Congestive heart failure (CHF) affects how well the heart pumps blood, which can lead to fluid buildup, swelling, and shortness of breath. Having CHF also increases the risk of other heart issues like atrial fibrillation (Afib), hypertension, heart attack, impaired liver and kidney function, malnutrition, and cardiac cachexia, which is severe weight loss due to decreased heart function.

Alongside medications and medical care, what you eat plays a major role in managing symptoms and protecting heart function. Certain foods can worsen fluid retention and strain the heart, while others help support strength, energy, and circulation, and can help prevent progression of the disease. 

Why Diet Matters in Congestive Heart Failure

A heart failure diet focuses largely on sodium restriction because sodium plays a significant role in fluid balance. When sodium intake is high, your body holds onto more water, which can increase blood volume and make the heart work harder, worsening swelling, shortness of breath, and fatigue. 

People with CHF have traditionally been told to limit their sodium intake to 1,500-2,000 mg per day, similar to general AHA guidelines. However, newer research suggests higher levels may be appropriate for some individuals taking diuretics, since these medications increase sodium and fluid loss. 

So, the goal isn’t to eliminate sodium entirely on a low salt diet for CHF,​ as we require some regardless. Food should still be enjoyable and flavorful, while being mindful of how much you’re consuming and your primary sources. 

Some great ways to enhance flavor without adding salt include herbs, spices, lemon juice, vinegar, garlic, and pepper.

Foods to Avoid with Congestive Heart Failure

Putting it all into context, here are some of the types of foods you’ll want to avoid on a heart failure diet:

Foods high in sodium: 

• Processed meats, including deli meats, hot dogs, sausages, and jerky
• Some canned foods, including soup, beans, and vegetables
• Store-bought broth/stock
• Salty snacks, such as chips, pretzels, crackers, salted nuts, etc.
• Condiments, such as soy sauce, mustard, relishes, salad dressings, and prepared marinades and sauces
• Foods packaged in brine, such as pickles, sauerkraut, and olives 
• Vegetable/tomato juice

Refined carbohydrates: 

• White bread
• White rice
• Pasta
• Biscuits, pizza dough, and other bread products made with all-purpose white flour
• Some cereals

Added sugars: 

• Sugar-sweetened drinks, such as soda and energy drinks
• Candy, baked goods, and other sweet desserts
• Sweetened cereals

Foods high in saturated and trans fats: 

• Red meat
• Baked goods and pastries
• Fried foods
• Whole milk and other full-fat dairy products
• Unhealthy fats, including butter, coconut oil, palm oil, shortening, lard, and margarine

It’s also important to avoid alcohol because it can weaken the heart muscle, worsen fluid retention, interact with heart medications, and trigger irregular heart rhythms.

Foods to Eat on a CHF Diet

CHF increases the risk of developing nutrient deficiencies due to poor appetite, medication effects (especially diuretics), reduced digestion and absorption, and fluid restrictions that may limit food intake. 

When key nutrients are low, symptoms can worsen. For example, low potassium or magnesium can increase the risk of dangerous heart rhythm changes, low thiamine (vitamin B1) can impair energy production in the heart muscle, and inadequate protein may lead to muscle loss and reduced strength. 

Additionally, omega-3 fatty acids, antioxidants, and fiber play important roles in reducing inflammation, supporting vascular health, and improving cholesterol and blood pressure control.

So, the foods to eat on a heart failure diet aren’t just low in sodium, they’re nutrient-dense and rich in important compounds to support cardiovascular and overall health. 

Furthermore, the American Heart Association says that at least 20% of adults with heart failure have a low intake of vitamin A, calcium, magnesium, selenium, and iodine, and up to 75% have a low intake of vitamin D.

Here are some places to get these key nutrients: 

• Vitamin A: Sweet potatoes, carrots, pumpkin, spinach, kale, and other orange or dark leafy green vegetables provide beta-carotene, which the body converts to vitamin A.
• Calcium: Low-fat milk or yogurt, fortified plant-based milks, calcium-set tofu, broccoli, bok choy, and leafy greens like kale (check labels for sodium content).
• Magnesium: Beans and lentils, whole grains, nuts and seeds (especially pumpkin seeds and almonds), leafy greens, and avocados.
• Selenium: Brazil nuts (one to two per day is sufficient as this provides >100% of your Daily Value for selenium), sunflower seeds, whole grains, eggs, and seafood.
• Iodine: Iodized salt used sparingly, dairy products, eggs, and sea vegetables such as nori or kelp (small amounts only due to variability in iodine content). Some multivitamins also contain iodine.
• Vitamin D: Besides fatty fish, certain UV-treated mushrooms, and fortified dairy products, there aren’t many food sources of vitamin D. Many people benefit from a supplement, but it’s important to first have your blood levels checked. Your provider can recommend supplementation and follow-up (if needed) accordingly. 

Additionally, be sure to eat plenty of fruits and vegetables, whole grains, beans, lentils, healthy fats (from olive oil, avocados, nuts, and seeds), herbs and spices, and lean proteins to meet your macronutrient needs and get a wide array of vitamins, minerals, fiber, and antioxidants. 

Not all packaged foods are off-limits on a heart failure diet. Some store-bought items can still be used occasionally for convenience, as long as you look for low-sodium, nutrient-dense options. 

Practical Tips for a Sodium-Restricted Diet for Heart Failure

Remember, following a sodium-restricted diet for heart failure doesn’t mean eliminating salt entirely. Instead, it’s important to be aware of your sodium sources and be intentional about how much you’re using. 

Most sodium in the Western diet comes from packaged, convenience, and restaurant foods, not the salt shaker, so choosing more home-cooked meals and reading nutrition labels can make a big impact. 

Aim for products with 140 mg of sodium or less per serving when possible, and rinse canned beans or vegetables to reduce sodium further. 

To keep food enjoyable and flavorful, build taste using herbs, spices, garlic, onion, citrus, vinegar, pepper, and salt-free seasoning blends. Taste buds can adapt over a few weeks, making lower-sodium foods naturally more satisfying over time, which helps with long-term heart-healthy eating success.

Diet and Heart Failure FAQs

What foods should I avoid with congestive heart failure?

Avoid or limit high-sodium foods like canned soups, processed meats, fast food, salty snacks, alcohol, fried foods, refined sugars, saturated and trans fats, sugar-sweetened beverages, and heavily processed items, which can worsen fluid retention and strain the heart.

How much sodium should I have daily on a CHF diet?

Many experts recommend a sodium intake of 1,500-2,000 mg per day for people with heart failure, though this can vary depending on things like what stage of heart failure and whether certain medications are being used. For instance, sodium intake can often be higher (and should be personalized) for individuals on diuretics. Always check nutrition labels and choose fresh, minimally processed foods to stay within this range.

Can diet improve congestive heart failure symptoms?

Yes. A nutrient-dense diet and awareness of sodium intake can reduce fluid buildup, lower blood pressure, prevent plaque buildup, and ease strain on the heart. While diet cannot cure CHF, it can prevent its progression and reduce the workload on the heart. Nutrition is a key part of symptom management and overall quality of life.

The Bottom Line on a CHF Diet

Managing congestive heart failure with nutrition is more about fueling your body with the right nutrients to support your heart and overall health than it is about avoiding things. Because many people with CHF take medications like diuretics or blood pressure medicines that can affect electrolytes and nutrient balance, it’s essential to work with a dietitian who specializes in cardiovascular disease. 

With the right support, food becomes a powerful part of your treatment plan and your long-term wellness. Take the first step and schedule your complimentary 15-minute consultation. We’ll discuss your heart health goals, and I’ll advise you on how I can best serve your needs through either individual or group counseling. 

Sources

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