Nutrition Guide for Heart Failure

(2,000 mg sodium and fluid limited to 1.5 to 2 L per day)

Following a low-sodium diet and drinking less fluid 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 of high sodium foods, you have to be sure to eat enough to maintain good nutrition.

Nutrition and Heart Failure

Salt

 

The recommended salt intake is 2,000 mg of sodium per day.

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 when you have heart failure can cause fluid buildup in your legs, stomach and lungs and force you heart to work harder.

Most of the sodium we eat is hidden in foods. Even food that does not taste 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!
75% of the salt in the Canadian diet is hidden in processed foods.

Reading 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.

Low-Sodium Foods

low sodium foods

High Sodium Foods

high sodium foods

 

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.”

Finding Low-Sodium Recipes

1. Try a new cookbook:

The following associations offer low sodium recipe books:

  • Dietitians of Canada
  • American Heart Association

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.

  • Visit www.google.ca.
  • Type “low-sodium recipe” into the search screen.

Good websites to check out for recipes are:

low sodium recipes

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 
  • Baked potato
  • 5 oz. wine
  • Fruit salad or sorbet

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.
  • Ask your pharmacist about artificial saliva.

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.

  • 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 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.

If Your Appetite is Poor

Sometimes, when you are feeling sick, your appetite can decrease. You may lose muscle weight quickly and without trying. If you feel this is the case, please let your doctor know. You might need to be referred to a registered dietitian.

Here are some tips to help if your appetite is poor:

  • Eat smaller amounts of foods more often. Try eating every 2-3 hours.
  • Eat more food when your appetite is best.
  • Make every bite count. Eating half of a meal is still better than having nothing.
  • Ideas for nutritious snacks include: whole grain crackers and peanut butter or hummus, a piece of fruit and some cheese, frozen berries with granola and plain Greek yogourt or an egg, chicken salad or tuna sandwich.
  • Opt for milk, milkshakes, yogourt beverages or oral nutritional supplements such as Ensure instead of low energy fluids such as water, broth, tea or coffee.
  • Have easy to prepare meals and snacks readily on hand for when you don’t feel like cooking. Suggestions are: granola bars, unsalted nuts, Greek yogourt, pudding or cheese and crackers. 
  • You might want to use a service like Meals on Wheels or ask friends and family to help you with groceries and making your meals.
  • Add fats and oils at each meal. Top your salads, vegetables, pasta or rice with a few teaspoons of liquid oil such as olive or canola. Spread margarine or butter on your bread, vegetables and potatoes. This will increase the energy content of your food.
  • Avoid reduced-fat foods such as foods labelled “light”, “low fat” or “fat free”.
  • Try adding powdered milk to your soups, breakfast cereal, puddings or scrambled eggs for extra protein.