EATING PLAN FOR HEART FAILURE 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 below. 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 www.sodium101.ca 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 www.eatracker.ca or www.calorieking.com 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 salt. 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 www.ottawacvcentre.com. 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. FOOD SODIUM (MG) VEGETABLES 1-70 140-460 Tomato juice, canned, ½ c 330 Whole Grains Cooked cereal, rice, pasta (unsalted) ½ c 0-5 Ready to eat cereal, 1 c Bread, 1 slice SODIUM (MG) FRUIT Fresh or frozen ½ c Canned or ‘sauced’ ½ c FOOD 0-360 110-175 LOW-FAT OR FAT-FREE MILK & MILK PRODUCTS Fresh, frozen, canned, ½ c 0-5 Dried fruit 0-15 NUTS, SEEDS & LEGUMES Peanuts, salted, ½ c 120 Peanuts, unsalted, ½ c 0-5 Beans, cooked from dried or frozen, unsalted, ½ c 0-5 Beans, canned, ½ c 400 LEAN MEATS, FISH & POULTRY Milk, 1 c 107 Fresh meat, fish , poultry, 3 oz 30-90 Yogurt, 1c 175 Tuna canned, water packed, no added salt, 3 oz 35-45 Natural Cheese, 1 ½ oz 110-450 Processed Cheese, 2 oz 600 Tuna canned water pack 3oz Ham, lean, roasted, 3oz 230-350 1,020 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. Supplements 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 beverages. • 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 medications. To Reduce Weight If you are overweight a gradual reduction of 5-10% of your initial weight can reduce heart failure symptoms. Suggestions include: • 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. Breakfast 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 www.healthcanada.gc.ca/foodguide. Protein Starch Fruit Lunch & Supper Protein Starch Vegetables 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 – www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.php Healthy Eating Is In Store for You – www.healthyeatingisinstore.ca 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. FOODS TO CHOOSE 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 FOODS TO LIMIT OR AVOID • • • • • 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, beans) • • • Bacon fat Packaged gravies, sauces, salad and vegetable dips Commercial salad dressings, salted margarine Sweets • 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 Beverages 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 • FOODS TO CHOOSE FOODS TO LIMIT OR AVOID Soups • 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 Notes: 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 www.cvtoolbox.com for more information 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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