How Low-Salt Diets Can Help Those Living with Heart Failure

New research found that low-salt diets can help improve the quality of life for people who are living with heart failure. Bruce and Rebecca Meissner/Stocksy United

  • People living with heart failure are often advised to go on a low-salt diet.
  • A new study indicates that this may help improve people’s quality of life.
  • However, it did not seem to improve rates of death, hospitalization, or ER visits.
  • Patients are advised to keep their sodium consumption below 1,500 mg daily.

People living with heart failure – a chronic condition where the heart muscle is unable to pump enough blood to meet the body’s needs – are often advised to go on low-salt diets.

The reasoning behind this recommendation is that salt contains sodium and too much sodium may cause fluid retention.

Limiting dietary sodium may help minimize the buildup of extra fluid around the heart and lungs and in the legs of heart failure patients.

It is thought that this may ease the burden on an already overworked heart and reduce some of the negative symptoms associated with the condition, such as swelling, fatigue, and coughing.

Up until now, though, there was little scientific evidence to back up this assertion.

However, a new study published in The Lancet indicates that low-salt diets may indeed reduce these unpleasant symptoms and improve people’s overall quality of life.

To conduct the study, lead author Justin Ezekowitz, professor in the University of Alberta’s Faculty of Medicine & Dentistry and co-director of the Canadian VIGOUR Centre, and his team followed 806 heart failure patients at 26 medical centers in Canada, the United States, Columbia, Chile, Mexico, and New Zealand.

Half were randomly assigned to receive usual care. The rest were given counseling on how to reduce their salt consumption.

Those who received nutritional counseling were given menu suggestions designed by dietitians.

They were also encouraged to do their own cooking, avoiding salt and high-salt ingredients.

Their sodium goal was to consume under 1,500 mg per day – or about two-thirds of a teaspoon of salt.

The people who received dietary counseling made a greater reduction in their sodium consumption than the group who did not.

Prior to the study, patients were taking an average of 2,217 mg per day.

At the end of the one-year study, the patients receiving usual care still averaged about 2,073 mg of daily sodium.

On the other hand, the patients who received counseling were consuming much less at an average of 1,658 mg per day.

Results were mixed, however.

When it came to death rates from any cause, cardiovascular hospitalizations, and cardiovascular emergency room visits, there was no real difference between the two groups.

Where sodium restriction made a difference, however, was in people’s quality of life.

When the researchers assessed the patients’ quality of life using three different tools, they found significant improvements.

They also found improvements in a heart failure severity rating called the New York Heart Association Functional Classification.

What should the average person know about sodium? In a nutshell, we should probably all be eating less, especially those at risk for cardiovascular disease.

“When it comes to salt, most Americans are getting way more than we need in our diets,” said Molly Kimball, RD, CSSD, a registered dietitian with Ochsner Health and founder of Ochsner Eat Fit.

For healthy people, the recommendation is around 2,300 mg per day.

For people over the age of 51 or at risk for cardiovascular disease, the goal is to further slash salt consumption, to under 1,500 mg of sodium per day.

“Most of us get more than double that,” noted Kimball.

She further explained that only about 10 percent of the sodium in our diet comes from a shalt shaker.

Over 75 percent is from processed foods, food services, and restaurants.

To keep your sodium consumption under control, Kimball suggests keeping an eye out for what the American Heart Association calls “the Salty Six”: bread and rolls, pizza, sandwiches, deli and cured meats, canned soup, and burritos and tacos.

In addition, you should make sure you are reading labels and making product swaps for lower-sodium items.

Dr. Ragavendra Baliga, who specializes in heart disease and heart failure at The Ohio State University Wexner Medical Center, said that in addition to a low-salt diet, another dietary change that can be made under a doctor’s supervision is to restrict fluid intake, which will also reduce the fluid buildup around your heart and lungs.

He recommends that patients consume about 2 L of water per day (about 64 ounces).

He further pointed to four particular types of medications that are helpful for heart failure, which he called “the new four horsemen.”

These medications include:

  • The angiotensin neprilysin inhibitor (ARNi) Entresto, is a combination of two medications that reduce blood pressure, sacubitril and valsartan.
  • Sodium-glucose co-transporter inhibitors (SGLT2is) like dapagliflozin and empagliflozin, may help lower blood sugar and reduce hospitalizations of heart failure patients with diabetes.
  • Beta-blockers like carvedilol, metoprolol XL, and bisoprolol, slow the heart rate and reduce blood pressure.
  • Mineralocorticoid receptor antagonists (MRAs) like eplerenone and spironolactone can reduce fluid buildup and blood pressure.

Your doctor may use these medications, as well as others, in order to help your heart work more effectively or to reduce the strain on it.

Surgical procedures or the implantation of certain devices may also be appropriate for some patients.

 

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