If you have heart failure, you’ll quickly learn that to feel your best, the food and beverages you don’t consume may be as important as those you do.
“Your organs aren’t getting the proper nourishment and oxygen that they need,” says Leslie Beck, a registered dietitian in Toronto. You may find that you tire more easily or that you get short of breath.
Also, “when your heart is having more difficulty pumping blood, the body has trouble getting rid of that extra fluid and water.” If that happens, you may notice that your legs and ankles look and feel more swollen, she says.
Along with taking your medications and getting regular exercise, avoiding or cutting back on some types of food and drink can help guard against that uncomfortable swelling, says Barry Greenberg, MD, who directs the advanced heart failure treatment program at the University of California San Diego Health.
“They are really important in improving long-term outcomes,” he says. “The payoff can be substantial, and it’s absolutely worth doing.”
Diet choices you should add to your “watch” list to limit or avoid when you have heart failure include:
Sodium. You’ve probably heard this before, but it bears repeating that sodium can encourage fluid buildup, says Sitaramesh Emani, MD, a cardiologist who specializes in advanced heart failure at The Ohio State University Wexner Medical Center in Columbus. The reason, he says: “When an excess amount of sodium is consumed from dietary sources, the body wants to hold onto more fluid to go along with that sodium.”
Your doctor will recommend a sodium goal that’s best for you, typically no more than 1,500 to 2,000 milligrams a day, Emani says. (One teaspoon of salt contains 2,300 milligrams of sodium.) That limit falls well below the 3,400 milligrams each day that’s part of the average American diet, according to federal data.
Sodium often hides in places far less obvious than your saltshaker. A slice of bread may contain as much as 230 milligrams. That favorite breakfast cereal could clock in at 150 to 300 milligrams. Other potential culprits: processed lunch meats and canned soups.
Restaurant food. It may be quicker than cooking at home, but the meals sold at fast food outlets can be chock full of calories and sodium, says Greenberg, who recommends checking out nutritional information. That risk extends to sit-down restaurants as well, says Emani, who advises asking your server about sodium amounts.
“Salt is a great flavor enhancer,” Emani says, pointing out that restaurants want satisfied customers. “I often counsel my patients that if you or someone you directly know did not prepare the food, there is a high probability that more salt than you realize is being utilized.”
Daily fluids. You may need to watch your liquid intake, even water. Drinking too much can lead to extra fluids building up in your body. People with heart failure may be advised to limit fluids to 2 liters each day or less, depending upon how much their condition is under control, Greenberg says.
All liquids count, he adds. Keep track of not just water and coffee but soups and juicy fruits, such as grapefruit. “It really doesn’t matter the form that it comes in,” Greenberg says. “If it’s a liquid, it’s going to count.” Also, skip beverages that contain salt, such as some sports drinks, he says.
Alcohol. If your heart failure is controlled with medication and you’re not retaining fluids, Greenberg is OK with alcohol, but no more than one drink a day. Keep in mind that it will count toward your daily fluid intake.
Your doctor may tell you to skip alcohol entirely if you’re taking certain medications, such as some types of blood thinners, Emani says. Be honest about your alcohol serving — with your doctor and yourself. An extra-large margarita is not a standard-sized drink. And you can’t skip wine at dinner some days in order to drink more later in the week, Emani says. “You don’t get to bank your alcohol use.”
Caffeine. Be careful about coffee, soda, and chocolate, Emani says. It’s best not to exceed one to two servings a day. “Excess caffeine can make heart failure worse,” he says. “It can drive up the heart rate and increase the risk for irregular heart rhythms.”
Processed foods. These foods should be limited, not just because they’re more likely to be heavy on the sodium but also because they tend to lack fiber, Emani says. That’s particularly important if you have heart failure, as the medications can sometimes cause constipation, and fiber helps prevent that, he says.
“This is not just from a comfort standpoint,” Emani says. “If patients are straining a lot to have bowel movements, that act of straining increases the pressure on the heart.”
Diet rules for people with heart failure aren’t absolute and may be adjusted based on your symptoms and lifestyle, Greenberg says. For instance, if you live in a hot climate, your doctor may not want you to limit fluids, since you’ll be sweating out much of that liquid.
It isn’t always easy to make these diet changes, particularly when you’ve developed lifelong eating habits, Beck says. If you’re used to eating some type of salty or sweet snack after dinner, see if you can distract yourself for a time by doing something else you enjoy, she says. “Because cravings do pass.”
Or figure out a food substitution. If you want to munch on a bag of potato chips, replace them with unsalted air-popped popcorn so you can still enjoy that satisfying crunch, Beck says.
If your preferred comfort food runs to the sweet side, Beck suggests keeping fresh berries or frozen grapes handy for a quick fix. Savor a square of dark chocolate. Or make your own hot chocolate with cocoa and low-fat milk, and sip it slowly.
“It might take you 40 minutes to finish a hot beverage,” Beck says. “By that time, you’ve passed through that craving time, and you’ve nourished your body at the same time.”