eating plan for heart failure - Continuing Medical Implementation

eating plan for heart failure - Continuing Medical Implementation
This eating plan is limits salt (sodium) to 2000 milligrams per day. This
eating plan is also low in saturated and trans fat. It focuses on vegetables,
fruit, whole grains and lean protein choices for overall heart health.
Heart Failure (HF)
Also called congestive heart failure (CHF), is a condition that
affects the pumping function of the heart. Heart muscle that has
become weak or stiff is unable to properly fill the heart chambers
with blood and squeeze it out again. This results in reduced
movement of oxygen rich blood from the heart to the tissues of the
body. Because the heart is unable to pump well, extra fluid may
build up in the lungs, legs and belly. Extra fluid in the lungs is what
causes breathing difficulties with heart failure.
Symptoms include: shortness of breath when active or when
lying down, fatigue and weakness, swelling in your feet, ankles
and lower legs, rapid or irregular heartbeat, reduced ability to
exercise, persistent cough or wheezing, swelling of your belly,
sudden weight gain from fluid retention.
Causes include: damage to the heart from progressive
blockage of the arteries (atherosclerosis), heart attack,
high blood pressure, genetic defects such as faulty heart
valves, chronic diseases such as diabetes and lupus, thyroid
dysfunctions, obesity, inactivity, infections or viruses, alcohol
abuse, drug use and chronic abnormal heart rhythms.
Tips To Help Reduce HF Symptoms
1. Limit your daily salt (sodium) intake to 2000 mg or less.
2. Fluids may need to be limited to 2000 ml (2L) per day. See FACTS
3. Check your weight daily. If you gain 5 or more pounds (2kg) in 1to 3
days contact your doctor.
4. Eat heart healthy, less processed foods that are low fat and high fibre.
5. If you’re overweight, try to lose 5 to 10% of your present weight.
6. Be active each day. Walking is great – aim for 30 minutes each day!
7. Limit alcohol consumption.
8. Avoid smoking.
Do you know the top food sources of sodium
for Canadians?
Pizza, sandwiches, submarines, hamburgers
and hotdogs together accounted for almost
20% of our total sodium intake in a 2004
survey. Sodium is challenging to avoid –
if you’re “sick of it” check out for more.
Heart Failure FACTS – Focus on Salt and Fluid
Excess salt or sodium in the diet causes the body to retain more fluid.
Extra body fluid increases the work for the failing heart pump. This causes it to become progressively weaker. By reducing the
salt you consume, you help your body to maintain a better fluid balance, manage the symptoms of heart failure and protect your
hearts pumping ability. Your doctor may advise you to limit the fluids you drink if reduction of salt and addition of medications to
remove excess water from your body are not enough to control your symptoms.
Reducing Salt
Salt from the foods you eat will hold more water, or fluid, in the body. This fluid retention contributes to swelling in the feet, ankles,
legs and belly and congestion in the lungs making you feel short of breath.
Reducing salt is not easy because many of the foods we eat are processed or prepared with added salt. Cooking more from
scratch and reading labels to identify foods with less salt will be a very important part of managing your heart failure.
Keep a record of your salt intake for the day. You are aiming for less that 2000 mg in total. Use the chart below, information
from the package or online sites such as or to determine the salt you eat.
Review your recipes. Remove added salt and replace high sodium foods with low or no sodium options. See the next page
for a list of foods to avoid.
Take the salt-shaker off the table and do not add salt in cooking. Try seasoning your food with herbs, spices and garlic.
Lemon juice enhances our sense of saltiness in food.
Read the Nutrition Facts Tables when shopping. Choose packaged foods with less than 200 mg of sodium per serving.
Read ingredient lists. Foods listing salt or sodium at the beginning of the ingredient list or repeated times in the list are high in
Avoid fast food restaurants. Many menu items will have as much as your total daily salt intake in one serving! If it can’t be
avoided, review the nutrition information available in store or on line and choose options with less salt and limit the frequency
of eating there.
Focus on farm fresh, minimally processed foods. Fill your meals with vegetables, whole grains or starch and lean meat, fish,
poultry or vegetarian protein choices such as beans, nuts or eggs. Select lower fat dairy choices. Replace salty, high fat
snacks with fruit or vegetable based snacks. The DASH Eating plan is a great example of this style of eating. On the web,
enter Your Guide to Lowering Blood Pressure with DASH into your search engine for a complete guide or consult with a
registered dietitian for details.
More on general heart healthy eating can be found in Eating Plan for Hypertension and Eating Plan for High Cholesterol
available in our clinic or on line at
Did You Know?
One teaspoon of salt contains
approximately 2300 mg of sodium.
Your total daily intake, both what is in
the foods you eat and what you add to
your foods, should be less that what a
teaspoon would hold.
Homemade Herb Blend
This multi-purpose salt free seasoning can replace the salt in your table top
shaker and is great in casseroles, soups and just about any savory dish
you would otherwise salt.
1 Tbsp garlic powder
1 tsp each of dried, crumbled: basil, marjoram, thyme, parsley, savory, sage
1 tsp each of ground mace (or nutmeg), onion powder, pepper
½ tsp cayenne (optional)
In a small bowl, mix together all ingredients until well blended. Store in a jar
with a tight fitting lid in a cool, dry place for up to 6 months.
Source: AHA Low Salt Cookbook- 2nd ed.
Spice it Up!
Low salt doesn’t have to mean bland and blah! Try adding flavor with fresh or frozen herbs and spices such as basil,
parsley, ginger, garlic, oregano, and more! Find inspiration in these low sodium recipe collections: Hold the Salt by
Maureen Tilley, RD, Delicious Dash Flavours by Sandra Nowlan or The No Salt, Lowest Sodium Cookbook by Donald Gazzaniga.
Where’s The Salt?
Although about 80% of the salt we eat is added during processing and preparation, some salt does occur naturally in foods. Here
are some details on the amount of salt in food.
Tomato juice, canned, ½ c
Whole Grains
Cooked cereal, rice, pasta (unsalted) ½ c
Ready to eat cereal, 1 c
Bread, 1 slice
Fresh or frozen ½ c
Canned or ‘sauced’ ½ c
Fresh, frozen, canned, ½ c
Dried fruit
Peanuts, salted, ½ c
Peanuts, unsalted, ½ c
Beans, cooked from dried or frozen,
unsalted, ½ c
Beans, canned, ½ c
Milk, 1 c
Fresh meat, fish , poultry, 3 oz
Yogurt, 1c
Tuna canned, water packed, no
added salt, 3 oz
Natural Cheese, 1 ½ oz
Processed Cheese, 2 oz
Tuna canned water pack 3oz
Ham, lean, roasted, 3oz
Fluids and Heart Failure
The most effective way of reducing the fluid your body retains is to reduce your salt intake. If your heart failure is more advanced
or your body continues to retain fluid despite low salt eating and use of diuretic medications (‘water’ pills), your doctor may advise
you to limit your beverages to 2L or 2000ml per day.
Tips to help:
• Limit coffee or caffeine-containing beverages to 4 or less cups per day.
• Alcohol should be limited or avoided. If allowed, Men should consume 2 or fewer standard drinks per day and women should
consume no more than 1 standard drink per day.
• Keep a record and count all fluids consumed including coffee, tea, milk, juices, soups, water, pop, alcohol and any other
liquids consumed.
• 1 cup = 8oz = 250ml
• Measure your usual cups and glasses to determine how much they hold.
• You may want to keep an empty 2L bottle on your kitchen counter. Each time you have a drink, pour water of equal volume
into the 2L bottle. As the bottle fills it will be a visual reminder that you are reaching your 2L limit.
• If you have trouble with dry mouth or thirst, try sucking on mints, chewing gum or freezing small fruit like berries or grapes
and sucking on these. All of this stimulates saliva production that will wet your mouth.
Check with your Doctor, Dietitian or Pharmacist before starting a supplement.
• Heart Healthy Mixture = 1/3 ground flax, 1/3 oat bran and 1/3 psyllium. Use 2 Tablespoons per day added to foods or
• Omega 3 fish oil supplements – doses of 1000 mg/day of EPA+DHA have been shown to be safe and beneficial for overall
heart health but no specific benefits have been found for those with heart failure.
• Caution: Salt substitutes based on potassium such as “No Salt” or “Half Salt” are not recommended with some heart failure
To Reduce Weight
If you are overweight a gradual reduction of 5-10% of your initial weight can reduce heart failure symptoms. Suggestions
• Eat smaller portions of foods and remember the balance of foods on your plate: 1/4 protein, 1/4 starch (including
potatoes), 1/2 vegetables
• Eat 3 meals per day, no more than 6 hours apart. Don’t skip meals. Snack with fruit between meals.
• Choose foods lower in fat and sugar. Eating strategies including low glycemic index choices can be helpful. Learn
more from a registered dietitian.
• Aim for a maximum weight loss of 1- 2 lbs (0.5 -1 kg) per week.
“Waist loss” is as important as weight loss. For tips on how to trim your waist see our ‘Waisting Away – Healthy
Weight Management’ nutrition fact sheet.
Portions to Live By
• O
ne serving of whole grains is 1/2 cup cooked,
not the 3 or more cups served in most restaurants!
Too much of a good
thing is not a good thing.
• For more details on healthy portions see
Eating Well with Canada’s Food Guide
online at
Lunch & Supper
Decoding Food Labels
The Nutrition Facts table found on the side of packaged food can help you make better
food choices. Always check the serving size first and consider this in relation to how
much of the food you usually eat.
Look for choices with less fat, saturated fat, cholesterol and sodium. Look for choices
that give you more fibre.
Learn more about using food labels to make healthy choices on the web:
Health Canada –
Healthy Eating Is In Store for You –
General Healthier Eating Guidelines
Start with a balanced breakfast and follow up with a balanced lunch and supper.
Add colour with fruit and vegetables. Eat your choices more often than drinking them as juice for more fibre and
fewer calories.
Whole grain starchy food choices include whole wheat pasta, whole grain bread, brown rice, whole wheat
couscous, barley, quinoa or oats.
An eating pattern rich in plant based foods is rich in fibre. Fibre rich foods balance blood sugar, keep you feeling
full, lower cholesterol and blood pressure. (and keep you regular!)
Protein choices include low fat dairy or alternative choices such as milk, yogurt, cheese and lean meat and
alternative choices such as lean beef, pork, chicken, fish, eggs, tofu, beans, lentils, nuts and seeds.
Choose milk and yogurt with milk fat percent (%MF) of 1% or less. Cheese should be 20%MF or less. Lower fat
fortified soy milk is also a great option.
Lean meats have less “marbling” or white fat throughout the meat. Remove skin from poultry. Use cooking methods
such as grilling, broiling, poaching or stir-frying in a non-stick pan to reduce fat. Try a “meatless” meal including
beans, tofu or lentils for less fat and more fibre.
Restricted Sodium Eating Plan
1000-2000mg sodium/day. Reminder: read food labels for sodium content.
Whole Grains
• Fresh breads (without cheese), pasta, rice
• Cooked cereals without salt
• Unsalted and reduced salt crackers (choose low-fat)
• Choose whole and multigrain products
Crackers, bread, or rolls with salted tops
Packaged breading, stuffing, bread or biscuit mixes
Packaged instant cooked cereals
Pre-seasoned/flavoured rice or pasta products
Commercial waffles, pancakes and muffins
Vegetables and Fruit
• All fruits and fruit juices (without sodium additives)
• Fresh/frozen (no salt added) vegetables
• Low sodium canned vegetables
• Low sodium tomato or vegetable juice
• Low sodium tomato paste, canned tomatoes
and tomato sauce
Regular canned vegetables and vegetable juice
Artificial fruit flavoured crystals with sodium
Pickles vegetables (e.g. sauerkraut)
Instant or canned potatoes
Regular canned tomatoes, tomato/spaghetti sauce
No canned tomato/vegetable/clamato juice
(unless low sodium)
Milk and Alternatives
• Milk, yogurt, cream, sour cream - choose low fat
• Low sodium cheese and cottage cheese
Regular and processed cheese slices and spreads
Buttermilk, malted milk, evaporated or
condensed milk
Hot chocolate mixes
Meat and Alternatives
• Meat, poultry, fish without salt or sodium products
• Eggs, tofu, legumes (without added sodium)
• Unsalted peanut butter, nuts and seeds
• Choose low-fat protein choices
Fats and Oils
• Any except those on opposite list (in moderation)
Salted, smoked, cured, or pickled meat, fish, and
poultry: luncheon
meats, bacon, ham, sausages, wieners, sardines,
herring, pickled eggs
Salted peanut butter, nuts and seeds
Convenience foods (e.g. canned: stews, pastas,
Bacon fat
Packaged gravies, sauces, salad and vegetable dips
Commercial salad dressings, salted margarine
• Any except those on opposite list (in moderation)
Commercial cakes, pies, pastries, dessert,
and instant pudding mixes
Snack Foods – Unsalted Only!
• Unsalted popcorn (air popped)
Salted chips, cheezies, pretzels, and popcorn
If fluid restricted, limit to 2000ml (8 cups) fluid per day
• Any except those on opposite list
Water treated with water softener
Mineral waters with sodium content greater than
250 mg sodium/L
Ovaltine, sports beverages such as Gatorade
• Low sodium broth or canned soups, homemade soups
(made without salt)
Meat extracts (e.g. boullion, Oxo)
Regular canned soups or dried soups mixes
Sea salt, seaweed, Salted herbs (e.g. garlic salt)
Meat tenderizers
MSG (monosodium glutamate)
Salt substitutes containing salt (e.g. Lite Salt)
Regular pickles, olives, and relishes
Soya sauce and oriental sauces (e.g. teriyaki)
Most contain very high levels of salt/sodium. To verify
the sodium content of foods, ask for the company’s
“Nutritional Guide” or go to their website.
Seasonings and Condiments
• Unsalted herbs and spices
• Dry mustard
• Vanilla extract, lemon, lime, vinegar, cocoa
• Salt-free condiments (e.g. salt-free ketchup)
• Limit of 1 tsp (5 mL) per day of the following: barbeque,
steak and Worcestershire sauces, horseradish, ketchup,
prepared mustard, relish, salsa
Fast Food
• Plain ‘Garden’ salad – use a squeeze of lemon instead
of dressing
• Plain baked potato – can top with 1 tsp of soft margarine
and chives
Other Nutrition Fact Sheets Available:
Eating Plan for High Cholesterol
Eating Plan for Hypertension
Eating Plan for Type 2 Diabetes
Waisting Away – Healthy Weight Management
Potassium Modified Eating Plan
Please visit for more
Ottawa Cardiovascular Centre
502-1355 Bank Street
Ottawa, ON K1H 8K7
Phone: (613) 738-1584
Email:[email protected]
Eating Plan for Heart Failure, November 2010
Danielle Aldous, BSc, RD (From Original 2006 Helene Charlebois, BsC, RD & Jasna Robinson, DI)
© Continuing Medical Implementation ® Inc.
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