According to the American Heart Association (AHA), the average American takes in more than 3,400 milligrams (mg) of sodium each day. The organization recommends consuming no more than 2,300 mg of sodium per day, while working towards an ideal limit of 1,500 mg per day for most adults. “Too much salt is bad for the heart,” explains Rebecca Fuller, RD, a cardiovascular intensive care dietitian at MUSC Heart and Vascular Center in Charleston, South Carolina. “Sodium acts as a magnet for fluid, which can lead to an increase in fluid retention and blood pressure.” Your heart has to work harder when there’s extra fluid in your body. “Over time, high blood pressure can increase risk of stroke, heart failure, and kidney disease.” Individuals with congestive heart failure generally benefit from a reduced sodium diet, as well. But while congestive heart failure patients should also avoid excess salt in their diet, exactly how much salt they should be consuming is still up for debate. For patients with more severe heart failure, the guidelines state that there’s currently not enough evidence to endorse a specific level of sodium intake.
The Challenge in Recommending Sodium Intake for People With Heart Failure
“This is an area that’s in desperate need of research,” says Lawrence Appel, MD, director of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins Medical Institutions in Baltimore. “In the general population, we’re trying prevent or control hypertension, so there are set recommendations, but with heart failure it’s really tricky.” That’s because individuals with heart failure are often heavily medicated. These drugs often include diuretics, which increase the production of urine. Dr. Appel says that if heart failure patients abruptly decrease their sodium intake while taking diuretics, they can put themselves at risk of dehydration. If the body’s sodium level drops too low, it can lead to muscle cramps and disorientation, and if it’s severely depleted and not treated, seizures and coma could result, Fuller explains. It’s a balancing act, though, because excess sodium should be avoided in heart failure patients, as well, experts say. Fuller points to a study published in the Journal of Clinical Nursing that found high levels of sodium to be harmful to patients with heart failure. “In individuals with heart failure, consuming more than 3,000 mg a day increased symptoms which can lead to more ER visits, hospitalizations, and death when compared with those with heart failure who consume lower amounts of sodium,” she says. So how can patients with heart failure know exactly how much sodium they should be consuming? The answer, Appel says, must be worked out with your doctor. “The bottom line is, ideally, don’t consume excess sodium,” he says. “Certainly don’t increase it or decrease it abruptly.” Aim to keep it at constant level and your clinician will adjust your medication around that. “Any major changes should be done in conjunction with your healthcare provider.”
