Heart Failure: How Much Salt Can I Eat?

Salt, Sodium and Heart Failure

By Jason L. Guichard, MD, PhD

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.

About Jason L. Guichard, MD, PhD

Dr. Guichard is a physician-scientist who is dual trained in clinical medicine and basic science research. He completed his training through a highly competitive and prestigious National Institutes of Health (NIH)-funded Medical Scientist Training Program (MSTP) earning both a M.D. and a Ph.D. in cardiovascular biology. He is nationally and internationally recognized for his contributions to clinical and basic science research in the fields of cardiovascular biology and metabolism, mitochondrial structure and function, aging, hypertension, heart disease, and heart failure.
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8 Responses to Heart Failure: How Much Salt Can I Eat?

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  5. Duncan Park says:

    Does the sodium level in a blood test have any relationship with the intake of salt?

    • Jason L. Guichard, MD, PhD says:

      Thank you very much for your question. Generally speaking, your serum sodium (what is measured in a blood test) does not necessarily represent or correlate with your intake of salt. However, there are certain specific medical conditions where salt tablets are prescribed to raise someone’s serum sodium, but those are unique and special cases.

      Your serum sodium is more a measure of your hydration status. A high sodium indicates a lack of free water in your blood (one possibility would be dehydration). A low sodium indicates an excess of free water in your blood (one possibility would be heart failure or other volume overloaded states).

      To answer your question about measuring someone’s estimated salt intake, the easiest way is by measuring a 24-hour urinary excretion of sodium. A high urinary sodium excretion correlates with a high salt intake diet. We hope this helps and please let us know if you have any additional questions.

  6. Rose says:

    My mother in law (84) was recently hospitalized for four days with mild dehydration and very low sodium. On the advice of her doctor she almost completely eliminated salt from her diet; we called her a salt miser. The problem, as we have thought about it was that she cooks all her own food. It would be wise for a doctor to ask an elderly patient if they do cook their own food and to make sure they salt it lightly. Much of society’s intake of salt comes from prepackaged or fast food which is mainly the culprit. Interesting response above.

    • Jason L. Guichard, MD, PhD says:

      Yes, that is one of the certain specific medical conditions that I was alluding to before and it is referred to as the “tea and toast” phenomenon. The long-winded medical term is euvolemic hypotonic hyponatremia.

      In elderly patients with a diet low in protein and sodium, a low serum sodium may be caused by their reduced solute (e.g. carbohydrates, proteins, electrolytes, etc.) intake. Your kidneys need solutes in your blood for water excretion. Therefore, if your solutes are low, then your water excretion will be low. Over time, you will develop excess free water in your blood leading to a low serum sodium (hyponatremia). An increase in dietary protein and salt intake can help improve water excretion and normalize the serum sodium. Thank you for your comment!

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