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John G. King, MD, MPH, is a family medicine physician at Family Medicine-Milton. He is also Vice Chair for Family Medicine at the UVM Medical Center and professor at the Larner College of Medicine at UVM.

We often tell patients that if they have heart failure they should restrict the amount of salt in their diet to less than 2,000-3,000 milligrams per day. Generally this is true, but it is not black and white. Let’s talk about the gray area.

The Connection Between Salt and Heart Failure

First thing first: what is the connection between the two? Simply put, if you have heart failure, eating salty foods tends to cause fluid retention, which can lead to shortness of breath and even hospitalization.

We recommend restricting salt because we think, based on medical evidence, that in the early stages of heart failure when only hypertension, hypertrophy (an increase in thickness of the heart wall) or cardiovascular disease may be present, sodium restriction may prevent progression of the disease.

That said, studies have shown that in patients with severe heart failure, sodium restriction is associated with poorer outcomes. Why? These patients already had reduced heart function. Once heart failure reduces function and activity, strong diurectics are often recommended to patients, which may make sodium restriction more prone to complications.

Talk to your doctor so you know what your heart failure status is.

How do I decrease salt in my diet?

Look at nutrition labels to compare sodium content.

Look at nutrition labels to compare sodium content.

Decreasing salt in your diet means two things: 1) Not adding salt to food; and 2) Avoiding foods that are high in sodium. Fortunately, that leaves plenty of foods to eat and enjoy. “Whole” foods such as fruits, vegetables, and meat are all low in sodium. Packaged foods include a nutrition label that plainly lists the milligrams of sodium in a serving.

Eat as much of the whole foods as you like! When it comes to packaged items, review the labels. When you have a choice between two items, choose the one with lower sodium content. You’ll be well on your way to a low sodium diet.

“But I like salt!”

Our bodies and taste buds are designed to get used to the amount of salt we usually take in, so when you first cut back on sodium, foods won’t taste as good. Be patient: After a few weeks, your taste buds will develop more sensitivity to salt and before long what used to taste just right will taste salty – and it will be much easier to eat less salty food.

Stay tuned in to your own body and how it responds to more or less sodium in foods. The best way to do this is check your weight every day in the morning. A weight increase may indicate you are getting too much sodium, because it causes your body to retain water. Speak to your doctor or nurse right away if you have a change of more than a few pounds in your weight. Also ask you provider if he or she recommends a specific sodium intake for you based on your heart function and medications. In most cases don’t severely restrict your sodium intake if you are on strong diuretics, such as furosemide (Lasix) or torsemide (Demodex), unless you find that it prevents you from gaining weight.

John G. King, MD, MPH, is a family medicine physician at Family Medicine-Milton. He is also Vice Chair for Family Medicine at the UVM Medical Center and professor at the Larner College of Medicine at UVM.

Sources

Paterna S, Parrinello G, Cannizzaro S, et al. Medium term effects of different dosage of diuretic, sodium, and fluid administration on neurohormonal and clinical outcome in patients with recently compensated heart failure. Am J Cardiol 2009;103:93–102.

Paterna S, Gaspare P, Fasullo S, et al. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci (Lond) 2008;114:221–30.

Parrinello G, Di Pasquale P, Licata G, et al. Long-term effects of dietary sodium intake on cytokines and neurohormonal activation in patients with recently compensated congestive heart failure. J Card Fail 2009;15: 864–73.

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