Heart failure dietary taboos

Strictly control excessive water and sodium intake, avoid foods that increase cardiometabolic burden, and avoid diets that may interfere with the effects of therapeutic drugs. Patients who fail to do these three points are more than three times more likely to be hospitalized for recurrence than those who strictly follow doctor's instructions. This is the most intuitive conclusion I have drawn from the follow-up data of nearly a thousand heart failure patients during my 8 years in the Department of Cardiology.

Think of the heart as an old water pump that has been used for decades. It is not powerful enough. If you fill the pipe with too much water, or there is too much sediment or oil in the water, the pump will not only have to work harder to rotate, but it will also get stuck and break faster. Let’s start with the sodium restriction that everyone is most familiar with. In fact, the standards in the industry have been adjusted in the past two years. The old guidelines required all patients to strictly control sodium intake within 2g per day, which is about the amount of a beer bottle cap. However, the 2023 version of the Chinese Heart Failure Guidelines and the latest European ESC Guidelines have updated their recommendations: for NYHA classification For patients in the stable stage of Grade 1-2 with no obvious edema, the sodium intake can be relaxed to within 3g. It does not need to be too tight, but it can avoid the dizziness and fatigue problems caused by hyponatremia. However, for patients who are in the acute attack stage and have pits in their lower limbs every time they press, they still have to strictly return to the standard of less than 2g. Don't take chances. Don’t believe it. There was a 62-year-old patient, Uncle Zhang, who had stable heart failure for almost 2 years. In the summer, he secretly ate pickled radish with porridge twice. Within a week, his legs were so swollen that he couldn’t even wear leather shoes.

Many people think that everything will be fine if they control salt and drink too much water. This is also a very common pitfall. I took in a 70-year-old aunt two months ago. I heard people say that she drinks more water to maintain her health and detoxify. She soaks wolfberry in a thermos cup every day. She drank almost 3000ml a day. She was so breathless in the middle of the night that she couldn't lie down. When she called 120, her lips were purple. Water restriction is not a one-size-fits-all approach. For patients without edema in the stable stage, it is absolutely fine to drink 1500-2000ml a day. For those who already have edema and have a daily urine output of less than 1000ml, they must control the amount of water they drink to 500ml less than the previous day's urine output. When drinking water, sip it in small sips. If you are not thirsty, drink half a bottle. If you feel dry, you can hold an ice cube or rinse your mouth. It is much more comfortable than drinking a large glass.

Don't think that as long as it's light, there's no problem. High-fat, high-sugar, overeating can cause problems. Last month, a patient's daughter just came back from abroad. She was filial and cooked a pot of tomahawk steak for the old man. The old man was so happy that he ate almost a pound and drank less than half a glass of red wine. That night, he felt chest tightness and broke into a cold sweat. The BNP (heart failure specific indicator) in the emergency room soared to 10 times the usual level. Here I have to talk about a point that many people misunderstand: before, everyone said that patients with heart failure should not touch red meat at all, but this is no longer required in clinical practice. It is perfectly fine to eat one or two lean pork or lean beef every day. On the contrary, it can supplement protein, avoid malnutrition and reduce resistance. If you are afraid of eating too much in one meal, the blood supply demand of the gastrointestinal tract will suddenly increase, and the heart will have to work hard to pump blood, which will directly overload. I usually tell patients that when they eat, they should eat until they are 70% full. If they are hungry, they can eat in 4-5 meals, which is much better than filling them up in one meal.

The last thing to mention is foods that are likely to conflict with medications. This is also the most easily overlooked. For example, for patients taking warfarin for anticoagulation, many people say that they should not touch dark green vegetables at all. In fact, this is not true at all. Vitamin K does affect the effect of warfarin, but as long as the amount you eat every day is stable, for example, if you eat a small bowl of spinach every day, then the doctor will adjust the dosage. There is no problem if you adjust it to the appropriate range. I am afraid that if you don’t eat a bite of green vegetables this week and eat a pound every next week, the INR value (coagulation index) will fluctuate up and down. Either the anticoagulation is not enough and it is easy to develop blood clots, or the anticoagulation is too much and it is easy to bleed, which will increase the risk. There are also patients who take aldosterone receptor antagonists such as spironolactone and have poor kidney function. Don’t show off several bananas and half a coconut at once. Eating too much of these high-potassium foods can easily induce hyperkalemia, which can even lead to sudden death from arrhythmia. This is not alarmist.

In fact, there is really no need to hold a comparison chart and not dare to eat anything. You have to live your life even if you are sick, right? Occasionally eating a bite of pickles or eating two bites of cake to satisfy your craving is absolutely fine, as long as you don’t eat it all at once or in large quantities. The safest thing is to find your own doctor and tailor a diet plan based on your heart failure grade, kidney function, and medications. This is much more reliable than the unified standard found online.