Behavior matters


Small changes can make a big difference


Appropriate management of chronic heart failure and its signs and symptoms requires a considerable amount of participation by patients. Behavioral changes that prevent or minimize signs and symptoms and disease progression are just as important as the medications prescribed to treat the heart failure. Self awareness is key to achieve goals.


Self Management — MAWDS for Heart Failure

There are five things you need to do every day at home to manage your heart failure. The following MAWDS acronym may help you remember — and follow — these basic steps:

  • Medications: Take your medications as prescribed by your doctor.

  • Activity: Stay active every day.

  • Weight: Weigh yourself each day.

  • Diet: Follow your diet.

  • Symptoms: Recognize your symptoms and know when to call for help.




Following Key Elements.


How do I follow a 2,000mg Sodium Diet? The average American eats around 6,000-7,000mg of sodium a day, so it is really important to closely watch what you eat to keep your sodium intake low.

You should:

1. Read food labels Look at the serving size. One package may have many servings.

2. Compare the serving size on the label with the amount of food you are eating. If you eat more than 1 serving, you will be getting more sodium than what it says on the label.

3. Look at the amount of sodium. Try to pick foods with less than 140 mg per serving. This food has 40 mg of sodium per serving —this is a good choice. You do not need to pay attention to the “Percent Daily Value”. This number is a guide for people WITHOUT heart failure. 2

4. Throw out your salt shaker One teaspoon of salt is equal to about 2,300 mg of sodium.


WHAT IS SODIUM?

Sodium is an element that is naturally found in many foods. The body requires sodium in the diet to control blood pressure and blood volume. A healthy level of sodium SHOULD LIMIT the intake of sodium. People with certain medical conditions such as high blood pressure, kidney disease, and heart problems can benefit from a diet that is lower in sodium.

WHY SHOULD I REDUCE SODIUM IN MY DIET?

Reducing sodium intake lowers blood pressure in people with high and borderline high blood pressure. Reducing sodium can also help to prevent the retention of fluid in body. People with chronic kidney disease and heart failure due retain salt and fluid more avidly so special attention needs to be paid to what is ingested. Switching from a higher-sodium diet to a lower-sodium diet can reduce blood pressure and help prevent heart failure. It qalso enhances the effectiveness of heart failure medications and can help with weight loss.

WHERE IS SODIUM FOUND?

The main sources of sodium in the diet are processed foods, restaurant prepared foods, and salt added to food at the table. Processed foods include frozen meals, canned foods, soups, pickled foods, snack foods, lunch meats, cheese, condiments, sauces, dressings, breads, and cereals. Sodium found in processed food accounts for approximately 80 percent of a person's daily sodium intake.


What do Guidelines recommend?

Several professional organizations have issued evidence-based guidelines for reducing sodium intake. Most clinicians agree that people should aim a diet around 2 grams of salt. Lower salt intake than 2 grams has not been shown in randomized trial to results in better outcomes. It's recommended for patient to consult a reference book. Many websites provide nutrient data (eg, www.nutrition.gov), and low-sodium cookbooks are also available.

HOW DO I CUT DOWN ON SODIUM?

Although it is difficult initially to cut back on the amount of sodium in the diet, most people find that their taste adjusts quickly to reduced sodium. Salt is an acquired taste, and taste buds can be retrained in less than one to two weeks if people stick with the lower-sodium diet. Fresh herbs, spice blends without sodium, citrus, and flavored vinegar make tasty alternatives to the salt shaker.

It may be helpful to keep a detailed food record and add up sodium intake. Within a short period of time (less than a week), the main sources of sodium can be identified and daily intake can be calculated.

Suggestions to decrease sodium include the following:

● Avoid restaurants of fast food

● Put away the salt shaker and reduce or eliminate salt used in cooking. Experiment with herbs, spices, garlic, onions, or lemon instead.

● Look for low-sodium products such as spice blends, and read labels.

● Make a list of healthy low-sodium foods to substitute.

● Do not add salt to food while cooking or before eating. Teach family members to taste food before adding salt.

● Do not use salt substitutes that are high in potassium unless a health care provider approves. Herb and spice combinations that are salt-free are widely available and can be used to flavor foods.

● Looks at labels.

● Fresh fruits and vegetables are naturally low in sodium. The DASH diet (Dietary Approaches to Stop Hypertension) is a well-known intervention to treat high blood pressure. The DASH diet requires the person to eat four to five servings of fruit, four to five servings of vegetables, and two to three servings of low-fat dairy, and all foods must contain less than 25 percent total fat per serving.


Foods to choose — The following are examples of foods that may be lower in sodium. It is essential, however, to check the labels to determine the actual amount of sodium present, as amounts can vary widely from one brand to another.

● Biscuits – Whole-grain breads, English muffins, bagels, corn and flour tortillas, most muffins

● Cereals – Many cooked low-salt (read the label to determine sodium content) hot cereals (not instant) such as oatmeal, cream of wheat, rice, or farina, puffed wheat, puffed rice, shredded wheat

● Crackers and snack foods – All unsalted crackers and snack foods, unsalted peanut butter, unsalted nuts or seeds, unsalted popcorn

● Pasta, rice, and potatoes – Any type of pasta (cooked in unsalted water), potatoes, white or brown rice

● Dried peas and beans – Any cooked dried beans or peas (without seasoning packet), or low-salt canned beans and peas

● Meats and protein – Fresh or frozen beef, poultry, and fish; low-sodium canned tuna and salmon; eggs or egg substitutes

● Fruits and vegetables – Any fresh, frozen, or canned fruit, any fresh or frozen vegetables without sauce, canned vegetables without salt, low-salt tomato sauce/paste

● Dairy products – Milk, cream, sour cream, non-dairy creamer, yogurt, lower-sodium cottage and other cheeses (be sure to read labels for serving size)

● Fats and oils – Plant oils (olive, canola, corn, peanut), unsalted butter or margarine

● Soups – Salt-free soups and low-sodium bouillon cubes, unsalted broth, homemade soup without added salt

● Sweets – Gelatin, sherbet, pudding, ice cream, some baked goods, sugar, honey, jam, jelly, marmalade, syrup

● Beverages – Coffee, tea, soft drinks, fruit-flavored drinks, low-salt tomato juice, any fruit juice

● Condiments – Fresh and dried herbs; lemon juice; low-salt mustard (not commercially available but can be made at home), vinegar, and "hot" sauce; low- or no-salt ketchup; seasoning blends that do not contain salt

Foods to avoid — Many foods, especially those that are processed, have a high sodium content. Items that can be substituted for high-sodium foods are listed in the following table.

● Breads and biscuits – Biscuits, prepared mixes (pancake, muffin, cornbread), instant hot cereals, many boxed cold cereals, self-rising flour

● Crackers and snack foods – Salted crackers and snack items (chips, pretzels, popcorn), regular peanut butter, prepared dips/spreads, salted nuts or seeds

● Pasta, rice, and potatoes (processed or from restaurants) – Macaroni and cheese mix; rice, noodle, or spaghetti mixes; canned spaghetti; frozen lasagna; instant potatoes; seasoned potato mixes

● Beans and peas – Beans or peas prepared with ham, bacon, salt pork, or bacon grease; most canned beans and peas unless labeled as low-sodium

● Meats and proteins – Salted, smoked, canned, spiced, and cured meat, poultry, or fish; many deli meats and poultry, unless stated to be low salt; bacon; ham; sausage; lunch meats; hot dogs; breaded frozen meat, fish, or poultry; frozen dinners and other frozen meals; pizza

● Fruits and vegetables – Regular canned vegetables and vegetable juices, regular tomato sauce and tomato paste, olives, pickles, relishes, sauerkraut, frozen vegetables in butter or sauces, crystallized and glazed fruit, maraschino cherries, fruit dried with sodium sulfite

● Dairy products – Buttermilk, Dutch-processed chocolate milk, processed cheese slices and spreads, most cottage cheese, aged or natural cheeses

● Fats and oils – Prepared salad dressings, bacon, salt pork, fatback, salted butter or margarine

● Soups – Regular canned or prepared soups, stews, broths, or bouillon; packaged and frozen soups

● Desserts – Packaged baked goods

● Beverages – Softened water; carbonated beverages with sodium or salt added; regular tomato or vegetable juice; some alcoholic beverages (variable sodium content)

● Condiments – Table salt, lite salt, bouillon cubes, meat extract, taco seasoning, Worcestershire sauce, tartar sauce, ketchup, chili sauce, cooking sherry and wine, onion salt, mustard, garlic salt, soy sauce, tamari, meat flavoring or tenderizer, steak and barbecue sauce, seasoned salt, monosodium glutamate (MSG), Dutch-processed cocoa



Helpful Nutrition Tips

Eat fresh food. The fresher the food, the less sodium it has, so enjoy! Crush herbs between the palms of your hands before adding them to your dish. This releases their full flavor and aroma. If you like your food spicy, try hot peppers, such as jalapenos or serranos (fresh or dried). Keep a list of sodium free foods handy for snacking. Try fresh fruits and vegetables, yogurt and unsalted nuts. Talk with your heart failure specialist before starting salt substitutes (such as Nu-Salt®, Saltless®, Half Salt®). Tell your friends and family that you are on a low sodium diet. This way they can prepare foods that you can enjoy. When eating in restaurants: o Avoid deep fried foods. Choose foods that are baked, broiled, grilled, poached, roasted or steamed, and ask for sauces on the side. o If a dish comes with French fries or onion rings, ask for a baked potato or unsalted vegetables instead. o Add fresh lemon juice to fish and vegetables instead of salt. o Use oil and vinegar instead of prepared salad dressings, since dressings usually have a lot of added salt! For more healthy eating tips, see pages 13-15.



Tracking your daily fluid intake

If you have heart failure, it’s common for your body to retain fluid. So your healthcare team may recommend limiting your liquid intake. (64-96 oz of fluid a day - 2 liters = 2,000 milliliters OR 2 liters = 8 cups = 64 ounces) Many people are prescribed diuretics (water pills) to help them get rid of extra water and sodium to reduce their heart’s workload. Talk with your doctor about how much liquid to drink every day. Fluid restriction does includes water, coffee, tea, soup, soda, gelatin and juice. The amount of fluid you drink every day is important. You may see your legs or abdomen become swollen. Closely watching your weight may prevent you from going to the hospital.

  • Tips for weighing yourself:

    • Use the same scale every day.

    • Place the scale on a flat, hard surface.

    • Weigh yourself in the morning after you have gone to the bathroom and before you eat or drink anything.

    • Wear the same clothes each time you weigh yourself.

    • Write down your weight in your Daily Weight Record

    • Do it right away so you do not forget it.

    • Call your heart failure specialist if you gain: o 2 or more pounds in one day, or o 5 or more pounds in one week



Quitting smoking

Each puff of nicotine from tobacco smoke temporarily increases heart rate and blood pressure. Smoking also leads to blockages in the blood vessels feeding the heart. People who quit smoking are more likely to have their heart failure symptoms improve. Learn more about quitting smoking.


Maintaining or losing weight

Sudden weight gain or loss can be a sign that you’re developing heart failure, or that your heart failure is progressing. Weigh yourself at the same time each morning, preferably before breakfast and after urinating. Be consistent when recording weights. Keep a log to discuss with medical provider. Notify your healthcare professional if you gain three or more pounds in one day, five or more pounds in one week, or whatever amount you were told to report. Learn more about maintaining a healthy weight.


Being physically active

If you’re not physically active, talk to your doctor about starting an exercise regimen. Schedule physical activity at the same time every day so it becomes a regular part of your lifestyle. If moderate exercise isn’t possible for you, consider participating in a structured rehabilitation program. The guidelines do recommend 30 minutes of walking a day. If you are not used to walking 30 minutes, start with 5 minutes a day and slowly increase time.

Exercise and Activity for Heart Failure People with heart failure should stay active. Activities, including exercise, work, and sex, are safe for most people with stable heart failure. Exercise is important in maintaining healthy muscle and energy. Things you should do: Ask your heart failure specialist before you start exercising. Gradually increase your activity. Wait at least 1½ hours after eating a meal before exercising. Exercise at least 20 to 30 minutes, 3 to 5 times a week. Try walking, swimming, low-intensity aerobics, cycling on a stationary bike or using a treadmill.

Things you should avoid: Avoid exercises that involve straining or sudden bursts of energy, such as push-ups, sit-ups or heavy lifting. Weight lifting with light weights can be used for strengthening, but ask your heart failure specialist how much is safe for you. Avoid exercising outdoors when it is too cold, hot, or humid. When extreme temperatures occur, exercise indoors, such as walking in a mall or around your home or your building hallway. Avoid exercising when you are not feeling well or you have a fever. You should wait until all of your symptoms disappear before you restart your exercise program. Avoid steam rooms, hot tubs or saunas. These extreme temperatures can cause your heart to work harder.


Avoiding or limiting alcohol

If you drink alcohol, do so in moderation. This means no more than one to two drinks per day for men and one drink per day for women. Talk to your doctor about whether it’s OK for you to drink alcohol.


Avoiding or limiting caffeine

Consume only a moderate amount of caffeine per day, no more than a cup or two of coffee.


Managing stress

Take 15 to 20 minutes a day to sit quietly, breathe deeply and think of a peaceful scene. Or try a class in yoga or meditation. (Check with your doctor first before undertaking a strenuous yoga class.) When you get angry, count to 10 before responding to help reduce your stress.


Getting adequate rest

To improve your sleep at night, use pillows to prop up your head. Avoid naps and big meals right before bedtime. Try napping after lunch or putting your feet up for a few minutes every couple of hours.


Seeking support

Join a support group for people with heart failure and other heart conditions. Contact local health centers to find out about programs that provide meals, transportation and errand services for people who need assistance.


Avoiding flu and pneumonia with vaccinations

Flu and pneumonia pose greater dangers for people who have heart failure (or any heart condition) than for healthy people. Pneumonia is a lung infection that keeps your body from using oxygen as efficiently as it should. Your heart has to work harder to pump oxygenated blood through the body. If you have heart failure, you should avoid putting this extra stress on your heart.

Ask your doctor or another healthcare professional about getting a yearly influenza (flu) vaccine and a one-time pneumococcal vaccine. (The latter guards against the most common form of bacterial pneumonia.) Both vaccines are generally safe.


Following heart patient guidelines for sexual activity

Many people with heart failure can still be sexually active. Choose a time when you’re feeling rested and free from the day’s stresses.


Selecting appropriate clothing

Avoid tight socks or stockings, such as thigh-high or knee-high hose, that slow blood flow to the legs and cause clots. Avoid temperature extremes as much as possible, too. Dress in layers so that you can add or remove garments as needed.