What can you drink with congestive heart failure

Congestive heart failure (CHF) occurs when the heart does not pump efficiently and is not able to deliver enough oxygen to the body. It can be caused by high blood pressure or other heart problems. When you eat too much sodium (and salt) or drink too many fluids, your heart has to work even harder to pump the extra blood volume through your blood vessels. The heart does not have to work quite as hard when you make changes to your diet.

All heart-healthy guidelines are important for people with CHF, but it is extra important to follow a low-sodium diet-1,500 milligrams-to prevent fluid retention in the body. Sodium makes you thirsty and makes your body hold onto fluids rather than urinating them out. In addition, it is important to limit the amount of fluids you drink. The amount can vary and your doctor will let you know how much you should be drinking in a day. The extra fluid may make it very hard to breathe and it may be life-threatening and require hospitalization. So, following low-sodium and fluid guidelines are a vital part of the treatment for CHF.

Here are some ways to help manage congestive heart failure with your eating plan:

1. Slash Sodium.

• Eat plenty of fruits and vegetables, which are naturally low in sodium.
• Choose fresh foods, including lean meats, fish, poultry, dry and fresh legumes (or rinsed canned beans), eggs, milk, yogurt, plain rice, pasta and oatmeal.
• Choose lower-sodium sensible snacks.
  
• Avoid using the salt shaker. Or replace it with a sodium-free blend of herbs, such as Mrs. Dash.
• Cut the sodium completely, or at least reduce it by half in recipes. Be a creative cook-use herbs, onion, garlic, citrus and other fruit juices, and vinegars to add flavor.
• Be careful of condiments-ketchup, mayonnaise, mustard, pickles, olives, marinades, tenderizers, soy sauce, lemon pepper and some seasoning blends contain a lot of sodium. Check the ingredient list for salt.
• Avoid convenience foods, Chinese food, and fast foods. Follow tips for heart-healthy dining out, but limit how frequently you go out to eat because it is very difficult to restrict sodium enough even when special requests can be made.
• Read food labels  for sodium content before you buy packaged or canned foods.

2. Weigh Yourself Daily

In order to catch any fluid retention or worsening of congestive heart failure early, it is very important to weight yourself every day. A gain of 1 to 2 pounds overnight, or 5 pounds in a week, is a signal that your body is retaining extra fluid. If this occurs, call your healthcare provider right away because you may need to make adjustments in your diet or medications. Noting and dealing with fluid weight gain promptly may prevent worsening heart failure and the need for hospitalization.

Weigh yourself on the same scale every day when you wake up. Urinate first, and always wear the same amount of clothing. Record your weight, and bring your log with you to all of your appointments with your healthcare provider.

3. Keep Food Intake (and Calories) in Check

Because CHF can make it hard to breathe, physical activity may be restricted by your doctor. As a result, it may be difficult to maintain or reach a healthy weight with weight loss. It is even more important to restrict calorie intake to prevent weight gain if exercise must be limited due to heart-related breathing problems. Learning how to read food labels can help you keep track of calories.

Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes fluid to build up in your body. Limiting how much you drink and how much salt (sodium) you take in can help prevent these symptoms.

When you have heart failure, your heart does not pump out enough blood. This causes fluids to build up in your body. If you drink too many fluids, you may get symptoms such as swelling, weight gain, and shortness of breath. Limiting how much you drink and how much salt (sodium) you take in can help prevent these symptoms.

Your family members can help you take care of yourself. They can keep an eye on how much you drink. They can make sure you are taking your medicines the right way. And they can learn to recognize your symptoms early.

Your health care provider may ask you to lower the amount of fluids you drink:

• When your heart failure is not very bad, you may not have to limit your fluids too much.
• As your heart failure gets worse, you may need to limit fluids to 6 to 9 cups (1.5 to 2 liters) a day.

Remember, some foods, such as soups, puddings, gelatin, ice cream, popsicles and others contain fluids. When you eat chunky soups, use a fork if you can, and leave the broth behind.

Use a small cup at home for your liquids at meals, and drink just 1 cupful (240 mL). After drinking 1 cup (240 mL) of fluid at a restaurant, turn your cup over to let your server know you do not want more. Find ways to keep from getting too thirsty:

• When you are thirsty, chew some gum, rinse your mouth with cold water and spit it out, or suck on something such as hard candy, a slice of lemon, or small pieces of ice.
• Stay cool. Getting overheated will make you thirsty.

If you have trouble keeping track of it, write down how much you are drinking during the day.

Eating too much salt can make you thirsty, which can make you drink too much. Extra salt also makes more fluid stay in your body. Many foods contain "hidden salt," including prepared, canned and frozen foods. Learn how to eat a low-salt diet.

Diuretics help your body get rid of extra fluid. They are often called "water pills." There are many brands of diuretics. Some are taken 1 time a day. Others are taken 2 times a day. The three common types are:

• Thiazides: Chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide (Lozol), hydrochlorothiazide (Esidrix, HydroDiuril), and metolazone (Mykrox, Zaroxolyn)
• Loop diuretics: Bumetanide (Bumex), furosemide (Lasix), and torsemide (Demadex)
• Potassium-sparing agents: Amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium)

There are also diuretics that contain a combination of two of the drugs above.

When you are taking diuretics, you will need to have regular checkups so that your provider can check your potassium levels and monitor how your kidneys are working.

Diuretics make you urinate more often. Try not to take them at night before you go to bed. Take them at the same time every day.

Common side effects of diuretics are:

• Fatigue, muscle cramps, or weakness from low potassium levels
• Dizziness or lightheadedness
• Numbness or tingling
• Heart palpitations, or a "fluttery" heartbeat
• Gout
• Depression
• Irritability
• Urinary incontinence (not being able to hold your urine)
• Loss of sex drive (from potassium-sparing diuretics), or inability to have an erection
• Hair growth, menstrual changes, and a deepening voice in women (from potassium-sparing diuretics)
• Breast swelling in men or breast tenderness in women (from potassium-sparing diuretics)
• Allergic reactions -- if you are allergic to sulfa drugs, you should not use thiazides.

Be sure to take your diuretic the way you have been told.

You will get to know what weight is right for you. Weighing yourself will help you know if there is too much fluid in your body. You might also find that your clothes and shoes are feeling tighter than normal when there is too much fluid in your body.

Weigh yourself every morning on the same scale when you get up -- before you eat and after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it.

Call your provider if your weight goes up by more than 2 to 3 pounds (1 to 1.5 kilograms, kg) in a day or 5 pounds (2 kg) in a week. Also call your provider if you lose a lot of weight.

Call your provider if:

• You are tired or weak.
• You feel short of breath when you are active or when you are at rest.
• You feel short of breath when you lie down, or an hour or two after falling asleep.
• You are wheezing and having trouble breathing.
• You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
• You have swelling in your feet, ankles, or legs.
• You have to urinate a lot, particularly at night.
• You have gained or lost weight.
• You have pain and tenderness in your belly.
• You have symptoms that you think might be from your medicines.
• Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.

HF - fluids and diuretics; CHF - ICD discharge; Cardiomyopathy - ICD discharge

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Mann DL. Management of patients with heart failure with reduced ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 25.

Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/ AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161. PMID: 28455343 pubmed.ncbi.nlm.nih.gov/28455343/.

Zile MR, Litwin SE. Heart failure with a preserved ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 26.

Updated by: Micaela Iantorno, MD MSc FAHA RPVI, Interventional Cardiologist at Mary Washington Hospital Center, Fredericksburg, VA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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