Heart Failure: Nutritional Considerations

Diet therapy for congestive heart failure involves restriction of excess sodium and fluids, which can overburden the heart. Because the condition is usually the result of long–term cardiovascular disease, treatment should also include diet therapy for CHD (see Coronary Heart Disease), along with adequate food to prevent excessive weight loss. The primary nutritional considerations are as follows:

• Sodium reduction: A higher intake of dietary sodium is a strong risk factor for heart failure in overweight persons. In patients with heart failure, sodium restriction is an important part of treatment and may reduce the need for drug therapy. Restriction of sodium to 2,000 to 2,400 milligrams per day, along with fluid restriction to 1.5 liters daily, improves heart function and reduces leg swelling. Moderation in sodium intake is also important for the control and treatment of hypertension (see Hypertension), which increases risk for heart failure.
  
• Magnesium: About 30 percent of heart failure patients have magnesium deficiency, which can cause increased sodium levels and decreased potassium levels and is associated with poorer long–term health.
  
• Thiamine supplements for patients treated with diuretics: Evidence of thiamine (vitamin B₁) deficiency has been found in many patients treated with diuretics. Supplementation with high–dose thiamine (200 milligrams a day) improves the disease.
  
• Dietary supplements: A meta–analysis of controlled clinical trials with coenzyme Q10 found significant improvements in heart function in patients with heart failure. Amounts typically used range from 150 to 300 milligrams per day. Other supplements, including L–carnitine, taurine, and the herb crataegus oxycantha L, are under investigation for possible roles in heart failure treatment. However, none of these is yet established as safe and effective.