Nutrition and Heart Failure

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy!

Amanda Vest, MBBS:

Hello, Amanda Vest here, and I'd like to talk with you today about nutrition advice specifically for patients with heart failure and their caregivers. We're going to talk about salt and water restriction as well as recommended dietary patterns for patients with heart failure. I'm also going to touch on situations where patients experience weight gain or weight loss and how we may manage that.

Now, sodium/salt restriction remains a little bit controversial for patients with heart failure. You may have heard different guidance along the way with your heart failure journey. What we do think is that where the sodium goes, the water tends to follow, meaning that patients who take a larger amount of dietary sodium do tend to have more water stay on their body.

For example, in their lungs, around the abdomen or in their legs. The recent very nice clinical trial to address this issue and give some guidance. The researchers recruited 806 patients across six countries and randomly assigned them to either standard of care or a sodium restricted diet of less than 1,500 milligrams per day.

That sodium restriction was effective. On average, the sodium restricted group took in 450 milligrams less of sodium per day than standard of care. The results were somewhat surprising, there was actually no difference in survival or heart failure hospitalizations between the two groups. Although, the patients who took the lowest sodium diet did tend to feel better.They had improved patient reported health status on standard questionnaires. This emphasizes for us that there may be benefit for patients with congestion, which is fluid overload in their body to follow a lower sodium diet.

Now, the exact sodium limit will depend upon your local clinical care. Ask your team if you're not sure. Many centers would recommend limiting to around 2,000 milligrams of sodium a day. This is supported by a recent clinical practice guidelines for heart failure, where for patients with heart failure avoiding excessive sodium intake is a reasonable intervention to reduce congestion.

A little less certain as to whether fluid restriction is useful. Really, there are only a few scenarios where the blood levels of sodium are very low that a doctor would recommend you to keep low on your fluid intake. If you are following a strict fluid restriction, maybe that's something you want to talk to your care team about. It may not be necessary to keep really low on your water intake.

Hopefully, you've received some guidance such as this when trying to limit sodium rich foods. You want to be on the lookout for some of the higher sodium type meals. On the other hand, there are freshly prepared foods such as lean meats, fish, vegetables, and healthy fats, oils, and eggs that are good to eat and can be very low in sodium.

Now, sometimes we've had a tendency to just categorize foods as bad versus good, and that may not always be helpful. I think what we do want to help you to achieve is a dietary pattern where you are able to enjoy your foods and eat very healthful foods that fuel your body and promote your overall cardiovascular health.

We were very keen to point out that overly restrictive dietary counseling, for example, that which focuses just on cutting out salt or cutting out other elements of the diet can lead to patients having inadequate nutrient intake. It may even prompt malnutrition or unintentional weight loss, and those aren't good for patients with heart failure.

Instead, we endorse dietary patterns such as the Mediterranean-DASH or plant-based patterns and calorie restricted versions can be appropriate for people who've been recommended to lose weight. We do want to encourage this whole food approach of thinking about all the nutrients that your overall diet can provide rather than focusing on a single supplement or pill to add to your diets.

It's important to know that taking sufficient protein, the recommendations are 0.8 grams per kilogram per day at least, can help maintain good muscle mass. We don't want patients with heart conditions to be losing muscle mass because that can cause weakness and loss of functional capacity. Important to maintain those muscles with healthy proteins. Thank you and bye for now.

Announcer:

Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts or listen at clevelandclinic.org/loveyourheartpodcast.