicken breast to use in sandwiches the next day).
  • Make your own or choose low-sodium sauces.
  • Make salad dressing with fresh garlic, herbs, olive oil and flavoured vinegar.
  • Add seasonings to soups during the last hour of cooking for maximum flavour.
  • At the grocery store, choose items labelled “no salt added” or “low sodium.”

 Drawing of recipe books and cardsFinding Low-Sodium Recipes

1. Try a new cookbook:

  • American Heart Association Low-Salt Cookbook, 4th Edition: A Complete Guide to Reducing Sodium and Fat in your Diet. American Heart Association. New York: Clarkson Potter, 2011.
  • Hold the Salt!: 50+ Quick & Easy Recipes to Help You Eliminate Salt from Your Diet! Maureen Tilley. Halifax, Nova Scotia: Formac, 2009. 

2. The Internet is an endless source of low-sodium recipes. Try searching for your favourite low sodium recipes. Use a search engine, such as Google, to find others. Type “low-sodium recipe” into the search screen.
 

When You Eat Out

  • Ask for food cooked with no salt.
  • Do not use the salt shaker.
  • Avoid cheese or sauces.
  • Avoid fried foods—choose grilled, baked or steamed items.
  • Choose oil and vinegar salad dressing.
  • Avoid bacon, sausage and ham.
  • Request that foods be served without the high-salt condiments or sides (e.g., avoid relish, mustard, ketchup, pickles, potato chips, sauces and dressings). Ask for low-salt substitutions, such as tomatoes, cucumbers, lettuce, horseradish, oil and vinegar, and lemon.
  • Eat foods in their fresh states because fresh foods are naturally low in sodium. Try grilled vegetables or fish rather than battered and deep fried.
  • Ask for dressings and sauces on the side so you can control how much you add. 
  • A quick rule of thumb for fast food dining is to limit your sodium intake at one meal to ¼ of your total salt/sodium for the day (about 600 mg of sodium per meal). Most restaurants have a guide listing the sodium content of their food items.
  • Bring half of your dish back home with you.
  • If you can’t avoid eating a high-sodium meal occasionally, cut down on the portion size and make low-sodium choices for the other meals of the day. For example, if you are celebrating a holiday and you know your dinner will be higher in sodium than usual, make sure to choose low-sodium options for your other meals.

Example of what to order when dining out:

  • Grilled steak or chicken 
  • Salad with balsamic vinegar and oil on the side so you can keep the portion to a small amount 
  • Steamed or roasted vegetables 
  • Angel food cake, fruit salad or sorbet 
  • Roll or bread stick 
  • 4 oz. white wine

Fluids

The recommended fluid intake is 1,500 mL (6 cups) to 2,000 mL (8 cups) per day.

When you have heart failure, you will be asked to reduce the amount of fluid you drink in a day. This is because the more you drink, the more blood there is in your body, and the harder your heart has to work to pump it all. This can cause swelling in your feet, legs or belly. Fluid can also build up in your lungs, which may cause you to have trouble breathing. 

Find the Fluid 

Any food or drink that is liquid at room and body temperature is considered a fluid. These items should be counted into your daily fluid intake.

  • Water
  • Milk
  • Juices
  • Soft drinks
  • Tea
  • Coffee
  • Alcohol
  • Soup
  • Ice cubes
  • Jell-O™
  • Ice cream
  • Sorbet

 Arrow pointing from large glass of liquid to a small glassTips to Reduce Fluid Intake

  • Drain excess fluid from canned fruit. 
  • Use smaller cups, bowls and glasses. 
  • If you can, swallow your pills with soft food, like yogourt or applesauce. 
  • Sip your fluids slowly

Thirsty?

  • Snack on a small piece of cold or frozen fruit, such as a frozen grape or cold orange slice.
  • Brush your teeth often.
  • Rinse with chilled, alcohol-free mouthwash.
  • Suck on hard candies or chew gum—try sugar-free varieties.
  • Add a few drops of lemon juice to the water you drink.
  • Use lip balm to keep your lips from drying out.

Track Your Fluid

Measure your fluid intake over 24 hours until your fluid limit becomes routine. Fill a pitcher with water to equal your total daily fluid allowance. Every time you drink fluid, pour out an equal amount of water from the pitcher. The amount of water remaining is your fluid allowance for the rest of the day.

 A measuring cup of liquidWater Weight

Day-to-day weight gain is usually fluid gain, not weight gain by calories.

  • Weigh yourself every morning using these tips:
  • Empty your bladder before getting on the scale.
  • Weigh yourself in the same amount of clothing.
  • Weigh yourself before breakfast.
  • Buy a digital scale and use the same scale each day.
  • Record your weight daily.

A sudden weight gain when you have been eating a normal amount may be an early sign of fluid buildup.

If you notice muscle wasting and significant weight loss, you may need one-on-one counselling with your doctor or nutritionist.

Important

Call your nurse or doctor if your weight increases more than 2 pounds in one day or 5 pounds in a single week. Your diuretic dose or water pill may need to be increased.