The importance of diet in heart failure has been recognized since last many years. The cornerstone of nutritional therapy in heart failure prevention and treatment has been restriction of excess sodium intake in order to prevent fluid overload. While sodium remains important, in recent times, macronutrient nutrition has also appeared important in the prevention, particularly there is a role for heart healthy diet because majority of cases of heart failure develop after long-standing coronary heart disease. Healthy dietary patterns high in fruits and vegetables and the inclusion of fish appear important in preventing heart failure, and the benefit of certain dietary supplements (thiamine, Coenzyme Q10) has been suggested.
Salt restriction :
Restriction of excess sodium is important in reducing the risk for heart failure. Salt restriction of 2-3 g/day is recommended for heart failure patients but when weather is hot allowance must be made if the patient is sweating. In any case, high salt containing foods and addition of extra salt to prepared foods must be strictly discouraged because high salt intake not only contributes to recurrence of heart failure and increased hospital re-admissions but also increases the need for urgent cardiac transplantation.
Monitoring magnesium status :
Magnesium has several benefits for heart failure patients (vasodilator, anti-inflammatory, anti-ischaemic, and anti-arrhythmic). However, due to the use of certain drugs (diuretics) upto ½ the patients may have decrease in serum magnesium. Periodic measurements of magnesium values are essential in heart failure patients and those found deficient should receive its supplementation.
Thiamine supplements for patients treated with diuretics :
Certain drugs, particularly furosemide (lasix) are responsible for increasing vitamin B6 (thiamine excretion). If deficient, high-dose thiamine supplementation (300 mg/day) may prove beneficial.
Moderation in alcohol consumption :
Moderate alcohol consumption (upto 10 drinks per week) may slightly lower the risk for heart failure but higher dose could be harmful.
Avoidance of saturated fat and fried foods :
The risk for heart failure increases with higher amounts of red meat, fried foods and daily consumption of eggs. These food items are also sources of advanced glycation end products, which have been related to the severity of heart failure and are independent predictors for cardiac events in these patients.
Omega-6 to omega-3 fatty acids ratio :
The recommended ratio of omega-6 to omega-3 fatty acids in the diet is ≤4:1. However, most diets have a ratio between 10:1 – 50:1. This ratio predisposes individuals to atherosclerosis and inflammation that are often precursors of heart failure. In general, animal foods are rich in omega-6 fatty acids and there is a need to counterbalance it by using plant-based diets which is associated with improvements in major cardiac risk factors. In addition to plant diets, foods specifically rich in omega 3 fats could also be used, like crab, fish (tuna, cod, and salmon), mussels, rapini (Broccoli Rabe), spinach, flax seeds, mangoes, lettuce, and kidney beans. Upto 1600 mg per day is recommended.
Fruits and vegetables :
Eating fruits and vegetables decreases the risk of heart failure and therefore eating a minimum of five fruits and vegetables per day is recommended. Interestingly, vegetables seem to be more protective against heart failure than fruits, the intake of ≥5 daily servings fruits and vegetables (combined) can decrease the risk by 1/5th.
Healthy diet pattern :
Both Mediterranean (rich in salads, olive oil, and nuts) and DASH (sodium restriction) style diets, as well as diets with lower meat content, higher unsaturated fat and those higher in fish, can contribute to lower risk of heart failure.
