Diet for heart failure

Relative salt restriction

Patients with heart failure often tend to retain more salt (sodium chloride, NaCl). Higher intake of this salt causes more water retention and possibly an increase in heart failure symptoms. It has long been recommended that heart failure patients limit their daily salt and fluid intake so that the body retains less fluid and puts less strain on the heart. However, an effect of this on hard clinical endpoints (fewer hospital admissions, longer life, etc.) could not yet be scientifically demonstrated. A strict salt restriction is therefore less and less recommended, especially if no water pills (water tablets, diuretics) need to be taken. The higher the dose of diuretic medication required, the higher the tendency to retain salt and fluid and the stricter the salt restriction should be. In patients who receive renal replacement therapy (dialysis) and no longer urinate themselves, salt restriction must always be strictly followed.

Everyone has to get used to a new taste, including dishes with less salt. Our taste buds renew themselves every 7 to 10 days. After 2 or 3 weeks, patients normally become accustomed to a low-salt diet.

General advice

Fruits and vegetables contain hardly any salt.
Unprocessed, fresh foods are preferable.
Do not add table salt and sodium-rich products when cooking. Table salt, sea salt, aroma salt and celery salt contain the same amount of sodium. Stock cubes normally contain a lot of salt, although there are also low-salt ones (e.g. Liebig low-fat and low-salt).
Ready to eat food almost always contains a lot of salt.
All canned or glass foods contain a lot of salt. Salt is added to keep the food longer.
If meals are delivered at home, you must ask to prepare these dishes without salt.

Seasonings without salt

Herbs and spices contain little salt and can therefore be used safely to add flavor to meals.
All kinds of herbal mixtures are for sale in the store. These often contain a lot of salt, although there are also low-salt ones. The packaging will then state 'without added salt'.
Most fresh herbs are best added to the dish at the end (basil, chives, dill, coriander, mint, parsley, etc.).
Dried herbs and fresh rosemary, thyme and lovage release their flavor better while cooking. These are therefore added from the start of preparation.
There are substitute salts with a 70% lower sodium content (JOZO conscious, LOSALT). The disadvantage is that patients then continue to cling to the taste of salt. In addition, these products contain a lot of potassium. This can be disadvantageous in patients with an increased potassium level in the blood due to medication or renal insufficiency.
Certain fruit juices can also provide extra flavor (lemon, lime, orange, etc.).

Bread

Patients are usually allowed to eat normal bread.
If strict salt restriction is necessary, it may be necessary to buy bread without salt. To give this meal more character, it can help to toast these sandwiches.

Topping

Cheese

Cheese spread should be avoided.
Preference for cheeses with a low salt content:
- Fresh cheeses: Philadelphia, Boursin natural, Mozzarella, Chavroux, Castello pineapple or chives.
- Soft ripened cheeses: Président, Coulommiers, Suprême des Ducs, Cambozola, Reblochon, Saint-Albray, Tommette de Savoie.
- Abbey cheeses: Affligem, Chimay, Passchendaele classic.
- Hard cheeses: Emmentaler, Nazareth, Comté.

Cured meats and fish preparations should be avoided:

Smoked meat and fish: bacon, filet de saxe, smoked salmon or halibut, etc.
Pickled fish: buddies, rollmops, etc.
All types of salami.
Meat (TV sausages, etc.) and canned fish.
Shrimps

Try vegetables or fruit on bread:

Lettuce, arugula, cress.
Slices of cucumber, tomato, pepper, radish.
Slices of apple, pear, banana, kiwi, etc.

Peanut butter and speculoos spread contain a lot of salt.

Soup

Best to make it fresh using low-salt stock cubes.

Meat

Unprocessed meat is preferable.
Salt is often added to processed meats (minced meat, breaded meat, marinated and smoked meat, etc.).
Extra flavor can be added to the meat:
- Marinate yourself with a low-sodium herb mixture.
- To be fried together with onion, garlic, tomato, etc.
- To grill.

Fish

Unprocessed fish is preferable.
Salt is often added to processed fish products (breaded or marinated fish, fish sticks, etc.).
Fish prepared in the microwave or steam oven remains juicy and retains a lot of flavor.
Extra flavor can be achieved by:
- Add lemon.
- Add herbs: pepper, dill, parsley, basil, etc.

Vegetables

Cook fresh or frozen vegetables for as short a time as possible to retain optimal flavor.
Pieces of vegetables can also be cooked in a pan to retain more flavor.
Canned vegetables contain more salt and are best avoided.

Potatoes, legumes, pasta and rice

Cook potatoes in their skins to preserve their flavor better.
Flavor can be added with green herbs, onion, fine leek rings, tomato pieces, curry or paprika powder.

Snacks

To avoid:

Appetizer cookies or nuts, chips, olives, tapenades, sun-dried tomatoes, cubes of cheese or salami, chicken drumsticks.
Drop.
Food or juice from a can or glass.

To prefer:

Vegetables: cherry tomatoes, radishes, pieces of carrot or cucumber, etc.
Fruits.

Water and drinks

To avoid (high sodium content > 50 mg sodium per liter): Vichy, Schweppes, Appolinaris, Badoit, Soda, Tönissteiner, Saint Léger, San Pellegrino, Perrier.
Preferred (low sodium content < 50 mg sodium per liter): Spa Reine, Valvert, Evian, Bru, Mont Calm, Chaudfontaine, Contrex, Nestlé pure life.

General healthy diet

In addition to the relative salt restriction, a general healthy diet is always very important. This includes:

Regular meals at fixed times, without skipping meals. Dinner should not be eaten too late (not within 2 hours before going to sleep).
A varied diet.
Healthy snacks.
Lots of vegetables, fruit and unprocessed nuts.
Limit fat, cholesterol, sugar and salt.
Limit saturated fats: fatty meat, palm and coconut oil, cheese, butter, pastries, fried foods, etc.
More unsaturated fats: olive oil and other oils (sunflower, corn, soy), avocado, fish, walnuts, etc.
As many pure foods as possible. Limit processed foods or fast food.
Limit meat. Preference for poultry over red pork and beef.
Limiting fast sugars (these are quickly absorbed and cause a peak in blood sugar levels): soft drinks, fruit juices, white bread, pasta, pastries, cookies, snacks, etc.
More slow sugars (starches - these are absorbed more slowly and more gradually): whole wheat bread and pasta, oatmeal, legumes, potatoes, milk.

The aim should be to maintain a healthy weight while avoiding obesity ( BMI > 30 kg/m²) and underweight ( BMI < 20 kg/m²) .

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What about a reduced appetite?

Patients with advanced heart failure sometimes have a reduced appetite, partly due to fatigue or a dry mouth.

The following tips can help you:

Eat slowly and chew well.
Have breakfast before washing.
Soft foods are easier to eat. For example: soft meats, fish, cooked vegetables, stew, pasta.
Try to rest a little before and after meals.
Have several smaller meals or healthy snacks per day.
Frozen or ready-to-cook vegetables are easy to prepare.
There are meal delivery services that can deliver hot meals.

If the weight continues to drop, your doctor, dietician or pharmacist can give advice about enriching the meal or supplementary feeding.

Potassium and magnesium in the diet

Potassium is a very important mineral or salt in the blood and cells. It is necessary for the proper functioning of cells and the body. The amount of potassium in the blood must always remain within certain limits. This is regulated by the kidneys. Both too low and too high potassium can be dangerous and lead to cardiac arrhythmias, sudden death and other symptoms.

The use of diuretics (plasma medication) in particular can lead to low potassium. These also ensure that you pee more potassium. Your doctor may then recommend that you consume more potassium-rich foods.

Potassium can become too high due to poor kidney function and/or certain drugs that are commonly prescribed for the treatment of heart failure . Anti-inflammatories (NSAIDs) also increase potassium and should be avoided (read: medication). Your doctor may then recommend that you follow a low-potassium diet. Sometimes a powder form of medication is prescribed (Lokelma, Veltassa, Kayexalate). These bind the potassium in the intestine so that the potassium in the diet is not absorbed into the body. Read: Peroral potassium binders.

Use of diuretics (water pills) can also lead to low magnesium by also urinating more magnesium. This can also lead to muscle cramps, weakness and having less energy. Your doctor may then recommend that you consume more magnesium-rich foods or magnesium supplements. Most potassium-rich foods also contain more magnesium: vegetables (spinach, etc.), fruit (bananas, raspberries, passion fruit, etc.), whole wheat bread, legumes (chickpeas, soy beans, etc.), nuts and seeds.

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