Low-Salt Diets for Heart Failure Patients: a Recipe for Success?

Conventional wisdom would suggest a reduction in dietary salt intake for heart failure patients. For some, however, the elimination comes with added risk.

7:00 AM

Author | Scott Hummel, M.D.

Patients with heart failure are physiologically attuned to retain sodium and fluid because of neurohormonal activation and often renal dysfunction.

MORE FROM THE LAB: Subscribe to our weekly newsletter

Because worsening symptoms in heart failure are typically due to fluid congestion, the conventional wisdom has been to reduce dietary salt intake. In observational studies, low sodium intake is associated with fewer hospitalizations for decompensated heart failure.

However, restricting sodium also comes with a risk: an increase in systemic neurohormonal activity, which could be detrimental, particularly in patients with heart failure and reduced ejection fraction.

And some randomized trials, though flawed and challenging to interpret, suggest that sodium restriction increases readmission and mortality risk.

What's more, studies in hypertensive animal models — as well as in humans with hypertension — imply that the response to sodium is not inherently the same in all patients. "Salt-sensitive" people have greater increases than others in blood pressure, oxidative stress and inflammation during high sodium intake that may contribute to the development and worsening of heart failure. This has traditionally been attributed to impaired renal sodium excretion.

However, recent work suggests that some ingested sodium is not processed through the kidneys, but stored nonosmotically in the skin and other organs. The purpose and cardiovascular effects of this storage are not yet known. We and others are studying the endothelial glycocalyx, a thin glycoprotein lining of blood vessels, as a possible link between sodium intake and vascular dysfunction.

With the increasing understanding that frailty, sarcopenia (diminished muscle mass) and metabolic disarray are common and contribute to poor prognosis in older patients with heart failure, a blanket recommendation to eat less salt could have other unintended consequences.

In dietary surveys, older adults with heart failure who report eating a low-sodium diet frequently have calorie- and micronutrient-intake deficiencies that could directly contribute to weight loss and impaired mitochondrial function.

At this point, the only certainty is that further research is needed to define the appropriate diet for older patients with heart failure — and the answer may not be the same for everyone. Ongoing studies will provide more information over the next few years.

Until then, a proclivity to restrict salt intake is reasonable — provided that careful attention is paid to volume management and diuretic dosing to avoid excessive neurohormonal activation. In my practice, I also recommend consultation with a dietitian to make sure that a well-intentioned focus on sodium doesn't contribute to deficiencies in caloric or other nutrient intake.

This article was originally published on aginghearts.org and is republished here with permission.

More Articles About: Industry DX Heart Failure Health Care Delivery, Policy and Economics Cardiovascular: Diseases & Conditions
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories A collection of hospital wristbands signifying hospital readmission
Health Lab
Study: Medicare Readmission Penalties Need to Weigh Socioeconomic Factors
U-M study shows patients’ race, income, & family support play a role in hospital readmission rates. See their recommendations for Medicare readmission penalties.
person in white coat at laptop green fruit in hand
Health Lab
Both virtual and in-person nutrition visits help to lower cholesterol
The use of telehealth remains high, with over 20% of American adults taking appointments online. These visits include video calls with registered dietitian nutritionists, who have a critical role in helping patients take on lifestyle changes through medical nutrition therapy. With a focus on the changing digital landscape, researchers at Michigan Medicine found that telemedicine patients with hyperlipidemia — an excess of cholesterol or fats in the blood — experienced similar positive health benefits compared to those who had in-person visits.
smart watch on wrist
Health Lab
Clinical smart watch finds success at identifying atrial fibrillation
A Michigan Medicine research team developed a prescription wristwatch that continuously monitors the wearer’s heart rhythm and uses a unique algorithm to detect atrial fibrillation. The clinical-grade device, called the Verily Study Watch, proved very accurate at identifying atrial fibrillation in participants.
supar molecule teal blue yellow red
Health Lab
Immune protein suPAR links viral infection as possible cause of kidney disease
Through a series of experiments in non-human primates, mice and humans, a multi-institutional team led by researchers from Michigan Medicine and Rush University found that the immune protein soluble urokinase plasminogen activator receptor, or suPAR, is an important link between viral infections and proteinuria; the elevation of protein in the urine is known to cause glomerulopathy, a common form of kidney disease.
person holding walker with nurse next to them closer up on hands lower body
Health Lab
Long COVID happens in nursing homes, too
Post-acute sequelae of Sars-COV2 (PASC, long COVID) caused a decrease in independence and cognitive ability after coronavirus infection in nursing home residents
expert at stand hearing in suit
Health Lab
Keep telehealth alive and well, experts tell Senate subcommittee
Telehealth coverage by Medicare is scheduled to expire at the end of 2024; experts told Senators what they think should happen to preserve it.