Transcription:
Dietary Considerations for Living With Heart Failure

Scott Webb (Host): Welcome back to heart. Speak with Baylor Scott and white heart and vascular hospital in Dallas and Fort worth. I'm Scott Webb. And today we're speaking with Katie bike, a registered dietician nutritionist associated with Baylor Scott and white health. Katie. Great to have you on tell us again where you practice and the program name.

Katherine "Katie" Beich, MS, RDN/LD, CDCES (Guest): Well, I practice in Dallas. I practice at the downtown facility, Baylor Scott and White And currently I work in the transplant area for solid organ transplant.

Host: That sounds great. You know, and in today's podcast, we're going to discuss dietary considerations for heart failure. According to the most recent statistics from the Heart Failure Society of America, heart failure affects nearly 6.5 million adults in America. Heart failure is the number one cause of hospitalization in the Medicare population, creating a huge financial burden on the healthcare system. It accounts for an estimated 36% of all cardiovascular disease deaths in the US. So Katie, what exactly are we talking about when we talk about heart failure?

Katie: Well, simply speaking, the term heart failure refers to a weak pumping action of the heart muscle. So, when the pumping function is weak, it lacks the necessary force to get the blood to the different organs, the first of which are the kidneys. So, then the kidneys interpret this low blood flow from the heart, as a lack of fluid in the body. And they, the kidneys, therefore decrease urine output. And this leads to excessive fluid to be accumulated in the body. When this fluid backs up into the lungs, it decreases space for air and that leads to difficulty breathing. And the heart compensates for the weak pumping action by working harder and pumping more often, this makes the heart muscle grow larger than normal.

And this makes it as an even less efficient pump. This vicious cycle just overworks the heart. And it becomes progressively weaker. The most obvious symptoms of a weak pumping action are fatigue or tiredness, shortness of breath, reduced exercise capacity and sometimes swelling of the ankles and legs.

And heart failure is actually a progressive condition in that it starts slowly and it gradually worsens. It's characterized by four stages beginning with no symptoms, but at risk for advancement and ending with the fourth stage where the symptoms are advanced and not responsive to standard treatment.

Host: Yeah. So it does seem, as you say, because this is a progressive condition, or situation for folks that early diagnosis would be key. And I'm sure as a part of that, it would be helpful for folks to know what their risk factors are. So, what are the risk factors for heart failure, especially the ones that are influenced by diet?

Katie: Well, that's a good question. Many of the risk factors have some genetic or environmental predisposition to their occurrence, but even so, the composition of the diet plays a really significant role in the occurrence and the treatment of most cases of heart failure. You know, a person can even circumvent the occurrence of heart failure with a proper diet, or if someone already has some degree of heart failure, a diet can potentially avoid or slow the progression of heart failure to more serious stages.

While, on the other hand, a poor diet can lead to and advance the progression of heart failure. So, one of the primary causes of heart failure is high blood pressure also known as hypertension. So, when the blood is pumped at high pressures, the force of the blood hitting the inside of the blood vessels, actually cause the vessels to become stiff and damaged.

And then lesions like scabs form on the inside walls of the vessels. And these are prone to plaque buildup. The plaque buildup called atherosclerosis narrows the space through which the blood flows through the vessels. And this further increases blood pressure and the workload on the heart. So, blood pressure is very strongly influenced by the minerals, sodium and potassium, both which get into our bodies by the food we eat. Multiple studies, including large and international research clearly demonstrate that the more sodium consumed, the higher the blood pressure. Salt and processed foods are highest in sodium. On the other hand, potassium relaxes blood vessels and can promote normal blood pressure. Rich sources of potassium include fruits, leafy green vegetables, beans, nuts, dairy foods, and starchy vegetables like winter squash and all kinds of potatoes.

A second major cause of heart failure is cardiovascular disease often occurring sometime after a myocardial infarction or heart attack. So, when the cholesterol plaque inside the walls of the blood vessels narrow the diameter of the vessels to the point where clots form and stop the flow of blood and oxygen to the heart, portions of the muscle die. And this damage to the heart can interfere with the signals that control the rhythm and pumping action of the heart. And this leads to heart failure eventually. The fatty deposits, the plaque inside the blood vessels are enhanced by a diet that is rich in saturated fats. Now saturated fats are those that are solid at room temperature, and they include fats from animal sources except fish has a different type of fat. Coconut oil, fats from dairy products, lard and shortenings are all saturated and can increase harmful blood cholesterol levels. On the other hand, unsaturated fats, which are those that are liquid at room temperature can actually decrease detrimental blood cholesterol. Oils derived from fish and plant-based sources are considered healthy fats, including vegetable oil, corn, canola, olive, nut and seed oils. And then avocados, olives, nuts and seeds are all rich sources of unsaturated fats. A third major risk factor for heart failure is high blood sugar, including pre-diabetes and uncontrolled diabetes. So, when the level of sugar is elevated and the blood is sticky and sticky blood is going to more easily attach to the tears and fatty plaque inside the blood vessels contributing to the narrowing of the blood vessels and reduced blood flow. And again, this increases the work of the heart, the risk of a heart attack and high blood pressure. And so obviously the overall meal composition is a fundamental component in the management of both diabetes and pre-diabetes.

And finally being significantly overweight is a risk factor for the development and progression of heart failure. And this is by multiple complex mechanisms. For example, obesity simply increases the workload of the heart by the fact that the heart must work harder to get blood to more body mass. Fat can accumulate in and around the heart, changing the structure and the ability to pump efficiently and disrupt heart rhythms and obesity increases the predisposition to other risks for heart failure, along with sleep apnea, which is a stress on the heart muscle. So, these four risk factors for heart failure, high blood pressure, high blood sugar, atherosclerosis, and obesity are generally preventable conditions, strongly influenced by lifestyle choices.

And the sooner lifestyle interventions, including diet are initiated and followed, the better the prognosis, or progression to more serious disease and disability can actually be mitigated by longterm commitment to healthy eating and exercise.

Host: Yeah, I love hearing generally preventable, preventable, manageable. Those are always good buzzwords for me. I definitely should have eaten before we did this podcast because you were going through all the foods, avocados and fruits. And it definitely made me even hungrier, but I, I can really appreciate what you're saying, Katie. And once someone is diagnosed with heart failure, is there a specific diet that you recommend?

Katie: Any diet prescriptions are going to focus on the risk and causes for heart failure. For example, if a person is significantly overweight, the plan will include strategies to promote weight loss, or if high blood sugar is an issue, carbohydrate recommendations will be addressed. If the kidneys are working normally, though diet recommendations for heart failure, encourage foods rich in potassium, especially vegetables, and also beans and fruit. Alternatively, anyone with heart failure would benefit from limiting sodium in the diet to foster normal blood pressure and fluid balance in the body. One function of sodium is to attach to fluid and hold onto it like a magnet.

Just consider how thirsty you feel after consuming a salty meal. Well, we're thirsty because the abundance of sodium we put into our body supplied by the food we eat or have eaten, it craves the fluid to attach to and hang on to. So, when heart failure is present, again, those kidneys will decrease the amount of fluid excreted from the body. So, together more fluid is consumed, less is excreted, and the result is excessive fluid retention, which further overworks the heart.

Now salt and sodium are not really the same thing. They're connected, but they're not the same. Salt, we commonly call table salt that is added to food is a compound composed of 40% sodium and 60% chloride. It doesn't matter if the salt mined from the ground or evaporated from the sea, like sea salt, or even as a gourmet flavored salt to some type. Each teaspoon of fine granulated salt contains approximately 2300 milligrams of sodium. Salt though is the only food or additive that is naturally high in sodium as it's found in nature.

Now, sodium is a mineral that is in foods naturally in small amounts. And it is added during processing of food by food companies. So, the average intake in America is about 3,400 milligrams of sodium per day, per person, average. Now the general recommendation for someone with heart failure is to consume about 2000 milligrams of sodium daily. In America, we simply consume too much sodium. The biggest contributor to sodium intake is not the salt shaker, rather Americans in general, consume a lot of processed foods and restaurant foods because they're quick, they're easy and they're convenient. When foods, as they're found in nature are processed by food companies, sodium is added to enhance flavor.

It's used as a preservative to extend shelf life. And it improves texture and appearance. Approximately 70% of sodium in the American food supply is hidden in commercially processed foods and restaurant food. The other 30% is divided between what is in foods naturally and salt containing seasonings, which are added during cooking or when eating. So, the connection between heart disease, including heart failure and excess sodium intake in the American diet is clear cut. In fact, the evidence is so strong that on October 13th, 2021, the Food and Drug Administration issued a petition to food companies and restaurants to voluntarily reduce sodium content in 163 categories of food, and this was done to potentially improve population health and to decrease the huge financial burden on the healthcare stemming from chronic health conditions, fueled by the processed food choices we make.

The problem with this strategy is that salt is an acquired taste. So, in other words, the more sodium a person consumes, the more they desire it. And it takes time to adapt to the taste of lower sodium foods. So, in America, where there is fierce competition for our food dollar, in fact, there's more food and more calories produced than consumed or should be consumed. And you can tell that by all the marketing that takes place. In fact, processed and convenience foods are sold everywhere and food companies and restaurants that reduce salt and sodium would likely not be able to remain competitive with companies that do not change the sodium content of their products.

So, Americans in general have acquired a taste for salt. It's just a cheap additive that keeps people coming back for more.

Host: Yeah, it really does. It's almost in a way just to paraphrase, it almost seems like we're sort of addicted to sodium in a way, addicted to salt. And, and when things don't taste the way we're accustomed to them tasting, then it feels like there's something wrong with the food. When in fact what's probably wrong with it, quote unquote, is that it's actually better for us, right? It's just missing the stuff that we're used to, as you say, the food companies and restaurants. So, what can we do? What suggestions do you have for us to be able to lower our sodium intake if the food companies and restaurants won't play ball?

Katie: There's a lot that can be done to eat a diet that has a healthy balance of sodium and potassium, and is also delicious. I like to divide strategies into four broad categories. Within each category, the strategies can be as simple or as elaborate as someone desires. The point is, just about everyone can do something to move toward a healthier diet.

The first strategy is really the simplest. It's simply to choose seasonings that are salt-free or are labeled as no added salt. This could be substituting fresh or dried or powdered garlic and onion for garlic and onion salt. There's lots of salt-free seasoning blends available for purchase, or they can be homemade. Dried and fresh herbs and hot or sharper tasting spices add lots of flavor. And acidic foods such as flavored vinegars, lemon juice or lemon zest, these act as flavor enhancers, similar to salt.

The second strategy of the four is the most comprehensive and also the most beneficial and it's to choose foods that are naturally low in sodium and avoid foods that are high in sodium. And this strategy really underscores the point that what to eat is just as important as what to avoid eating. A grocery shopping list can be a valuable tool to make this strategy work and start with vegetables, making them the center piece of meals and stacks, fresh vegetables are ideal and they're abundant.

There's also many canned and frozen vegetables available that are not processed with added salt. You know, some people think they don't like vegetables or they don't know how to prepare them. So, one of the most useful resources I use sometimes is simply a sheet of paper with 50 different colorful pictures of non-starchy vegetables. And we'll just sit down and identify which vegetables they already like, which ones they're willing to try. And then practically explore easy and tasty ways to prepare and enjoy them. So, they're more likely to be consumed in abundance. Next, consider protein sources that are lowest in sodium. You know, meats that are processed, contain a lot of sodium. And these include bacon, sausage, hot dogs, all kinds of sandwich and deli meats, and ham. Fresh meats that are not seasoned or processed, are just naturally low in sodium, including pork or poultry, beef, fish, all kinds of dried beans and pea's are good sources of protein and also potassium. And they're great substitutes for fatty and processed meats.

Now all fruits are just naturally low in sodium and they're ideal substitutes for fatty and salty snacks. Sodium rich processed foods include prepared frozen meals and entrees, soups, prepared soups, many packaged foods, such as seasoned side dishes and all kinds of mixes. Most bread products are not significantly high in sodium, but they do contribute to a significant amount of sodium to the average American diet, largely because we tend to eat so much bread.

So, substituting potatoes, sweet potatoes that would provide a lot less sodium and yet an abundance of potassium. Whole grains, such as oats and barley, quinoa, popcorn and even black rice and other starch alternatives. They offer a variety of tastes and textures. The third strategy is to use the nutrition facts label to make lower sodium choices. This information is posted on all processed foods. And this is where the goal to reduce total sodium intake to about 2000 milligrams per day is a useful reference point. The milligrams of sodium in a product is what is contained in one serving as specified on the food label. For example, the specified serving amount for canned tomato sauce is one fourth cup. That's just two tablespoons. Most canned tomato sauce has about 400 milligrams of sodium per one fourth cup. But when processed without salt and labeled no salt added, one fourth cup has only 15 milligrams of sodium. So, comparing that to the total goal of about 2000 milligrams per day, only one fourth cup of tomato sauce processed with salt provides 20% of the daily goal, whereas the tomato sauce process without salt provides a negligible amount of sodium.

Or think of another example is fresh meat. So, fresh meats contain anywhere from about 20 to maybe up to 50 milligrams of sodium per ounce, but processed meats contain over 350 milligrams of sodium per ounce. So, a three ounce serving of a processed let's say deli meat or ham would provide over 50% of a total 2000 milligram daily sodium goal.

While vegetable salads are considered healthy; prepared salad dressings often contain anywhere from 200 to 400 milligrams of sodium in just two tablespoons. So, an oil and vinegar-based salad dressing can easily be mixed with some spices to contain a fraction of the sodium and enjoyed with these potassium rich greens. So, the nutrition facts food label, and the 2000 milligram daily sodium benchmark are great tools to gauge the serving sizes and the sodium content of foods.

Lastly, the fourth strategy is to consider sodium content of foods when choosing foods from restaurants. So, many chain restaurants, especially fast food restaurants list the sodium content of menu items on their websites, and sometimes on a brochure located at the restaurant. This information can be used to make lower sodium choices. If this information is not available, just try to choose the least processed food and avoid added salt and sauces or serving sizes can be limited by splitting meals or taking part of the meal home to eat at another time.

Keeping that daily sodium intake generally close to 2000 milligrams a day may mean eating restaurant food less often. And having a plan for simple, easy to fix meals at home that are low in sodium and rich in nutrition. However, consider supporting restaurants that provide choices that are lower in sodium, you know, money talks. And when a majority of people care more about their health and long-term quality of life than the immediate gratification of sweet, salty and fatty foods, it will be economically viable to decrease the sodium content of food supplied in America. A healthful diet limited in sodium and abundant in potassium can actually be easy, convenient, affordable, and most of all tasty. It does require a commitment to including more plant-based foods and less processed products, whether eating home cooked meals or restaurant food.

Host: Yeah, I think you're so right, Katie, that money definitely talks. And if we just choose not to spend our money where, you know, on the foods or the restaurants that just won't do the right thing when it comes to sodium and other things, of course, then maybe, you know, they'll just be forced to make the changes we want them to make. This has been really educational today. As we wrap up Katie, what additional resources are available to identify a healthy diet composition to support a diet controlled in sodium for heart failure?

Katie: Well there's many good resources available on the worldwide web. The American Heart Association has many recipes. They even have videos to learn cooking skills, which incorporate more vegetables. The American Diabetes Association has a site called the Diabetes Food Hub and it organizes preferred recipes and meal plans. It even creates an individualized grocery list.

For guidance on ideal diet composition, search Mediterranean Diet or Dash diet, D-A-S-H on the web. Dash, standing for dietary approaches to stop hypertension. You know, it's really hugely beneficial to meet individually with the registered dieticians. You know, registered dieticians are not going to tell anyone what to do. Instead we come alongside each person to listen and then clarify nutrition goals and priorities on health conditions. Social and personal influences and preferences are always considered. Dieticians assist and support people to move from where they are, to where they want to be successfully and specific for each person. Weight and calorie goals, kidney function, resources, skills,

all kinds of things are taken into consideration. Registered dieticians can be found at most hospitals and on the Academy of Nutrition and Dietetics website, which is eatright.org. You know, just to wrap up, there's really no detrimental side effect to a healthy diet. It has the potential to add quality of life to a longer life. You know, the saying the food you eat can either be the most powerful form of medicine or the slowest form of poison. That's really true.

Host: Yeah, we really are. As I've come to learn, we really are what we eat. Right. And we would just be better for eating less sodium, eating healthier, getting more exercise, speaking with registered dieticians to help us, as you say, there's no judging there. It's just about working alongside people to try to have them not only live longer, but have that quality of life as they live longer. So, Katie, this has been so educational. I'm so hungry. I'm going to go eat. Thank you so much for your time today and you stay well.

Katie: All right. Thank you so much. I've enjoyed this very much.

Host: The Baylor Scott and White Advanced Heart Failure Clinic provides access to the largest heart transplant program in Texas and the second largest in the nation, in terms of volumes. In addition to the Dallas Clinic, there are outreach clinics across the state of Texas. To find an advanced heart failure cardiologist or a cardiac surgeon specializing in advanced heart failure on the medical staff at Baylor Scott and White Heart and Vascular Hospital, Dallas and Baylor University Medical Center, call 1-844-BSW-DOCS.

Scott Webb (Host): And to learn more about the advanced heart failure program. Visit BSW health.com/heart Dallas. Or download the Baylor heart center app on your apple device. Thanks for listening to heart speak the podcast or Baylor Scott and white heart and vascular hospital in Dallas and Fort worth. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest.

I'm Scott Webb. Thanks for listening.

Host: Baylor Scott and White Heart and Vascular Hospital, Dallas, Fort Worth, joint ownership with physicians.