Chf Diet And Fluid Restriction

Tips For Reducing Sodium Consumption

Fluid Restriction – Heart Failure

Your body is constantly trying to strike the perfect balance between electrolytes, including sodium, and water. When you consume a lot of sodium, your body hangs on to extra water to balance it. For most people, this just results in some bloating and mild discomfort.

However, people with CHF already have extra fluid in their bodies, which makes fluid retention a more serious health concern. Doctors generally recommend that people with CHF limit their sodium intake to about 2,000 milligrams per day. This is slightly less than 1 teaspoon of salt.

While this might seem like a hard amount to limit yourself to, there are several easy steps you can take to eliminate extra salt from your diet without sacrificing flavor.

What Is The Best Diet For Congestive Heart Failure

Once you are diagnosed with congestive heart failure, you will meet with your medical team, which includes a nutritionist. They will provide you with guidelines on what activities you can do, along with an eating plan that helps manage your condition. Your diet should be low in sodium, cholesterol, and saturated fat. You can still eat lean protein like chicken, certain types of fish, seafood, legumes, whole grains, fresh fruit, and vegetables.

Counterpoint: Moderate Sodium Intake Is Not Harmful For People With Heart Failure

Cardiologists tend to practice evidence-based medicine, yet many of our recommendations regarding sodium intake for people with heart failure are based on assumptions. Surprisingly, it is hard to say there is enough evidence to state beyond a shadow of a doubt that patients with heart failure should be restricted to the 2,000 mg of salt per day most physicians recommend. And realistically speaking, how many patients abide by this restriction remains unclear, because sodium is in almost everything we consume.

In a systematic review of nine studies recently published in JAMA Internal Medicine, only limited and inconsistent evidence was found supporting any benefit of salt-restricted diets for non-hospitalized people with heart failure. The evidence for salt restriction was inconclusive in patients admitted to the hospital for heart failure. This was a well-done study only nine of 2,655 studies evaluated were rigorous enough to include in the review. So perhaps most importantly, this review illustrates that regardless of the conclusion, rigorous, evidence-based data regarding sodium restriction in heart failure are not available.

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Lower Fat And Cholesterol

Studies have shown that the rate of heart failure is lower in people who follow a DASH diet , which centers on consuming polyunsaturated fats, complex carbohydrates like brown rice, low amounts of saturated fats, and fruits and vegetables.

Saturated fat and cholesterol can lead to other cardiovascular issues like atherosclerosis, which is the buildup of plaque on the walls of the arteries. To reduce that risk, eliminate butter, shortening, and margarine, and consume limited amounts of olive, peanut, and canola oils.

To lower your fat intake, avoid fatty cuts of meat, remove the skin from poultry, and consume more fish. Replace high-fat dairy with low-fat or nonfat options, eat whole grains for their high fiber content, and limit condiments and salad dressings that are high in fat and sodium. When preparing your food, avoid frying, and choose to bake, broil, poach, boil, or steam instead.

Heart Failure: Are Sodium And Fluid Restriction Necessary

Kidney Failure Fluid Restriction

Charles P. Vega, MD Ileana L. Piña, MD, MPH

Charles P. Vega, MD: Hello and welcome to Critical Issues in Cardiology. My name is Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Today we are going to be talking about heart failure, specifically an important but unfortunately too often ignored concern, and that is nutrition and nutrition supplements for patients with heart failure. To help me with this discussion, I am excited to have Dr Ileana Piña, a professor in the department of medicine, division of cardiology, at the Montefiore Medical Center. Dr Piña is also associate chief for academic affairs there as well. Ileana is a real expert in heart failure, so I am really excited that we could have this conversation. Thank you very much for joining us, Ileana.

Ileana L. Piña, MD, MPH: Thank you for having me.

What About Sodium?

Dr Vega: First of all, sodium intake. A lot of clinicians recommend 2-3 g of sodium per day for patients. That is about half of what the average US adult consumes on a daily basis. It is a challenge to get patients to adhere to a low sodium diet, but there is also some research showing that a very low sodium diet can produce higher rates of readmission compared with just a low sodium diet. What are you recommending to your patients regarding sodium intake? Secondarily, how do you promote adherence? How do you get patients to stick to that regimen? That is a challenge.

  • Diuretics

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    What Are The Next Steps You Need To Know About Maintaining A Fluid Restriction

    • Ask your health care provider about how much fluid you should limit yourself to each day. For patients with heart failure, this is usually 1.5 to 2 L per day. This is the equivalent of about 6 to 8 cups.
    • It is important to remember that this is not just the water you drink. This includes coffee, tea, juice, soup, JELL-O, ice cream, and even some fruit .

    diureticwater pill

    Restricting Water Intake: Necessary Or Not

    Dr Vega: That is great advice. It is important to think about water intake, too. Again, a common recommendation to patients is a fluid restriction to less than 2 L a day of free liquids. Again, we are not sure how effective that might be. A meta-analysis of randomized trials that examined liberal fluid intake versus a more restricted intake found no difference in terms of mortality or readmission. Is fluid restriction for everyone, or should you reserve it for certain patients? Patients can get very frustrated with fluid restriction.

    Dr Piña: I do not restrict fluids at all. If patients follow the reasonable sodium diet you and I have just discussed, the water follows. A lot of the thirst has to do with the disease and the central mechanism of angiotensin II, which causes thirst, and patients think that they need more fluid. If you neurohormonally block that mechanism well, patients will not have that thirst. So I do not restrict fluid at all unless the patient is hyponatremic. That is when you get into trouble, and that is the hardest one to do. Patients who are not neurohormonally blocked, which is usually the reason behind the hyponatremia, are usually undermedicated. Once you medicate them, the thirst gets better. But until then, it is very hard to restrict fluids. These folks will drink from the faucet. They will drink from the bathroom. There is a huge drive to drink that fluid. Those patients need to be handled very carefully.

    What About Supplements?


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      Congestive Heart Failure Increases Fluid Retention

      With heart failure, your heart pumps less blood than it otherwise would if it was healthy, causing a decrease in blood pressure.

      To compensate for reduced blood flow, your heart beats faster, your veins constrict, and your kidneys retain water to maintain proper blood circulation .

      Over time, these compensatory methods to maintain proper blood circulation to your bodys tissues cause fluid buildup or congestion in and around organs such as the lungs, ankles, and feet.

      This fluid accumulates gradually over time, causing shortness of breath and swelling in your lower legs. Your doctor may prescribe you medications to reduce fluid buildup, but eating the right diet can also help.

      How Much Salt Should You Eat

      Fluid Restriction – Heart Failure

      If youâre living with congestive heart failure, itâs best if you limit the sodium in your diet to less than 1,500 milligrams a day. Thatâs far less than the amount that most Americans eat — 3,400 milligrams.

      You may not realize it, but itâs likely that more than 70% of the sodium in your diet comes from packaged foods and meals cooked in restaurants. Buying fresh foods and cooking at home are some of the best ways to cut back.

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      Recommended Guidelines For Fluid Intake

      The National Academies of Sciences, Engineering, and Medicine recommend that females consume close to 2.7 liters , or 91 ounces , of fluid per day. Males should consume about 3.7 l, or 125 oz.

      For people restricting fluid, the standard recommended intake is 1.5 to 2 l per day. The exact amount will depend on how much a person weighs, their basal metabolic rate , and the severity of their heart failure.

      One 2016 review concluded that restricting fluid intake to 30 milliliters per kilogram of body weight per day was reasonable. The researchers noted that this amount of fluid intake also had the most minor effect on a persons thirst level.

      A doctor can advise a person regarding how much fluid they should aim to consume per day.

      A person with heart failure should reduce their fluid intake if a doctor recommends doing so. Not restricting fluid intake may result in a person:

      • developing swollen hands, feet, legs, abdomen, and veins in the neck

      2021 article , fluid restriction can lead to an imbalance in a persons internal water and sodium levels. If a person does not take in enough fluid, the sodium level in the body can become more concentrated. This can lead to increased feelings of thirst and fluid retention.

      If a person has too much sodium in their blood, their body will try to dilute it by increasing a persons thirst. The body will also try to hold on to water already inside it, leading to fluid retention.

      Why Do You Need To Limit Sodium Or Fluid


      Sodium causes your body to hold on to extra water. This may cause your heart failure symptoms to get worse. Eating too much sodium can even trigger sudden heart failure.

      Limiting sodium may help you feel better and prevent sudden heart failure.

      Your doctor will tell you how much sodium you can eat each day. You may need to limit sodium to less than 2,000 mg each day.


      Fluid intake is not routinely restricted. It may be restricted in advanced cases to maintain your body’s 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 and report them to your doctor.

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      What Is Congestive Heart Failure

      Heart failure is a condition in which the chambers of your heart dont fill with enough blood or your heart isnt strong enough to pump sufficient blood from these chambers to your bodys tissues.

      Its commonly caused by heart disease, high blood pressure, and diabetes, and most often occurs in older adults and people who are obese .

      As a risk factor for heart disease, high cholesterol can also increase your risk of developing heart failure.

      Heart failure symptoms may include :

      • shortness of breath
      • swelling in your ankles and feet
      • swelling of your abdomen
      • rapid weight gain from fluid retention
      • poor appetite
      • fast heart rate

      Your doctor may review your medical history, conduct a physical examination, and perform tests like a chest X-ray or heart ultrasound to diagnose heart failure .

      Do You Need Vitamin Or Mineral Supplements

      Nutrition in renal patient

      You can usually get all of your vitamins and minerals by eating a heart-healthy diet that is rich in fruits and vegetables.

      Your doctor might recommend a multivitamin/mineral supplement if you are undernourished or cannot completely meet your nutritional needs through food.

      If you take a diuretic for heart failure, this medicine might change your dietary needs for potassium, magnesium, calcium, and zinc. Ask your doctor if you should take supplements or eat certain foods to get enough of these minerals.

      Fish oil supplements have been shown to help some heart failure patients. In some studies, fish oil supplements, taken along with other heart failure medicines, helped people stay out of the hospital and live longer.footnote 1

      Talk to your doctor before you take any over-the-counter medicine or supplement. They are used along with medical treatments for heart failure, not instead of treatment.


      If you take a diuretic, ask your doctor if you need to take a potassium supplement or if you need to watch the amount of potassium in your diet. If you take a loop diuretic or thiazide diuretic, your doctor may suggest that you get extra potassium because these medicines lower your potassium levels. But if you take a potassium-sparing diuretic, you might not need to get extra potassium in your diet.


      Good food sources of magnesium include seeds, nuts, legumes, unmilled cereal grains, and dark green vegetables.

      Calcium and zinc

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      Portion Out Your Fluids

      Try to distribute your fluid consumption throughout your day. If you wake up and drink a bunch of coffee and water, you might not have much room for other fluids throughout the day.

      Budget the 2,000 mL throughout your day. For example, have 500 mL for breakfast, lunch, and dinner. This leaves with room for two 250 mL drinks between meals.

      Work with your doctor to determine how much you need to restrict your fluid intake.

      Nutrition Guide For Heart Failure

      Following a low-sodium diet and drinking less fluid can help you feel better and allow your heart failure medicines to work better. A low-sodium diet may even keep you out of the hospital. It is not an easy diet to follow. You may find eating with heart failure is a bit of a balancing act. While you dont want to eat too much of high sodium foods, you have to be sure to eat enough to maintain good nutrition.

      Nutrition and Heart Failure

      The recommended salt intake is 2,000 mg of sodium per day.

      Salt is a mineral that is made of sodium and chloride. It is found in food, table salt and sea salt. Sodium acts like a sponge and makes the body hold water.

      Eating too much sodium when you have heart failure can cause fluid buildup in your legs, stomach and lungs and force you heart to work harder.

      Most of the sodium we eat is hidden in foods. Even food that does not taste salty can contain a lot of sodium.

      You should restrict the amount of sodium you eat to 2,000 mg or less each day. Try to keep the sodium content of each meal to less than 600 mg. This helps spread out your sodium intake over the day to prevent excessive fluid retention.

      You can take a few basic steps to reduce the amount of sodium in your diet:

      • Dont add salt when you cook or at the table
      • Learn to read food labels
      • Choose more foods that are lower in sodium
      • Limit high sodium foods

      Reading a Food Label for Sodium

      Follow these easy steps to read the label:

      Low-Sodium Foods

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      What To Expect At Home

      When you have heart failure, your heart does not pump out enough blood. This causes fluids to build up in your body. If you drink too many fluids, you may get symptoms such as swelling, weight gain, and shortness of breath. Limiting how much you drink and how much salt you take in can help prevent these symptoms.

      Your family members can help you take care of yourself. They can keep an eye on how much you drink. They can make sure you are taking your medicines the right way. And they can learn to recognize your symptoms early.

      Your health care provider may ask you to lower the amount of fluids you drink:

      • When your heart failure is not very bad, you may not have to limit your fluids too much.
      • As your heart failure gets worse, you may need to limit fluids to 6 to 9 cups a day.

      The Verdict: Until We Have More Evidence Its A Draw

      How to handle Fluid Restriction In Heart Failure

      Take some of what we say with a grain of salt . There is not yet enough evidence for either side of the great salt debate to win. And our discussion should not lead patients to consume salt in excess until we know for sure. Indeed, in the absence of good clinical data, one must accept the need for good clinical judgment: avoiding excessive amounts of sodium is a healthy move for all of us, including those with heart failure.

      Its also highly likely that some patients are more salt-sensitive than others. Thus, directing salt restriction to those most vulnerable might be better than a one-size-fits-all approach. Studies in this area are very much needed. Fortunately, clinical trials to address this question are ongoing, so stay tuned!

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      Can You Drink Coffee If You Have Congestive Heart Failure

      According to recent studies, as noted by the American Heart Association, drinking one or more cups of caffeinated coffee may reduce the risk of heart failure. But other studies noted that drinking several cups throughout the day may not be safe. When in doubt, talk to your cardiologist and nutritionist about the amount of coffee you can drink.

      Tips For Limiting Fluid Intake

      In addition to limiting sodium, a doctor may also recommend limiting fluids. This helps to keep the heart from being overloaded with fluids throughout the day.

      While the amount of fluid restriction varies from person to person, doctors often recommend people with CHF aim for 2,000 milliliters of fluid a day. This is the equivalent of 2 quarts of fluid.

      When it comes to restricting fluid, make sure to account for anything thats a fluid at room temperature. This includes things like soups, gelatin, and ice cream.

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