Taking your medicines and following the diet your doctor has
recommended for you will make it easier for you to breathe and help you feel
better and be able to do more of your normal daily activities. A registered
dietitian can help you make needed dietary changes by providing
meal-planning guidelines that are realistic and specifically tailored to your
individual needs and preferences.
Diet is critical in the treatment of
Sodium is the key nutrient that must be controlled in
order to improve the status of your heart failure (prevent fluid buildup). But
some other nutrients or substances also play a role as well. Heart failure can
become more severe if diet and medicine recommendations for heart failure are
not closely followed. Medicine and diet therapy are most effective when used
together in the treatment of heart failure.
Edema is the medical term for swelling. It is a general response of the body to injury or inflammation. Edema can be isolated to a small area or affect the entire body. Medications, infections, pregnancy, and many medical problems can cause edema.
Edema results whenever small blood vessels become "leaky" and release fluid into nearby tissues. The extra fluid accumulates, causing the tissue to swell.
How does my diet affect my heart failure? As heart failure progresses, the
heart loses its ability to pump strongly, and blood flow throughout the body
decreases. This causes a number of reactions throughout the body. Decreased
blood flow to the kidneys hinders their ability to remove excess sodium from
Reduced cardiac output from ineffective pumping
stimulates the kidneys to retain fluid. Retained fluid causes congestion in the
lungs and difficulty breathing. Excess sodium in the body results in the
release of a hormone called aldosterone that causes the body to retain fluid as
well. Fluid builds up in the body and causes congestion in the lungs, which
makes breathing difficult. Also, fluid may build up in the wall of your
intestines, which can make it difficult to absorb nutrients from your food. If
your body does not receive the nutrition that it needs, you will lose muscle
tissue and your body will not be able to fight off infections.
The role of sodium. The role of sodium in the
treatment of heart failure cannot be overemphasized, especially as the
condition progresses. If you consume too much sodium, it will cause your body
to retain excess fluid. Excess fluid in the body will cause swelling, breathing
difficulties, fatigue, and other unpleasant side effects.
intake is generally limited to less than 2,000 mg each day.
The first step should be to get rid of salt at the
table, followed by elimination of salt in cooking, and finally the start of a
low-sodium diet (decreasing the amount of sodium obtained from packaged foods,
beverages, and medicines). Weigh yourself in the morning after
urinating, but before you eat or drink anything. If your weight changes
drastically, such as a gain of
3 lb (1.4 kg) or more in 2 to 3
days, call your doctor.
Why fluid intake is important. Fluid intake is not routinely restricted. It may be
restricted in advanced cases to maintain your
electrolyte balance. Closely following your low-sodium
diet will help to decrease or eliminate the need for fluid restriction. It is
very important that you watch for any signs of fluid gain (swelling or increase
in body weight) and report them to your doctor.
The role of potassium. Some diuretics are potassium-sparing,
others are not. The aggressive use of diuretics that are not potassium-sparing
can cause your body to lose too much potassium. Potassium plays a major role in
the regulation of your heartbeat. So it is essential that the proper balance of
potassium be maintained in your body. If potassium is lost as a result of
diuretic use, it must be replaced. Replacement of potassium can be achieved by
including foods with a high potassium content in the diet or by using potassium
Significant sources of potassium in the diet
Milk and milk products.
Whole grains (bran cereals,
Fruits (bananas, oranges, cantaloupe,
strawberries, apricots), and especially dried fruits (raisins and
Vegetables (potatoes, greens, cabbage, broccoli, tomatoes,
Salt substitutes that contain potassium chloride can be used
as a potassium supplement. But these should be used only if your doctor
recommends or approves them for you. Excess potassium can be as bad for your
health as not having enough potassium. Your doctor will be able to tell you
what level is safe for you. Always ask your doctor before you use any type of
dietary supplement, including salt substitutes.
Other minerals and vitamins. Just like potassium, blood levels
of magnesium are generally low with extensive diuretic use. Magnesium plays a
role in holding on to potassium in the body. So if you need to
replenish potassium, you need to consume enough magnesium also to optimize
the body's ability to retain the potassium you are consuming.
food sources of magnesium include seeds, nuts, legumes, unmilled cereal grains,
and dark green vegetables. Long-term use of diuretics can also deplete your
body of calcium and zinc. Adequate calcium must also be consumed to prevent
bone loss, which can occur in people who are not able to be physically
Good food sources of calcium include milk and milk
products, calcium-fortified foods and beverages, broccoli, greens, and kale.
Good food sources of zinc include meat, fish (especially oysters), poultry, and
milk and milk products.
A multivitamin/mineral supplement might be recommended for
people with heart failure who are undernourished or are unable to completely
meet their nutritional needs through dietary intake.
Restricting alcohol and caffeine. Drinking alcohol should be
strictly limited (to no more than
1 drink a day, and only if approved by your doctor) or eliminated
altogether. Alcohol consumption can make high blood pressure worse and cause
further damage to the heart. Also, heart failure can often cause poor
appetite due to the feeling of fullness that excess fluid accumulation causes
and due to fatigue and breathing difficulties. If alcoholic beverages are
consumed, they will likely take the place of foods or other beverages that
would have provided nutrients that your body needs.
increase heart rate and cause changes in your heart rhythm. So limit your intake of caffeine.
About calories and protein. In severe heart failure, more calories are often
needed because of the increased workload of the heart and lungs. But calorie
requirements will vary, based on your current nutritional status.
If you are obese, a gradual weight loss will be beneficial for
you, because it will help relieve some stress from your heart and make it
easier for you to breathe. If you are underweight or malnourished, you will
need to increase your intake to obtain sufficient calories and protein to
prevent the loss of muscle tissue, maintain or gain weight, and achieve a
healthy level of protein (albumin) in the blood.
whose activity is very limited (those who are bedridden), it is important to
obtain sufficient calories and protein to prevent the development of pressure
ulcers (bed sores). Increased food intake is often difficult for individuals
with moderate to severe heart failure because of the congestion, poor appetite,
shortness of breath, and nausea that are often caused by this condition or by
the medicines used to treat it.
The body's increased energy
demands along with the obstacles to sufficient intake can often lead to
malnutrition in people with heart failure. The following is a list of
suggestions to help you boost your appetite (by reducing fatigue) and to help
you increase your calories and protein with as little volume and discomfort as
Tips for increasing your calorie and protein intake:
Eat small, frequent meals (five or six) rather
than three large meals each day.
Eat foods with a soft texture to
minimize the amount of chewing you need to do.
Rest before and
Use more of your sodium allowance at your best meal
time of the day to maximize food intake.
Avoid spicy foods and
gas-forming vegetables (such as beans, broccoli, cauliflower, brussels sprouts,
cauliflower, cabbage, and onions) if they cause you discomfort (heartburn,
feeling of fullness, and gas).
Add nonfat dry milk to gravies,
sauces, mashed potatoes (to increase protein intake).
Add butter to
vegetables, breads, hot cereals. Use olive oil to saute foods and top
Try nuts, peanut butter, and dried fruits for
Talk to your doctor about including nutrition supplement
beverages in your diet if you are malnourished and not able to take in enough
food to meet your calorie and protein needs. Those that provide the most
calories and protein in each can will provide a lot of nutrition in a smaller