Meal Planning: The Best Foods to Manage Heart Failure with Julia Zumpano, RD

Podcast Transcript

John Horton:

Hey there and welcome to another Health Essentials Podcast. I'm John Horton, your host. Heart failure is as serious and life-threatening as it sounds. It's the medical term for when your ticker can't quite pump enough blood to meet your body's needs. There's no known cure for heart failure. What you eat can help you manage the condition and minimize its impact. So, what food should and should not be on your plate? That's what we're going to chat about today with registered dietitian Julia Zumpano, who is back for another turn in the podcast guest scene. She is one of the many experts at Cleveland Clinic who pop into our weekly show to help us live healthier lives. So, with that, let's learn how eating right can help you live your best life with heart failure.

Welcome back to the podcast, Julia. So glad you were able to carve out a little time on your calendar and come back and chat with us.

Julia Zumpano:

Thanks so much for having me today, John.

John Horton:

Well, we always love it. And today, we are talking about what you eat and how it affects your heart, and I'm guessing that that is a topic that comes up every now and then given your role as a preventative cardiology nutritionist.

Julia Zumpano:

It sure does, all the time.

John Horton:

So, do most people think that there is that sort of connection? You think of your stomach, you don't think of food affecting your heart. Is it that big of a thing?

Julia Zumpano:

Absolutely. Everything we eat affects our whole entire body, including our heart. So really, we want to make the best choices we can to support all of our body, including our heart.

John Horton:

Just to get us started, from what I read, it seems like there's one tip in particular that is just the big one, which is reduce sodium intake. Tell us why.

Julia Zumpano:

Yeah, sodium is an extremely important mineral to reduce in your diet when you have heart failure. So, sodium is responsible for the balance of fluid in the body. So, the more sodium we consume, the more fluid we can absorb and hold onto our bodies. Now, if we are not very efficient at getting rid of sodium, it can cause more fluid buildup and increase your blood volume, put more pressure on your blood vessels. It can also put more strain and pressure on your heart to pump this extra blood, and your heart gets tired. So, it starts to pocket this extra fluid in certain spots in your body. It could be your hands or your feet, it could be your chest or your lungs, your abdomen. We can carry fluid in all of those areas. So, if your heart is not working appropriately to remove this extra fluid, then we want to reduce your sodium intake to reduce the amount of fluid retention that we will have in the body.

John Horton:

So obviously you want to cut down on your sodium. And let me ask you this. I think a lot of people confuse sodium and salt and they think that they're the same thing, but they're not, right?

Julia Zumpano:

Sure. So salt is made out of sodium chloride. So, salt essentially is a form of sodium that we can consume in the diet. So, we want to be very cautious about how much salt or table salt we're using. All forms of table salt - whether they're Himalayan or pink or sea salt - they all contain sodium. So, you want to be mindful of all of them. Sodium can also be used as a preservative in many foods. So, although we may not be adding sodium, we could still be consuming a very high-sodium diet because the food that we're consuming already has sodium added as a preservative.

John Horton:

Well, and that's where I think a lot of the misunderstanding comes in. People think to just go low sodium, it's just a matter of hiding the saltshaker that's on your table and putting it away. But it sounds like you need to do a lot more than that. And I'm guessing, then, this is where we start talking about reading food labels and looking for sodium in food there.

Julia Zumpano:

Absolutely. The first step is definitely to omit the saltshaker or any forms of added salt. We want to be sure that we are looking at other seasonings, too, that are in our cupboard because there's a lot of spice blends and seasonings that contain salts mixed in with other herbs. So, we want to be mindful of those as well if they're containing salt.

Next, we do really want to look at those nutrition labels. We really want to read the labels for sodium, and my general rule is to try to keep a single food item under 140 milligrams of sodium per serving. So, we really want to look at that. So, the average amount of sodium that someone who is on a heart failure diet or plan should limit to is about 2,000 milligrams per day. So that comes out to be less than what's in a teaspoon of salt. So, a teaspoon of salt has 2,300 milligrams of sodium in it, just a small teaspoon. So that's why it's so important to omit any added salt first and then to start to look at labels and really compare labels and really look for that sodium milligram dosage on the label.

Another thing you want to look at is the ingredient list and make sure there aren't any ingredients that say salt- or sodium-based ingredients. And if there are and there's just a small amount, we know kind of what that criteria would be, that cutoff of 140 milligrams of sodium per serving of a single food item. We do lump that together, maybe look at a whole meal and combine that, keeping a meal around 600 milligrams of sodium or less. But that can be variable meal by meal, day by day, as long as you keep your day's allotment below 2,000.

John Horton:

I can't believe it. 2,000 milligrams sounds like it should be a lot. I can't believe it's less than a teaspoon. That's incredible.

Julia Zumpano:

Yeah, and teaspoons add up so quickly. I often advise my patients to fill an empty saltshaker with about a quarter of a teaspoon of salt, and that provides them with a little less than 600 milligrams of sodium. And if they wanted to have that little allotment of salt that they can use day by day, that gives them a little bit to add for the day, but then they would need to further reduce their daily intake to about 1,500 milligrams.

John Horton:

That's a fabulous tip, Julia. And I know you mentioned a little bit about how sodium can be hidden in foods, and I know a lot of times, I'm amazed when I look at the food labels for some kind of pre-packaged or processed foods with just how much sodium is in there. It's staggering sometimes.

Julia Zumpano:

Absolutely. There is a tremendous amount of sodium in store-bought products, specifically convenience foods such as frozen meals or box prepared meals — canned foods, canned meals, canned meats, processed meats are extremely high in sodium. And surprisingly, one of the most common sources of sodium that Americans eat are bread products. So, bread and bread products contain a large amount of sodium per serving. And then, the volume that we eat as Americans is so vast when it comes to bread products, that we're really consuming a large portion of our sodium intake from that category of foods.

John Horton:

It's amazing how it's just hidden in all these places. Why is that? because obviously too much sodium is not good for the human body. So how does all this sodium end up in these food products?

Julia Zumpano:

It's a very simple preservative to use. It's inexpensive, it's effective. So really, it's mainly because of the need to preserve foods. I think we're, as a society, highly dependent on convenience foods and these foods need to be preserved in some way, and sodium is really one of the best ways to preserve these convenience foods. So, we want to try to take a step back and see if we can add a couple of steps to the preparation process with our meals and we can save a tremendous amount of sodium in our day that way.

John Horton:

Well, since we can't take you with us every time we go to the store, as much as we would love to — because I think then, we'd know we were getting good stuff — can you give us some tips as to what we should be looking for when we're filling our carts and getting ready to fill our pantry and fridge back home?

Julia Zumpano:

Sure. That's a great question. So, I often suggest you try to shop outside of the grocery store. So, we think about what's on the outside. We have your produce, we have your fresh meat, your fresh dairy. So, we're really looking at fresh ingredients. So fresh fruits and vegetables have no, if very, very little natural sodium. And we are never concerned with the amount that's in naturally fresh food.

John Horton:

I have to say, I've never talked with a dietitian yet and had you said, "Don't eat veggies." So that's all, those are good?

Julia Zumpano:

Always, always eat your veggies. Nutrient-packed. So obviously, fruits and veggies, fresh meats, dairy products. So, we want to look for yogurt and milk that aren't very high in sodium. Now cheese is the area of dairy that we do get into some trouble when it comes to sodium. So, we really want to choose fresh or more natural cheeses that are low in sodium. So, if you have a deli and you can ask for low-sodium cheeses, that would be great. Swiss and fresh mozzarella are naturally lower, so lower in sodium cheeses, as is brick and goat cheese. So, we really want to stick to those types of cheeses. Again, label-reading is going to be key here. So, we really want to focus on the outside of the grocery store. And in nuts and seeds, as long as you choose them unsalted, those are great.

Grains that are fresh grains, just plain brown or wild rice or oats. Again, very, very low, if any sodium at all. If you are going to choose beans, again, dried beans if you can, that can be kind of a tedious process to cook the beans yourself. If you're going to choose canned foods just because you really do need that convenience factor. There are low-sodium or no-salt-added canned foods, specifically things like beans or vegetables if you're going to make a soup or even broths if you're going to make a soup. So, you really want to look for that low-sodium or no-salt-added when it comes to canned foods. And they still can be incorporated and give you convenience without the added sodium.

John Horton:

And I know you had mentioned rice, and rice is always one of those things that amazes me because I know if you just get regular long grain rice and just plain rice, I'd imagine there's very little sodium in that, as opposed to if you get one of those pre-done boxes, and those are the ones that always just blow my mind when I look at the sodium that's in there. So do the things where you have to cook it and you have to prepare it as opposed to where it's pre-done.

Julia Zumpano:

Yes, those dry powder packets inside dishes like the rice you mentioned, or even the noodle packets, or even the potato palette packets like those scalloped potatoes, anything that has that dry powder packet, that's most likely going to be loaded in sodium. So, you really want to cook everything fresh on your own if you can. If can't or you have a whole cupboard of those box prepared side dishes, you can make the rice or the potatoes or the noodles and either use half the packet or quarter of the packet or none of the packet at all and just season it on your own with what you have in your cupboard that is low-sodium or salt-free.

John Horton:

See, it’s these great tips why we keep asking you to come back.

Julia Zumpano:

I appreciate it.

John Horton:

So, you were talking about preparing food there. So even if you get the best ingredients at the store, obviously, you can mess that up if you prepare it incorrectly. So, what sort of things should you be looking at once you get home and you start getting your meals together when you're cooking with the food — what you should avoid using, what you should lean toward using?

Julia Zumpano:

Obviously, we want to look at, of course, any high-sodium condiments or additives you're putting into your food. So salt, we've already addressed that, but there's a tremendous number of condiments that are very high in sodium. Sauces, salad dressing, such as, like a teriyaki or a soy sauce, Worcestershire sauce, bouillon cubes or the jarred bouillon. Those are extremely high in sodium. Some of the seasoning salts. So, all of those products, even things like salad dressings, have a tremendous amount of sodium. Marinades.

So, you really want to take an extra look at what you're adding to that fresh meat to marinate it in or what seasoning it with. So really looking through the cupboard, reading labels, looking at the ingredients and being very aware of which ones, which condiments are very high in sodium and being able to find good alternatives or replacements for those. And like I mentioned, herbs and seasonings are a great way to go. They don't have any sodium. Low-sodium broths of all kinds are great. I often recommend something called coconut aminos. It's an alternative to soy sauce. It's not necessarily low sodium, but it's drastically lower than traditional soy sauce. So, I recommend that often and it has a very similar taste.

I also recommend something called nutritional yeast. Nutritional yeast is often used for plant-based diets for a cheese alternative, but it's really just a seasoning and a spice and can almost taste a little cheesy and it has very, very little sodium. So, I often recommend that as a nice spice, especially if you're trying to back off on cheese and you want something that's kind of going to give you a little bit of that similar flavor. I'd recommend that a lot. So, looking at fresh herbs, again seasonally, we're walking into a season now, spring and then summer, where we can get a lot of fresh herbs. Fresh herbs add so much more flavor than dried herbs. So, using fresh herbs as often as you can is going to add so much flavor that you won't need so many condiments and sauces and additives to your foods to add flavor.

John Horton:

Fresh always seems to be the way to go. So, we've talked about what to do with that. What food should you absolutely look to avoid when you're at the store?

Julia Zumpano:

Well, when your grocery shopping, you really want to look to avoid those very heavily processed meats. So those can be loaded in sodium.

John Horton:

And the lunch meat you're talking about, right? Lunch meat and hot dogs and sausages?

Julia Zumpano:

It could be deli meat, but it also could be processed meats like in the form of bacon, or sausages, or hot dogs. Those are also high in sodium as well. So that's probably one of the biggest categories that I think on average Americans consume greatly that we really want to avoid. Even the low-sodium versions of those can still contain a large amount of sodium. So that doesn't mean we have to completely avoid those, but just be mindful of that. If you're choosing the low-sodium variety, just know that they still do have a good decent amount of sodium. So just be mindful of the portion and frequency of those foods.

John Horton:

Where do those fall in the, you had said the 140 milligrams, to shoot for the bar? I take it most luncheon meats would be far over that?

Julia Zumpano:

Well over that. Even the low-sodium versions are going to be well over that. So, they'll probably be like in the 300s, maybe 400s per serving. A good example is soy sauce. So, I have a lot of my patients saying, "Oh, I use low-sodium soy sauce." Well, a teaspoon of soy sauce has about 1,000 milligrams of sodium.

John Horton:

Wow.

Julia Zumpano:

The low-sodium soy sauce only has half the sodium, so it's only cut out 50 percent of the sodium, but it's still over your meal's allotment in a teaspoon. So, you just want to be really, really mindful, even though it says low-sodium or 50 percent less salt. If you're starting with a product that has half of your day's allotment in a teaspoon, you're really not making huge headway towards a low-sodium diet when you're choosing such high-sodium condiments.

John Horton:

Half is better, but it's not getting you where you need to go.

Julia Zumpano:

Yeah, it's just such a large contributor that you are going to have to limit so much in other areas that I often recommend, pick and choose where your favorite sodium foods are, your favorite sodium choices are, whether they're in a food or you just like to add salt and give yourself an allotment for that, like a little bank of sodium for that, and then adjust the rest of your day to be able to incorporate that on a regular basis. So, it's not about deprivation, it's not about just avoiding everything. It's about getting the knowledge and education on what a low-sodium diet means and how you can start to incorporate the foods that you really enjoy and want to eat by backing off on other areas so you can still enjoy the food, because we really want to find joy in what we're eating. It's very important to still be happy and joyful around food. And oftentimes, when we feel so restricted, that joy is, unfortunately, taken away.

John Horton:

Yeah, no, that's great advice. So, you should learn to embrace that pinch as opposed to that long shake that a lot of people do.

Julia Zumpano:

Absolutely. Yeah. And as you go on following a low-sodium diet, your taste buds will change and something that didn't taste salty to you in the past will taste extremely salty to you after adhering to a low-sodium diet for even a week or two.

John Horton:

Wow. It's amazing that your body and your taste buds adjust that quickly.

Julia Zumpano:

Mm-hmm, and the benefit of expelling all the extra fluid you're losing, you'll feel so much better. You'll be able to breathe better, move better. It'll all just come together, and it'll be more reinforcing, as well as you feel better. It'll be easier to follow the restriction.

John Horton:

Now we focus so much on eating, which is obviously a big part of it. I don't want to forget the talk about just actually drinking, I mean just drinking fluids. And I saw in some of the research I was doing ahead of this that there's recommendations that you should limit how much you drink per day, just regular fluids, to help your heart and help with heart failure. Why is that?

Julia Zumpano:

So, a note on fluids, not everyone needs to follow a low-fluid diet. So, some patients need more support when it comes to restricting fluid because they're still holding on to so much extra fluid and the mechanisms that they're using to help expel the fluid may not be working as efficiently as the clinician may hope for. So not all heart failure patients need to be on a fluid restriction. So that's something really important to know.

You can ask your doctor — I'm sure your doctor will advise you towards a fluid restricted diet when you need one. But I would say probably 50 percent or less of my heart failure patients are also actually on a fluid restriction. But the reason for following a fluid restriction is that if you are retaining fluid and your body's having trouble getting rid of it and you're consistently adding more fluid, it's just going to cause your body to retain more fluid. So, by restricting your fluid intake, we restrict the ability for more fluid retention.

John Horton:

That makes a lot of sense. So, you've given us a ton of low-sodium information to digest. So, before we say our goodbyes, is there anything else you'd like to add?

Julia Zumpano:

Well, one last note, and I always like to add this little tip when it comes to any dietary changes, when you're making a change in your diet, even if it's a long-term or short-term plan, we're starting new foods and we're trying new things and oftentimes, we may not enjoy them the first time we try them, but I think it's important to try something at least more than once. Whether it's a new recipe, or a seasoning, or a sauce, or whatever it may be, give yourself at least two times to try something new before you discount it or dislike it. So have an open mind, keep an open mind, and keep very flexible goals when it comes to nutrition.

John Horton:

Perfect way to wrap things up. So, thanks again for joining us, Julia, and I look forward to having you back.

Julia Zumpano:

Thank you so much for having me.

John Horton:

Millions of people are living with heart failure and those who do best in this situation typically make dietary changes to minimize it. The choices you make at the table will go a long way toward determining the life you can live with the condition. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.