Heart failure is a devastating disease. By 2030, it is estimated that almost 1 in every 30 Americans will have heart failure. Right now, heart failure is the most common cause of hospitalization among older Americans. If you are reading this and have the diagnosis of heart failure, you are certainly not alone.
Even though the name “heart failure” sounds incurable and fatal, patients with heart failure are still able to live long and healthy lives. The key to heart failure management is early diagnosis and treatment. We will discuss the diagnosis of heart failure in future posts. The treatment of heart failure is complex and individualized to each and every patient, however, there are standard treatment guidelines. These treatment guidelines are designed to prevent the symptoms of heart failure and reduce the chances of being admitted to the hospital. One such treatment guideline is dietary salt restriction or a “low-salt” diet, which we will discuss for the remainder of this post.
How much salt do I eat?
Salt is sodium chloride. It is the sodium in salt that is the main concern and the terms “salt” and “sodium” are typically used interchangeably. Increased dietary salt is associated with higher blood pressure; however, it is debatable if salt alone contributes to the development of cardiovascular disease in the general population. Currently, the United States recommended amount of salt is less than 2,300 mg per day. Despite these recommendations, Americans still consume ~ 3,400 mg of salt per day. Here is a small list of some common foods and the average salt content:
Big Mac = 970 mg
Quarter Pounder with Cheese = 1,100 mg
Large French Fries = 350 mg
Large Diet Coke (30 fl oz) = 35 mg
Canned Green Beans (1 can) = 1,400 mg
One Slice of Bread (1 oz, typical) = 100-200 mg, remember this is just ONE slice!
Believe it or not, bread is probably the single largest contributor of salt in the American diet, and bread doesn’t even taste salty! Think, how much salt must be in the foods that actually taste salty? The answer is, a lot. Another shocking revelation is the amount of salt in an average restaurant meal = 2,200 mg, and who doesn’t eat at a restaurant several times a week? Salt is sneaky – very sneaky – mostly because it makes food taste better, which is something that food manufacturers and restaurants know very well.
How does salt affect heart failure?
In heart failure, the heart is unable to keep up with the body’s demands and patients may “retain fluid” or become “volume overloaded.” Without getting too technical, excessive dietary salt is associated with increased volume or fluid retention. Normal sodium balance is altered in heart failure, which causes a vicious cycle of sodium and water retention despite the body already being volume overloaded.
How much salt can I eat?
Clinical studies looking at the effect of dietary salt restriction in patients with heart failure are limited. Despite the limited evidence, dietary salt restriction is recommended by all heart failure guidelines and is arguably the cornerstone treatment for patients with heart failure. Most experts recommend an amount of salt less than 2,000 mg per day for patients with symptomatic heart failure. Dietary salt restriction is difficult to adhere to and only about 1 out of 3 patients with heart failure follow the recommendations. Clearly, an amount of salt less than 2,000 mg per day is difficult to achieve. The issue is not completely resolved, however, and in some clinical studies of patients with advanced heart failure the findings suggest that dietary salt restriction may even lead to worse outcomes! These unsettling results have led to an appeal for new, well-designed clinical studies to better understand dietary salt restriction in patients with heart failure.
What is the bottom line?
The bottom line is that most experts strongly recommend dietary salt restriction for patients with heart failure, so current heart failure guidelines recommend an amount of salt less than 2,000 mg per day.