Scott Webb (Host): Though proper nutrition is a good thing for all of us, it's especially important for heart failure patients. I'm joined today by Heather Gengnagel, she's a nurse practitioner with Franciscan Health, and she's here to tell us who's at the highest risk for heart failure, how proper nutrition benefits heart failure patients, and so much more.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Heather, it's nice to have you here today. We're going to talk about heart failure, sure, but we're also really going to focus in on how those things are connected, right? How nutrition and heart failure and avoiding it and living with it and all that good stuff.

So, I just want to have you start by explaining the ways a person can develop heart failure and what that does to the heart's ability to function normally. In other words, what puts people at risk for heart failure? I'm sure family history and genetics is a part of it, but I'm also sure it's also like lifestyle and behavior and eating and all that stuff. So from your perspective, what puts us at risk?

Heather Gengnagel: There are some that you've touched on, too, but there's multiple risk factors for developing heart failure: coronary artery disease, heart valve disease, hypertension, thyroid disease, alcohol and drug abuse, obesity and metabolic issues. And then, we do have, like you said, the genetic pathologies can lead to it, as well as some treatments for maybe cancer, such as chemotherapy, radiation.

So, there are a vast amount of things that can lead to heart failure, including some of the lifestyle, choices that we choose, especially as Americans, that lack of activity, that poor diet, things like that. A lot of different risk factors.

Host: Yeah, for sure. There's a lot. As you and I were discussing before we got rolling, heart failure is bad. We don't want heart failure. We want to avoid heart failure. And as you're saying, it's multifactorial, but also lifestyle is a big part of it. Sedentary lifestyle, if you will, and really nutrition. So, let's talk about that. Why is it so important when we're dealing with heart failure really to understand, especially from someone like yourself, an expert, how nutrition plays an important part in our overall care and especially avoiding heart failure?

Heather Gengnagel: From a diet standpoint, diets that a lot of patients we see, say, with the coronary artery disease, hypertension that I talked about, we suggest that DASH diet, which is for hypertension or the Mediterranean diet. These are diets that are low in like the red meats, low in fats and sodium, to help with the heart. And all those things are bad for the heart. The, DASH diet, Mediterranean diet are associated with significant reductions in the risk for heart failure as well as coronary artery disease. Controlling the sodium a lot remains important, so that's one of the macronutrients that we find in our foods. Too much sodium can cause the body to retain that water, and I think a lot of people listening will know If they go out or have a high sodium meal or a lot of potato chips one night, things like that, they tend to feel that swelling in their body. When that heart isn't pumping real well, not efficiently, such as in heart failure, that excess sodium causes even more fluid to build up. And you can see swelling in the legs, abdomen even around the lungs that we see on x-rays. It's important to monitor those parts of the diet.

Host: So, you gave us a sense of what to avoid there, but what foods are good? Like what foods are beneficial to patients with congestive heart failure and why? And maybe again, like what are some of the other things we should avoid?

Heather Gengnagel: Right. So, there are a lot of foods that are great and healthy for us. Don't think of it as the limitations, just think of it as the choices that we make. So, fruits and vegetables, they are packed with those nutrients that you need for your body. The fruits and vegetables that are fresh and available to you, even like the frozen ones, they're very naturally low in sodium. Fresh beef, fresh pork and poultry, fish that's non-processed, non-packaged, those typically are good for you and with a low sodium content.

Dairy. Dairy is good. Most yogurts and milk, they're naturally low in sodium. You just have to watch the labels, because a lot of the marketers and companies, they add extra things in there to make it taste better so you do have to watch that label on the back of the foods that you buy. Unsalted nuts and seeds are great and they are a good source of magnesium, which is one of those micronutrients that's really good for the heart. Fresh grains such as like the brown rice, wild rice, some oats, beans, those are low in sodium, but also good to have on board for a healthy diet.

Overall, limiting those processed foods that we find in packaging that we find in cans, limiting fast foods that, you know, stopping on the way home from work, watching for the high sodium in those labels and avoiding that. One of the places that sodium, I feel like, hides from people is in drinks. They don't think of their liquid intake. But if you look on the back of the sports drink and diet drinks, you'll see a high sodium content. You've got to make sure to monitor the fluids as well. I know we all like sometimes to have an alcoholic beverage, but avoiding an excess of alcohol has really shown to be beneficial for heart disease in general.

Host: Yeah. And you mentioned magnesium there as one of the nutrients that is good for us, but I'm thinking in terms of like a heart failure diet, if you will, if there are some nutrients, or wondering anyway, if there's some nutrients that just aren't as good for us or maybe worsen heart failure. So, maybe you can give us some examples of those nutrients that we just may not even think of. Like, yeah, you say sodium and salt. Sure, we all kind of know that one, one of the greatest hits if you will. But what are some of the other ones, those hidden nutrients that might actually make things worse for us?

Heather Gengnagel: Thinking about nutrients and dietary intake, and a little bit of this may seem advanced, but you can look it up on American Heart Association website, they've got great tutorials and things. There's the macronutrients, which are building blocks where the body gets energy, and those are your proteins, your fats, and your carbs. When we look at your macronutrients, you need that protein. It keeps your metabolism going. It gives you that energy. It helps with healing and things and maintains fluid balances in the body.

So, the good types of proteins that you want to include in your diet would be like eggs, that fresh meat that we talked about, such as chicken, pork, turkey, beef, that's not processed; the dairy products, and beans and nuts. Those are all good forms of proteins. You don't want to be frying the food, getting the burgers on the way home from work or anything like that.

Another macronutrient is fat. And a lot of people think, "Wait. Fats are bad." But your body does need some fat to help absorb vitamins, minerals that we take in. You know, we use fat for energy, but there's healthy forms of fat. We want to think of the healthy forms of fat being like the olive oils, nuts, seeds, and some fish is like high in fat content. But trying to limit that and avoiding those saturated fats, which I always think of saturated fats as you think of if you leave it out, is it going to keep the form of that fat or is it going to melt? So when it keeps that form, you figure that's probably what it's going to do in your body, right? So, limiting or avoiding those butters, those cheeses. Okay, ice cream is an exception because it melts when you leave it out, but a form of saturated fat.

And then, another macronutrient, so that building block, is carbohydrates. And I know everybody's heard that word for sure, and there's tons of diets that even focus on carbohydrates. So, you do need carbohydrates for energy. But just again is making sure that your diet's full of the healthy carbs, and those include fruits, your vegetables, whole grains, some beans and then avoiding those carbohydrates that really have no benefit for you, which would be those candies, sugars, sweet sodas, and like I talked, the drinks, you know, that are just full of that sugar. Those are the carbs to avoid.

So, macronutrient wise, yes, we need protein, we need fat, we need carbs. It's a matter of choosing the right ones that are going to be best for our health and our heart. You'd mentioned the magnesium. We have micronutrients as well that play with the macronutrients. So, the micronutrients, those are like your vitamins, your minerals, and those help to contribute to your body's functions.

A few of them that I would mention: sodium, we talked about; potassium, magnesium. And actually, I think they're finding more and more. Magnesium, it does have a lot to do with heart failure. And there's a range that's healthy for the body. Too much can be bad and cause issues.

But sodium, essentially, we want our sodium intake to be less than 2,000 milligrams a day. Some patients with advanced heart failure symptoms or who are very sensitive to that sodium absorption. We even limit to like 1,500 milligrams a day for their sodium intake. Potassium is important. It's essential for the body as well. It helps with cardiac function, helps send signals, so it's very important, and as well, it's like a tight balance that we want that potassium level at to help that heartbeat regular. And then, magnesium helps the heart in several ways. It helps with the cardiac muscle function again. And it helps with the dilation of the vessels. It can sometimes reduce blood pressure. And the workload of the heart. It has some anti-inflammatory effects, which is good, helping to protect our body from the free radicals things that can cause cardiovascular disease. Just reading labels, and then knowing you need those proteins, fats, carbs and those micronutrients, just choose those healthy ones.

Host: And we've talked about salt and sodium. And sure, I know that it's not good for us necessarily. It might make foods taste good, but isn't necessarily good for us. And I know it's a big factor in hypertension, high blood pressure, those kinds of things, but I don't exactly know why it's bad for us, Heather. So, why is the sodium not such a good thing for us?

Heather Gengnagel: That's where it's like that, you know, watching that amount. The excess is not good for us, because too much sodium causes your body to retain that excess fluid, excess water. And then, when that starts to accumulate, it can accumulate in the body different places. Some patients are more prone to it accumulate in their lower legs and they get swelling. Their ankles turn into cankles. And then, some people tend to have that extra fluid maybe retain more in abdominal area. They get that belly bloat, which really puts a lot of pressure on all those organs that are mid body. It causes those symptoms with shortness of breath. It can cause some fatigue, because then it's putting all that pressure around the heart too. And, even can cause like a cough. Patients may develop a cough if they start retaining a lot of fluid. And they may think, "I'm getting a cold' or "I got an allergy to something," when in fact, they've just got all this extra fluid up and around their heart or lungs. So, that excess of sodium can lean to that fluid retention. And that's why we want to monitor the amount that we have and not take in too much.

Host: What other suggestions do you have to help heart failure patients to lower their sodium intake?

Heather Gengnagel: The first thing I think I usually tell patients that I see who I'm already having that sodium talk with them is just put away the salt shaker. So, put it up in the cabinet or just get rid of it all together. Just by not adding the additional salt, that's a good first step.

Another second step and can be a fun step is using different herbs and trying different recipes that have just some natural herbs and seasonings to add for that flavor that the salt adds. So, I can use like the crushed red pepper a lot of times in lower doses because I don't like hot stuff. But just to give that little bit of extra ting, you know, that gives the food a little bit of liveliness so it's not so bland.

And then, of course, reading those nutritional labels, looking at the labels because there may be five different brands of the same box of stuffing, but you can get a low sodium soup, a low sodium what have you, just to make sure you can understand reading those labels, what to look for and checking the serving size, of course, and making sure you understand how much you truly are taking in.

Host: Heather, this has been great. And way back when we started here, we mentioned exercise and we know that exercise is important, but I want to finish up there and talk about why or how exercise is important in lowering our risk for heart disease and the complications, how it dovetails with nutrition, how all that works. Just to have you sort of emphasize here at the end the importance of exercise.

Heather Gengnagel: For sure. And we're all guilty of those times when we would fall off the wagon with exercise, right? Just starting that routine of exercise, it's going to be good for your overall health. Not just your heart health, your mental health, physical health and strength. But exercise conditioning, it helps when you exercise, it helps you tolerate more exercise, which is great because it helps work that heart out, and with the oxygen in your body to improve the heart function in the overall condition.

Heart failure, we look at heart failure, it's usually a progressive disease. It's chronic. So, if you have heart failure, you have it, but you can improve your symptoms. Patients can improve their heart function and reduce those symptoms, and a lot of times avoid being admitted to the hospital with like exacerbations if they start with the lifestyle changes. The diet and the food that we talked about, exercising daily, and you may have to start low and then build that tolerance up. But as I said, when you start low, it kind of trains that body to Be able to tolerate more exercise as you go.

One thing that we can do for our patients is sign them up for cardiac rehab. I used to think, actually, that cardiac rehab was just for patients who had stents or open hearts to rehab afterwards. But being in the field of heart failure, I find out even insurance, they'll pay for that for those heart failure patients because it's important to work that heart out to make it stronger as well. Sometimes it does take a support system, having that family or having that encouragement, having that partner at home that will say, "Okay we'll walk after dinner, every night and I'll do that with you." Being able to have kind of support to implement that exercise is helpful as well. At least, I know it is for me, having a partner in crime, right?

Host: Absolutely. Or maybe if you have a pet, you know, family pet who likes to go for walks too, that always helps.

Heather Gengnagel: Oh, for sure.

Host: Good stuff today. Cardiac rehab through Franciscan Health, of course, but things that we can do to help ourselves can outrun our family history and genetics, but we can eat better, we can get more exercise, we can limit our salt intake, all that good stuff. So, thank you so much.

Heather Gengnagel: Yeah. I appreciate it. Thanks, Scott.

Host: And to learn more, visit franciscanhealth.org and search heart failure or heart disease. And if you have heart failure or another form of heart disease and are looking for a specialist, go to our website and click on Find a Provider at the top of the home page and select Cardiology.

And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.