July 8, 2024 -- Cutting back on salt might not always be the best idea for everyone with heart problems. While it’s well known that limiting salt can help to lower blood pressure, questions remain if restricting it really helps people with heart failure. Could these patients sprinkle some salt and not worry so much?
A recent review from the European Journal of Clinical Investigation suggests yes. Researchers looked at studies between 2000 and 2023 and found that there has been no clinical proof that severe salt restriction benefits patients with heart failure. They also found that restricting sodium did not result in fewer instances of deaths or hospitalizations.
Limiting salt intake for heart failure has been widely advised based on traditional teachings rather than strong randomized data, said Deepa M. Gopal, MD, assistant professor of cardiovascular medicine at Boston University's Chobanian and Avedisian School of Medicine.
“Most of the idea that we need to be restricting our salt intake comes from acute decompensated heart failure (worsening of symptoms, such as labored breathing and extreme fatigue, that requires immediate medical attention) patients,” according to James DiNicolantonio, PharmD, a cardiovascular research scientist and author of The Salt Fix. “However, once stabilized and on diuretics (medication that helps your body remove excess salt and fluid), many times these individuals do worse if they restrict their salt intake too much."
It’s normal for our bodies to hold onto fluid when we have an extra salty meal. But if you have heart failure, your body doesn’t remove the fluid as easily, Gopal said. This can lead to fluid and salt buildup in your feet, ankles, and lungs, among other organs, and can heighten your blood pressure.
But patients with stable heart failure can generally consume between 2,300 and 3,000 milligrams of sodium per day (or 1 1/3 teaspoons of salt), according to DiNicolantonio. About 25% of patients with heart failure have low blood sodium, so salt intake recommendations should be personalized to the patient, especially since many take diuretics, he said.
Like most things related to health, a balanced approach to salt consumption often works best.
For Gopal’s patients, “I seek for them to self-identify and eliminate or minimize foods that are very high in salt content to really enable them to optimize a diet that gives them quality of life and enjoyment that can keep them healthy but is also sustainable over years,” she said. While highly restricting salt can lead to poor health outcomes in some cases, so does eating a high-salt diet. Gopal advises to avoid the extremes. One way to monitor your sodium intake is being aware of foods that you have not prepared yourself, such as at restaurants or fast-food joints, said DiNicolantonio. Savory foods like ramen noodles, cheeseburgers, and pizza are notoriously high in salt. Chips, cold-cut meats, and seasoning packets are also sodium-rich foods to watch out for, said Gopal.
“When patients with heart failure have a decompensation event and we identify high-salt foods as part of the precipitant, I do think that can be very empowering to the patient to know they have control over helping them feel and do better moving forward with reduction of their salt intake,” Gopal said.
Ultimately, experts suggest patients with heart failure examine their sodium intake, but don’t be overly restrictive or skip out on family dinners or social gatherings. You don’t have to rotate a host of bland meals, either, noted Maya Guglin, MD, immediate past chair of the American College of Cardiology Heart Failure and Transplant Council.
“With no good evidence, I don't really see the point of decreasing the quality of life of our patients, pushing them to limit sodium intake to the point when food becomes tasteless,” she said.
