# Nutrition and diets in chronic heart failure
In chronic heart failure, nutrition plays an important role. The body struggles to pump blood, which can cause salt and fluid to accumulate, among other things. At the same time, treatment medications can affect the absorption of certain nutrients. This tab describes which dietary patterns and diets are being studied or applied, and what is known about them.
Sodium restriction (low-salt diet)
ProveniIncluded in official guidelines, or approved by EMA or FDA
A low-salt diet means you eat less sodium (salt). Salt causes your body to retain more fluid. In heart failure, this fluid accumulation can lead to swollen legs, shortness of breath, and overload on the heart. A low-salt diet can reduce this fluid retention.
This pattern has been used in heart failure treatment for decades. Studies from the 2000-2010 period showed that moderate sodium restriction helps with fluid balance and symptoms. In severe heart failure, it is usually advised to limit salt in the diet; how strictly depends on the stage and kidney function.
**Risks:** Too much salt restriction can have a paradoxical effect. Research suggests that extremely low sodium intake (below 1000 mg per day) may be associated with worse outcomes in some patients. This is something the treating physician watches for in individual situations.
Fluid restriction
ProveniIncluded in official guidelines, or approved by EMA or FDA
Fluid restriction means you consume less liquid daily (drinking, but also soups, fluid from food). In heart failure, the heart may struggle to handle the increased blood volume; fluid restriction helps control this volume.
This is not the same as not drinking at all — usually it involves a moderate restriction of, for example, 1.5 to 2 liters per day, depending on severity. This is widely used in clinical practice and helps prevent fluid accumulation.
**Risks:** Too rigid fluid restriction can lead to dehydration and kidney problems, especially if you are also taking certain medications. It must be balanced.
Mediterranean dietary pattern
ResearchediPositive results in clinical studies, not yet standard treatment
This pattern consists of plenty of vegetables, fruit, whole grains, fish, olive oil, and limited red meat. It originated from research on health in Mediterranean regions.
In heart failure, several small studies have been conducted where this pattern was positively associated with fewer hospital admissions and better quality of life. The benefits seem partly to come from the anti-inflammatory properties and healthy fats. The pattern is of course also beneficial for blood pressure and cholesterol.
**Risks:** This pattern itself usually requires no special precautions, as long as you remain alert to salt and fluid considerations where relevant.
DASH diet
ResearchediPositive results in clinical studies, not yet standard treatment
DASH stands for Dietary Approaches to Stop Hypertension. It emphasizes low salt, plenty of vegetables, fruit, whole grains, and lean proteins. It was developed for blood pressure control.
In heart failure, this pattern can be useful, especially since heart failure is often accompanied by high blood pressure. It combines salt restriction with beneficial nutrients. Positive associations have been reported with fewer hospitalizations, but the evidence is not as strong as for classic sodium restriction alone.
**Risks:** Like Mediterranean — manageable as long as fluid intake is also monitored.
Zinc-rich nutrition
ResearchediPositive results in clinical studies, not yet standard treatment
Zinc plays a role in heart function and immune response. Recent research (2026) has found evidence that zinc deficiency is associated with progression of cardiorenal and metabolic problems, and that this also occurs in heart failure.
Zinc-rich foods include oysters, red meat, nuts, seeds, and legumes. Whether supplementation is beneficial is still unclear; more research is ongoing.
**Risks:** Too much zinc (especially via supplements) can be harmful and affect medications. This requires guidance.
Protein-rich nutrition
ResearchediPositive results in clinical studies, not yet standard treatment
In chronic heart failure, muscle loss can occur (cachexia), especially in later stages. Adequate protein intake can help maintain muscle and muscle strength.
The role of specific protein consumption in heart failure has not been exhaustively investigated, but healthy protein sources (fish, poultry, legumes) appear to be supportive. Excessive animal fat should be avoided.
**Risks:** In severe heart failure and kidney problems, protein intake sometimes needs to be more moderate. This requires individual adjustment.
Ketogenic diet
ExperimentaliOngoing in study setting, outcome still unknown
This is a very low-carbohydrate and high-fat diet that was initially used for epilepsy. Recently, interest has been sparked in metabolic effects, including on heart function.
In heart failure, some animal studies and very small human studies have been conducted, with mixed outcomes. The effects on cardiac energy and inflammation seem interesting, but the evidence is still very preliminary. Many cardiological organizations have not yet made recommendations.
**Risks:** A strict ketogenic diet can cause fluid balance problems (electrolyte shifts) that are critical especially for heart failure patients. Furthermore, saturated fat in some versions can be harmful to coronary vessels. Much more research is needed.
Periodic fasting / Intermittent fasting
ExperimentaliOngoing in study setting, outcome still unknown
This pattern varies: complete fasting periods (for example 16 hours without food per day) alternated with eating windows.
In heart failure, this has not yet been well investigated. Theoretically, metabolic changes could be beneficial, but there are also risks: fluid imbalance, electrolyte disturbances, and possible stress on an already weakened heart. Medical supervision would be essential.
**Risks:** For heart failure patients, this can be dangerous without strict medical guidance. Certainly with certain medications, this can become risky.
Diet low in triglycerides
ResearchediPositive results in clinical studies, not yet standard treatment
Recent research (2026) suggests that elevated triglyceride-glucose ratio and metabolic dysregulation are associated with worse prognosis in heart failure. This points to the importance of nutrition that keeps triglycerides low.
This happens through less refined carbohydrates, sugar and certain fats, and more fiber-rich and whole grains. It is not a separate diet, but rather a focus within healthy eating.
**Risks:** No specific risks beyond normal precautions for fluid intake.
Low-salt and fluid-restricted: the practice
Most heart failure patients follow a combination: low-salt food together with fluid restriction. This is not a strict diet, but rather a cautious approach. Many patients quickly learn what their body can handle; less salt becomes normal over time.
It is important to understand that these dietary choices are very personal. They depend on the stage of heart failure, kidney function, the type of treatment, and other illnesses. Someone with severe heart failure and kidney problems receives different guidelines than someone in an earlier stage. A dietitian specializing in cardiac or renal care can help find a pattern that works for your situation — not too strict, but effective.
Every choice around nutrition belongs in conversation with your treatment team. Many changes at once can be confusing; small and gradual often works better.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._