Nutrition for cardiovascular diseases: everything is in our hands

General rules

Chronic heart failure is a complex of symptoms that occurs in various diseases of the cardiovascular system, in which the inability of the heart develops to function normally and provide a sufficient volume of blood output to meet the needs of the body. Its clinical manifestations are shortness of breath , edema caused by sodium and water retention, weakness and limitation of physical activity. Probable causes of this condition: myocardial diseases, heart valve defects, coronary artery diseases. In older age groups, this condition is most often caused by coronary heart disease , arterial hypertension and diabetes mellitus .
With age, due to progressive changes in the heart muscle and a decrease in the number of cardiomyocytes myocardial hypertrophy occurs with a decrease in the pumping function of the heart and deterioration of blood circulation. This leads to gas exchange disorders in the body, swelling and congestion in various organs (lungs, kidneys and gastrointestinal tract).

Congestive gastritis , appearing with nausea, loss of appetite, vomiting, congestion in the intestines, which impairs the digestion of food and its absorption, weight loss, a tendency to constipation and flatulence .

In patients, nutritional deficiency progresses, which manifests itself in hypoproteinemia (decreased protein levels in the blood), vitamin (in particular B1 ), loss of muscle protein and weight. Therefore, the diet for heart failure should be aimed at eliminating these disorders.

Dietary features for CHF include limiting salt and water (with severe edema). Food should be easily digestible, rich in vitamins and have sufficient protein content. The calorie content of the diet is in the range of 1900-2500 kcal. Patients are recommended to eat split meals up to 6 times a day. Eating a lot of food causes the diaphragm to rise, and this worsens the functioning of the heart. Eating small portions is of particular importance for patients on bed rest.

The degree of salt restriction in the diet for CHF depends on the severity of congestion:

• I FC – salty food is excluded from the diet; it is not salted during cooking, and the amount of salt for adding salt is 3 g.
• II FC – salty foods are excluded and adding salt is not allowed. In general, it can be consumed up to 1.5 g.
• III FC – cooking without salt, eating salt-free bread, adding salt is excluded (less than 1.0 g).

Fluid restriction is important in extreme situations - during decompensation, when it is necessary to administer diuretics intravenously. Thus, with CHF IIB and III FC, fluid is limited to 0.5-0.8 l, and with CHF IIA - to 1.0 l. In normal situations, the fluid volume can be 1.5 l/day. The diet depends on the stage of CHF.

The diet for heart failure of stages I and II A is aimed at facilitating the function of the cardiovascular system, improving the functioning of the kidneys, digestive organs and diuresis. The standard Diet No. 10 . The diet should include 80-90 g of protein (most animals), 70 g of fat and 350 g of carbohydrates. The calorie content of the diet is 2300-2500 kcal. Moderate mechanical sparing of the gastrointestinal tract is provided.

Recommended limit:

• Salts and liquids. Food is prepared without salt, it is allowed in a certain amount.
• Foods rich in cholesterol (offal, sausages).
• Coarse fiber in the diet, which can cause fermentation and gas formation.
• Dishes that cause flatulence (legumes, kvass, fresh yeast baked goods, carbonated drinks, grapes, raisins, gooseberries, bran, mushrooms, sprouted grains).
• Stimulating the activity of the cardiovascular system and nervous system (chocolate, very strong coffee, tea, cocoa, tonics).
• Irritating to the liver and kidneys (spicy, fried, extractive substances).
• Fluid consumption up to 1.2 - 1.5 liters.
• Sugar (50 g per day), it can be replaced with honey or unsweetened jam. If you are overweight, simple carbohydrates are significantly limited.
• Spicy snacks, fatty fried foods, fatty meats and fish, meat, fish/mushroom broths are excluded.

There is no reason to refuse the moderate use of spicy vegetables, herbs and seasonings, onions, and garlic. You can add lemon and tomato juice or a little apple cider vinegar, ketchup and homemade mayonnaise (without salt) to your dishes. This allows unsalted food to add flavor, and given that patients often have reduced appetite, this becomes relevant.

It is important to enrich the patient’s diet with vitamins, potassium and magnesium salts. Potassium has a diuretic effect, which is very important for these patients, improves cardiac activity and reduces the risk of rhythm disturbances. Foods high in it include baked potatoes, raisins, citrus fruits, pine nuts and walnuts, kohlrabi, pumpkin, dates, cucumbers, lentils, figs, peas, beans, soy products, grapes, Brussels sprouts, apricots, apple juice, bananas, seaweed, peaches, spinach, eggplant, watermelon, prunes, apricots and dried apricots, sardines, carrots. One of the best sources of it is bananas, which you should eat every day.

Magnesium is also necessary because patients constantly take diuretics. It promotes vasodilation, the removal of excess cholesterol , its presence is necessary for the absorption of calcium and phosphorus. The most important are its hypotensive, anti-ischemic and antiarrhythmic effects. With a lack of magnesium, the progression of atherosclerosis and mitral valve prolapse , persistent tachycardia and arrhythmias , and there is an increase in mortality from coronary artery disease. Cases of myocardial infarction at 30-40 years of age are associated with a reduced content of it in the heart muscle. You can get it with the following products: pumpkin and sunflower seeds, wheat bran, walnuts, spinach, sesame seeds, almonds, pine nuts, peanuts, beans, dates.

Patients with stages II B and III CHF are provided with meals within the treatment Table No. 10A . The basic requirements remain the same, but salt is more limited - up to 1.5 g per day. This food has a lower energy value (1800-1900 kcal), proteins are limited to 60 g, and fats to 50 g per day.

Dishes are prepared pureed and only boiled. Because patients' activity is limited, bowel function often decreases. In this case, more laxative foods are introduced into the diet: steamed dried apricots and prunes, ripe fruits, baked apples and pureed fresh ones, boiled carrots and beets, mashed cauliflower, pumpkin and zucchini, fermented milk drinks. If you are overweight, fasting days are prescribed, once a week.

For patients with severe circulatory failure when standard dietary nutrition is ineffective, the Carrel diet . Its effect is due to the alkaline nature of foods (milk up to 7 times a day, salt-free bread, rice porridge, soft-boiled eggs, mashed potatoes), as well as the restriction of fluids and the exclusion of salt. This is food of sharply reduced energy value. Periodically, for different periods, a potassium diet can be prescribed, which helps normalize water-salt metabolism and increases urination.

cardiac cachexia develops ( severe degree of exhaustion), which is a factor in reducing the life expectancy of patients. This condition is an indication for nutritional support. The presence of cardiac cachexia is considered if there is a weight loss exceeding 5 kg in 6 months or a BMI less than 19 kg/m2.

Artificial nutrition for CHF allows you to increase the patient’s body weight, ventricular ejection fraction and reduce the functional class of failure. Before the appointment, the patient’s energy needs are determined (the basal metabolic rate is calculated) using the Harris-Benedict method using formulas. They take into account the patient’s activity (walking, bed or semi-bed rest), condition (after surgery or injury, peritonitis, cachexia, etc.), as well as the patient’s temperature. Then the patient’s protein deficiency is determined by the daily nitrogen balance.

A negative nitrogen balance indicates a predominance of protein losses over intake. A loss of 125-180 g of protein means a decrease in muscle mass by 500-750 g, respectively. The level of protein deficiency and weight deficiency is decisive when prescribing enteral nutrition.

High-calorie artificial nutrition can be used as additional or basic support for the patient. If the digestive function is preserved, the patient receives it in the form of a drink in the usual way or using a tube (in severely ill patients). Oligopeptide mixtures are used, for example, Peptamen or standard nutrients - Nutrizon , Nutren , Berlamin Modular , Nutrilan MST .

They start taking these medications with small doses (5% of the energy requirement) and the patient must take enzyme preparations. The volume of energy replenishment, and, consequently, the volume of the mixture, is gradually increased every 7 days.

In case of severe decompensation of CHF, mixtures based on hydrolyzed proteins, fats (medium chain triglycerides) and carbohydrates ( maltodextrin ) are optimal.
Taking mixtures corrects metabolic disorders, increases exercise endurance and slows down the development of CHF.

What is heart failure?

The evolution of this disease occurs gradually, problems in the functioning of the heart increase with the age of the patient. In his youth, he does not feel interruptions, because the heart tissues and blood vessels have sufficient tone to supply blood to all parts of the body. Gradually, under the influence of various factors, tissues and blood vessels lose their elasticity, the heart does not fully perform its main function and blood supply deteriorates.

Negative factors include:

• passion for bad habits (alcohol, smoking);
• sedentary lifestyle;
• eating disorders;
• hereditary heart diseases;
• unfavorable environment.

At the initial stage, changes occur in the structure of tissues - the ventricles of the heart and their muscles increase. Accordingly, the volume of blood in them increases. The heart muscle needs to work harder to push blood into the vascular system.

As a result, the heart is exhausted, and the walls of blood vessels, due to overload, lose their elasticity, narrow, quickly wear out and over time lose their ability to pass a normal volume of blood. At the same time, vascular pressure increases, and the person quickly gets tired. And the greater the degree of wear and tear of the heart and blood vessels, the faster fatigue sets in. With a high degree of cardiovascular insufficiency, the patient feels a loss of strength even when stationary.

Not only changes occur in the tissues of the heart and blood vessels. The body replenishes the lack of blood, primarily in the brain and the heart itself. Therefore, patients experience insufficient flow to the limbs and other organs. Peripheral vascular diseases, chronic renal failure develop, joints suffer from lack of blood circulation, etc.

Authorized Products

Nutrition for heart failure in non-severe patients includes:

• Wheat bread, slightly dried and salt-free, sponge cake, savory cookies.
• Vegetarian soups (with potatoes, cereals, vegetables), beetroot soup. Sour cream, herbs, lemon or citric acid are added to soups.
• Low-fat varieties of veal and beef, chicken, pork, rabbit, turkey. The meat is pre-boiled and used for subsequent baking and frying. You can cook any dishes from minced meat.
• Low-fat types of fish and moderately fatty ones. The cooking techniques are the same as for meat - boiling and then frying, preparing cutlets and meatballs. Any boiled seafood products are allowed. Fish is considered an easily digestible product, so it should be included in the diet 3-4 times a week, replacing meat dishes.
• Dairy products of medium fat content, cottage cheese and dishes made from it, fermented milk drinks. Sour cream, cream, fatty and salty cheese are consumed with restrictions.
• One egg per day (baked omelettes, soft-boiled eggs).
• Any cereal according to tolerance and preference. They are used to prepare porridge with milk and water, casseroles and puddings. Boiled pasta and vermicelli are allowed.
• Vegetables you can eat: potatoes, carrots, beets, cauliflower, zucchini, pumpkin, tomatoes, green lettuce, cucumbers. Most vegetables are cooked boiled or baked. You can add green onions, parsley and dill to ready-made dishes. Remember that cabbage and green peas can cause bloating, so consume them sparingly.
• Salads from fresh vegetables, vinaigrettes, vegetable stew and caviar, and any salads with seafood are allowed.
• Ripe fruits and berries, all dried fruits (raisins are limited), milk jelly, compotes, jelly, honey, jam, mousses, jellies, and creams, caramel, marmalade. Chocolate consumption is limited.
• Homemade sauces: vegetable, sour cream, tomato, milk, onion, fruit. You can add bay leaf, citric acid, dried herbs, vanillin, and cinnamon to dishes.
• Weak tea and natural coffee, green tea with lemon, cocoa, coffee drinks, any juices (except grape), rosehip infusion.
• Unsalted butter, various vegetable oils. Olive oil is rich in oleic acid , and sources of omega-6 fatty acids are: cottonseed, corn, sunflower.

Table of permitted products

Symptoms of acute heart failure

Symptoms increase quickly and even rapidly. Pathological changes occur in different ventricles of the heart, therefore the following symptoms of heart failure are distinguished.

If the right ventricle is damaged:

• veins in the neck swell;
• fingers, ears, tip of nose turn blue;
• limbs swell;
• the liver enlarges, and the skin turns slightly yellow.
• For left ventricular failure:
• shortness of breath and suffocation develop;
• coughing attacks are accompanied by the release of sputum and foam;
• the patient tries to sit up in bed with his legs down;
• Moist rales are heard in the lungs.

A common symptom is dizziness, loss of balance due to a sharp deterioration in blood supply to the brain. In response to a decrease in the amount of blood in the vessels, tachycardia rapidly develops. The patient may also feel nauseated.

Fully or partially limited products

• Fresh bread, pastry and cream products.
• It is not allowed to consume meat/fish/mushroom broths or legume soups.
• Prohibited are fatty varieties of pork, cooking fats, kidneys, liver, goose, sausages, duck, canned smoked foods, very fatty fish, canned food, fish caviar, salted and smoked fish products.
• Fatty dairy products.
• Vegetables with coarse fiber (radish, radish, turnip, rutabaga), mushrooms, sorrel and spinach due to their high uric acid content.
• Strong tea and coffee are prohibited; they can be consumed weak and with milk. Chocolate can be consumed very rarely.
• Mustard, horseradish and pepper.
• The consumption of dishes made from legumes, grape juice, and cabbage is limited, as they cause bloating.
• In case of obesity , simple carbohydrates (sugar, honey, jam, sweet fruits, grapes and dried grapes, ice cream, sweet confectionery) are significantly limited.

Table of prohibited products

First aid for heart failure

First aid for heart failure is mainly required for acute illness, when the risk of myocardial infarction increases. Only a team of resuscitators with special equipment can provide qualified help. Therefore, you urgently need to call an ambulance.

While you are waiting for doctors, provide first aid for acute heart failure:

• make the patient sit with pillows around him;
• give him a nitroglycerin tablet;
• provide air access.

If the patient has lost consciousness, it is necessary to perform an indirect cardiac massage.

Menu (Power Mode)

Knowing the permitted foods and methods of preparing them, it is not difficult to create a diet, especially since there are not so many restrictions. The main condition is to prepare dishes without salt and add the amount of salt allowed for the whole day. To fulfill this requirement, you need to give up ready-made meat and fish products, cheeses that contain salt. For the whole day you can consume 150 g of white stale salt-free bread, up to 40-50 g of sugar and 15 g of butter.

Diagnosis of heart failure

At an early stage, methods are used to detect interruptions in the functioning of the heart under load that are not noticeable in a calm state. At the CBCP clinic, patients are offered the most effective of these methods:

• daily ECG monitoring;
• stress ECG;
• Holter ECG;
• Ultrasound of the heart;
• stress echocardiography.

To diagnose chronic heart failure and study various abnormalities in the structure of the heart and blood vessels, CBCP also uses 24-hour blood pressure monitoring (ABPM), cardiac rhythmography, and a special cardiac screening program.

Reviews and results

This therapeutic diet is well tolerated, but many people find it difficult to get used to the reduced amount of salt. However, this is the main nutritional condition for losing excess fluid in the body and facilitating cardiac activity. Using salt substitutes as directed by your doctor or adding lemon juice, apple cider vinegar and herbs will slightly improve the taste of food. Limiting carbohydrates (simple) and fatty foods has a positive effect on excess weight.

• “... I suffered from myocarditis, and they discovered mild heart failure. The doctors were worried about how the pregnancy and childbirth would proceed, so she was hospitalized several times. She gave birth safely, but after the birth her insufficiency began to progress. This forced me to watch my diet (limit salt and fatty foods, don’t overeat), exercise, and walk daily. Be sure to eat dried apricots and raisins every day. Nutritional therapy helped me lose weight. I periodically drink Panangin, Pumpan and Mildronate. Today my condition is normal, I live a full life, I just can’t stand the stuffiness well”;
• “... Tricuspid and mitral valve insufficiency was discovered in childhood. Against this background, insufficiency developed. I absolutely cannot get hypothermic and get sick. That's why I always dress warmly, and before cold seasons I take a course of vitamins and echinacea. In good weather - walks in the fresh air. The doctor said that it is important to eliminate stress and get good sleep. I try to eat healthy: chicken, fish, beef, vegetables and fruits all year round, dried fruits, as I need vitamins for my heart. A low-salt diet helps. Shortness of breath immediately disappears, it becomes easy to walk and breathe. Therefore, limiting salt is very important to me. At first it was difficult to eat unsalted food, and I was tempted to eat forbidden sausage and salted fish, but then I got used to it. I’m losing weight well on a salt-free diet”;
• “...Heart defect since childhood. With a small load, shortness of breath, constant swelling in the legs and pressure began to increase. Therefore, limiting salt in my diet is a vital necessity for me. If I increase the amount of salt for 3-5 days and eat something salty, the swelling returns and shortness of breath increases. I’ve been used to this kind of food for a long time. The only difficulty is that you need to cook for yourself separately. I cook some dishes to share, and then my family add salt to taste. In addition to the fact that everyone eats dried apricots, prunes, raisins, bananas, I always take vitamin and mineral complexes, omega-3, Panangin for 2 months. This is necessary to maintain the heart muscle.”

Stages of heart failure

In medicine, there are 4 stages (degrees) of heart failure.

• First . Mild manifestations of the disease during physical activity (fatigue, shortness of breath, increased heart rate), which most patients usually do not pay attention to. In a calm state, the symptoms disappear.
• Second . Quite long-term, increasing changes in the functions of the heart occur. The patient begins to feel interruptions in heart rhythm and shortness of breath already at rest, but their degree still remains moderate. Moreover, symptoms may appear suddenly, for example, when trying to get out of bed.
• Third . In the end, interruptions in the functioning of other organs and blood vessels make themselves felt, accompanied by pathological changes in their tissues and the circulatory system.

Features of diets against edema

• Uncontrolled and prolonged use of diuretics can lead to dehydration and disruption of water-salt balance.
• Abuse of a decongestant diet is fraught with the appearance of severe weakness. At risk are patients with liver and kidney failure.
• To improve the taste of salt-free food during a therapeutic diet, table salt substitutes are used.
• In case of severe swelling, fasting days will help to cope with the malaise. But without control, they can worsen the problem, so it is important to listen to the opinion of your doctor. The most physiological are curd, milk and rice fasting days.